To increase the options for hospice and life-sustaining treatment users, the government pushes to expand the target diseases and the timing to suspend end-of-life care that has been limited to patients’ dying days.

The Ministry of Health and Welfare said Tuesday that it has finalized the "Second Comprehensive Plan for Hospice and Life-Sustaining Treatment” through the National Hospice and End-of-Life Care Committee discussion.

The ministry has collected opinions through research services, on-site inspections, advisory meetings, and discussions while holding public hearings and meetings of the National Bioethics Committee since last year.

Hospice and palliative care refer to holistic treatment and care for patients and families with terminal illnesses aimed at improving the quality of life at the end of life rather than curative treatment. The decision to discontinue life-sustaining treatment is to not implement or discontinue life-sustaining treatment that only prolongs the duration of the dying process without any curative effect.

As older adults grow and social interest in the end of life increases, public demand for expanding hospice services and the end-of-life decision-making system increases, ministry officials said.

According to the first comprehensive plan, which covered from 2019 to 2023, the government made hospice a main business of specialized home-based and consultative hospice organizations. It expanded the target diseases to five, including terminal cancer.

Regarding the life-sustaining care program, it established advance directive registries in all cities, counties, and districts nationwide and expanded the number of medical institutions participating in the program by including regular nurses and expanding the public ethics committee.

The second plan envisions “a society where everyone is guaranteed a dignified end to life,” and the government has identified detailed tasks, including expanding the right to choose for users of the hospice and end-of-life decision-making system, strengthening the foundation for implementing the system, and improving and spreading awareness of it.

Specifically, the government will gradually expand the number of affected diseases to expand the right of choice for users of the hospice and end-of-life decision-making system.

It will also develop services, such as spiritual care and bereavement family programs for patients and families, and seek to institutionalize family care support for pediatric and adolescent patients.

In addition, it will rationalize end-of-life decision-making subjects and strengthen advance directive management.

Accordingly, the government will expand the timing when people can create an advance directive to start communicating with their healthcare team about end-of-life care earlier. Currently, people can complete an advance directive after they are diagnosed with a terminal illness, but the new system will allow people to do so before the end of life begins.

It will also promote social discussions on the timing of the withdrawal of life-sustaining treatment, which is currently limited to dying days, and allow organizations without a medical, institutional ethics committee to inquire about life-sustaining treatment information.

Besides, it will supplement the system by allowing the withdrawal of life-sustaining treatment in cases where the patient's intention is unknown and no family member can make the decision.

The government will increase the number of specialized hospice organizations from 188 in 2023 to 360 in 2028, and life the utilization rate of hospice patients will rise from 33 percent in 2023 to 50 percent by 2028.

Regarding the end-of-life decision-making system, the government will expand the number of medical and institutional ethics committees from 430 in 2023 to 650 in 2028 and seek an expanded balance in advance directive registries among local healthcare organizations and medical institutions.

To strengthen the foundation for implementing the hospice and end-of-life decision-making system, the government will change the staffing standard for hospice-specialized institutions from the number of beds to the number of patients to promote efficient ward operation, considering the bed utilization rate.

In addition, the government will reduce fees for home-based hospice workers to a reasonable level, improve the staffing standards for auxiliary activities, and strengthen support for hospice and end-of-life care sites by considering compensation plans for patients and families after the implementation of life-sustaining medical treatment.

According to the new plan, the government plans to improve and spread awareness of the hospice and end-of-life decision-making system, activate research, raise policy awareness through public outreach, and strengthen community linkages.

In particular, to strengthen community connections and governance, the ministry plans to provide hospice services in conjunction with community home visits and explore new service types.

"There is a growing social interest in ending one's life with dignity and comfort as much as living a healthy and happy life," said Jeon Byeong-wang, head of the ministry’s Healthcare Policy Office. "We will continue implementing this comprehensive plan so everyone can enjoy a dignified end to their lives."