韩国央行-维持生命的治疗，谁的决定：患者偏好与医疗现实之间的差异及其政策影响.pdfVIP

No.2025-38BANKOFKOREA

BOKIssueNoteDecember11,2025

Life-SustainingTreatment,WhoseDecision:

DiscrepanciesBetweenPatientPreferences

andMedicalReality,andPolicyImplications

KimTaekyung,LeeInro,ChungJongwoo,YooInkyung

DemographicLaborEconomicsTeam,

EconomicResearchInstitute,BOK

HanEun-jeong,ParkYeongwoo

DepartmentofLong-TermCareResearch,

HeathInsuranceResearchInstitute,NHIS

1.ThreeMillionDecisions:AchievementsoftheDecisionsonLife-SustainingTreatment

ActandNextSteps

Inordertosafeguardpatients’righttoself-determinationanddignity,Decisionson

Life-SustainingTreatmentActcameintoforcein218.Sincethen,Koreansocietyhas

madesubstantialprogresstowarddiscussingtheend-of-lifemoreopenlyand

fosteringacultureofthoughtfulreflectiononend-of-lifecare.Asthesystemhas

becomemorefirmlyestablished,thenumberofcasesinwhichlife-sustaining

treatment(LST)hasbeenwithdrawnorwithheldhassteadilyincreased,andthe

numberofindividualswhohaveregisteredanAdvanceDirectiveonLife-Sustaining

Treatmenthassurpassedthreemillion.Buildingontheseachievements,itisnow

timetoaddressthelimitationsrevealedinthecourseofimplementingthesystem

andtofurtheradvancetheframeworksothatpatients’wishescanbemorefully

realizedinclinicalsettings.

2.RefusalIntentionsat84.1%vs.ActualWithdrawalat16.7%:TheGapBetweenPatient

PreferencesandclinicalReality

Amongadultsaged65andolder,84.1%reportthattheywouldrefuseLSTin

situationswithnoprospectofrecovery.