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Reframing Research Ethics in the Age of Generative Artificial Intelligence:Key Issues and Practical Proposals

Korean Journal of Medical Ethics.2025;28(4):279-292. doi:10.35301/ksme.2025.28.4.279

This article explores how the traditional framework of research ethics must be redefined in response to the ethical challenges posed by the academic use of generative artificial intelligence (Gen AI).As Gen AI technologies become increasingly integrated across various stages of research—from study design and data analysis to manuscript writing—they offer notable gains in efficiency, while simultaneously expanding ethical gray areas. In particular, issues such as factual inaccuracies and hallucinations, violations of privacy and copyright, ambiguous authorship, and the deskilling of researchers are becoming increasingly entangled, posing serious threats to the credibility and integrity of academic work. To address these concerns, the article proposes four core ethical principles suited to the Gen AI era: truthfulness and explainability, respect for intellectual property, field-specific guidelines, and the cultivation of researcher competence. The central concern is not merely whether such technologies should be adopted, but rather how the identity and responsibility of researchers, and the sustainability of scholarly communities, can be ethically restructured in the face of transformative technological change.

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The Grammar of Medical Practice and the Middle Voice: Toward Middle-Voice Justice and a More Inclusive Medical Culture

Cheul KANG ; Sangtae CHOI

Korean Journal of Medical Ethics.2025;28(4):241-256. doi:10.35301/ksme.2025.28.4.241

Medical practice is a multi-layered phenomenon characterized by systemic complexity, epistemic uncertainty, and outcome‑oriented nature. However, legal discourse in medical litigation often reduces this complexity by employing active/passive grammatical constructions, framing clinician– patient interactions in terms of a simplistic offender/victim binary. In response, this article introduces the concept of the middle-voice, defined by two grammatical features: (1) the internal involvement of human and non-human elements in the occurrence of action, and (2) the dynamic emergence of action through contextual interactions. It proposes a middle-voice structure that incorporates antecedent-condition clauses, inanimate subject constructions, and the Korean “-ge doeda” form (equivalent to the English verb “become”). This framework supports the development of middlevoice justice, which moves beyond adversarial models and promotes a more inclusive culture of medical accountability and safety. By offering a theoretical basis for institutional applications, such as in the design of apology laws, this approach enables more accurate descriptions of medical accidents, more balanced attributions of responsibility, and reconsideration of the institutional foundations necessary for a just medical culture.

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A National Survey of Public Attitudes toward Biobanks and Human Bioresource Donation

Hyeonji JEON ; Seungmin NAM ; Ivo KWON

Korean Journal of Medical Ethics.2025;28(4):293-305. doi:10.35301/ksme.2025.28.4.293

The increasing use of human biospecimens and health data in research raises ethical and legal concerns regarding privacy, consent, and ownership. This study examined public awareness, attitudes, and concerns related to biospecimen and health data in South Korea. A nationwide online survey was conducted with 500 adults, stratified by region, age, and gender. The questionnaire assessed awareness levels, donation experience, motivations, and concerns related to biospecimen and health data donation. Statistical analyses using SPSS (version 29) included chi-square tests across demographic variables such as gender, age, education, and occupation. Awareness of biospecimen donation was moderate for biomedical research (55.2%) but lower for industrial research (42.2%).Awareness of biobanks was low (21.4%). Willingness to donate was higher for biomedical research (biospecimens 54.0%, health data 50.6%) than for industrial purposes (48.2%, 43.8%). The main motivations included humanitarian concerns and public benefit, while major concerns focused on privacy and physical discomfort. Most participants (72.2%) preferred detailed consent. Men were more willing to donate and expressed more favorable attitudes toward biospecimen and health data donation than women. The findings indicate moderate public awareness and willingness to donate biospecimens and health data, alongside persistent concerns about privacy, ownership, and compensation. Enhancing ethical governance and public engagement is essential to building trust in biobank-based research.

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Health Care Reform and Democratic Expertise in South Korea

Ungki JUNG

Korean Journal of Medical Ethics.2025;28(4):257-277. doi:10.35301/ksme.2025.28.4.257

The evidence advisory system (EAS) is often criticized for serving to legitimize governmentpreferred policies rather than facilitating independent deliberation. Underlying this critique is a more fundamental question: Is expertise compatible with democratic governance? This article addresses that question by advancing two arguments in support of democratic expertise. First, drawing on theories of deliberative democracy, it argues that the epistemic authority of experts depends largely on the active judgment of citizens. The formation of expert consensus, which is central to EAS operations, is discussed as a working example. Second, using the framework of the politics of evidence, it contends that the legitimacy of the EAS hinges on institutional arrangements that enable the effective and democratic use of evidence. Together, these arguments clarify how ordinary citizens can develop the deliberative capacities needed to engage critically with expert knowledge.

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Ghost Surgeries in South Korea: Variations in Practice and the Need for Clear Guidelines in Resident Surgical Training

Seong Joon CHO ; Se-Ran YANG ; Semin RYU ; Sung-Min PARK

Korean Journal of Medical Ethics.2025;28(2):103-123. doi:10.35301/ksme.2025.28.2.103

This article examines the problem of ghost surgeries in South Korea, which gained national attention following the death of Kwon Dae-hee and led to revisions in the Medical Service Act, including a government mandate for video surveillance in operating rooms. While ghost surgeries have been discussed in legal and academic circles, there has been a lack of analysis from the perspective of actual clinical practice. In South Korea, ghost surgeries vary widely depending on the type of hospital, the person replacing the primary surgeon, and the underlying motivation. In teaching hospitals, surgeries performed by residents or fellows during training can be misinterpreted as ghost surgeries, creating a legal and ethical gray area. Despite stricter training regulations, there are still no clear, standardized guidelines for surgical education. Accordingly, this article argues that the relevant authorities—such as the Ministry of Health and Welfare, surgical societies, and medical education institutions—should examine international models and develop clear principles for resident and fellow participation in surgery. This would help ensure informed patient consent, protect medical trainees, promote ethical practices, and ultimately contribute to greater transparency, enhanced surgical education, and a safer healthcare environment for both patients and providers.

