3,000 South Koreans opting to 'die well'

An elderly woman sits inside a small store at a village in South Korea.
An elderly woman sits inside a small store at a village in South Korea. PHOTO: REUTERS

They opt to forgo treatment when incurably ill, ahead of new law

More than 3,000 people have signed papers to forgo artificial life-extending treatment when they become incurably ill, in a pilot programme leading up to South Korea's first "dying well" law.

The Bill, passed in Parliament early this year after nearly two decades of debate, will go into effect in February.

The trial, which started on Oct 23 after months of preparation for end-of-life care, will allow the authorities and hospitals to test public reaction and check what measures are lacking, said Vice-Minister of Health Kwon Deok Cheol.

"We will respect a patient's will to die with dignity and do our best to guarantee the patient's well-being," he said in a statement.

At least seven people who joined the trial, conducted over three months at 13 hospitals around the country, have since died.

The first is a man in his 50s, who died of gastrointestinal cancer last month. He had signed a Physician Order for Life-Sustaining Treatment, which allowed him to reject four life-prolonging treatments - cardiopulmonary resuscitation, kidney dialysis, mechanical ventilation and cancer medication.

  • TOP KILLERS

    #1  CANCER accounting for 27.8% of all deaths.

    #2 HEART-RELATED DISEASES make up 10.6%.

    #3 NEUROLOGICAL ILLNESSES make up 8.3%.

Death is a taboo subject in South Korea's Confucian society, which values respect for the elderly and caring for aged parents.

The dying well law has been hotly debated 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.

Attitudes started shifting as the country tackled problems arising from a fast-ageing society and increasing elderly suicide rates.

A 2009 landmark ruling by the Supreme Court for a hospital to respect a family's wish to remove life support for a 76-year-old comatose woman paved the way for a dying well movement in the country.

  • Laws elsewhere

  • Assisted dying is legal in several countries and states in the US. There are also nations that allow terminally-ill patients to reject life-prolonging treatments. Here are some examples:

    OREGON, UNITED STATES: Oregon passed its Death with Dignity Act in 1994 - the first in the world. Since 1997, terminally-ill patients with six months left to live have been allowed to end their life through voluntary administration of lethal drugs prescribed by doctors.

    SINGAPORE: Singapore passed the Advance Medical Directive Act in 1996, allowing people to sign a legal document in advance to indicate they do not want any life-sustaining treatment when they become terminally ill.

    TAIWAN: Dying with dignity became a legal option in Taiwan in 2000 when a Bill was passed to allow terminally-ill patients to reject medication or treatment that they think would only prolong their pain. In 2011, close relatives of such patients were given the right to decide whether to remove life support, a move the Health Department said was aimed at preventing unnecessary suffering.

    THE NETHERLANDS: It legalised euthanasia and assisted suicide in 2002. But there are stringent conditions, like the patient must be stricken with an incurable disease, suffering unbearable pain and fully conscious when requesting death. VICTORIA, AUSTRALIA: The state will allow voluntary assisted dying from June 2019, after a landmark Bill was passed last month. The law, which passed by 22 to 18 votes despite opponents trying to defer the motion indefinitely, will allow incurably-ill patients to ask for a lethal drug after clearing two independent medical reviews.

    Chang May Choon

Surveys have shown that over 80 to 90 per cent of South Koreans do not want to receive life-prolonging treatment if they know they are beyond hope of recovery.

Cancer is the top cause of death in South Korea. More than 78,000 people died of it last year, accounting for 27.8 per cent of total deaths, according to Statistics Korea.

Heart-related diseases are second (10.6 per cent), followed by neurological illnesses (8.3 per cent).

The dying well law was passed on Jan 8, despite criticism from civic and religious groups which said it is immoral. A similar legislation was passed in Singapore in 1996, and in Taiwan in 2000.

Pathology professor Yu Eun Sil of Seoul's Asan Medical Centre, who has written books about how to die well, said South Koreans should start opening up about the topic of death. In interviews with local media, she voiced hopes that the law can spark more discussion.

Dr Lee Dong Hyoun from Kangbuk Samsung Hospital told The Sunday Times that the new law would "allow patients to make choices about their life and prevent excessive medical spending".

But he warned of difficulties faced by doctors in deciding on the right time to stop treatment, and said that legal protection should be provided for medical staff, in case of disputes with family members.

The new law requires two doctors to make the decision, but some doctors think that stopping treatment at any stage is morally wrong.

For relocation agent Kim Jung Pil, 52, the new law is a welcome move as she grapples with the care of her elderly in-laws. Medical bills for her 83-year-old mother-in-law, who has dementia and diabetes and is staying in a hospice, cost the family more than 30 million won (S$37,000) a year.

"Hospitals are making money out of prolonging old people's suffering," she told The Sunday Times.

"My father-in-law has already said he does not want to spend money extending his life if it's such poor quality, and I also don't want to be a burden to my family when my time comes. I'd rather die with dignity than to suffer."

A version of this article appeared in the print edition of The Sunday Times on December 17, 2017, with the headline '3,000 South Koreans opting to 'die well''. Print Edition | Subscribe