사전의료지시의 한계

오세혁,정화성 대한의료법학회 2010 의료법학 Vol.11 No.2

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

간호대학생의 좋은 죽음에 대한 인식, 사전의료의향서에 대한 지식 및 태도

권말숙(Mal Suk Kwon),홍주영(Ju Young Hong) 학습자중심교과교육학회 2019 학습자중심교과교육연구 Vol.19 No.3

본 연구는 간호대학생의 좋은 죽음에 대한 인식, 사전의료의향에 대한 지식과 태도의 관계를 확인하고, 사전의료의향서에 대한 태도의 영향 요인을 알아보고자 수행되었다. 3개 대학교 간호대학생 173명을 대상으로 구조화된 설문지를 통해 2018년 7월 부터 9월까지 조사하였다. 수집된 자료는 SPSS 22.0프로그램을 이용하여 t-test 와 ANOVA, Scheffe test, Person’s correlation, multiple regression을 실시하였다. 연구결과로 첫째, 좋은 죽음 인식은 4점 만점에 2.88점, 사전의료의향서에 대한 지식은 9점 만점에 7.50점, 사전의료의향서에 대한 태도는 4점 만점에 2.83점으로 나타났다. 둘째, 간호대학생의 좋은 죽음에 대한 인식 및 사전의료의향서에 대한 지식은 사전의료의향서에 대한 태도와 유의한 정적인 상관관계가 있었다. 셋째, 간호대학생의 사전의료의향서에 대한 태도의 영향요인을 분석한 결과, 좋은 죽음에 대한 인식(β =0.435, p<.001) 사전의료의향서 작성의향(β=0.248, p<.001), 사전의료의향서 작성 시기(β=0.154, p=.014), 가족, 친지 임종경험(β=144, p=.026)이며, 설명력은 34.5 %로 나타났다. 결론적으로 간호대학생의 사전의료의향서에 대한 태도를 증진시키기 위한 다양한 요인을 파악하고, 좋은 죽음에 대한 교육 프로그램 개발이 요구된다. The purpose of this study was to identify the factors influencing on nursing student’ attitudes toward Advanced Directives. Nursing students from 3 nursing college in D city were selected for the research and a survey was carried out from July to September, 2018. A total of 173 nursing students participated in this study. To data were analyzed by t-test, ANOVA, Scheffe test, Person’s correlation, multiple regression using SPSS statistics 22.0. According to the result, The mean score of perception of good death was 2.88, knowledge for advance directives was 7.50, attitudes for advance directives was 2.83. Attitudes toward advance directives was significant positive correlations between perception of good death and knowledge for advanced directives. The significant influencing factors on attitude toward advanced directives were perception of good death (β=0.435, p<.001), intention of documenting written advanced directives(β=0.248, p<.001), time of documenting written advanced directives (β=0.154, p=.014) and experience of death in the family members(β=144, p=.026) explaining 34.5% of the variance in the multiple regression analysis. Therefore, in order to improve the nursing students attitude for advanced directives, it is necessary to understand factor influencing attitudes toward advanced directives and develop strategies and educational programs for nursing student about end-of-life-care.

