Experts pointed out once again on Wednesday that physician-assisted suicide could become an “inevitable option” instead of a “choice of last resort” for terminally ill patients to die with dignity.
They argued that patients may be forced to choose doctor-aided suicide because it is easier and less expensive than hospice palliative care.
These assertions came at a public debate organized by the National Human Rights Commission to discuss human rights issues and alternatives to physician-assisted suicide. Pros and cons of the so-called act on assisted death with dignity, which recently sparked controversy in Korea.
Professor Yoon Young-ho of the Family Medicine Department at Seoul National University Hospital pointed out that “well-dying” is not being adequately realized, noting that diseases for which hospice palliative care is available are limited. According to the National Cancer Center, only 23 percent of cancer deaths in 2020 used hospice palliative care institutions, 6 percent of the total deaths.
“The inequality in well-dying is a serious human rights violation,” Yoon said. “More and more people are seeking physician-assisted suicide. As of 2022, 117 Koreans had registered with Dignitas, a Swiss nonprofit organization that provides physician-assisted suicide services, the most among Asian countries.”
Most Koreans approve of physician-assisted suicide, and nearly half of doctors are also joining in.
“According to a survey by KBS, the Seoul Shinmun, and Kstat Research released Wednesday, 81 percent of people, 51 percent of lawmakers, and 50 percent of doctors were in favor of physician-assisted suicide,” Yoon said. “The Korean Medical Association has been opposing it, but it needs to take a stand after conducting research.”
He also maintained that Korea should expand the well-dying options of terminally ill patients by simultaneously legislating physician-assisted suicide and expanding hospice palliative care, adding that a policy shift is needed to spread a culture of well-dying.
“According to a study in Belgium, 74 percent of patients executing physician-assisted suicide used palliative care before the end of life. In the U.S. states of Oregon and Washington, 76 percent of patients used hospice before physician-assisted suicide,” the professor said. “Physician-assisted suicide and hospice palliative care can work together.”
He went on to say, “We can use the money saved from physician-assisted suicide and hospice palliative care as a fund to expand the culture of well-being. We should also strengthen the right to self-determination by recognizing health insurance coverage for advance directives and obligating hospitals to confirm advance directives.”
‘Some may choose physician-assisted suicide due to financial burden’
On the other hand, Dr. Kim Yuly, a professor of biography and bioethics at the University of Tokyo, argued that it might be challenging to promote physician-assisted suicide and hospice palliative care if foreign examples are any guide.
“According to a study published in 2011, a university hospital in Geneva, Switzerland, reduced the number of palliative care doctors from two to 1.5 after allowing physician-assisted suicide,” Kim said. “Providing palliative care requires commitment and effort from clinicians. However, when physician-assisted suicide is perceived as an easy solution, it can make providing palliative care difficult.”
If physician-assisted suicide becomes an option for patients, insurance may cover it. In that case, the cost of dying by assisted suicide would be less than that of hospitalized care, Dr. Kim said. Some patients may have no choice but to choose assisted suicide over treatment. There are ethical as well as economic issues to consider, she added.
Even if physician-assisted suicide is introduced, only a small number of doctors will likely perform it, making it difficult for terminally ill patients to receive timely service.
“When we asked U.S. physicians, 49 percent approved of physician-assisted suicide as a valid medical option, but only 9 percent said they would perform it unconditionally,” Dr. Kim said. “If it is introduced and only a small number of physicians perform it, there could be a waiting list. It would not differ from the current medical situation where people flock to large hospitals to find a doctor.”
She went on to say, “In Korea, where medical facilities and financial support for terminally ill patients are insufficient, should physician-assisted suicide be an option? It is necessary to alleviate patients’ suffering and ensure their quality of life. Still, there is no reason why it should only be physician-assisted suicide.”
Lawmaker will ‘institutionalize palliative care infrastructure if bill passes’
Lee Jeong-hyo, an aide to Rep. Ahn Kyu-baek who proposed the bill (on hospice, palliative care, and terminally ill patients’ decision on life-sustaining care), said the amendment seeks to make the physician-assisted suicide and hospice palliative care systems function complementarily.
“The bill limits eligibility to those who are terminally ill, experiencing unacceptable suffering, and wishing to request physician-assisted suicide with their own will,” Lee said. “f they do not meet the requirements, they can be referred to hospice palliative care. If the bill is passed in the future, we will supplement it institutionally, including investment in hospice palliative care infrastructure.”
He went on to say, “As the Korean healthcare system is one of the best in the world, the medical community will be able to prepare for this by developing relevant guidelines and protocols while strengthening cooperation among medical professionals. We will also work together.”