South Korea's end-of-life law creates 'paradox' of isolation

South Korea's law on end-of-life decisions, intended to respect patient autonomy, is facing criticism for paradoxically isolating terminally ill individuals during their final moments. The Act on Hospice, Palliative Care, and Decisions on Life-Sustaining Treatment for Patients at the End of Life requires individuals to formally declare their wishes regarding life-sustaining treatments like artificial respiration and CPR.

While the law's intention is to uphold the "self-determination" of patients, critics argue it places an undue burden on individuals who are at their most vulnerable. The law frames patients as rational, modern subjects, making their "right to self-determination" the absolute standard. However, this approach overlooks the inherent fragility of humans facing death and the crucial role of social support systems and cultural traditions that traditionally helped individuals navigate this process.

The article draws parallels with the philosophy of Ivan Illich and Lee Hoina-ki's book "Amicus Mortis" (Friend of Death). Illich criticized medical overreach, and Hoina-ki observed his own brother's peaceful death at home surrounded by loved ones, contrasting it with others whose lives were "devastated" by an inability to relinquish medical interventions. The book explores how a "friend of death", family, friends, community, and customs, can support an individual in maintaining their sense of self until the end.

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the proceedings had been “exceptional” in nature

In contemporary South Korean society, the responsibility for death has shifted from community and culture to individuals and the law. The law's emphasis on individual decision-making, without adequate consideration for the psychological and emotional support needed, can transform the act of refusing treatment into a lonely, frightening experience, potentially feeling like a "self-inflicted" end. The legal process, rather than facilitating a peaceful transition, can foster suspicion and fear.

Concerns have been raised even within the judiciary. During the "Grandmother Kim" case, which spurred the legislation, a constitutional appeal argued the state's responsibility in establishing frameworks for life and death. Although the Constitutional Court dismissed the appeal, it acknowledged the need for societal discussion. Justice Lee Gong-hyun expressed concern that a system prioritizing an abstract "right to self-determination," not deeply rooted in Korean customs, could be dangerous.

However, the prevailing tendency in South Korea to resolve social conflicts through legislation led to the swift enactment of a law centered on self-determination. The law defines life-sustaining treatment as harmful, merely prolonging the dying process without therapeutic effect. Yet, critics argue this perspective is driven by government convenience to minimize disputes and the general public's desire to avoid death, rather than a deep understanding of the terminally ill patient's experience. This leads to complex procedures, requiring confirmation from multiple doctors and mandating continued hydration and oxygen supply, often resulting in patients enduring physical discomfort, such as bruised limbs and the inability to remove tubes, until their last breath.

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