임상간호사의 좋은 죽음에 대한 인식, 생명의료윤리의식, 도덕적 민감성이 사전연명의료의향서에 대한 태도에 미치는 영향

김희숙 인천가톨릭대학교 대학원 2020 국내석사

This study aims to verify the perception of good death, consciousness of biomedical ethics, and moral sensitivity of clinical nurses, and also to understand the effects of those factors on the attitude toward advance directives, so that the clinical nurses could be equipped with an ability to provide necessary information to patients and their guardians. This study conducted a survey targeting total 176 clinical nurses working for C university hospital in Incheon, from July 10th 2019 to July 20th 2019. As a research tool, this study used the self-administered questionnaire for the general characteristics including the measurement tool for good death(Jeong, Hyeon-Sook, 2010), the measurement tool for the consciousness of biomedical ethics(Kwon, Seon-Joo, 2003), the measurement tool for moral sensitivity(Han, Kim, Kim & Ahn, 2010), and the measurement tool for advance directives(Nolan & Bruder, 1997). Using the SPSS WIN 23.0 Statistics Program, the collected data was analyzed through the frequency, percentage, mean, standard deviation, independent samples t-test, ANOVA, Scheffe test, Pearson's correlation coefficient, and the hierarchical regression analysis. The results of this study are as follows. The perception of good death was 3.10±0.31 in the 4-point scale while the consciousness of biomedical ethics was 2.87±0.21 in the 4-point scale. In the sub-areas, the newborn baby’s right to life was 3.06±0.44, and the organ transplant was 3.02±0.41. The moral sensitivity was 5.10±0.53 in the 7-point scale while the attitude toward advance directives was 2.88±0.28 in the 4-point scale. The perception of good death showed significant differences in accordance with age and working department. The consciousness of biomedical ethics showed significant differences in accordance with age, religion, degree of education, and total clinical experience. The moral sensitivity showed significant differences in accordance with age, marital status, total clinical experience, and working pattern. The advance directives showed significant differences in accordance with age, marital status, religion, total clinical experience, and position. In the correlations of perception of good death, consciousness of biomedical ethics, moral sensitivity, and attitude toward advance directives, the perception of good death(r=.331, p<.001), artificial insemination(r=.200, p=.008) and organ transplant(r=.235, p=.002) of sub-areas of consciousness of biomedical ethics, and moral sensitivity(r=.323, p<.001) had positive correlations. In the results of analyzing the factors having effects on the attitude toward advance directives, the age(β=.441, p=.010), values of advance medical care for life prolongation of the characteristics related to the medical care for life prolongation(β=.235, p<.001), perception of good death(β=.283, p<.001), euthanasia of consciousness of biomedical ethics(β=-.153, p=.049), human biotechnology(β=-.213, p=.007), and moral sensitivity(β=.206, p=.005) had effects on the attitude toward advance directives, and the explanatory power of regression model was 31.1%(F=5.059, p<.001). In the results of this study, when the age was higher, they agreed on the values of advance medical care for life prolongation, and they were also positive toward the perception of good death, and euthanasia and human biotechnology of sub-areas of consciousness of biomedical ethics. When the moral sensitivity was higher, it had effects on the attitude toward advance directives. In conclusion, it would be necessary to develop the systematic educational programs that could positively improve the attitude toward advance directives by establishing the perception of good death, and increasing the consciousness of biomedical ethics and moral sensitivity of nurses. 본 연구는 임상간호사들의 좋은 죽음에 대한 인식, 생명의료윤리의식, 도덕적 민감성을 확인하고 사전연명의료의향서에 대한 태도에 미치는 영향을 파악하여 임상간호사들이 환자와 보호자들에게 필요한 정보를 제공할 수 있는 능력을 갖추고자 한다. 연구 대상은 인천 소재의 C 대학병원 근무하고 있는 임상간호사 176명이며, 자료 수집은 2019년 7월 10일부터 2019년 7월 20일까지 실시하였다. 연구 도구는 자가 보고식 설문지로 일반적 특성, 좋은 죽음 측정도구(정현숙, 2010), 생명의료윤리의식 측정도구(권선주, 2003), 도덕적 민감성 측정도구(Han, Kim, Kim & Ahn, 2010), 사전연명의료의향서 측정도구(Nolan & Bruder, 1997)를 사용하였다. 수집된 자료분석은 SPSS WIN 23.0 통계 프로그램을 이용하여 빈도와 백분율, 평균과 표준편차, 독립표본 t-test, ANOVA, Scheffe test, Pearson's Correlation coefficient, 위계적 회귀분석 방법을 사용하였다. 본 연구의 결과는 다음과 같다. 좋은 죽음에 대한 인식은 4점 척도에서 3.10±0.31점으로 나타났고, 생명의료윤리의식은 4점 척도에서 2.87±0.21점으로 나타났으며 하위 영역에서 신생아의 생명권이 3.06±0.44점, 장기이식이 3.02±0.41점으로 나타났다. 도덕적 민감성은 7점 척도에서 5.10±0.53점으로 나타났으며, 사전연명의료의향서에 대한 태도는 4점 척도에서 2.88±0.28점으로 나타났다. 좋은 죽음에 대한 인식은 연령, 근무부서에서 유의한 차이가 있었고 생명의료윤리의식은 연령, 종교, 교육정도, 총 임상경력에서 유의한 차이가 있었다. 도덕적 민감성은 연령, 결혼상태, 총 임상경력, 근무형태에서 유의한 차이를 보였고 사전연명의료의향서는 연령, 결혼상태, 종교, 총 임상경력, 직위에서 유의한 차이를 보였다. 좋은 죽음에 대한 인식, 생명의료윤리의식, 도덕적 민감성과 사전연명의료의향서에 대한 태도 정도와의 상관관계는 좋은 죽음에 대한 인식(r=.331, p<.001), 생명의료윤리의식의 하위 영역 중 인공수정(r=.200, p=.008), 장기이식(r=.235, p=.002), 도덕적 민감성(r=.323, p<.001)과 양의 상관관계가 있는 것으로 나타났다. 사전연명의료의향서에 대한 태도에 영향을 주는 요인을 분석한 결과, 연령(β=.441, p=.010)과 연명의료관련특성의 사전연명의료에 대한 가치관(β=.235, p<.001), 좋은 죽음에 대한 인식(β=.283, p<.001)과 생명의료윤리의식의 하위 영역인 안락사(β=-.153, p=.049), 인간생명공학(β=-.213, p=.007), 도덕적 민감성(β=.206, p=.005)이 사전연명의료의향서에 대한 태도에 영향을 미치는 것으로 나타났고, 회귀모형의 설명력은 31.1%였다(F=5.059, p<.001). 본 연구결과 연령이 높을수록, 사전연명의료에 대한 가치관에 찬성하며, 좋은 죽음에 대한 인식, 생명의료윤리의식의 하위 영역 중 안락사와 인간생명공학 의식에 긍정적이며 도덕적 민감성이 높을수록 사전연명의료의향서에 대한 태도에 영향을 미치는 것으로 나타났다. 결론적으로 간호사의 좋은 죽음에 대한 인식을 정립시키며 생명의료윤리의식을 높이고 도덕적 민감성을 높여 사전연명의료의향서에 대한 태도를 긍정적으로 향상시킬 수 있는 체계적인 교육 프로그램의 개발이 필요하다고 본다.

