2025, Vol.28, No.1

Korean Journal of Medical Ethics 2023 KCI Impact Factor : 1.21

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

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.

Advance care planning (ACP) and life-sustaining treatment decisions in Korea remain more procedural than patient-centered. Discussions tend to focus more on discontinuing life-sustaining treatment or transitioning to hospice than on integrating palliative care throughout the course of an illness. This commentary analyzes a case in which a terminal cancer patient passed away at home without formal ACP or hospice enrollment. While legally unproblematic, this outcome raises concerns about whether the patient’s values and care goals were adequately addressed. The Korean healthcare system limits palliative care services to specific terminal illnesses, and ACP typically begins only after a terminal diagnosis. This leads to fragmented decision-making, with care goal discussed too late and palliative care viewed as an alternative to life-sustaining treatment rather than an integral part of medical care. Additionally, the lack of multidisciplinary collaboration and structured communication hinders effective ACP implementation. This article argues that bridging this gap requires that palliative care be embedded into routine clinical practice, ensuring early and evolving care goal discussions. Strengthening palliative care education, expanding multidisciplinary collaboration, and developing structured decision-making support systems are proposed as essential strategies to achieve meaningful ACP and improve end-of-life care.