In this blog post, we examine whether discontinuing life-sustaining treatment is giving up on life or choosing a humane 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. In addition to the development of steam engines and other machines, basic science and engineering, and mass production of food, there have been significant advances in medicine, including the development of antibiotics and vaccines and the establishment of medical systems. As a result, the average 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. This 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 is raised, 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, causing the death of a patient who is beyond hope of recovery in order to relieve their suffering.” Euthanasia is often broadly classified as active euthanasia, passive euthanasia, voluntary euthanasia, non-voluntary euthanasia, and involuntary euthanasia. In this article, we will explain euthanasia using 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 an incurable disease by using drugs or other means. Passive euthanasia, on the other hand, refers to the act of giving up on prolonging the life of a patient who cannot be revived by discontinuing life-sustaining treatment. 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 involving 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 after being discharged from the hospital at the strong insistence of the patient’s guardian. The actual case was closer to “discharge of a patient against medical advice (DAMA)” than euthanasia, but it sparked considerable social debate on euthanasia and DAMA. Since then, the most socially controversial case involving euthanasia was the “Grandma Kim case” in 2008-2009. In February 2008, Kim Grandmother underwent a lung biopsy at Severance Hospital and suffered cardiac arrest due to excessive bleeding, leaving her in a vegetative state. In June 2008, Kim’s family filed a civil lawsuit against the hospital, requesting that it stop futile life-sustaining treatment. 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 Constitution’s Article 10, which guarantees the right to personal integrity and the pursuit of happiness, 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. The court also presented the following criteria for discontinuing life-sustaining treatment. 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 a 9:4 split among the Supreme Court justices, 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 as of 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, not ethically acceptable from a bioethical perspective. Of course, those in favor of active euthanasia may argue that the patient’s body and life are their own property, and therefore they have the freedom to decide how to end their own life. Of course, the autonomy of the patient is extremely important in the treatment process. 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 doctors to save lives and the decisions of patients. Of course, in some exceptional cases, it is ethically acceptable 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 to patients and their guardians. Furthermore, unlike active euthanasia, passive euthanasia is less likely to violate the principles of non-maleficence and beneficence in medical ethics. 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 meaningless life-sustaining treatment for brain-dead patients who have no chance of recovery and organ donation from brain-dead patients are currently practiced worldwide. Therefore, we can conclude that passive euthanasia is the most desirable method of providing the best interests of the patient only when meaningless life-sustaining treatment is continued. 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 looked at 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.
