[AtoZ into Korean mind] Death & denial: Why Koreans refuse to contemplate the end

A few years ago, Kim Sun-yong (not her real name) stumbled upon a Facebook post written by an acquaintance from work. The author, an American who was battling late-stage cancer with no prospects of recovery, asked his Facebook friends for suggestions on what to include on his bucket list as he braced for the inevitable.

Most comments expressed their sadness about the man's impending death and offered suggestions as asked. But one comment written by a person with a Korean name responded, “Please don’t say that. You won’t die.”

There, in the acceptance of a friend's mortality, Kim sensed a significant cultural clash.

"We, Koreans, would never suggest bucket list items to a friend who is dying. It's just something we can't bring ourselves to say," she said. The responses from everyone except that one Korean were, to her, "very strange."

‘Live’

It is quite common for Koreans to deny the imminence of death, even for patients in their final stages, encouraging them to hold on to hopes for recovery. Even when doctors say there’s no hope, miracles are cited as a reason to keep hoping.

Many fear that bringing up the topic of death might give the impression that they are giving up on the person who is fighting to live, or may dampen the person’s courage to fight.

Jung Hyun-chae, an honorary professor of internal medicine at Seoul National University, says that although fear of mortality is universal, Koreans collectively have a particularly strong aversion to accepting death and openly discussing it.

“Koreans tend to either ignore death or strongly deny it,” he said.

The professor, who authored the book “Why We Don’t Need to be Afraid of Death" (unofficial translation), said this aversion to death is affecting end-of-life care in Korea, in ways that do not benefit people who are dying.

He pointed out that the use of narcotic painkillers, which are the most powerful means for alleviating pain in terminally ill patients, stands at only one-tenth of the levels used in other countries. This is because the focus of patients and their families is more on seeking improvement, rather than accepting and preparing for the inevitable, he explained.

“Even when there are only a few days left to live, families worry about the potential for addiction to narcotic painkillers,” he said. “It’s really unfortunate.”

What lies underneath?

Jung believes that Confucianism played a significant role in shaping Koreans' attitudes toward death.

Contrary to most other religions, Confucianism does not have a concept of life after death. Its influence as the dominant belief system in Korea during the Joseon era (1392-1910) led people to believe that living a long life was of the utmost importance, fostering an underlying fear of death.

Jung said that today, although Confucianism no longer holds the sway it once did, its influence persists in the minds of many Koreans.

“Even those with (other) religious beliefs hesitate to talk about death and view it negatively,” he noted.

Park Joong-cheol, a family medicine and hospice doctor at Incheon St. Mary's Hospital and the author of “I Want a Kind Death,” traces the root of Koreans' refusal to contemplate death to more recent history.

The mindset is more likely a byproduct of their preoccupation with the harsh realities of 20th-century Korea, punctuated by foreign occupation, wars, and poverty, followed by rapid urbanization and industrialization, he said.

In the process, the value of life was replaced by the struggle for survival.

Even after the era of material abundance, a sense of “spiritual emptiness” prevails in Korea, he continued. Today, Koreans, exhausted by the relentless chase for success, find solace in crowds, seeking to escape their anxieties rather than “contemplating them in solitude.”

“This is because, for those who must endure life’s uncertainties alone, survival itself is a terror,” he said. “They do not wish to confront the additional anxiety of death.”

Choi Joon-sik, an emeritus professor at Ewha Womans University specializing in Korean religion and philosophy, notes that in contemporary Korea, death is increasingly alienated from life.

In the past, death was something people witnessed up close. Three generations lived under one roof and formed strong village communities with neighbors.

Back then, most deaths occurred at home. When the end grows near for a family member, the entire family would gather by the dying person’s side, sharing their fears and anxieties together. After the person's passing, the funeral would be conducted in the home, and the burial would occur on a hill behind the house.

“Children also participated in the whole process,” Choi said.

“But now, we have become observers, rather than participants in the process of death,” he added.

Children rarely live in the same house with their grandparents, resulting in fewer opportunities to encounter older people who are ill or dying. The fast-paced nature of modern life often prevents people from caring for their dying parents at home, resulting in a reliance on hospitals for end-of-life care.

Currently, a significant number of Koreans pass away in the isolation of intensive care units, encircled by impersonal machinery.

As of 2022, 74.8 percent of Koreans passed away in medical facilities. Only 16.5 percent passed away at home.

Funeral services are handled by professional service providers. Crematoriums, cemeteries and columbariums are situated away from city centers and residential zones, further distancing the living from the dead.

“As a result, death becomes an increasingly alien concept and a topic shrouded in taboo,” Choi said.

As death becomes distant from the daily lives of Koreans, their perceptions of it have grown vague and negative. This is evident in the tendency among Koreans to avoid bringing young children to funerals, fearing they might be shocked by the sight of grief.

Understanding death, understanding life

Albeit slowly, more Koreans are starting to contemplate and prepare for death.

As of December, over 2 million individuals had registered to forego life-sustaining treatment in the event of imminent death, a measure intended to avoid meaninglessly prolonging the process of dying.

Additionally, despite it still being a relatively new concept, some people are making plans for “well-dying,” an extension of “well-being.”

Song Kil-won, leader of the nongovernmental organization HiFamily and the Happy Ending School, noted that the school assists individuals in preparing for death by guiding them to write health care directives, funeral preferences, donation intentions and wills in advance.

He mentioned that Korea, as a society, is now past its rapid development stage, with more people intent on reflecting on life and seeking meaning beyond material possessions.

“Death is at the heart of humanity,” he said. “While the West has already integrated the study of death into education, this concept is only just beginning to emerge in our country.”

In several advanced countries, such as the US, the UK, Australia, Canada, Japan and the Netherlands, aspects of death education are increasingly being recognized for their importance within the curriculum.

Song said that properly addressing the topic of death in schools could contribute to reducing the rate of youth suicide. Multiple researches showed death education has a positive effect on reducing anxiety about death and suicidal ideations.

"Death doesn’t come with a warning. Living a life that prepares for death can make our lives stronger," he said. "Not only the elderly but also young people, not just individuals but our entire society, need to learn about death."