Over 3 Million Advance Directives Registered... More Than 50,000 Cases of Life-Sustaining Treatment Discontinued

Cumulative Discontinuation of Life-Sustaining Treatment Surpasses 450,000 Cases Since Implementation of the Act
Government Sets Target of 56.2% by 2028

Since the implementation of the Life-Sustaining Treatment Decision Act, the number of people who have expressed their intention in advance not to receive futile life-sustaining treatment has surpassed 3 million.

According to data released by the National Agency for Management of Life-Sustaining Treatment on October 26, the number of cases in which life-sustaining treatment was discontinued according to advance directives has exceeded 50,000.

Life-sustaining treatment refers to medical interventions such as cardiopulmonary resuscitation, mechanical ventilation, and hemodialysis that are administered when there is no possibility of recovery or when there is no medical benefit. The introduction of the Life-Sustaining Treatment Decision Act in February 2018 provided a legal framework that allows for the discontinuation or non-initiation of such futile life-sustaining treatments.

To withhold or discontinue life-sustaining treatment, medical professionals must first determine that there is no possibility of recovery. The decision is then made based on the patient's advance directive, life-sustaining treatment plan, or the statements of at least two family members regarding the patient's usual wishes, or by unanimous agreement of all family members.

According to the data, the cumulative number of cases in which life-sustaining treatment was withheld or discontinued since the implementation of the system has reached a total of 453,785. Of these, 50,130 cases involved discontinuation based on an advance directive completed by the patient. Notably, in September alone, more than 1,100 people opted not to receive life-sustaining treatment according to their advance directives.

When breaking down the cumulative cases by type, 146,770 cases were based on statements from at least two family members, 145,662 cases were based on the patient's life-sustaining treatment plan, and 111,223 cases were based on unanimous agreement of all family members.

Although the number of cases based on advance directives, as mentioned above, is just over 50,000-the lowest proportion among the types-it has been increasing rapidly in recent years. The 'self-determination respect rate,' which indicates the proportion of cases decided according to the patient's own wishes, was only 32.5% in 2018 when the system was first implemented, but it exceeded half at 50.8% last year, and rose further to 52.4% from January to September this year.

In particular, the rate of implementation through advance directives is also rising rapidly. In 2018, it accounted for only 0.8% of all cases, but soared to 18.5% last year, and reached 21.2% from January to September this year. As of the end of September, the number of registered advance directives had reached approximately 3,069,000.

Reflecting this trend, the government has set a goal in the Second Comprehensive Plan for Hospice and Life-Sustaining Treatment (2024-2028) to raise the self-determination respect rate to 56.2% by 2028. Authorities stated that they are expanding registration of advance directives and providing more information about the system to create an environment where patients can exercise their right to choose their end-of-life care.