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Impact of perception of socioeconomic burden on advocacy for patient autonomy in end-of-life decision making: a study of societal attitudes

National Cancer Center, National Cancer Control Research Institute (NCCRI) and Hospital, Goyang, Gyeonggi

DW Shin

National Cancer Center, National Cancer Control Research Institute (NCCRI) and Hospital, Goyang, Gyeonggi

JH Lee

Department of Family Medicine, Seoul National University Hospital, Seoul

DS Heo

Cancer Research Institute, Seoul National University College of Medicine, Seoul

YS Hong

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul

S-Y Kim

Department of Medical Oncology and Hematology, College of Medicine, Kyung Hee University, Seoul

YH Yun

National Cancer Center, National Cancer Control Research Institute (NCCRI) and Hospital, Goyang, Gyeonggi lawyun08{at}ncc.re.kr

We investigated the impact of perception of socioeconomic burden on beliefs regarding a patient’s autonomy in end-of-life (EOL) decision making. We also sought to identify the characteristics of individuals who advocate patient autonomy and their attitudes toward other EOL issues. A total of 1055 individuals from the Korean general population were interviewed through a telephone survey using a structured questionnaire that was designed to investigate public attitudes toward various EOL issues. Of 1019 individuals included in the analysis, 635 (62.3%) specified the patient and 221 (21.7%) the family, when asked who is the appropriate decision maker in terms of EOL decisions in the absence of perception of socioeconomic burden. In contrast, the numbers were 458 (44.9%) and 500 (49.1%), respectively, if substantial burden was assumed. Respondents who favoured the patient’s right to make decisions regardless of perception of socioeconomic burden numbered only 312 (30.6%) and were likely to be younger and have knowledge of hospice than who favoured family decision. Former group also favoured the disclosure of terminal illness to patients, withholding life-sustaining treatment, and preparation of advanced directives. Societal attitudes toward patient autonomy were significantly influenced by perception of socioeconomic burden. Open and balanced discussion about burden to family and adequate welfare support are thus suggested.

Key Words: decision making • end-of-life • patient autonomy • perception of socioeconomic burden

This version was published on January 1, 2009

Palliative Medicine, Vol. 23, No. 1, 87-94 (2009)
DOI: 10.1177/0269216308099244


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