Where does Korea stand on assisted death?

Lee Myung-shik, 63, is paralyzed from the waist down as a result of acute myelitis, a condition he developed after retiring from his public service job in 2019.

Unable to perform basic bodily functions independently, he requires the constant use of a urinary catheter and the assistance of his daughter to manually remove stool from his rectum.

“Usually, when a person’s lower body is paralyzed, they normally do not have any sensation from the affected parts, but it’s different in my case,” said Lee, sitting in his wheelchair at his home on Jeju Island.

“Some nerves remain intact, causing me to continually experience excruciating pain. Painkillers don’t help. I just have to endure it,” he said.

What frustrated him most was that his life was not going to fade away anytime soon. He is not terminally ill.

The only way out, he determined after some time, was to get to Switzerland for physician-assisted suicide. While going through the cumbersome task of preparing all the required documents in English for Dignitas, the Swiss nonprofit group assisting people like him, he realized an insurmountable barrier: He could not travel to Zurich alone.

“If my daughter or someone accompanies me there, the person will be punished for aiding in suicide under the current Korean laws,” Lee said.

So in December, Lee set out to challenge the local laws that do not allow for assisted death. He filed a petition to the Constitutional Court to review the constitutionality of the laws that limit one’s right to die with dignity and penalize all forms of assisted suicide.

In January, the Constitutional Court deemed Lee’s petition legitimate and initiated a review of his case. This marks the first time for the top court to examine the legality of preventing an individual's voluntary choice to end their life.

End-of-life choices in S. Korea

While South Korea criminalizes any form of assisted dying, at least 204 South Koreans, as of April 2023, have obtained membership for assisted dying facilities in Switzerland; Dignitas had 136 Korean members and Lifecircle had 13, according to a report from local newspaper Seoul Shinmun.

At least 10 Koreans so far have made the final journey to Switzerland to die at such clinics, the report said.

Kim Young-in, who has been living with complex regional pain syndrome since 2013, joined Dignitas in 2020.

“Securing Dignitas's approval (for the assisted dying process) brought me peace,” he said. “What I feared was not death, but the endless pain. Knowing I have the option to end this pain, even as soon as tomorrow, grants me the ability to live today in peace."

There, a pressing question arises: Should Korea grant the same choice to myelitis patient Lee, and other people who are in great pain or are terminally ill?

For South Korea to find an answer, the conversation is only just beginning according to Park Joong-cheol, a family medicine and hospice doctor at Incheon St. Mary's Hospital and author of “I Want a Kind Death.”

“In Korea, there has been hardly any social discussion on these matters,” he pointed out.

Whether it’s assisted suicide or euthanasia, countries where these practices are legal have undergone centuries of debate to build a national consensus, he continued.

Prior to a milestone ruling in May 2009, South Korea compelled doctors to persist in treating patients who have entered the dying process, regardless of the futility of the effort or prolongation of suffering. The removal of life-sustaining devices could lead to criminal charges against those involved.

The 2009 decision by the Supreme Court to allow the removal of life-sustaining devices from an elderly patient in a vegetative state led to years of discussions around the concept of a Korean “well-dying bill.” Finally, in February 2018, these efforts culminated in the implementation of the Act on Decisions on Life-Sustaining Treatment, which allows patients to refuse the use of life support when death is imminent.

As of 2024, South Korea's position on end-of-life choices remains unchanged, with no further advancements beyond the 2018 legislation.

In 2022, an opposition lawmaker solely campaigned for an amendment of that law to allow medically assisted deaths.

The bill, drafted and submitted by Rep. Ahn Gyu-back of the Democratic Party of Korea, hasn’t made any progress in the legislative process. Given that the current parliamentary session is set to conclude in three months, it will likely be shelved.

Rep. Ahn says he will reintroduce the same bill if he’s reelected to the next parliament.

Pro-life vs. pro-choice

Assisted death has wide public backing in South Korea, one public opinion poll shows.

The poll, conducted by Hankook Research on 1,000 adults in 2022, found that 82 percent of respondents supported the concept. The primary reason for their support was the right to self-determination at 25 percent, closely followed by the belief in one’s right to die with dignity at 23 percent.

The third most significant factor, chosen by 20 percent of respondents, was the concern over the “pain and burden inflicted on the family.”

And this is partly the reason why religious and medical communities are worried and oppose legalizing assisted death.

Patients’ decisions could be influenced by economic reasons or other considerations, for instance, their wishes not to burden their families with medical bills and caregiving responsibilities.

The Bioethics Committee of the Catholic Bishops' Conference of Korea, in response to Rep. Ahn’s bill in 2022, stated, "Euthanasia is often portrayed with the beautified image of a death in which the patient dies with dignity and grace, without pain, but in reality, it is an act of suicide and participating in murder.”

Religious groups argue that institutionalizing medically assisted death is so out of step for a country that is endeavoring to curb suicides and change its culture that undervalues life.

With 25.2 deaths per 100,000 people in 2022, South Korea topped the ranks of the 38-member Organization for Economic Cooperation and Development in terms of suicide rates. This rate is more than double that of the OECD average of around 10-11 deaths per 100,000.

The Korean Medical Association also pointed out that offering patients medical assistance in dying would conflict with the Act on the Prevention of Suicide.

Hospice doctor and author Park said that assisted suicide ultimately means that doctors become agents of the act and, consequently, the responsibility and legal implications would fall on the doctors.

“Physicians carry a tremendous fear and burden regarding the notion of having the power to decide on matters of life and death,” he said. “Before enacting (the assisted death) law, there should be sufficient dialogue, social consensus and comprehensive discourse on euthanasia and dignified death.”

Globally, countries that allow physician-assisted death or euthanasia include Switzerland, the Netherlands, Belgium, Spain, Luxembourg, Canada, some states in the United States, Australia, New Zealand and Colombia. All have undergone heated debate, he stressed.

Cries of pain continue

Preparing for the interview, the myelitis patient Lee had taken the strongest painkiller available to be able to speak for his right to live and die in dignity.

He expressed mixed feelings concerning his daughter, who has put her social life and career on hold to care for him.

But, the more overwhelming feeling, he said, is misery, stemming from his inability to control his life and the uncertainty of when his suffering will end.

"Advocates of life's sanctity say life is precious and that I must endure the pain until I die," he said. "But enduring not knowing when this will end is painful."

Kim Jae-ryon, Lee’s legal representative for the Constitutional Court case, said that both opponents and proponents of assisted death talk about the same thing: human dignity.

Supporters of assisted death argue for the right to end one’s life “with dignity,” while opponents contend that life should not be artificially terminated, as there is intrinsic dignity in each human life, whether in its final stages or not.

“The debate on dignified death is essentially a conflict between two interpretations of dignity," Kim said.

While opponents view dignity as an abstract principle underscoring the sanctity of life, for patients seeking to end their suffering, dignity represents a "specific and concrete" consideration, directly tied to the misery and pain permeating their daily existence, Kim contended.

“Is it right to force individuals, who find themselves devoid of human dignity because of severe pain, to continue to bear such suffering because of a general emphasis on the importance of human dignity?”

Choi Da-hye, head of the Korea Association of Right to Die, added, “Allowing assisted suicide does not mean that all patients in pain will choose to die immediately.”

“It is about providing the option to choose death,” Choi said.

The fear of endless pain, coupled with the absence of hope for recovery or relief, is what deeply frustrates patients most and makes their lives more painful, she added.