Recognition of Advance Directives by Advanced Cancer Patients and Medical Doctors in Hospice Care Ward
Recognition of Advance Directives by Advanced Cancer Patients and Medical Doctors in Hospice Care Ward
D. Sun,Y. Chun,5 Authors,Hoon‐Kyo Kim
TLDR
Most of patients did not know about ADs and how to make it, however, they showed positive attitudes about it, and it is highly likely that a large number of cancer patients would make their living wills easily by ADs.
Abstract
Purpose: We undertook this study to find out the recognitions of termina l cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. Methods: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscit ate (DNR), medical power of attorney, living will and medical options. Results: One hundred thirty patients (97%) and 38 doctors (39.2%) were u nfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agr eed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreea ble to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not wa nt medical options to be in terminal conditions, and hoped to die in peace. Conclusion: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoin g communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths. (Korean J Hosp Palliat Care 2009;12:20-26)Key Words: Advance directives, DNR, Dying with dignity서론현대 의학의 발전과 첨단 과학기술이 접목된 의료장비의 보편적 사용으로 과거 불치의 질병으로 여겼던 급 ㆍ만성 질환이 치유 가능하게 되면서 죽음 직전에 있는 환자의 생명까지 연장시킬 수 있게 되었다 . 하지만, 그 이면에는 회생 가능성이 희박한 환자들까지도 인공호흡기와 같은 생명유지 장치에 의존하며 무의미하게 연명 받고 있다. 더욱이 말기 암 환자의 경우 항암치료의 발전으로 투병기간이 길어지면서 치료와 관련된 여러 합병증에 노출되면서 삶의 질이 급격히 저하되고, 죽음직전 까지도 힘든 치료를 받으며 결국 편안하지 못하게 삶을 맺고 있다. 생활과 의식 수준이 향상되면서 의미 없는 생명 연장에서 벗어나 환자 개인의 존엄을 우선하는 ‘삶의 질’과