Korean Medical Education Review (의학교육논단)

Yonsei university college of medicine (연세대학교 의과대학)
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A Preliminary Study to Improve Death Education for the Public and Medical Students after the Enforcement of the Life-Sustaining Treatment Decision Act

연명의료결정법 시행 이후 일반인과 의대생 대상 죽음교육 개선을 위한 예비연구

  • Kim, Claire Junga (Department of Medical Humanities, Dong-A University College of Medicine) ;
  • Ahn, Kyongjin (School of Liberal Arts, Seoul National University of Science and Technology)
  • 김정아 (동아대학교 의과대학 의료인문학교실) ;
  • 안경진 (서울과학기술대학교 기초교육학부)
  • Received : 2021.12.14
  • Accepted : 2022.03.29
  • Published : 2022.06.30
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Abstract

Considering the recent medicalization of death, the importance of preparing both laypersons and medical students to have meaningful end-of-life conversations, which is among the objectives of death education, will grow. The Act of Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life provided a new source of momentum to death education for both laypersons and medical professionals, as the importance of education on death is widely recognized. However, problems remain regarding how to prepare people for productive conversations at the end-of-life and how to secure the continuity of care. Different focuses and deficiencies are observed in death education programs for each category of learner. In education for laypeople, tangible information on how to actualize one's existential and personal understanding of death through real-life options is lacking, except for presenting the "protocol" of the Act. Conversely, basic medical education lacks an understanding of or confrontation with death on the existential and personal levels. Death education should aim to build a shared understanding that can facilitate communication between the two groups. The scant overlap between layperson education and basic medical education even after the Act's enactment is worrisome. Further fundamental changes in death education are required regarding its content. Topics that patients and doctors can share and discuss regarding death and end-of-life care should be discovered and provided as educational content both to laypeople and future medical professionals.

Keywords

Acknowledgement

이 논문은 동아대학교 교내 연구비 지원에 의하여 연구되었다.

