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2015 Care Rights Report for the Survey
Question 1:
What is the role of your organization? Do you participate in MIPAA implementation or
monitoring thereof?
1.1. Care Rights Mission and Goals
Care Rights aims to protect and advocate for elderly patients’ rights during the process of their end-of-life care
and decision making(EOLCD). At the core of our mission is our desire to safeguard not only the elderly
patients’ but also their caregivers’ and families’ autonomy, independence and dignity.
Care Rights works to address a ‘normative gap’, known as the lack of protection for older person's rights
through the existing human rights system, and promotes an ‘implementation gap’, known as the lack of
provision in international law, health care policy, and immigration law for their autonomy and wellbeing in the
process of EOL care and decision.
Under the mission, Care Rights sets the three goals. First goal is to educate and support elderly patients, family
caregivers, and their loved ones to build social and cultural support systems in EOL care and decision. The
second one is to promote and facilitate opportunities for legal action in the context of elderly patients’ rights in
EOL care and decisions under the principle of human rights. The third one is to raise public and professional
awareness of human rights in regards to one’s EOL care and decision, as well as for the protection of elderly
caregivers by spouses and partners.
1.2. Programs and Activities
Care Rights runs five activities to administer our goals :

Education & Counseling Program

Enactment & Advocacy Program

UN Activities

Survey & Research Program

Hospice Camp for Diaspora Community
1.3. MIPPA & Principles
Our operating principles are in alignment with those outlined in the Madrid International Plan of Action Ageing
(MIPAA)that all the elderly ought to be free from discrimination, isolation, and inequality, especially as they
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navigate the often painful and isolating experience of EOL care and decision. Figure 1 shows the items for older
person's rights that were outlined from the MIPPA.
Figure 1. The Items for Older Person's Rights that were Outlined from the MIPPA
59. The World Health Organization defines health as a state of complete physical,
mental and social well-being, not merely the absence of disease and infirmity...
61. The growing need for care and treatment of an ageing population requires adequate
policies. The absence of such policies can cause major cost increases...
69. Investing in health care and rehabilitation for older persons extends their healthy and
active years. The ultimate goal is a continuum of care ranging from health promotion
and disease prevention to the provision of primary health care, acute care treatment,
rehabilitation, community care for chronic health problems, physical and mental
rehabilitation for older persons including older persons with disabilities and palliative
care for older persons suffering painful or incurable illness or disease...
Section for
Advancing health
care and well-being
into old age
76. Objective 3: Development of a continuum of health care to meet the needs of older
persons. Actions (d) Support the provision of palliative care and its integration into
comprehensive health care. To this end, develop standards for training and palliative
care and encourage multidisciplinary approaches for all service providers of palliative
care;
86. Objective 1: Development of comprehensive mental health-care services ranging
from prevention to early intervention, the provision of treatment services and the
management of mental health problems in older persons. Actions (c) Provide programs
to help persons with Alzheimer’s disease and mental illness due to other sources of
dementia to be able to live at home for as long as possible and to respond to their health
needs;
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Question 2:
Has a human rights-based approach been integrated in the implementation framework of
MIPAA in your country and if so, how did this translate into concrete policies and normative
actions? Are there any mechanisms to monitor and assess the impact of MIPAA implementation
on the enjoyment of all human rights by older persons?
2.1. Human rights implementation framework
South Korea has developed and operated multiple social policies and actions in the implementation framework
of MIPAA including social security policy, health care policy, and human right policy for older persons as
below1:
A.
Social security policy : Basic pension to older persons.
The nation requires citizens to subscribe to 4 compulsory social insurances by law. Secure income,
medical treatment, rehabilitation, and employment opportunity as a social safeguard against disease,
disability, old age, death, and unemployment. Four types of Social Insurances are : Health insurance,
National Pension, Industrial Accident Compensation Insurance, and Unemployment Insurance.
B.
Health care policy
The nation requires citizens to subscribe to 4 compulsory health security systems. National Health
Insurance Program, Medical Aid Program, Long-Term Care Insurance Program and Health Insurance
System.
However, the report of the Korea National Human Rights Commission (2009) found that Korean elderly is not
properly guaranteed their rights for basic income, residential security, unemployment, retirement benefit, health
care coverage as well as social activities2. Figure 2 shows the status of the poverty rates by age group.
