A dignified end, chosen in advance

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A dignified end, chosen in advance

Published: 30 Apr. 2025, 01:01

Audio report: written by reporters, read by AI

Shin Sung-sik

The author is a welfare specialist reporter at the JoongAng Ilbo.

“The Pope always said he wanted to close his eyes for the last time at home. In the end, he passed away peacefully, without pain, at home.”

So said Dr. Sergio Alfieri, Pope Francis’s personal physician. The Pope quietly passed away at his residence in the Casa Santa Marta on April 21. He did not go to the emergency room. Reports say he had long maintained a firm stance against undergoing meaningless life-prolonging treatment. “He gave clear instructions never to be intubated under any circumstances,” Alfieri added.

True to his modest lifestyle — he left behind only $100 in assets, according to Argentine media — the Pope departed this world just as humbly. His farewell calls to mind that of the late Korean Cardinals Stephen Kim Sou-hwan and Nicholas Cheong Jin-suk, both of whom refused life-sustaining treatment and donated their organs upon death.

The Vatican's camerlengo, Cardinal Kevin Joseph Farrell, right, diffuses incense next to the body of Pope Francis lies in state at St. Peters Basilica, in Vatican City on April 23. [EPA/YONHAP]

In Korea, the choice to forgo life-prolonging care — commonly known as a dignified death — is gradually taking root. The principle of “my final journey, my decision” is gaining ground. According to the National Agency for Management of Life-Sustaining Treatment, of the 70,061 people who ceased or refused life-sustaining treatment last year, 12,936 (18.5 percent) had written advance directives, and 22,663 (32.3 percent) had completed life-sustaining treatment plans in consultation with doctors — both documents asserting their right to self-determination. Combined, these account for over 50 percent of cases — the first time that threshold has been crossed since the legal system was introduced in 2018. Over the past seven years, 42 percent of 410,000 people who chose to die with dignity followed either procedure.

'A life well begun, a life well lived'
“'It’s spread to the lymph nodes and bones. There’s no hope,' the doctor said coldly. I was at an age where dying wouldn’t come as a surprise. No regrets, I told myself — but in my heart, I still wanted to live. [...] To my children, I love you. And to my dear wife in the nursing home...Where I’m going — it’s a picnic after a long life’s tunnel. A life well begun, a life well lived."

This is an excerpt from “The Day of the Picnic,” which received an honorable mention in the 2024 writing contest hosted by the National Agency for Management of Life-Sustaining Treatment. The entry was written from the perspective of a 78-year-old lung cancer patient, by his daughter, based on her year of caregiving.

The patient had completed an advance directive. “Even I could hardly bear it. Could the kids ever let me go?” he wondered. “I’m so glad I filled that form.” Life-sustaining treatment, as defined by Korean law, refers to withdrawing or withholding procedures such as CPR, dialysis, transfusions, chemotherapy or ventilator use in terminally ill patients. An advance directive is a legal document stating these preferences in advance.

The share of patients who used advance directives rose from just 0.8 percent in 2018 to 18.5 percent last year. As of the end of 2023, more than 2.7 million Koreans had submitted one — about 20 percent of all Koreans aged 65 and older. A life-sustaining treatment plan, meanwhile, is a document prepared jointly by terminal or end-of-life patients and their physician, and likewise reflects the patient's wishes.

Without these documents, a spouse or two adult children may testify that the patient had not wanted aggressive treatment. If even that is unavailable, unanimous family consent is required — a method widely seen as vulnerable to misrepresenting the patient’s true intent. Fortunately, the rate of such cases declined from 36.1 percent in 2018 to 20.2 percent last year.

Medical professionals prepare for emergency cases at the Korean Armed Forces Capital Hospital in Seongnam, Gyeonggi, on Feb. 20, 2024. As of l2024, 75.1 percent of Koreans died in hospitals. Only 15.2 percent died at home—a figure unchanged from a decade ago. [NEWS1]

'Please don’t try so hard to save me'
Home hospice care is becoming more important. In “They Want to Die With Dignity,” which won the grand prize in the same essay contest, a 77-year-old lung cancer patient and Vietnam War veteran told his nurse shortly before passing away at home:

“I know I’m not going to get better. Please don’t try so hard to save me. I think my kids are trying too hard to keep me alive. But I’m trying to die.”

The nurse wrote, “Having witnessed countless battlefield deaths, he faced his own with the resolve of a soldier. He didn’t beg.” The man's children, she noted, also respected his dignity and refrained from insisting on diapers or interventions.

75 percent of deaths still occur in hospitals
What distinguishes the Pope’s final moments from those of most Koreans is location. As of last year, 75.1 percent of Koreans died in hospitals. Only 15.2 percent died at home — a figure unchanged from a decade ago. Jo Jeong-sook, director of the National Life-Sustaining Treatment Center, says the country must revise its complicated death certificate process and extend eligibility for life-sustaining treatment plans to home-based patients, not just those hospitalized.

At the Spring Symposium of the Korean Society for Home-Based Care on April 20, experts proposed expanding hospice care at home, supporting family education, and establishing 24-hour consultation systems to strengthen end-of-life care.

Translated from the JoongAng Ilbo using generative AI and edited by Korea JoongAng Daily staff.