Sounding the Dead in Cambodia: Cultivating Ethics, Generating Wellbeing, and Living With History Through Music and Sound

Dyer, Jeffrey Boston University ProQuest Dissertations & Theses 2022 해외박사(DDOD)

This dissertation rethinks the ethics of history and trauma in post-genocide Cambodia by examining how Cambodians use a broad repertoire of sounded practices to form relations of mutual care with ancestors, dead teachers, deities, and other predecessors. At its root, the dissertation is the study of an ethical-religious-aesthetic system by which Cambodians recall predecessors' legacies, care for the dead, and engage ancestors and deities as supportive co-presences. Traditional and popular musics, Buddhist chants and incantations, whispers, and the non-acoustic practice of "speaking in the heart" (niyay knung citt) are among the primary sounded practices that Cambodians use to engage the dead. Parts One and Two detail those sounded practices and their social implications. I discuss how previous approaches have misinterpreted the nature and capacities of Cambodian music and other ritualized sounds through historicist, colonialist, and secular epistemologies, which cast those sounds as "culture" or "performance" and ignore their capacities as modes of ethics and exchange with the dead. Instead, by rethinking those sounded practices as Cambodian-Buddhist ethics and exchange, I examine how Cambodians fulfill an obligation to care for the ancestors who have supported themselves. I suggest fulfilling that obligation generates personal wellbeing and provides a new model for what living with history can sound like and feel like. Taken together, in Parts One and Two, I detail the non-linear temporalities, types of personhood, ethics, exchange with the dead, and the intergenerational mode of living with history that Cambodians bring into being through music and sound.Part Three zooms further out to discuss how sounded relations with the dead have consequences for national and international politics, which leads to larger critiques of the Cambodian government's politicization of Khmer Rouge remembrance and international humanitarian efforts that attempt to help Cambodians heal from trauma. Since at least the mid-1990s, a plurality of international activists, scholars, volunteers, and development workers have concluded that Cambodians perpetuate a silence about the Khmer Rouge era that furthers their traumatization. Most observers suggest that Cambodians need to provide public testimony about that violent past in order to heal. This dissertation contests those conclusions, following work in anthropology and trauma studies that problematizes the universalization of the Western psychotherapeutic notion of biomedical trauma and its treatments. I suggest that those calls for a testimonial voice presuppose historicist modes of remembrance and knowledge production that naturalize liberal Western models of personhood, citizenship, justice, wellness, and political agency. To move away from those models, I argue that Cambodian sounded and ritual practices generate what I term "modes of being historical" and "ways of living with history" that are intimate, familial, intergenerational, engage national pasts, and can be a mode of political action. Those "modes of being historical" include but are not limited to telling stories of others' struggles and deaths. I illustrate how Cambodians have long used a multitude of sounded practices to engage the past, grapple with life's difficulties, and care for themselves and their ancestors.This dissertation posits that sound studies and ethnomusicology can further the emerging scholarly shifts toward the culturally specific ways people cope with difficult pasts. I propose a new approach to post-violence ethics and history by arguing for the decolonizing possibilities of emphasizing the modes of being historical, ethical relations of mutual care, and ontological entanglements with the dead that Cambodians generate through music and sound.

