한국정신병리진단분류학회

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Abstract

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Seon Jin Yim

DOI:10.36430/kjp.2024.28.1.001

Abstract

Mindfulness, originally defined by Kabat-Zinn, has its importance in paying attention to the present moment experience. Studies reporting the benefits of mindfulness-based interventions described positive outcomes in mental and physical, cognitive, affective and interpersonal aspects. Mindfulness-based interventions have been being integrated in treatment for patients with mental health problems in a wide range of clinical settings. Its neurocognitive frameworks also have been described by several studies. Various interventions based on mindfulness such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), mindfulness-based relapse prevention (MBRP) and mindfulness-based relationship enhancement (MBRP) have been developed and many of them have been proved their therapeutical effectiveness among population with various mental health problems. However, not as many mindfulness-based interventions have been applied among older adults. This article aims to review literatures to explore the effects of mindfulness-based interventions among the older adults with mental health problems, and discuss the suggestions for the further applications.

Key Words

Older adults, Mindfulness, Interventions, Mental health

김형덕 Hyung Duk Kim , 강상경 Sang Kyoung Kahng

DOI:10.36430/kjp.2024.28.1.002

Abstract

This paper examines shared decision-making (SDM), which is discussed as an alternative to expert decision-making in the medical field, from the perspective of self-determination principles. As stipulated in the Code of Ethics for Social Workers, the core principle of decision-making in the field of social welfare is self-determination. Since most of the social welfare recipients are cognitively intact enough to make their own decisions, social workers in principle support clients to make decisions on their own. When the client has a cognitive impairment and thus has impaired self-determination capability, SDM can be considered as an alternative. When the client’s decision-making capability is completely lost, a decision-making supported by a guardian can be an alternative, but for clients with even a little residual decision-making capability, it is a principle to make self-determination as much as possible. SDM in the social welfare field are also made by experts like in the medical field. In the field of social welfare, however, there are various parties of SDM partners such as families, friends, and peer individuals. SDM in the medical field is a form of decision-making between experts and patients. The key difference between two fields is that in the medical field, SDM is being considered to overcome the limitations of expert decision-making, while in the social welfare field, SDM is being considered as a form of supported decision-making only for people with decision-making difficulties.

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Shared decision-making, Self-determination principles, Supported decision making, Social welfare field, Medical field

김천수 Cheonsoo Kim

DOI:10.36430/kjp.2024.28.1.003

Abstract

This paper examines shared decision-making (SDM) as an alternative to expert decision-making in the medical field from the perspective of self-determination principles. The Code of Ethics for Social Workers stipulates that self-determination is the core principle in social welfare decision-making. Since most social welfare recipients can make their own decisions, social workers support clients in this process. When clients have cognitive impairments, SDM can be an alternative. If a client’s decision-making capability is completely lost, a guardian can make decisions, but clients with residual capability should still participate as much as possible. In social welfare, SDM involves various parties such as families, friends, and peers, unlike the medical field, where it is primarily between experts and patients. In the medical field, SDM aims to overcome the limitations of expert decision-making, while in social welfare, it supports individuals with decision-making difficulties. In medical practice, if a patient can consent, no one else has the right to consent. However, the ability to consent can be ambiguous. Medical practitioners aim to get consent from both the patient and someone who can act on their behalf if necessary. When decisions conflict, the medically reasonable decision takes precedence. If both are reasonable, the patient's decision is prioritized. Legal liability for not obtaining valid consent involves damages for failing to disclose necessary information, usually limited to mental damages. However, if hypothetical refusal is proved, damages for physical harm are also included. Ambiguity in consent ability can be mitigated by objectifying negligence, but legislative measures are advisable to establish regulations for assessing consent ability.

Key Words

Patient’s ability to consent, Physician’s appropriate explanation, Legal liability for medical malpractice