최근 12명의 국회의원이 발의한 소위 '조력존엄사법안'에 대한 토론회가 국회에서 열렸다. 이는 많은 논란 끝에 의료 현장에 적용되고 있는 '연명의료결정법'이 불과 4년밖에 경과되지 않은 점 등을 고려해 보면 빠른 사회 변화라고 할 수 있다. 이 논문은 우리 사회에서의 의사조력자살 법제화에 대하여 임종 방식과 시기를 선택할 환자의 권리, 발의된 '조력존엄사' 법률안의 내용, 의사조력자살을 보조하는 의료 행위의 정당성, 의료계의 의사조력자살에 대한 준비, 현행 '연명의료결정법'의 보완 및 좋은 죽음에 관한 논의를 이어갈 사회 기구의 측면을 살펴본 것이다. 무엇보다도 환자가 원하지 않는 연명 혹은 집중치료의 거절이 '임종 과정'에서만 존중되는 현행 '연명의료결정법'을 보완하여, 말기부터 환자의 자율성이 존중될 수 있게 하는 것이 시급하다.

In 2011 Korean Medical Association proposed guidelines concerning the withdrawal of life-sustaining medical treatment, but in the years that followed, the proposal and the issue it addressed failed to receive any significant public attention. However, Korean legislators have recently held discussions on the so-called “Aided Dignity Death Act” (i.e. the Partial Amendment to the “Act On Hospice And Palliative Care And Decisions On Life-sustaining Treatment For Patients At The End Of Life”). Public discussions such as these are evidence of the rapid social changes that are taking place in Korean attitudes towards end-of-life care. In light of these recent changes, efforts should now be made to build a social consensus on the rights of patients at the end of life. This article contributes to that consensus-building process by analyzing the following six aspects of the proposed legalization of physician-assisted suicide (PAS): a patient's right to choose the manner and timing of their death, the contents of the proposed act, the legitimacy of medical practices to support PAS, how prepared the Korean medical community is for the implementation of PAS legislation, the complement of the current legislation on end-of-life care, and the necessity of an organization for facilitating social discussions on PAS. The article argues for extending the right of patients to decline any intensive care from the “period of imminent death” that is mentioned in the current legislation on end-of-life care to the “terminal stage of life.”

In South Korea, a proposal that would legalize physician-assisted suicide was recently introduced in the National Assembly. According to this proposal, patients with a terminal illness who are experiencing constant and unbearable physical or mental suffering that cannot be alleviated could request medical assistance in the suspension of life. This article describes the current status of physician-assisted suicide in countries that have already legalized it, such as the Netherlands, Belgium, and Canada, and discusses some of the controversial aspects concerning the recent proposal to legalize physician-assisted suicide in South Korea.

South Korea has low scores on both the Happy Planet Index (HPI) and Quality of Death Index (QDI) in comparison to other countries with similar levels of economic development. As the number of hospital deaths increases, so too does the number of people experiencing miserable deaths due to the availability and perhaps misuse of life-sustaining treatment. However, given the current individualized social structure, an increasing number of people will spend the end of their lives in elderly care facilities and hospitals, experiencing miserable deaths. Although many people fear misery at the end of life, a realistic solution to this problem has not yet been found in South Korea. For this reason, a recent proposal to legalize physician-assisted suicide in South Korea has received strong public support. This article argues that past opportunities for meaningful public discussions concerning dignified dying have been squandered and that what is needed at this point is not further legislation that enables us to avoid thinking about these issues but rather mature discussions concerning how we want to die.

In a recent proposed amendment to Korea's legislation governing decisions on life-sustaining treatment, physician-assisted suicide is characterized as a form of “death with dignity.” However, there is no legal right to suicide in South Korea and the idea that physician-assisted suicide is a permissible and dignified way of dying is based on a misunderstanding of the constitutional right of self-determination, which entails only a right to refuse unwanted medical care. This article explains these misunderstandings concerning the concept of death with dignity and a patient's right to self-determination and critically reviews the proposed legislation concerning physician-assisted suicide.

With the recent proposal in the Korean National Assembly of the so-called “Aided Dignity Death Act,” which allows certain patients to end their lives with the help of medical professionals, public debates are underway in South Korea concerning appropriate end-of-life medical care and what it means to die with dignity. This article argues that preemptive concerns about the death of assistance dignity should be prioritized. As a result of this, continuous discussion and interest in assisted suicide, that is, assisted suicide, are naturally necessary.

We strongly agree with the feature paper's argument concerning the need for better discussions and a social consensus concerning end-of-life medical care. We also insist that there is a lack of empirical research related to end-of-life care in Korean society and that greater investment in relevant research is a prerequisite for productive discussion and consensus-building. Unfortunately, many of the premises in the Life-sustaining Treatment Decision Act of 2016 were not subjected to any critical analysis or empirical testing. In this article, we argue that empirical studies should be conducted concerning what Korean citizens―individually and collectively―know or believe, and also what we do not know, concerning issues and unmet needs around end-of-life care and social support in South Korea.

