군진의학 연구에서 인간대상 연구윤리

권복규,Kwon, Ivo 대한기관윤리심의기구협의회 2022 대한기관윤리심의기구협의회지(JKIRB) Vol.4 No.2

The goal of the military medicine is not as same as that of the civil medical practice, and consequently the characteristics of military biomedical researches have their own uniqueness. In front of the prerogative of national defense, some of the human rights ordinarily ensured in normal researches with human subjects are not to be fully guaranteed. The hierarchic system of the military would complicate the issue when the soldiers are enrolled as human subject for the research. Some researches could be classified as a military secret, therefore, the confidentiality issues need to be well addressed. Institutional Review Board and review procedure should be modified for the military purposes. So, it is necessary to establish the appropriate regulatory system for the military biomedical researches with human subject to manage the complicated issues involved in them.

한국인의 전통 죽음관

권복규,Kwon, Ivo 한국호스피스완화의료학회 2013 한국호스피스.완화의료학회지 Vol.16 No.3

한국인의 전통적 죽음관은 유교, 불교, 도교, 그리고 샤머니즘의 깊은 영향을 받았다. 유교에서는 죽음이 모든 생명이 겪는 자연스러운 운명이며, 죽음을 고민하기보다는 현세의 삶에 충실할 것을, 도교에서는 삶과 죽음이 크게 다르지 않으니 자연에 순응하여 살아갈 것을, 그리고 불교에서는 삶과 죽음이 모두 허상임을 깨달으면 궁극적인 진리에 도달하여 죽음을 극복할 수 있다는 가르침을 배웠다. 이러한 사상들은 한민족 고유의 샤머니즘과 결합하여 현세를 중시하지만 사후세계와 윤회전생을 믿는 태도를 낳기도 하였다. 이러한 모습들은 역사를 통해서 매우 다양한 내러티브들로 나타나며 현대 한국인들이 죽음을 맞는 모습에도 여전히 큰 영향을 미치고 있다. Koreans' traditional view on death has been much influenced by Confucianism, Taoism, Buddhism, and shamanism since ancient times. Confucianism emphasizes the importance of the real life in this world and highly praises doing good deeds for the family and the community. It also praises people who are enlightened by education and self-discipline. Confucian scholars admit that death cannot be understood by rational thinking although it is unavoidable as a cosmic order. Taoism sees life as the same entity as death; Both are two different aspects of the same cosmos or the wholeness. However, the disciples of Taoism became much interested in a long life and well being that may be achieved by harmonizing with the cosmic order. Buddhism thinks that death and life are an "illusion". It says that people can be enlightened by recognizing the fact that "Nothing is born and nothing is dying in this world. Everything is the product of your mind occupied with false belief." However, secular Buddhists believe in the afterlife and metempsychosis of the soul. This belief is sometimes connected with the view of the traditional shamanism. Shamanism dichotomizes the world between "this world" and "that world". After death, the person's soul travels to "that world", where it may influence life of people who reside in "this world". And shamans who are spiritual beings living in "this world" mediate souls and living people. In conclusion, there are various views and beliefs regarding death, which are influenced by a number of religions and philosophies. They should be seriously considered when making a medical decision regarding the end of patients' life.

인체조직물의 연구 목적 활용과 관련된 윤리적 문제

권복규 ( Ivo Kwon ) 한국의료윤리학회 2003 한국의료윤리학회지 Vol.6 No.1

의학교육에서 의료인문학의 가치: 의사학을 중심으로

권복규(Ivo Kwon) 대한의사학회 2022 醫史學 Vol.31 No.3

The history of medicine has been continuously devaluated in medical education but its importance should not be ignored as for other medical humanities. The educational value of the history of medicine could be summarized as follows ; it allows the students 1) to understand the humane aspect of medicine by telling them how medicine has dealt with human health-disease phenomena in each era of the human history. 2) to improve the professionalism by recognizing that medicine is a profession with a long tradition that dates back to the Hippocratic era 3) to improve current medical practice by understanding the limitations and uncertainties of medicine. 4) to understanding the historical changes of the disease phenomena 5) to develop the basic competence of learned intellectual. 6) to integrate the tradition of their own institutions with themselves.

