Korean J Med Ethics.  2012 Aug;15(2):160-183.

Ethical Issues in End-of-Life Decision Making:A New Model for Medical Decisions

• LEE EY

Abstract

Although informed consent was introduced as a method for respecting patient autonomy in the medical decision-making process, it fails to involve various contextual aspects of medical decisions. Informed consent presupposes personal rationality and only accepts choices made by the individual patient. Thus,if the family of an incompetent patient makes decisions on the patient’s behalf, those choices are not seen as autonomous. Accordingly, a new perspective is needed, one which strengthens patient autonomy and reflects the fact that, in countries such as Korea, a patient’s family members are properly regarded as proxy decision makers with the right to become involved in discussions and decisions concerning the patient’s medical treatment. Traditional shared decision-making is a collaborative process involving the patient and doctor. It excludes, not only the patient's family, but also ethical consultants that can act as mediators to help resolve any conflicts. This article critically analyzes the traditional shared decisionmaking process and then proposes a new shared decision-making model.

Keyword

patient autonomy; end-of-life decisions; informed consent; shared decision-making; physician-patient relations