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Original Article Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
Jae Young Moon, Hee Young Lee, Chae Man Lim, Younsuck Koh

1Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2National Health Insurance Corporation Research Fellow, Seoul, Korea.
3Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea.
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In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines.
The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers.
75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying.
In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent.

ACC : Acute and Critical Care