J Hosp Palliat Care.
2024 Dec;27(4):107-119. 10.14475/jhpc.2024.27.4.107.
Advance Care Planning in Palliative Care in Asia: Barriers and Implications
- Affiliations
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- 1Palliative Care Center and Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
- 2Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Korea
- 3Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- 4Department of Family Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
- 5Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan and Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
- 6Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia and Universitas Indonesia Hospital, Universitas Indonesia, Depok, Indonesia
- 7Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- 8Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si and Department of Medicine, College of Medicine, Dongguk University, Seoul, Korea
- KMID: 2562419
- DOI: http://doi.org/10.14475/jhpc.2024.27.4.107
Abstract
- Advance care planning (ACP) in palliative care is essential for patient autonomy and quality of dying. This review explores ACP practices in South Korea, Japan, and Taiwan, highlighting how legislation and cultural values shape those practices. In these three sectors, which are influenced by Confucian values, family involvement plays a significant role in decision-making. In South Korea, the Life-Sustaining Treatment Decisions Act made ACP processes mandatory at all healthcare institutions and rapidly created advance directive registration agencies nationwide, with a national web-based system for legal documentation. The Act’s narrow focus on terminal illness and dying phase may inadvertently delay end-of-life discussions. A broader social consensus is needed to allocate end-of-life care resources in a way that reflects patients’ and families’ wishes. Japan’s family-based approach highlights relational autonomy, with ACP timing varying and no formal legal frameworks for advance directives. Expanded palliative care, ACP guidelines, systemic support, and public awareness drive progress in Japan. Taiwan’s two relevant legislative frameworks—the Hospice Palliative Care Act and Patient Right to Autonomy Act—expand palliative care services for terminal illnesses and non-cancer diseases such as severe dementia, irreversible coma, and a persistent vegetative state. Misunderstandings of ACP and family-led decision-making may hinder ACP uptake. ACP referral based on patient care needs rather than terminal diagnoses is suggested. Overcoming common barriers in Asia necessitates open dialogues about death and public education. A standardized legal framework and comprehensive training for healthcare providers are equally important. Further international collaboration will suggest culturally sensitive ACP conversations across Asia.
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