Korea's parliament research service calls for separate law to govern assisted dying

South Korea's National Assembly Research Service has called for a national debate on physician-assisted dying to address the severe suffering of terminally and non-terminally ill patients that falls outside the scope of the current life-sustaining treatment regime. The service said that if such a system were introduced, enacting a separate special law would be more appropriate than amending the existing Life-Sustaining Treatment Decisions Act, and that assisted dying should be treated as a narrow, last-resort exception — not a general right to die.

In a report published Wednesday titled "Review of Foreign Physician-Assisted Dying Regimes and the Direction of Domestic Legislation," the service said the current system "was designed around the withdrawal of futile life-sustaining treatment and does not adequately cover the persistent and severe suffering of non-terminally ill patients with serious conditions, or their needs regarding the end of life."

South Korea has enforced the Life-Sustaining Treatment Decisions Act since February 2018. The law allows patients in the dying process to refuse or discontinue life-sustaining measures such as cardiopulmonary resuscitation, mechanical ventilation and vasopressors.

However, the law applies only to patients already deemed to be in the dying process, and the permitted actions are limited to withholding or withdrawing life-sustaining treatment. Patients with serious conditions who are not yet considered to be in the final stage of dying but have virtually no chance of recovery and continue to suffer severely are largely unable to benefit from the system.

Physician-assisted dying involves a doctor prescribing or providing a lethal drug and advising the patient on how to take it, with the patient self-administering the substance to end their life. Unlike a decision to withdraw life-sustaining treatment, it directly results in the shortening of life, giving it a distinct legal and ethical character. Under current law, a physician who provides such assistance could be prosecuted for aiding suicide under Article 252 of the Criminal Act.

The report categorized foreign physician-assisted dying regimes into four broad types.

The four types are: a "terminal-only" model, as in Oregon, which permits only self-administration for terminally ill patients with roughly six months or less to live; a "comprehensive" model, as in the Netherlands and Belgium, which allows both patient self-administration and direct administration by a physician; a "medical assistance in dying" model, as in Canada and Australia, which integrates assisted dying within the broader healthcare system; and a "special permissive" model, as in Switzerland and Germany, which operates through criminal law, case law and private organizations.

Countries with broader eligibility have faced ongoing "slippery slope" debates. The Netherlands' 2024 euthanasia report included 427 cases involving dementia and 219 involving psychiatric conditions. Canada expanded eligibility through a 2021 legislative amendment to include non-terminally ill patients with serious conditions and people with disabilities whose natural death is not imminent.

The research service said South Korea is not yet ready to adopt a broad model like those of the Netherlands or Canada. It said the country should first examine allowing physician-assisted dying through self-administration for terminally ill patients only, alongside a more carefully calibrated expansion of the existing life-sustaining treatment withdrawal system.

A bill on assisted dignified dying is currently pending in the 22nd National Assembly. Under the bill, a patient with no prospect of recovery could apply to an assisted dignified dying review committee for a determination of eligibility. Once designated, the patient could proceed after one month by reconfirming their wish to their attending physician and two specialist doctors. The bill also includes a provision exempting attending physicians who follow lawful procedures from prosecution for aiding suicide.

The research service said that if a system is to be introduced, enacting a separate special law would be more legally coherent than adding provisions to the Life-Sustaining Treatment Decisions Act. Withdrawing life-sustaining treatment is a passive decision to stop treatment, whereas physician-assisted dying would exceptionally permit an active act of life-shortening that is in principle subject to criminal punishment.

The special law should clearly define eligible conditions and prognosis, the patient's decision-making capacity, requirements for repeated requests and a reflection period, assessment by multiple medical professionals, independent review, the availability of palliative care, and post-procedure reporting and oversight. The service also recommended that the law address the scope of criminal, civil and administrative immunity for lawful assistance, as well as the right of medical professionals to refuse participation on religious or ethical grounds.

Above all, the service said, care and social security systems must be strengthened before any debate on assisted dying can proceed. It said it is essential to prevent situations in which people choose death because they have no family, face financial hardship or fear becoming a burden to loved ones.

"Physician-assisted dying can only be discussed as a last resort — and only for those who, after sufficient deliberation, still wish to choose it — once pain management, palliative care, psychological and social support, services to ease the caregiving burden on families, and income, residential and medical cost support are all adequately guaranteed," said Kim Eun-jeong, a legislative researcher at the National Assembly Research Service.