New bill aims to advance end-of-life decision making to terminal stage

A law has been proposed to advance the decision to stop life-sustaining treatment and its implementation from patients’ dying days to the terminal stage.

Rep. Nam In-soon of the Democratic Party of Korea, a member of the National Assembly's Health and Welfare Committee, said Thursday that she has proposed an amendment to the Act on End-of-Life Decisions for Patients in Hospice, Palliative Care and the Dying Process.

The amendment removes the distinction between dying and terminally ill patients and allows terminally ill patients to implement decisions, including those on withdrawing life-sustaining treatment.

The current law categorizes people who are close to death as dying patients and those who are expected to die within a few months as terminally ill. It stipulates that decisions, such as the withdrawal of life-sustaining treatment, can be made only for patients who are in the process of dying.

However, medical professionals have pointed out difficulties distinguishing and judging the terminal and dying phases in implementing the end-of-life decision-making system in the medical field.

Among major OECD countries with end-of-life decision-making systems, South Korea is the only country limiting its implementation scope to the end of life.

Since the implementation of the system in February 2018, the number of advance directives has increased due to changes in social awareness. However, experts have argued that patients' right to self-determination still needs improvement. The number of people registering advance directives increased from 530,000 in 2019 to 1 million in August 2021 and more than 2 million in October 2023.

"There is a problem that the process of making and implementing decisions, such as withdrawal of life-sustaining treatment, is carried out at the end of life. Therefore, we want to improve the system by extending it to the terminal stage so that patients can make their decisions with sufficient time for deliberation," Rep. Nam said. "We are pushing for the revision of the End-of-Life Decision Act to strengthen patients' self-determination rights and ensure their best interests, including their dignity and value as human beings."

The DPK lawmaker continued, "Korea is expected to enter a superaged society next year, with the share of older adults exceeding 20 percent of the total population. It is an urgent task to create an environment where people can realize their right to self-determination and a dignified end of life in response to the ultra-elderly society."