|A medical staffer takes care of a patient in the intensive care unit (ICU) at the Severance Hospital in Sinchon, Seoul, in this March 21, 2018 photo. / Korea Times file|
About 800,000 people sign advance directive refusing life-prolonging treatment
By Lee Hyo-jin
Three years have passed since the so-called "Death with Dignity Act" came into effect here in February 2018, which enabled people to make a choice about ceasing life-prolonging medical treatment.
During this period, nearly 800,000 individuals have signed up for the program by submitting an advance directive forgoing life sustaining treatment in the event they fall terminally ill with no chance of recovery.
Park Jin-sook, 56, a medical staffer at a nursing hospital in Seoul, is one of them.
She has seen many deaths throughout her three decades working in the medical sector, making her frequently imagine the last moments of her life. But what she feared more than death itself was the "meaningless" end-of-life care she could receive lying in coma in an intensive care unit bed, incapable of expressing her own wishes.
"Ever since I came across the end-of-life program back in 2019, I thought that signing the form would relieve some of my concerns. After deep consideration and discussions with my family, I finally completed the form last November," Park said.
With her documents registered in a government databank shared by hospitals and public health institutions, life-extension treatment if Park falls terminally ill can be halted under several conditions: confirmation by a family member, approval from the ethics committee at the medical institution, and a prognosis from two doctors confirming her as a terminal patient.
Currently, four types of treatment ― cardiopulmonary resuscitation (CPR), use of artificial respiration, hemodialysis, and administration of anti-cancer drugs ― are categorized by the government as life-extension care.
Any person above the age 19 can register the advance directive, which they can also withdraw at any time.
Since its launch in February 2018, a total of 790,193 people have signed up for the program, according to recent data from the National Agency for Management of Life-Sustaining Treatment, which runs the program.
More specifically, 105,529 people registered in 2018. The number surged to 432,138 in 2019 and fell to 257,526 in 2020. About 88 percent of the registration were made by people over 60.
A survey conducted in December by the Korea National Institute for Bioethics Policy (NIBP) showed that a vast majority, or 91 percent of 300 respondents, were aware of the program. About 81 percent said they had a positive view on it, while 60 percent replied they were willing to register in the future.
Kim Myung-hee, head of the NIBP, said there were multiple reasons as to why the program had gained a lot of public attention.
"It reflects the not-so-sudden public interest in death with dignity," Kim said during a phone interview with The Korea Times.
"Since a local court's landmark ruling in 2009 allowing euthanasia for an elderly woman surnamed Kim, the idea of death with dignity has emerged as a trend. Many people have wanted the legal grounds to allow the act and a government plan to formally guarantee their right to it," she explained.
She added that active campaigns held by civic groups promoting the program has also encouraged people to register.
Kim saw that the decrease in numbers in 2020 as possibly attributable to the COVID-19 pandemic.
"Those who are mostly interested in the program are elderly citizens over age 70, but their outdoor activities have been highly limited since the coronavirus outbreak," she said.
However, despite rising demand, the actual ending of life extension treatment is not easily carried out in medical institutions, mainly due to the absence of an ethics committee.
About half of 320 general hospitals nationwide have such a committee, but only 4 percent of 1,585 nursing homes have one, according to government data.
Kim stated that the government is trying to expand the program especially at nursing homes, by engaging in continuous talks with medical organizations.
For those who are considering or planning to sign the advance directive, Kim advised a prudent approach in making the "life-and-death" decision. "It is important to frequently think about death in our daily life, which is the inevitable ending of life, and how one wants to be prepared for it," she said.
"Also, it should be thoroughly discussed with family members, relatives or friends, as they will be deeply involved in carrying out the subsequent actions," Kim advised.