사전지시에 의한 연명치료의 중단에 관한 연구

강명구(Kwang, Myeng-Ku) 원광대학교 법학연구소 2012 圓光法學 Vol.28 No.4

2009년에 우리 나라 대법원은 영구적으로 의식이 없는 말기적 질환 상태에 있는 환자에게 연명장치의 제거를 허용하는 판결을 하였다. 대법원이 인정한 연명치료 중단의 요건은 다음과 같다. 첫째, 환자가 말기적 질환 상태에 있어서 이의 회복가능성이 없을 것, 둘째, 환자가 사전지시를 하였을 것, 만약 환자가 사전지시를 하지 않았다면 이를 인정할만한 다른 사정으로 환자의 의사를 추정할 수 있을 것, 셋째, 환자의 지시는 충분한 의료정보를 가지고 행하여 졌을 것, 넷째, 사전지시는 의료공급자에게 행하여지고, 이를 충분히 입증할 것 다섯째, 환자가 말기상태인지 여부는 법원 혹은 관련 위원회의 판단을 따를 것을 요건으로 하였다. 요컨대 대법원 판결은 환자가 자기결정권 차원에서 스스로 연명치료 중단결정을 할 수 있다는 것을 인정한 다음, 사전의료지시에 의한 연명치료중단의 요건을 제시한 것이다. 그러나 대법원이 제시한 연명치료중단의 사전지시의 요건중 환자가 충분한 의료정보를 취득한 후 이를 지시하여야 한다는 요건은 환자가 연명치료중단을 위한 사전지시를 하는 것을 불가능하게 요건이며, 이는 연명치료의 중단과 상관없는 일반적인 의료행위의 지시에 경우에 적용되어야 하는 것으로 적절하지 않다는 점을 지적하였다. 또, 2011년 개정민법상 성년후견제도 및 임의후견계약제도에서 개정민법은 2013년부터 후견인이 신상보호를 할 수 있도록 하고 있는데, 이러한 신상보호의 개념속에 사전의료지시에 의한 연명치료의 중단이 포함될 수 있을 것인지도 살펴보았다. 사견으로는 개정민법상 성년후견 및 임의후견제도에서 연명치료중단을 위한 사전지시가 가능하다고 보고 있지만, 연명치료중단을 위한 지시를 실행함에 있어서 관련자의 민형사상 직무상 면책규정이 없는 상황이므로 이의 활성화를 위해서 는 입법이 필요로 하고, 이를 위해서는 외국의 법 특히 미국 각주의 지속적 대리인의 선임 및 생전유언제도에서 규정하고 있는 제요소를 참조할 것을 제언하였다. In 2009, the Korea Supreme Court held that discontinuance of life-extending treatment can be allowed, upon reaching the stage of irrecoverable death, on the ground of the patient’s right to self decision to die based on dignity, value and the right to pursuit of happiness as a human being. The Court noted following requisites of the withholding or withdrawal of life-prolonging treatment by advanced directive for health care. First, the patient should be in the terminal condition, that will result in imminent death or has an irreversible injury or illness that results in a persistent vegetative state or permanent unconsciousness. Second, there should be patient’s advanced directive for withholding or withdrawal of life-prolonging treatment on his or her terminal condition. Third, provided medical information directly from medical provider or physician, the competent patient should execute the advance directive soberly as to the specific medical treatment based on the medical information and his own values. Fourth, The advance directive should be executed to the patient’s medical provider or patient’s attending physician and it’s existence should be clearly proved by written instructions or medical records. And last, unless the patient files a lawsuit directly in court, it is desirable that a committee composed of expert doctors, etc. decides whether the patient has reached the irrecoverable death stage. This paper notes that the third requisite of the Court for withholding or withdrawal of life-prolonging treatment may be the obstacle to be executed a valid advance directive by patient. Since, generally, prior to the patient’s terminal and irreversible condition, sufficient medical information of the patient’s irreversible injury or illness, is not provided to patient/declarant executing advance directive. This paper argues that the requisite may be fitted to the advance directive for medical treatment irrelevant to patient’s terminal condition. This paper also examines, the amended Korean Civil Code Article 947-2(effective on July.1.2013) that provides the adult guardian’s power of decision regarding personal affairs of the incompetent adult, the amended Code of Article 959-14 that provides the durable power of attorney by contract between principal and agent. The power of attorney created by principal will take effective when the principal loses capacity to decide his or her personal affairs. According to the Art. 947-2 or 959-14, this paper admits the possibility, a principal giving advance directive for health care to withhold or withdraw life-prolonging treatment. But, there is no provision immunizing criminal, civil, or professional liability of physicians or the agents who participated in advance directive regarding life-sustaining treatment. So, this paper insists to establish an Act that permits individuals to execute advance directive for health care.

