무의미한 연명치료 중단에 대한 중환자 전담의사의 인식: 포커스그룹 인터뷰를 중심으로

Abstract

This study was designed to examine intensive care providers` perceptions of medically futile treatment. Focus group interviews were conducted with 18 intensive care physicians in charge of critical care units at tertiary hospitals in Daegu, Gwangju, and Seoul, South Korea. Results are as follow. 1. More than half of the participants opposed the inclusion of persistent vegetative state (PVS) patients in the category of medically futile treatment. 2. And though the distinctions between ordinary and extraordinary treatment, and between the withholding and withdrawal of treatment, were not clinically meaningful in the intensive care units under study, they are nevertheless relevant because of individual religious beliefs and Korean cultural traditions. 3. Since the beliefs and traditions of family members often makes it difficult for a patient to fill out advance directives, we argue that a gradual approach would be useful in choosing advance directives, making those directives optional rather than mandatory. 4. Economic factors also play a crucial role in the decision-making process regarding futile treatment in Korea. These factors were neglected in earlier surveys. Finally, the participants insisted that the physician`s right to make clinical decisions about medically futile treatment should be legislatively guaranteed based on their convictions. Based on the results of this study, we suggest the follow: a) that detailed criteria for medically futile treatments be established; b) that a decision-making process be developed that is culturally, ethically, medically, and legally acceptable; and c) that ethical education be provided to intensive care physicians.