Figure 2. Relative Poverty Rates by Age Group (South Korea)
1
2
National Health Insurance Service, http://www.nhis.or.kr/static/html/wbd/g/a/wbdga0301.html
National Human Rights Commission of Korea, 2009,
https://library.humanrights.go.kr/hermes/web.search.Search.ex?command=SearchDetailGet,
http://library.humanrights.go.kr/hermes/imgview/10-04.pdf
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2.2. Poverty and Suicide Rate
First of all, both poverty and suicide rate are the highest among OECD member countries. The poverty rate of
older people (65+) is the highest in OECD area. According to figure 2, overall the poverty rate over age 65
increases rapidly. Especially the poverty rate of those above75 increased compared to 2006 and 2011. The
poverty rate of the group at 2011 is higher than 2006.3
The suicide rate of Korean elderly population is the highest compared to other age groups. According to national
survey(2014), 10.9% of older people have thought about suicide among 60 years and older. Around 12.5% said
they actually had tried. They wanted to commit suicide because of economic difficulty(40.4%), health
problems(24.4) and etc.4
Especially, some elderly in the community would decide to commit suicide due to severe physical and
emotional pain in end stage of life without fully developed emerging services such as inpatient and home-based
palliative and hospice care services.(Chang, 2013)
2.3. End of Life Care and Decision
World Health Organization(WHO) reported that 56 million deaths occurred worldwide during 2012. Of these,
38 million were due to Non Communicable Diseases (NCDs) between 2000- 2012 principally cardiovascular
diseases, cancer and chronic respiratory diseases. In S. Korea 266,000 of total death, 89.2% of older persons
have NCDs. 79% of total death accounted with NCDs.5
According to the national survey for older person's life and status (2014), 43.7% of them rate their overall state
of health is not good, 32.4% of them rate it is good. Most of caregivers are their family members. In these
3
OECD, OECD Economic Surveys: Korea 2014, http://www.oecd-ilibrary.org/economics/oecd-economic-
surveys-korea-2014_eco_surveys-kor-2014-en
4
The Ministry of Health and Welfare, 2014 research on actual condition of aged,
http://www.prism.go.kr/homepage/researchCommon/retrieveResearchDetailPopup.do?research_id=1351000201500109
5
WHO, Noncommunicable diseases country profiles 2014, http://www.who.int/nmh/publications/ncd-profiles-
2014/en/
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survey, subjects were asked about what their preference is for end-of-life care and decision.6
A.
Violation of Older Person's Autonomy in EOL care and decision(EOLCD).
From a human rights perspective, the elderly patients’ autonomy regarding EOLCD is an essential
part of human well-being. They must be informed about the clarification for diagnosis and treatment
options, and respected in consideration of their values, goals, and wishes in their end of life care. The
right for the elderly to make decisions regarding the type and extent of treatments during final life
stages is drawn from guidelines prepared by the Council of Europe that state “Older persons should
receive medical care only upon their free and informed consent and may also freely withdraw consent
at any time.” (Council of Europe, Recommendation CM/Rec(2014)2, 2014). From a human rights
perspective, therefore the elderly patients’ autonomy regarding EOLCD is an essential part of human
well-being.
The UN principles for older persons indicates that the government should completely guarantee older
people’s dignity, faith, desire and privacy. It indicated that especially protecting dignity is greatly
important and protecting their self-dignity is also important. According to 7research of older persons’
status in 2014, 88.9% of subjects are against life sustaining treatment in the condition of non-treatable.
However the legislation is yet not established and older persons’ preferences are not fully supported.
B.
Under-developed Infra system for EOLCD
When we compared welfare facility program in S. Korea to ombudsman of America, right for self
determination is not in the program. Right for self determination is the right to choose doctors, right to
participate in care, treatment, related changes and right to be informed about them. “Recommendation
for EOLCD”,which was decided by Korea National Institute for Bioethics Council, shows ‘all patients
have right to know their illness, progress of sickness, treatment that will be conducted, and right to
decide for themselves. Also it accentuated active establishment of systems by government and society,
in order to let patients freely choose hospice & palliative care. The recommendation targets patients
who are non-treatable, aggravating dramatically, and in end stage of life. At present, a legislative bill
regarding “Hospice & Palliative Care Act” is under examination. 8 The purpose of the draft is to
expand the targets of hospice service, which is currently limited to cancer patients. On the other hand,
legislative law related to offering comprehensive care to those in end of life stage, and their family is
under examination.9 At the same time, a draft that supplemented “the counsel” is also under
examination. It says if there were no Advance Medical Directives, estimating the mind of patients
6
The Ministry of Health and Welfare, The survey for older person's life and condition 2014,
http://www.prism.go.kr/homepage/researchCommon/retrieveResearchDetailPopup.do?research_id=1351000201500109This research is conducted in every 3 years
7
8
The Ministry of Health and Welfare, The survey for older person's life and condition 2014, op. cit.
