의료윤리 의사결정 방법론으로써 결의론의 가능성

이일학 ( Il Hak Lee ) 한국의료윤리학회 2010 한국의료윤리학회지 Vol.13 No.4

In this article casuistical deliberation is explained and examined in regards to whether or not it is suitable for clinical ethics deliberation. Casuistry is the analysis of moral issues using reasoning based on paradigms and analogies. Such case-based reasoning leads to the formation of expert opinions about moral obligations that are general but not universal or invariable. Casuists try to give guidance in cases in which no clear ethical principles can be applied and to categorize cases into paradigms and maxims. This article provides a casuistical analysis of a clinical case and argues that casuistical deliberation is an effective means of giving guidance on clinical ethics to clients.

연명의료결정법과 임상윤리서비스

이일학(Lee Il-hak) 한국생명윤리학회 2017 생명윤리 Vol.18 No.1

호스피스-완화의료 및 임종과정에 있는 환자의 연명의료에 관한 법률(연명의료결정법)은 의료기관 내에 연명의료결정에 관련하여 자문과 상담을 제공하는 의료기관윤리위원회 구성을 요구한다. 윤리자문이 제도화된다는 큰 변화에 비하면 연구는 아직 미진한 편이다. 본 논문은 임상윤리가 자문과 상담을 넘어 좀더 포괄적인 개념인 임상윤리서비스의 개념으로 발전해야 함을 강조한다. 임상윤리서비스는 윤리학, 법학, 종교학을 포함한 다양한 분야의 전문성을 갖추어 의료기관 내에서 제공되는 서비스의 하나다. 윤리적 가치문제를 내포한 임상적 판단 과정에서 의료인과 환자를 지원하여 합리적 판단과 결정이 가능하도록 상담과 자문을 지원하며 의료 서비스의 윤리성을 제고하고 기관 구성원의 도덕적 갈등과 고뇌를 해소하기 위해 의료기관 성원의 교육과 상담을 제공한다. 이 서비스에는 대화, 공식적 상담, 전문가적 자문, 위원회 심의 및 관련 법률에 따라 의료기관이 제공해야 하는 연명의료관련 상담 등이 포함되는 것으로 정의할 수 있다. 이런 서비스는 지금까지 생각해 온 임상윤리서비스의 범위를 넘는 것이며 팀 단위로 제공되어야 하는 것으로 생명윤리전공자들은 이론과 연구역량을 갖춘 팀의 일원으로 기여할 수 있다. 특히 지금까지 서비스의 수준을 향상시키는 연구에 대한 생명윤리학계의 관심이 필요하다. “Patient End-of-Life Decision Act 2016” mandate ethics consultation and review for end of life care decisions in practically every health care institute. But little attention has been given to issue of how the clinical ethics is provided to practitioners and patients. In this article I will argue that clinical ethics should be understood as ‘clinical ethics service’ that is composed of consultation, counseling, education and even administration: consultation for particular decisions about individual case; counseling to motivate professionals and promote ethical awareness and reasoning as well as support and comforting patients in difficult situtation; educating procedures to comply with law; administration such as document piling and reporting. This service should be provided in a team approach and clinical ethicists are part of team, equipped with theory and research capabilities. The research agenda for better clinical ethics service is presented.

종설논문 : 의료인-제약산업 관계의 이해상충과 윤리적 원칙

이일학 ( Il Hak Lee ),구영모 ( Young Mo Koo ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.2

This article examines the four principles of biomedical ethics introduced by Beauchamp and Childress for possible use in deliberating ethical issues that arise in the context of physician-pharmaceutical industry interactions (PPII). PPII is regarded as a threat to the ideal physician-patient relationship because it blurs the scientific, objective, and altruistic ideals of professional medical practice. Several guidelines have been proposed to redress the undesirable effects of PPII, but few have provided any ethical justification or mechanism to resolve possible internal conflicts. The principle-based approach is a good starting point because it focuses on practical solutions for decision-making as well as on theoretical justifications. This article shows how the four ethical principles can be specified and applied in three hypothetical cases of PPII, and how two practical rules, the rule of transparency and avoidance, can be assimilated.

