Although the Supreme Court have ruled that doctors should remove the artificial respirator from a patient with vegetable status that suddenly fell into a coma during a lung biopsy in February 2008, on the basis of her presumed wishes, there are still considerable disparity between hope and reality in high quality of care at end-of-life. Korean physicians have to show leadership and partnership to take initiative and set an example for 'National Campaign for Death with Dignity' with the administrative sector, the National Assembly, and other social groups.
Biopsy ; Coma ; Humans ; Leadership ; Lung ; Right to Die ; Vegetables ; Ventilators, Mechanical

PURPOSE: This correlation study was performed to examine Korean adults' perceptions and attitudes towards death with dignity and the withdrawal of life sustaining treatment and to identify factors that predict their attitude towards death with dignity. METHODS: The study was conducted using convenience sampling of 291 adults from three towns of a metropolitan city in Korea. Data were collected using structured questionnaires which surveyed people's perception about and attitudes towards withdrawal of life sustaining treatment and scaled their attitude towards death with dignity. Data were analyzed by using descriptive statistics, Pearson correlation coefficients and multiple regression. RESULTS: The attitude towards the withdrawal of life sustaining treatment and death with dignity showed a significant positive correlation (r=0.49, P<0.001). For attitudes towards death with dignity, significant predictors were attitudes towards the withdrawal of life sustaining treatment, age, religion, a proper withdrawal process and advanced medical directives, which explained 49.3% of total variance. CONCLUSION: The results of this study may contribute to development of a new medical decision-making system including nurses' appropriate roles in the process of withdrawing life sustaining treatment and advanced medical directives.
Adult ; Humanism ; Humans ; Korea ; Life Support Care ; Right to Die ; Statistics as Topic

The decision to withdrawal of life-sustaining management for dying patients is one of the most difficult challenges in modern medical ethics. Due to the advances in medical science and technology, terminally ill patients can survive longer than ever expected before. More specifically, artificial ventilation, nutrition, and recently developed drugs constitute the cores of life -sustaining management for dying patients. The issues of patients' autonomy, medical paternalism and sanctity of life are related with this particular problem. Korean Supreme Court recently approved the request of a permanent vegetative status patients' family to terminate the artificial ventilation and allow the patient to die. Korean Medical Association is currently seeking to establish the guideline. Korean government and parliament are also looking for a way to enact the law. However, religious sector including Catholic Church and a significant proportion of the population have opposed the legalization of euthanasia. A careful study in other countries' legislations related to the care for dying patients would help to establish the consensus in the nation.
Advance Directives ; Consensus ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Paternalism ; Right to Die ; Terminally Ill ; Value of Life ; Ventilation

Although the word 'euthanasia', a compound word of eu- (good, well) and thanatos (death) is widely known, it is greatly misunderstood. With regard to end-of-life medicine, several phrases, including death with dignity, passive euthanasia, and natural death also need to be clarified. A review of their meanings and connotations is provided along with a brief history of the discussion in Korea on forgoing life support. Korea has no law regarding the cessation of artificial ventilation, but several judgments of law courts provide us with a general principle that cessation could be applied if the patient is in an irreversible or dying condition medically, and has presented his or her intention with something like an advance directives, or is reasonably presumed to have such a will.
Advance Directives ; Euthanasia ; Euthanasia, Passive ; Humans ; Intention ; Judgment ; Jurisprudence ; Korea ; Right to Die ; Suicide, Assisted ; Ventilation

The right to die in dignity and comfort is one of the gravest concerns due to the ever-increasing number of patients with incapacitating illnesses who experience a prolonged painful death, and to the modern trend to place an emphasis on the improvement of quality of life whenever possible. According to the guidelines issued by the Korean Medical Association in 2002, in cases of incurable illnesses, such as terminal stage cancer, meaningless life-maintaining management may be terminated to allow patients to die with dignity. However, the Korean Ministry of Health and Welfare maintains the stance that such guidelines overtly support the institutionalization of "passive euthanasia", and that those who follow such guidelines should be charged with murder, in accordance with the requirements of the existing Korean law. Given that, any one of us may be confronted with such a miserable death, we all have a compelling interest in the revision of the existing legislation, perhaps by using the "U.S. Living Will Registry" as a model.
Euthanasia ; Homicide ; Humans ; Institutionalization ; Jurisprudence ; Living Wills ; Quality of Life ; Right to Die*

BACKGROUND: This study investigated the current status of communication about death and confidence levels concerning death-related issues among Korean adults.METHODS: A survey was conducted to ascertain the frequency of death related communication, factors promoting and impeding such communication, and confidence levels concerning death-related issues. Data of 112 participants who completed the survey were analyzed using descriptive statistics, a chi square test, and multiple logistic regression.RESULTS: More than half of the participants (52.7%–84.0%) appeared to have infrequent (never/at least one) conversations about death or death-related issues. Owing to socio-cultural aspects, death-related communication was considered a taboo or an unpleasant topic of conversation. Additionally, indifference toward death inhibited people from communicating; however, personal experiences of death or morbidity and favorable social contexts promoted communication. Overall, the confidence levels concerning death-related issues was low. Only 17.9%–32.2% of the participants were confident/very confident about their preferences concerning death-related issues. The more people talked about death, the more likely they were to develop a confident attitude toward death-related issues (odds ratio, 3.45; 95% confidence interval, 1.37–8.69).CONCLUSION: This study confirmed that communication about death is being withheld among Koreans, and this could possibly lower their level of confidence regarding death-related issues. To achieve death with dignity, a ‘death culture’ needs to be promoted alongside legislation and infrastructure.
Adult ; Advance Care Planning ; Attitude to Death ; Humans ; Logistic Models ; Personal Autonomy ; Right to Die ; Taboo ; Terminal Care

