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Lee HY, Kim HJ, Kwon JH, Baek SK, Won YW, Kim YJ, Baik SJ, Ryu H. The Situation of Life-Sustaining Treatment One Year After Enforcement of the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life in Korea: Data of National Agency for Management of Life-Sustaining Treatment. Cancer Res Treat 2021; 53:897-907. [PMID: 34082496 PMCID: PMC8524023 DOI: 10.4143/crt.2021.327] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life” was enacted on February 3, 2016 and went into effect on February 4, 2018 in Korea. This study reviewed the first year of determination to life-sustaining treatment (LST) through data analysis of the National Agency for Management of Life-Sustaining Treatment. Materials and Methods The National Agency for Management of LST provided data between February 4, 2018 and January 31, 2019 anonymously from 33,549 patients. According to the forms patients were defined as either elf-determinants or family-determinants. Results The median age of the patient was 73 and the majority was male (59.9%). Cancer patients were 59% and self-determinants were 32.1%. Cancer patients had a higher rate of self-determinants than non-cancer (47.3% vs. 10.1%). Plan for hospice service was high in cancer patients among self-determinants (81.0% vs. 37.5%, p < 0.001). In comparison to family-determinants, self-determinants were younger (median age, 67 years vs. 75 years; p < 0.001) and had more cancer diagnosis (87.1% vs. 45.9%, p < 0.001). Decision of withholding or withdrawing of LSTs in cancer patients was higher than non-cancer patients in four items. Conclusion Cancer patients had a higher rate in self-determination and withholding or withdrawing of LSTs than non-cancer patients. Continued revision of the law and education of the public will be able to promote withdrawing or withholding the futile LSTs in patients at end-of-life. Further study following the revision of the law should be evaluated to change of end-of-life care.
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Affiliation(s)
- Ha Yeon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Sejong Chungnam National University Hospital, Sejong, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyung Baek
- Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Su Jin Baik
- Korea National Institute for Bioethics Policy, Seoul, Korea
| | - Hyewon Ryu
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Chungnam National University College of Medicine, Daejeon, Korea
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2
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Jin S, Kim J, Lee JY, Ko TY, Oh GM. End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience. HAN'GUK HOSUP'ISU WANHWA UIRYO HAKHOE CHI = THE KOREAN JOURNAL OF HOSPICE AND PALLIATIVE CARE 2020; 23:93-102. [PMID: 37497083 PMCID: PMC10332712 DOI: 10.14475/kjhpc.2020.23.2.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 07/28/2023]
Abstract
Purpose The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld lifesustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods We retrospectively analyzed the medical records of patients who died after agreeing to withhold lifesustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop lifesustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion In many cases, the decision to discontinue lifesustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.
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Affiliation(s)
- Sol Jin
- Departments of Internal medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jehun Kim
- Departments of Pulmonology, Kosin University Gospel Hospital, Busan, Korea
| | - Jin Young Lee
- Departments of Infectious disease, Kosin University Gospel Hospital, Busan, Korea
| | - Taek Yong Ko
- Departments of Internal medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Gyu Man Oh
- Departments of Internal medicine, Kosin University Gospel Hospital, Busan, Korea
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Kwon KT. Implementation of Antimicrobial Stewardship Programs in End-of-Life Care. Infect Chemother 2019; 51:89-97. [PMID: 31270988 PMCID: PMC6609743 DOI: 10.3947/ic.2019.51.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Indexed: 12/17/2022] Open
Abstract
Many terminal patients at the end-of-life have been receiving antimicrobial therapy despite concerns including futile use, potential lack of efficacy, increased patient burden, excess costs, high risk of adverse effects, and increased antimicrobial resistance. Thus, the implementation of antimicrobial stewardship programs (ASPs) in end-of-life care needs to be discussed. But, the topics of antimicrobial therapy and ASPs have not been addressed in the Life-Sustaining Treatment Decision Act enacted in the Korea in February 2016. Antimicrobial therapy should be included in the decision-making framework for end-of-life care similar to other life-sustaining treatment decisions. If the antimicrobial therapy is legally considered as a life-sustaining treatment which can be withdrawn or withheld in patients at the end-of-life, the feasibility of implementing ASPs among this patient population may improve. Various researches on antimicrobial therapy for patients at the end-of-life need to be conducted and collaborations are required between ASPs professionals and many other concerned parties involved in the legislative process of the Life-Sustaining Treatment Decision Act. This review aims to summarize previous studies on the use of antimicrobials for end-of-life care and reveal important aspects for applying ASPs to this population in Korea.