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The Impact of Moral Courage and Ethical Climate on Moral Distress among Clinical Nurses

Yeo-Beun HEO ; Eun-Young KIM

Korean Journal of Medical Ethics.2025;28(2):145-156. doi:10.35301/ksme.2025.28.2.145

This descriptive correlational study aimed to examine the impact of moral courage and ethical climate on moral distress among clinical nurses. Data were collected from August to September 2024, through an online survey distributed to nurses working at two tertiary hospitals and one general hospital in a city in South Korea. The results indicate that the mean moral courage, ethical climate and moral distress were 3.20 ± 0.58, 3.42 ± 0.52, and 78.22 ± 53.89, respectively. Multiple regression revealed that factors affecting moral distress among clinical nurses included years of clinical experience (β=.23, p=.014), moral courage (ß=.40, p<.001) and ethical climate (β=-.44, p<.001).These variables explained 22% of the variance in moral distress. These findings suggest that there is a need for institutional strategies to improve the ethical climate and to support nurses' moral courage in order to alleviate moral distress.

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Enhancing Korean Clinical Trial Excellence:Addressing Regulatory Gaps and Implementing Competency-Based Education in a Global Context

Eun-Kyeong LEE

Korean Journal of Medical Ethics.2025;28(2):125-144. doi:10.35301/ksme.2025.28.2.125

This article critically evaluates Korea's current mandatory, time-based clinical trial education system in light of the rapidly changing global clinical trial landscape and international best practices. It identifies key limitations and proposes a strategic shift towards a Competency-Based Education (CBE) model to enhance the quality, safety, and national competitiveness of clinical trials. By analyzing the new competencies required by technological innovations such as Decentralized Clinical Trials (DCTs) and Artificial Intelligence (AI), as well as the latest ICH GCP E6(R3) guideline, and by comparing Korea's system with the educational frameworks of the United States, United Kingdom, and European Union, this article diagnoses the shortcomings of the current system, including its rigidity, emphasis on compliance over competence, and misalignment with global trends. As a solution, the article explains the necessity of adopting a CBE model and offers specific policy directions based on the internationally recognized Joint Task Force (JTF) for Clinical Trial Competency framework. The proposals presented here aim to improve the quality of clinical trials in Korea, enhance participant safety, and ultimately contribute to building an ethical, efficient, and globally competitive clinical trial ecosystem.

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Protherapeutic Authoritarianism: Predicting Contributing Factors to ICU Conflicts in Life-sustaining Treatment Decisions in South Korea

Seongwon YUN

Korean Journal of Medical Ethics.2025;28(1):61-74. doi:10.35301/ksme.2025.28.1.61

The concept of protherapeutic authoritarianism, a critical notion in medical ethics, has received insufficient attention in the literature and remains underdeveloped even though 40 years have passed since the first significant publication on the topic. This article introduces a revised and updated framework for protherapeutic authoritarianism, one that is designed to identify factors influencing the conflicts that arise during life-sustaining treatment decisions. Specifically, the article pursues three objectives: first, it defines protherapeutic authoritarianism and traces the evolution of that concept;second, it explores studies on the forms and manifestations of conflicts within Intensive Care Units;third, it illustrates how protherapeutic authoritarianism may have contributed to the emergence of such conflicts.

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The 2024 Medical-political Conflict and the Future of Korean Healthcare

Yooseock CHEONG

Korean Journal of Medical Ethics.2025;28(1):93-101. doi:10.35301/ksme.2025.28.1.93

In 2024, the South Korean healthcare system experienced an unprecedented crisis amid severe conflicts between the government and the medical community. The government’s unilateral healthcare policies—especially its proposed increase of 2,000 medical school admissions and its strict countermeasures against protesting physicians—triggered a mass exodus of students, residents, and faculty members crucial to essential medical services. Consequently, medical education across the nation was suspended for a year, and university hospitals experienced severe disruptions in clinical operations as a result of residents abandoning their training. This study provides a multifaceted analysis of the impact of the 2024 healthcare crisis on the Korean medical system, focusing on the collapse of the residency training system, the crisis in medical education, and the disruptions in clinical services. Furthermore, it investigates the remaining challenges and critical actions needed from both Korean society and the medical community to forge a more sustainable healthcare system in Korea.

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The Ideal Physician-patient Relationship in Narrative Medicine

Donghyun AHN

Korean Journal of Medical Ethics.2025;28(1):75-91. doi:10.35301/ksme.2025.28.1.75

Narrative medicine aims to enhance empathetic, patient-centered care by listening to patients’ narratives and understanding their experiences. This article examines Emanuel and Emanuel’s four models of the physician-patient relationship—paternalistic, informative, interpretive, and deliberative—highlighting their distinctions and connections to narrative medicine. By comparing these models, the article shows how narrative medicine addresses some of the limitations of traditional approaches to patient care. Drawing on analyses of literary works such as Tolstoy’s The Death of Ivan Ilyich, Edison’s Wit, and Roth’s Everyman, the article explores how the paternalistic and informative models manifest in real-world clinical interactions and illustrates how narrative medicine can mitigate their shortcomings. In the context of healthcare systems driven by efficiency and constrained consultation times, narrative medicine offers a way to improve patients’ quality of life and foster trust between doctors and patients. This article argues for integrating narrative medicine into medical education and healthcare practice as an essential step toward cultivating ethical and effective physician-patient relationships.

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