연명의료결정제도의 발전적 전개를 위한 방법론의 모색 — 사전연명의료의향서의 법적 지위 및 역할의 강화 필요성 —

Given the rapid aging trend of our society, it is demanded to establish and inspect the so-called end-of-life health care system for the elderly population. In this regard, the ‘Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life’ (hereinafter referred to as the “Act”) is currently in force. This legislated the patient's ‘right to self-determination’ about life, which can be evaluated as a turning point in the attitude of the state and society towards bioethics. Under the Act, the ‘determination to terminate, etc. life-sustaining treatment’ is the core of the end-of-life health care system. As a justification for this, the Act basically presents the patient's right to self-determination, and supplements the patient's right to self-determination with objective circumstances and requirements that consider medical standards. Meanwhile, the key bases for confirming a patient's intention for the determination to terminate, etc. life-sustaining treatment are the advance statement on life-sustaining treatment and the life-sustaining treatment plan. It is known that the AD(Advance Directives) and the POLST(Physician Orders for Life-Sustaining Treatment) form of the United States were referred to respectively during the legislative process. An AD is a legal document used to provide guidance about what types of treatments a patient may want to receive in case of a future, unknown medical emergency, whereas a POLST form is a portable medical order for specific medical treatments a patient would want based on his/her diagnosis, prognosis and goals of care in a medical emergency. As such, the two are different in their legal nature and content, etc. Furthermore, the two are not in an optional or alternative relationship with each other, but rather operate in a complementary relationship. Therefore, it is distinct from the advance statement on life-sustaining treatment and the life-sustaining treatment plan under Korean legislation, which function as an optional means of confirming the patient's intention for the determination to terminate, etc. life-sustaining treatment, and there is no significant difference between them in terms of content. The core of the system of decisions on life-sustaining treatment is the patient's right to self-determination. In order to faithfully adhere to this, it is judged that it is institutional reasonable to confirm the determination to terminate, etc. life-sustaining treatment based on a advance statement on life-sustaining treatment. Therefore, a more serious review of this aspect is requested in the future. Furthermore, in terms of more active respect for the patient's right to self-determination, it is necessary to actively consider developing the Act into a more general so-called ‘Patient Self-Determination Act’ in the future.