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한국의료윤리학회> 한국의료윤리학회지> 의료 전문직의 자율성과 자율성 확보를 위한 실천 방안

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의료 전문직의 자율성과 자율성 확보를 위한 실천 방안

Autonomy in the Medical Profession and the Practice in Ensuring Respect for Their Professional Autonomy

김도경 ( Do Kyong Kim ) , 권복규 ( Ivo Kwon )
  • : 한국의료윤리학회
  • : 한국의료윤리학회지 16권2호
  • : 연속간행물
  • : 2013년 08월
  • : 159-173(15pages)

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초록 보기

 
Physician autonomy and medical professionalism have been changing ever since the patient-physician medical relationship was changed to patient-physician-third-party payer medical relationships. Until now, physician autonomy has meant that physicians should have complete freedom to provide the best treatments for their patients, without external constraints, but ever since medical insurance was introduced, medical decisions have been controlled by the third-party payers, and many conflicts have emerged in the patient-physician-third-party payer medical relationships. The concept of physician autonomy thus has to be changed. That is, the society should respect the rational and deliberated deci-sions of the physicians to resolve the conflicts between their patients and the third-party payers beyond the obligation of beneficence towards the patients. To mediate between their patients and the third-party payers, the physicians should carry out two roles - as healer and as manager-and should adjust the different applicable principles, such as patient autonomy, beneficence, and justice. The physicians have to be well acquainted with such principles and should make the appropriate decisions so as to gain social trust. To help resolve the conflicts between the patients and the third-party payers, the physicians should effectively carry out their roles as healer and manager by considering evidence-based practice, the treatment goal, and cost-effectiveness in their clinical practice. These criteria can help the physicians make reasonable and well-deliberated decisions in relation to their just provision of medical care for their individual patients.

ECN

ECN-0102-2014-500-002094557


UCI

I410-ECN-0102-2014-500-002094557

간행물정보

  • : 의약학분야  > 기타(의약학)
  • : KCI 등재
  • : -
  • : 계간
  • : 2005-8284
  • :
  • : 학술지
  • : 연속간행물
  • : 1998-2018
  • : 405


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발행기관 최신논문
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1의료 전문직의 자율성과 자율성 확보를 위한 실천 방안

저자 : 김도경 ( Do Kyong Kim ) , 권복규 ( Ivo Kwon )

발행기관 : 한국의료윤리학회 간행물 : 한국의료윤리학회지 16권 2호 발행 연도 : 2013 페이지 : pp. 159-173 (15 pages)

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초록보기

Physician autonomy and medical professionalism have been changing ever since the patient-physician medical relationship was changed to patient-physician-third-party payer medical relationships. Until now, physician autonomy has meant that physicians should have complete freedom to provide the best treatments for their patients, without external constraints, but ever since medical insurance was introduced, medical decisions have been controlled by the third-party payers, and many conflicts have emerged in the patient-physician-third-party payer medical relationships. The concept of physician autonomy thus has to be changed. That is, the society should respect the rational and deliberated deci-sions of the physicians to resolve the conflicts between their patients and the third-party payers beyond the obligation of beneficence towards the patients. To mediate between their patients and the third-party payers, the physicians should carry out two roles - as healer and as manager-and should adjust the different applicable principles, such as patient autonomy, beneficence, and justice. The physicians have to be well acquainted with such principles and should make the appropriate decisions so as to gain social trust. To help resolve the conflicts between the patients and the third-party payers, the physicians should effectively carry out their roles as healer and manager by considering evidence-based practice, the treatment goal, and cost-effectiveness in their clinical practice. These criteria can help the physicians make reasonable and well-deliberated decisions in relation to their just provision of medical care for their individual patients.

2현대 다원주의 사회에 적합한 자율성 모색: 역량 중심 접근법에 입각한 관계적 자율성과 다형적 모델을 중심으로

저자 : 목광수 ( Kwang Su Mok ) , 류재한 ( Jae Han Ryu )

발행기관 : 한국의료윤리학회 간행물 : 한국의료윤리학회지 16권 2호 발행 연도 : 2013 페이지 : pp. 174-193 (20 pages)

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The purpose of this paper is to search for a justifiable concept of autonomy that feasibly applies to bio-ethics and, based on this inquiry, suggest a practical model in a modern pluralist society. For this pur-pose, we classify personal autonomy into 'metaphysical autonomy' as the ideal theory guiding practical theories and both 'narrow bioethical autonomy' and 'wide bioethical autonomy' as non-ideal theories. We criticize narrow bioethical autonomy theories such as those posited by Tom Beauchamp and James Childress. Not only do they fail to flesh out metaphysical autonomy theories such as Harry Frankfurt`s, but they are not feasible because they ignore patient relationships and circumstances. We argue that Amartya Sen`s capability approach compliments the feminist concept of relational autonomy. Not only can this combination overcome the weaknesses found in narrow bioethical autonomy theories, but it allows for a practical framework to remove injustice and support autonomy. We call this combination 'relational autonomy based on the capability approach' and classify it as a theory of 'wide bioethical au-tonomy.' Based on this inquiry, we suggest a 'plural forms model' in a reasonable pluralism, which can reduce many of the autonomy-related conflicts. This model is useful in medical institution reform for explaining the plurality in both physicians` identities and cases of patients` autonomy (such as ambiva-lence) while it enhances patient autonomy through institutional and non-institutional reforms.

