Korea still at the start of the road to dying well

Four years ago, Korea passed the Life Sustaining Treatment Determination Act, known as the Death With Dignity Law. It was a breakthrough and more than a million Koreans have since signed documents telling their families how they feel about life-sustaining treatments -- and when to cut them off.

But it is still illegal for even the sickest Korean to take their own life, even if there is no possibility of recovery and death is imminent.

Kim Kyung-tae, 42, suffers from Complex Regional Pain Syndrome (CPRS), an enigmatic and sometimes fatal condition. Kim recently joined Dignitas, a Swiss organization that helps fatally ill people commit suicide. He is one of 104 Koreans who have joined Dignitas, a number that has doubled since 2019. Kim fears that he may want to end his own life someday, and won't be able to. He hopes his membership in Dignitas will convince his family and friends to let him go -- if that's what he chooses.

Switzerland legalized assisted suicide in 1942, whereby a patient can inject or take a drug himself with the help of a doctor. This is different from “passive euthanasia,” which stops life-sustaining treatment such as nutritional supply -- now allowed in Korea -- or “active euthanasia,” where drugs are injected by a doctor to relieve the pain of critically ill patients nearing death.

A total of 3,460 people died through assisted suicide with the help of Dignitas in Switzerland since 1998, including foreigners. Last year, 212 people died with its help. With other organizations also providing assisted suicide, the total number of deaths by assisted suicide in Switzerland is estimated to be even larger.

Here is the story of one man who traveled to Switzerland to end his life the way he wished to:

Last August, a Korean-Australian, who didn't want be named for his family's sake, made the decision to end his life with the help of a Swiss organization called Pegasos. He had been diagnosed with terminal lung cancer. The doctors told him he had only three months to live. Those three months were already up.

He had been an avid reader and literature lover throughout his life. He contacted one of the authors whose books he had enjoyed reading, Shin Ayoun, who had lived in Australia for over 20 years. He wanted Shin to accompany him to Switzerland. “He wanted to be remembered, just like the rest of us,” Shin said.

“I don't recall how he got in contact with me at first,” Shin told the Korea JoongAng Daily. “I was surprised at how fit he seemed to be. He had lived a very full life. Always giving to everyone else, always caring.”

They met for the first time on Aug. 24, 2021, in Basel.

“He was unbelievably calm, like nothing was wrong. His calmness came as a shock.”

He hosted a small get-together for the friends and family who accompanied him to Switzerland the night he arrived, drinking wine and talking about life.

"Whenever he would mention what was about to happen, my heart would sink," Shin recalled. "We had all traveled there to dissuade him from his decision. But we couldn’t. He said he wanted to end his life as if he was having a last party."

“Each of us would take turns going to the bathroom to cry,” said Shin. “Each of us tried to persuade him against his decision.”

On the second day after their arrival, he met with doctors. He joked that the Grim Reaper had come for him. He told Shin that she should write “words for others,” and that he would be thankful if his story could be told through her writing.

“That’s why I am writing my new book,” said Shin. “But I want it to be made clear that I am not advocating assisted suicide or euthanasia in any way. On the contrary, I want to tell readers that this is something you shouldn’t go ahead with. I plan to write my book as if I am a war reporter, to tell what it was like being in that room, being beside him.” Shin said that she has become religious since the trip to Switzerland.

Around ten in the morning on the last day, he gave out presents to his relatives and friends and said his goodbyes. His relatives, who had resisted his idea for more than a year, seemed to be resigned to what was about to happen.

“This is just like getting an endoscopy,” he joked, "although at the end of an endoscopy you wake up and go home."

In the afternoon, he was accompanied by his relatives and friends to the headquarters of Pegasos. They huddled around the bed as the doctors came in and started preparations. An IV was put in his vein, connected to a device to release fatal drugs.

“He pressed the button before the doctors even finished explaining the procedure,” remembered Shin. “He went smiling ever so faintly.”

How tolerant a society is of assisted suicide varies from country to country.

In Korea, the 2018 Death with Dignity law allows for life-sustaining treatment to be stopped through an agreement between family members or a written “advanced directive” by a patient who will not recover from an illness. As of last February, 1,210,953 people had written such advanced directives, and there were more than 200,000 cases of suspension or reservation of life-sustaining treatment since the law passed.

In a Ministry of Health and Welfare survey last year of 9,930 people over the age of 65, 85.6 percent said they were against the idea of life-sustaining treatment. Furthermore, 90.5 percent agreed that it was important to die without physical and mental pain.

But death with dignity or “dying well” are not precise terms. Experts in Korea say it's time for this society to think about the issue together, especially as it becomes a “super-aged society,” in which more than 20 percent of a population is above 65.

“Korea’s situation is mirrored by that of Japan,” said Dr. Heo Dae-seog, a professor emeritus at Seoul National University’s School of Medicine, who took an active role in passing the Life Sustaining Treatment Determination Act.

“And with such a super-aged society, the matter of dying well becomes even more pertinent. Over 50 percent of people aged over 85 cannot look after themselves. Extended life becomes a period of suffering. We as a society need to discuss this deeply, and figure out what is best for patients and the elderly.”

Such discussions are slowly taking place. Kang Won-nam, Director of the Good Death Well-Dying Institute in Korea, told the Korea JoongAng Daily that conversations on death and dying well have been more open recently despite a cultural hesitancy on the subject. “The elderly who participate in our institute’s classes say that they want to realize the value of life through dying well,” Kang said. “They also want the younger generation to join discussions on death and dying well.”

“Since our society has not thought too much about death, it is a discussion that needs much attention and investment in general,” said Jeong Ik-joong, a professor of social welfare at Ewha Women’s University. “If assisted suicide or euthanasia are introduced too quickly, it can become an uneven situation where it appears as if those options are the only answers.”

Heo agrees. “We have to start by amending current laws such as the Life Sustaining Treatment Determination Act and go from there,” he said. “The closest model we have when it comes to assisted suicide and euthanasia is Taiwan, and it took them nearly 20 years to amend their laws. Much social discussion and agreement will need to precede any change.”

BY YUN HYE-IN, LIM JEONGWON [lim.jeongwon@joongang.co.kr]