Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act.
Clinical Ethics
Clinical Ethics Support
Ethics Committees
Ethics Consultation
Retrospective Review
Journal
Journal of Korean medical science
ISSN: 1598-6357
Titre abrégé: J Korean Med Sci
Pays: Korea (South)
ID NLM: 8703518
Informations de publication
Date de publication:
19 Jun 2023
19 Jun 2023
Historique:
received:
07
09
2022
accepted:
06
03
2023
medline:
21
6
2023
pubmed:
20
6
2023
entrez:
20
6
2023
Statut:
epublish
Résumé
Clinical ethics support is a form of preventive ethics aimed at mediating ethics-related conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018. A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultation-related documents. A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage. The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical ethics support is a form of preventive ethics aimed at mediating ethics-related conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018.
METHODS
METHODS
A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultation-related documents.
RESULTS
RESULTS
A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage.
CONCLUSION
CONCLUSIONS
The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.
Identifiants
pubmed: 37337807
pii: 38.e182
doi: 10.3346/jkms.2023.38.e182
pmc: PMC10279517
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e182Subventions
Organisme : Seoul National University Hospital
ID : 04-2020-0070
Pays : Korea
Informations de copyright
© 2023 The Korean Academy of Medical Sciences.
Déclaration de conflit d'intérêts
The authors have no potential conflicts of interest to disclose.
Références
Crit Care Med. 2020 Sep;48(9):1349-1357
pubmed: 32618689
Am J Bioeth. 2007 Feb;7(2):13-25
pubmed: 17366184
AJOB Empir Bioeth. 2017 Apr-Jun;8(2):116-127
pubmed: 28949846
Minerva Anestesiol. 2020 Jun;86(6):670-677
pubmed: 32000471
HEC Forum. 2016 Sep;28(3):217-28
pubmed: 26423767
Pediatrics. 2008 Feb;121(2):282-8
pubmed: 18245419
Cancer Res Treat. 2021 Apr;53(2):584-592
pubmed: 33211941
Acta Paediatr. 2015 May;104(5):529-34
pubmed: 25611088
HEC Forum. 2017 Dec;29(4):313-346
pubmed: 28600658
J Med Ethics. 2001 Apr;27 Suppl 1:i2-8
pubmed: 11314606
Crit Care Med. 2018 May;46(5):799-808
pubmed: 29394183
Nurs Ethics. 2013 Nov;20(7):771-83
pubmed: 23715555
Asian Bioeth Rev. 2018 Mar 23;10(1):37-51
pubmed: 33717274
Age Ageing. 2005 May;34(3):218-27
pubmed: 15863407
Med Health Care Philos. 2019 Sep;22(3):475-486
pubmed: 30671733
AJOB Empir Bioeth. 2019 Jan-Mar;10(1):44-54
pubmed: 30908109
AJOB Empir Bioeth. 2020 Oct-Dec;11(4):275-286
pubmed: 32940565
J Med Ethics. 2008 Dec;34(12):858-62
pubmed: 19043109