The impact of the Well-Dying Law in Korea: comparing clinical characteristics and ICU admissions

Abstract

Background: Since Korea implemented the Well-Dying Law in 2018, intensive, and end-of-life care have greatly changed. This study sought to determine whether there were any changes in the clinical aspects or appropriateness of intensive care unit admissions before and after the law was implemented. Methods: We performed a single-center retrospective study for 3 months with patients admitted to a medical intensive care unit before and after the law was implemented. We studied a total of 178 patients, divided pre-legislative group (83 patients) and a post-legislative group (95 patients). Results: There were no significant differences in baseline characteristics, including age, sex, educational level, religion, economic status, and the Eastern Cooperative Oncology Group performance scale at the time of admission to the intensive care unit. There were no changes in the proportion of patients with terminal comorbidities, including malignancy and chronic lung diseases, with the exception of a decrease in patients with liver cirrhosis (12.1% in pre vs. 3.2% in post-legislative group, P=0.040). There were no differences in the APACHE II score at the time of admission, or in prognosis, including in-unit mortality (33.7 vs. 33.6%, P=0.53), in-hospital mortality (38.6% vs. 42.1%, P=0.73), and length of stay in the intensive care unit (IQR, 4.0–11.0 vs. 3.0–11.0 days, P=0.493). Last, no differences were observed in the appropriateness of admission, which was assessed by two separate intensivists, before and after implementing the law (P=0.646, and P=0.315, respectively). Conclusions: After the Well-Dying Law was implemented, there was a significant decrease in the number of liver cirrhosis patients admitted to the intensive care unit. No changes in other clinical characteristics, prognosis, and the appropriateness of admission were evident with the implementation of the law.