The National Assembly of the Republic of Korea, a draft related to hospice & palliative care, bill number
1914991,http://likms.assembly.go.kr/bill/jsp/BillDetail.jsp?bill_id=PRC_F1L5E0A4S3M0R1G8A1L6B5Y9Q4
N8E3
9
The National Assembly of the Republic of Korea, Draft regarding the use of hospice & palliative care and end-
of-life-stage patient’s decision making on life sustaining treatment,
2015,http://likms.assembly.go.kr/bill/jsp/BillDetail.jsp?bill_id=PRC_M1K5N0R7R0U7S1B5X0F4S5C8Y9Z8K
5
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should be available. Also it suggests patients who are non-treatable and in end stage of life, should
freely want and request hospice & palliative care.
However, National Human Rights Commission of Korea recommends arranging a standard long-term
care service but it's not established nor enacted.10 Also Figure 3 shows that there are very short of
numbers of beds and facilities. To make matters worse, government supplementary subsidy is also not
enough. Consequently Korea's hospice facilities is deteriorated and limited. Furthermore Korea’s
guideline is not sufficient to guarantee patient’s neither self-determination nor autonomy of advanced
medical directives.11
In result, 62.6% of advanced demented, older patients end their life in a nursing home in the U.S.;
however, only 5.5% of Korean elderly patients end their life in a nursing facility compared to 73.6%
of elderly patients receiving acute hospital care in South Korea (J of American Health Care
Administration, 2015)
Figure 3. The Status of Hospice Services in South Korea12
Management by Administration
Number of Facilities
Number of Beds
Public Health Care Organization
12
209
Designated Hospice Organization
2
31
Regional Cancer Organization
12
154
Religious Hospice Organization
25
440
3
32
Hospice Unit by Private Medical Center
C.
Monitor Mechanism
In current, there are a few monitor mechanisms to observe the disparities for the older persons' human
rights including governmental institution for Human Rights Commission of Korea and civic
organizations such as Helpage Korea and CareRights, Kakdang 13 social welfare foundation, and
14
Korean Initiative for Advance Directive. Kakdang runs rainbow hospice program. Care Rights
mainly concerns in guaranteeing self determination, developing standards and protocols, and also
offers education and counseling for older persons and participates in enacting progress by public
hearing. Figure 4 shows the recent tragic cases resulting from those lack of legislation and monitoring
mechanism for health care setting in S. Korea. According to Han's studies, there are no regulations
10
150224 Press Release: recommendation for protecting human rights for users of Elderly Medical Welfare
Facility
11
refer appendix
12
Family Experiences of End of Life Care Decisions for Elderly Patients in South Korea, Soo Han, Tae Hyun
Kim
13
Care Rights, http;//www.carerights.org,
http://www.kakdang.or.kr/
14
KAKDANG
Korean Initiative for Advance Directive, http://www.sasilmo.net/
SOCIAL
WELFARE
FOUNDATION,
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and guidelines for social worker's engagement of the process of EOLCD for older patients and their
family caregivers.15
15
Han, S. (2015a). "A Study of Social Worker' Understanding of Elderly Patients' and Family Caregivers'
Rights to End-of-Life Care Decisions and of Their Own Roles in the Process." Korean J Hosp Palliat Care,
18(1), 42-50.
Han, S. (2015b). "Social Workers' Knowledge of Advance Directives for Health Care and Understanding of
their Role on Elderly Patients and Family Caregivers' End-of-Life Care Decision in Long Term Care Facilities."
Studies on Life and Culture, 36(2).
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Figure 4. Recently Occurred Tragic Cases
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Question 3:
Have the needs of specific groups of older persons been taken into consideration in the process
of implementation of MIPAA and if so, how?
3.1. NCDs and Older Patients
The proportion of older persons in S. Korea is gradually growing, and it was 12.22% of total Korea population
(OECD, 2014).16 Figure 5 shows in regard of location of older persons’ death, the proportion of death in
medical institution increased 68.5% to 73.1% between 2011 and 2014.17 Even though those who passed away in
medical institution are mostly non treatable, they received life sustaining treatment. However the proposed bill
is for dying patients who are near death and the conditions between them and patients with NCDs are different.
For that reason, patients with NCDs should be considered particularly. Therefore it is essential to be protected
and guaranteed their rights for self determination in order to let them free from unwanted life sustaining
treatment.
