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A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan
  1. Kwon Ivo1,
  2. Koh Younsuck2,
  3. Yun Young Ho3,
  4. Suh Sang-Yeon4,
  5. Heo Dae Seog5,
  6. Bae Hyunah6,
  7. Hattori Kenji7,
  8. Zhai Xiaomei8
  1. 1Department of Medical Education, School of Medicine, Ewha Womans University, Seoul, Korea
  2. 2Department of Pulmonary and Clinical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  3. 3Cancer Management Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
  4. 4Department of Medicine, Dongguk University, Seoul, Korea
  5. 5Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  6. 6Law School, Ewha Womans University, Seoul, Korea
  7. 7Graduate School of Medicine, Gunma University, Gunma, Japan
  8. 8Research Center for Bioethics, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
  1. Correspondence to Dr Ivo Kwon, Department of Medical Education, School of Medicine, Ewha Woman's University, 911-1, Mok-6-dong, Yangchon-gu, 158-710 Seoul, Korea; kivo{at}


Purpose The debate about the end-of-life care decision is becoming a serious ethical and legal concern in the Far-Eastern countries of Korea, China and Japan. However, the issues regarding end-of-life care will reflect the cultural background, current medical practices and socioeconomic conditions of the countries, which are different from Western countries and between each other. Understanding the genuine thoughts of patients who are critically ill is the first step in confronting the issues, and a comparative descriptive study of these perspectives was conducted by collaboration between researchers in all three countries.

Methods Surveys using self-reporting paper questionnaire forms were conducted from December 2008 to April 2009 in Korea (six hospitals in two regions), China (five hospitals in four regions) and Japan (nine hospitals in one region). The subjects were patients who were critically ill who had been diagnosed as having cancer. A total of 235 participants (Korea, 91; China, 62; Japan, 52) were eventually recruited and statistically analysed.

Results Most respondents had sometimes or often thought of their own death, mostly fear of ‘separation from loved ones’. They wanted to hear the news regarding their own condition directly and frankly from the physician. A quarter of them preferred making end-of-life care decisions by themselves, while many respondents favoured a ‘joint decision’ with their family members. The most favoured proxy decision maker was the spouse, followed by the children. Most admitted the necessity of ‘advance directives’ and agreed with artificial ventilation withdrawal in irreversible conditions. The most common reason was ‘artificial prolongation of life is unnecessary’. Most respondents agreed with the concept of active euthanasia; however, significant differences were sometimes observed in the responses according to variables such as patient's country of origin, age, gender and education level.

Conclusion Patients in Far-Eastern countries gave various responses regarding end-of-life care decisions. Although familial input is still influential, most patients think of themselves as the major decision maker and accept the necessity of advance directives with Westernization of the society. Artificial ventilation withdrawal and even active euthanasia may be acceptable to them.

  • End of life decision
  • Withdrawal of LST
  • euthanasia
  • far east Asian countries
  • biomedical ethics
  • abortion
  • aged
  • allocation of healthcare resources
  • allowing minors to die
  • allocation of organs/tissues
  • elderly and terminally ill
  • attitudes toward death
  • care of the dying patient
  • death education
  • education for healthcare professionals
  • clinical ethics
  • concept of health
  • philosophy of medicine
  • public health ethics

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  • Funding This work was supported by the Korean Research Foundation Grant funded by the Korean government (MOEHRD, Basic Research Promotion Fund) (KRF-2008-321-A-00024).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Ewha Womans University Mokdong Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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