8 out of 10 Citizens Support Assisted Dignified Death... Social Consensus Remains Stalled [Eotteon Jugeum]

③Debate Over Assisted Dignified Death 'Tense'
Over 2.5 Million Registered in Advance Medical Care Directive
2009 Ruling Allows Discontinuation of Life-Sustaining Treatment

Recently, as interest in dignified death has increased, voices advocating for the guarantee of patients' right to self-determination have grown louder. The actual number of registered advance directives for life-sustaining treatment has surpassed 2.5 million, and a survey found that 8 out of 10 people support assisted dignified death. However, everyone only expresses the fundamental position that social consensus is necessary, and even minimal discussions are not taking place.

Life-Sustaining Treatment Decision System Promotional Video. [Image source=National Agency for Management of Life-Sustaining Treatment website]

◆Increasing Advance Directives for Life-Sustaining Treatment... "Reducing Family Burden"

According to the National Agency for Management of Life-Sustaining Treatment on the 25th, as of last month, the cumulative number of registered advance directives for life-sustaining treatment was 2,535,285. By age group, there were 6,830 under 30, 15,169 between 30 and 39, 69,756 between 40 and 49, 248,587 between 50 and 59, 717,173 between 60 and 69, 1,016,016 between 70 and 79, and 461,754 aged 80 and above. By gender, there were 831,950 males and 1,703,335 females.

The advance directive for life-sustaining treatment was established with the enactment of the Life-Sustaining Treatment Decision Act in 2016. It allows adults aged 19 and over to prepare a written document in advance to decide to discontinue life-sustaining treatment when they become patients in the dying process. Life-sustaining treatment cannot be stopped solely based on the patient's will; it requires consultation with medical staff and family.

Minjeong Kim (68), living in Gangdong-gu, Seoul, said, "I want to make a beautiful final choice myself and do not want to be a burden to my spouse or children." Jiwon Kim (57) from Nam-gu, Busan, stated, "My father underwent colon cancer surgery, and while caring for him, I felt that if I were not healthy, I would be a burden to others." Soyeong Bang (33) from Gwanak-gu, Seoul, said, "I am not confident in bearing unnecessary medical expenses and do not want to be a burden to my family." Eunjeong Choi (53) from Gangnam-gu, Seoul, explained, "I became interested after seeing it on TV. I wrote it because I did not want to burden my only son later."

◆Supporters: "Guarantee of Self-Determination," Opponents: "Concerns about Abuse"

Dignified death is classified into three types. Passive dignified death means discontinuing life-sustaining treatment. Assisted dignified death involves the patient taking medication prescribed by a doctor, and active dignified death means the doctor directly administers the medication. According to a survey conducted by Korea Research in July 2022 targeting 1,000 men and women aged 18 and over nationwide, 82% supported the assisted dignified death law, while 18% opposed it.

Supporters of assisted dignified death argue that the right of patients capable of expressing their wishes to choose death must be recognized. They claim that the right to self-determination to protect human dignity cannot be restricted or replaced and can be institutionalized by law. On the other hand, opponents argue that abuse cases may occur where death is decided under socioeconomic pressure, which amounts to a form of social homicide. They contend that it is much more dignified to prepare for death by discontinuing nutrition and controlling pain based on the patient's own decision.

The 1997 Boramae Hospital case was the first incident in South Korea to bring dignified death into public discussion. A 58-year-old male patient was kept alive with an oxygen respirator, but treatment was stopped at his wife's request, and he eventually died. At that time, the hospital completed discharge procedures after obtaining a signed pledge stating that they would not raise legal objections to the patient's death. The deceased's siblings filed charges against the medical staff, and the doctor was charged with aiding and abetting murder. Since then, it became practically impossible to decide to discontinue life-sustaining treatment.

The 2008 Sinchon Severance Hospital case marked a turning point in discontinuing life-sustaining treatment. Grandma Kim became a vegetative patient, and her family requested to stop life-sustaining treatment, saying, "She always asked not to be put on an oxygen respirator." The hospital refused, stating that treatment could not be stopped, and the family filed a lawsuit. In June 2009, the Supreme Court ruled, "If it is recognized that the patient exercises the right to self-determination, discontinuation of life-sustaining treatment can be permitted unless there are special circumstances."

Professor Leejong Seo of the Department of Sociology at Seoul National University said, "In our society, hospice, palliative care, and the Life-Sustaining Treatment Decision Act for patients in the dying process have not yet been firmly established, and supplementary legislation continues to emerge." He added, "I support expanding the discontinuation of life-sustaining treatment for terminal patients, but the assisted dignified death law should be approached cautiously. Cases of abuse under the pretext of the right to self-determination in death may occur, and we need to carefully examine what kind of social shock it might cause."