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간호사의 간호 제공 의무와 말기 환자의 간호 거부에 관련된 윤리 문제에 관한 연구
Refusal of care by chronically and terminally ill patients : An ethical problem faced by nurses

엄영란    (서울보건전문대학   ); 홍여신    (서울대학교 간호대학  );
  • 초록

    Respect for human life and respect for human dignity are two basic values to which organized nursing has urged its members to adhere in their service to mankind. Thus it is the nurses' duty to provide health care in support of sustenance of life and to pay respect for the patient's right to dignity. In practice, however, nurses may experience dilemmas between these duties much due to the de velopment of modern advanced techniques. These dilemmas have become more complex and difficult to resolve. Nurses are often faced with situations in which the terminally ill refuse professional care, posing serious conflicts between respect for human life and respect for human rights to self-determination. In such cases, resolution of the problem is not a simple matter, thus requires intensive study into the ethical questions related to the situation. The purpose of this study was to identify ethical problems that nurses experience in caring for terminally ill patients and explore the ways to the resolution of problems within the context of the situations. The methodology used for the study was a case study method which 'New Casuistry' proposed by Jonsen & Toulmin(1988) and the 'Specified Principlism' proposed by Degrazia(1992) as an alternative to old deductive and intuitive method. Cases were developed through semistructured indepth interviews according to the casutistry method. A total of seven nurses were interviewd who were caring for therminally ill patients. Four cases out of a total 14 cases were related to the topic. Through the case analysis it became evident that nurses appreciated other values more often than respect for the patient's right to self-determination. These other values were convenience and efficiency in nursing practice in case 1, preservation of life above all other values in case 2, provision of nursing care to fulfill the nurse's professional obligation at most in case 3, and respect for the family's demand against the patient's wish in case 4. This study showed that the most important ethical problems were conflict between respect for the patient's right to self-determination and sustenance of life for the fulfillment of professional obligation. For this problem, benefit /burden analysis from the perspective of the patient and family for the promotion of patient's wellbeing may be a way to resolve the conflict. Further, through these analysis it was shown that physicians' and families' opinions dominated in the decision - making and the opinions of nurses' and patients' tended not to be reflected. Thus the patient's right to his or her care was not readily respected. To solve this problem. nurses should make efforts to communicate reciprocally with their patients, family members and physicians in an effort to respect for their patient's rights to life and diginity from the point of view and values of the patient. It is also important that nurses provide good basic nursing care up to the time of death regardless of decisions about providing or not aggressive treat-ment for chronically and terminally ill patients.


  • 주제어

    간호 거부 .   간호 제공 의무 .   윤리 문제.  

 저자의 다른 논문

  • 엄영란 (16)

    1. 1992 "간호학생의 생명에 대한 태도 유형 분석 : Q-방법론적 접근" 대한간호학회지= Journal of Korean academy of nursing 22 (3): 389~406    
    2. 1994 "한국적 간호윤리 정립을 위한 전통적 가치관의 고찰" 대한간호 = The Korean nurse 33 (4): 15~27    
    3. 1996 "인공임신중절과 관련된 윤리학적 논쟁과 문제 분석" 여성건강간호학회지 = Korean journal of women health nursing 2 (2): 230~252    
    4. 1997 "저강도 운동프로그램이 입원노인의 일상활동 기능회복에 미치는 영향" 대한간호학회지= Journal of Korean academy of nursing 27 (4): 807~819    
    5. 1997 "노인의 일상활동수행에 대한 자기효능척도의 신뢰도 및 타당도 평가" 대한간호학회지= Journal of Korean academy of nursing 27 (4): 831~842    
    6. 1997 "새로운 간호윤리학 방법론;통합된 사례방법론" 간호행정학회지 = Journal of Korean academy of nursing administration 3 (1): 51~64    
    7. 1998 "한국의 장기이식과 관련된 윤리적 고려사항의 분석" 대한간호학회지= Journal of Korean academy of nursing 28 (1): 26~36    
    8. 1998 "임신중 피로에 관한 조사연구" 여성건강간호학회지 = Korean journal of women health nursing 4 (3): 429~440    
    9. 1998 "실무수행능력 중심의 교육모형 및 측정도구 개발" 한국간호교육학회지 = The Journal of Korean Academic Society of Nursing Education 4 (2): 220~235    
    10. 1998 "장기공여를 위한 사전동의의 생의윤리학적 고찰" 간호행정학회지 = Journal of Korean academy of nursing administration 4 (2): 475~487    
  • 홍여신 (13)

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