When facing a serious illness such as cancer, patients and families often confront a difficult question: how should decisions about life-sustaining treatment be made? A common source of confusion is whether the relevant paperwork must be signed well in advance, or whether it can wait until a person's condition worsens. The short answer is that planning ahead is encouraged for good reasons, but it is not something you are forced to complete while still healthy.
In Korea, the documents fall into two broad types. An advance directive (사전연명의료의향서) can be completed by any adult, even without illness, at a designated registration center. A separate physician's plan (연명의료계획서) is prepared together with the attending medical team, but only for a patient who has been diagnosed as terminally ill or entering the dying process. In other words, one is written ahead of time by a healthy person, and the other is written later, once the disease has progressed.
So why is planning ahead recommended? If a condition deteriorates quickly and a person enters intensive care or loses clear consciousness, they may no longer be able to express their own wishes. At that moment, families are left to make heavy decisions under pressure, and they may disagree about what the patient would have wanted. Recording your wishes in advance eases that burden and makes your own voice clear.
Still, "in advance" does not mean "right now" or "unchangeable." Either document can be withdrawn or revised at any time if your feelings change. Wanting to try treatment as far as it can reasonably go, and to decide later, is a valid choice. Many people complete a plan with their care team only after reaching an advanced stage.
You may have heard that consent is sometimes obtained in the intensive care unit. This happens because, at that point, the patient decides if they are able to speak for themselves; if not, the process relies on any wishes recorded earlier or on confirmation from family. Either way, it helps enormously when family members already know what you would want.
Finally, choosing to forgo life-prolonging measures is not the opposite of palliative care. Palliative care, which focuses on easing pain and symptoms and keeping a person comfortable, can be received alongside treatment at any stage. If the timing feels confusing, ask your medical team to explain the difference between the two documents, and talk it over with your family in advance.
This article is for general information only and does not replace personal medical care. Please discuss specific decisions and paperwork with your own medical team.