In this blog post, we will examine whether discontinuing life-sustaining treatment is giving up on life or choosing a dignified death from ethical and legal perspectives.
Since the Industrial Revolution in England at the end of the 18th century, humanity has made rapid progress in various fields. There have been significant advances in the development of machinery, including steam engines, basic science and engineering, mass production of food, as well as in the field of medicine, such as the development of antibiotics and vaccines and the establishment of medical systems. As a result, the life expectancy of humans has increased from the 20s to the mid-60s, and in developed countries, it has increased to the 80s. However, the increase in life expectancy and advances in medicine have recently raised social and ethical issues. That is the issue of euthanasia. Currently, euthanasia is prohibited in South Korea under Article 252 of the Criminal Act, but every time the issue of euthanasia arises, it causes intense conflict in society. To understand this, we will examine social perceptions and court precedents related to euthanasia through several cases, and then discuss the issue from the perspective of biomedical ethics. Before proceeding with the main discussion, we will explain the key concept of euthanasia, which appears frequently in this article.
Euthanasia is “the act of a person, usually a medical professional, ending the life of a patient who is terminally ill and suffering, in order to relieve their suffering.” Euthanasia is often divided into active euthanasia and passive euthanasia, or voluntary euthanasia, involuntary euthanasia, and involuntary euthanasia. In this article, we will explain euthanasia based on the more widely used classification of active euthanasia and passive euthanasia. First, active euthanasia refers to the act of actively shortening the life of a patient who is suffering greatly or has a terminal illness by using drugs or other means. On the other hand, passive euthanasia refers to the act of giving up on prolonging life by discontinuing life-sustaining treatment for patients who cannot be revived. In other words, active euthanasia and passive euthanasia differ in that they terminate life through active measures or neglect.
Now, let’s look at some social issues related to euthanasia that have actually occurred in South Korea. The first court case dealing with euthanasia in South Korea was the Boramae Hospital case in 1997. In the Boramae Hospital case, medical staff were charged with murder for discharging a patient who was clearly going to die if discharged, at the strong insistence of the patient’s guardian. The actual case was closer to “discharge against medical advice (DAMA)” than euthanasia, but it sparked considerable social debate on euthanasia and DAMA. Subsequently, among the discussions on euthanasia, the incident that caused the greatest social uproar was the “Grandma Kim incident” in 2008-2009. In February 2008, Grandma Kim underwent a lung cancer biopsy at Severance Hospital and suffered cardiac arrest due to excessive bleeding, leaving her in a vegetative state. Subsequently, Kim’s family filed a civil lawsuit against the hospital in June 2008, requesting that meaningless life-prolonging treatment be discontinued. After about a year of appeals and appeals, the case was finally settled on May 21, 2009, with the Supreme Court ruling in favor of Kim’s family. The Supreme Court ruled that based on the right to self-determination protected by the right to personality and the right to pursue happiness stipulated in Article 10 of the Constitution, it is possible to request the discontinuation of treatment that is solely intended to maintain the current state of a patient who has no chance of recovery. In addition, the following requirements for the discontinuation of life-sustaining treatment were presented. First, the patient must be in a state of death with no chance of recovery. Furthermore, treatment that can be discontinued is limited to life-sustaining treatment for the purpose of maintaining the status quo. If a person has expressed their intention to refuse or discontinue life-sustaining treatment in advance through a medical professional in preparation for an unexpected situation, this advance medical directive is accepted as an exercise of their right to self-determination. Above all, it is clearly stated that whether or not a patient has reached the stage of irreversible death must be determined by a committee that includes a specialist. However, the ruling was not entirely unanimous, with nine judges dissenting and five concurring, indicating that the controversy has not been completely resolved. After much social debate, the Act on Decisions on Life-Sustaining Treatment and Hospice Care, also known as the “Life-Sustaining Treatment Act,” was enacted in early 2016, and since February 4, 2018, life-sustaining treatment can be discontinued with the consent of the patient or their family.
We have looked at the discussions on euthanasia in Korea over the past 20 years through the two court cases and one law discussed above. What is characteristic is that all three cases deal with passive euthanasia, not active euthanasia. There are almost no cases related to active euthanasia in Korea. This is because, unlike passive euthanasia, active euthanasia is strictly prohibited by law in most countries, including South Korea, with the exception of the Netherlands. Furthermore, regardless of its legality, active euthanasia is, in most cases, ethically wrong. Of course, those in favor of active euthanasia may argue that a patient’s body and life are their own property, and therefore they have the freedom to decide how to end their own life. The patient’s autonomy in the treatment process is, of course, extremely important. However, this argument by liberals is not justified. First, in the case of active euthanasia, it is not easy to find criteria for distinguishing between terminally ill patients and patients in severe pain. Therefore, if everyone is given the right to end their lives as they wish, as they argue, the distinction between suicide and active euthanasia will become ambiguous. For this reason, active euthanasia, whether voluntary or involuntary, has more potential for abuse than passive euthanasia. Above all, active euthanasia is completely contrary to the basic principle of medical professionals, which is to save lives. If active euthanasia is practiced as liberals argue, there will be a direct conflict between the basic duty of individual doctors to save lives and the decisions of patients. Of course, in some exceptional cases, it is ethically acceptable and permissible to perform active euthanasia in accordance with the wishes and values of the patient. However, I believe it is unreasonable to legislate cases where passive euthanasia is permissible. On the other hand, I believe that passive euthanasia can be permitted to a certain extent. Does meaningless life-prolonging treatment really help patients and their guardians? Rather, meaningless life-prolonging treatment only causes meaningless suffering for patients and their guardians. Furthermore, unlike active euthanasia, passive euthanasia is unlikely to violate the principles of non-maleficence and beneficence, which are principles of bioethics. There are medical practices similar to passive euthanasia that are currently legal. These are the withdrawal of life-sustaining treatment for brain-dead patients and organ donation. The withdrawal of futile life-sustaining treatment for brain-dead patients and organ donation are already practiced worldwide. Therefore, we conclude that passive euthanasia is the most desirable method of providing the best interests of the patient only when meaningless life-sustaining treatment continues. Of course, decisions regarding medically meaningless life-sustaining treatment and the condition of patients who cannot be revived must be made strictly by a committee composed of multiple experts, as in the case of determining brain death.
We have examined social issues and court precedents related to euthanasia. We also discussed cases where active and passive euthanasia can be justified and cases where they cannot. Euthanasia is a relatively recent issue, and there is much debate for and against it, so some of the points discussed above may be considered illogical from other perspectives. However, considering the situation in which discussions on euthanasia have not been properly conducted due to the proliferation of various classification criteria, complex definitions, and illogical preconceptions, this article can be seen as presenting a desirable direction for discussion. I would like to conclude this article with the hope that there will be many more discussions on the bioethics of medically controversial practices such as euthanasia in the future.