중환자실 간호사의 생명의료윤리의식, 좋은 죽음 인식 및 사전연명의료의향서 지식이 연명의료중단 태도에 미치는 영향

이은정 건양대학교 2021 국내석사

This is a descriptive investigative study aimed at assessing the factors of biomedical ethics consciousness, good death recognition and knowledge on advance directive affecting the attitude toward withdrawal of life-sustaining medical care of nurses in intensive care units as the participants. 190 nurses working in intensive care units at general hospitals with more than 300 beds, including K, E, D, and S Hospitals in D City and W Hospital in I City were selected by means of convenience sampling extraction and nurses therein were administered questionnaire surveys as the participants of the study. Data collected from 177 of these 190 subjects were used for final analysis. Data collected from September 21, 2020 to October 9, 2020 were analyzed by means of frequency, percentage, mean and standard deviation, independent-test, one-way ANOVA, Scheffe test, Pearson's Correlation Coefficient and Stepwise Multiple Regression Analysis using SPSS Windows 23.0 Program. The results of this study are as follows. 1. The average score for consciousness of biomedical ethics was 2.93 ±.26 points out of 4, with the highest score achieved for organ transplantation at 3.40 ±.56 and the lowest score for brain death at 2.60 ±.48 as factors in subordinate domains thereof. The average score for awareness of good death was 3.00±.47 points out of 4, with the scores of 3.21±.52, 2.76±.49, and 2.76±.49 points for closure, personal control and clinical, respectively, as factors in subordinate domains thereof. Meanwhile, the average scores for knowledge on advance directive and attitude toward withdrawal of life-sustaining treatment were 17.18±3.37 points out of 23 and 3.62±45 points out of 5, respectively. 2. The consciousness of biomedical ethics in accordance with the study subjects’ general characteristics displayed statistically significant differences in terms of age, position, total work experiences, work experiences in ICU, completion of biomedical ethics education, and experience of death of close family members or relatives. Scores for males for recognition of good death were higher than those of females with a statistically significant difference, while scores for the degree of knowledge on advance directive displayed statistically significant differences in terms of age, marital status, total work experiences and work experience in ICU. The scores for attitude toward withdrawal of life-sustaining treatment displayed statistically significant differences in terms of gender with males having higher scores than females. 3. The attitude toward the withdrawal of life-sustaining medical care of ICU nurses displayed a statistically significant relationship with the subordinate factors of biomedical ethics consciousness including the fetus’ right to life (r=-.205, p=.006), artificial insemination (r=-.149, p=.047), euthanasia (r=-.154, p=040), organ transplant (r=.204, p=.006), and human biotechnology (r=.229, p=.002). Meanwhile, attitude toward the withdrawal of life-sustaining medical care was found to have significant positive correlation with recognition of good death (r=.351, p<.001) and a statistically significant relationship with knowledge on advance directive (r=.180, p<.017). 