The public opinion on the legalization of physician-assisted suicide (PAS) seems positive. 82% of the respondents agreed to the concept in the survey used as the framework of the proposition of the “Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life” proposed by member of the National Assembly Ahn Gyuback. However, this is not because PAS is the only way to go for terminal patients, but because they cannot expect a dignified end-of-life and an easeful death. Hidden behind the high approval of PAS, we must first pay attention to Korea's poor end-of-life care system.

According to a survey conducted by the Korean Society for Hospice and Palliative Care on "priority policies of the administration and National Assembly for dignified death," the majority of respondents opposed the ‘preferential promotion’ of PAS. “Legalization of PAS” ranked 13.6%, the lowest in priority among all items. Prior to that comes the establishment of a care system for terminal patients and the expansion of hospice palliative care (HPC). In fact, "Arrangement of a support system to reduce the burden of nursing (subvention for nursing expenses, introduction of a paid leave system for nursing, etc.)” (28.6%), "financial support (reducing medical expenses, including the cost burden after diagnosed with late-stage, etc.)” (26.7%), "expansion and support of HPC" (25.4%) were all higher in priority.

After all, the more urgent task than the permission for assisted suicide is the organization of end-of-life care. According to the Ministry of Health and Welfare's 2022 survey on senior citizens, the majority of Koreans perceive that a ‘good death’ is a "death that does not burden their family or acquaintances" (90.6%). However, it is difficult for patients in Korea to anticipate a death which relieves the burden of caring by their families. Terminal patients need 24-hour care, but hiring caregivers has many difficulties. The average nursing time for patients with advanced diseases is 6 hours a day, and the average cost of hiring caregivers is 100,000 ~ 130,000 won per day. Terminal patients would require even more time and costs due to higher intensity of care. But matching the caregivers is left to the private sector rather than governmental management since caregivers have no specified qualification requirements, and caregiver agencies tend to avoid patients with relatively high care intensity.

On the other hand, in the case of terminal patients who choose to meet their death at hospices, the economic and time burden can be reduced by certain hospices that adopt a helper system to deploy professional caregivers. It is thanks to the fact that health insurance has been applied to hospice support personnel since 2015.[1] However, hospices currently lack infrastructure and do not have enough beds. In Seoul in 2020, only 3,186 (22%) of the 14,377 deaths by hospice-targeted diseases were able to receive HPC. On average, the length of stay in an inpatient hospice is only 20 days, while patients must wait 21 days only to enter a hospice in Seoul. We should keep in mind, that in this high approval rate for PAS is the sorrow of end-of-life patients who cannot expect a dignified death under the current medical system.

To systematize end-of-life treatment, securing hospice beds through national subsidies is necessary. Along with that should come positive change in perception of hospice from 'a place for dying' to 'the best place to care for end-of-life patients.' Furthermore, the medical system should respect the needs of most end-of-life patients who wish to die in their communities and homes. We should gradually establish a home-based palliative care system, more than just general inpatient care.[2]

Of course, easing the burden of nursing care and expanding hospices may not completely replace the high demand for PAS. In that it realizes more active decision-making rights about life, the legalization of PAS is a debatable issue as an option for patients at the end of life. However, behind the pros and cons of par value, the preceding tasks of PAS must be solved preferentially to discuss the methods of a dignified death more carefully.