[In Fact] Wife Charged with Murder for Removing Husband's Ventilator, Doctor Charged with Aiding Murder (Part 1)

Reflecting on the Euthanasia Debate through the Film 'Sopung'
Switzerland Allowing Assisted Suicide Since 1942
Dr. Goodall First Choosing Euthanasia Due to Old Age
Japan Faces Controversy over Izumi and Kawasaki Hospital Cases

In the film 'Sopung,' Go Eun-sim (Na Moon-hee) is frail. She suffers from Parkinson's disease and often trembles in her wrists. Sometimes, she does not even recognize her son Song Hae-ung (Ryu Seung-soo). Her sister-in-law and friend, Jin Geum-soon (Kim Young-ok), is in a similar condition. Due to daily farm work, she lives with chronic back pain. Occasionally, the pain becomes so severe that she cannot move and has to relieve herself in bed.

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They do not want to be a burden to their families but fear living a life where they lose themselves. They hope to have the right to decide about their own death. The fate of a friend they spent their school days with becomes a decisive turning point. They liken life in a nursing hospital to a "Goryeojang" (a traditional practice of abandoning the elderly). They perceive the caregiver's care as oppression and persuasion, leading to self-pity about their situation.

Many people regard a state of relying on others for basic physiological functions as a life where dignity is compromised. However, if you look around, you will find many severely ill patients, elderly, and disabled people who receive help because they cannot manage excretion on their own. Can we truly say their lives have lost dignity?

Sociologist Ueno Chizuko explains in her book Recommending Dying Alone at Home that "aging is a process in which everyone becomes partially disabled, and within this partial disability, there are not only physical inconveniences but also impairments in the brain and mind, either wholly or partially." She criticizes those who propose euthanasia as an alternative to the fear of dementia, pointing out that "behind such thoughts lies the idea of distinguishing between lives that are 'worth living' and those that are not."

Writer Lee Ji-eun, co-author of Bodies at Three in the Morning, introduces findings from scholars who have long studied dementia care, writing: "Some parts that constitute the self do not completely disappear due to dementia. Minor bodily actions that carry traces of previous life are, in fact, ways the person continues their life." This means the human body is not merely a vessel containing a damaged brain.

Dignity likely exists somewhere within the continuation of life. Of course, even if we come to view the meaning of a damaged life differently, the sorrow inherent in the situation is unavoidable. Especially for family members, despite doing everything possible, feelings of helplessness are common.

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Unfortunately, Go Eun-sim and Jin Geum-soon cannot expect such care. They have felt the limits even in lives where they care for each other. Therefore, the destination they head toward is quite radical, diverging from the societal atmosphere that does not recognize death by individual self-determination.

It is impossible to declare a single correct answer because each individual has different wishes about when, where, and how they want to face death. Our society is unlikely to accept all of these. However, at least within a broad framework, individuals should be able to choose a dignified death they desire. For some, that may be 'Sopung'...

'Did you know?' provides information in a somewhat disorganized manner. It is a tip for enjoying the film more interestingly.

*In South Korea, the law on dignified death is the Life-Sustaining Treatment Decision Act, effective since February 2018 (Act on Decisions on Life-Sustaining Treatment for Patients at the End of Life, Hospice and Palliative Care). It allows patients in the dying process to stop life-sustaining treatments such as cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, and chemotherapy if they feel these treatments are meaningless and unwanted. From the perspective that views passive euthanasia and active euthanasia as forms of dignified death, this law represents the lowest level of dignified death. The law narrowly defines its subjects as 'patients in the dying process,' excluding terminal patients or those in a vegetative state.

*Passive euthanasia refers to stopping life-sustaining treatments such as nutrition supply for unconscious patients like those in a vegetative state, leading to death. A representative case often cited is the March 2005 Terry Schiavo case in the United States. Terry Schiavo, who had been in a vegetative state for 15 years, died after a court ordered the removal of her feeding tube.

*Active euthanasia involves shortening life by a third party, such as a doctor, prescribing or injecting lethal drugs to terminal or vegetative patients, going beyond the passive act of stopping treatments like nutrition supply.