Figure 5. Death Place and Increasing rate
Location of death
%(2011>2014)
Medical Institution (hospital, and convalescent hospital)
68.5>73.1
Private Home
19.8>16.6
Others (Long Term Care Institutional Facility, Paramedic Ambulance Service,
Workplace, etc.)
11.6>10.3
3.2. Older immigrants
In 2013, the number of immigrants worldwide reached 232 million, up from 154 million in 1990. 18 Globally,
there are close to 26 million migrants aged 65 and over. 19 Older migrants represent 11 percent of the total
16
OECD Data, https://data.oecd.org/pop/elderly-population.htm#indicator-chart
17
STATISTICS KOREA. 2014 Statistics of birth & death,
http://kostat.go.kr/portal/korea/kor_nw/2/2/3/index.board?bmode=read&aSeq=333915,
2011 Statistics of birth & death,
http://kostat.go.kr/portal/korea/kor_nw/2/2/3/index.board?bmode=read&bSeq=&aSeq=253821&pageNo=6&ro
wNum=10&navCount=10&currPg=&sTarget=title&sTxt=
18
U.N. Department of Economic and Social Affairs (2013). World Population Polices 2013. New York: U.N. ,
http://www.un.org/en/development/desa/population/publications/pdf/trends/Concise%20Report%20on%20the%
20World%20Population%20Situation%202014/en.pdf
19
U.N DESA. (2013). World Population Ageing 2013. New York: U.N.
http://www.un.org/en/development/desa/population/publications/pdf/popfacts/popfacts_2013-4.pdf
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migrant population, as compared to 8 percent for the world’s population. South Korea has the fastest growing
ageing population in Eastern Asia.
20
In 2014, the number of international migration of Korea is 1,328,711. The
number of non-Koreans living in Korea now exceeds 1.74 million people. 21 Lack of Health Care Legislation
promoting Advance Directives raises the risk of immature EOL decisions that could result in healthcare deficits
such as neglect, abuse, and discrimination for elderly patients’ EOLCD, domestic/abroad. Differences in legal
systems and health insurance plans among countries in EOL care & decision results in lack coordination in
upholding the Emergency Medical Service Act and utilizing the Emergency Service Fund (ESF) to aid domestic
and foreign older patients.
3.3.Older Patients with Advanced Dementia
During 2008 to 2012, the rate of older dementia patients increased from 8.4% to 9.18%. 22 The number of aged
patients with dementia in 2012 had increased by 26.8% compared to 2008. According to research which
conducted by Ministry of Health and Welfare, prevalence rate of dementia between age 65~69 was 1.3%,
however those older than 85 was 33.9%.23 We can say the rate rapidly increased and the financial burdens of
treating dementia are also increased. According to a study, among annual total medical expenses, dementia was
about 810 billion won in 2010.24 In regard to dementia, the total medical expenditure of dementia increased
1,232.1% in 2010 than that of 2002.25
20
International Migration by Age and Sex.(National and foreign),
http://kosis.kr/eng/statisticsList/statisticsList_01List.jsp?vwcd=MT_ETITLE&parmTabId=M_01_01#SubCont
21
Ministry of Foreign Affairs, Republic of Korea, 2015,
http://www.korea.net/NewsFocus/Society/view?articleId=128653
22
Ministry of Health and Welfare, 2012,Nationalwide study on the prevalence of dementia in Korean
elders,http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SE
Q=286138&page=1
23
Ministry of Health and Welfare, 2012,Nationalwide study on the prevalence of dementia in Korean elders, op.
cit.
