The advance in the medical technology makes prolonging the life of unconscious patient possible. It is the benefit to someone who recovers from coma, but many patients fall into persistent vegetative state, a deep and usually permanent state of unawareness hopelessly. When further intervention to prolong the life of a patient becomes futile, the patient's family and physicians are confronted with the ethical and legal problem seriously.
Life-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical condition. Life-sustaining treatment may include, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration. In Korea, withdrawal of life-sustaining treatment of a patient in the persistent vegetative state is discussed as a type of the passive euthanasia, which the criminal law does not permit clearly yet. But in clinical circumstance, without clear guidelines that withdrawal has been carried out implicitly when the patient's family and medical team mutually agreed on.
Nevertheless the debate on the permission of passive euthanasia makes no progress by the 'slippery slope' argument of the opponents of euthanasia. Because the euthanasia could also readily be extended to incompetent patients and other vulnerable populations. But now, the main aim of the policy should be to bring matters into the open, to apply uniform criteria in assessing every case in which the life-sustaining treatment is withdrawn, and to ensure that maximum care is exercised in such cases.
In America, after the long 'death debate' and California's Natural Death Act that makes living wills legally binding, the principle of patient autonomy requires that physicians respect the decision to forego life-sustaining treatment of a patient who possesses decision-making capacity. And according to the AMA's Code of Medical Ethics, even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis.
In many countries, desisting from treatment when further intervention is pointless and allowing nature to take its course is accepted medical practice.
Futhermore Oregon's Death with Dignity Act, and the Dutch Euthanasia Legislation make physician-assisted suicide legal. But the legislation of active euthanasia or physician-assisted suicide requires some social precondition. For example, people in the Netherlands do not request euthanasia out of concern at the cost of treatment, since everyone is fully insured under the social security system.
Code of Medical Ethics of Korean Medical Association forbids the physicians to participate in euthanasia and physician-assisted suicide. And that code approves withholding or withdrawal of life-support systems in some conditions, which are confronted with great objection.
But a competent, adult patient could, in advance, formulate and provide a valid consent to the withholding or withdrawal of life-support systems in the event that injury or illness renders that individual incompetent to make such a decision. Without advance directives, withdrawal of life-support systems from a patient in coma or PVS should be permitted in case that some requirements are meeted.
This study has done to examine the euthanasia debate and the practices of withdrawal of life-sustaining treatment of a patient in Korea, and propose withdrawal of life-sustaining treatment of a patient should be permitted through public debate and social consensus. And this study asserts that the legislation of withdrawal of life-sustaining treatment after public debate should be desirable.