호스피스를 넘어, 돌봄의 목표로서의 완화의료: 완화의료의사의 관점에서 본 사전돌봄계획과 연명의료결정
Palliative Care as a Goal: Advance Care Planning and Life-sustaining Treatment Decisions from a Physician’s Perspective
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Advance care planning (ACP) and life-sustaining treatment decisions in Korea remain more procedural than patient-centered. Discussions tend to focus more on discontinuing life-sustaining treatment or transitioning to hospice than on integrating palliative care throughout the course of an illness. This commentary analyzes a case in which a terminal cancer patient passed away at home without formal ACP or hospice enrollment. While legally unproblematic, this outcome raises concerns about whether the patient’s values and care goals were adequately addressed. The Korean healthcare system limits palliative care services to specific terminal illnesses, and ACP typically begins only after a terminal diagnosis. This leads to fragmented decision-making, with care goal discussed too late and palliative care viewed as an alternative to life-sustaining treatment rather than an integral part of medical care. Additionally, the lack of multidisciplinary collaboration and structured communication hinders effective ACP implementation. This article argues that bridging this gap requires that palliative care be embedded into routine clinical practice, ensuring early and evolving care goal discussions. Strengthening palliative care education, expanding multidisciplinary collaboration, and developing structured decision-making support systems are proposed as essential strategies to achieve meaningful ACP and improve end-of-life care.
Abstract
Advance care planning (ACP) and life-sustaining treatment decisions in Korea remain more procedural than patient-centered. Discussions tend to focus more on discontinuing life-sustaining treatment or transitioning to hospice than on integrating palliative care throughout the course of an illness. This commentary analyzes a case in which a terminal cancer patient passed away at home without formal ACP or hospice enrollment. While legally unproblematic, this outcome raises concerns about whether the patient’s values and care goals were adequately addressed. The Korean healthcare system limits palliative care services to specific terminal illnesses, and ACP typically begins only after a terminal diagnosis. This leads to fragmented decision-making, with care goal discussed too late and palliative care viewed as an alternative to life-sustaining treatment rather than an integral part of medical care. Additionally, the lack of multidisciplinary collaboration and structured communication hinders effective ACP implementation. This article argues that bridging this gap requires that palliative care be embedded into routine clinical practice, ensuring early and evolving care goal discussions. Strengthening palliative care education, expanding multidisciplinary collaboration, and developing structured decision-making support systems are proposed as essential strategies to achieve meaningful ACP and improve end-of-life care.