Patient Autonomy and Advance Directives in Korea

Dae Seog Heo

doi:10.5124/jkma.2009.52.9.865

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Heo: Patient Autonomy and Advance Directives in Korea

Focused Issue of This Month

The Withdrawal of Life-sustaining Management

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2009; 52(9): 865-870.

Published online: 30 September 2009

DOI: https://doi.org/10.5124/jkma.2009.52.9.865

Patient Autonomy and Advance Directives in Korea

Dae Seog Heo, MD

National Evidence-based Healthcare Collaborating Agency, Korea. heo1013@snu.ac.kr

Abstract

There has been a controversy in Korea regarding a 'death with dignity' in comparison to a 'natural death'. However, the issue of patient autonomy is often overlooked. Decision on withholding or withdrawing life-sustaining treatment should be based on the patients' self-determination, prefereably in the form of advance directives. Consensus developed by the National Evidence-based Healthcare Collaborating Agency is as follows: ① a doctor should offer a detailed explanation to patients, including about hospice-palliative care and advance directives, ② when a terminally ill patient expresses reluctance regarding cardiopulmonary resuscitation or an artificial respirator in advance, such medical actions can be removed, with basic nutrition supply and pain control maintained. However, more discussions should be made in the case of a patient in "persistent vegetative state".

Keywords: Patient autonomy, Advance directives, Terminal patient, Withdrawal of life-sustaining treatment

Figures and Tables

Table 1

Acceptance of ventilator in terminal cancer patients

^*concordance rate for the application of a ventilator between physicians and families: 39.3% (37/94).

Table 2

DNR in Korea

Table 3

Discrepancy between survey results and practice

References

1. Heo DS. End-of-life Decision in Korea. J Korean Med Assoc. 2008. 51:524–529.

2. Oh DY, Kim JE, Lee CH, Lim JS, Jung KH, Heo DS, Bang YJ, Kim NK. Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies. Cancer. 2004. 100:1961–1966.

3. Song TJ, Kim KP, Koh Y. Factors determining the establishment of DNR orders in oncologic patients at a university hospital in Korea. Korean J Med. 2008. 74:403–410.

4. Shim BY, Hong SI, Park JM, Cho HJ, Ok JS, Kim SY, Han SA, Lee OK, Kim HK. DNR Order for Terminal Cancer Patients at Hospice Ward. Korean J Hosp Palliat Care. 2004. 7:232–237.

5. Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK. CPR or DNR? End-of-life decision in Korean cancer patients: a single center's experience. Support Care Cancer. 2006. 14:103–108.

6. Kim do Y, Lee KE, Nam EM, Lee HR, Lee KW, Kim JH, Lee JS, Lee SN. Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea. J Palliat Med. 2007. 10:1153–1158.

7. Yun YH, Lee CG, Kim SY, Lee SW, Heo DS, Kim JS, Lee KS, Hong YS, Lee JS, You CH. The attitudes of cancer patients and their families toward the disclosure of terminal illness. J Clin Oncol. 2004. 22:307–314.

8. Yun YH, Rhee YS, Nam SY, Chae YM, Heo DS, Lee SW, Hong YS, Kim SY, Lee KS. Public Attitudes Toward Dying with Dignity and Hospice-Palliative Care. Korean J Hosp Palliat Care. 2004. 7:17–28.

9. Nam YH, Seo IS, Lim JH, Choi JH, Kim JE, Choi JH, Oh JM, Kwon KH, Yoon SJ, Yoon SM. Application of Advance Directives for Patients with End Stage Renal Disease. Korean J Nephrol. 2008. 27:85–93.

10. Bulow HH, Sprung CL, Reinhart K, Prayag S, Du B, Armaganidis A, Abronug F, Levy MM. The world's major religions' points of view on end-of-life decision in the ICU. Intensive Care Medicine. 2008. 34:423–430.

11. Oh do Y, Kim JH, Lee SH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK. Artificial nutrition and hydration in terminal cancer patients: the real and the ideal. Support Care Cancer. 2007. 15:631–636.

12. National Evidence-based Healthcare Collaborating Agency. Social Consensus on End-of-life decision in Korea 2009.

13. Wilkinson A, Wenger N, Shugarman LR. Literature Review on Advance Directives. U.S. Department of Health and Human Services 2007.

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