A Korean Perspective on Developing a Global Policy for Advance Directives

Abstract

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.

TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders

“…In some European and Asian countries, they are not legally recognized, whereas in others, it is a requirement for euthanasia to be enacted (4,5). As such, it is critical that we recognize the implications of living wills and clarify documents to ensure patient care and safety.…”

A taboo in healthcare; life support decisions at the terminal stage

“…Ancak bu durum hala, Uzak-Doğu-Asya ülkelerinde yaygın olarak kabul edilmemektedir. Aile bağlantılı Konfüçyüs Kültürü'nün yaygın olduğu bu ülkelerde, özerklik ve önceden verilen direktif kavramı soru işareti olarak kalmaktadır [15][16][17].…”

A Family-Oriented Confucian Approach to Advance Directives in End-of-Life Decision Making for Incompetent Elderly Patients

“…For instance, the familyoriented Confucian tradition in East Asia has been acknowledged as the guiding influence for end-of-life decision making (Ho et al 2010;Chen and Fan 2010). In a family-centered society, ADs may conflict with family values (Kim et al 2010;Blank 2011). In spite of these obstacles, some scholars still believe that ADs should be universally promoted and that international organizations, such as the World Health Organization, should play an important role in doing so.…”

“…3 The principles of autonomy, dignity, and informed consent endorsed by international declarations, can be used to establish a universal basis for the global use of ADs. In the same sense, Kim et al (2010) argue that respect for patient autonomy must be universally understood and it should serve as the underlying principle for the global promotion of ADs.…”

“…Despite legal advancements in the United States and several Western countries,1 ADs are still in a "nascent" stage in most Asian and African countries (Kim et al 2010). In Asia, only some developed areas legally acknowledge ADs 2 .…”