현행 우리나라 연명의료중단제도의 주요 쟁점과 개선 방향

Abstract

The ACT ON HOSPICE AND PALLIATIVE CARE AND DECISIONS ON LIFE- SUSTAINING TREATMENT FOR PATIENTS AT THE END OF LIFE limits the discontinuation of life-sustaining treatment to only patients in the dying process, failing to guarantee the right to self-determination of terminally ill patients and patients in a persistent vegetative state. In addition, general life-sustaining treatment is excluded from the scope of life-sustaining treatment that can be discontinued, thereby reducing the effectiveness of the decision to discontinue life-sustaining treatment. In addition, there are uncertainties in presumption of intention and representation, the risk of discontinuation of life-sustaining treatment due to economic interests, and the issue of guaranteeing minors' right to self-determination. Accordingly, in order to faithfully achieve the purpose at the time of the original enactment of the law, we propose the following alternatives. First, discontinuation of life-sustaining treatment should be allowed for terminally ill patients and patients in a persistent vegetative state. In order to increase the effectiveness of discontinuation of life-sustaining treatment, discontinuation of general life-sustaining treatment should also be permitted. However, if the scope of discontinuation of life-sustaining treatment is expanded and discontinuation of general life-sustaining treatment is permitted, the issue of ensuring the patient's right to self-determination becomes more important, so more stringent procedural justification will need to be secured. Therefore, it is necessary to determine the patient's intention with the doctor or medical institution ethics committee or go through the court's prior control procedures. There is also a need to simplify the currently complex decision-making process for discontinuing life-sustaining treatment. In addition, there is a need to introduce the so-called ‘assisted death with dignity' system. In addition, it is necessary to secure expertise by strengthening education on the life-sustaining treatment discontinuation system and hospice-related laws for medical personnel such as doctors and nurses at frontline hospitals who are in charge of discontinuing life-sustaining treatment. Additionally, it is necessary to separate and supplement the laws regarding decisions to discontinue life-sustaining treatment. In other words, the 'Act on the process of deciding to discontinue life-sustaining treatment' and the 'Act on the institutionalization and quality services of hospice palliative care' need to be separated.