3한국 인문간호교육의 현황과 과제

저자 : 박명희 ( Myeung Hee Park )

발행기관 : 한국의료윤리학회 간행물 : 한국의료윤리학회지 16권 2호 발행 연도 : 2013 페이지 : pp. 194-215 (22 pages)

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This paper considers humanistic perspectives for nursing science considering the invisible aspects of human life in scientific nursing which is heavily dependent on positivism. Humanity care is car-ing based on a comprehensive understanding of the true nature of humanity. Humanity care has to be executed at the nursing education level. For this we need to examine accreditation in baccalaureate nursing programs, the educational objectives of nursing colleges, the nature of nursing, the features of nursing-science, the tendencies of modern nursing, and the views of nursing scholars. The common key-concepts of such categories can be summarized as follows: nursing professionalism, holistic care, and life. For this, I have grasped the current situation of the curriculum related to liberal arts taught at 60 nursing colleges, and nursing departments, nationwide, in view of these categories. The result is that subjects such as personality and self-development, life, writing, nursing philosophy, creativity explora-tion, culture and nursing, and art and nursing, are insufficient. So, this dissertation suggests that there is need to open these subjects sufficiently. Nursing-education has to be based on a curriculum enabling students to consider holistic care and life from the view of nursing-professionalism. The assignments for holistic care, an independent arena of nursing, include shedding new light on the nature of nursing and having educational introspection into reestablishing the status and identity of nursing-science.

4요양병원 간호사의 도덕적 민감성, 노인에 대한 태도 및 노인간호실천

저자 : 장혜영 ( Hye Young Chang ) , 송주은 ( Ju Eun Song ) , 김용순 ( Yong Soon Kim ) , 유미애 ( Mi Ae You )

발행기관 : 한국의료윤리학회 간행물 : 한국의료윤리학회지 16권 2호 발행 연도 : 2013 페이지 : pp. 216-230 (15 pages)

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This study was a descriptive correlational study to examine the relationships among moral sensitivity, attitude, and nursing practices for older people among nurses in long term care hospitals. Data collec-tion was performed from June 30 to September 15, 2012 using a self-administered questionnaire from 208 nurses. The instruments used for this study were the moral sensitivity questionnaire, the scale for attitudes toward age groups, and the nursing practices tool. The collected data were analyzed using IBM SPSS Statistics Win 19.0 program. The mean score of the moral sensitivity was 5.10 out of 7 point scale and the mean score of the attitude toward older people was 3.05 out of 5 point scale. On a 4 point scale, the mean score of the nursing practices was 3.78. There was a significant positive correlation between moral sensitivity and nursing practices. These results showed that the moral sensitivity was the impor-tant factor of nursing practices among nurses in long term care hospitals. Therefore, it is necessary to develop on-the-job training programs focused on improvement of moral sensitivity and positive atti-tudes toward older people in order to high quality of nursing care in long term care hospitals.

5인지향상에 관한 윤리적 논쟁

저자 : 이상목 ( Sang Mok Lee ) , 최종현 ( Jong Hyun Choi )

발행기관 : 한국의료윤리학회 간행물 : 한국의료윤리학회지 16권 2호 발행 연도 : 2013 페이지 : pp. 231-248 (18 pages)

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Since the last part of the 20th century, some healthy people have widely used central nervous system stimulants as cognitive enhancers and this phenomenon has become not only a social issue but also an important academic issue. When some scholars, especially neuroethicsts seek to legalize the cognitive enhancers used by healthy adults, there has been a huge debate over legalizing cognitive enhancement. Critics on cognitive enhancement point out five ethical problems if cognitive enhancement would be allowed by the pharmaceutical authority and widely spread in a western society. First, cognitive en-hancement has a safety problem and could cause various side effects, addiction, and cognitive tradeoff. Second, cognitive enhancement is morally undesirable because it is unnatural. Third, cognitive enhance-ment before the exam might be cheating. Forth, cognitive enhancement would cause social inequality and thus widen cognitive gap between riches and poors. Fifth, if cognitive enhancement would be al-lowed and widely spread among our society, many people might face pressure to take cognitive enhanc-ers for winning the competition or doing their work well. However, proponents on cognitive enhance-ment argue that these ethical concerns are exaggerated or will be resolved near in the future. They also argue that together with discussing cognitive enhancement, the evidence-based research on cognitive enhancement should take place and this would clearly reveal the risk and benefit of cognitive enhancers.

6자유의지와 신경결정론

저자 : 최경석 ( Kyung Suk Choi )

발행기관 : 한국의료윤리학회 간행물 : 한국의료윤리학회지 16권 2호 발행 연도 : 2013 페이지 : pp. 249-260 (12 pages)

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The development of neuroscience and brain science makes people express the way of thinking based on brain centrism or neural centrism. Brain centrism or neural centrism may wrongly lead us to think that a brain is identified with a self in itself. Neural determinism is a strongest and most extended ver-sion of physicalism than a physicalist`s account that allows causation in neural activities and provides physical accounts for our behaviors. I argue against neural determinism and for the physicalism that al-lows free will and also makes neuroscience research possible. With the denial of the dichotomy between mind and body, I argue that free will can be understood to be a neural activities for decision making involving cognitive activities and the ability of volition. We cannot know what mental contents will oc-cur when we observe particular areas of brain activated. In addition, even if the same areas are activated across individuals, different mental contents will be made depending on an individual`s belief system as well as his/her past experience and memory. Therefore, there may be neural activities that physicalism applies and are explained by causation. But this does not imply that neural determinism is true. The possibility of causal explanation does not imply the denial of free will. Cognitive activities involving free will may be ones to recognize perceptive responses, to evaluate them, to form beliefs, to compare and evaluate beliefs and values, and to judge them. Thus, the outcomes of these activities are hard to pre-dict. In this respect, they are not deterministic.

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