Incentives for end-of-life counseling
This January, the National Assembly passed the Death with Dignity Act, which will allow terminally ill patients to halt medical procedures starting in 2018. Although this act is an important step in reinforcing patient rights, more must be done to help individuals take control of their end-of-life care while they are still capable of doing so. For instance, encouraging patients to establish advance directives through a living or a written will can help convey their medical care preferences and help the patients’ family members make difficult decisions on their behalf.
Because talking about death is considered to be a cultural taboo, many individuals may not feel the need to think about the circumstances of their death and whether they would want intensive interventions like ventilators, feeding tubes and catheters at the end of their lives. In a 2012 study published in Nursing Research and Practice, researchers from the College of Nursing at Yonsei University found that 58.3 percent of survey participants had never thought about end-of-life treatment preferences and that 83 percent did not have a will.
Fortunately, a 2011 study in Nursing Ethics suggests that South Koreans are open to the idea of advance care directives. Researchers asked study participants, “Due to a sudden illness (i.e. stroke) or accident (i.e. traffic accident), you may become incapable of communicating and thus making decisions. In such a case, to express the wishes regarding medical treatment in advance is called advance directives. Do you agree with these advance directives?” An overwhelming 92.7 percent chose “strongly agree” or “moderately agree.” Researchers also found that respondents who thought of themselves as healthy were more likely to have positive attitudes toward advance care directives.
Health care providers can jump-start the idea of advance directives for all patients - especially healthy patients - by integrating questions about end-of-life preferences into regular check-ups for those over 65. These discussions will help patients explore their personal values regarding what they would consider “a life worth living” and turn those preferences into actionable advance care health decisions long before they find themselves with a serious medical situation. However, doctors may find it difficult to conduct end-of-life discussions because it takes time, empathy and the ability navigate complex medical, familial and spiritual dynamics unique to each patient. For this reason, the National Health Insurance Service must increase incentives for health care providers to engage patients in advance care planning. South Korea might learn a lesson from the United States, where the Centers for Medicare and Medicaid Services announced that doctors would be able to bill Medicare - a national insurance program for qualified seniors - for end-of-life counseling starting in 2016.
Overall, our society must become more open to the idea of discussing death. Individuals must be encouraged to undertake end-of-life planning with their family members and health care providers to make sure that their desires are explored, shared and upheld. As a country, we must encourage more of these talks to occur - now and in the future - as we all inevitably face the process of dying.
Kim Yoo-jung, First-year medical student at the Stanford University School of Medicine
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