[Viewpoint] Preparing for death

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[Viewpoint] Preparing for death

Korea’s society has dealt with all social and economic issues in a condensed manner. We are experiencing even the issues of life-extending treatment and death with dignity belatedly in the usual condensed way.

In 1976, the New Jersey Supreme Court accepted a right to refuse medical treatment to Karen Quinlan who had been in a vegetative state and kept alive depending on a respirator, and permitted removal of the respirator. Based on her having said to his friend that she did not want to get treatment using a respirator, the court accepted a person’s guardian talking about the person’s rights when the person could not do it on his own.

Of course, it was only on the condition that a patient’s and his guardian’s interests are not at adds. According to the ruling, the respirator was taken away from Quinlan but she did not die immediately. She kept on living for 10 more years. Many in the United States criticized the court for making a decision about a person’s life too lightly and hastily.

Fourteen years later, a Nancy Cruzan case took place. Being influenced by Quinlan’s case, the Supreme Court of Missouri did not accept ending supply of nutrition to Cruzan, citing that it was impossible to understand the patient’s opinion clearly and persuasively as a reason. As the media ran articles of her on the front pages her case became famous across the country.

Then it became known that her maiden name was Davis and people who knew her as Nancy Davis testified that she used to say she would not want to receive life-extending treatment. As reliable witnesses stepped forward, her family appealed the case that they had lost to the Supreme Court of the United States.

The Supreme Court ruled that in order to ending treatment, the patient, not her family or other people, must express her wish and thoughts clearly and persuasively. The court required a much more strict and accurate process to confirm the person’s opinions than in the case of Quinlan. The next year, Congress passed an act on patients’ right to die.

A patient’s wish must be expressed in a written or spoken form and if there is no such record an ethics council must be established in the hospital to check the patient’s wish and medical state. Thanks to Quinlan and Cruzan, the United States could have an advanced institution for a right to die.

Although our society has debate on the issue some 20 years after the United States, we have been having the debate for a year while the United States has developed it for 16 years. A woman, known as Kim, and her family filed a lawsuit through a legal representative, asking for her right to make her own decision to end life-extending treatment. It was a courageous move.

At the first trial, the court released an epoch-making ruling. The hospital formed an ethics council and in the meantime it wanted to file a lawsuit directly with the Supreme Court to get a ruling as quickly as possible. But it had to go to a High Court first. The High Court released a ruling with improved logic after a shorter period than in the first trial, leaving the final decision to the Supreme Court. The Supreme Court left the case to en banc and had a hearing. After collecting opinions by law professionals of our society, the court accepted the woman’s right to make her own decision to end life-extending treatment.

Kim lived until the ruling was complete. Even after the respirator was removed she did not pass away immediately. By continuing living, she sent us a message to expand the debate in the issue. Through her case, she is telling us to prepare the most appropriate type of death to our society.

George Bernad Shaw wrote his own epitaph “I knew if I stayed around long enough, something like this would happen.” We must not hesitate and take too long a time preparing a social institution to accept individuals’ right to die with dignity.

Koreans usually hide what they really think in ordinary times because they do not want to lose face or because they want to have good manners. But in a time of an emergency, they reveal their thoughts abruptly. Koreans’ view on death is revealed when they are diagnosed with terminal disease and hospitalized, rather than in ordinary times.

When facing a crisis of nearing death, people tend to shake off thoughts that others have infused in them, listen to their own inner voices and act accordingly. We might have an accident suddenly or get a serious disease. While we are still alive, we should imagine the moment of death, think seriously about how we want to die whom we want to be with in such moment, and write it down.

Some suggest that people should write down their wish or thoughts about death and a bill to institutionalize it is being discussed in the National Assembly.

Kim’s case is giving us an opportunity to prepare for our death. I would like to thank for such opportunity and I wish God bless Kim.

*The writer is a professor at Yonsei University Graduate School of Public Health. Translation by the JoongAng Daily staff.


by Sohn Myung-sei

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