2024, Vol.27, No.2

Korean Journal of Medical Ethics 2024 KCI Impact Factor : 1.15

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 (ELDA) was passed by the Korean National Assembly in 2016 and came into effect in 2018. Although the stated purpose of the act is to uphold patient autonomy and dignity in the context of end-of-life (EOL) care, its utilization remains low, with only some 40% of EOL decisions reflecting patients’ direct opinions. This study aims to pinpoint areas for enhancing ELDA by comparing it with similar systems in other countries and gathering expert opinions. To achieve this, we reviewed ELDA, compared it with EOL care systems in Taiwan, Japan, the UK, the US, and Germany, and surveyed Korean medical experts to collect their thoughts on how ELDA might be improved. On this basis, we make several recommendations, including broadening the scope of ELDA, bolstering the role of advance directives, and providing education for healthcare professionals. These recommendations are expected to increase the utilization rate of ELDA and enhance the quality of EOL care in South Korea.

This article examines shared decision-making, a concept that extends beyond informed consent to safeguard patients’ right to self-determination in medical decision-making, emphasizing mutuality with patients. After reviewing the relevant legislation concerning consent, we argue that there are limitations to using this legislation as a basis for integrating shared decision-making across various medical domains. We assess the applicability, acceptability, and consistency of this legislation within the medico-legal system. In particular, we scrutinize the roles of so-called “participants” in shared decision-making, the content of shared information, and potential legal liabilities stemming from deficiencies in this process. Through this examination, we analyze legal precedents concerning the duty to inform and propose policy adjustments necessary for the institutionalization of shared decision-making within the medico-legal framework.

Medical care is an essential social service that supports other valued goods, such as life, health, safety, and the guarantee of social opportunities. In many countries, access to medical care is provided through public health insurance systems. South Korea’s medical insurance system, which has expanded at an unprecedented rate in recent decades, performs very well by several internationally recognized indicators. However, excessive government regulations, a private-centered supply of medical resources, and overuse of the system by patients have led to a misallocation of medical resources. This article examines the supply and use of medical care by the Korean government, the medical community, patients, and citizens, highlighting awareness gaps in the public value and nature of medical care. Recognizing this issue is the first step in building a sustainable medical system that ensures that medical resources are appropriately allocated and utilized.