Top court upholds ‘die with dignity’ right
The Supreme Court upheld earlier lower court rulings yesterday that doctors should remove an artificial respirator from a comatose patient based on her presumed wishes. By Cho Mun-gyu
The 13-member panel of the nation’s highest court announced its decision at 2 p.m., ending a year-long battle between Yonsei University’s Severance Hospital and the patient’s family. The 76-year-old patient’s children had sought to have the artificial respirator keeping her alive removed, arguing that she would not have wanted a pointless life to continue.
The Supreme Court upheld earlier lower court decisions that the hospital should unplug the respirator based on the presumed will of the patient.
“When a patient has no possibility of regaining consciousness and bodily functions critical to maintaining life are unrecoverable, and when it is clear that the patient will soon die, we can say that the patient has entered the irreversible stage of death,” the Supreme Court said in the ruling. “For such a patient, ending life-sustaining treatment in respect to the patient’s will is in line with the societal norms of protecting human dignity and the right to happiness. It also does not violate the spirit of the Constitution.”
The court said a patient can make such a decision through advance directives, but it is also possible to end life-sustaining treatment based on the patient’s presumed will.
The court said all possible data - including the patient’s opinions made to friends and family throughout a lifetime, the patient’s age and the patient’s reaction to other people’s life-sustaining treatment - should be considered in determining presumed wishes.
Four of the 13 justices opposed the majority opinion. Citing the doctors’ opinions that the patient has four months to live or more, the dissenters said it is premature to say that she had entered the irreversible stage of death.
Shortly after the ruling, the family of the patient issued a statement through their lawyers, demanding the hospital remove the artificial respirator immediately.
“This was a lawsuit to respect the patient’s presumed intention because she had fallen into an unrecoverable state due to an unexpected medical accident, and to let her die peacefully,” the statement said. “This was a lawsuit about the right to choose medical care, not to actively demand the right to die.”
The family said they have suffered for a significant time because the hospital refused to stop medical treatment. “The Supreme Court has made the final ruling on this matter, so we urge Severance Hospital to immediately follow the order.”
Despite the family’s demand, Severance Hospital still showed some reservations. “Although the patient is dependent on the artificial respirator due to brain damage, she reacts to pain and her blood pressure is stable. She also shows no rejection to the feeding tube, so we have a different opinion from the Supreme Court’s ruling that she has entered the clear stage of death,” said Park Chang-il, the head of Severance Hospital. “However, we will discuss ways to accept the court’s decision.”
Park said doctors will unplug the artificial respirator only after sufficient discussion with the family and the hospital’s ethics board.
He also urged the National Assembly to establish a law governing “dying with dignity” based on the Supreme Court precedent and public opinion.
After the patient fell into a coma in February 2008 following bleeding during a lung biopsy, her children asked the Seoul Western District Court to grant them legal permission to stop the medical treatment that was keeping her alive.
The district court ruled that doctors could unplug the patient’s respirator. At the time, the court made clear that it was not granting the children’s request, but was instead ruling based on the presumed will of the patient. The hospital challenged the ruling, and the case was appealed at the Seoul High Court. Even after the high court supported the end-of-life decision, the hospital took the case to the Supreme Court.
Because of the sensitivity of the matter in Korean society, all the Supreme Court’s 13 judges reviewed the case. The top court decided that the ruling must be made while the patient is still alive, and the trial proceeded quickly. The court’s ruling came only 80 days after the appeal was made.
In a press release, the Supreme Court said yesterday’s ruling was made based on the constitutional spirit that human dignity must be maintained based on the free will of a patient even at the last stage of life. The court said the ruling is particularly important because it was the first ever legal interpretation of the current law to respect changed awareness about end-of-life decisions.
“It is also meaningful as the precedent has delineated the requirement to stop life-sustaining treatment at hospitals,” the court said, noting that it believes the ruling will play an important role in resolving future debates on end-of-life decisions.
“The ruling is very meaningful because it showed that a patient can be the main decision maker for the medical treatment that he or she is receiving,” said Shin Hyeon-ho, a lawyer representing the family. “Until now, doctors have decided all treatment methods.”
The Korea Medical Association issued a statement yesterday welcoming the Supreme Court ruling. “The decision is important because the Supreme Court allowed the life-sustaining treatment for a hopeless patient to end based on medical judgment and in respect to the patient’s right to choose to die with dignity,” the doctors’ group said.
The doctors’ group warned against possible abuse of end-of-life decisions due to economic reasons. “The government must create a system to provide life-sustaining treatment for patients who may be tempted to make the decision because medical care is too costly,” said Jwa Hun-jeong, spokesman for the association.
By Ser Myo-ja [myoja@joongang.co.kr]
with the Korea JoongAng Daily
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