Life-sustaining treatment withdrawal is no longer a distant or unfamiliar issue in Korea.

According to data submitted by the Ministry of Health and Welfare and the 2024 annual report on life-sustaining treatment decisions published by the Korea National Institute for Bioethics Policy, Rep. Seo Young-seok of the Democratic Party of Korea revealed that nearly 450,000 cases of life-sustaining treatment withdrawal have been recorded since the system took effect in 2018.

Yet, only half of these decisions were made directly by patients themselves.

The number of withdrawals has climbed sharply each year, reaching 70,061 cases in 2024 alone. This represented a slight decline of 0.9 percent compared to 2023, but by August 2025 the cumulative total neared 450,000, underscoring how quickly the system has become embedded in Korean society.

Pre-registration for advance directives has also grown steadily. As of August 2025, more than 3 million individuals had registered, with 332,834 new registrations that year alone. Institutions authorized to handle advance directives expanded from 686 in 2023 to 760 in 2024, an increase of 10.8 percent.

The life-sustaining treatment decision system is composed of several documents -- advance directives written by healthy adults, life-sustaining treatment plans drafted by terminally ill patients, and family statements submitted when patients cannot express their wishes.

Despite the system’s intent to respect autonomy, statistics show that decisions still often fall to family members.

In 2018, the first year of implementation, only 32.4 percent of withdrawals were based on patients’ own decisions.

“That figure rose to 50.8 percent in 2024, but this means that one out of every two cases is still decided by families rather than patients themselves,” the lawmaker said. “This reality highlights ongoing limitations in achieving the system’s central goal of protecting self-determination.”

Korea has entered a super-aged society, and questions about how to conclude life with dignity are growing more important, he added.

Seo said that the steady increase in life-sustaining treatment withdrawals shows that awareness of good death is spreading, but too many people still remain unaware of the advance directive system.”

Seo concluded that the government must step up efforts to raise awareness and improve access, so that everyone can choose for themselves until the very end.

“Beyond ensuring a dignified death, these choices should also lead to a better quality of life,” he said.