"Over 3 Million Pledge to Discontinue Life-Sustaining Treatment... How It Differs from 'Euthanasia' [News Seolcham]"

Life-Sustaining Treatment Can Only Be Discontinued for Patients Near Death
Significant Differences from Physician-Assisted Dying
Ongoing Controversy Over Euthanasia Even in Countries Where It Is Legal

Editor's Note'Seolcham' is a newly coined term meaning "please refer to the explanation for more details." In [News Seolcham], we aim to highlight and explain in detail the parts of the news that require fact-checking or further clarification.

The number of people who have pledged to discontinue life-sustaining treatment right before death has surpassed 3 million, accounting for about 7% of the adult population in Korea. The discontinuation of life-sustaining treatment is rooted in the Act on Decisions on Life-Sustaining Treatment, commonly known as the "Dignified Death Act," which was implemented in 2018. However, this is classified as passive euthanasia, which is distinctly different from physician-assisted dying or active euthanasia, where medical professionals help end a patient's life.

Discontinuation Allowed Only When Recovery Is Impossible and Death Is Imminent

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The Act on Decisions on Life-Sustaining Treatment was passed by the National Assembly in 2016 and implemented after a two-year grace period. The law was designed to respect the decision-making rights of patients by preventing the meaningless extension of life for those with no chance of recovery. At the time, it was referred to as the "Well-Dying Act" or the "Dignified Death Act."

Today, adults aged 19 and older in Korea can prepare an "Advance Directive on Life-Sustaining Treatment" in anticipation of the end of life. By preparing this directive, individuals can decide whether to discontinue life-sustaining treatment should they become critically ill in the future.

However, the discontinuation of life-sustaining treatment currently practiced in Korea is classified as passive euthanasia and is distinctly different from physician-assisted dying, where a patient takes prescribed medication, or active euthanasia, where a physician administers the medication directly. Compared to major countries overseas, patients in Korea have fewer options. To discontinue life-sustaining treatment, the following conditions must be met: ▲ the patient must have no possibility of recovery, ▲ symptoms must be rapidly worsening and death must be imminent, and ▲ confirmation from the attending physician and one specialist is required. In other words, there must be clear evidence that the individual requesting it is at death's door for it to be permitted.

Despite these limitations, the number of people expressing their intention to discontinue life-sustaining treatment has been increasing every year. In the first year of implementation, 2018, only about 60,000 people had expressed this intention, but by early August this year, the number surpassed 3 million. Notably, 25% of women aged 65 and older have expressed a desire to discontinue life-sustaining treatment.

Criteria for Discontinuing Life-Sustaining Treatment Vary by Country... Euthanasia Is a Separate Issue

The criteria for discontinuing life-sustaining treatment differ from country to country. In major countries that introduced such systems earlier than Korea, the decision-making rights of patients are generally respected more broadly, covering not only terminally ill patients but also those in a vegetative state or with severe dementia.

The United States institutionalized the discontinuation of life-sustaining treatment in 1991, becoming the first country in the world to do so. As a result, both terminally ill patients and those near death in the U.S. can discontinue treatment with the consent of family members or legal representatives. In the United Kingdom, the Mental Capacity Act allows the discontinuation of medical care for terminally ill patients and those in a vegetative state.

In Asia, Taiwan was the first to introduce the discontinuation of life-sustaining treatment in 2000 through the Hospice Palliative Care Act. Initially, the law applied only to terminally ill patients, but in 2015, it was expanded to allow those in an irreversible vegetative state to discontinue medical care, recognizing broader self-determination rights. In Japan, discontinuation is permitted for terminally ill patients but not for those in a vegetative state or with severe dementia.

Physician-assisted dying involves patients ending their own lives by taking medication prescribed by medical professionals, making it fundamentally different from the discontinuation of life-sustaining treatment in terms of "active" involvement. The first case of legalized physician-assisted dying was in Oregon, USA, and since then, countries such as the Netherlands and Canada have permitted it. This year, both the French and British lower houses passed bills on physician-assisted dying. However, the legislative process has sparked fierce debates for and against, and even in countries that adopted the system early, there are ongoing controversies over issues such as the spread of disregard for life, indicating that the debate is far from settled.

Euthanasia, where a competent adult actively requests and receives a lethal injection from a physician, is illegal in every country worldwide, including the United States. However, in Switzerland, it is legal as long as the individual carries out the process themselves.

Public Opinion in Korea Favors Discontinuation of Life-Sustaining Treatment and Physician-Assisted Dying

In Korea, there are calls to expand the current system, which restricts the discontinuation of life-sustaining treatment to patients right before death, to include terminally ill patients as well. Minister of Health and Welfare Chung Eun-kyung also acknowledged this in her written response during her pre-appointment parliamentary hearing, stating, "There are concerns that limiting the implementation of decisions to withhold or discontinue life-sustaining treatment to the end-of-life stage restricts patient self-determination and the guarantee of their best interests," and added, "I agree on the need to review expanding the scope of implementation (of discontinuation of life-sustaining treatment)."

Public opinion in Korea is favorable toward the discontinuation of life-sustaining treatment. In a report titled "Trends and Challenges in Well-Dying Discussions for Future Society," published by the Korea Institute for Health and Social Affairs in February, the results of a recent survey on physician-assisted dying were presented. Among 1,021 adult respondents, 91.9% said they would be willing to discontinue life-sustaining treatment if they became terminally ill, and 82% supported the legalization of physician-assisted dying.