Over 3 million South Koreans protest against continued life-sustaining care

In South Korea, the End-of-Life Care Decision Act, implemented in 2018, has enabled over 3 million citizens to refuse life-sustaining treatment near death through advance directives, reflecting a growing societal acceptance of dignified death. However, challenges in implementation, narrow legal scope, and ongoing debates about medical ethics and patient autonomy create both challenges and active efforts for reform and expansion.

The current law allows two doctors to withdraw life-sustaining treatment if the patient’s directive is on file and the patient is judged to be in the "imminent death" stage. Despite the broad registration, doctors often find it challenging to determine the precise timing for stopping treatment, leading to continuation of some interventions due to fear of legal consequences and family demands.

The proposed changes aim to expand access to hospice and palliative care, relaxing nurse qualification requirements for home-based hospice services to meet rising demand for dignified death at home. Legal discussions and reforms remain ongoing, as some elements like Do Not Resuscitate (DNR) consent remain legally complex or constrained, and decisions around treatment withdrawal still face limitations and legal uncertainties.

One of the controversies surrounds medical professionals' interpretation of when to stop life-sustaining treatment, balancing advance directives with family wishes and fear of litigation. Some argue that refusal of life-sustaining treatment could be viewed as "murder by omission," reflecting conservative views on the state's role to protect life and provide treatment until death.

The law's limited applicability excludes some patients or conditions, leading to calls for broader or clearer guidelines, especially in complex cases such as severe psychiatric disorders or non-terminal chronic illnesses. Cultural factors and family-centered decision-making further complicate implementation, with doctors sometimes compelled to continue treatment contrary to patient directives.

Women account for two-thirds of those who have decided to refuse life-sustaining treatment. The number of people in South Korea who have signed forms to refuse life-sustaining treatments in case of untreatable diseases has surpassed 3 million. The proposed revision would allow an end of treatment for patients not only in the terminal stage but also in the period leading up to likely death.

Rep. Nam In-soon stated that the proposed change would strengthen patients' right to decide and preserve their dignity as human beings. Lawmakers, including Rep. Nam In-soon, are discussing a broader application of the related law, aiming to include patients in the "final stages" of a disease.

As of Saturday, the number of those who had signed advance statements accounts for 6.8 percent of the country's adult population. A total of 443,874 people have had their life-sustaining treatment discontinued since the system was introduced. A report by local broadcaster KBS showed that 82 percent of heads of medical societies in the country agree that the existing law should be expanded to include patients in the final stages of terminal disease.

The criteria for withdrawal of treatment include being in the "end-of-life process," which means a state of imminent death with no possibility of revitalization or recovery. The bill for the revision is currently pending deliberation at the National Assembly. Jung Eun-kyeong, the recently appointed minister of health and welfare, recognizes the necessity of expanding eligibility in the current system.

The number of people who signed the advance statement rapidly increased from 86,691 in 2018 to nearly 4 million by 2023. This choice is referred to in ethics as a "dignified death." The patient remained unconscious for another week before passing away, amidst a case of a patient with terminal cancer that remained controversial due to the specific conditions in the law, preventing doctors from discontinuing life-prolonging treatment despite the patient's signed refusal and wife's request.

In summary, South Korea’s approach to refusal of life-sustaining treatment has made significant legal and social strides, but practical difficulties in implementation, narrow legal scope, and ongoing debates about medical ethics and patient autonomy create both challenges and active efforts for reform and expansion.

The End-of-Life Care Decision Act in South Korea, implemented in 2018, enables citizens to refuse life-sustaining treatment through advance directives, reflecting a growing societal acceptance of dignified death.
Doctors often find it challenging to determine the precise timing for stopping treatment, leading to continuation of some interventions due to fear of legal consequences and family demands.
Proposed changes aim to expand access to hospice and palliative care, relaxing nurse qualification requirements for home-based hospice services.
Legal discussions and reforms remain ongoing, as some elements like DNR consent continue to be legally complex or constrained.
Some argue that refusal of life-sustaining treatment could be viewed as "murder by omission," reflecting conservative views on the state's role to protect life.
The law's limited applicability excludes some patients or conditions, leading to calls for broader or clearer guidelines.
Women account for two-thirds of those who have decided to refuse life-sustaining treatment, with the number of people in South Korea who have signed forms exceeding 3 million.
Lawmakers are discussing a broader application of the related law, aiming to include patients in the final stages of disease.
As of Saturday, the number of those who had signed advance statements accounts for 6.8 percent of the country's adult population.
A report by local broadcaster KBS showed that 82 percent of heads of medical societies in the country agree that the existing law should be expanded.
The criteria for withdrawal of treatment include being in the "end-of-life process," which means a state of imminent death with no possibility of revitalization or recovery.
The patient remained unconscious for another week before passing away, amidst a case of a patient with terminal cancer that remained controversial due to the specific conditions in the law.
South Korea’s approach to refusal of life-sustaining treatment has made significant legal and social strides, but practical difficulties in implementation and ongoing debates about medical ethics create challenges.
Hospice and palliative care, relaxation of nurse qualification requirements, and expansion of the law to include patients in the final stages of disease may address some of these challenges.
Issues like cultural factors, family-centered decision-making, and fear of litigation also play a role in the implementation of the law.
The bill for the revision is currently pending deliberation at the National Assembly, with the minister of health and welfare recognizing the necessity of expanding eligibility.
This movement towards dignified death is not exclusive to South Korea, as it is a growing concern and topic in discussions about health and wellness, mental health, and therapies and treatments worldwide.