More than 35,000 people have refused life-sustaining medical treatment since legislation on end-of-life care went into effect Feb. 4, 2018, the Ministry of Health and Welfare and the Korea National Institute for Bioethics Policy said Wednesday.

The law enables terminally ill patients to refuse life-sustaining treatment, including CPR, hemodialysis and the use of respirators or anti-cancer drugs, when there is no chance of recovery or improvement. 

Under the law, any individual over the age of 19 can submit a written form in advance indicating his or her intention of refusing treatment, even before receiving a diagnosis of terminal illness. Patients can also exercise the right to die naturally if two doctors certify that they they are expected to die within a few months.

If the patient is incapable of expressing his or her wishes and has not submitted the form in advance, the doctor in charge can terminate life-sustaining treatment with the confirmation of another doctor and a statement from the family that the patient would not want the treatment.

As of Monday, a total of 35,431 patients -- 21,291 male patients and 14,140 female patients -- had forgone life-prolonging medical treatment in keeping with the law.

Of those patients, 14,787 had refused life-prolonging treatment within the first six months after the law took effect. Their numbers had grown to 17,830 by the seventh month, 20,742 by the eighth month, 24,331 by the ninth month and 28,256 by the 10th month.

Among the 35,431 patients, only 0.8 percent had submitted written forms ahead of time. About 31 percent decided to terminate treatment only after being diagnosed as terminally ill, and in the other 67.7 percent of cases the families consented on behalf of patients who were unable to express their wishes.

Meanwhile, since Oct. 2017, when the government launched a three-month trial phase ahead of implementing the law, 113,059 individuals without terminal illnesses had submitted the forms expressing their intentions of refusing life-sustaining treatment. Women in this group outnumbered men by more than 2 to 1, with 76,551 women signing the forms as compared with 36,508 men.

People can sign and submit the forms at 290 locations, including designated local health centers and hospitals nationwide. Starting Jan. 7, the Health Ministry has issued cards to signatories so that they can show proof if needed. They can change their minds anytime.

The law, called the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life, was introduced in February 2016 in response to changing public attitudes about the need for more choices about end-of-life care. It took two years for the law to be deliberated, passed and implemented.

According to a survey jointly conducted by Seoul National University Hospital and the National Cancer Center in 2016, 46.2 percent of 1,241 healthy respondents and 59.1 percent of cancer patients answered that they would submit the forms before receiving a terminal diagnosis.

Some respondents answered that they would not submit the forms because they felt uncomfortable about preparing for a worst-case scenario, or because they thought they might change their minds if faced with such a situation in real life.

By Park Ju-young (jupark@heraldcorp.com)