The Problem between Clinical Ethics and Medical Therapy

Background: The problem of clinical ethics is not a special case. In daily clinical practice, with considering and analyzing various problems among patients, their families, and surround medical stuffs, to search for the best solution with respect is an important attitude. In recent 2 years we have experienced 9 times for 6 cases of discussion at clinical ethics committee (CEC) (42 to 85 year-old) in our hospital. We have reported with scientific investigation. Four cases were discussed about extubation on the assumption without performing intubation in case of worsening respiratory failure. In the remaining 2 cases, the discussion point was about removal their percutaneous cardiopulmonary (PCPS) support without introducing PCPS again in case of assuming hemodynamic breakdown. The members of the CEC were our hospital executives consisting of each section chief appointed by the director of our hospital. After introducing patient's medical history from the attending physician, discussion was done on whether substition for advanced invasive medical therapy was possible or not, because continuing current treatment may give a great distress to the patients and violation of fundamental human rights. Based on the practical approach to ethical decisions in clinical medicine, 1. medical indication, 2. Patient preferences, 3. patient's QOL and 4. contextual features surrounding patient had been figure out. In our cases after precise discussion, we have withhold treatment.