Public debates and discussions concerning physician-assisted suicide have recently arisen in South Korea in response to proposals made in the National Assembly for new legislation governing this and other aspects of end-of-life medical care. Two contrasting positions can be discerned in these debates: one position views physician-assisted suicide as respecting patients' autonomy and guaranteeing their right to a “death with dignity”; the other argues that physician-assisted suicide might be transformed into a “duty to die,” especially since dying care has not yet been well established in Korea. On this latter view, the expansion of hospice for end-of-life care should precede the introduction of physician-assisted suicide. The present article examines these two views in detail and explores the state of end-of-life medical care in Korea.

2022년 6월 발의된 연명의료결정법 개정안에는 '조력존엄사'를 허용하는 내용이 추가되었다. 개정안에서 사용한 '조력존엄사'는 일반적으로 말하는 '의사조력자살'이다. 안락사의 한 형태인 의사조력자살을 합법화하는 개정안을 둘러싸고 한국 사회에서 논의가 진행 중이다. 합법화를 통해 환자의 죽음에 대한 자기결정권이 보장될 수 있고 보다 존엄한 죽음을 맞이할 수 있다는 의견이 있다. 반면 현재 한국에서 의사조력자살에 대해서는 충분한 논의가 부족하고 사회적인 합의가 도출되었다고 보기 어려우며, 호스피스·완화의료 시스템 미비, 높은 자살률 등 좋은 죽음을 맞이하기 힘든 사회경제적 상황에서 의료제도 안에서의 자살을 합법화하는 것은 시기상조라는 주장도 있다. 본 논문에서는 이미 의사조력자살을 합법화한 국가의 사례들을 개괄하고, 한국 개정안의 논의점에 대해서 분석한다. 이를 통해 의사조력자살 합법화의 함의 및 합법화가 가져올 수 있는 사회적, 윤리적 영향에 대해 고찰한다.

Discussions are currently underway in South Korean society about the possibility of legalizing physician-assisted suicide. There is an opinion that the legalization of physician-assisted suicide would guarantee patients' right to a self-determined death and enable patients to die with dignity. Others contend that it would be premature at best to legalize physician-assisted suicide in South Korea since (a) there is no social consensus on the issue within Korean society, (b) the country lacks a well-established system of hospice and palliative care, and (c) the country has a relatively high suicide rate. This article analyzes several cases from countries that have already legalized physician-assisted suicide in an attempt to identify the likely social and ethical implications of legalizing physician-assisted suicide in South Korea.

이 글은 최근 의사조력자살 법제화 논의에 대한 고윤석의 논문을 검토하고, 고윤석의 주장과 이유를 검토하고 평가한다. 아울러 필자가 동의하는 고윤석의 주장에 대해서도 보완하여 제시될 근거가 있다면 그것이 무엇인지 밝히고 있다. 그런데 고윤석은 의사조력자살의 법제화 반대 외에 현행법의 개선 방안에 대해서도 의견을 피력하고 있다. 연명의료 유보나 중단의 이행시기는 적어도 환자의 자기결정권 존중에 부합하는 경우에는 임종기가 아니라 말기로 확대될 필요가 있다고 고윤석은 주장한다. 필자는 고윤석이 의사조력자살에 대해 제시했던 우려의 논리와 논거가 이행시기의 확대에도 그대로 적용된다고 주장한다. 또한 연명의료 유보 또는 중단의 이행시기 확대는 새로운 사회적 합의를 전제한다. 왜냐하면 현재의 보수적인 이행시기 설정은 당시의 사회적 합의에 기초한 것이기 때문이다. 또한 자기결정권 존중이란 원칙이 우리 사회에 실현되기 위해서는 앞서 갖추어져야 할 것들이 존재한다고 필자는 주장한다. 예를 들어, '자기결정권 존중'이란 미명하에 강요된 선택이 발생하지 않도록 생애말기 돌봄 서비스가 확충되어야 하고, 자기결정권 행사의 오남용을 방지할 수 있는 제도적 장치 또한 논의되고 추진되어야 한다.

In this article I review Koh YS's recent article concerning the legalization of physician-assisted suicide and provide additional support for the arguments he advances. Koh argues against the legalization of physican-assisted suicide and for an extension of the period in which the withholding or withdrawal of life-sustaining treatment is carried out following a patient's request. I claim that the very arguments Koh presents against the legalization of physician-assisted suicide may be arguments against the extension. In particular, the extension presupposes a new social consensus just as the current performance period for withholding or withdrawing life-sustaining treatment was based on the social consensus that existed at the time that legislation was passed. Additionally, I argue that certain safeguards must be established or implemented to respect the right to self-determination in our society. For example, the monitoring and service of end-of-life care must be enhanced in order to prevent any coercion or abuse in individual decisions on life-sustaining treatment.