24
National dementia management plan, 2012, download :
https://www.google.co.kr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCIQFjAAahUKEwian8_37
pTHAhVhL6YKHQr3Ao8&url=http%3A%2F%2Fwww.alzza.or.kr%2Fezboard%2Fezboard.asp%3Fmode%3
Ddown%26id%3Dnotice%26idx%3D11811%26filei%3D1%26filename%3D%25C1%25A62%25C2%25F7%2
5B1%25B9%25B0%25A1%25C4%25A1%25B8%25C5%25B0%25FC%25B8%25AE%25C1%25BE%25C7%
25D5%25B0%25E8%25C8%25B9_2012.7.30.hwp&ei=5onDVZqUKOHemAWK7ov4CA&usg=AFQjCNG5z
GNVq6RFPsx3-d-SD9wLGWMYWg&sig2=J7K5HNSZZuUzAni3iHCfmQ&bvm=bv.99556055,d.dGY
25
Korea Institute for Health and Social Affairs, Older persons medical expenditure growth and effective way of
management, 2011,
https://www.google.co.kr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCIQFjAAahUKEwjym8jsq
5XHAhXBoJQKHZ5WCpc&url=https%3A%2F%2Fwww.kihasa.re.kr%2Fhtml%2Fjsp%2Fshare%2Fdownloa
d_forum.jsp%3Fbid%3D21%26aid%3D114%26ano%3D1&ei=xsnDVfKgAsHB0gSeram4CQ&usg=AFQjCNG
9wQ2O4UnDOezpU-W_vFhEDo69QA&sig2=T2cywWQ9PnGCnT94WXOUXQ&bvm=bv.99556055,d.dGo
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Question 4:
Have older persons been informed about MIPAA and if so, how? How are older persons
participating in the implementation of MIPAA including in decision-making about MIPAA
implementation?
4.1. Lack of awareness and knowledge about EOL care and decision
Even though, 86% of subjects want about discontinuing life sustaining treatment and think the enactment of
related laws is essential. However, only 6% of the patients were benefited to have DNR order in advanced.
Another studies conducted in South Korea found that Korean older persons and their family caregivers tend to
be limited in their knowledge of EOLCD and that Korean elderly prefer to relegate their decisions to the family
even if they are able to make them on their own. (Hong, 2010; Hong and Kim, 2013). 26
Even if elderly individuals may wish to move forward with their decision, their families may resist because
allowing the elderly relatives to make their own decisions or initiate communication is antithetical to the
principle of filial piety, which is a critical aspect of their cultural and family norms (Kim & Han, 2013; Park &
Song, 2013). Often, older persons are not allowed to get informed about their illness and decision-making.
Usually people regard that informing about their illness and close to death is bad for them, so older persons
cannot prepare for their death properly. Furthermore, when there are conflicts in the family of patients, Hospital
ethic committee will mediate their difference of opinions.
4.2. Education and Counseling
Educating and counseling for older persons can be important implementation tool to inform them about
MIPAA, Also civic agencies and experts can be helpful resources for them. Letting international societies know
the actual states of Korea is necessary.
Care Rights held education & counseling program ‘Well-dying & Older person’s Rights” at Gangnam Senior
Plaza in Seoul. Now Care Rights are carrying counseling program at Seocho district office, “Well-dying and
education & counseling of Hyo program”. In 2015, we are going to participate for public education in ‘2015
ASEM CONFERENCE ON GLOBAL AGEING AND HUMAN RIGHTS OF OLDER PERSONS’27.
4.3. Advocating and Enactment
Public campaign is also essential tools for older persons to participate implementation of MIPAA. Care rights
26
Hong, S. 2010, "An empirical study for model development concerning advance directives." Journal of
Korean Gerontology, 30(4). 1197-1211, Hong, S. W. & Kim, S. M. 2013, "Knowledge regarding advance
directives among community-dweling elderly." Journal of Korean Academic Society of Nursing Education,
19(3), 330-340.
27
2015 ASEM CONFERENCE ON GLOBAL AGEING AND HUMAN RIGHTS OF OLDER PERSONS,
http://www.aseminfoboard.org/events/20151026?field_upcoming=All
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participated in legislative process.28 We are participating in enacting process through public hearing.29
28
29
Care Rights, 2015, http://med.carerights.org/bbs/board.php?bo_table=dbcenter&wr_id=9
http://carerights.org/bbs/board.php?bo_table=dbcenter
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Question 5:
What impact has MIPAA implementation had on equality and non-discrimination of older
persons?
5.1. History of Hospice & Palliative Care in Korea
Hospice was first introduced by 'Little Company of Mary' In 1963. After that, operated hospitals and facilities
remained unchanged by some religious communities for about half a century. It hasn't been activated so far.
Government created legal basis for people with advanced cancer through the "Act on Management of Cancer" in
2011. But unfortunately, the law didn't include all patients suffering from terminal disease. It is a law restricting
patients from receiving palliative care services as patients with terminal cancer.
Facilities and perspectives for hospice are in poor condition to such an extend Around 260,000 people die, but
hospice & palliative care services used for just two percent of them. 1,300,000 Korean suffers, including
patients and family caregivers in this situation (KOSIS, 2013). 30
So "Act on Palliative Care & Hospice (No. 14991)31" was proposed in Apr, 30, 2015. The law protect human's
dignity for terminal patients and provide care that patients and family caregivers need by defining the main
thing about hospice & palliative care.
