Confusion in Terminology Related to End-of-Life Decisions: Euthanasia, Physician-Assisted Suicide and Decisions on Life-Sustaining Treatment: A Survey of Korean Public

Abstract

Background: Despite high approval for euthanasia and physician-assisted suicide (PAS) reported recently in South Korea, confusion from varying term interpretations must be addressed. This study assesses public understanding of end-of-life terminology and preferred decisions among Koreans. Methods: An online survey was conducted with 1,000 adult Koreans from June 10 to 14, 2024. To assess their understanding of end-of-life decision terms, participants were presented with scenarios on euthanasia, PAS, and decisions on forgoing life-sustaining treatment (DLST) and asked to select appropriate terms from each of the conventional (natural death, death with dignity, euthanasia) and objective (euthanasia, PAS, DLST) categories. To examine whether agreement levels differed between questions on terms alone and those with scenarios, initial agreement on euthanasia, PAS, death with dignity, natural death, and DLST was measured using a 5-point Likert scale, followed by case-specific agreement for euthanasia, PAS, and DLST. Finally, participants selected their preferred end-of-life decision, assuming terminal cancer. Results: 1) When scenarios involving euthanasia, PAS, and DLST were presented, respondents correctly identified each medical practice using objective terminology at rates of 37.4%, 53.8%, and 85.9%, respectively. 2) When the same medical practices were presented and respondents were asked to choose conventional terminology, the perception of these practices as "death with dignity" was 27.3% for euthanasia, 34.3% for PAS, and 57.2% for DLST. This result indicates that the subjective term "death with dignity" does not effectively differentiate between the three medical practices. 3) The initial agreement rates with the terms alone were 66.6% for euthanasia, 47.8% for death with dignity, 72.1% for PAS, 72.0% for natural death, and 75.5% for DLST. However, after presenting scenarios explaining each medical practice, some changes in agreement rates were observed. 4) When asked what decision they would personally choose in an end-of-life situation, 35.5% accepted euthanasia, 15.4% accepted PAS, and 41.3% accepted DLST. Conclusion: There is considerable confusion regarding end-of-life decision terminology among Koreans, particularly with “death with dignity,” which significantly confounds opinions on euthanasia and PAS. Therefore, objective terms should be used in end-of-life decisions discussions. Finally, DLST was the most preferred end-of-life decision among Koreans.