It is natural for all human beings to die; hence, death is an inevitable event. However, advances in medical technology are changing the meaning of natural death. These advanced treatments provide the capability to intervene at the time of death and to reshape the circumstances around natural death, by sustaining human life. However, it is extremely difficult to judge when treatment is futile for the patient's best interests. It is therefore recommended to make time to discuss the concept of medical futility during the course of caring for a critically ill patient. Despite the expectations and efforts of the patient, the patient's family, and medical staff, the patient will eventually, have a ‘hopeless’ medical condition. Most discussions about decision-making in end-of-life treatment have neen ethical debates focused on the patient's self-determination and best interest in the context of concepts such as euthanasia or death with dignity. However, such discussions are insufficient for resolving the wide variety of circumstances that occur in clinical settings. Instead, the various ethical dilemmas inherent to end-of-life care should be approached by educating medical teams, patients, and their families about how to recognize medical futility. Furthermore, it is important to optimize the balance between the rights of patients and the responsibility of physicians.
Critical Illness ; Euthanasia ; Humans ; Medical Futility ; Medical Staff ; Personal Autonomy ; Right to Die ; Withholding Treatment

PURPOSE: We explored Koreans' perception of the meaning of death with dignity that Korean people. METHODS: A phenomenological research methodology was applied. A total of 13 participants were sampled based on their age and gender. Participants were interviewed in depth from September 2015 through February 2016. Colaizzi's phenomenological analysis method was used for data analysis. To establish the validity of the study, we evaluated its realistic value, applicability, consistency and neutrality of the qualitative evaluation criteria of Lincoln and Guba. RESULTS: Koreans' perception of death with dignity was structured as 19 themes, nine theme clusters and four categories. The four categories were “comfortable death”, “good death”, “resolving problems before death”, and “death with good reputation”. The theme clusters were “death without pain”, “death submitting to one's fate”, “death that is not ugly”, “leaving good memories to others”, “dying in a way we want”, “death after proper settling of things”, “dealing with chronic resentment before death”, “death after living a good life”, and “death with recognition”. CONCLUSION: For Koreans, death with dignity meant not burdening others, settling things right and leaving good memories to their families and friends. Such perceptions can be applied to hospice care for terminally ill patients.
Evaluation Studies as Topic ; Friends ; Hospice Care ; Hospices ; Humans ; Methods ; Research Design ; Right to Die ; Statistics as Topic ; Terminally Ill

Recent developments in medicine in our society have drawn attention to various phenomena related to death, such as brain death, cardiac death, vegetative death, euthanasia, death with dignity, near-death experiences, hospice, and suicide. The definition and conception of death is significant because its reductionist determination may bring about a denial or taboo of death and a certain limitation on the modes of life and death. As religious traditions like Christianity and Buddhism and life and death studies show, human death cannot and should not be explained by physical and biological criterion of death like brain death or cardiac death alone. In a society with such a reductionist definition of death there can be no space for a mature culture of death and only a colossal number of miserable deaths like suicide. Therefore, as Kubler Ross argues, death should be defined in terms of considering the continued existence of certain realities as to psyche, spirit, and the meaning of life beyond physical and biological aspects. The medical and legal approach to death is greatly incomplete and restricted in taking into account the physical and biological aspect of death. Thus, it is necessary to precisely and deeply reconsider the definition and understanding of death from a broader and more comprehensive perspective rather than concentrating solely on the physical and biological criterion of death such as brain death or cardiac death.
Brain Death ; Buddhism ; Christianity ; Death ; Denial (Psychology) ; Euthanasia ; Fertilization ; Hospices ; Humans ; Right to Die ; Spirituality ; Suicide ; Taboo ; Thanatology

This year on May 21st, the full panel of the Supreme Court in Korea had first made a judgment on 'withdrawal of life-sustaining management'. In this case, where a 76 -year-old patient was represented by her children, while being in a persistent vegetative status, the Supreme Court ruled that if a patient is in an irreversible condition with imminent death and the discontinuation of treatment can be approved as the patient's self -determination, while such action will not be allowed in any other special circumstances. This judgement presented the general criteria and process of withdrawal of life -sustaining management in Korea for the first time. The Supreme Court also brought about the specific requirements of advance directives and decided that in case where legal proceedings are not taken, the hospital ethic committee constiting of medical specialists should decide whether the patient is in an irreversible condition. However, the judgment vaguely defined the concept of 'irreversible death-imminent condition' and did not clearly examine the relations between the patient's right on self-determination and the duty of the national government to protect the life of the people, and the discretionary power of the doctor.
Advance Directives ; Child ; Ethics Committees, Clinical ; Ethics, Institutional ; Euthanasia ; Federal Government ; Humans ; Judgment ; Korea ; Patient Rights ; Right to Die ; Specialization