Everyone shall die someday in the future. Men were fearful of death regardless of the era and wanted to die without pains. How to die was thought to be important. In the past, physicians had professionally asked to extend and maintain of life of a patient. This was because the government's legal order was thought to be legal interest that could be protected at the highest state that prohibited making comparison of men's lives. There still exist so many incurable diseases. Men can extend lives in various ways owing to medical science technology that has developed day by day. The more men can maintain life artificially, the more doubtful agreement with a patient's will. These days, a patient's self-determination right at the time of dying is largely admitted to be valuable as much as life. And, rejection against valueless withdrawal of life sustaining treatment that is inconsistent with a patient's will is also thought to be important at self-determination right. Physician's duty of unconditional keeping of life is thought not to be significant. This is because a patient's self-determination right concerning medical treatment of prolongation of life is related with how to die.
Netherlands passed a bill of active euthanasia in 2001, and Belgium did in 2002. The active euthanasia is admitted when a patient is able to express his or her idea clearly and definitely. The withdrawal of Life sustaining treatment of critical patient who has no possibility of recovery to be unconscious is said to have another kind of problem. When a patient is able to exercise self-determination right, conformity with his or her will can be discussed: But, unconscious patient may be difficult to disclose his or her consciousness itself. When a patient is unable to disclose his or her will, his or her self-determination right can be of no value. In Korea, upon strong request of family, physicians often give up, reserve and suspend medical treatment at clinical cases. The physicians may have difficulties at giving medical treatment until what time.
On May 21, 2009, the Supreme Court judged suspension of medical treatment for prolongation of life for the first time in Korea. The sentencing of the case was on dispute to discuss needs of advance directive of a patient intensively, and it said 'advance directive' that a patient told a physician his or her will of rejection and withdrawal of life sustaining treatment in advance in preparation for death. The sentencing also said that unless a patient made change of his or her will he or she could be admitted to exercise self-determination right, so that it expressed advance directive. The advance directive is thought to be important considering assurance of a patient's self-determination right.
The Ministry of Health, Welfare and Family's Cancer Policy Team made efforts to legislate 'the Act on Hospice Palliative Care, and legislator Shin Sang-jin submitted 'A bill of death with dignity' to the National Assembly and legislator Kim Se-yeon did 'A bill on the rights of natural death at last stage of his or her life' so that the National Assembly as well as NGO had meetings several times to discuss the subject. And, the Korean Medical Association organized the Special Committee of Enactment of Guidelines of withdrawal of life sustaining treatment to open a seminar with the Korean Bar Association with a subject of 'a guideline (draft) on withdrawal of life sustaining treatment'. Immediately before the court judgment, Severance Hospital made so called 'A guideline of death with dignity' that classified status of a patient into three stages. And, the Seoul National University Hospital officially put 'CPR for terminal cancer patient and advance directive of withdrawal of life sustaining treatment' into practice.
The movement was not focused on a patient's advance directive or advance directive, and it was certain to be important at the discussion. The movement reflected needs of investigation of legal systems in foreign countries that put a patient's advance directive into practice earlier than Korea did.

The findings were as follow:

1) The Supreme Court's panel of judges released sentencing on the case of Severance Hospital on May 21, 2009 to call advance directive that a patient asked a physician to reject or withdrawal of life sustaining treatment in preparation for death at the stage of impossible recovery, and that a patient was admitted to exercise self-determination right unless he or she made change of will. Since then, a patient's advance directive was actively discussed. The advance directive can help solve various kinds of composite problems in withdrawal of life sustaining treatment in the society. However, the system requires some of preconditions before putting it into practice.
2) First of all, rejection to medial treatment shall be systematically admitted. The advance directive is much likely to include rejection against some of specific medical treatment. The United States put durable power of attorney into practice, and not only Germany but also Austria did Patientenverfügung. The rejection to medical treatment shall be admitted to put the legal system into practice. The durable power of attorney allows an agent who knows a patient's ideas the best make decision of medical practice, and it admits of DAMA(discharge against medical advice). The durable power of attorney of medical treatment can decide upon continuity of medical practice according to an agent's will to include agent's rejection against medical practice into DAMA. Physicians are not legally responsible for the results.
