Park Chung-nam has decided to refuse medical care for life extension if he becomes terminally ill.

“I believe it’s not up to doctors to decide whether to prolong suffering in my final days. If I become terminally ill, medical aid options could extend my life, but not save it,” said Park, 72, adding that as a church elder, he has seen several members of his church die in hospitals. “I’d rather die with dignity.”


Park was one of three people who The Korea Herald met at Kakdang Social Welfare Foundation, a local welfare center in Seoul, and who signed a written request for “the natural way of dying.”

It was Tuesday, the second day into the government’s pilot program that enables individuals to choose how they want to approach the end of their lives -- with or without life-prolonging medical treatment when there is no chance of recovery.

Kakdang, located in Jongno-gu, central Seoul, is one of the five places designated as consultation centers for the program. Anyone aged over 19 can submit a written form of their intention to exercise the right to die in the future, if diagnosed by two doctors as terminally ill.

Once you sign up, hospital staff will not do artificial life-prolonging treatment on you, such as cardiopulmonary resuscitation, hemodialysis, the use of respirators or anti-cancer drugs, under severe medical conditions.

Heo Jung-guk, 46, who visited the center after work at 7 p.m., said he has interest in both good health and a “good death.”

“My grandfather and my father died early, so I inevitably became interested in the way of life and the way of death, although I’m relatively young to think about such issues,” Heo said after he finished filling out the form.

Another visitor, Choi In-ja, 64, said she has two daughters, one of whom is married. She said she does not want to be a burden on them in the future after a 30-minute consultation with the center’s staff members.

“I’m not sure how to talk to my family about my decision, but it’s my own life and I’d like to decide how to end it when the time comes,” Choi said.

Manager of the welfare center Lee Hye-won, who also provides consultation to applicants, said the center has received lots of phone calls from those who want to schedule visits and those asking how to sign the agreement.

“Most of them are elderly, but we also have visitors in their 30s and 40s or those calling to make appointments,” Lee added.

As of Tuesday, 37 people had submitted the form against the use of artificial life-prolonging treatment, and the number is expected to keep rising, said the Ministry of Welfare, which is in charge of the end-of-life care program.

In South Korea, the idea of seriously ill people embracing death has been uncomfortable for many. Cancer patients -- even in very advanced stages -- would continue chemotherapy until their final days, as they are encouraged not to give up. Embracing death was deemed as disrespect for life and as being against Confucian values.

Today, the ageing population and increasing longevity have led to a shift in the attitude, raising demand for end-of-life care, or the so-called “well-dying” -- a play on well-being.

A survey conducted by the state-run Korea Institute for Health and Social Affairs in 2014 showed that 88.9 percent of 10,452 people aged 65 and over said they object to continuing medical care to prolong life without the possibility of recovery, while 3.9 percent chose to support continued treatment.

Another set of data from the institute also revealed that over 80 percent of 300 elderly people responded in 2015 that they would “accept death and spend their final days preparing to die a natural death,” while the rest said they would fight it with every medical aid available.

In light of the reality, the National Assembly passed a law that allows incurable patients to reject life-prolonging treatment last January, a milestone in a country where euthanasia is strictly prohibited.

The law will take effect from February next year, following a three-month pilot run which began Monday.

Professor Yu Eun-sil of Seoul Asan Medical Center’s pathology department said it is time for South Korea to look at the matter of death more liberally.

According to Yu, who has authored and translated books on how to die well, South Koreans spend almost the entirety of their lifetime medical expenses in the final year of their lives -- half of them in the last three months just to prolong life.

“The issue of death was always seen as a taboo in the country. But the launch of the end-of-life care will help Koreans have more discussions about it,” Yu said in interviews with local media.

“Even my fellow doctors who have to deal with death every day, or people with terminally ill family members have little time to think about it for themselves. I recommend them to read and think about death in advance,” Yu added.

Critics, however, say the new law must be implemented carefully to avoid ethical problems.

How to define “terminally ill” for patients wanting death over treatment is one of the problems, says professor Heo Dae-seog of Seoul National University Hospital’s hematology and oncology department.

“The law applies to terminally ill patients who are expected to die within a period of time. But, technically speaking, it is extremely difficult to define who falls under the categories of the terminally ill,” Heo said.

President of the Korean Bioethics Association Koo Young-mo also said that in the trial period, the government must handle cases of patients wanting to end their lives very carefully to protect the basic values of human life.

An official from the Ministry of Welfare said the country “already went through many debates” over the past decade on whether to allow patients the right to end their life.

“It is our understanding that the majority in our society demands alternative options in their final days of life for more dignity, and the law strictly limits this to certain cases of patients who have consulted doctors, and most importantly, out of their own will,” the official added.

By Bak Se-hwan (sh@heraldcorp.com)