Here are the ramifications of the new law.

Definition of hospice, palliative care and life sustaining treatment (Amendment No.2)

National planning about hospice & palliative care is a renewable on a five-year (Amendment No.6)

Development of specialists on the staff (Amendment No. 8)

Fill in an advance directives form (Amendment No. 20)

Financial aid of government for hospice & palliative care (Amendment No. 22)
5.2. Target Area and Population
A.
Elderly Patients
Cultural norms and expectations for the family caregiving play an essential role in the process of end-
30
KOSIS. 2013, “Annual Report on the Causes of Death Statistics”, Available from
http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B34E01&vw_cd=MT_OTITLE&list_id=MT_CTI
TLE_1&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=K2
31
The National Assembly of the Republic of Korea. 2015, “Act on Palliative care & Hospice”, Available from
http://likms.assembly.go.kr/bill/jsp/BillDetail.jsp?bill_id=PRC_F1L5E0A4S3M0R1G8A1L6B5Y9Q4N8E3
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of-life care decision making: Many Asian countries consider these discussions with their elderly
relatives as a taboo and a filial impiety (Kim & Han, 2013)32.
Often, elderly patients do not understand the concept of the autonomy. Thus, they prefer to relegate
their EOL care decisions to their family caregivers (Kwon, 2010) 33. According to the Korean
statistical information service (KOSIS, 2013)34, 73% of the total elderly population end their life not
in their private homes but in intensive care units, hospital for acute and skilled nursing care, and longterm care facilities.
B.
Elderly Immigrants
Domestic and foreign elderly patients are too often deprived of their rights to informed consent during
EOL care & decision in S. Korea. Their desire to refuse aggressive life-sustaining treatments may not
be fully preserved, if they are unable to make EOL decisions at the time of service in S. Korea.
However, they are often given unwanted aggressive life-sustaining treatments without protection from
culturally-designed, advanced EOL decision making process that makes available and promotes painfree and comfortable hospice care.
Lack of Health Care Legislation promoting Advance Directives raises the risk of immature EOL
decisions that could result in health care deficits such as neglect, abuse, and discrimination for elderly
patients’ EOL care & decision, domestic/abroad,
C.
Older Person with Advanced Dementia
Elderly patients diagnosed with advanced dementia are transferred to acute hospital if they need
treatment, regardless of their decision for hospice or any other type of EOLCD in advance.
Also it may cause greater confusion to discuss about EOLCD with family caregivers of elderly
relatives with advanced dementia because of the stigma of certain diseases, and lack of knowledge
about EOLCD.
32
Kim, T. H. & Han, S. Y. 2013, “Family Life of Older Korean”, 『Ageing in Korea 3rd』, Seoul: Med Inc.
33
Kwon, H. N. 2010, “A Study on Case Comparison of Withdrawal of Life-Sustaining Care and Possibility of
justification in Death with Dignity – Focused on cases of Cardinal Kim Soo-Hwan and former president Kim
Dae-Jung”, J of Bioethics, 11(1), 33-49.
34
KOSIS, 2013, “2013 Annual Report on the Causes of Death Statistics”, Available from
http://kosis.kr/ups/ups_01List.jsp?pubcode=YD
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Question 6:
What impact has MIPAA implementation had on the fulfillment of the right of older persons to
an adequate standard of living?
There are two different standards regarding EOLCD that we searched. In figure 6 and figure 7, they show the
standard of the unit for hospice palliative care and long-term care facility. We could not find the protocol of
EOLCD and advance directives. According to the recent survey of Korean ministry of health and welfare
(2015)35, 21.4 percent of the total palliative care units are not up to standard; 12 units of 56 palliative care units.
They unmet the requirements of the facility standard, including number of required nurse, training, protocols for
EOLCD in the palliative care.
Here is the <Standard of Palliative Care Units in Korea> 36
Figure 6. Standard of Palliative Care Units in Korea
Standard of Palliative Care Units in Korea
1.
A.
B.
Balanced Allotment of Workers
Essential Staff
Physician or Doctor of Korean Medicine : At least five percent of an average annual
patients in facilities(units)
Nurse (of palliative care units) : At least 50 percent of an average annual patients in
facilities(units)
Social Worker : At least one person (Full-time)
Training : The essential staffs must complete education about palliative care.
a.
-
Educational contents :
Evaluation method of patient with terminal cancer
Pre-hospice care planning
Communication for patients and family caregivers
Contents about palliative care including pain of patients and management of
symptoms
b.