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*Assisted suicide refers to cases where terminal patients with no chance of recovery receive lethal drugs or injections from a doctor to relieve suffering and then end their own lives. It differs from active euthanasia in that the patient must take the lethal drugs themselves, even if prescribed by a doctor. In Europe, due to the Nazi regime's misuse of the term euthanasia during the Holocaust, 'assisted suicide' and 'active euthanasia' are strictly distinguished.

*Dignitas, a Swiss assisted suicide support organization, announced that the first Korean to undergo assisted suicide did so in 2016. This is reported as the first case of a Korean choosing assisted suicide abroad.

*Switzerland has allowed assisted suicide for both its citizens and foreigners since 1942. After long debates, the Swiss Federal Supreme Court finally recognized euthanasia in 2006, ending the controversy. Currently, organizations such as Dignitas, Eternal Spirit, and Exit International assist foreigners with assisted suicide in Switzerland. Among them, Exit International is famous for assisting the euthanasia of Australian botanist David Goodall, who was 104 years old in 2018. Although Goodall had no particular illness, he publicly announced his trip to Switzerland to have a dignified death. In April 2018, after a serious injury at home, he was unable to get up for two days and judged that living alone was difficult. The day before ending his life, he held his last press conference at a small hotel in Basel. "I am glad to spend the last week with my family. There are many things I want to do, but it is too late. I am satisfied to leave them behind," he said. When asked about the music he wanted to hear at the last moment, he replied, "There is none. But if I had to choose, it would be the final movement of Beethoven's Symphony No. 9, 'Ode to Joy,'" and sang a few bars in German with vigor. The next day, Goodall died after receiving a lethal dose of sedatives under the watch of medical staff and his grandchildren. He opened the valve to inject the solution into his vein himself. The entire process was recorded on video. He left a will saying, "Do not hold a funeral. Do not hold any memorial events to remember me. Donate my body for dissection." Philip Nitschke, founder of Exit International, stated, "As far as I know, Dr. Goodall is the first case of choosing euthanasia due to old age rather than incurable disease."

*In the film 'Me Before You,' the male protagonist, who becomes quadriplegic after a traffic accident, leaves the UK to go to Switzerland to end his life.

*At Dignitas, euthanasia proceeds in the following order: ▲Admission and final farewell with family ▲Final confirmation of necessary documents such as doctor's diagnosis ▲Repeated confirmation of the patient's intention to proceed with euthanasia ▲Patient self-administration of drugs ▲Death confirmation. Afterward, ▲Explanation of post-euthanasia procedures to family ▲Police and forensic examination to confirm whether the death was voluntary euthanasia or homicide ▲Coffin placement ▲Transfer by hearse ▲Cremation follow sequentially.

*The Swiss federal government did not criminalize suicide in the early 20th century. Assisting suicide was also not punishable. However, due to issues such as children assisting parents' suicide to inherit property quickly, Article 115 of the Criminal Code was enacted in 1942 to prevent abuse. In Switzerland, assisted suicide has been customary for a long time, but no law explicitly defines it as dignified death. There is no legal definition of what exactly it is. However, Article 115, effective since 1942, states, "Whoever induces or assists another's suicide or suicide attempt with selfish motives shall be punished by imprisonment of up to five years or a fine if the other person actually commits or attempts suicide." This is interpreted to mean that assisting suicide without selfish motives, such as for profit, is not punishable. When Dignitas founder Ludwig Minella was prosecuted, the main charge was not how many people he led to assisted suicide but whether there was a profit motive in the assistance process. The allowance of assisted suicide in Switzerland is based not on a specific provision but on the absence of regulations or punishments against it.

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*Switzerland, which values individual autonomy highly, sets only minimal principles in law. Within this framework, a strong social and cultural atmosphere permits everything. This structure allowed foreign assisted suicide support organizations like Dignitas to be established. From the perspective of South Korea, which regulates everything in detail by law, this may appear as a 'legal vacuum.'

