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KMID : 1025620180210020095
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Korean Journal of Medical Ethics
2018 Volume.21 No. 2 p.95 ~ p.113
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Using a Health Care Proxy to Overcome Limitations of the Act on Decisions on Life-sustaining Treatment
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Kim Bo-Bae
Kim Myung-Hee
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Abstract
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The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for patients at the End of Life was finally signed into law in South Korea following a long process of consensus-building. However, the appointment of proxy decision-makers was excluded from the recommendations made by the National Bioethics Committee and was not included in the provisions concerning life-sustaining treatment. Considering the increasing number of single-person families as well as the limited information that is typically available in making decisions concerning life-sustaining treatment, a system for designating surrogate decision-makers should be introduced into the provisions on life-sustaining treatment. The most appropriate system, which is currently used in the United States, is one that allows patients to designate healthcare proxies to make decisions on their behalf. A designated agent can make the best decisions for a patient based on both a substituted judgment standard as well as a best interest standard. However, when the two standards conflict or in other cases in which it is difficult to administer the decision of the designated agent, we recommend that the system allow physicians to receive help from either an institutional ethics committee or a clinical ethics service.
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KEYWORD
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The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for patients at the End of Life, health care proxy, substituted judgement, best interests, advance statements on life-sustaining treatment, clinical ethics service
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