Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea.
Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2023 Jun 19;38(24):e182. doi: 10.3346/jkms.2023.38.e182.
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.
临床伦理支持是一种预防伦理形式，旨在调解医疗保健环境中出现的与伦理相关的冲突和管理伦理问题。然而，关于临床实践中的具体伦理问题的证据有限。本研究旨在探讨 2018 年韩国新的临终关怀和临终决策立法实施后，向临床伦理支持转介的案例中的不同伦理问题。
对韩国一家大学医院 2018 年 2 月至 2021 年 2 月期间向临床伦理支持转介的案例进行回顾性研究。通过对伦理咨询相关文件的定性内容分析，分析转介时的伦理问题。
本研究共纳入 57 例患者的 60 例病例，其中男性占 52.6%，年龄大于 60 岁的占 56.1%。大多数病例（80%）来自重症监护病房。三分之一的患者被判断处于临终阶段。最常见的伦理类别是治疗/护理目标（78.3%）、决策（75%）、关系（41.7%）和临终问题（31.7%）。更具体地说，最佳利益（71.7%）、利益和负担/危害（61.7%）、拒绝（53.3%）和替代决策（33.3%），其次是保留或停止（28.3%）是报告的最常见伦理问题，这些问题随着年份的不同而变得多样化。此外，伦理问题似乎因年龄组和临终阶段的判断而有所不同。
本研究的结果扩展了对自韩国新立法实施以来向临床伦理支持转介的决策和治疗/护理目标等不同伦理问题的理解。本研究表明，需要进一步研究多个医疗中心的伦理问题的纵向探索和临床伦理支持的实施。
