End-of-life care new focus in aging Korea

When the cherry blossoms began to bloom, the 45-year-old Kim Chang-ho (a pseudonym), hospitalized for late-stage pancreatic cancer, said, “After leaving the hospital, I’ll go home.”

The medical team shook their heads. Suspending the treatment would result in septicemia and would place his life at risk. A few days later, he pleaded, “I have to leave because I made a promise with my two sons to go camping on Children’s Day with them.”

In a compromise, Kim was relocated to a hospice ward instead and planned to have a picnic at the Children’s Grand Park in Seoul with his two sons. However, his health took a turn for the worse. “If I can’t go on a picnic, I want to at least give Legos to my young one,” Kim said.

Kim did not have enough time. Before his child came, he passed away. “Dad, didn’t you forget my present?” the child said as he held his father’s still warm body. A nun at the hospice presented the gift in Kim’s stead.

“Young children usually have their eyes on the present, but the child was strangely holding onto his dad’s hand,” said Ra Jeong-ran, a sister at the Catholic University of Korea Seoul St. Mary’s Hospital hospice’s palliative care center. “The deceased’s expression lit up. They say immediately after the heart stops beating, one’s sense of hearing is still active, after I saw how his expression changed, I felt there was a spiritual connection between the father and the son.”

Ra added, “If he had suspended his life-prolonging treatment, could he have gone camping with his son?”

There is growing interest in rejecting life-prolonging treatments and opting to die while spending one’s last moments with one’s family. In 2009, the Grandmother Kim case, which involved Shin Hyeon-ho, lawyer at Shin & Partners, centered on the family of Kim, who requested the suspension of her life support only to face refusal by the medical staff, resulting in a debate in Korean society over the distinction between “death-support” and “life-support.”

“Due to our aging society,” Shin said, “end-of-life care has become more prominent. There is a new value in dying while preserving one’s dignity and their identity in life.”

“Forcefully extending one’s life contrary to one’s wishes is the biggest affront,” said British astrophysicist Stephen Hawking.

When hooked up to a respirator, one cannot eat or speak. In the ICU, patients cannot meet their family and there are numerous cases of people giving their farewells at the door.

“One person’s death transforms those people around them,” said Ra. “Before passing, reconciliation often happens with the family. There are many instances of patients being mentally, physically and financially drained while engaging in useless life support.”

According to the 2014 Survey on the Elderly from the Korea Institute for Health and Social Affairs, 88.9 percent of senior adults are against life-prolonging treatment.

Reflecting public opinion, the Well-dying Act for the terminally ill, giving individuals the right to reject life-prolonging treatment, palliative care and end-of-life care will take effect in a year. The act will allow patients who have no possibility of recovery to choose personally or with their family’s consent whether to reject such treatment.

However, there are several flaws in the law. Yun Young-ho, head of the Smart Management Strategy for Health laboratory at Seoul National University Hospital, said, “The law is limited to four illnesses and I expect there to be a mess with shortages with hospice facilities.” So far, the utilization of hospices by Koreans is 13.8 percent compared to 43 percent in America and 95 percent in Britain. The ambiguity on the regulation of “terminal state” is also of concern.

There are a number of issues that must be resolved when it comes to national life-prolonging services, such as drawing up advanced directives like living wills, creating clinical practice guidelines and resolving insufficiencies in facilities.

One medical practitioner said, “While the Well-dying Act gives the right to refuse to terminally ill patients, I will not give the right to refuse to those who require life prolonging treatment.”

The Huffington Post reported that 18 Koreans have applied to join Dignitas, a Swiss non-profit for assisted dying. Unlike passive euthanasia by unplugging life support, the patient receives a prescription from a doctor and engages in assisted dying by dosing themselves. Some believe assisted dying remains in the far future for Korea, yet Korea has the highest number of those who applied for assisted dying among Asian countries, with Japan at 17, Thailand at 10 and China at seven.

Questioned on Dignitas, Kim Jun-gyu, a medical student at Sunkyunkwan University, Kim said, “I see suffering from hopeless life-prolonging treatment for the patient and their family as no different from hell … assisted suicide is necessary for those who definitely need it.”

Park Hyeong-uk, medical ethics professor at Dankook University said, “In the long-term, I may agree, however, public opinion in [Korea] means acceptance will be difficult. Even suspending life prolonging treatment was a conservative and very limited legislative attempt.”

BY SUNG HO-JUN [hwang.hosub@joongang.co.kr]