Although the Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented in South Korea in 2018 to ensure the dignity of death for patients, adequate data are not available about whether patients' preferences are being re ected in end-of-life decisions. By using the data of 79,863 patients from the database of national institutions, this study examined the actual condition and characteristics of the life sustaining treatment decisions (LSTD) system since its implementation. The patients were divided into four groups according to the decisionmaking method (G1, G2, G3, and G4), and descriptive statistical analysis was performed. Logistic regression analysis was performed by dividing the patients into self-determining (G1, G2) and familydetermining patients (G3, G4). The results revealed signi cant relationships between the variables; age, disease, and hospice use of patients showed differences in each group. Age was found to have a major impact on LSTD, and with increase in age, the family, and not the patient, made the LSTD. The LSTD method also differed depending on the disease. The self-determination rates of patients with circulatory or digestive diseases were somewhat lower than that of those with neoplastic diseases. Regarding the period from decision making to the implementation of the LSTD life judgment, the ndings revealed hurried decision making and inadequate time for the patient to prepare for death. The ndings highlights the need for ensuring that the patients are the subjects of their treatment decisions and for beginning LSTD consultation sooner.