Minimum educational requirements : The 60 hour basic education and four hour
refresher training per year
c.
35
Education institutions :
Regional Cancer Center
Palliative Care Unit
National Cancer Center
Medical · Korean Medicine · Nurse Association
Korea Association of Social Workers
Association about Palliative Care
Asia Today(Newspaper). 03. 12. 2015, Available from
http://www.asiatoday.co.kr/view.php?key=20150312010007660
36
Korean Ministry of Government Legislation. “Enforcement Regulation from Act on Management of Cancer (Amendment
No. 13)”, Available from
http://www.law.go.kr/lumLsLinkPop.do?lsId=009513&lsThdCmpCls=LR&joNo=002500000
CARE RIGHTS SURVEY
2.
Standard of Facilities & Equipment
Aside of the other units, the palliative care unit operates for patients with terminal cancer separately
A.
B.
16
Detailed criteria
Room
Quantity
Facilities & Equipment
Suction unit, Oxygen
concentrator, Wheelchair
Notes
Distinction of sex
Less than five beds per room
Separate sections
Patient’s room
3
Room for last day
1
Shower room
1
Family lounge
1
Counseling room
1
Separate sections
Nurse station
1
Separate sections
Treatment room
1
Restroom
2
Necessary equipment for
providing bath services
Facilities for rest of
patients and family
caregivers
Located in palliative care unit
Separate sections
Syringe, Dressing,
Disinfectant, Tool of
venoclysis, etc.
Separate sections
Distinction of sex
Here is the <Standard of Long-term Care Facilities in Korea>
Figure 7. Installment standard of requirement of long-term care institution
Installment standard of requirement of long-term care institution
(Article 22 Section 1 related)
1. Common matter
A. Scale of facility
Long-term care institution (hereafter “facility”) should be able to accommodate different number of patients
according to the following facility type.
(1) Facility: more than ten people (more than 23.6㎡ space per one person)
(2) Group home: more than five and less than nine people (more than 20.5㎡ space per person)
B. Structure and equipment of facility
(1) The facility’s structure and equipment should consider lighting, ventilation, residents’ sanitation and
environmental safety, etc.
(2) Equipment frequently used by residents such as corridors, lavatory, bedroom, etc. should have space for a
wheel chair to pass by, and should be convenient for elderly’s activities.
(3) Facility should have emergency exit and fire-fighting material. However, facility with fewer than ten
residents may take precautions for disasters according to the facility’s circumstances.
…
3. Facility standard
Room type
Facility type
Patient
room
office
Staff
room
Volunteer
room
Medic
and
nurse
room
Physical
therapy
room
Program
room
Cafeteria,
kitchen
Emergency
evacuation
facility
Toilet
Shower
room
Laundry
room
17
CARE RIGHTS SURVEY
Facility
More than
30
residents
O
More than
10,
less
than
30
residents
O
Group home
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Remarks: …
(2) … however the facility should install slopes and elevators for the residents’ convenience if the
common physical therapy room is in a different floor with the patient room.
4. Equipment standard
A. Bedroom
…
(2) Men and women bedroom should be separated.
(3) 6.6 ㎡ bedroom space per resident is required.
(4) Residential room’s capacity is four people or less.
…
5. Required standard of employee
Type
Required standard
Administrator of facility
Licensed social work under <Social Service Law> and medical staff under the <Health law>
Social worker
Licensed social work under <Social Service Law>
Rehabilitation therapist
Licensed rehabilitation therapist under <Law regarding nursing technician>
Nursing assistance
First level certification of nursing assistance staff
6. Standard for employee’s allocation
Type of
occupat
ion
Administrat
or
of facility
Manage
r
Social
worker
Doctor(includi
ng oriental
medical
doctor or staff
doctor)
Nurse
or
nursing
assistan
t
Rehabilitati
on
therapist
Nonmedica
l
staff
Office
worker
Dietitia
ns
Kitche
n staff
Housekeepi
ng staff
Securit
y
More
than 30
residen
ts
1
1(only
when
there
are
more
than 50
resident
s)
1 (1 per
100
resident
s)
More than 1
1 per
25
residen
ts
1 (1 per
100
residents)
1 per
2.5
residen
ts
Requir
ed
number
1 (only
when
there is
more
than 50
kitchen
staff)
Requir
ed
number
Required
number
Requir
ed
number
More
than 10
and
less
than 30
residen
ts
1
1
1
1
Required
number
1 per
2.5
residen
ts
Requir
ed
number
Required
number
Type of facility
Facili
ty
Group house
1
1
1 per 3
residen
ts
Remarks: …
(2) Social worker establishes plans for providing elderly welfare such as health maintenance,
recreational activity program and basic counseling service for the elderly residents. However, it was
not mentioned for their role for engagement in the process of EOLCD.
