No abstract available.
Delivery of Health Care ; Health Care Reform ; Health Policy* ; Human ; Korea

With development of new techniques for medical intervention, there has been a big dilemma for physicians about their decision when to stop treatment. Application of life-sustaining device sometimes results in a prolongation of painful period (dying process) for patients. Regarding the role of physician in the end-of-life decision, there could be two extremes : euthanasia vs. therapeutic tenacity (futility or accanimento terapeutico). Either extreme has its own limitations. One of possible solutions is an appropriate application of withholding and withdrawing interventions. However, several considerations are necessary for this. First, the clinical aspect of decision is whether a certain management is proportionate or non-proportionate for a given situation. If there is a chemotherapy regimen that has an efficacy of 15% partial response rate with side effects in the previous study, is it propotionate or non-proportionate treatment for advanced cancer patients? Other aspects of decision is regarding ethical, economical, and legal issues. One type of circumstances that may prompt claims of futility is the discrepancy between the values or goals of involved parties. Other concerns on futility issues are ① is it easy to break the bad news to dying patients in Korean culture? (communication problems at various levels) ② is social welfare system adequate enough not to interfere with a fair decision? Values on the issues like therapeutic decision and withholding life-sustaining treatments in terminally ill cancer patients are discordant between physicians and family members. To resolve controversies on the role of physicians as well as those of patients and their family members should be considered in the final decision.
Drug Therapy ; Euthanasia ; Humans ; Medical Futility ; Social Welfare ; Terminally Ill

No abstract available.
Delivery of Health Care ; Health Care Reform ; Health Policy* ; Human ; Korea

No abstract available.
Palliative Care

No abstract available.
Palliative Care

National Evidence-based Healthcare Collaborating Agency (NECA) is established in Dec, 2008 to implement evidence-based healthcare system in Korea. Transition from management-based to evidence-based system is expected. Evidence will be evaluated in terms of efficacy and toxicity as well as social values. It can be considered as an 'essential' health technology in case of good evidence and high social values, but it will be 'optional' with low social values in spite of good evidence. Conditional coverage with evidence development program will help to accept new technology in case of insufficient evidence despite high social values.
Biomedical Technology ; Delivery of Health Care ; Korea ; Social Values

No abstract available.
Decision Making ; Euthanasia, Passive/legislation & jurisprudence/*psychology ; Humans ; Life Support Care/legislation & jurisprudence/*psychology ; Neoplasms/psychology ; Republic of Korea ; Terminally Ill/legislation & jurisprudence/psychology

According to Organization of Economic Co-operation and Development health statistics data, out-of-pocket expenditures account for 36.8% of current health expenditures in Korea, in contrast to the Organization of Economic Co-operation and Development average of 20.3%. The government has announced the implementation of a new healthcare policy to reduce out-of-pocket expenditures. Korea already has a universal coverage system for most essential health care services. Even though health services based on out-of-pocket expenditures are usually optional, and are supported by lower levels of evidence, the National Health Insurance program has promised to cover all medical services except for cosmetic plastic surgery. This will drive more demand for optional health services and drain healthcare resources. Korea needs improvement of its quality care system instead of high-cost optional services, because of the rapid transition to an aging society.
Aging ; Delivery of Health Care ; Fantasy ; Health Expenditures ; Health Services ; Insurance Coverage ; Korea ; National Health Programs ; Surgery, Plastic ; Universal Coverage

Although Korea was the first country to provide hospice services in Asia, in 1965, a hospice-palliative care system has not yet been firmly established. Because of controversies surrounding end-of-life decision-making, the passage of the Hospice-Palliative Care and End-of-Life Decision Act was delayed in the National Assembly. It will finally be implemented in August 2017. For this new legislation to be successful, regulatory support from the government is essential, because there are many pitfalls in the law. In addition, a cultural movement towards ‘death with dignity’ is necessary, and the National Health Insurance system should support the cost of providing adequate care to terminal patients.
Asia ; Hospices ; Humans ; Jurisprudence ; Korea ; National Health Programs

No abstract available.
Genes, Neoplasm*