KIHASA has published the Global Social Security Review, No. 30, the Autumn Volume. The feature articles in this volume review global trends in policies toward ensuring an End-of-Life with Dignity.

FEATURE ARTICLES: Global Trends in Policies Toward Ensuring an End-of-Life with Dignity

"Trends in Life Sustaining Treatment Decision System in the United States, Taiwan and the United Kingdom," Choi Soyoung, KIHASA

As attention grows around the notion of a ‘good death’, some countries have put in place policies to support a dignified end of life. Instituted as part of advance care planning, initiatives for life-sustaining treatment decisions, though varying by country in their methods, criteria, and procedures, share the common goal of respecting patients’ preference of death over specific treatments and ensuring their self-determination through the appointment of a health care agent. Korea adopted a life-sustaining treatment decision system in February 2018, following the corresponding legislation enacted two years earlier. The practices from selected countries, as discussed here, offer a point of reference that Korea could look for guidance when seeking to enhance and ensure patients’ self-determination in end-of-life care.

"End-of-Life Decisions and Aid in Dying: Current Situations in Four European Countries," Shin Jiyoung & Baek Juha, KIHASA

End-of-life decisions may include matters concerning a living will, hospice care, life-sustaining treatments, and preferred funeral arrangements. Another important end-of-life decision pertains to euthanasia, which, permitted in some European countries, is also called physician-assisted suicide or aid in dying, depending on the method used for ending life. These countries have legal provisions in place that authorize the practice of euthanasia. In this article, we explore the euthanasia systems implemented in selected European countries, including the Netherlands, Switzerland, Belgium, and Spain.

"Community-Based End-of-Life Care in the United States: Trends and Implication," Baek Sehyun, New York University & Shin Esther, Illinois State University

In Korea, end-of-life care is limited to individuals diagnosed with certain diseases and is primarily provided in inpatient settings, as outlined in the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life, remaining mostly unavailable in community settings. In contrast, end-of-life care in the US is not restricted to certain diseases and is commonly delivered in community-based settings, including individuals’ homes. This article examines the US end-of-life care policy in detail and explores its implications for policymaking in Korea.

"Comparison of Quality of Death Index in Switzerland and the UK: Context of the Relationship between Assisted Suicide and Palliative Care," Kim DaeKyun, The Catholic University of Korea St. Mary's Hospital Incheon

Switzerland is a country where assisted suicide is legal and practiced predominantly by such organizations as EXIT and Dignitas. Assisted suicide in Switzerland, administered mostly to terminal cancer patients, accounts for an estimated 2.1 percent of all deaths in the country. The UK presents a high quality-of-death index on the strength of a well-integrated system of palliative and hospice care. The UK government has enhanced the quality of end-of-life care through strategic support and an integrated approach, emphasizing the education of healthcare professionals and community-based support. In contrast, Switzerland, while offering, through the legalization of assisted suicide, the freedom to determine the manner of death for terminally ill individuals, has room for improvements in the accessibility and quality of palliative care, as suggested by the fact that its health system remains segmented across subnational regions. Switzerland also needs increased effort in raising public awareness and understanding of palliative care.

ISSUE ANALYSIS

"The Establishment of the Dementia Basic Act in Japan: Key Contents and Implications," Lim Deokyoung, KIHASA

As Japan has become a “super-aged society” earlier than the rest of the world, it has been ahead of the curve in addressing the problem of dementia at the national and societal levels. Japan’s Basic Act on Dementia to Promote an Inclusive Society, enacted in 2023 and composed of a total of four sections and 37 articles, is a mainstay legal framework that broadly defines policy norms and values concerning dementia. This article explores the content and significance of Japan’s Dementia Act, focusing on its composition, objectives, underlying principles, related policies, timeframes, and national and local governments’ responsibilities in planning and implementing programs. The Act is significant for its integrated approach that combines medical treatment and caregiving, for ensuring that the perspectives and rights of individuals with dementia and their families are reflected and protected, and for the emphasis it places on the importance of communal efforts that engage various stakeholder groups.