…
CARE RIGHTS SURVEY
18
Question 7:
Please provide examples of best practices from a human rights perspective in your country in the
implementation, monitoring, review and appraisal of MIPAA.
7.1. Care Rights provide,
A.
Education & Counseling
This program is designed to clearly elucidate the end-of-life care decision making process through
advanced care counseling services and psychosocial support.
It serves to guide primarily those who are actively navigating their end-of-life care including their
families and health care staffs, but it is also highly recommended to anyone who wants to be planned
in advance.
B.
Advocacy & Enactment
This entails encouraging stakeholders, policy makers, as well as the general public to advocate for
sound legislations related to end-of-life care and decision making by collaborating with seminars,
forums and campaigns.
C.
Survey & Research
We oversee data collection and analysis to develop evidence-based counseling programs, educational
manuals for elderly patients, family caregivers, and health care staffs. This program is sponsored by
the SSK project under the umbrella of the Korean National Research Foundation and Namseoul
University Academic Foundation.
D.
UN Activity
Partnering with the UN and civil organizations, we help design and refine services pertaining to
Sustainable Development Goals(SDGs). Participating in the 2015 UN SDGs forum, the 6th Open
Ended Working Group on Ageing( OEWGA) meeting and the survey on UN Geneva Human Rights.
7.2. We also conduct project for the 2015,
CARE RIGHTS SURVEY
A.
19
Education & Counseling
"End-of-Life Care Decision & Older Persons Rights" is an educational program about advance
directives, and other ways to safeguard one's autonomy.
"Well-Dying &HYO(Filial Piety)". We are infusing Korean cultural norm of filial piety -HYO- into
our educational content to help better facilitate end-of-life care & decision making. This program
equips them with the tools necessary to discuss and plan their advance care in long term care facilities.
B.
Advocacy & Enactment
Care Rights participated at the public hearing of "Legislation about Hospice & Palliative Care" &
"Legislation about End-of-Life Care Decision Making" in S. Korea. The events included introduction
to legislation of hospice & palliative care, discussion about details and multidisciplinary
announcement was a good opportunity for hospice & palliative care system.
And we join in side event on the occasion of the 6th Open Ended Working Group from UN DESA. We
announced cultural differences in recognizing and protecting older person’s rights in end of life care
and decisions through the presentation.
And, also, forum on “Hospice & Palliative Care Model of New Paradigm ” was hold in Seoul.
Practitioners and administrators for hospice & palliative care facility and home based service in
domestic and abroad was discussed about operating the hospice & palliative care unit for patients and
family caregivers.
The Join World Conference on Social Work, Education and Social Development, under the theme
“Promoting the dignity and worth of people”, will be held from 2016 at COEX in Seoul, Korea. The
first day of the event, International Health Care Decision Day held by Care Rights, The program will
include symposium, exhibition and activities for fill out the advance directives with UN experts,
research, NGOs & CSOs that work for older person’s rights, SSK research team of Seoul National
University.
CARE RIGHTS SURVEY
20
Question 8:
Please provide information about the main challenges (such as institutional, structural and
circumstantial obstacles) your country faces at the various levels of government (communal,
provincial and national etc.) to fully respect, protect and fulfill the human rights of older
persons in the implementation of MIPAA.
8.1. Government and Policy Makers
“Act on Palliative Care & Hospice (No. 14991)” was proposed for more than 50 years. The government and
policy makere therefore, should proceed and support the activation and development of hospice & palliative
care by establishing a law about it.
8.2. Health care providers
Patients with terminal illness stay mainly Intensive Care Unit at hospitals, therefore professional medical staffs
including physicians, nurses, social worker should have a broad knowledge of hospice & palliative care
including evaluation method of patient with terminal condition, creative advanced care planning,
communication for patients and family caregivers. And they should follow the protocol by the government so
the service is sustainable.
8.3. NGOs & CSOs
Taboo to do advance care planning is still prevalent in Korean society. However, this consciousness is illogical
and must be combated with public education and awareness. That is a key part of NGOs & CSOs’ role. And
NGOs & CSOs should demand legislation from the government for the patients suffering from terminal disease,
provide public education, create community service that facilities cannot do such as home hospice, volunteer
service.
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21
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