Where does Korea stand in well-dying act

Hospice for the phase of final days in life will change to allow for cessation of medical aid for life prolongation for a patient in the dying phase beginning in February 201,. in accordance with the act on hospice and (pain) relieving treatment, and determination on medical aid for life prolongation of a patient in the dying phase, which passed the National Assembly early this year. The act has been enacted through intense dispute and debate, but definitions of the phase of final days in life and the dying phase have yet to be made, and therefore Korea still has a long way to go, including preparation of executive ordinances, and related rules and regulations.

For one, as for the definitions of the phase of final days in life and the dying phase, the Health and Welfare Ministry is in the process of devising detailed guidelines based on a draft prepared by the medical community. The former includes a cancer patient, whose disease continues to develop despite anti-cancer treatment and who is expected to die in months; a patient of chronic hepatocirrhosis who has hepatorenal syndrome that causes trouble in urination; a patient with chromic destructive pulmonary disease, who can hardly sit in the chair due to shortness of breathing; and an AIDS patient with encephalopathy. Those in the dying phase include four categories namely a patient with acute illness, chronic disease or chronic severe illness, and a patient under extracorporeal membrane oxygenation (ECMO) treatment, respectively.

Controversy has flared up over who will determine a patient in the dying phase. The law provides that two doctors namely the doctor in charge of the patient and a specialist in the treatment area of medicine shall determine. Medical community insiders have raised concern that if only the doctors who passed the license test in respective fields of medicine after completing three- to four-year residency in the specialty field as literally required, the patient will have no choice but to move around large hospitals, which could result in collapse of the medical service delivery system. Commenting on this concern, the Korea National Institute for Bioethics Policy recently submitted to the authority a report suggesting that it is desirable to recognize a medical doctor designated by a hospital president as a specialist doctor and thus allow him or her to determine such a patient.

However, the Health and Welfare Ministry has expressed objection, claiming that if the eligibility requirements defined by law are eased, credibility of such determination could be questioned. But if a patient, who has moved from a large hospital to a mid- to small-size hospital such as nursery hospital, opts for cessation of medical aid for life prolongation, the ministry plans to allow the specialist doctor from the previous hospital to determine whether the patient is in the dying phase or not.

Other critics say that education and promotion of the act to the general public and patients are hardly sufficient. Anyone aged 19 or older can fill in the form to express in advance intent on medical aid for life prolongation and keep the document with a registered organization. The content of the form is considered the patient’s expressed intent in the event that he or she cannot recover consciousness after suddenly losing consciousness. A patient in the phase of final days in life or the dying phase can fill in a form to plan on medical aid for life prolongation in consultation with the doctor in charge. An official with the council of people seeking to put into practice plans on medical treatment in advance said, “Since only one year and a half is left before the effectuation of the act, the government should beef up education and promotion of the act as early as possible.”

“It would not be easy to revise the act, which was enacted through intense dispute and debate,” said Prof. Jang Young-min at the Ewha Womans University law school. “In order to reduce confusion on the medical frontiers, detailed executive ordinances and rules should be put into place promptly.”