Gov’t panel draws up guidelines for 'death with dignity' bill(koreatimess)

Gov’t panel draws up guidelines for 'death with dignity' bill

By Bae Ji-sook
Staff reporter

A group of medical and ethics experts as well as governmental officials suggested Wednesday a set of guidelines for the National Assembly to reflect on for a pending bill allowing doctors to halt excessive life-sustaining treatment on terminally ill patients.

The guidelines are expected to set standards for the practice.

A government consultative group of 18 including doctors, university professors, a lawyer and civil servants have held seven meetings to systemize the "death with dignity" act since last December.

Though they haven't reached a consensus on every issue, they have agreed that the practice could be conducted on patients in the terminal stage of illnesses including those in persistent vegetative and brain-dead states.

Removing artificial devices such as respirators or following "do not resuscitate" (DNR) instructions is allowed. But cutting off water and nutrition supply will be banned because the patient may still have to receive other medical treatment.

Patients will be required to sign a consent form after consulting with their doctors for a minimum of two weeks. Verbal confirmation will also be acknowledged.

An ethics committee must be created at medical facilities allowing death with dignity and the Ministry of Health and Welfare will establish an oversight commission.

Whether to follow a patient's request will be decided by the concerned doctors and the former's legal guardians. However, if they cannot reach a decision, it will be referred to the respective hospital's ethics committee. If any dispute ensues, a court will give a final ruling.

Quality of life

Lawyer Shin Hyun-ho, a member the group, said the guidelines were to codify actions that in reality are already in practice.

"About 180,000 people die of illnesses a year at medical institutions here. Among them, only 30,000 are on life-sustaining equipment while others die without artificial efforts. This means that in the actual world, the stoppage of excessive treatment has already been settled," he said.

Hur Dae-seog, the director in charge of the National Evidence-based Healthcare Collaborating Agency, said the guidelines will mainly benefit patients who have no hope being cured and are in extreme pain from unwanted, elongated treatment.

"Using life sustaining devices or performing resuscitation may leave only pain, which substantially lowers the quality of life. It is the patients who call for the cessation of treatment. Their families follow the order because they cannot stand the enormous amount of pain their loved ones suffer," he said.

After a series of debates, the group couldn't come to an agreement regarding whether to let a third party ― family members or other legal guardians ― sign the consent form for the patient.

Professor Koh Youn-suk of Asan Medical Center and head of the Korea Society for Medical Ethics stressed that some acknowledgement was necessary.

"In Korean culture, family members are given nearly equal legal status as the person being treated. Accepting family members' requests for terminating treatment has long been accepted in other countries," he said.

Currently the U.K., Australia, Taiwan, Japan, Albania, Denmark, Netherlands, Belgium and several states in the U.S. have adopted such a proactive measure at differing levels; allowing family members to make decisions for comatose patients under strict monitoring by doctors.

However, Professor Lee Sang-won of Chongshin University remains opposed to the idea.

"There is always the chance that doctors can make the wrong diagnosis. There is always the chance that families do not understand the desires of the patient. If death is involved, we should always pay extra attention to it rather than just go with the international flow," he said.

The agreed guidelines will be submitted to parliament where lawmakers are studying the pros and cons of the pertinent bill.

The bill was submitted in response to a Supreme Court ruling in 2008 allowing the removal of a respirator from a woman in a persistent vegetative state. The ruling triggered disputes but also highlighted the discussion on the right for people to choose death with dignity.