연명의료결정법과 환자자율성 증진에 관한 문제제기: 미국 환자자기결정권 제정 이후 논쟁분석*,**

Abstract

In February 2018 the “Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life” (hereafter the “Life-Sustaining Treatment Decisions Act”) went into effect in South Korea.” In order learn the lesson for Korean physicians’ practice in end-of-life care, we reviewed the debates surrounding the passage of similar legislation in the US. In particular, we examined the debates concerning the “Patient Self-Determination Act,” which was implemented in the US in 1991. We systemically searched for related medical articles on PubMed online and reviewed 17 articles that were retrieved through this search. One of the main findings of this review is that most of the articles expressed support for the Patient Self-determination Act on the grounds that it would enhance patient autonomy. In contrast with this, the Korean medical society criticized the Life-Sustaining Treatment Decisions Act on the grounds that it would undermine physician authority and limit respect for patient autonomy. This reflects the fact that Korean physicians are unfamiliar or uncomfortable with the idea of respecting patient autonomy as a way of furthering the patient’s best interests. In this article I argue that the reasons for welcoming the provisions of the Life-Sustaining Treatment Decisions Act are not only legal, but also medical and ethical: the law can improve the end-of-life care that is given in healthcare settings. However, in order to achieve this goal, patients must be fully informed about their rights and physicians should initiate discussions about advance care planning, as part of general health care, before serious illness arises.