"The Establishment of the Dementia Basic Act in Japan: Key Contents and Implications," Lim Deokyoung, KIHASA

As Japan has become a “super-aged society” earlier than the rest of the world, it has been ahead of the curve in addressing the problem of dementia at the national and societal levels. Japan’s Basic Act on Dementia to Promote an Inclusive Society, enacted in 2023 and composed of a total of four sections and 37 articles, is a mainstay legal framework that broadly defines policy norms and values concerning dementia. This article explores the content and significance of Japan’s Dementia Act, focusing on its composition, objectives, underlying principles, related policies, timeframes, and national and local governments’ responsibilities in planning and implementing programs. The Act is significant for its integrated approach that combines medical treatment and caregiving, for ensuring that the perspectives and rights of individuals with dementia and their families are reflected and protected, and for the emphasis it places on the importance of communal efforts that engage various stakeholder groups.

"Support Policies for Vulnerable Young Adults in Japan: A Focus on NEETs and Hikikomori," Noh Hyun Ju & Kim Seonga, KIHASA

This article surveys policy measures taken in Japan for socially vulnerable youth, with special reference to two key support projects that the Ministry of Health, Labor, and Welfare has embarked on targeting “hikikomori” and community youth. These projects shift away from transitional employment-focused approaches to the youth problem to customized support aimed at recovery and independent living, delivering a wide range of services through the network of responsible agencies, local governments, and private-sector organizations. However, they face challenges that stem from the absence of a connection between the support for hikikomori and that for NEET youth. We draw from these findings implications for developing a comprehensive welfare policy scheme for socially vulnerable youth in Korea.

"How Japan Has Improved Healthcare Accessibility in Depopulated Areas," Kim Dongjin, KIHASA

For many subnational regions, population outflows and the declining number of health care establishments are connected to one another in a vicious cycle. Securing health care provision and access at local levels is not only crucial for the protection of health for the populations that remain in these areas; it is also a significant part of the response to local depopulation. Japan’s health care support measures for sparsely populated regions differ in program and delivery method from their counterparts in Korea. Japan’s efforts on this front offer valuable lessons for Korea as it strives to: improve the role division between the central and local governments; develop mechanisms to address localities’ specific needs while maintaining local governments’ autonomy; attain the needed health care workforce, facilities, and equipment; strengthen the governance of local health care; and secure financial resources for necessary projects and activities.

"How Japan Has Improved Healthcare Accessibility in Depopulated Areas," Kim Dongjin, KIHASA

For many subnational regions, population outflows and the declining number of health care establishments are connected to one another in a vicious cycle. Securing health care provision and access at local levels is not only crucial for the protection of health for the populations that remain in these areas; it is also a significant part of the response to local depopulation. Japan’s health care support measures for sparsely populated regions differ in program and delivery method from their counterparts in Korea. Japan’s efforts on this front offer valuable lessons for Korea as it strives to: improve the role division between the central and local governments; develop mechanisms to address localities’ specific needs while maintaining local governments’ autonomy; attain the needed health care workforce, facilities, and equipment; strengthen the governance of local health care; and secure financial resources for necessary projects and activities.

"International Trends in Preconception Care Support Policies: A Focus on China and Japan," Lee Nagyeong, Jung Youn, & Lee Jae-eun, KIHASA

To ensure healthy pregnancies and childbirths, it is important that interventions are made early on, building on an understanding of risk factors that may start having effects on pregnancy even before conception. As the importance of preconceptual health has been increasingly emphasized at the international level, many countries have developed guidelines and policies for preconception care. China and Japan are examples of countries where preconception care services are provided at both national and local levels in a comprehensive range, encompassing education, health checkups, and consultations. This article examines these preconception care services and discusses their implications for policymaking in Korea.

"The Use of Online Prescription Information in Europe and Japan and Its Implications," Park Eunja, KIHASA

With the growing utilization of e-prescriptions, the use of online prescription information as part of personal health records has gained increasing attention. The EU has built an international system of e-prescription and e-dispensation that enables users to overcome geographic and linguistic barriers. Japan last year adopted the use of e-prescriptions and, by linking online prescription information with the patient’s “electronic medication notebooks,” allowed physicians and pharmacists to keep track of all the medication intakes. The EU and Japan exemplify how online prescription information can enhance the quality of health care services and make medication intake safer and more effective.

Global Social Security Trends

• ■"Reducing Administrative Burdens in Medicaid After the COVID-19 Pandemic," Jeong Soyun, University at Albany, State University of New York
  
  

• ■"The 2024 National Strategy for Suicide Prevention in the United States," Choi Soyoung, KIHASA
  
  

• ■"Healthcare REITs Market Trends in Japan," Choi Hee-jeoung, WELL-AGING LAB Co., Ltd.