The number of cases in which life-sustaining treatment was actually withdrawn after a pledge not to receive meaningless life-prolonging treatment at the end of life has surpassed 50,000.
Life-sustaining treatment refers to procedures that extend life for a short period for patients near death, such as cardiopulmonary resuscitation, mechanical ventilation, and hemodialysis. Because it can increase suffering without therapeutic effect, some call it "meaningless life-prolonging treatment." A path for patients to refuse or stop such procedures opened after the Act on Decisions on Life-Sustaining Treatment took effect in 2018.
According to statistics from the National Agency for Management of Life-Sustaining Treatment on the 26th, the total number of cases of withholding or withdrawing life-sustaining treatment since the system took effect in 2018 has reached 453,785. Of these, 50,130 cases were stopped in accordance with an Advance Directive on Life-Sustaining Treatment that the patient had prepared in advance. In September alone, 1,100 people did not receive life-sustaining treatment in accordance with their prior pledge.
To withdraw life-sustaining treatment, a medical judgment must first be made that the patient has no possibility of recovery, and then the patient's intent must be confirmed by one of four methods: ▲ the patient prepares an Advance Directive on Life-Sustaining Treatment or a Life-Sustaining Treatment Plan; ▲ two or more family members testify to the patient's usual wishes; or ▲ all of the patient's family members reach an agreement.
Among these, an Advance Directive on Life-Sustaining Treatment can be prepared at any time by any adult. In contrast, a Life-Sustaining Treatment Plan is a document prepared by a terminally ill patient or a patient near death in consultation with the attending physician.
In cumulative statistics, the most common were cases withdrawn based on testimony from two or more family members, at 146,770, followed by 145,662 cases according to a Life-Sustaining Treatment Plan. Decisions based on the patient's own documents accounted for 43% of the total, and those made by family accounted for 57%.
However, the share that respects the individual's wishes—the "self-determination respect rate"—has been rising every year. The rate of decisions made by the patient, which was 32.5% of all withdrawals in 2018, rose to 50.8% last year, and this year (January–September) accounted for 52.4%.
In particular, decisions made through an Advance Directive on Life-Sustaining Treatment are increasing rapidly. They accounted for only 0.8% in 2018, but rose to 18.5% last year and 21.2% this year.
The number of people who have registered an Advance Directive on Life-Sustaining Treatment is continuing to grow, totaling about 3,069,000 as of the end of September. Accordingly, the number of cases in which the pledge is actually carried out is expected to increase further.
In the Second Comprehensive Plan for Hospice and Life-Sustaining Treatment (2024–2028), the government set a goal of raising the self-determination respect rate at the time of withdrawing life-sustaining treatment to 56.2% by 2028.