Jaehan Ryu

Clinical Ethics Support Services (CESS) improve health-care quality by systematically identifying and resolving ethical issues. CESS providers should be trained to understand patients’ difficulties with existential issues and advocate on their behalf. This study evaluates the effectiveness of educational programs to enhance the competencies to solve ethical issues in clinical practice for CESS providers related to life-sustaining-treatment, based on Jonsen et al.’s “the four topics approach.” This is an explanatory sequential mixed-method study conducted in quantitative and qualitative phases. Participants included 52 life-sustaining medical workers at general hospitals. The participants were categorized into 24 experimental and 28 control groups, including nurses, social workers, and legal administrations. The program encompassed bioethics, end-of-life care, critical thinking, decision-making training through clinical ethics cases, role-playing, communication skills, and discussions. In the quantitative phase, a quasi-experimental study design with pre-test, intervention, and post-test was used. The program for experimental group was provided through 8 sessions spread across 4 weeks. The participants’ experiences were explored through semi-structured interviews in the qualitative phase. After the education, the experimental and control groups differed significantly in critical thinking disposition, and hospice and palliative care knowledge. Participants acknowledged that critical thinking education improved their ability to analyze and evaluate clinical ethical dilemmas. The case-based, role-playing intervention effectively enhanced participants’ communication and critical thinking skills concerning life-sustaining treatments. Participants highlighted the importance of ongoing education and professional development to maintain core knowledge and skills, aiming to enhance the quality of care for patients, families, and colleagues. This study was retrospectively registered as a code (No: KCT0009687) in the Korean Clinical Trial Service on August 9, 2024.URL: https://cris.nih.go.kr/cris/search/detailSearch.do?seq=27805&status=5&seq_group=27805&search_page=M .

This scoping review examines the “System for Decisions to Forgo Life-Sustaining Treatment” in Korea from 2018 to 2022 and is based on an analysis of 285 research studies, published in either domestic or international journals. Of the articles examined, 164 (57.5%) focused on issues related to health science, while 121 (42.5%) addressed ethical and legal aspects of the system. Articles in the former category of health science focused on advance care plans, contemplation on death, decision-making, end-of-life care, biomedical ethics, and psychosocial factors. Articles in the latter category of the ethical and legal aspects of the system focused on legal challenges, the right to self-determination, death with dignity, surrogate decision-making, contemplation of death, biomedical ethics, and legal frameworks. To ensure the system’s stable integration into society during this transitional period, it is crucial to continuously assess its operation in clinical settings. Efforts to establish a societal consensus on dignified end-of-life experiences and to conduct future multidisciplinary research should persist.