복지관 이용 노인의 사전의사결정에 대한 태도

이혜림; 박연환

서지반출

국문초록

2009년 선종한 김수환 추기경이 무의미한 연명치료를 거 부한 사례와 2010년 1월 10일 뇌 손상으로 인공호흡기를 통 해 연명하다 제거한 뒤 사망한 이른바 세브란스 병원의 ‘김 할 머니 사건’은 현 의료계에 ‘존엄사’에 대한 논의를 불러왔다. 의료기술의 발달로 인간 생명을 연장하는 기술은 나날이 발전 하고 있으며 이에 따라 의료비는 해마다 증가하여 2012년 전 체 진료비 중 65세 이상 고령자가 차지하는 비중은 34.3%로 나타났다(Park, 2013). 이는 2005년 의료비의 두 배를 넘는 것이며, 2009년에 비해 14.5%로 증가한 규모로 앞으로도 급 속도로 증가할 전망이다. 또한 연명치료 기술 발달과 더불어 임종 직전 한 달 동안 쓰이는 의료비가 전 생의 의료비 지출의 절반 정도를 차지하는 것은 남아있는 가족에게 큰 짐이 될 수 밖에 없다(Gwon, 2009). 이처럼 무의미한 연명치료이며, 이 를 유지하기 위해 막대한 의료비를 지출하는 것이 과연 인간으로서의 존엄성을 지킬 수 있는 것인가에 대한 논란의 목소 리도 높아지고 있다. 이들의 주장은 오래 사는 것에 가치를 두 는 것이 아니라, 삶을 인간답게 마감하는 ‘잘 죽는 것(good death)’에 그 초점이 맞춰지고 있다. ‘잘 죽는 것’은 주로 ‘존 엄사(품위 있는 죽음; dying with dignity)’나 ‘자연사(natural death)’로 개념화되고 있다(Kim, 2010). 존엄사가 이슈화 되면서 존엄사를 입법화하기 위한 움직임 이 일고 있다. 동시에 인간으로서 지녀야 할 최소한의 품위와 가치를 지키면서 죽을 수 있게 하는 행위인 존엄사를 이루기 위한 방법이 구체화 되어가고 있다. 2009년 존엄사 법안 발의 를 시작으로 사회적 협의체, 국가생명윤리위원회 등의 논의 기구를 통해 보건복지부가 2013년 11월 28일 연명의료결정 법 초안을 발표하였으며, 2014년 3월 ‘삶의 마지막 단계에서 자연스러운 죽음을 맞을 권리 관련 법률’이 발의된 상태이다 (Min, 2014).

영문초록

Purpose: The aims of this study were to identify attitudes toward advance directives (ADs) of community dwelling older adults and factors related to ADs. Methods: Participants were 180 older Korean adults (mean age=74.2 years, 70.6% women) from two senior centers in a metropolitan city in South Korea. Data were collected through face to face interviews during September, 2011. The Advanced Directives Attitude Survey (ADAS) and questionnaires including socio-demographic and health related characteristics were used. Data were analyzed using t-test, one-way ANOVA, and Scheffe? test. Results: The mean score for ADAS was 45.12, which showed elders' positive attitudes toward ADs. Of the elders, 61.1% agreed to prepare ADs. The socio-demographic characteristics of age, level of education, and monthly income were significantly related to the elders' attitudes toward ADs. In addition, medical service use, medical expenses, experiences of significant others' admission in intensive care units and death were significantly related factors to the elders' attitudes toward ADs. Conclusion: Findings from this study suggest that thoughtful approaches with respect for values and attitudes of older adults need to be considered in adapting ADs to Korean health care systems.

키워드

Advance directives Attitudes Aged

참고문헌 (29건)

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