Murad Jacob "Jack" Kevorkian, or “Dr. Death,” caused great controversy in the U.S. in the 1990s by championing terminal patients’ right to die by physician-assisted suicide – and assisting at least 130 patients to that end.

In conclusion, Koreans are unlikely to see a local version of Dr. Death.

An opposition lawmaker has recently submitted a bill that allows “physician-assisted death with dignity” for patients suffering from severe pains. However, all parties involved – the medical community, patients’ groups, and legal circles – opposed the proposed law, making it difficult to introduce the system in this country.

If doctor-assisted euthanasia becomes legal, there can be a culture that forces death, the opponents say.

They also pointed out patient's right to self-determination does not include the right to commit suicide, stressing that before discussing doctor-assisted suicide, the government should first strengthen the end-of-life help system.

The pros and cons exchanged views at a recent debate at the National Assembly organized by Rep. Shin Hyun-young of the opposition Democratic Party of Korea and the Korean Society for Hospice and Palliative Care.

Almost all participants expressed deep concerns over the bill in unison.

Proposed law will create a culture where death is an option

“I have treated more than 1,000 terminal patients a year for over a decade,” said Kim Cheol-min, a professor of family medicine at the Catholic University of Korea St. Mary’s Hospital. “However, I could never comply with two of their pleas – a plea for help and a plea for death.”

Professor Kim said, “If physician-assisted suicide becomes legal, creating a culture where death is a basic option, suicide gets contagious, terminal patients are subtly forced to die, and terminal patients are encouraged to abandon hope, terminal patients and their families will become like balls standing on a slippery slope.”

He added that critical patients often pleas to kill, but that should not be understood as revealing their true intentions for euthanasia.

Kim I-yeon, director of public relations at the Korea Medical Association, said, “Instead of amending laws to allow physician-assisted euthanasia, it is more necessary to work out systems to support patients’ quality of life and provide psychiatric and psychosocial support for them, including expanding the scope of diseases subject to hospice and palliative care.”

Kim took issue with the proposed composition of the screening committee determining physician-assisted euthanasia.

“I doubt the country has sufficient experts related to doctor-assisted suicide and whether the health-welfare minister and other ranking officials have the ability and authorization to judge the subjects of death with dignity with the help of physicians,” he said. “That’s an issue requiring professional judgment and national consensus.”

Lack of measures to protect physicians who assist death with dignity

Kim also pointed out that measures are insufficient to protect physicians who assist terminal patients’ death with dignity.

“Although the submitted bill calls for ruling out the application of aiding and abetting suicide under the criminal law, the legal definitions of murder and suicide are vague,” he said. “Accordingly, even if it absolves doctors of assisted suicide, legal, ethical and religious problems are highly likely to occur, and therefore, multi-faceted review and countermeasures are crucial.”

The KMA director suggested community care that provides integrated care as the fundamental solution for terminal patients’ final moments.

A legal expert said that although he agreed with the purpose of the proposed law to respect the patient's right to self-determination, its direction is wrong.

“Patients’ right to self-determination does not include the right to commit suicide,” said Lee Seok-bae, a law professor at Dankook University. “The right to die with dignity refers to the right to reject life-sustaining treatment and die of its reflex effect according to patients’ right to self-determination, but not a legal right to kill oneself.”

On the other hand, physician-assisted suicide becomes possible only when the right to direct suicide is recognized, requiring discussion on a different dimension, Lee added.

Survey results on physician-assisted suicide are hard to believe

Professor Lee also said he could not trust the survey results that “80 percent of adults approved euthanasia,” as cited by Rep. Ahn Kyu-baek다다 of the Democratic Party of Korea when he submitted the legal amendment bill.

A Seoul National University Hospital team, led by Professor Yoon Young-ho of family medicine, surveyed 1,000 adults ages 19 and older from March to April 2021, asking about their attitudes on euthanasia or physician-assisted suicide. The team published the result in the recent issue of the International Journal of Environmental Research and Public Health.

Asked whether they agree with legalizing euthanasia or doctor-assisted suicide, 61.9 percent of respondents said, “very much agree.” An additional 14.4 percent said they “agree,” increasing the share of proponents for its legalization to 76.3 percent, according to the survey result.

“If pollsters ask whether survey participants agree on ‘death with dignity,’ 70-80 percent has no choice but to agree,” Professor Lee said. “However, if the survey asks more specifically by, for instance, zoning down the targets to ‘your parents’ or ‘your children,’ no high agreement rate will come out.”

Pointing out that survey results can vary widely by only changing one word, Professor Lee said, “I don’t trust survey results (especially regarding death with dignity).”

A representative of patients also argued that creating an environment for providing high-quality care at the end of life should come ahead of legalizing physician-assisted suicides.

“The development of medicine has drastically eased the extreme pains of terminal patients. However, some patients could waste precious time by opting for physician-assisted suicide by yielding to the vague fears of intolerable pain,” said Ahn Ki-jong, head of the Korea Alliance of Patients Organization. “Before emphasizing the right for self-determination for death with dignity, medical workers and guardians need to provide sufficient information on using the remaining time meaningfully by managing physical and mental pains using up-to-date medicine.”

Health-welfare ministry stresses need for in-depth discussion

A senior official at the Ministry of Health and Welfare also emphasized the need for having an in-depth discussion on the amendment to the act on physician-assisted suicide.

“We first need to discuss whether it is right to include physician-assisted suicide in the law that determines the continuity of meaningless life-sustaining treatment,” said Han Sang-kyun, director of the Disease Policy Division at the Ministry of Health and Welfare. “Also, the health-welfare minister is supposed to chair the screening committee for physician-assisted suicide. However, we need to examine whether it is right for the minister, who originally has to prevent suicide, should chair the committee.”

It was this past June that Rep. Ahn proposed the bill to introduce the amendment bill to the “Act on hospice, palliative care, and decision on medical care for prolonging the life of patients on their deathbed,,” which called for introducing “physician-assisted death with dignity” for terminal patients suffering from unendurable pain.

Specifically, the bill contains the definition of physician-assisted suicide and its targets, the formation of the screening committee under the minister of health and welfare, and detailed implementation procedures.

It also contained a clause to protect medical doctors who assisted such suicides by excluding them from the application of the crime of aiding or abetting suicide according to the criminal law.