[Editorial] Expanding the debate on dignified death

One clear certainty is that every human being dies. German philosopher Martin Heidegger defined human existence as “being towards death.” He said, “Only humanity ‘has’ the distinction of standing and facing death, because the human being is earnest about Being.” The end of life, therefore, must bear the same dignity of having lived in earnest. Death with dignity has been gaining advocacy around the world as a personal choice and virtue.

South Korea also enacted the Life-Sustaining Treatment Decisions Act five years ago. The attitude toward the end-of-life choices has changed due to greater attention on death with dignity, but there is still much room for improvement. According to the National Agency for Management of Life-Sustaining Treatment, 250,000 have chosen to discontinue life-sustaining procedures since the law took effect in February 2018. Of them, 83 percent made the decision toward the end of life based on an “agreement with their offspring” or on their family’s “assumption of the patients.”

The choice of deathbed is also controversial. 74.8 percent of the people who died last year ended their life at medical institutions, which is sharply higher than 29.1 percent in the Netherlands, 42 percent in Sweden and 43 percent in the U.S. Many would wish to die peacefully at their home and a comfortable environment, but they cannot do so due to a lack of homecare and service for treating the dead, for instance. A practical option could be including death-at-home in the insurance policy.

Dying in dignity can be challenging at institutional care facilities. When choosing to end the life-sustaining treatment, the decision needs to go through the ethics committee of a hospital. But of 1,433 nursing hospitals, 1,328 do not have such a system. People also die on their bed in a room shared by five to seven others or even in a 20-bed room. The scene cannot be deemed “well-dying.”

A consensus on death with dignity needs to be made. Patients deserve a clear explaination about the plan and scope of using life-support equipment. A social debate must start on the idea of expanding the option for terminal patients as done in developed countries to help ease the pain for the patients as well as the families.

French President Emmanuel Macron earlier this week announced his government will present a bill on the “French model of end-of-life options” by the end of summer. “Active assistance in dying” may be too premature for our society. But we can discuss measures to widen the end-of-life options. Life must be respected, but the choice to die with dignity also must be respected for humans with free will.