*South Korea's Criminal Code does not criminalize suicide but does criminalize incitement and assistance to suicide. Unlike Switzerland, it does not distinguish criminality based on 'motives,' leaving no room for assisted suicide. Even if a doctor prescribes lethal drugs 'in good faith' to a patient who desperately wants to die, they are punished without exception.

*From 1998 to 2019, 3,027 foreigners ended their lives through Dignitas over 22 years. Many people from neighboring countries where euthanasia is prohibited, such as Germany, the UK, and France, frequently travel to Switzerland to seek euthanasia.

*The largest assisted suicide support organization in Switzerland is Exit. Founded in 1982, it accepts only Swiss citizens as members. It has over 100,000 members, more than 1% of Switzerland's total population.

*In May 2011, the Zurich cantonal parliament proposed a bill to ban assisted suicide itself and prohibit it for foreigners. However, 85% and 78% of Zurich citizens voted against it, respectively, maintaining the existing law.

*One reason Dignitas was prosecuted was that it received membership fees and donations. There were concerns that this constituted profit-making. To apply for assisted suicide, one must first become a member, with an initial fee of 200 Swiss francs (about 300,000 KRW). An annual fee of at least 80 francs (about 120,000 KRW) is required to maintain membership. Assisted suicide incurs additional costs. It is reported that about 10,500 francs (approximately 15.92 million KRW) are needed, covering medical diagnosis, drug prescription, post-mortem funeral, and administrative procedures. Dignitas discloses cost items, explaining that the largest expense (4,000 francs) is finding a doctor to assist with assisted suicide.

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*Switzerland's allowance of assisted suicide is not only due to respect for individual self-determination but also because of its high suicide rate. If completely preventing suicide is impossible, public opinion favored opening a relatively humane way to die, leading to changes in laws and systems. In Switzerland, from 2012 to 2016, there were over 100 train-jumping suicides annually. Previously, firearm suicides were also an issue. Switzerland's suicide rate was 11.1 per 100,000 people in 2019, the average among OECD countries. South Korea ranked first with 24.1 per 100,000 in 2020, 3.8 higher than Lithuania's 20.3 per 100,000 in 2020, which ranked second.

*The Netherlands is a representative country that allows both active euthanasia and assisted suicide. It was the first in the world to legalize euthanasia and assisted suicide. When the Dutch Criminal Code was first enacted in 1886, euthanasia was criminalized, but after various court rulings, the Euthanasia Act was enforced in April 2002. Of course, euthanasia had been practiced conventionally before legalization. The number of people choosing euthanasia in the Netherlands increased steadily from 1,882 in 2002 to 6,585 in 2017, then slightly decreased to 6,126 in 2018 and 6,351 in 2019. Euthanasia still accounts for about 4% of all deaths in the Netherlands. In October 2020, the scope of euthanasia eligibility was expanded to include children under 12 with terminal illnesses.

*Belgium also legalized active euthanasia and assisted suicide in 2003. It was the second Catholic country after the Netherlands. In 2018, 2,358 people chose euthanasia in Belgium, a country with 11 million people, averaging about six cases per day. Among them, over 40% were aged 80 or older, and most were over 60.

*Luxembourg passed a law for euthanasia in 2009.

*In Canada, only Quebec prohibits euthanasia but allows assisted suicide. Other provinces recognize both euthanasia and assisted suicide.

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*In the United States, Oregon was the first state to allow assisted suicide in 1997 for patients with a prognosis of six months or less to live. Subsequently, Colorado, California, Montana, Vermont, Washington State, and Washington DC legalized it. Hawaii, New Jersey, and Maine also legalized assisted suicide in 2018 and 2019, respectively. Australia’s Victoria state has implemented a law allowing assisted suicide since 2019.

*In the UK, assisted suicide bills were introduced four times until 2015 but failed to pass Parliament. Strong opposition from the Church of England, Jewish, and Islamic leaders on bioethical grounds prevented the bills from passing.

