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ACT ON HOSPICE AND PALLIATIVE CARE AND DECISIONS ON LIFE-SUSTAINING TREATMENT FOR PATIENTS AT THE END OF LIFE

Act No. 14013, Feb. 3, 2016

CHAPTER I GENERAL PROVISIONS
 Article 1 (Purpose)
The purpose of this Act is to prescribe matters necessary for hospice and palliative care and life-sustaining treatment for patients at the end of life, determination to terminate, etc., such life-sustaining treatment, and the implementation thereof, and thereby to protect the dignity and value of human beings by assuring the best interests of the patients and by respecting their self-determination.
 Article 2 (Definitions)
The definitions of terms used in this Act are as follows:
1. The term "end-of-life process" means a state of imminent death, in which there is no possibility of revitalization or recovery despite treatment, and symptoms worsen rapidly;
2. The term "patient at the end of life" means a person who has received a medical prognosis under Article 16, from the doctor in charge and one medical specialist in the relevant field that he/she is in the end-of-life process;
3. The term "terminal patient" means a patient who has been diagnosed as expected to die within a few months from the doctor in charge and one medical specialist in the relevant field in accordance with the procedures and guidelines prescribed by Ordinance of the Ministry of Health and Welfare, because there is no possibility of a fundamental recovery, and the symptoms gradually worsen despite proactive treatment of any of the following diseases:
(a) Cancer;
(b) Acquired immune deficiency syndrome (AIDS);
(c) Chronic obstructive respiratory disease;
(d) Chronic liver cirrhosis;
(e) Any other disease prescribed by Ordinance of the Ministry of Health and Welfare;
4. The term "life-sustaining treatment" means medical treatment by cardiopulmonary resuscitation, hemodialysis, administering anticancer drugs, and mechanical ventilation to a patient at the end of life, which merely extend the duration of the end-of-life process without curative effect;
5. The term "determination to terminate, etc., life-sustaining treatment" means a decision made to withhold life-sustaining treatment, or to terminate it for a patient at the end of life;
6. The term "hospice and palliative care" (hereinafter referred to as "hospice care") means the medical care provided to a terminal patient or patient at the end of life (hereinafter referred to as "terminal patient, etc.") and his/her family for the purpose of comprehensively evaluating and providing treatment in physical, psychosocial and spiritual domains, including pain and symptom relief;
7. The term "doctor in charge" is a doctor under the Medical Service Act who directly treats a terminal patient, etc.;
8. The term "life-sustaining treatment plan" means a written plan prepared by a doctor in charge for the matters concerning the determination to terminate, etc., life-sustaining treatment and hospice care for a patient according to the intention of a terminal patient, etc.;
9. The term "advance statement on life-sustaining treatment" means a written statement prepared by a person aged at least 19 on his/her own determination to terminate, etc., life-sustaining treatment and hospice care.
 Article 3 (Basic Principles)
(1) All activities concerning hospice care, life-sustaining treatment, and determination to terminate, etc., life-sustaining treatment shall not infringe on the human dignity and value of patients.
(2) Every patient has the right to receive the best treatment and clearly know about the status and prognosis of the injury or disease he/she suffers and the subsequent medical services, and to make decisions for himself/herself thereon.
(3) Each medical person under the Medical Service Act (hereinafter referred to as "medical person") shall provide patients with the best treatment, explain hospice, palliative care, and determination to terminate, etc., life-sustaining treatment, accurately and in detail, and shall respect the patient's decision made based thereon.
 Article 4 (Relationship to other Acts)
This Act shall take precedence over other Acts with respect to hospice, palliative care, and determination to terminate, etc., life-sustaining treatment, and the implementation thereof.
 Article 5 (Obligations of the State and Local Governments)
(1) The State and local governments shall strive to establish social and cultural foundations that protect dignity and value of patients as human beings.
(2) The State and local governments shall give priority to formulating policies necessary to establish a foundation for using hospice care to protect patients' best interests.
 Article 6 (Designation of Hospice Day)
(1) In order to give wider publicity to the meaning and value of life and death, to form a national consensus, to actively use hospice, and to create a social atmosphere that respects the patients' intention regarding life-sustaining treatment, every second Saturday of October shall be declared as "Hospice Day."
(2) The State and local governments shall strive to administer events, education and publicity activities that conform to the purport of Hospice Day.
 Article 7 (Implementation and Formulation of Comprehensive Plans)
(1) The Minister for Health and Welfare shall formulate and implement a comprehensive plan for hospice, palliative care, and determination to terminate, etc., life-sustaining treatment (hereinafter referred to as "comprehensive plan") every five years, following deliberation by the National Hospice and Palliative Care Committee prescribed in Article 8.
(2) A comprehensive plan shall include the following:
1. Direction-setting and establishing the foundation for institutionally establishing hospice, palliative care, and determination to terminate, etc., life-sustaining treatment;
2. Providing information related to hospice, palliative care, and determination to terminate, etc., life-sustaining treatment, and implementing and supporting education thereon;
3. Providing support necessary for establishing and operating an institutional ethics committee pursuant to Article 14;
4. Developing and disseminating educational programs and guidelines to improve the quality of life of terminal patients, etc. and their families;
5. Fostering institutions specialized in hospice care referred to in Article 25 and training professional personnel;
6. Developing various hospice services;
7. Matters concerning researching and studying hospice, palliative care, and determination to terminate, etc., life-sustaining treatment;
8. Other matters necessary for the institutional establishment of hospice, palliative care, and determination to terminate, etc., life-sustaining treatment.
