Korean J Hosp Palliat Care.  2020 Jun;23(2):93-102. 10.14475/kjhpc.2020.23.2.93.

End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience

  • 1Departments of Internal medicine, Kosin University Gospel Hospital, Busan, Korea
  • 2Departments of Pulmonology, Kosin University Gospel Hospital, Busan, Korea
  • 3Departments of Infectious disease, Kosin University Gospel Hospital, Busan, Korea
  • 4Departments of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Busan, Korea


The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld lifesustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination.
We retrospectively analyzed the medical records of patients who died after agreeing to withhold lifesustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed.
Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient’s wishes. When the patient decided to stop lifesustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001).
In many cases, the decision to discontinue lifesustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients’ self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.


Advance care planning; Terminal care; Korea
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