Purpose: Korea is one of the few industrialized countries that have yet to come to a consensus on end-of–life (EOL) treatments. We attempted to evaluate the current status of EOL treatments in Korea with a National survey and claims data of Health Insurance Review & Assessment Service (HIRA), the single payer in health insurance in Korea.
Method: Data was extracted from the database of medical care fee claim submitted by medical institutes in Korea to HIRA in 2007. The source population was defined as individuals who died in 2007 with a history of medical service utilization in the last 30 days before death. We also surveyed Koreans and asked the following questions. 1) Are ventilator-dependent PVS patients candidates for end-of life treatment decisions? 2) Is withholding and withdrawing EOL treatment equivalent? 3) If an unconscious terminally ill patient’s wishes regarding EOL treatment are unknown, on what grounds should EOL decisions be made? 4) How should disagreements between or amongst medical staff and the patient’s family on EOL decisions be settled?
Result: The average days of hospital visit was 17.1 days in the last month of life with an average cost per visit of US$ 141. The average length of hospital stay in the last month of life was 10.3 days. One quarter of Koreans received ICU care, 17.6% received CPR, and 16.5% received mechanical ventilation in their last month. Only 56.5% received pain killers whereas 16.3% and 34.8% received antibiotics and transfusion in their last month. The national survey of 1500 Koreans revealed the following. Fifty-seven percent of general Koreans and 67% of Korean healthcare professionals consider ventilator-dependent PVS patients as candidates for EOL treatment decisions. Only one quarter of all respondents thought of withholding and withdrawing EOL treatment as equivalent. Just over 50% thought that EOL treatment decision should be made through discussions between the physician and the patient’s family. For settling disagreements, 75% of general Koreans preferred direct settlement between the medical staff and the patient’s family while 55% of healthcare professionals preferred calling in the hospital ethics committee.
Conclusion: Despite the high costs associated with life sustaining EOL treatment, greater societal consensus is required in order to develop a national guideline/regulation regarding EOL treatment decisions.