References

  1. Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for patients at the End of Life, Act No. 14013 (Feb 3, 2016) [Internet]. Sejong: Korean Law Information Center; [date unknown] [cited 2021 Nov 21]. Available from: https://www.law.go.kr/engLsSc.do?menuId=1&subMenuId=21&tabMenuId=117#.
  2. Murder (Approved Crime Name: Aiding Murder) and Murder, Supreme Court Sentence No. 2002Do995 (Jun 24, 2004) [Internet]. Sejong: Korean Law Information Center; 2004 [cited 2021 Nov 21]. Available from: https://www.law.go.kr/%ED%8C%90%EB%A1%80/(2002%EB%8F%84995).
  3. Removal of Meaningless Life-Sustaining Treatment Devices, Etc., Supreme Court Sentence No. 2009Da17417 (May 21, 2009) [Internet]. Sejong: Korean Law Information Center; 2009 [cited 2021 Nov 21]. Available from: https://www.law.go.kr/%ED%8C%90%EB%A1%80/(2009%EB%8B%A417417).
  4. Confirmation of Legislative Nonfeasance Unconstitutionality, Constitutional Court of Korea 2008Hunma385 (Nov 26, 2009) [Internet]. Seoul: Constitutional Court of Korea; 2009 [cited 2021 Nov 21]. Available from: http://search.ccourt.go.kr/ths/pr/ths_pr0101_P1.do.
  5. National Evidence-based Healthcare Collaboration Agency. Providing a social consensus to withdraw futile life-sustaining treatment. Seoul: National Evidence-based Healthcare Collaboration Agency; 2009.
  6. Ahn KJ, Kong BH, Song YJ. A study on the life-sustaining treatment decision-making and end-of-life care experiences of intensive care nurses after the enforcement of the Life-Sustaining Treatment Decision-Making Act. J Korean Bioeth Assoc. 2020;21(2):31-53. https://doi.org/10.37305/JKBA.2020.12.21.2.31
  7. Oh MH. Lower statues of Life-Sustaining Treatment Decision Act, incites unnecessary life-sustaining treatment. KHA News [Internet]. 2017 Apr 26 [cited 2021 Nov 21]. Available from: https://www.khanews.com/news/articleView.html?idxno=128897.
  8. Hwang H, Kim CJ. Nurse roles in the advance directive system in Korea. Int Nurs Rev. 2021 Jun 11 [Epub]. https://doi.org/10.1111/inr.12683.
  9. Ministry of Health and Welfare; National Agency for Management of Life-Sustaining Treatment. 2020 Annual report on decision making system on life-sustaining treatment. Sejong: Ministry of Health and Welfare; 2020.
  10. Hetzler PT 3rd, Dugdale LS. How do medicalization and rescue fantasy prevent healthy dying? AMA J Ethics. 2018;20(8):E766-73. https://doi.org/10.1001/amajethics.2018.766
  11. Park JC. A critical examination of the attitude of modern medicine toward death: in the perspective of existentialist psychology. Philos Med. 2017;24:39-76.
  12. Gawande A. Being mortal: medicine and what matters in the end. New York (NY): Metropolitan Books, Holt and Company; 2014.
  13. Kim EY. Over the past 10 years, decrease in the number of deaths at home of the elderly and increase in the death in medical institutions. Cheongnyeonuisa [Internet]. 2021 Aug 13 [citied 2021 Nov 21]. Available from: https://www.docdocdoc.co.kr/news/articleView.html?idxno=2013520.
  14. Kim KJ, Kim DY, Shin SJ, Heo DS, Nam EM. Do Korean medical schools provide adequate end-of-life care education?: a nationwide survey of the Republic of Korea's end-of-life care curricula. J Hosp Palliat Care. 2019;22(4):207-18. https://doi.org/10.14475/kjhpc.2019.22.4.207
  15. Meekin SA, Klein JE, Fleischman AR, Fins JJ. Development of a palliative education assessment tool for medical student education. Acad Med. 2000;75(10):986-92. https://doi.org/10.1097/00001888-200010000-00011
  16. Warren WG. Death education and research: critical perspectives. Binghamton (NY): The Haworth Press; 1989.
  17. Deeken A. Death education as the liberal arts. Jun SK, translator. Goyang: Humanlove; 2008.
  18. Corr CA, Nabe CM, Corr DM. Death and dying, life and living. 3rd ed. Belmont (CA): Wadsworth Publishing; 2000.
  19. Park JE. The effects of death education on the emotion, cognition and behavior of the elderly. J Soc Work Pract. 2009;8:79-109.
  20. Kubler-Ross E. On death and dying: what the dying have to teach doctors, nurses, clergy and their own families. New York (NY): Scribner; 1969.
  21. Lee LJ. A study on the current state of death education and urgent problem. Korean J Educ Gerontol. 2016;2(1):69-88.
  22. Chang KE. Effects of death education on college students' death orientation and suicidal ideation: with a focus on college students majoring in social welfare in Daegu, Korea. Korean J Hum Ecol. 2012;21(3):423-37. https://doi.org/10.5934/KJHE.2012.21.3.423
  23. Lee YJ, Jo KH, Lee HJ, An exploration of death education model for high-touch major students. Asian J Educ. 2006;7(3):121-40.
