@article{ART003351143},
author={Taekyung Kim and Eun-Jeong Han and Lee, Inro and Jongwoo Chung and Inkyung Yoo and Park, Yeongwoo},
title={Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System},
journal={Korean Journal of Medical Ethics },
issn={2005-8284},
year={2026},
volume={29},
number={2},
pages={49-64}
TY - JOUR
AU - Taekyung Kim
AU - Eun-Jeong Han
AU - Lee, Inro
AU - Jongwoo Chung
AU - Inkyung Yoo
AU - Park, Yeongwoo
TI - Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System
JO - Korean Journal of Medical Ethics
PY - 2026
VL - 29
IS - 2
PB - The Korean Society For Medical Ethics
SP - 49
EP - 64
SN - 2005-8284
AB - Although South Korea’s Life-Sustaining Treatment Act institutionalized self-determination in end-of-life care, a substantial gap remains between stated preferences and care delivered near death. This study examines the pathway through which patient preferences are formed, documented, and translated into care. Using National Health Insurance claims for 2013–2023 (N ≈ 2.59 million decedents aged ≥ 65), we compare the pre-implementation (2013–2017) and post-implementation (2019–2023) periods, quantifying burdens through an LST Distress Index and associated expenditures. Claims are complemented by surveys of 500 older cancer patients, 1,000 bereaved family members, and a randomized experiment among 2,000 adults. Findings show that despite the Act, end-of-life LST exposure remains common, decisions are often delayed, and burdens concentrate in the final stage of life. This gap reflects frictions across linked stages: limited early conversations, unspecified or inaccessible documentation, uneven ethics committee access, uncertainty in determining the dying phase, and weak palliative care continuity. We propose policy interventions to strengthen the linkage between early preference formation and clinical execution, including integrating advance directives with physician-patient advance care planning, broadening participation, addressing institutional blind spots, and enhancing care continuity.
KW - life support care;patient preference;advance directives;palliative care;health expenditures
DO -
UR -
ER -
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo and Park, Yeongwoo. (2026). Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System. Korean Journal of Medical Ethics , 29(2), 49-64.
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo and Park, Yeongwoo. 2026, "Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System", Korean Journal of Medical Ethics , vol.29, no.2 pp.49-64.
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo, Park, Yeongwoo "Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System" Korean Journal of Medical Ethics 29.2 pp.49-64 (2026) : 49.
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo, Park, Yeongwoo. Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System. 2026; 29(2), 49-64.
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo and Park, Yeongwoo. "Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System" Korean Journal of Medical Ethics 29, no.2 (2026) : 49-64.
Taekyung Kim; Eun-Jeong Han; Lee, Inro; Jongwoo Chung; Inkyung Yoo; Park, Yeongwoo. Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System. Korean Journal of Medical Ethics , 29(2), 49-64.
Taekyung Kim; Eun-Jeong Han; Lee, Inro; Jongwoo Chung; Inkyung Yoo; Park, Yeongwoo. Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System. Korean Journal of Medical Ethics . 2026; 29(2) 49-64.
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo, Park, Yeongwoo. Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System. 2026; 29(2), 49-64.
Taekyung Kim, Eun-Jeong Han, Lee, Inro, Jongwoo Chung, Inkyung Yoo and Park, Yeongwoo. "Advance Formation and Barriers to Implementing End-of-Life Preferences: Policy Challenges for South Korea’s Life-Sustaining Treatment System" Korean Journal of Medical Ethics 29, no.2 (2026) : 49-64.