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Affiliation(s)
- Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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Lee SM, Kim SJ, Choi YS, Heo DS, Baik S, Choi BM, Kim D, Moon JY, Park SY, Chang YJ, Hwang IC, Kwon JH, Kim SH, Kim YJ, Park J, Ahn HJ, Lee HW, Kwon I, Kim DK, Kim OJ, Yoo SH, Cheong YS, Koh Y. Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.8.509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sang-Min Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jung Kim
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sujin Baik
- Korea National Institute for Bioethics Policy, Seoul, Korea
| | - Bo Moon Choi
- Education Center for Public Health & Medicine, National Medical Center of Korea, Seoul, Korea
| | - Daekyun Kim
- Department of Family Medicine, Incheon St. Mary's Hospital, Incheon, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - So Young Park
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoon Jung Chang
- Hospice and Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | | | - Ho Jung Ahn
- Division of Oncology, Department of Internal Medicine, Catholic University St. Vincent's Hospital, Seoul, Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University Hospital, Suwon, Korea
| | - Ivo Kwon
- Department of Medical Education, Ewha Womans University College of Medicine, Seoul, Korea
| | - Do-Kyong Kim
- Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea
| | - Ock-Joo Kim
- Department of the History of Medicine and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Ho Yoo
- Department of Medical Humanities and Ethics, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Seock Cheong
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Younsuck Koh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nam EJ, Lee SN, Lee R. Comparison of Life-Sustaining Treatment in Terminal Cancer Patients between a Cancer and Hospice Unit after Do-Not-Resuscitate Orders. ASIAN ONCOLOGY NURSING 2018. [DOI: 10.5388/aon.2018.18.4.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eun Jeong Nam
- Department of Hospice Palliative Service, National Cancer Center, Goyang, Korea
| | - Se-Na Lee
- Department of Nursing, National Cancer Center, Goyang, Korea
| | - Ran Lee
- Department of Nursing, National Cancer Center, Goyang, Korea
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Kim J, Kim S, Hong SW, Kang SW, An M. Validation of the Decisional Conflict Scale for Evaluating Advance Care Decision Conflict in Community-dwelling Older Adults. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11:297-303. [DOI: 10.1016/j.anr.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/11/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022] Open
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Feasibility of the Korean-Advance Directives Among Community-Dwelling Elderly Persons. Holist Nurs Pract 2017; 31:234-242. [PMID: 28609408 DOI: 10.1097/hnp.0000000000000216] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A newly developed Korean-Advance Directive (K-AD) consists of a value statement, treatment directives, and proxy appointment. It remains undetermined whether K-AD is applicable to community-dwelling persons (≥ aged 60 years). Using a descriptive study design, 275 elderly persons completed the K-AD (mean age = 77.28 ± 8.24 years). The most frequent value at the end of life was comfort dying, followed by no burden to family (23.6%). Among 4 K-AD treatment options, more than half had a preference for hospice care and had reluctance with aggressive treatment choices of cardiopulmonary resuscitation (76.4%), artificial ventilation (75.6%), and tube feeding (76.4%), with one-fifth having a desire for such options. All persons provided proxies, who were predominantly descendants (77.1%), followed by spouses (17.5%). For treatment preferences, men and those with no religion were more likely to receive life-sustaining treatments. These data support the K-AD as being applicable and acceptable among community-dwelling elderly persons; awareness of the K-AD in the community setting may facilitate future application when the need occurs.
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Lee JY, Lee YM, Jang JI. Intensive Care Nurses’ Experiences of Death of Patients with DNR Orders. ACTA ACUST UNITED AC 2017. [DOI: 10.14475/kjhpc.2017.20.2.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ji Yun Lee
- Department of Nursing, Kangwon National University, Chuncheon, Korea
| | - Yong Mi Lee
- Department of Nursing, Kangwon National University, Chuncheon, Korea
| | - Jae In Jang
- Department of Nursing, Kangwon National University, Chuncheon, Korea
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Park DW, Moon JY, Ku EY, Kim SJ, Koo YM, Kim OJ, Lee SH, Jo MW, Lim CM, Armstrong JD, Koh Y. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. J Korean Med Sci 2015; 30:495-501. [PMID: 25829820 PMCID: PMC4366973 DOI: 10.3346/jkms.2015.30.4.495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/12/2014] [Indexed: 11/20/2022] Open
Abstract
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
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Affiliation(s)
- Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University College of Medicine. Daejeon, Korea
| | - Eun Yong Ku
- Department of Nursing, College of Medicine, Konkuk University, Seoul, Korea
| | - Sun Jong Kim
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Young-Mo Koo
- Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Ock-Joo Kim
- Department of Medical History and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Haeng Lee
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Younsuck Koh
- Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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End-of-life considerations in the ICU in Japan: ethical and legal perspectives. J Intensive Care 2014; 2:9. [PMID: 25520825 PMCID: PMC4267582 DOI: 10.1186/2052-0492-2-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/21/2014] [Indexed: 11/30/2022] Open
Abstract
In Japan, the continuation of critical care at the end of life is a common practice due to the threat of legal action against physicians that may choose a palliative care approach. This is beginning to change due to public debate related to a series of controversial incidents concerning end-of-life care over the last decade. In this review we contrast and compare the history and evolution of end-of-life care in Japan vs. the USA and other Asian countries. Efforts by the Japanese Society of Intensive Care Medicine (JSICM) to establish better end-of-life care systems, as well as future directions in palliative care in Japan, are discussed.
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11
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Shin K, Mok JH, Lee SH, Kim EJ, Seok NR, Ryu SS, Ha MN, Lee K. The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kyunghwa Shin
- Department of Internal Medicine, Daedong Hospital, Busan, Korea
| | - Jeong Ha Mok
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Jung Kim
- Medical Intensive Care Unit, Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Na Ri Seok
- Medical Intensive Care Unit, Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Sun Suk Ryu
- Medical Intensive Care Unit, Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Myoung Nam Ha
- Medical Intensive Care Unit, Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Kwangha Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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12
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Park AR, So HS, Chae MC. Recognition of Patients, Families, Nurses, and Physicians about Clinical Decision-making and Biomedical Ethics. ASIAN ONCOLOGY NURSING 2014. [DOI: 10.5388/aon.2014.14.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ae Ran Park
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Hyang Sook So
- College of Nursing, Chonnam National University, Gwangju, Korea
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13
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Affiliation(s)
- Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yong Sup Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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14
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Affiliation(s)
- Dae Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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15
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Lee YS. On the life-sustaining treatment in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.12.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yoon-seong Lee
- Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea
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Moon JY, Lee HY, Lim CM, Koh Y. Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.1.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Young Lee
- National Health Insurance Corporation Research Fellow, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea
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Koh Y. Current status of end-of-life care in Korean hospitals. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.12.1171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, Korea
- Medical Humanities and Social Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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