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Death with Dignity
사회부 정기자 김지원
Recently there has been a great change in Korea. The death with dignity that has been felt far has approached the Korean society with the legislative intention that the patient will be aware of own illness and decide to suspend the medical care by oneself at the time when the dying process is predicted.
In Korea, Death with dignity was mentioned in earnest after the 'Boramae Hospital case' in December 1997 in Korea. The family of a sufferer who relied on the ventilator demanded a discharge from hospital because he couldn’t afford the hospital expenses, and the hospital discharged the patient. In 2004, the court condemned physicians and family to aiding a murder and murder respectively. This case caused great controversy. In 2008, however, the 'Kim's grandmother case' at Severance Hospital resulted in the opposite. The family of a sufferer, who was a vegetative state at the time, asked the hospital to stop the meaningless treatment, but hospital was rejected. Then the family applied for a preliminary injunction. As a result, the court ruled for the first time in Korea to suspend medical care. The two cases that produced conflicting results led to interest in dignity as well as confusion.
Eventually, Korea implemented a pilot project regarding the practice of 'death with dignity' throughout 10 hospitals from 2017 October to 2018 January. In the process, more than 3,000 people wrote the letter of intent to prescribe medical dignity necessary for dignity. The Ministry of Health and Welfare terminated its three month pilot project following 'the law regarding the decision for medical care for life prolongation of patients undergoing of hospice, palliative care and death' and launches the 'medical care for life prolongation decision system'. Therefore it is becoming increasingly imperative to acquire detailed information over the concept of death with dignity.
Death with dignity means literally dying and maintaining human dignity. It is applied to patients with zero possibility of medical treatment/revival and to those who are considered to be progressing to death due to sharp declines in symptoms. It means discontinuing cardiopulmonary resuscitation, hemodialysis, injections of anticancer drugs and respirator services to these patients to offer them a death with dignity. However, medical treatment for relieving pain and simple supply of nutrients, water, and oxygen shouldn’t be stopped even if prolongation treatment is stopped.
After the clinician and the field specialist diagnose the patient as being in the process of dying, patients must declare that they do not want to receive lifesaving through a prior written medical intent or health plan. (The health plan can only be made at a medical institution registered with the Ethics Committee of the Medical Institution.) However, if the patient is unconscious and has not written a plan in advance, two patients' family members may make a statement of the patient's consent, family can decide to stop medical care. If there is no patient’s family or friends, such as an elderly person living alone, the patient may suspend prolongation treatment only when the patient has made a statement about the decision to suspend the medical care of the patient himself or herself by writing a health plan. In other words, if the patient is in a medical condition that can’t be expressed, he or she can’t suspend or discontinue medical care.
Many of the terms related to these systems are mixed. Death with dignity in Korea is different from euthanasia. To clarify the terms more clearly, the concept is mainly divided according to the subject who decides and enforces death. Euthanasia refers to an act in which a physician intentionally causes a patient to die. Among euthanasia, it is called "active euthanasia" when it accelerates death through aggressive intervention such as sedation, or "passive euthanasia" when it stops death of a patient who has already reached the crisis of death and dies. The death with dignity is in accord with 'passive euthanasia'. In fact, there are only two branches, but there is no debate about artificial death, so Korea has not been classified in detail.
Death with dignity and euthanasia are very different depending on the situation and degree. These two schemes are implemented at various levels in each country. In 2002, the Netherlands became the first country in the world to legalize euthanasia. The Netherlands is expected to pass legislation to allow euthanasia, not just illness like cancer, at the end of this year, but also painfulness such as simple weakness and solitude. Currently, six countries, including the Netherlands, Belgium, Luxembourg, Switzerland, Colombia and Canada, allow active euthanasia. The United States was legalized in five states. And as the New York State legalizes euthanasia last year and the United Kingdom has resubmitted the euthanasia law that it rejected in 2015, the move toward the right to die is spreading worldwide.
There is also a negative attitude toward death with dignity, the right to die like a person. There is a concern that the death with dignity can easily abandon life or abuse it for the purpose of insurance, mainly focusing on stratum that can’t afford the economic burden of life-saving treatment. In addition, the concern of the religious community, which point out the misdiagnose and the life neglect, can be a big barrier. As a case to support this case, in the case of Kim’s grandmother the court recognized the right of the patient and her
family to choose dignified death at the crossroads of life and death, and in June 2009 Kim’s ventilator was removed. But Kim was alive with her own breathing, and died in January 2010, just over 201 days. It was only 692 days after unconsciousness.
Euthanasia and death with dignity are very sensitive issues in both legal and ethical and a sharp between the pros and cons. However, As the voices of self-determination of death are increasing in Korea, it seems to need social consensus.
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