Guidelines detail end-of-life terms

Following years of public discussion on how to ensure terminally ill patients live their last moments with dignity, the Ministry of Health and Welfare yesterday unveiled the first draft of its “death with dignity” guidelines, which was drawn up in collaboration with Seoul’s Yonsei University’s Medical and Bio Ethics Committee.

Under the proposal, which was announced at a public hearing at the university, the government is seeking to allow terminally ill patients to forgo life-sustaining medical care in the event that they sign an “advanced directive,” which indicates that treatment will be withdrawn when there is no chance of recovery.

The guidelines also said that even without an advanced directive, life-sustaining procedures can be stopped if more than two members of the family confirm that the patient preferred to waive his or her end-of-life treatment. In such a case, the consent of two doctors would also be necessary.

The ethics committee said the newly announced guidelines are different from existing practices because they mandate that medical staff give the highest consideration to patients’ wishes, rather than the opinions of family members or attending doctors.

The Yonsei panel also proposed that hospitals operate an ethics committee to determine the withdrawal of the life-sustaining equipment, and asked the government to provide subsidies for the operation of these committees.

With an advanced directive from the patient and an agreement from two doctors, a decision to suspend life-sustaining care can be made, the committee said. Such treatments include artificial respiration, CPR, blood filtration and the use of anti-cancer drugs.

The committee added that if a person destroys an advanced directive without consent from a patient, he or she could be sentenced up to five years in prison or ordered to pay a fine up to 20 million won ($18,840).

Yet, it remains to be seen whether the “death with dignity” guidelines announced yesterday will become law, as some civic and religious groups have objected to allowing family members or medical staff to make decisions regarding end-of-life care on behalf of terminally ill patients.

Some religious groups oppose the withdrawal of end-of-life care, saying it devalues human life. Because there is no law stipulating standards for life-sustaining treatments or procedures, some hospitals have set their own regulations on such medical service, with different criteria for these cases.

For instance, Seoul National University Hospital considers cardiopulmonary resuscitation and hemodialysis as end-of-life treatments that patients can refuse.

“[These guidelines are] a turning point for Korean society to recognize the need to institutionalize and set standards on end-of-life procedures,” said Sohn Myung-sei, dean of the Graduate School of Public Health at Yonsei University.

BY KANG JIN-KYU [jkkang2@joongang.co.kr]