Market scope note: This article covers information from both Korea and the United States. Each piece of information is marked in the text with 🇰🇷 Korea (Korea) or 🇺🇸 U.S. (U.S.) to indicate which country it applies to.
The moment a parent receives a terminal diagnosis, the family is plunged into a profound dilemma — whether to continue curative treatment or to shift toward comfort-focused care. This choice is also deeply tied to a person's dignity and values. Both countries have established institutional frameworks to address this. Knowing about them in advance allows families to honor their parents' wishes more calmly when a crisis arrives.
🇰🇷 Korea The Life-Sustaining Treatment Decisions Act, which took effect in February 2018, provides the legal basis for withholding or withdrawing life-sustaining treatments — such as cardiopulmonary resuscitation, mechanical ventilation, and hemodialysis — in accordance with the patient's own wishes. The law was partially amended again in April 2025, reflecting ongoing refinement of the system. There are two key documents. The first is the Life-Sustaining Treatment Plan (연명의료계획서), completed jointly by the patient and a physician when the patient is in a terminal or dying stage. The second is the Advance Directive for Life-Sustaining Treatment (사전연명의료의향서), which a person prepares while still healthy. The latter can be completed at more than 760 registered institutions nationwide, and as of August 2025, the cumulative number of registrations has surpassed 3 million.
🇰🇷 Korea Since the system took effect, the number of cases involving the withdrawal of life-sustaining treatment has grown rapidly — from approximately 31,000 per year in 2018 (10.6% of all deaths) to 70,061 in 2024 (19.6%). A notable shift is the rate of self-determination. The proportion of decisions made based on an advance directive left by the patient themselves rose from 35.1% in the first quarter of 2018 to 52.5% in the fourth quarter of 2024. Still, nearly half of all cases continue to rely on family decisions, underscoring just how important it is to confirm a parent's wishes in advance.
🇰🇷 Korea Hospice and palliative care, alongside the life-sustaining treatment decision system, form the two pillars of end-of-life care. Patients enrolled in the National Health Insurance (국민건강보험) who are diagnosed with a terminal illness may access three types of services: inpatient, home-based, and consultative. These include pain management, end-of-life care, bereavement support for families, spiritual care, and music and art therapy. As of 2023, there were 188 designated hospice facilities. The government has set a target to expand this to 360 facilities by 2028 — doubling the current number — and to raise the utilization rate from approximately 25% to 50%.
🇺🇸 U.S. Patients enrolled in Medicare Part A who receive a terminal diagnosis of six months or less to live from two physicians may apply for the Medicare Hospice Benefit. After using two initial 90-day periods, the benefit can be extended in 60-day increments with no limit on the number of extensions. In other words, even if a patient survives beyond six months, the benefit continues as long as a physician recertifies the terminal condition. In 2024, 1,910,000 Medicare beneficiaries used hospice services — an increase of 4.4% from the previous year. Notably, 53.1% of Medicare decedents that same year died while receiving hospice care, a historic milestone representing the first time this figure has exceeded half.
🇺🇸 U.S. Under the Medicare Hospice Benefit, Medicare covers the majority of costs including nursing, medical equipment, symptom-relief medications, counseling, and short-term inpatient care. The patient's out-of-pocket costs are limited to a maximum of $5 per prescription for symptom-relief medications and 5% of the cost for respite care. However, medical treatments aimed at curing the terminal illness itself can no longer be billed to Medicare once a patient elects hospice, so it is important to have a thorough conversation with the attending physician before making the transition to hospice. In the United States, completing a POLST (Physician Orders for Life-Sustaining Treatment) ensures that a person's wishes carry legal force as medical orders across a range of care settings, including nursing facilities and emergency situations.
There is one thing both countries' systems have in common: an honest conversation with your parent comes before any paperwork. What kind of care do they want, and under what circumstances? Do they wish to spend their final days at home, or would they prefer the care of a specialized facility? Having this conversation in advance allows the family to make decisions that most closely reflect the parent's wishes when a crisis unfolds. Registering the documents is simply the step that formalizes the outcome of that conversation.
Sources: National Agency for Management of Life-Sustaining Treatment (lst.go.kr) monthly statistics; National Bioethics Policy Institute, '2024 Life-Sustaining Treatment Decisions System Annual Report'; Medicaltimes (September 2025 report); Republic of Korea Policy Briefing (April 2024 announcement of the Comprehensive Hospice and Life-Sustaining Treatment Plan); National Health Insurance Service (국민건강보험공단) guide to health insurance coverage for hospice and palliative care; National Cancer Center Cancer Monitoring Portal; National Alliance for Care at Home, '2025 Facts and Figures' (March 2026); CMS Medicare Hospice Benefit official guidance (cms.gov); Center for Medicare Advocacy.
Note: This article was compiled by AI from the sources cited above. We strive for accuracy, but for decisions about your specific situation, please confirm the latest guidance from a professional or the relevant agency.