4. The main factors influencing the attitude to withdrawal of life-sustaining medical care included recognition of good death (β=.283, p<.001), the fetus’ right to life (β=-.107, p=.018), human biotechnology (β=.134) , p=.034), knowledge on advance directive (β=.026, p=.005), gender (β=-.199, p=.027), and artificial insemination (β=-.118, p=. 037), and the overall explanatory power of the model was 23%. Through the aforementioned study results, it is deemed necessary to develop a systematic education program to improve recognition of good death and to develop continuous education programs for life-sustaining medical care and advance directive in accordance with the revision of the relevant law in order to improve the attitude of ICU nurses toward the withdrawal of life-sustaining medical care. As such, repetitive and comparative studies for the investigation of new, related variables that influence the attitude toward the withdrawal life-sustaining medical care by expanding the range of study subjects in the future are suggested. 본 연구는 중환자실 간호사를 대상으로 생명의료윤리의식, 좋은 죽음 인식 및 사전연명의료의향서 지식이 연명의료중단 태도에 미치는 영향요인을 파악하기 위한 서술적 조사연구이다. 연구대상자는 300병상 이상의 종합병원 중환자실에서 근무하는 간호사를 대상으로 D시의 K병원, E병원, D병원, S병원, I시의 W병원에서 편의표본 추출방식으로 190명을 설문조사하였으며, 그 중 177명을 최종 분석 대상으로 하였다. 자료수집 기간은 2020년 9월 21일부터 2020년 10월 9일까지이고, 수집된 연구 자료는 SPSS WIN 23.0 프로그램을 이용하여 빈도, 백분율, 평균과 표준편차, Independent t-test, one-way ANOVA, Scheffe tset, Pearson's Correlation Coefficient, Stepwise Multiple Regression analysis를 이용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 생명의료윤리의식은 4점 만점에 평균 2.93±.26점이었고, 하위영역 중 장기이식이 3.40±.56점으로 가장 높았으며, 뇌사가 2.60±.48점으로 가장 낮았다. 좋은 죽음 인식은 4점 만점에 평균 3.00±.47점이었고, 하위영역별 점수는 친밀감이 3.21±.52점, 통제감 2.76±.80점, 임상증상 2.76±.49점 순으로 나타났다. 사전연명의료의향서 지식은 23점 만점에 평균 17.18±3.37점으로 나타났다. 연명의료중단 태도의 정도는 5점 만점에 평균 3.62±.45점이었다. 2. 연구대상자의 일반적 특성에 따른 생명의료윤리의식은 연령, 직위, 총 근무경력, 중환자실 근무경력, 생명의료윤리 교육 이수 유무, 가까운 가족이나 친지의 죽음 경험 유무에서 통계적으로 유의한 차이를 보였다. 좋은 죽음 인식은 성별에서 남자가 여자보다 높은 점수를 보이며 통계적으로 유의한 차이를 보였고, 사전연명의료의향서 지식 정도는 연령, 결혼상태, 총 근무경력, 중환자실 근무경력에서 통계적으로 유의한 차이를 보였다. 연명의료중단 태도는 성별에서 통계적으로 유의한 차이를 보였는데, 남자가 여자보다 유의하게 더 높게 나타났다. 3. 중환자실 간호사의 연명의료중단 태도는 생명의료윤리의식의 하위영역인 태아의 생명권(r=-.205, p=.006), 인공수정(r=-.149, p=.047), 안락사(r=-.154, p=040), 장기이식(r=.204, p=.006), 인간생명공학(r=.229, p=.002)과 통계적으로 유의한 관계를 보였다. 연명의료중단 태도와 좋은 죽음 인식은 유의한 정적(양) 상관관계(r=.351, p<.001)가 있는 것으로 나타났고, 사전연명의료의향서 지식과는 통계적으로 유의한 관계(r=.180, p<.017)가 있는 것으로 나타났다. 4. 연명의료 중단 태도에 영향을 미치는 주요 요인은 좋은 죽음 인식(β=.283, p<.001), 태아의 생명권(β=-.107, p=.018), 인간생명공학(β=.134, p=.034), 사전연명의료의향서 지식(β=.026, p=.005), 성별(β=-.199, p=.027), 인공수정(β=-.118, p=.037)이었고, 모형의 전체 설명력은 23%로 나타났다. 이상의 연구결과를 통해 중환자실 간호사의 연명의료중단 태도를 높이기 위해서는 좋은 죽음 인식 향상을 위한 체계적인 교육프로그램 개발과 법 개정에 맞춘 연명의료 및 사전연명의료의향서에 대한 지속적인 교육프로그램 개발이 필요하며, 추후 연구대상자를 확대하여 연명의료중단 태도에 영향을 미치는 새로운 관련 변인을 규명하는 반복 및 비교 연구를 제언한다.

