'Dignified death' more accessible to wealthier people, city residents: report

This photo is not directly related to the story. (123rf)

New research showed Monday that access to end-of-life medical decisions varies depending on income level and proximity to major hospitals, even as the option is widely viewed as being crucial to a "dignified death."

According to a report released last week by the National Health Insurance Service, the group of the top 20 percent of income earners accounted for 31.5 percent of those who withdrew life-sustaining treatment in 2023. In contrast, the same top earners were 25.8 percent of those who made no decision.

In contrast, beneficiaries of state medical aid, provided to people with an income at 40 percent or less of the national median income, were just 10.9 percent of those who discontinued life-prolonging treatments. The same group accounted for 16.8 percent of those who did not make a decision.

The numbers suggest that income level is a substantial factor in deciding to discontinue life-sustaining treatment.

Regional disparities were also evident. Residents of major cities made up 45.6 percent of those who chose to forgo life-sustaining treatment, compared with 37.1 percent among those who did not use the system.

The report pointed to unequal access to hospitals as a key factor behind the imbalance, noting that information about the system and the practical ability to exercise the choice are largely mediated through medical institutions.

“Although the end-of-life medical decision system was introduced to guarantee equal access to a dignified death, the skewed participation pattern suggests that this choice is not evenly available across the population,” said a researcher at Korea’s public health insurance operator.

First introduced in 2018, the decision to withdraw life-sustaining treatment has gained broader acceptance in Korea. According to a survey by the Ministry of Health and Welfare in 2023, 84.1 percent of people aged 65 and older expressed positive views about discontinuing life-sustaining treatment.

The analysis of public health insurance subscribers in 2023 covered 52,000 deaths involving the implementation of the life-sustaining treatment decision system and 286,000 deaths in which the system was not used.