KIHASA has published the September issue of the Health and Welfare Policy Forum (No. 336), which focuses on "Characteristics of Living in Later Life Based on the 2023 Survey of Older Koreans." (Click here to download the articles.)

SUMMARY OF THE FOREWORD

As the subject of ending life with dignity and comfort has become as crucial a social concern as healthy, joyful living, expectations about the end-of-life experience have risen, leading to practical policy responses. With the implementation of the Life-Sustaining Treatment Decision Act in February 2018, standards and procedures have been established to allow terminal patients to decline or discontinue ineffective life-sustaining treatments. By August 2024, an estimated 2.5 million people had specified their preferences for end-of-life medical treatment through advance directives. Furthermore, patients nearing death now have greater self-determination and can make their own decisions rather than relying solely on family choices, thanks to the ‘life-sustaining treatment plan.’ In April 2023, the government established the Second 5-Year Masterplan for Hospice and Life-Sustaining Treatment, envisioning “a society that guarantees all can close life with dignity.” Recently, the National Assembly proposed an amendment bill that would allow patients to refuse or discontinue treatments not just in the imminent-death period but also during the terminal stage, heightening public expectations for greater patient self-determination at the end of life. The October issue of the Health and Welfare Forum revolves around Korea’s Life-Sustaining Treatment Decision Scheme (LSTDS). Seven years after the introduction of the Life-Sustaining Treatment Decision Act and following the recent launch of the second masterplan, it is now time to revisit the current state of the LSTDS, focusing on its achievements and operational details. We analyze the evolving policy environment and social demands, exploring how the scheme can further help individuals conclude their lives with dignity. A significant portion of the October issue addresses tasks outlined in the second masterplan and explores short-term policy options for implementation. We also suggest a long-term direction for advancing the scheme to ensure a dignified end-of-life stage, along with policy options for improving end-of-life care.

MONTHLY FOCUST: Characteristics of Living in Later Life Based on the 2023 Survey of Older Koreans

"The Life-Sustaining Treatment Decision Scheme in Korea: Current Status and Achievements," Cho Jung Sook, Korea National Institute for Bioethics Policy

This article examines the outcome of the Life-Sustaining Treatment Decision Scheme (LSTDS) as implemented through the 1st Masterplan for Hospice and Life-Sustaining Treatment. The public perception of LSTDS has improved. The scheme is more accessible now that the infrastructure has expanded. It has enhanced its counseling workforce and developed and implemented education programs for medical staff and counselors. With participation in the LSTDS made subject to performance evaluations and integrated into the medical service fee system, the number of medical establishments accommodating the scheme has increased, leading to a significant rise in physicianconsented implementations of patients’ wishes regarding life-sustaining treatment. Based on these findings, this article identifies the aspects of the scheme that should be further expanded and improved in such a way as to better help individuals to exercise their right to self-determination and conclude their lives with dignity.

"The Changing Policy Environment and Its Implications for the Life-Sustaining Treatment Decision Scheme," Kim Hee-Nyun, KIHASA

The life-sustaining treatment decision scheme (LSTDS) is designed to help individuals make choices on their own regarding the final moments of their lives, ward off ineffectual life-sustaining procedures, and preserve dignity at the end-of-life stage. As people live longer and medical technology advances, the LSTDS has drawn growing public attention. Life expectancy and healthy life expectancy have extended to such an extent that death is now, quite paradoxically, both more distant to individuals and closer at hand as a social concern. With mortality increasingly attributed to chronic diseases, the need for death preparation looms large. Over the years, ‘death with dignity’ as an active life decision has sparked keen debates, and, along the way, people’s interest in the scheme has shifted away from its formalities to its qualitative aspect. However, despite the progress it made in step with the enhancement of the health and social welfare systems, the scheme still has a long way to go to reach its full potential. The LSTDS should reshape how people view death; its undertakings down the road should involve transitioning end-of-life preparation from a death-oriented approach to a life-oriented one, ensuring the self-determination of individuals, and assisting those nearing the end of life to conclude their life’s journey with dignity.

"The 2nd Five-Year Masterplan for Life-Sustaining Treatment: Key Features and Tasks," Go Dun-Sol, KIHASA

In April this year, the government put forth the 2nd five-year Masterplan for Hospice and Life-Sustaining Treatment. Seven years after the Life-Sustaining Treatment Decision Act was implemented, the new Masterplan outlines visions and tasks for advancing the Life-Sustaining Treatment Decision Scheme (LSTDS) beyond its earlier phases―its launch pursuant to the enactment of the law and the subsequent buildup through the 1st Masterplan―toward a mature system. This article reviews the main advancements achieved and limitations remaining around the LSTDS under the 1st Masterplan, and sheds light on key features of the 2nd Masterplan. In addition, this article offers several policy suggestions. First, the scheme should pursue qualitative enhancement, going beyond quantitative growth. Second, organizations working under the scheme each currently operate largely singly, and this approach should shift to one where they collaborate more effectively within their localities or regions. Third, to ensure that individuals can conclude their lives with dignity, the LSTDS should be linked to various other social services.

"Proposal for End-of-Life Care Policy for Dignified End-of-Life," Lee Ilhak, Yonsei University

As Korean society rapidly ages, the focus on quality of life and dignified end-of-life care becomes increasingly significant. The Life-Sustaining Treatment Decision Act, enacted in 2016 and implemented in 2018, ensures patients’ right to self-determination, allowing them to forgo futile life-sustaining treatments. This law stipulates the conditions and procedures for discontinuing such treatments, aiming to enhance patients’ quality of life. Since its implementation, the Life-Sustaining Treatment Decision System has seen notable achievements, including an increase in the number of advance directive registrations and the expansion of medical ethics committees within healthcare institutions. However, there remains a need for consistency in policy execution and improvement in the level of care provided. Currently, the Ministry of Health and Welfare and the National Agency for Management of Life-Sustaining Treatment oversee the system, supported by advance directive registration centers and medical ethics committees. Despite these efforts, challenges such as a lack of understanding, confusion between futile life-sustaining treatments, euthanasia, and dignified death, and low installation rates of medical ethics committees persist. Addressing these issues requires fostering a culture of active public participation, improving medical professionals’ awareness and involvement, and promoting advance care planning. Additionally, enhancing information systems, strengthening legal and institutional foundations, and integrating with social welfare systems are crucial. Ultimately, the Life-Sustaining Treatment Decision System is a vital framework that respects patients’ right to self-determination and helps them conclude their lives with dignity. It is essential to integrate medical and social welfare services and community resources while expanding patient and family involvement. Enhancing the system’s transparency and fairness through the participation of various stakeholders will build public trust. The development of this system aims to ensure that all patients can experience a dignified end-of-life.

POLICY ANALYSIS AND TRENDS

"The Changing Characteristics and Policy Needs of One-Person Households among Middle-Aged and Older Adults," Kim Sejin & Kim Hyesoo, KIHASA

This article aims to discuss policy strategies for supporting one-person households among middle-aged and older adults. Using time-series analysis, I examined changes in the share and characteristics of middle-aged and older adults living alone, outlining a profile of their past, present, and projected living conditions. I also highlighted challenges and support needs specific to different age groups within the demographic. Based on the findings, this article presents policy options, from both short- and long-term perspectives, to better address the health, housing, and emotional needs of these one-person households.

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