《교과내용학》 : 다산 정약용의 『목민심서』에 나타난 자(慈)의 원리와 한국 HIV,AIDS 감염인의 인권을 위한 의료인의 역할

정창록 ( Chang Rok Jeong ),이일학 ( Lee Il Hak ) 한국윤리교육학회 2014 윤리교육연구 Vol.0 No.34

본 논문의 목적은 에이즈 환자가 갖는 인권에 관해 정리하고 현재 한국의 에이즈 환자 인권 현황에 관해 살펴본 후에 그 대안을 제시하는 것이다· 연구자는 에이즈 환자의 인권 보장을 위해 가장 필요한 것은 에이즈에 관한 편견을 바로 잡는 것이라고 본다· 병에 대한 편견의 역사는 인류보편의 역사라 할 수 있다· 우리는 과거에 결핵 환자를 두려워하고 격리시켰으나 현재는 그렇게 하지 않는다· 결핵은 약으로서 얼마든지 다스릴 수 있다고 생각하기 때문이다· 보건의료를 위시한 사회의 적극적인 대처로 인하여 HIV·AIDS는 관리 가능한 질병이 되었다· 그러나 그 기전은 감염인을 국가적으로 관리 감독하는 방식이다· 감염인은 다른 질병과 달리 격리되고, 동시에 사회적으로 고립되는 경우가 허다하다· 가족들에게도 버림받고 취직도 할 수 없는 이들은 어디에도 의탁할 곳이 없는 궁(窮)한 처지에 있다· 연구자가 볼 때 에이즈 환자를 돕기에 가장 적합한 대상은 의료인이다· 의사들은 의료 목민관으로서 이들의 오해를 풀어주고, 이들이 인간으로서의 최소한의 권리인 인권을 지켜나갈 수 있도록 도울 수 있다· 본 논문에서 연구자들은 다산(茶山) 정약용(丁若鏞)이 공자(公子)를 계승하며 강조한 인(仁)의 덕목을 맹자(孟子)의 삼덕(三德)인 효제자(孝悌慈)로 설명한 것에 근거하여 자신의 저서 『목민심서(牧民心書)』에서 특히 자(慈)의 원리를 강조했다고 보았다· 이것에 관해서는 선행논문에서 다산이 『목민심서』에서 강조했다고 연구자들이 생각하는 자(慈)의 원리가 어떻게 의료인의 윤리로 설명될 수 있는가를 밝혔다고 여기고, 본 논문에서는 그 원리를 구체적인 한국적 의료 문제 상황 중에서 특히 에이즈 환자의 인권 보장을 위한 의료인의 책무를 부각시키는 것에 적용해 보려 한다. HIV·AIDS Patients` Human rights have been abused by strong prejudice in South Korea. This paper is based on the Dasan(茶山) Jeong Yakyong`s Mokminsimseo(牧民心書) which may lay ground work for medical professionals that provide health care to these patients. Firstly, the authors tried to show current status of human rights among HIV·AIDS patients in Korea. Nextly, this paper emphasizes the moral role of Korean medical professionals based on Dasan(茶山) Jeong Yakyong`s Mokminsimseo(牧民心書) in medical practice. We believe that Jeong Yakyong`s concept of Mercy(慈) can be the principle of caring for the patients that are in desperate needs(窮). And we developed the theoretical framework for medical professionals to apply, that they can protect HIV·AIDS` Human rights.

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.

