New law enables South Koreans to 'die well'

The law, passed on Jan 8, has drawn support from the elderly. A recent survey showed that nine in 10 South Koreans aged 65 and older did not want treatment to extend their lives if they knew they had an incurable disease.
The law, passed on Jan 8, has drawn support from the elderly. A recent survey showed that nine in 10 South Koreans aged 65 and older did not want treatment to extend their lives if they knew they had an incurable disease.PHOTO: REUTERS

New law enables terminally ill patients to reject treatment and die with dignity

As she ages, housewife Lee Hyeon Seon, 60, is becoming more afraid of contracting some form of cancer - the number one killer in South Korea. If that happens and she becomes seriously ill, she hopes that her children will respect her wish to reject artificial life-prolonging treatment in hospital and allow her to spend her final days at home.

This way of dying with dignity, also called "well-dying" in South Korea, has been the subject of a national debate for nearly two decades, since two doctors were convicted of assisted murder and given suspended prison terms in 1997 for pulling the plug on a brain-damaged patient at the request of his wife.

Come 2018, Ms Lee will be able to indicate how she wants her life to end, when a well-dying Bill comes into effect.

The law, which allows incurably ill patients to opt out of life-prolonging treatment, was passed by the National Assembly on Jan 8, paving the way for the development of palliative and hospice care services that are lacking in the country.

This is similar to the Advance Medical Directive Act passed in Singapore in 1996. Taiwan adopted similar legislation in 2000.

  • Right to reject 4 kinds of treatment

  • South Korea's "well-dying" Bill, passed on Jan 8, will allow terminally ill patients to forgo artificial life-prolonging treatment in the last phase of their life.

    But it applies only to patients who have entered the dying process - not upon diagnosis - and have no chance of recovery. These patients will be allowed to refuse four kinds of procedures: cardiopulmonary resuscitation, mechanical ventilation, kidney dialysis and cancer treatment.

    To do so, patients must sign an Advance Medical Directive, a document indicating they do not wish to be hooked to life support machines when they are gravely ill.

    Another option is to obtain a Doctor's Order. Two doctors must sign the order and consent must also be given by the patient's family.

    The law will go into effect only in 2018. This is to allow time for the authorities to work out the details and boost medical facilities like hospices and palliative care centres, which are needed to cope with an expected surge in demand.

    First proposed in 2013, the Bill was stuck at the National Assembly for three years before it was passed.

    Chang May Choon

In South Korea, critics and religious groups have criticised the Bill, saying it can be deemed as disrespect for life and goes against Confucian values of filial piety.

There are also concerns over the potential for abuse if doctors allow patients and their family members to choose death over treatment.

But the law has drawn support from elderly folk. A survey last year showed that nine in 10 Koreans aged 65 and older did not want to receive treatment to extend their lives if they knew they were suffering from an incurable disease.

"I don't want to prolong the pain and suffering," said Ms Lee. "It's my own life. I want to make my own decision how it should end."

As she does not want to burden her two daughters, who are in their 30s, she said she intends to hire a caregiver to look after her during her last days.

Faced with a rapidly ageing population - 37 per cent by 2050 - and a high suicide rate among the elderly, the South Korean authorities have been trying to promote the concept of well-dying in recent years to encourage elderly folk to open up about a topic once deemed taboo.

Interest in courses that show seniors how to prepare for death has grown over the years. Some even stage their own mock funerals, lying in a coffin-like box to experience the end of life.

The shift in attitudes can be attributed to a 2009 landmark ruling by the Supreme Court for a hospital in Seoul to respect a family's request to remove life support for a comatose woman aged 76. The judge said that to continue treatment when there is no chance of survival can "tarnish one's dignity".

Since then, major hospitals have started allowing terminally ill patients or their family to decline life support. Various civic organisations have also sprung up in favour of well-dying and research centres set up to study the subject.

Professor Choi Joon Sik, an expert on Korean studies who also studies death, said: "The concept of death to Koreans is becoming more practical. It is even okay to mention 'well-dying' in TV programmes, which was taboo several years ago."

Prof Choi said the Bill should have been passed earlier, to help relieve the suffering and financial burden of futile medical treatments on patients.

But he warned that there is a need to address a shortage of hospices within two years, before the law comes into effect.

About 50,000 people die of terminal illnesses every year, according to official statistics. But there are only about 1,000 hospices in the country, which can cater mainly to about 14 per cent of gravely ill cancer patients.

A version of this article appeared in the print edition of The Straits Times on January 29, 2016, with the headline 'South Koreans get to 'die well''. Print Edition | Subscribe