The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life (ELDA) was passed by the Korean National Assembly in 2016 and came into effect in 2018. Although the stated purpose of the act is to uphold patient autonomy and dignity in the context of end-of-life (EOL) care, its utilization remains low, with only some 40% of EOL decisions reflecting patients’ direct opinions. This study aims to pinpoint areas for enhancing ELDA by comparing it with similar systems in other countries and gathering expert opinions. To achieve this, we reviewed ELDA, compared it with EOL care systems in Taiwan, Japan, the UK, the US, and Germany, and surveyed Korean medical experts to collect their thoughts on how ELDA might be improved. On this basis, we make several recommendations, including broadening the scope of ELDA, bolstering the role of advance directives, and providing education for healthcare professionals. These recommendations are expected to increase the utilization rate of ELDA and enhance the quality of EOL care in South Korea.