A nurse, a secret, and two hospital plays

The notes open on ethics controversies they say had lately drawn notice: a demand at Severance Hospital, by a patient they call Kim, to stop life-sustaining treatment, and a debate over a dual-penalty rule on medical rebates. Ethics, they write, is the duty a person ought to keep; a dilemma is the bind when both sides have a point. Medical ethics is hard for the public to follow, they add, because the information sits with clinicians and the content is technical, yet it runs from a well-meant lie to a patient, to the question of who should receive a scarce organ such as a liver or a kidney, to abortion, embryo cloning, and euthanasia.

Nurses, they write, are told more and more firmly to protect a patient’s personal information, and still fall into a dilemma about whether secrecy is always right. Two plays make the bind concrete. In Uncomfortable Truth, at Inha University Hospital, a mother brings her daughter to the emergency room with abdominal pain and startles when the staff propose a pregnancy test. The result is an ectopic pregnancy that needs emergency surgery, but the daughter asks the nurse to keep it from her mother and wants to go home. Secrecy and the duty to protect life, the notes write, collide. In You Are a Bad Person, at Chung-Ang University Hospital, a man who cannot father a child because of azoospermia asks that his wife not be told; the wife tells the nurse she has a right to the result. In both plays the nurse persuades the patient to let the family know; in a real ward, the notes say, the bind is sharper.

A ten-year-old, and a refused transfusion

A ten-year-old is transferred to a university emergency room after a traffic accident, with a ruptured spleen and a suspected need for a large transfusion. Blood pressure is falling, and surgery is urgent. The parents, who have themselves escaped serious injury, say that even if there is an operation, a transfusion must not be given. The whole family, the notes write, are fervent followers of a particular religion, and a transfusion would go against its teaching.

Even parents, the notes say, do not have the right to dispose of a child’s life. The practical question is whether a doctor can impose a transfusion against that refusal. Unlike in the West, they write, Korean feeling still gives the family’s view more weight than the individual’s, so it is hard for a doctor to proceed on clinical judgment alone while the parents withhold permission. If there are domestic or foreign rulings, they add, those legal grounds may be the only way to persuade the parents. They leave the religion unnamed, and they do not record a specific court case.

Life-sustaining care, two doctors, and four principles

To stop life-sustaining treatment, the notes write, there should first be an expression of the patient’s will. If the patient is conscious, the patient can decide; if not, an advance medical directive — a written statement made while the person was healthy or clear-headed, saying which treatments to accept and when to stop care that only prolongs dying — can make that will known, so that clinicians and family can follow it. After the will is confirmed, two doctors must also confirm it, and only in a medically clear dying stage, as judged by the attending doctor and specialists. The directive can later be withdrawn or changed. If the patient cannot speak, two or more family members may submit a statement that the patient did not want life-sustaining care, and two doctors confirm it; if another family member disagrees, the stop does not go through.

Stopping that care, they write, does not mean stopping all treatment: water, nutrition, simple oxygen, and pain relief continue; a ventilator, dialysis, or cancer drugs may stop. Once the conditions are confirmed, the doctor should carry them out at once; if that doctor refuses, the hospital director, after an ethics-committee review, replaces the attending doctor. The notes hope a well-dying law will protect dignity. They also set out four principles often cited in medical ethics: respect for autonomy, beneficence, non-maleficence — including not running excessive tests or taking rebates for profit — and justice in the use of limited resources. Those conditions and that hope stay as the notes record them, not as a later official code. The same Korean report, at fuller length, is on CampusDown.

Sources

1. The notes’ three bedside cases: confidentiality, a refused transfusion, and the conditions they record for stopping life-sustaining care

Last updated: 14 November 2026