J Korean Med Assoc.  2011 Jul;54(7):747-757.

Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 3Cancer Management Branch, National Cancer Center, Goyang, Korea.
  • 4Department of Rehabilitation, the Catholic University of Korea College of Medicine, Seoul, Korea.
  • 5Department of Medical Ethics, Dankook University College of Medicine, Seoul, Korea.
  • 6Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
  • 7Gwangju Buk-gu Public Health Center, Gwangju, Korea.
  • 8Health Insurance Review and Assessament Service, Seoul, Korea.
  • 9Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea. yoonsl@snu.ac.kr

Abstract

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care.

Keyword

Consensus guideline; End-of-life care; Autonomy; System

MeSH Terms

Advance Directives
Consensus
Humans
Societies, Medical

Figure

  • Figure 1 Algorithm for the decision process of do-not resuscitation (DNR) order and/or the withdrawing of mechanical ventilation in terminally ill patients. LST, life-sustaining therapies.

  • Figure 2 Algorithm for the decision process of withholding (WH) and/or withdrawing (WD) of a life-sustaining therapy (LST) in terminally ill patients.


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