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

Affiliations
  • 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

Abstract

Purpose
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.
Methods
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.
Results
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).
Conclusion
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.

Keyword

Advance care planning; Terminal care; Korea
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