사전지시(Advance Directives) 제도의 윤리적․사회적 함의

Living will or durable power of attorney are called by "advance directives." Living will has serious problems in the interpretation and abstractness of its content. Durable power of attorney cannot fully guarantee the reflection of a patient's will. Thus, the introduction of advance directives into the Korean society is a societal decision that our society will accept them and respect a patient's will in them despite the above problems. Advance directives invokes a fundamental philosophical and ethical question of an identity problem. Buchanan argues that a living will need not be respected in the case of an identity change such as that of a dementia patient because an identity is a psychological continuity. But this is not the only plausible view. Davis introduces the notions of "earlier preference," "latest preference," and "highest-order preference" and argues that earlier autonomy also should be respected. I argue that advance directives should be introduced after the following consideration is reviewed. First, we have to take into account an aspect of Korean culture that family members have played a key role in medical decision-making. Second, a regulation on a right to refuse a treatment should be built up. We have to decide if a feeding tube is a medical treatment that can be withdrawn. Third, there must be better accessibility to health care service than now. We can prevent the abuse and misuse of advance directives when we can respect right to receive treatments as much as right to refuse treatments