J Korean Med Assoc.  2018 Aug;61(8):509-521. 10.5124/jkma.2018.61.8.509.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

• Lee SM
• Kim SJ
• Choi YS
• Heo DS
• Baik S
• Choi BM
• Kim D
• Moon JY
• Park SY
• Chang YJ
• Hwang IC
• Kwon JH
• Kim SH
• Kim YJ
• Park J
• Ahn HJ
• Lee HW
• Kwon I
• Kim DK
• Kim OJ
• Yoo SH
• Cheong YS
• Koh Y

• KMID: 2428826
• DOI: http://doi.org/10.5124/jkma.2018.61.8.509

Abstract

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of "˜the end stage of disease' and "˜last days of life' and the criteria for medical judgment are presented and summarized. According to the guidelines, the term "˜end stage of disease' refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms "˜the last days of life' and "˜the final days of life' refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either "˜end stage of disease' for hospice/palliative care or "˜the last days of life' for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or "˜end stage of disease' care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

Keyword

Consensus guideline; Palliative care; Hospice; End-of-life care; Advance care planning

MeSH Terms

Advance Care Planning
Caregivers
Consensus*
Hospices
Humans
Judgment*
Jurisprudence
Korea
Palliative Care
Patient Care
Specialization

Figure

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  Figure 1 The relationships of advance care planning (ACP) to advance directives (AD) and physician orders for life-sustaining treatment (POLST).

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  Figure 2 An example for implementation of advance care planning. AD, advance directive; EOL, end-of-life; POLST, physician orders for life-sustaining therapy.

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