On the Ethics of Neuroenhancements and the Use of Race Theory in Biomedical Ethics

Peebles, Ian Shane ProQuest Dissertations & Theses University of Penn 2022 해외박사(DDOD)

Drawing from normative ethics and analytic philosophy of race, this dissertation focuses on the ethical, legal, and social implications (ELSI) of emerging biotechnologies and novel clinical practices in relation to potentially vulnerable populations. The first two chapters challenge presumptive duties in favor of moral bioenhancements (MBs). Here, MBs are understood as medical interventions that alter human moral cognition – e.g., the use of non-invasive brain stimulation to mitigate aggressive behavior. In Chapter 1, I argue that there is no universal moral obligation to utilize MBs, because the mass utilization of MBs may undermine the moral dispositions they seek to promote through unwarranted differential treatment between enhanced individuals and unenhanced individuals. Chapter 2 zooms in to focus on the obligations owed to and by individuals with psychiatric disorders. I argue that when an individual with a psychiatric disorder can act autonomously and make informed decisions, and when there are viable alternatives to MBs for the prevention of harm, the person with a psychiatric disorder is not obligated to utilize MBs. The second pair of chapters demonstrate how race theory from the analytic philosophy tradition can and should inform discourse in medical ethics and public health policy. In Chapter 3, I use a virtue theoretic framework to construct a decision tree to determine when, if ever, it is morally permissible to use a biological racial classification in medicine. In Chapter 4, I offer a modified version of Jorge L.A. Garcia’s volitional account of racism (VAR) and argue that my modified account is a superior alternative to competing theories of racism when considered in a healthcare context because of its accuracy and comprehensiveness. Though seemingly disparate topics, each chapter aims to promote the just and benevolent treatment of all humans contending with life, death, and health – so, everyone.

임상간호사의 생명의료윤리의식, 전문직관이 장기이식의 태도에 미치는 영향

이호숙 경북대학교 2017 국내석사

The purpose of this study is to investigate the effect of clinical nurse 's biomedical ethics consciousness and professional intuition on the attitude of organ transplantation. We surveyed 230 nurses who worked in a university hospital for more than 6 months. The instrument was analyzed by SPSS with 49 items of biomedical ethics, 18 items of nursing professional intuition, and 20 items of organ transplantation. The mean biomedical ethics consciousness of general characteristics was the right of the fetus was the highest at 3.25 ± 0.54. The average of nursing professional intuition was high (3.59 ± 0.42). The mean for the attitude of organ transplantation was 3.51 ± 0.35, which was positive. The difference of biomedical ethics consciousness about general characteristics showed significant difference according to age, religion, hope of organ donation. There was a significant difference according to sex, age, religion, and education level (P <0.05) as a result of analysis of differences in general medical ethics awareness, nursing professional intuition, and organ transplantation attitude. The regression analysis of the effects of biomedical ethics consciousness and professional intuition on general attitudes of organ transplantation was significant as nursing professional intuition (β=.156, P<.027). Therefore, measures should be taken to improve the hospital environment and the fathers in order to raise the social awareness of the lowest score in the nursing professional intuition. In addition, in the effect of nurses' attitude on organ transplantation, And to develop an education program related to organ transplantation to contribute to the activation of organ transplantation.

