State agency presents 7 principles on ‘good death’ for general public

The National Evidence-based Healthcare Collaborating Agency (NECA) has presented seven principles for “good death,” drawing public attention.

The principles center on establishing a mid-to-long-term healthcare system and changing social and cultural awareness through the “NECA Resonance,” a roundtable meeting with experts from various walks of society.

NECA announced seven principles and 16 key points for “good death” in Korean society at the NECA Resonance of the 2024 Roundtable, where various stakeholders shared opinions and deliberated on issues and problems in the healthcare area.

The number of deaths in Korea has exceeded the number of births since 2020 due to a declining birthrate and an aging population. With 80 percent of Koreans in favor of euthanasia and assisted dying, there is a growing interest in the quality of death. Korea has seen a decrease in unnecessary life-saving treatments since the “Act on Hospice, Palliative Care and End-of-Life Decisions for Patients in the Dying Process” in 2018. However, discussions are still ongoing in areas that need improvement.

Against this backdrop, NECA organized a roundtable discussion on “Social Issues Surrounding Dignified Dying” to gather opinions from experts working in various areas and fields, including general hospitals, nursing hospitals, home healthcare, and visiting nurses, as well as experts in related fields, such as law, bioethics, and the media.

The roundtable also emphasized the importance of changing the perception toward “death needing preparations” and that integrated and value-centered care is needed at the end of life beyond the fragmented and technology-driven medical approach.

It was also suggested that mid- to long-term and continuous efforts are needed to improve the quality of end-of-life care.

Based on the roundtable discussions, the participants drafted a consensus statement that outlines the basic principles for realizing a good death in our society and the key actions needed at the end of life to ensure that patients, families, and the public embrace them.

The seven guiding principles for a good death are:

● Provide person-centered end-of-life care.

● Plan for end-of-life care in advance.

● Ensure patients' right to self-determination.

● Provide holistic and integrated end-of-life care.

● Prioritize patients’ comfort.

● Respect patients' needs and preferences at the end of life.

● Strengthen national investment in quality end-of-life care.

Along with these seven principles are 16 key points to consider under each principle.

In Principle 1 of “Provide person-centered end-of-life care,” the experts emphasized that end-of-life care services should be value-based rather than technology-based and that end-of-life care conversations should center on patients and families.

In Principle 2 of “Plan for end-of-life care in advance,” they stressed the importance of identifying people who need end-of-life care services and developing advance care plans once they are identified as candidates for end-of-life care.

In Principle 3 of “Ensure patients’ right to self-determination,” they called for healthcare providers and patients to make important decisions together, prioritizing patient input and providing patients and families with easy-to-understand information.

In Principle 4 of “Provide holistic and integrated end-of-life care,” they called for the patient-centered integration of medical and social resources for the provision of end-of-life care services, the establishment of multidisciplinary care partnerships involving skilled professionals, and the creation of systems to improve the quality of end-of-life care.

In Principle 5 of “Prioritize patients’ comfort,” they emphasized that end-of-life care should not burden the patient.

In Principle 6 of “Respect patients' needs and preferences at the end of life,” the participants emphasized the importance of creating a patient-centered end-of-life environment that involves patients and families and providing grief support for families after a death.

Finally, in Principle 7 of “Strengthen national investments in quality end-of-life care,” they emphasized the need to improve access to end-of-life care services, develop laws and institutions to ensure a good death, establish governance to integrate end-of-life care planning and implementation and spread awareness that dying is part of life.

“At a time when our society is entering into an era of numerous deaths, it is very meaningful to share opinions on good death and suggest directions for improving the system,” NECA President Lee Jae-tae said. “As a national research institute, NECA will continue to provide a forum for public discussion of issues in the healthcare field with various stakeholders and contribute to rational policy-making and the provision of correct information.”