The level of end-of-life (EOL) care quality in the Republic of Korea has been regarded as inferior to more advanced countries. The EOL care delivered has varied depending on physicians' perceptions and patients' family requests for care. A consensus guideline on withdrawing life-sustaining therapies, which has been endorsed by the Korean Medical Association, Korean Academy of Medical Sciences, and Korean Hospital Association, was published on 13 October 2009. However, the guideline seems to be still not widely applied in our hospitals. The acknowledgment of patient wish, reflected by such as an advance directives (AD) is the most important ethical and legal requirement in EOL care decisions. However, there are barriers to adopting the AD as a solely legitimate tool of EOL decision making even in Western societies. Advance care planning depending on a patient's condition seems to be a more reasonable approach for better EOL care. For an appropriate advance care planning, open communications between physicians and patients or their surrogates is crucial. The lack of an open approach to discussing EOL care with patients results in inappropriate prolongation of patients' dying process. In summary, physicians, who know the clinical signficance of treatments to be delivered to EOL patients, should play a central role based on the 2009 consensus guideline to help patients and their families make good decisions on EOL care. EOL care should be individualized to meet a patient's and family's wishes about the forgoing of life-sustaining therapy. Moreover, concerted actions between the public sector and a governmental organization are required to address ongoing public demands for better EOL care. social requests.