임상의학 진료, 연구에서의 이해상충

윤영훈 ( Young Hoon Youn ),이일학 ( Il Hak Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.3

In recent years, medical professionals are in charge with multiple roles. They have to work as an educator, researcher, and administrator, as well as medical practitioner. In addition, they experience a conflict between the primary responsibilities that each role requires of them. A conflict of interest (COI) is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. It occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other. The COI should be managed appropriately to preserve the value of public trust, scientific objectivity, and the benefit and safety of patients. Primary interest of medical professionals refers to the principal goals of the medical profession, such as the health and safety of patients, and the integrity of research. Secondary interest includes not only financial gain but also such motives as the desire for professional advancement and the wish to do favors for family and friends, but COI rules usually focus on financial relationships because they are relatively more objective, fungible, and quantifiable. This article will briefly review the COI in medical practice and research, discuss about what is COI, why we should manage it, and how we can manage it. (Korean J Gastroenterol 2012;60:149-154)

의료사고 분쟁에 소요되는 총비용 추계

손명세 ( Myongsei Sohu ),민혜영 ( Hye Young Min ),이일학 ( Il Hak Lee ),이미진 ( Mijin Lee ) 한국의료법학회 2005 한국의료법학회지 Vol.13 No.2

Unexpected results caused by medical services are defined as “"malpractice,” and the doctor must bear the responsibilities following the medical treatment. Malpractice disputes are disputes between patients, who are seen as the only victim in this way, and medical personnel who do not admit to the charges. Unfortunately, in reality, an official approach to mutual understanding and communication in the instance of such disputes does not exist. Moreover, an exact estimation of the total cost required to settle all malpractice disputes, which is the most important matter in creating such communication possible, is not being conducted. Therefore, this paper estimates the current medical dispute settlement cost of Korea by use of indexes appropriate for an exact estimation. These indexes will be obtained by analyzing related subject matters from secondary data, and hospital and clinic survey data. This paper cross-investigates the secondary data and survey data to compare and examine the reasonable malpractice dispute occurrence rate and cost of compensation. Since malpractice disputes at the clinic level and those at the hospital level have different aspects, disputes will be categorized into these two groups, analyzed, and then combined for the estimation. Building the framework for a practical compensation system is the most essential matter in the malpractice dispute settlement system. By estimating the total cost of malpractice dispute settlement, this paper will provide basic data to build the framework.

전공의를 위한 의료윤리 교육목표의 개발

정유석 ( Yoo Seock Cheong ),고윤석 ( Youn Suck Koh ),권복규 ( Ivo Kwon ),김옥주 ( Ock Joo Kim ),박재현 ( Jae Hyun Park ),손명세 ( Myong Sei Sohn ),이일학 ( Il Hak Lee ),임기영 ( Ki Young Lim ),장기현 ( Kee Hyun Chang ) 한국의료윤리학회 2008 한국의료윤리학회지 Vol.11 No.2

In 2007, the Korean Society for Medical Ethics Education (KSMEE), with the support of the Korean Academy of Medicine (KAM), developed a clinical ethics core curriculum for medical trainees in Korea. This article provides a summary of the contents of the curriculum developed by the KSMEE. The curriculum consists of six main subjects: doctor-patient relationships, interpersonal relationships with colleagues and paramedical persons, ethics related health policy, withholding and withdrawing of treatment, research ethics, and professionalism. Each main subject has three to four sub-sections. All issues were generated by medical ethics experts by means of group discussions and a survey of medical trainees at various university hospitals in Korea. Each subtitle has four parts including a general overview, learning goals, and two to three relevant clinical cases with key references. This curriculum is primarily for medical trainees, who are not well prepared for the diverse ethical challenges and ethical dilemmas they may face during their daily clinical activities.

의학연구에서 위험성 평가 : 기관생명윤리심의위원회의 평가를 위해 고려할 사항들

이일학 이화여자대학교 생명의료법연구소 2008 생명윤리정책연구 Vol.2 No.3

A theory of social contract for risk in medical research is tried. Though nresearchers have long understood the nature of risk and responded in many ways, there are still unsolved problems, such as the setting the limit of autonomy, allowing participation of healthy subjects for non-beneficial intervention, and preventing possible harming of socially-deprived people. For building social contract, two conceptions of risk were identified: quantitative risk and social risk. Then concept of harm and benefit, and social contract were discussed. Three principles of risk social contract were identified and suggestion for implementation were discussed.