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KMID : 1025620170200020131
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Korean Journal of Medical Ethics
2017 Volume.20 No. 2 p.131 ~ p.151
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The Decision-Making Process Regarding Life-Sustaining Treatment in Four Countries: Taiwan, Japan, the US, and the UK
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Choi Eun-Kyung
Hong Jin-Ui
Kim Min-Sun
Keam Bhum-Suk
Kim Mi-So
Heo Dae-Seog
Park Hye-Yoon
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Abstract
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The “Act on Life-Sustaining Treatment Determination” was passed in Korea in 2016 and will take effect after the enactment of certain ordinances and rules. In this study, we analyzed the decision-making process regarding the withholding and withdrawal of life-sustaining treatment in four countries: Taiwan, Japan, the US, and the UK. Each country introduced advance directives either through legal forms (Taiwan, the US), limited legal forms (the UK), or arbitrary forms (Japan). Japan takes a guideline-centered approach, whereas Taiwan takes law-centered approach. And while a patient`s will about life-sustaining treatment (LST) is respected as part of a patient`s self-determination in the US, physicians can refuse treatment if its benefits are extremely uncertain. On the other hand, in the UK, if a patient has lost decision-making capacity, physicians can make decision regarding the patient`s best interests. In this article, it is argued that minimal standards should be established in Korea to prevent possible abuse as well as to respect patients` right to self-determination; however, it is desirable to support good decision-making processes between physicians and patients (and their family members) rather than to over-regulate current practice.
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KEYWORD
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Act on Life-Sustaining Treatment Determination, advance directive, medical ethics committee, respect of self-determination, best interests
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