간호사의 생명의료윤리 의식과 연명치료중단에 대한 태도

최은숙 강릉원주대학교 일반대학원 2015 국내석사

연구의 필요성 및 목적: 생명의료윤리에 대한 간호사들의 확고한 의식은 연명치료중단과 의료현장 에서 발생하는 윤리적 문제에 직면했을 때 중요한 요인으로 작용할 수 있다. 이에 본 연구는 간호사들을 대상으로 생명윤리의식 정도를 파악하고 이에 따른 연명치료중단에 대한 태도를 조사하여 간호사들의 바람직한 생명윤리관 확립을 위하여 연구를 시도하게 되었다. 연구방법: 본 연구는 간호사들의 생명의료윤리 의식과 연명치료중단에 대한 태도 및 상관관계를 파악하기 위한 서술적 조사연구이다. 생명의료윤리 의식은 이영숙(1990)이 고안한 윤리적인 가치관 설문지를 권선주(2003)가 수정하고 보완한 49문항의 4점 척도를 사용하여 점수가 높을수록 인간생명을 존중하는 생명의료윤리 의식이 높음을 의미한다. 연명치료중단에 대한 태도는 박계선(2000)에 의해 개발된 연명치료중단에 대한 태도 측정도구를 변은경 등(2003)이 수정하고 보완한 19문항의 5점 척도를 사용하여 점수가 높을수록 연명치료 중단에 긍정적인 입장을 의미한다. 본 연구의 신뢰도는 생명의료윤리 의식은 Cronbach's α = .73였고 연명치료중단에 대한 태도 에서는 Cronbach's α= .81이었다. 자료수집 기간은 2015년 9월 5일부터 9월 15일까지 였으며, Y병원에 근무하는 간호사 중 연구에 동의하는 자로, 배부된 250부 중 230부가 회수되어 최종 분석을 하였다. 수집된 자료는 SPSS 21.0 WIN Program을 이용하여 빈도, 백분율, 평균, 표준편차, t-test, ANOVA, 사후분석은 scheffe test를 하였으며, Pearson��s 상관관계 분석을 하였다. 연구결과: 1. 연령에서는 29세 이하가 51.3%로 가장 많았고 결혼 상태에서는 미혼이 62.2%, 학력에서는 4년제 간호대학이 70.9%, 근무경력에서는 1년에서 10년 미만이 45.2%, 근무 부서에서는 병동이 59.6%, 직위에서는 일반 간호사가 91.7%이었으며 종교에서는 종교가 있다 63.9%, 종교생활 참여정도 에서는 거의 하지 않는다가 26.5%, 윤리적 가치관에서는 가끔 혼동된다가 46.1%, 생명의료윤리 교육 받은 경험에서는 없다가 75.2% 이었다. 2. 생명의료윤리의식의 평균 평점은 4점 만점을 기준으로 3.03점, 하위 영역별 평균점수는 태아의 생명권이 3.38점으로 가장 높았고, 뇌사가 2.58점으로 가장 낮게 나타났다. 3. 연명치료중단에 대한 태도는 평균평점이 5점 만점을 기준으로 3.40점이었고 19개 문항의 평균점수에서 점수가 가장 높은 문항은‘환자는 본인의 죽음을 결정할 권리가 있다.’가 평균 4.24점으로 가장 높았으며, 가장 낮은 점수를 보인 문항은‘회복 불가능한 환자라도 병원에 입원해 있는 경우 기본적인 투약(수액, 항생제 등)은 해주어야 한다.’가 2.06점으로 가장 낮았다. 4. 일반적 특성에 따른 생명의료윤리 의식에서는 연령(F=4.67, p=.010), 결혼상태(t=-3.79, p<.001), 근무경력(F=5.23, p=.006), 종교참여도(F=3.16, p=.026)에서 유의한 차이가 있었다. 5. 일반적 특성에 따른 연명치료중단에 대한 태도에서는 유의한 차이가 없었다. 6. 생명의료윤리 의식과 연명치료중단 태도의 상관관계에서는 역상관 관계가 있는 것으로 유의한 차이가 있었다(r=-.200, p=.003). 생명의료윤리 의식 영역에서 인공임신중절(r=-.179, p=.007), 안락사(r=-.418, p<.001), 신생아생명권(r=-.383, p<.001)에서 유의한 상관관계를 나타내었다. 생명의료윤리 의식 점수가 높을수록 연명치료중단에 대한 태도가 부정적인 것으로 나타났다. 결 론: 본 연구에서 생명의료윤리에 대한 간호사들의 의식은 높은 편이였으며 연명치료중단 태도와의 관련성을 볼 때, 전체적으로 생명의료윤리 의식이 높을수록 연명치료 중단에 대한 태도가 부정적인 것을 알 수 있었다. 이는 의료현장에서 발생하는 윤리적 문제에 직면했을 때 중요한 요인으로 작용할 수 있다고 생각한다. 이상의 결과를 바탕으로 간호사들이 쉽게 접할 수 있는 올바른 윤리관 확립을 위한 지속적인 교육이 필요하며 생명의료윤리 의식과 연명치료중단에 대한 선행적인 연구가 부족하였으므로 반복 연구와 생명의료윤리 의식의 하위 영역별 갈등에 대한 구체적인 연구가 이루어져야 하고 또한 간호사는 간호제공자로서 연명치료중단 결정 과정에서 적절한 중재와 역할을 할 수 있도록 질적 연구가 이루어지길 제언한다.

