President Lee Jae-myung, regarding the decision to withdraw life-sustaining treatment, said, "Separate from the bioethics debate, there is also a need to consider the practical medical finance issue at the policy level," calling for an institutional review.
On the afternoon of the 16th, at the Health and Welfare Ministry's work briefing held at the Government Sejong Convention Center, the president said, "It is clearly the case that medical expenditure drops significantly when one chooses not to receive life-sustaining treatment," adding, "We need to consider how the resulting fiscal savings could be returned to society or designed as incentives."
Under current law, the withdrawal of life-sustaining treatment is strictly limited by the Act on Decisions on Life-Sustaining Treatment. Withdrawal is allowed only when a terminal patient has previously completed an advance directive or a life-sustaining treatment plan and two physicians reach the same judgment.
The government, however, maintained a cautious stance. The Health and Welfare Ministry said, "There is still not enough precise research on how much medical expense reduction actually results from withdrawing life-sustaining treatment," adding, "Accurate analysis must come first before policy discussions are possible."
The possibility of ethical controversy was also raised. Health and Welfare Minister Jung Eun-kyeong said, "The original purpose of withdrawing life-sustaining treatment is to ensure a dignified end of life," adding, "If fiscal incentives are combined, the intent of the system could be distorted or unexpected side effects could arise."
In response, the president said, "I fully recognize that there are bioethical issues," but added, "While respecting individual choice, we should look into whether there are systems that reasonably manage social expense, including overseas examples," and asked, "Please review the ethical and legal issues together."
The social burden surrounding life-sustaining care is growing. According to a report titled "Life-sustaining care: Whose choice is it?" released by the Bank of Korea Economic Research Institute on the 11th, the number of patients who received life-sustaining care rose by an average of 6.4% annually from 2013 to 2023. During the same period, the length of life-sustaining treatment also increased from an average of 19 days to 21 days.
Although the enforcement of the Act on Decisions on Life-Sustaining Treatment in 2018 allowed patients to express in advance their intention to refuse life-sustaining care, actual implementation of life-sustaining care has instead increased. According to a survey of the elderly released by the Health and Welfare Ministry in Oct. last year, 84.1% of those 65 or older said they intended to refuse life-sustaining care. However, the Bank of Korea (BOK) found that the actual rate of discontinuing life-sustaining care was only 16.7%.
Analyses suggest that family burdens and conflicts lie behind the provision of unwanted life-sustaining treatment. In the BOK survey, about 20% of bereaved families who decided to withdraw life-sustaining care said they experienced family conflict.
The economic burden is also significant. The average end-of-life (the final year before death) medical expense per life-sustaining care patient nearly doubled from 5.47 million won in 2013 to 10.88 million won in 2023. The average annual growth rate was 7.2%, which is about 40% of the median income for households aged 65 or older (26.93 million won).
The caregiving burden is likewise being passed directly to families. In a survey conducted in Sept. this year by the BOK of 1,000 families of cancer patients who died after receiving life-sustaining care, 49% hired a caregiver, with a monthly average expense of 2.24 million won. Some 46% said they or another family member quit work to provide care, and in those cases, monthly income fell by an average of 3.27 million won. Among households that hired caregivers, 93% said "the expense is burdensome," and among those that quit work, 87% said "they suffered financial hardship due to lower income."