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의학적 무의미함의 윤리적 판단기준의 숙고와 실천적 함의
조은진,김상희 한국생명윤리학회 2022 생명윤리 Vol.23 No.1
Currently, our medical field has developed medical knowledge and technology to prolong the life of patients, but it has limitations that are seen as conflicts for life-determination between healthcare providers and patients/surrogate. In this regard, there are differences in views on life extension between healthcare providers and patients/surrogate, and the concept of medical futility is often used to justify each other without narrowing. Medical futility means that medical treatment available to patients will no longer improve the patient's medical situation and that medically proposed treatment should not be performed, but medical futility is still ethically controversial because it is judged by differences in their positions. It is difficult to agree on medical futility in various medical situations, and there is often a serious discrepancy between healthcare providers, patients, and patient families about the benefits of continuous treatment to patients. However, rather than sticking to a sharp confrontation from their respective positions on medical futility, medical futility needs to move toward a strategy that optimizes decision-making between healthcare providers and patients/surrogate. In this paper, the definition and issues of medical futility up to now are discussed, and ethical criteria for medical futility are considered and discussed for a practical approach in the medical field.
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죽음을 대하는 현대의학의 태도 비판- 어네스트 베커의 실존주의 심리학의 관점에서
박중철 한국의철학회 2017 의철학연구 Vol.24 No.-
Since the solidarity of the traditional community has collapsed, deaths in modern society are proceeding with privatization, banalization, and medicalization. In particular, 75 percent of Koreans are dying in medical institutions today, so the death in hospitals has become a common occurrence. There is also a proliferation of medical futility in life-sustaining treatment, which is closely related to attitude of medicine toward death. Such attitude have several characteristics. First, the medical profession recognize death as a medical defeat, and they resist it through advanced technology. Second, such resistance is rationalizing through ‘Dogma’, such as ‘principles of ethics’ and ‘treatment guidelines’. This article analyze the medical futility relying on ‘technological possibility’ and ‘medical dogmas’ in perspective of ‘existentialist psychology’ which persist that Human beings overcome the fear of death through an attempt to be a hero. One of them, Ernest Becker, explained how human beings become heroes through the psychological mechanisms of ‘narcissism’ and ‘transference’. According to Becker, It is narcissism to regard one’s ability as basis of self-esteem, and transference is the identification by subjugate ones’ own self under superior groups or cultures. Modern medicine has depended on the technological narcissism, and subjugating under the dogmas(laws, principle of ethics, treatment guidelines) to preserve itself from the fear of death. Ultimately, these technicism and dogmatism have become the identity of modern medicine against inevitable death. This identity of medical practice ultimately justifies life-sustaining treatment by allowing it’s intervention to deprive patients’ sovereignty in their dying process. If the patient wants to refuse life-sustaining treatment, they should rely on the legal and ethical principles of the law. In this case, the death of a patient is because of its own abandonment, not because of medical failures. And medicine can preserve the identity which it have to struggle against death. Medicine now needs a new identity to protect its self-esteem without violating patients’ sovereignty over their dying process. In order to achieve this, it is necessary to move the goal of medical practice to helping the completion of life not artificial prolongation of life. Ultimately, this will serve as an opportunity for our society to renew the culture of death.
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생명 말기의 법적 안정성 : 환자의 생명 징후와 관련한 연명치료 중단의 허용 요건을 중심으로
류화신(Ryoo Hwa-Shin) 忠北大學校 法科大學 法學硏究所 2010 法學硏究 Vol.21 No.2
This study discusses legal issues surrounding the withdrawal of treatment for terminal patients. on May 21, 2009, the Supreme Court of Korea ruled that patients have the right to terminate medically meaningless treatment upon confirmation that their illness is indeed irreversible. The Supreme Court´s decision thus makes proof of the irreversibility of a patient´s condition an important process in legitimatizing a patient´s decision to terminate life-sustaining treatment. However, since medical practice rejects explanations in terms of "essences" and is affected by issues of subjectivity, I argue that physicians cannot give indisputable confirmation of the irreversibility of a patient´s terminal illness, as required by the Supreme Court´ ruling. So, this study points to a need for greater social consensus in Korea on the permissible level for the rejection of life-sustaining treatment not to damage the legal stability.
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