*The dignified death debate in South Korea was first triggered by the 1997 Boramae Hospital case. A patient who could no longer breathe independently after brain surgery was discharged from the hospital at the spouse's request. The patient died immediately after the ventilator was removed, and the attending doctors were charged with murder. This case shocked doctors at the time, making them aware that discharging a patient with no chance of recovery could lead to murder charges. In May 2004, the Supreme Court confirmed the lower court’s ruling sentencing the attending doctors and residents to 1 year and 6 months imprisonment with 2 years probation for aiding and abetting murder, not murder. The court acknowledged their assistance in the act of killing but added, "Allowing discharge merely entrusted the patient's life or death to the family's duty of care and thus cannot be punished as murder." The wife was sentenced to 3 years imprisonment with 4 years probation for omission-based murder in the appellate court and gave up appeal. Only the intern who removed the ventilator under orders was acquitted.

*In 2008 at Seoul Severance Hospital, the family of a grandmother in a vegetative state due to brain injury earnestly requested to stop life-sustaining treatment. The hospital insisted on preserving life and continued treatment for months. The family requested removal of the ventilator, but the hospital refused. The family filed a provisional injunction in May and a civil lawsuit in June. The injunction was dismissed, but the civil suit resulted in the first dignified death ruling ordering removal of the ventilator. The court stated, "The patient's right to self-determination to refuse life extension and request ventilator removal is not restricted and cannot be denied. The act of removing the ventilator is a legitimate reason to stop emergency medical care, and the doctor bears no criminal or civil liability." The hospital appealed, and the grandmother’s life-sustaining treatment continued for 14 months until June the following year. In May 2009, the Supreme Court finally recognized dignified death, and on June 23, the ventilator was removed. Contrary to the hospital’s prediction that death would be immediate, the grandmother breathed independently and lived for about 200 more days, passing away after 1 year and 10 months of unconsciousness.

*In Japan, administering drugs leading to death by oneself or a proxy is generally called 'euthanasia.' Meanwhile, refusing life-sustaining treatment by one’s own will and receiving appropriate palliative care to die naturally is generally called 'dignified death' or 'passive euthanasia.' Japan broadly uses these definitions. According to this, dignified death refers to natural death without life-sustaining treatment, and while stopping life-sustaining treatment is allowed, administering lethal drugs or assisting suicide by a doctor is not included.

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*In Japan, the Izumi Citizen Hospital case sparked a dignified death controversy. From 2000 to 2005, seven patients in irreversible comas had their ventilators removed, leading to death. Among them, only one had documented consent from family and patient; the other six had no consent records. A similar case occurred in Kawasaki. In 1998, a doctor at Kawasaki Cooperative Hospital removed an endotracheal tube from a patient with bronchial suffocation and cardiac arrest, with family consent. When the patient began to breathe painfully, the doctor administered muscle relaxants, causing death.

*Strictly speaking, euthanasia practiced in Switzerland and the US is closer to assisted suicide, where doctors prescribe lethal drugs for patients to end their own lives. In other countries or regions, doctors administer lethal drugs directly to euthanize patients.

*In Victoria, Australia, where euthanasia was legalized, Dr. Philip Nitschke developed the capsule-type euthanasia device 'Sarco,' which gained attention. Pressing a button fills the capsule with liquid nitrogen, creating an environment with oxygen levels too low for human survival, causing death instantly. Its sleek design has drawn criticism for glamorizing suicide.

References: Yoo Young-gyu, Lim Ju-hyung, Lee Seong-won, Shin Yung-ah, Lee Hye-ri, It’s Not Because I Want to Die (2020), published by Bookcomma; Oku Shinya, translated by Lee Sodam, Everyone Has Aged But No One Dies (2023), published by RH Korea; Marcel Langeraade, translated by Yoo Dong-ik, My Sibling Chose Euthanasia (2020), published by Courier; Shin Ah-yeon, Visited the Swiss Euthanasia Site (2022), published by Book and Tree; Ronald Dworkin, translated by Park Kyung-shin and Kim Ji-mi, The Domain of Life: Abortion, Euthanasia, and Personal Freedom (2014), published by Rhodos; Dan Mohaim, translated by Noh Hye-sook, supervised by Lee Il-hak, A Better Death to Complete My Life (2012), published by Anima; Kim Hee-kyung, Aging Solo (2023), published by East Asia, etc.