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정유석 ( Yoo Seock Cheong ) 한국의료윤리학회 2009 한국의료윤리학회지 Vol.12 No.2
The increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and medical institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. When CAM and conventional medical therapies intersect, there is the potential for serious physician-patient conflicts as well as harm to patients. Some CAM therapies in and of themselves can be hazardous, but harm can also occur indirectly when patients choose less effective CAM treatments instead of conventional methods that have demonstrated efficacy. Physician-patient conflicts arising from issues related to CAM therapies are common, but the physician-patient relationship is more likely to remain intact if physicians are willing to engage creatively with patients when problems seem unsolvable. Even in the absence of scientific evidence for CAM therapies, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to clarify the patient`s core values and beliefs when counseling about CAM therapies. The commitment to joint problem-solving over time, which is a central obligation of the physician-patient relationship, becomes even more important when considering the use of CAM therapies. A long-standing, carefully nurtured partnership between a physician and a patient that has grown over time may be strained or completely destroyed if common ground in such situations cannot be found. The way forward for physicians involves not only preventing negligence and fraud, but also facilitating therapeutic exchanges between various healthcare providers and their patients. The use of case-based reasoning in questions of CAM therapy allows a fuller appreciation of the way in which circumstances play an intrinsic role in moral judgments. This paper presents two prototypical cases that illustrate the challenges already discussed as well as other ethical challenges that will arise as CAM therapies gain popularity in Korea.
정유석(Cheong Yoo-Seock),박석건(Park Seok Gun) 한국의학교육학회 2000 Korean journal of medical education Vol.12 No.1
의과대학 4학년에서 새로이 의료윤리과목을 개설하고 토론식 수업과 이론식 수업을 교대로 배치하여 진행하였다. 토론식 수업에서는 흥미를 유발하기 위해 도입부에 영상매체를 사용하였다. 이론은 평면적으로 소개하기보다는 3가지 분석의 틀을 제공하고, 이것을 이용하여 사례를 분석하도록 하였다. 강의를 전후하여 같은 내용의 설문조사를 함으로써 강의의 효과를 측정하였다. 낙태문제에 대하여서는 강좌 수강 전 후 모두 ‘살인행위로 볼 수 없다’는 견해가 가장 많았다. 낙태금지법에 대한 견해는 강좌 수강 후에 ‘산모의 자율성을 존중해야 한다’는 의견이 다소 증가하였으나 ‘임신 초기의 낙태만 허용하고 그 이후는 철저히 단속해야 한다’는 견해가 가장 많았다. 신약에 대한 임상실험에 대하여서는 비교적 가벼운 질병인 두통의 경우보다 불치병에 걸렸을 때 ‘허락하겠다’는 비율이 높음을 알 수 있었다. 장기 이식문제도 생명에 지장이 없는 신장, 각막 등의 매매 행위를 허락해야 한다는 의견이 가장 많았다. 암환자의 진단 통보에 관하여서는 환자의 자율권을 존중하여 솔직하게 이야기하겠다 는 견해가 가장 많았다. The Korean medical establishment has traditionally shown little concern for formal training in medical ethics; only recently have courses in medical ethics been included in the curricula of Korea s medical schools. The importance and effectiveness of such courses is still a matter of some debate. This study attempted to measure the effects of a course in medical ethics on senior medical students. For this study, a discussion based course was designed, which made considerable use of video-taped ethical situations. Students were requested to answer a series of ethics related questions both before and after taking the course. Prior to taking the course, students indicated that treatment refusal, abortion, sex pre-selection, and euthanasia are the most important ethical issues in contemporary medical practice in Korea. However, after taking the course, students modified this list slightly by replacing the issue of euthanasia with that of equal access to health care resources. No significant changes were observed in students value systems. The students response to the course was favorable.
정유석 ( Yoo Seock Cheong ),박재현 ( Jae Hyun Park ),고윤석 ( Youn Suck Koh ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.2
The pharmaceutical industry interacts with the medical profession by supporting clinical research and assisting in medical education activities in academic medical centers. Medical students and residents spend years establishing patterns of prescribing and making relationships with pharmaceutical companies. The pharmaceutical industry has a significant presence during residency training, gaining the overall acceptance of trainees, and appears to influence prescribing behavior. Contact with pharmaceutical representatives is common among medical students and residents. Residents acknowledge the potential for industry influence in others, but generally not in themselves, despite evidence that they themselves are influenced as well. The prescriptions written by residents are associated with pharmaceutical representative visits and the availability of samples. A variety of policy and educational guidelines appear to influence residents` attitudes toward interactions with industry representatives, although data on the long-term effects of these interventions are limited. This article contends that medical training programs can benefit from policies and curricula that teach medical students and residents about the influence of marketing and how to critically evaluate the information they receive from industry representatives.
정유석 ( Yoo Seock Cheong ) 한국의료윤리학회 2007 한국의료윤리학회지 Vol.10 No.1
Medical schools in the United States and Canada now include medical ethics education as an essential part of their curricula. Despite this, recent studies point to deep shortcomings in the literature on medical ethics education. Deficits exist in all areas of the literature: in the theoretical work done on the overall goals of medical ethics education, in the empirical studies that attempt to examine outcomes for students, and in the studies evaluating the effectiveness of various teaching methods. This article summarizes the main findings of three important articles concerning medical ethics education that were originally published in the journal Academic Medicine. This article also discusses the implications of these findings for medical ethics education in Korea. It is argued that further progress in medical ethics education may depend on the willingness of medical schools to devote more curricular time and funding to medical ethics.