Most Koreans want to die at home. Few do

Lee Jin-seok, 31, not his real name, lost his father to cancer five years ago.

When his dad , who had been told he had only months to live, began showing unusual symptoms early one morning, Lee was faced with a choice that still lingers.

His father had said he wanted to remain at home with his family until the end. But Lee called an ambulance, worried about the consequences of not seeking medical help — including the possibility of a police investigation if his father died at home, and the fear he might later blame himself.

His father remained conscious after being hospitalized but died there several weeks later, at a time when family visits were restricted under COVID-19 rules.

“It was the (legally) safer choice, as he may have lived longer,” Lee said. “But I still can’t shake the thought that there might have been a better way to spend his last precious days.”

For many in South Korea, the choice Lee faced is not unusual. Despite a widespread preference to die at home, legal risks and gaps in medical support continue to push families toward hospital care in patients’ final days.

Only 8.3 percent of deaths in 2024 occurred at home, even though 67.5 percent of welfare recipients with age-related illnesses said they hoped to die there.

Instead, about 75 percent die in hospitals, a far higher share than the 43 percent reported in the US.

The gap has drawn criticism that patients are spending their final days in shared hospital wards alongside others nearing death, placing emotional strain on both patients and their families.

Korea has begun shifting its elderly care system from a hospital-centered model to one based in homes and communities, a transition that has gained traction since late March.

But experts say structural barriers continue to push families toward hospitals at the end of life.

Under the Medical Service Act, a doctor may issue a death certificate without reexamining a patient only if the death occurs within 48 hours of the last consultation with the patient.

Beyond that window, the case is often reported to police as a potential “unnatural death,” triggering an investigation and, in some cases, an autopsy.

“Even legal experts cannot avoid investigation on suspicion of elder abuse when a family member dies at home,” said Shin Hyun-ho, a lawyer at Haeul. He cited cases in which funerals were delayed due to police inquiries.

Such concerns can influence decisions in critical moments. In some cases, families and paramedics agree to transport someone who is clearly deceased to a hospital so that the death can be formally declared there.

Experts say investigations and repeated police visits can place a significant emotional burden on grieving families. They call for systems that ensure timely access to medical personnel, so families are not left in a position where they must effectively prove their innocence.

Shin said that, given the lack of a fully developed system for home care, authorities should consider easing the rules on treating deaths as suspicious in cases involving clearly life-limiting conditions such as terminal cancer.

“Of course, exceptional cases of abuse or murder must be handled carefully,” Shin said. “But society needs more humane approaches that ease the burden of dying, especially for patients surrounded by others in hospital beds nearing the end of life.”

Doctors say families receiving home-based care face another challenge: The difficulty of predicting when death will occur, which can make it harder to forgo hospital treatment.

“Such patients are often frail and suffer from multiple conditions such as dementia, stroke and heart failure,” said Jeong Hye-jin, director of the Korean Association of Home-based Medicine. “Their physical strength gradually declines, swallowing difficulties emerge, and they cycle through periods of deterioration and stabilization before entering the final stage of life.”

Jeong stressed that a 24-hour, seven-day care system is essential for end-of-life care, adding that ensuring the availability of medical personnel within local communities to respond to emergencies is urgent.

The government began accepting applications on March 27 for an integrated care package that provides home visits, daily care and mobility support to help elderly and disabled people remain in their communities. Health Minister Jeong Eun-kyeong said around 3,000 people had been linked to the services as of April 13.

However, experts say the system focuses largely on how people live, while overlooking how they die. They call for end-of-life care to be incorporated into the framework, including comprehensive support for terminal patients at home, recognition of such care as an essential medical service and support for family caregivers.

“At the end of life, patients require the most intensive support from both medical and welfare systems, yet many are forced into a revolving door of hospital-home-hospital care,” said Kim Dae-kyun, a professor of family medicine at Incheon St. Mary’s Hospital.

“For community-based care to truly extend to end-of-life patients, hospice must be recognized as essential care and backed by bold financial investment.”

forestjs@heraldcorp.com