From August 8th to 12th, 2025,Support for sustainable decision-making and arrangements that preserve dignity for everyone during and after life" project, I visited Seoul, Korea to investigate decision-making support for the elderly. The outline of the investigation is as follows:HerePlease see the article.
On August 11, the project research team visited the Center for Palliative Care and Clinical Ethics at Seoul National University Hospital. In this article, Researcher Nam reports on what he learned during the visit.
The university hospital is located in Seoul and has a capacity of 1,800 beds, with approximately 9,000 staff members, including approximately 2,000 doctors, treating approximately 3 million patients annually.
First, we toured the Cancer Center, ICU (Intensive Care Unit), Palliative Care Ward, etc. We heard that the new lounge at the Cancer Center was modeled after the one at Kyoto University Hospital.
Below: The cancer center's lounge and counseling room
The University Hospital's Center for Palliative Care and Clinical Ethics is dedicated to helping patients with serious illnesses and their families live meaningful, dignified lives by facilitating difficult decisions and navigating ethical conflicts related to treatment and patient care.
Although the Palliative Care and Clinical Ethics Center is located within the Cancer Center building, it handles clinical ethics issues not only for the Cancer Center but for the entire university hospital.
According to its website, the center was established in 1996 as a "Hospice Room," renamed the "Hospice Center" in 2014, and began operating a clinical ethics consultation team in 2015. Following the enforcement of the "Act on Hospice, Palliative Care, and Decisions Regarding Life-Sustaining Care for Terminally Ill Patients" (Life-Sustaining Care Decision-Making Act) in 2017, the center was renamed the "Palliative Care and Clinical Ethics Center" in 2018, and provides holistic care through an interdisciplinary team approach involving doctors, nurses, and social workers in both the fields of palliative care and clinical ethics, and supports ethical issues in the medical field.
The state of decision support in medical care in Korea
In connection with the research project, we exchanged views on the topic of decision-making for elderly people in the terminal stage of life with Professor Kim Beom-seok and Professor Yoo Shin-haenae, palliative care physicians working in clinical ethics, and staff members of the center.
First, Professor Kodama from the SMBC Kyoto University Studio introduced the main contents of the project. He explained the project's intentions and objectives, in particular a conceptual presentation of the decision-making and attitudes of the elderly, an introduction to related research, and future plans.
From the Center, Professor Yoo Shin-hae-nae gave a presentation on advance care planning (ACP) (*1) and end-of-life care (EOL Care) (*2) in Korea. Her presentation focused on the background and purpose of the "Life-Sustaining Medical Decision-Making Act," which directly links ACP and EOL Care in Korea, the implementation status of ACP and EOL Care decision-making since the law's enactment, and the current status of advance directives (AD) (*3) and life-sustaining treatment. In particular, she provided specific explanations of the content of life-sustaining treatment as defined by law, patient regulations, and related medical procedures. Finally, she presented the limitations of AD in Korea, issues related to patient families and ethics committees in ACP/EOL Care, and issues regarding care disparities in the societal context.
(*1) Advance Care Planning (ACP): Discussing future medical and care policies with the individual, their family, and medical professionals in preparation for the time when they no longer have the ability to make decisions.
(*2) End of Life Care (EOL Care): Providing medical care, nursing care, and care to help patients pass away peacefully.
(*3) Advance Directive (AD): Expressing your wishes in advance regarding medical procedures to be performed on you in the future when you lose the ability to make decisions. Also, this refers to the document (advance directive) for this purpose.
What are the methods of decision support in end-of-life care?
This was followed by a general discussion among all participants, where opinions were exchanged on methods of decision-making support in end-of-life care, based on the experiences of both Japan and Korea.
The Korean case study raised the following important points regarding end-of-life decision-making. First, in end-of-life care, family members have a particularly large influence on decision-making. In many cases, family members are responsible for caregiving and financial support during the patient's treatment process. When someone in the family is primarily responsible for caregiving and support, it can become difficult to make decisions in the field if that family member opposes a decision regarding a particular treatment.
The above points are also related to decision-making using advance directives (ADs) based on legal frameworks. Even if a patient has previously created an advance directive, there are cases where the patient falls into a serious condition without the family being aware of its contents. In such cases, decisions should be made in accordance with the patient's wishes, but in practice, this is not easy to do if there are strong requests from family members who are responsible for care and support.
To address these difficulties, Seoul National University Hospital has set up a dedicated counseling room in accordance with the law to provide consultations regarding decisions regarding end-of-life medical care. At this specialized counseling room, specialized staff explain the procedures involved to patients and their families during consultations. Furthermore, if there are difficulties with nursing care or financial support, the social support team will consider solutions tailored to the patient's situation and help them receive appropriate care and support.
Furthermore, to raise awareness of these activities, we regularly hold workshops and training sessions within the hospital to improve the capabilities of those in charge and the hospital's medical team.
However, it was also pointed out that there are differences in these efforts between medical institutions, which was an impressive point of discussion.
A word from the project representative (Kodama Satoshi)
In South Korea, it will soon be 10 years since the "Life-Sustaining Medical Treatment Decision-Making Act," which legalized the discontinuation of treatment for terminally ill patients based on advance directives, came into effect in 2017. The number of people who have developed AD has already exceeded 3 million (South Korea's population is approximately 51 million), indicating the high level of public interest.
It has been pointed out that ADs have problems such as being difficult to interpret due to the limited content and lack of a system for regular updates, and these are issues that need to be addressed in future legal reforms. In particular, the number of patients without relatives is increasing in Korea, and although ADs allow the appointment of a surrogate decision-maker, in principle this is limited to family members of the first degree of kinship, so it seems that it is necessary to consider who can make decisions on behalf of patients.
We would like to continue exchanging opinions with Korean medical professionals and researchers on topics such as raising public awareness and supporting decision-making for patients and their families.
