[News Terms] 'Advance Medical Directive' Refusing Meaningless Treatment

As the number of people expressing their intention not to receive life-sustaining treatments such as cardiopulmonary resuscitation, dialysis, or chemotherapy before death rapidly increases, interest in the 'Life-Sustaining Treatment Decision System' and the 'Advance Directive for Life-Sustaining Treatment' is growing.

The Life-Sustaining Treatment Decision System is a system that establishes standards and procedures to allow patients to avoid or discontinue life-sustaining treatments that only prolong the dying process without therapeutic effect, helping patients to conclude their lives with dignity. It has been implemented in South Korea since February 2018. The dying process here refers to a state where the patient has no chance of recovery, will not recover even with treatment, and symptoms rapidly worsen, with death expected within 2 to 3 days.

[Image source=Yonhap News]

To decide on discontinuing life-sustaining treatment, the judgment of two physicians regarding the dying process and the patient's intention are required. The patient's intention is confirmed through an advance directive for life-sustaining treatment, a life-sustaining treatment plan, or statements from two family members; if the patient's intention cannot be confirmed, consensus from all family members is necessary.

In South Korea, any citizen aged 19 or older can prepare in advance their intentions regarding life-sustaining treatment by completing an advance directive for life-sustaining treatment. This document directly records their wishes about discontinuing life-sustaining treatment and using hospice services. As of August 2021, three years and six months after the system's implementation, one million people had completed an advance directive, and as of the 11th of last month, just two years and two months later, that number exceeded two million. In addition to those who signed the directive, there have been approximately 300,000 cases where decisions such as discontinuing life-sustaining treatment were actually implemented in medical institutions. Given the current trend of increasing advance directives, this growth is expected to accelerate further in the future.

If you wish to complete an advance directive for life-sustaining treatment, you can visit a nearby registration institution and complete and register the document through a one-on-one consultation with a counselor. Registration institutions can be found on the National Life-Sustaining Treatment Management Agency website, and there are currently 667 locations nationwide, including public health centers (151), medical institutions (171), non-profit organizations (34), public institutions (240), and senior welfare centers (71). There are 420 medical institutions authorized to decide on discontinuing life-sustaining treatment.

Park Hyang, Director of Public Health Policy at the Ministry of Health and Welfare, said, "The participation of two million people in the system over about five years reflects a societal change in awareness and interest in dignified end-of-life care," adding, "We will strengthen the system to ensure that the self-determination rights of citizens who have completed the advance directive are respected."

Status of Life-Sustaining Treatment Decision System Operation