Korean J Hosp Palliat Care.  2022 Mar;25(1):1-11. 10.14475/jhpc.2022.25.1.1.

Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement

Affiliations
  • 1Patient-Centered Clinical Research Coordinating Center, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
  • 2Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
  • 3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 4Department of Medical Humanities and Ethics, Hanyang University College of Medicine, Seoul, Korea
  • 5Department of Internal Medicine, Asan Medical Center, Seoul, Korea

Abstract

The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for endof-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified “terminal stage.” The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients’ wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient’s judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients’ right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.

Keyword

Death; Palliative medicine; Hospice care; Terminal care; Patient self-determination act; Personal autonomy
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