Dying well doesn't come easy in Korea

Mr. Chun's father was diagnosed with Alzheimer's Disease in 2011 and grade 5 dementia in 2014. He lives in a nursing hospital.

There is not much hope.

“It’s difficult to even see my father as a human being now," says Chun, 55. "What is the meaning of all this medical treatment if it barely keeps him alive? He’s not conscious most of the time, and even when he is, he cannot recognize his family or talk.

“I think euthanasia is necessary in such a hopeless and protracted situation. When he still has consciousness, he should have the right to decide the end of his life. Not just for us, but for himself too.”

Korea has become a super-aged society since the late 2010s, which means more than 20 percent of its population is above 65. In a super-aged society, the right to willingly end one’s life gains greater meaning for a lot of the population. Many are demanding the legalization of doctor-assisted suicide or even euthanasia.

On June 15, a bill that would allow doctor-assisted suicide was introduced in the National Assembly. The following day, the Senior Union and My Last Donation Club, made up of senior citizens in their 70s, demanded the legalization of euthanasia.

According to a survey led by Professor Yoon Young-ho and his research team from the Department of Family Medicine at Seoul National University Hospital, three out of four respondents were in favor of the legalization of euthanasia and doctor-assisted suicide. Some 61.9 percent strongly agreed with those ideas, 14.4 percent agreed and 21.7 percent disagreed.

That approval rate was almost double that of a 2016 survey, which showed a 41.4 percent approval rate.

“Number of deaths is expected to increase over the years, to 350,000 in 2025 and 500,000 in 2040,” says Professor Yoon. “But the quality of death has significantly decreased over the years to the point where it is difficult for both the patient and the family to bear.

"Even though life expectancy has increased to 83.5 years, the healthy life expectancy remains at only 66.3 years, which means many live with bad physical health for around 17 years.

"The demand for legislation on euthanasia and doctor-assisted suicide will grow."

The World Health Organization (WHO) defines a “dignified” death as one in which “patients, their families and their caregivers are freed from physical and mental suffering, their wishes are respected, and treatment meets clinical, cultural and ethical standards.”

Of the 300,000 annual deaths in South Korea, more than 80 percent are people who die in hospitals or nursing homes, often after treatment that goes on for too long. It is not uncommon for unconscious patients to receive life-sustaining treatment or for terminally-ill patients to go through months of pain before dying.

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.

In Korea, the 2018 Death with Dignity law allowed 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.

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.

Opinions on euthanasia and doctor-assisted suicide are sharply divided.

Though many believe it is an individual right, others argue it is undemocratic for the state to make a decision on the death of an individual. Some also point out that hospitals, families and patients are bound to abuse this right.

“Some patients could choose death purely due to the burden of medical expenses,” said Shin Hyun-ho, a lawyer practicing in Seoul.

“If self-harm and suicide become legalized, the value of life, which is the foundation of a society, may be shaken,” said Father Park Eun-ho, head of the Catholic Bioethics Institute.

However, all experts agree that a social and institutional infrastructure to aid people to a peaceful, dignified death is needed.

Experts mention hospice and palliative care often. They are a type of health care that center around the alleviation of a terminally-ill patient’s pain and symptoms, prioritizing the patient’s comfort and quality of life rather than the prolonging of life.

But hospice and palliative care is a relatively new concept in the Korean health care system. As of now, there are fewer than 1,500 hospice beds in use, compared to the 80,000 yearly deaths by cancer patients.

Many patients have said that their desired place of death is the house they lived in, a comfortable place with the people closest to them. With home hospice or palliative care, patients can focus on improving their quality of life, rather than clinging to meaningless treatment.

It is a common misconception that hospice and palliative care will be expensive, but that is not the case. In July 2015, the government started applying health insurance to hospice admissions for terminal cancer patients. Many health insurance companies have included home hospice services, reducing the cost to 18,000 - 23,000 won per day.

“Even if only 20 percent of terminal cancer patients stop life-sustaining treatments, about 80 billion won in health insurance can be saved each year. This money could be invested into the establishment of a “dying-well culture,” where a social infrastructure to lead people to dignified deaths is created,” says Professor Yoon.

“I think it is too early to introduce euthanasia and physician-assisted suicide in Korea," he continues. "One priority is to find a way to alleviate the physical pain and financial burden that makes you want to die. Then the number of people who dare to give up their lives will be greatly reduced. However, if there are people who cannot tolerate the pain and want rest, then is the time to truly discuss euthanasia and doctor-assisted suicide.”

BY KIM CHANG-WOO YUN HYE-IN [kjdnational@joongang.co.kr]