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J Korean Med Assoc > Volume 61(8); 2018 > Article
Journal of the Korean Medical Association 2018;61(8):509-521.
Published online August 21, 2018.
DOI: https://doi.org/10.5124/jkma.2018.61.8.509   
Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment
Sang Min Lee, Su Jung Kim, Youn Seon Choi, Dae Seog Heo, Sujin Baik, Bo Moon Choi, Daekyun Kim, Jae Young Moon, So Young Park, Yoon Jung Chang, In Cheol Hwang, Jung Hye Kwon, Sun Hyun Kim, Yu Jung Kim, Jeanno Park, Ho Jung Ahn, Hyun Woo Lee, Ivo Kwon, Do Kyong Kim, Ock Joo Kim, Sang Ho Yoo, Yoo Seock Cheong, Younsuck Koh
1Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea.
3Public Health Medical Service, Seoul National University Hospital, Seoul, Korea.
4Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea.
5Korea National Institute for Bioethics Policy, Seoul, Korea.
6Education Center for Public Health & Medicine, National Medical Center of Korea, Seoul, Korea.
7Department of Family Medicine, Incheon St. Mary's Hospital, Incheon, Korea.
8Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
9Hospice and Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
10Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea.
11Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
12Department of Family Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
13Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
14Bobath Memorial Hospital, Seongnam, Korea.
15Division of Oncology, Department of Internal Medicine, Catholic University St. Vincent's Hospital, Seoul, Korea.
16Department of Hematology-Oncology, Ajou University Hospital, Suwon, Korea.
17Department of Medical Education, Ewha Womans University College of Medicine, Seoul, Korea.
18Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea.
19Department of the History of Medicine and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea.
20Department of Medical Humanities and Ethics, Hanyang University College of Medicine, Seoul, Korea.
21Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea.
22Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. yskoh@amc.seoul.kr
In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.
Key Words: Consensus guideline, Palliative care, Hospice, End-of-life care, Advance care planning
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