‘무의미한 연명 치료 중단’에 대한 윤리적 쟁점

다국어 초록 (Multilingual Abstract)

The advanced modern medical technology could save the people from the death however it also could be the case of Intervention and interference of death which could be regarded as a meaningless extension of life. In this respect the requirement of dignity death has been stronger and the concept of dignity death is the part of the ‘quality of life’ concept has been extended. The first ‘Withdrawal of Meaningless Life-Sustaining’ has been recorded at Severance Hospital, Yonsei University Medical College in this country. Kim (77 years old) who was at vegetative state took off the respirator after a more than one year time. Supreme court made decision “When it is obvious that she will be die in a short period, continuing life-sustaining treatment is the against of the human dignity so it should be allowed stop treatment upon patient’s wishes.” Supreme court ruled to take off the respirator so the first ‘discontinue treatment’ had been recorded. In the light of this concern we would like to examine ‘end of life care decision’ in view of ethical contemplation. Firstly, the most concrete reason for discontinue-treatment would be ‘protection of human dignity’. Especially when the platform of human dignity basis on human being’s sanctity, and the elements of dignity is self-consciousness, rationality. In this sense discontinue-treatment would be more convincing. The concept of human dignity has related with self determination. According to Kantian ethics, The reason for human and all the rational beings has a dignity is basis on self determination. And human dignity is directly related with the freedom of select action which is recognized by the sound human reason. Secondly, In the medical practice determine patients self determination should be regarded as the most important thing. Every human being who are living in the society the freedom is guaranteed by the law, has a freedom and right to accept the doctor’s advice or not and also has a right to refuse the treatment at any time (except the emergency case) as long as the human has a consciousness. As a principle of biomedical ethics ‘self determination’ means that to itself to make decisions relating to the body in their own right. In the medical field the patient's self determination could appear in the form of 'consent'. When the patient’s decision has directly related with patient’s life just one time consent is not enough it requires at least 2 or 3 times consent and the consent should be explicit consent. Final decision should be done by written consent. In order to ensure objectivity, written consent requires two witness. The other method of self determination could be living will and advanced directives. Another important criterion in the medical field is opinions of medical experts. Stop life-support treatment decision should be made basis on medical judgments. If the patients is in the state of permanent vegetative or in case of too low to be of benefit from therapeutic medical treatment so that medical goals can not be achieved. In this case, the goal of treatment should be changed to comfort and care. Thirdly, regarding the limit of application for stop life-support treatment, there are ordinary means and extraordinary means. The ordinary means which imply nutrition and hydration supply, kind of general treatment should not be stopped unless patients serious, rational requirement. Looking at the ethical implications of stop life-support treatment, the concern should be termination of life which is done arbitrary and randomly. An estimable virtue of human life is not the part of the human being as a living cell by chance but he entire personality. Biological life is not a sufficient condition for entire personal life. In that sense death with dignity has a persuasive power. Before the legalization of death of dignity, the health care system improvement related with life-support treatment should be done first. So that they would not give up a life of their own because of the medical costs. Doctor’s duty to explain and guarantee of treatment options for patients is required. Prior research on the various ways to support the terminal patient and their family should be done properly as well. We have to think about the treatment focusing on pain relief rather than meaningless life-support treatment for the patients with a life expectancy less than six months. It is about time to discuss about social support for the hospice care for the death with dignity.

목차 (Table of Contents)

• I. 논의 과정
• II. 몇 가지 전제조건들
• 1. 안락사, 존엄사, 연명 치료 중단의 용어 구분
• 2. 윤리적 함의
• 3. 사회적 선결 과제
• IV. 인정 근거와 결정 주체, 결정 범위
• 1. 인정 근거
• 2. 결정 주체
• 3. 결정 범위
• IV. 제언
• 참고문헌