사전지시에 의한 연명치료의 중단에 관한 연구

강명구 원광대학교 법학연구소 2012 法學硏究 Vol.28 No.4

In 2009, the Korea Supreme Court held that discontinuance of life-extending treatment can be allowed, upon reaching the stage of irrecoverable death, on the ground of the patient’s right to self decision to die based on dignity, value and the right to pursuit of happiness as a human being. The Court noted following requisites of the withholding or withdrawal of life-prolonging treatment by advanced directive for health care. First, the patient should be in the terminal condition, that will result in imminent death or has an irreversible injury or illness that results in a persistent vegetative state or permanent unconsciousness. Second, there should be patient’s advanced directive for withholding or withdrawal of life-prolonging treatment on his or her terminal condition. Third, provided medical information directly from medical provider or physician, the competent patient should execute the advance directive soberly as to the specific medical treatment based on the medical information and his own values. Fourth, The advance directive should be executed to the patient’s medical provider or patient’s attending physician and it’s existence should be clearly proved by written instructions or medical records. And last, unless the patient files a lawsuit directly in court, it is desirable that a committee composed of expert doctors, etc. decides whether the patient has reached the irrecoverable death stage. This paper notes that the third requisite of the Court for withholding or withdrawal of life-prolonging treatment may be the obstacle to be executed a valid advance directive by patient. Since, generally, prior to the patient’s terminal and irreversible condition, sufficient medical information of the patient’s irreversible injury or illness, is not provided to patient/declarant executing advance directive. This paper argues that the requisite may be fitted to the advance directive for medical treatment irrelevant to patient’s terminal condition. This paper also examines, the amended Korean Civil Code Article 947-2(effective on July.1.2013) that provides the adult guardian’s power of decision regarding personal affairs of the incompetent adult, the amended Code of Article 959-14 that provides the durable power of attorney by contract between principal and agent. The power of attorney created by principal will take effective when the principal loses capacity to decide his or her personal affairs. According to the Art. 947-2 or 959-14, this paper admits the possibility, a principal giving advance directive for health care to withhold or withdraw life-prolonging treatment. But, there is no provision immunizing criminal, civil, or professional liability of physicians or the agents who participated in advance directive regarding life-sustaining treatment. So, this paper insists to establish an Act that permits individuals to execute advance directive for health care.

사전의사결정(Advance Directives, 死前意思決定)에 대한 사법연수원생들과 전공의와 수련의들의 인식도 조사

신영태 ( Young Tae Shin ),이일학 ( Il Hak Lee ),김선현 ( Sun Hyun Kim ),이희일 ( Hee Il Lee ) 한국의료윤리학회 2008 한국의료윤리학회지 Vol.11 No.1

Background: The legal and ethical issues related to advance directives have recently become controversial in Korea. This study was designed to determine whether there are any significant differences between judicial apprentices and medical trainees (including residents and interns) with respect to their attitudes toward advance directives. Methods: A questionnaire was administered to 283 judicial apprentices from May 29 to June 9, 2006, and to 254 medical trainees (150 residents and 104 interns) from May 1 to July 31, 2006. Thus, there were a total of 537 respondents in this study. Results: More medical trainees than judicial apprentices were familiar with advance directives (P < 0.05). More medical trainees than judicial apprentices claimed that a law for advance directives was necessary (P < 0.05). After adjusting for other predisposing factors, differences between the two groups were still statistically significant (P = 0.038). After adjusting other predisposing factors, it is found that the group which knew about advance directives beforehand responded more positively to the question whether legislation for advance directives was necessary than the group which didn`t(P=0.000). Conclusion: In this study, the difference in the number of medical trainees versus judicial apprentices who were familiar with advance directives was found to be statistically significant (P < 0.05). This caused statistically significant differences between the number of judicial apprentices versus medical trainees who believed that a law covering advance directives is needed. Therefore, greater awareness of advance directives is needed in order to establish a law governing them.

