KJCKorea
Journal Central

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Since the enactment, in South Korea, of the “Life-Sustaining Treatment Decisions Act,” public awareness of decisions regarding life-sustaining treatment has grown. However, healthcare providers continue to face challenges in making timely decisions and engaging in advance care planning. The medical literature on end-of-life decision-making in Korea often relies on hypothetical scenarios or translated cases from foreign journals, most of which focus narrowly on resolving conflicts that arise during the decision-making process. In practice, however, the difficulty terminally ill patients face in making appropriate decisions about life-sustaining treatment stems from more than just isolated moments in the progression of their disease. The challenge is shaped by a complex interplay of factors, including differing perspectives or conflicts among patients, their families, and healthcare professionals. Additionally, system issues—such as cognitive biases and fragmented coordination between healthcare providers—further complicate the decision-making process. This article describes the clinical journey of a patient with advanced cancer who progressed to the terminal stage and ultimately passed away. This case sheds light on the underlying factors that hinder the effective implementation of advance care planning and life-sustaining treatment decisions in clinical settings in Korea.

This article examines the care process and death of a terminal cancer patient from the perspective of a critical care physician, highlighting the challenges of making timely decisions about life-sustaining treatment. While the implementation of the Life-sustaining Treatment Decisions Act has faced criticism, it has significantly reduced conflicts over futile treatments that contradict the wishes of patients and families. Additionally, it has increased awareness among the public and medical professionals of the importance of dignity at the end of life. The case presented in this article reveals three important lessons regarding end-of-life care. First, patients with slowly progressive illnesses, such as metastatic cancer, present unique challenges to advance care planning due to the unpredictable nature of their disease trajectory and require early, structured, and ongoing conversations about their preferences. Second, properly conducted advance care planning fosters shared decision-making, aligns care with patients’ values, and ensures dignity at the end of life. Third, improving end-of-life care requires interdisciplinary collaboration, and institutional efforts to address barriers to advance care planning. To enhance the quality of healthcare and reduce moral distress among healthcare providers, this article calls for policies to integrate advance care planning into routine practice.