우리나라 일부 병원에서 환자, 보호자, 의료진의 연명치료 중지 관련 의사결정에 관한 태도

Abstract

A survey was conducted from September to December 2008 to examine the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients and other related issues. The subjects for the study were 91 cancer patients, 96 family members of cancer or other terminally ill patients, and 140 physicians. Most subjects acknowledge the need for an appropriate regulatory framework for the withdrawal of treatment for terminal patients. However, some discrepancies were found among the different groups (patients, family members, physicians) in this study. Patients showed a stronger preference for the withdrawal of treatment than did family members. Also, most patients claimed they wanted to receive the diagnosis of a terminal illness from their physician, while most family members seem to think it is their own duty to convey such a diagnosis to the patient. Both groups prefer co-decision-making about the withdrawal of treatment over individual decision-making by the patient. However, most family members admit that they do not know much about the patient’s wishes and lack the time for sufficient conversation with the patient. Physicians are skeptical of the authenticity of the decisions made by family members, and some physicians also regard hospital ethics committees as being ineffective for resolving these issues. The results of this study paint a unique picture of clinical culture in Korea, where family members still exert strong influence on clinical decision-making and little information is shared between patients, family members, and physicians. The study points to a need for greater public education in Korea on the practical and ethical issues surrounding the withdrawal of treatment for terminal patients.