| Maintaining the current definition of ‘Terminal Patient’ in the current act on the decisions on life-sustaining treatment: | Maintain current definition (32:2) | There is a suggestion to relax the scope and qualifications of physicians diagnosing terminal patients: “It would be better if the determination of a terminal patient could be made by the judgment of one physician.” |
| Allowing the advance care planning to be established early by enabling the creation and registration of a life-sustaining treatment plan not limited to the terminal stage: | Expansion (33:1) | The need for a more nuanced approach was mentioned: “In the case of actual cancer patients, there is a perception that metastatic cancer equals terminal stage, which can lead to inappropriate judgments by patients or intervention by non-specialist physicians.”, “Decisions on life-sustaining treatment should be possible as early as possible, and the patient’s opinion is the most important.” |
| Allowing the implementation of life-sustaining treatment decisions not only during the dying process but also in the terminal stage: | Expansion (29:5) | Concerns were raised about the implications of this change, given that most decisions are currently made by family surrogates during the dying process: “I agree with expanding the process of life-sustaining treatment termination from the dying process to the terminal stage. However, it seems difficult to distinguish between ‘unanimous statements of at least two family members’ and ‘family consensus’ in clinical practice because families often come to an agreement and present a unanimous statement. This point needs careful consideration.” |
| Allowing the decision and implementation of life-sustaining treatment termination based on the consensus of all family members when the patient’s wishes cannot be confirmed due to medical condition, even during the terminal stage: | Approval (26:8) | Concerns were raised about the implications of this change, given that most decisions are currently made by family surrogates during the end-of-life process: “Considering the intent of the law to respect self-determination, it is premature to expand to cases where the patient’s own wishes cannot be confirmed. Particularly for non-cancer diseases, there may be confusion during life-sustaining treatment termination, so even if expanded, a phased approach is necessary. Furthermore, if family decisions are made for socioeconomic reasons, the original intent of prioritizing the patient’s best interest could be undermined.” |
| Other opinions: | Reflecting clinical characteristics:“There should be a separate guide for pediatric and adolescent patients. It is unclear what process they should follow according to the above guide. It would be good to provide clear guidelines for pediatric and adolescent processes in the amendment and seek the opinion of the academic community again.” |
| Proposal regarding the legal representative system:“In the clinical field, the clause requiring consensus from all family members is unrealistic and burdensome for both medical staff and grieving families. Additionally, there are many cases where individuals listed as family members are not in actual contact. In such cases, it is often impossible to achieve a family consensus. Given the limitations of including all social scenarios in the legal text, it is currently stated that surrogate decisions in Article 18 of the Act on the Decisions on Life-Sustaining Treatment are limited to minors. Therefore, I believe it is necessary to designate a legal representative chosen by the patient. Allowing a patient to designate someone to make decisions on their behalf while they are cognitively intact aligns with the intent of the Act to respect self-determination.” |
| Expansion of care provision:“It is important to enhance care for terminal patients through the expansion of hospice specialist staff and educational facilities. Ultimately, improving the quality of life for patients at the ‘terminal’ stage is a critical goal." |