2018, Vol.21, No.2

Korean Journal of Medical Ethics 2023 KCI Impact Factor : 1.21

pISSN : 2005-8284 / eISSN : 2234-3598
https://journal.kci.go.kr/medethics

The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for patients at the End of Life was finally signed into law in South Korea following a long process of consensus-building. However, the appointment of proxy decision-makers was excluded from the recommendations made by the National Bioethics Committee and was not included in the provisions concerning life-sustaining treatment. Considering the increasing number of single-person families as well as the limited information that is typically available in making decisions concerning life-sustaining treatment, a system for designating surrogate decision-makers should be introduced into the provisions on life-sustaining treatment. The most appropriate system, which is currently used in the United States, is one that allows patients to designate healthcare proxies to make decisions on their behalf. A designated agent can make the best decisions for a patient based on both a substituted judgment standard as well as a best interest tandard. However, when the two standards conflict or in other cases in which it is difficult to administer the decision of the designated agent, we recommend that the system allow physicians to receive help from either an institutional ethics committee or a clinical ethics service.

The National Bioethics Committee of Korea recommended that hospital ethics committees should be allowed to make life-sustaining treatment decisions on behalf of patients without surrogate (family or friends). However, no such provision is included in the Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for patients at the End of Life (hereafter the “Act on Decisions in Life-sustaining Treatment”). While the Health and Welfare Committee of the Korean National Assembly did attempt to include such a provision in the form of an amendment to the aforementioned act, the Legislation and Judiciary Committee rejected it on the grounds that it did not specify the precise legal requirements of the hospital ethics committees. In other countries, including Taiwan, Japan, the U.S., and the U.K., there are laws or guidelines governing the medical decision-making process for patients without surrogate. In this article, we review the background of this issue, the current practices in other countries, and the relevant legislative process. We suggest that a system should be established in Korea for making life-sustaining treatment-decisions for patients without surrogate.

The Constitutional Court of Korea is currently tasked with making a decision on the country’s laws concerning abortion, which is one of the most divisive issues in medical ethics. However, as I argue in this article, the key ethical issue at the heart of this case—whether abortion should be decriminalized—need not be divisive at all. To move beyond the polarization this issue generates, the rights-based thinking that plagues so much of the abortion debate should be replaced with a pragmatic approach that attempts to assess the costs and benefits of maintaining the current abortion ban versus those of decriminalizing abortion. Progress can come when the groups that are divided on the abortion issue recognize that they have something in common, which I claim is the goal of reducing the number of abortions. The key question that is prioritized on the approach that I defend is whether the existing ban on abortion is the best or most effective way to reduce the abortion rate in this country. In this article I present evidence to suggest that it is not.