이종장기이식에 대한 우리나라 국민들의 인식 조사

권복규 ( Ivo Kwon ),김현철 ( Hyeon Cheol Kim ),최경석 ( Kyung Suk Choi ) 한국의료윤리학회 2005 한국의료윤리학회지 Vol.8 No.2

The telephone survey was conducted to investigate the opinions and attitudes of Koreans on organ xenotransplantation. Ten items were developed for this survey. Participants of this study was randomly selected in proportion to 2004 Korean census. Data from five hundred adults were analyzed with SPSS 12. The results showed that 61.6% of the respondents were positive for organ xenotransplantation while 30.8% of them were negative. After they were informed about benefits and risks, however, 49.0% of the respondents addressed the study on organ xenotransplantation should continue while 42.8% of them indicated the study be prohibited. Approximately fifty three percent of the respondents were against the con-position on organ xenotransplantation based on animal rights, but 44.2% of them agreed with the con-position. In addition, 53.0% of the respondents were for the gene transformation of pigs to obtain organs avoiding human immune rejection response. If organ xenotransplanation is safe, 64.0% of the respondents indicated that they would get the transplantation surgery and 71.0% of the respondents pointed out they would recommend it for their family members and relatives. Male persons are more positive than female on animal experimentation for organ xenotransplantation and the gene transformation of pigs, but 65.7% of male respondents and 58.0% of female respondents were positive for organ xenotransplantation. There were no significant differences according to different religions. Therefore, we concluded that Koreans have more positive attitudes than negative ones to organ xenotransplantation and animal experimentations to develop organs for that transplantation. However, the change in participant`s attitudes following informed benefits and risks suggests that the key issue is to reduce risks in organ xenotransplantation.

우리나라 의료윤리교육에 대한 비판적 고찰

권복규 ( Ivo Kwon ) 한국의료윤리학회 2006 한국의료윤리학회지 Vol.9 No.1

There are numerous problems with the medical ethics education currently practiced in Korea. In the first place, there is a lack of consensus regarding the goals of medical ethics education. Some educators seek to promote morality or good character in medical students, while others focus on advanced bioethical issues such as euthanasia or organ transplantation. Secondly, there is confusion concerning teaching methods. Lectures, small group discussions, so called "dilemma discussions", PBL, TBL, and public service components are all used without any clear educational purpose and strategy. Thirdly, there are problems with evaluation; few know how to evaluate students` performance or measure the effects of medical ethics education. In this article, I argue that the promotion of medical ethics competence based on the medical professionalism should be recognized as the ultimate goal of basic medical ethics education. Medical ethics competence is composed of knowledge, problem solving skills, and professionalism, and it covers three different domains: medical ethics, bioethics, and professional ethics. Instructional tools and methods should be constructed and implemented to achieve this goal of medical ethics competence, which will in turn help to promote medical professionalism in Korea.

인간대상연구에서 장애인으로부터 “충분한 정보에 의한 동의” 받기의 윤리적 쟁점 : 청각 및 시각 장애인을 중심으로

권복규(KWON Ivo) 이화여자대학교 생명의료법연구소 2022 Asia Pacific Journal of Health Law & Ethics Vol.15 No.2