Not only Germany but also Austria admits of a patient's rejection against medical treatment. A patient may exercise rights of rejection against medical treatment to have rights of dying passively. In the case, a patient can exercise rights, while a physician shall respect of patient's rights. When a patient expresses his or her rejection against medical treatment by advance directive under specific situation, physicians shall respect of patient's will. Therefore, physicians shall not be responsible for the results according to not only the Civil Code but also the Criminal Act. Strictly speaking, when a patient expresses rejection against medical treatment, physicians shall be free from obligations of the guarantor, in other words, duty of medical treatment. When physicians continue to give a patient medical treatment, they shall be punished according to Article 223 of the Criminal Act of injury crime and Article 110 of the Criminal Act of arbitrary medical treatment crime.
Therefore, with advance directive, physicians are allowed to withdrawal of life sustaining treatment according to a patient's will. However, in Korea, even patient who is able to make decision may be suspicious of assurance of rejection against medical treatment legally. The case of not only Severance Hospital but also SNU Boramae Medical Center admitted a guarantor's obligation of physicians despite a patient's rejection against medical treatment when life is jeopardized. Under the situation, physicians may have worrying attitude. The case of SNU Boramae Hospital that was not thought to have problem of withdrawal of life sustaining treatment could strengthen conservation of the physicians. Unless rejection against medical treatment is systematically made, physicians are likely to solve problems based on doing best to give medical treatment from point of view of not patient but physician. The legislation of advance directive shall institutionally assure of a patient's rights of rejection of medical treatment.
3) Being different from Austria and Germany, a patient's guardian in Korea plays large role in medical services. Article 17-2 of the Physician Ethics Guideline of the Korean Medical Association says as follow: "Even if a physician explains enough either family or guardian of a patient who is unconscious or is unable to express his or her ideas and asks the family and guardian to be given medical services continuously, the family and guardian may ask in writing to suspend medical services including life-support treatment or to leave hospital, or to repeatedly ask for getting out of hospital and reject and hinder medical treatment. When the patient is conscious, the physician may consider patient's ideas and benefits carefully and suspend medical treatment if not only family or guardian's ideas and requests but also the patient's estimated ideas could be accepted from point of view of medical science and socially accepted idea."
Article 18-3 of the Organ Transplant Act says as follow: "The organs of brain-dead patient and the dead can be donated when patient himself or herself agrees with donation of the organs before either brain-dead or death subject to conditions as follow: 1) no explicit rejection against donation of the organs by either family or the bereaved. 2) Either family or the bereaved of the patient agrees with donation of the organ when either rejection or agreement with the patient's idea of donation is not evidenced before either brain-dead or the death.
In Korea, a patient's advance directive shall finally follow will of either family or guardian as mentioned at aforementioned cases. Therefore, the advance directive that has been introduced to respect of a patient's decisionmaking shall lose values. A patient's advance directive shall be introduced to regulate contents in detail and to allow physicians to decide upon situation of the advance directive regardless of will of a patient's family and guardian. The Civil Code of Germany may be introduced if either the Civil Code or the Medical Treatment Law is not conflicting at interpretation each other.
4) Even if either family or guardian asks for specific medical treatment, physicians shall be allowed to take actions according to their own medical service decision. Under current situation, however, physicians may be difficult to reject requests of either family or guardian that is thought to be of no value.
5) On September 15, 2009, not only the Korean Bar Association but also the Korean Medical Association opened a seminar to suggest notarization that could assure of advance directive. But, notary system may not be good to reflect a patient's variable opinions. In Korea, patients are not easy to make use of either notary or lawyer because of high expenses compared with Austria that had already introduced notary system.
A patient makes advance directive in preparation for the future when he or she was unable to make decision. So, a patient's expression of will may be enough. And, the advance directive is thought to have no limitation of ways, in other words, verbal or in writing. But, when a patient's advance directive is needed, the probative force may vary depending upon situation. The advance directive had better be made in writing.
6) A patient shall prepare for advance directive to assure of his or her self-determination right. The patient is allowed not to prepare for advance directive. So, the advance directive shall not be precondition that can start medical service, for instance, Article 1901a-4 of revision of German Civil Code as well as Article 10 and Article 15 of the Advance Directive Act of Austria.
7) In Korea, legislators submitted two bills to the National Assembly. However, those bills are thought to be suspicious at reasonableness and appropriateness. Legislators had better investigate carefully cases in foreign countries that put the system into practice earlier than Korea did, and then they shall enact laws and regulations that can make advance directive become valid and effective actually.