[Editorial] 60,000 'Dying Refugees'... A Long Road to 'Dignified Death'

South Korea is grappling with a distressing reality: a significant portion of its aging population, who choose to forgo life-sustaining medical interventions, are left without proper palliative care, earning them the somber label of 'dying refugees.' This phenomenon, occurring in a nation that has been experiencing more deaths than births for seven years, highlights a critical gap in end-of-life services.

Last year, over 81,000 individuals opted to cease life-sustaining treatments. However, a stark statistic reveals that only 30% of these patients benefited from hospice care. The remaining 57,000-plus individuals faced their final moments in nursing homes, emergency rooms, or at home, often experiencing prolonged suffering and anxiety due to the lack of accessible and appropriate care facilities. This situation is exacerbated by the fact that hospice facilities are disproportionately concentrated in the Seoul metropolitan area, leaving those in provincial regions even more underserved.

The government's encouragement of Do-Not-Resuscitate (DNR) orders, aimed at promoting dignified deaths and reducing medical costs, is undermined by the scarcity of alternatives. While 84% of Koreans over 65 oppose life-sustaining treatment, the actual rate of DNR implementation remains below 20%. This reluctance stems from the fear of burdening families or facing neglect in hospitals and emergency rooms. The article argues for a substantial expansion of palliative and end-of-life care infrastructure, including increasing hospice beds, allowing nursing homes to operate hospices, expanding home hospice services, and broadening the range of eligible conditions to include chronic diseases like dementia. Without these crucial investments, the aspiration for a 'dignified death' remains an elusive goal for many South Koreans.