강원도 거주 성인의 사전연명의료의향서에 대한 인식

홍정주,이미옥 한국컴퓨터정보학회 2020 韓國컴퓨터情報學會論文誌 Vol.25 No.5

This study was attempted to know the awareness of Advance Directives of adults in Gandwon-do province. Data was surveyed from 60 adults in Gangwon-do province by 42 item questionnaire for the awareness of Advance Directives. Subcategories of Advanced Directives questionnaire were knowledge, preference, experience for life-sustaining treatment and Advance Directives. The data was analyzed with the frequency and percentage using SPSS 24.0. 45% of Participants replied they knew the ‘life-sustaining treatment’ exactly. They preferred CPR 78.3%, mechanical ventilation 63.3% and blood transfusion 51.7% for their future special life-sustaining treatments. They did not preferred hemodialysis 8.3%, artificial respiration 6.7%, intensive care unit 6.7%, 8.3 percent of participants said that they well aware of Advance Directives. 86.6% of them hoped to write their Advance Directives. Despite such low awareness of the Advance Directives, the intention to write Advance Directives was high. Based on these results, it was found that the level of awareness of Advance Directives was very important for the intention to prepare Advance Directives. Therefore, regional programs and education on Advance Directives and periodic survey study for awareness of Advance Directives should be continued. 본 연구는 강원도에 거주하는 성인의 사전연명의료의향서에 대한 인식을 알고자 시도되었다. 연구 자료는 강원도에 거주하는 성인 60명을 대상으로 42문항의 구성된 사전연명의료의향서 설문지를 이용하여 수집되었다. 연구 자료는 SPSS 24.0 프로그램을 이용하여 빈도와 백분율을 분석하였다. 사전연명의료의향서 인식의 설문지는 연명치료와 사전의료의향서의 지식, 경험, 선호도로구성되었다. 연구 결과는 다음과 같았다. 연구 참여자의 45%가 연명치료에 대해 정확이 알고 있다고 응답하였다. 연구 참여자가 선호하는 특수연명치료는 심폐소생술 78.3%, 기계 환기 63.3%, 수혈 51.7% 이었다. 연구 참여자가 피하고 싶어 하는 특수 연명치료는 신장투석 8.3%, 인공호흡6.7%, 중환자실 입원 6.7%로 나타났다. 사전연명의료의향서에 대해서는 8.3%만 인지하고 있었으며, 그럼에도 불구하고 응답자의 86.6%가 사전연명의료의향서 작성에 호의적이었다. 본 연구 참여자의 사전연명의료의향서에 대한 인식은 매우 낮았음에도 불구하고 이를 준비하겠다는 의도는 높았다. 따라서 이러한 결과를 기반으로 사전연명의료의향서에 대한 인식 수준이 사전의료의향서작성의도에 매우 중요함을 알 수 있다. 따라서 사전연명의료의향서에 대한 지역 프로그램과 교육과 주기적인 사전연명의료의향서에 대한 인식 연구가 계속되어야 한다.

사전의료의향서에 대한 의료기관 종사자들의 인식과 태도

황병덕,최령,박재우 한국보건사회학회 2014 보건과 사회과학 Vol.0 No.37

The purpose of this study is to investigate awareness on Medical personnel'sawareness and attitudes which affects to writing Advanced Medical Directives. Medical personnel(hospice volunteers, nurse, administrative personnel) from 11 hospital level in Busan were selected for the research and a survey was carried out for 47 daysfrom April 04, 2014 to February 17, 2014. The Medical personnel(hospice volunteers,nurse, administrative personnel) were asked to answer questions by themselves andanswers from a total of 665 Medical personnel(hospice volunteers: n=208, nurse:n=230, administrative personnel: n=227). To data were analyzed by factor analysis,crosstabs and logistic regression using SPSS statistics 21.0. According to the result, the hospice volunteers was influence on the writing Advanced Medical Directives of awareness writing Advanced Medical Directives. The nurse was influence on the include income, region of birth of awareness writing Advanced Medical Directives. The administrative personnel was influence on the include income, region of birth, career, legislation and representative of awareness writing Advanced Medical Directives. there is a need to understand that patients with incurable diseases have rights to die with dignity and to live on a life of a human being. and there is a need to awareness change to writing Advanced Medical Directives. 본 연구의 목적은 사전의료의향서에 대한 의료관계자들의 인식과 태도를 파악하는데 있다. 부산광역시 소재 병원 급 의료기관 7개에 종사하고 있는 호스피스, 간호사, 행정직원을 대상으로 설문조사를 시행하였으며, 최종 665부(호스피스:208, 간호사:230, 행정직원:227)를 분석하였다. 조사기간은2014년01월04일부터 01월25일까지 22일간 이었다. 자료처리는 일반적 특성, 인식과 수용태도, 작성자와 작성 시기, 제도 및 대리인 지정에 대한 태도를 알아보고자 χ2-test, 사전의료의향서 작성 동의에영향을 미치는 요인을 알아보기 위하여 로지스틱 회귀분석을 하였다. 연구결과, 사전의료의향서 작성동의에 영향을 미치는 요인으로 호스피스의 경우는 사전의료의향서 인식유무, 간호사의 경우는 소득,출생지역, 행정직원의 경우는 소득, 출생지역, 근무(봉사)경력, 법률제정, 법정 대리인 지정 변수가 영향요인으로 분석되었다. 본인의 의사를 자신의 생명결정권에 최대한 반영할 수 있도록 체계적인 기준마련, 사전의료의향서에 대한 인식변화 그리고 제도의 법제화가 이루어져야 한다.