인간대상연구에서 시각이나 청각장애인을 연구대상자로 참여시키기 위해 충분한 정보에 의 한 동의를 받는 과정은 쉬운 일은 아니다. 그러나 이들이 의사결정능력이 있는 한 그들의 자율성 은 존중되어야 하며, 이를 위해 합당한 의사소통 및 의사표현 방식을 채택해야 한다. 수어나 점자의 활용, 동의 과정의 녹화 혹은 녹취, 참관인의 활용 등은 이들로부터 합당한 동의를 받기 위 해 필요한 수단이며, 정보통신기술의 발전을 통해 다양한 매체와 수단을 활용하기가 더욱 용이해 졌다. 단지 통상적인 의사소통에만 어려움이 있을 뿐 의사결정능력이 온전한 장애인들은 장애가 있다는 이유로 그들에게 유익할 수 있는 인간대상연구로부터 배제되어서는 안 되며, 연구자는 이들로부터 윤리적으로 합당한 연구 참여에 대한 동의를 획득할 수 있도록 다양한 노력을 기울여야 한다. It is difficult to get the informed consent from the individuals who are disabled due to hearing loss or visual impairment so as to let them to participate in human subject researches. However, the researchers should try to their best to respect the autonomy of the potential human subjects and employ appropriate communicating tools considering their unique needs in the communication. For the purpose, the use of sign language or braille system, recording of the consent process, and the participation of the impartial witness could be suggested. We should not exclude the disabled, but mentally competent person from the enrollment of human subject researches, which might be beneficial to them only for the reason that they have the disability. The development of IT technology will help the researchers to communicate with the disabled individuals who are to participate in the research.

우리나라 일부 병원에서 환자, 보호자, 의료진의 연명치료 중지 관련 의사결정에 관한 태도 연구

권복규 ( Ivo Kwon ),고윤석 ( Youn Suck Koh ),윤영호 ( Young Ho Yun ),허대석 ( Dae Seog Heo ),서상연 ( Sang Yeon Seo ),김현철 ( Hyeon Chul Kim ),최경석 ( Kyung Suk Choi ),배현아 ( Hyun A Bae ),안경진 ( Kyung Jin Ahn ) 한국의료윤리학회 2010 한국의료윤리학회지 Vol.13 No.1

A survey was conducted from September to December 2008 to examine the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients and other related issues. The subjects for the study were 91 cancer patients, 96 family members of cancer or other terminally ill patients, and 140 physicians. Most subjects acknowledge the need for an appropriate regulatory framework for the withdrawal of treatment for terminal patients. However, some discrepancies were found among the different groups (patients, family members, physicians) in this study. Patients showed a stronger preference for the withdrawal of treatment than did family members. Also, most patients claimed they wanted to receive the diagnosis of a terminal illness from their physician, while most family members seem to think it is their own duty to convey such a diagnosis to the patient. Both groups prefer co-decision-making about the withdrawal of treatment over individual decision-making by the patient. However, most family members admit that they do not know much about the patient`s wishes and lack the time for sufficient conversation with the patient. Physicians are skeptical of the authenticity of the decisions made by family members, and some physicians also regard hospital ethics committees as being ineffective for resolving these issues. The results of this study paint a unique picture of clinical culture in Korea, where family members still exert strong influence on clinical decision-making and little information is shared between patients, family members, and physicians. The study points to a need for greater public education in Korea on the practical and ethical issues surrounding the withdrawal of treatment for terminal patients.

인터넷을 활용한 인턴 대상 의료윤리교육경험

권복규 ( Ivo Kwon ),구영모 ( Young Mo Koo ) 한국의료윤리학회 2002 한국의료윤리학회지 Vol.5 No.2

연구논문 : 임종기 진료결정과 관련된 윤리적 문제에 대한 내러티브 분석: 말기 암환자들을 대상으로

권복규 ( Ivo Kwon ),배현아 ( Hyun Ah Bae ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.2

In order to understand fully the issues involved in end-of-life care decisions, it is important to know the genuine wishes and thoughts of terminal patients themselves. This article reports on a narrative analysis of the data drawn from structured interviews with a number of terminal patients suffering from critical diseases such as cancer. Most patients approve of the withdrawal of life support treatment in irreversible and extremely painful conditions. They also admit the necessity of "advance directives" and even active euthanasia. However, their attitudes toward disease and death are emotionally complex. In facing their own death, patients need more emotional/medical support and pain control. Their relationships with family members or friends are also critical in this regard. Terminal patients are not entirely satisfied with current methods of communication with care givers, although they appreciate their concerns and goodwill. This analysis concludes that it is necessary to approach end-of-life care decisions in a more subtle and humane way that should be customized to the demand of each individual patient these decisions should be treated as part of the overall medical care given to terminal patients.