Essays on Economic Design

Munoz-Rodriguez, Edwin Northwestern University ProQuest Dissertations & T 2021 해외박사(DDOD)

How Scientists Produce Institutions: The Practice and Politics of Genome Editing

Molina, Santiago Jose University of California, Berkeley ProQuest Disser 2021 해외박사(DDOD)

The subject of the 2020 Nobel Prize in chemistry, the CRISPR-Cas9, has been heralded by researchers as a breakthrough biotechnology and has gained widespread use in biomedicine and the life sciences since the first publication that showed that the CRISPR-Cas9 system could be used as a tool for "editing" DNA sequences in 2012. With over 20 clinical trials for treating genetic diseases with genome-editing technologies underway, scientists, regulators, and patients continue to lag in addressing concerns over equity, racial justice, public health and ableism in biomedicine. This dissertation reframes concerns over the ethics of genome editing as a problem of institutionalization: How is the idea and discourse of genome editing rendered into a durable set of practices that become routine, legitimated and, ultimately, taken for granted? Methodologically I draw from participant observation, in-depth interviews, and archival research. From 2015 to 2019, I've conducted participant observation following the extended case method at sites ranging from laboratories in the San Francisco Bay Area, to conference halls in Hong Kong. By observing scientists across these sites, I trace the winding trajectory of scientific practices as they move from the laboratory to the clinic. I have supplemented these observations with in-depth interviews with over 60 researchers and regulators. To gain purchase on the broader context of these observational data, I have collected over 880 archival documents ranging from Twitter threads, news articles, and clinical trial registries. From these sources I unpack the discursive struggles being waged over the moral and technical basis of genome editing and piece together which stakeholders are involved and when. To describe processes of institutionalization, this project builds on past work in political sociology, science and technology studies (STS) and the sociology of organizations. Work at the intersection of these fields has analyzed the interplay between science and politics by tracing networks of actors and has identified mechanisms by which technologies are legitimated. I bridge these fields to develop a theory of institutionalization that centers the normative construction of technology. I describe how scientists produce new genome editing practices when managing technical, semantic, and regulatory uncertainty during the adoption of CRISPR technologies. These practices are then routinized and normalized in a way that affirms not only their epistemic contribution but also their moral value. For example, scientists used various metaphors, such as gene surgery, to bring these laboratory practices into the clinic. I further show how partnerships between academic laboratories and biopharmaceutical firms reify construction of genome editing as morally good.Ultimately, I argue that scientists shape the direction of genome editing by resisting the encroachment of regulatory bodies, co-opting bioethicists, and carefully drawing the boundaries of self-governance. While this has allowed them to establish discursive and practical autonomy, it has also left patient communities, disability justice advocates and civil society groups on the sidelines.