간호대학생의 사전의료의향서에 대한 태도 영향 요인

김희정(Kim, Hee-Jung) 한국간호교육학회 2019 한국간호교육학회지 Vol.25 No.2

Purpose: The purpose of this study was to identify nursing students’ knowledge and attitude toward advance directives and factors influencing the attitude. Methods: A cross-sectional survey design was used and 196 nursing students participated in the study. Data were collected from July 1 to August 30, 2018 using a structured questionnaire which included biomedical ethics, awareness of good death, knowledge and attitude toward advance directives. Data were analyzed using SPSS/WIN 25.0 program with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. Results: The mean score of biomedical ethics, awareness of good death, knowledge and attitude toward advance directives were 2.88±0.59, 3.18±0.48, 7.68±31.32, 31.00±3.09. Factors influencing the attitude toward advance directives were awareness of good death (β=.28, p<.001), intention of writing their advance directives (β=.19, p=.006), the knowledge related to advance directives (β=.15, p=.029). A total of 14% of attitude toward advance directives was explained by awareness of good death, the knowledge related to advance directives, and ntention of writing their advance directives. Conclusion: The findings of the study indicate that it is necessary to provide a systemic education program regarding advance directives for nursing students in order to provide knowledge related to advance directives and to help them establish positive attitudes toward advance directives.

중년기 급성심근경색증 환자의 죽음불안과 사전연명의료의향서에 대한 지식 및 태도 간의 관계

서미영(Suh, Mi Young),김정선(Kim, Jeong Sun) 한국노인간호학회 2021 노인간호학회지 Vol.23 No.3

Purpose: This study aimed to identify the relationship between death anxiety, knowledge, and attitudes toward advance directives in middle-aged patients with acute myocardial infarction. Methods: Data were collected through a survey of 142 middle-aged adults from August 27th to October 4th, 2019 in G city. Data analysis was performed using descriptive statistics, t-test, one-way ANOVA, Scheffé test, and Pearson correlation coefficient. Results: The average score of participants’ death anxiety and attitudes toward advance directives was 44.14±6.71 and 43.61±3.53, respectively, and the average correct rate in knowledge of advance directives was 57.1%. Participants showed significant differences in death anxiety (F=3.75, p=.013), knowledge of advance directives (F=3.02, p=.033), and attitudes toward advance directives (t=2.31, p=.022) depending on the presence or absence of an object to discuss their health status. Also, there were significant differences in knowledge of advance directives (t=3.43, p=.001) and attitude toward advance directives (t=2.23, p=.027) depending on whether participants perceived the meaning of advance directives. There were positive correlations (r=.38, p=<.001) between knowledge of advance directives and attitudes toward advance directives in middle-aged patients with acute myocardial infarction. Conclusion: Active information-provision and promotional strategies are needed to enhance a correct understanding of advance directives for middle-aged acute myocardial infarction patients with a high probability of sudden death to recognize the need for an advance directive and reinforce a positive attitude.