  24. Dickinson GE. Thirty-five years of end-of-life issues in US medical schools. Am J Hosp Palliat Care. 2011;28(6):412-7. https://doi.org/10.1177/1049909110397608
  25. Dickinson GE. A 40-year history of end-of-life offerings in US medical schools: 1975-2015. Am J Hosp Palliat Care. 2017;34(6):559-65. https://doi.org/10.1177/1049909116638071
  26. Dyer KA. The physician's role in end-of-life care. ADEC Forum. 2010;36(2):6.
  27. Institute of Medicine, Division of Health Care Services, Committee on Care at the End of Life, Field MJ, Cassel CK. Approaching death: improving care at the end of life. Washington (DC): National Academy Press; 1997.
  28. Wass H. Death education. In: Kastenbaum R, editor. Macmillan encyclopedia of death and dying. New York (NY): Macmillan Reference; 2002. p. 211-8.
  29. Feifel H. Introduction. In: Feifel H, editor. The meaning of death. New York (NY): McGraw-Hill; 1959. p. 11-6.
  30. World Health Organization. Palliative care [Internet]. Geneva: World Health Organization; 2021 [cited 2021 Nov 21]. Available from: https://www.who.int/health-topics/palliative-care.
  31. Korea Association of Medical Colleges. Learning outcomes of basic medical education: clinical competency-centered. 2nd ed. Seoul: Korea Association of Medical Colleges; 2016.
  32. Kim SH, Byun SW. Analysis of the trends of research education on death. J Digit Converg. 2014;12(12):469-75. https://doi.org/10.14400/JDC.2014.12.12.469
  33. Kim YA, Kwon YS. An analysis of research trend on death education in Korea. Keimyung J Nurs Sci. 2009;13(1):51-62.
  34. Yang KS. A study on the program development of death education: centering on institute of continuing education [dissertation]. Seoul: Yonsei University; 2008.
  35. Lee YS, Jang HY. Trend analysis of death preparation education from the perspective of lifelong education. J Educ Cult. 2020;26(2):435-55. https://doi.org/10.24159/JOEC.2020.26.2.435
  36. Lim HN, Kim KH. A study on how elderly people are preparing for dying well. J Korea Acad Ind Coop Soc. 2019;20(9):432-9.
  37. Kim SN, Choi SO, Lee JJ, Shin KI. Effects of death education program on attitude to death and meaning in life among university students. J Korean Soc Health Educ Promot. 2005;22(2):141-53.
  38. Kang KA. Development and effects of death preparation education for middle-aged adults. J Hosp Palliat Care. 2011;14(4):204-11. https://doi.org/10.14475/kjhpc.2011.14.4.204
  39. Jung EJ. Analysis of welldying program effectiveness. Asia-Pacific J Bus Ventur Entrep. 2012;7(2):189-94. https://doi.org/10.16972/apjbve.7.2.201207.189
  40. Kang WN, Lyu JY. Effect of death education for the elderly in the senior welfare center in Seoul. Hallym J Aging Stud. 2019;7(1):25-43.
  41. Ahn K, Park KS. Perceptions and experiences of the death of the elderly: suffering of death and meaning of life. Hum Beings Environ Their Future. 2021;(26):63-97. https://doi.org/10.34162/HEFINS.2021..26.003
  42. Suh YJ, Kim CW. A qualitative study on counseling experiences of counselors for advance directives. Korean J Care Manag. 2021;(41):119-46.
  43. National Coalition for Hospice and Palliative Care. Clinical practice guidelines for quality palliative care. 4th ed. Richmond (VA): National Coalition for Hospice and Palliative Care; 2018.
  44. Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med. 2008;36(3):953-63. https://doi.org/10.1097/CCM.0B013E3181659096
  45. Koh CK, Ko CM, Park H. Critical care nurses' perception of life-sustaining treatment at end of life: a content analysis. J Korean Crit Care Nurs. 2017;10(1):41-50.
  46. Lee E, Ji HJ, Cho JS. Roles of nurses in decision-making to withhold or withdraw life-sustaining treatment for patients according to the Life-Sustaining Treatment Decision-Making Act. Bio Ethics Policy. 2021;5(1):97-114.
  47. National Health Insurance Service. National Health Insurance Service runs a death-education program. NewsWire [Internet]. 2015 Aug 4 [cited 2021 Nov 30]. Available from: https://www.newswire.co.kr/newsRead.php?no=799587.
  48. Ministry of Health and Welfare. A study on the reorganization of the medical school curriculum to expand the awareness of the life-sustaining treatment decision system. Sejong: Ministry of Health and Welfare; 2021.
  49. Kim DY, Lee SN. Hospice and palliative care education for medical students in Korea. Korean Med Educ Rev. 2020;22(3):146-52. https://doi.org/10.17496/KMER.2020.22.3.146
  50. Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, et al. Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet. 2022;399(10327):837-84. https://doi.org/10.1016/S0140-6736(21)02314-X