연구논문 : 연명치료중단에 대한 환자측 사전 의료지시서의 법적효력에 대한 연구

고명환 ( Myung Hwan Ko ) 연세대학교 법학연구원 의료·과학기술과 법센터 2012 연세 의료·과학기술과 법 Vol.3 No.2

소위 김할머니 사건 판례는 환자 본인의 자기결정권을 어떻게 해석하여 연명치료를 중단할 것인가의 문제에 대하여 과감하게 접근한 판례이다. 다만 가족의 진술에 의한 추정적 의사해석을 주변인의 진술에 의존하여 판단하는 한계가 있다. 아직 의학적으로 명확하게 연명치료중단의 기준을 판별하기란 어려운 것이 현실이다. 그러나 법원이 본인의 추정적 의사에 관하여 판단하도록 일임할 것인지의 여부와 중단에 대한 의학전문가들의 판단에서 결정적으로 중요한 요소가 되는 것이 본인의 의사해석이다. 법원의 판단을 거치지만 결국 자기결정권을 최대한 존중해주는 것이 법적·윤리적으로 타당한 처신인가에 대한 물음에 대하여 외국의 앞선 존엄사법 등의 선례들을 보건데 결국 본인의 의사에 부합하도록 의사결정 방식에 대한 법원과 입법부의 고민이 최대의 관건이었다. 대법원이 밝힌 연명치료 중단에 대한 허용요건은 의학적으로 환자가 회복불가능한 사망의 단계에 진입했을 것과 환자의 의사표시를 인정할만한 사유가 있을 것 그리고 법원의 판결 또는 병원위원회의 판단이 있을 것을 요구한다. 이 중 다수의견과 소수의견간 첨예하게 대립한 부분은 환자의 자기결정권을 침해하지 않는 범위에서 환자 본인의 추정적 의사해석의 문제였다. 이에 대한 반성적 고려에서 사전의료지시서에 대한 논의가 추후 법학계와 의료계에서 이슈가 재점화 되었다. 법원에서 유효한 사전의료지시서의 요건을 명시화함으로써 실제의료기관과 환자, 보건복지부 등 관련 기관에서 사전의료지시서의 요건과 효력에 대한 구체적 논의가 진행중이다. 이에 대하여는 환자의 의사능력과 의사의 설명의무의 범위, 환자 대리인의 권한, 사전의료지시서의 요식성을 요구하는 문제 등에 대한 국내외의 다각적인 검토가 필요하다. 특히 환자의 의사능력과 관련하여 환자의 행위능력과 동의 능력과의 관계, 포괄적 대리권 행사, 의사 설명의무의 세부적 명문화 범위 등이 주요 고려사항이 될 것이다. 우리나라 국민 감정상 말기환자에 대하여 현재 상태에 관한 언급을 의사가 직접 하는 경우가 별로 없으며, 죽음에 관한 언급을 회피하는 경향이 있다. 또한 아직까지 사회적 함의 부족과 환자의 인식도가 성숙하지 않은 관계로 실행에 대한 한계 또한 고려된다. 그러나 보라매병원사건, 신촌세브란스 김할머니 사건처럼 본인 의사 확인이 안되어 야기되는 법적, 윤리적 수고스러움과 관련 분쟁의 해결을 위하여 본 지시서의 작성이 의료계약의 일환으로서 제도적 정착되어야 한다. The Supreme Court of Korea ruled that patients have the right to terminate medically meaningless treatment upon confirmation that their terminal 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 explanation in terms of "essences" and is affected by issues of subjectivity, some argue that physicians cannot give indisputable confirmation of the irreversibility of a patient`s terminal illness, as required by the Supreme Court`s ruling. Medical decision-making is influenced by a variety of factors, including cultural norms, regional practices, patient values, physician responsibilities, and patient autonomy, Whether or not a patient`s family members should also influence the medical decision-making process is a legitimate question. Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. It is the so-called Shinchon Severance Hospital Case brought to an end by the decision of the Supreme Court that opened the real discourse of withholding or withdrawing of LST(Life-Sustaining Treatment) in the legal profession as well as medical profession in Korea. People has sympathy with the validity and necessity of legal regulation on withdrawing-including withholding-of LST save the requirements & procedure of withdrawing of LST. In this situation, the legislative bill of amendment to the Korean Civil Law introducing of adult guardianship was pre-announced by the Ministry of Justice on September 18th 2009. The adult guardianship is a guardianship system that supports an mentally handicapped adult to deal with his affairs by support of a guardian. The object of adult guardianship includes affairs of body or well-being as well as property of adult wards. In particular, affairs of medical matters are of importance in the duty and authority of adult guardians. So, the introduction of adult guardianship is of much importance de lege lata as well as de lege ferena in th discussion of withdrawing of LST as a medical treatment. Since the legislation on withdrawing of LST intents to protect the right of death with dignity on the basis of patients` autonomy, the ratio legis of withdrawing of LST is variant from that of adult guardianship. In this context, it seems reasonable to legislate the withdrawing of LST separately from the adult.