(3) In formulating comprehensive plan, the Minister of Health and Welfare shall preconsult with the National Bioethics Committee in accordance with Article 7 of the Bioethics and Safety Act regarding matters that may have a serious social impact on bioethics and safety.
(4) The Minister of Health and Welfare shall formulate and implement an annual implementation plan based on a comprehensive plan and evaluate the outcomes of implementing such.
(5) Where the Minister of Health and Welfare formulates a comprehensive plan or amends important matters therein, he/she shall file a report thereon with the National Assembly without delay.
 Article 8 (National Hospice and Palliative Care Committee)
(1) In order to deliberate on comprehensive plans and implementation plans, the Ministry of Health and Welfare shall establish the National Hospice and Palliative Care Committee (hereinafter referred to as the "Committee") under the jurisdiction of the Minister of Health and Welfare.
(2) The Committee shall be comprised of not more than 15 members, including the chairperson.
(3) Vice Minister of Health and Welfare shall be the chairperson.
(4) Members shall be appointed or commissioned by the Minister of Health and Welfare from among experts from various fields, who have extensive knowledge on and experience in treating terminal patients, hospice care and end-of-life process.
(5) Other matters necessary for organizing and operating the Committee shall be prescribed by Presidential Decree.
CHAPTER II MANAGEMENT SYSTEM FOR DETERMINATION TO TERMINATE, ETC., LIFE-SUSTAINING TREATMENT
 Article 9 (National Agency for Management of Life-Sustaining Treatment)
(1) In order to manage matters concerning life-sustaining treatment, determination to terminate, etc., life-sustaining treatment, and implementing the same in an appropriate manner, the Minister of Health and Welfare shall establish the National Agency for Management of Life-Sustaining Treatment (hereinafter referred to as the "Managing Agency").
(2) The duties of the Managing Agency shall be as follows:
1. Establishing and managing of a database of plans for life-sustaining treatment registered under Article 10 and advance statements on life-sustaining treatment registered under Article 12;
2. Managing, guiding, and supervising agencies for registration of the advance statements on life-sustaining treatment prescribed in Article 11;
3. Replying to requests for inquiry to confirm plans for life-sustaining treatment and advance statements on life-sustaining treatment pursuant to Article 17 (2);
4. Investigating, researching, and gathering information concerning life-sustaining treatment, determination to terminate, etc., life-sustaining treatment and the implementation thereof; and producing statistics related thereto;
5. Other duties prescribed by Presidential Decree in connection with life-sustaining treatment, determination to terminate, etc., life-sustaining treatment, and the implementation thereof.
(3) Matters necessary for operating, etc., the Managing Agency shall be prescribed by Presidential Decree.
<<Enforcement Date: Feb. 4, 2018>>
 Article 10 (Preparation, Registration, etc., of Life-Sustaining Treatment Plans)
(1) A doctor in charge may provide a terminal patient, etc. with information on making a determination to terminate, etc., life-sustaining treatment, life-sustaining treatment plan, and hospice care.
(2) A terminal patient, etc. may request the doctor in charge to prepare a life-sustaining treatment plan at a medical institution (referring to a medical clinic, oriental medical clinic, hospital, oriental medical hospital, intermediate care hospital, and general hospital, among medical institutions prescribed in Article 3 of the Medical Service Act; hereinafter the same shall apply).
(3) A doctor in charge in receipt of a request under paragraph (2) shall explain the following matters to the relevant patient before preparing a life-sustaining treatment plan; and shall obtain confirmation from the patient that he/he has understood the details thereof. In such cases, if the relevant patient is a minor, the doctor in charge shall explain such matters to the patient and his/her legal representative:
1. Status of patient's disease and matters concerning the methods of treatment;
2. Matters concerning the methods of providing life-sustaining treatment and matters concerning determination to terminate, etc., life-sustaining treatment;
3. Matters concerning selecting and using hospice care;
4. Matters concerning preparing, registering, keeping, and notifying life-sustaining treatment plans;
5. Matters concerning amending and withdrawing life-sustaining treatment plans, and subsequent measures;
6. Other matters prescribed by Ordinance of the Ministry of Health and Welfare.
(4) A life-sustaining treatment plan shall include the following matters:
1. Matters concerning patients’ determination to terminate, etc., life-sustaining treatment and matters concerning use of hospice care;
2. Affixation of the patient's signature, name and seal of the patient to indicate that he/she has understood the explanation provided regarding the matters referred to in subparagraphs of paragraph (3), recording thereof, and confirmation by a method equivalent thereto prescribed by Presidential Decree;
3. Signature and seal of the doctor in charge;
4. Year, month, and date of preparation;
5. Other matters prescribed by Ordinance of the Ministry of Health and Welfare.
(5) A patient may request to amend or withdraw a life-sustaining treatment plan at any time. In such cases, the doctor in charge shall honor such request.
(6) The head of a medical institution shall register and keep a prepared life-sustaining treatment plan; and where a life-sustaining treatment plan is registered, amended or withdrawn, he/she shall notify the head of the Managing Agency of the outcome thereof.
(7) The form of a life-sustaining treatment plan, and matters necessary for preparing, registering, notifying, etc., a life-sustaining treatment plan, shall be prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 11 (Agency for Registration of Advance Statements on Life-Sustaining Treatment)
(1) The Minister of Health and Welfare may designate an agency for registration of advance statements on life-sustaining treatment, from among the following institutions which satisfy the requirements prescribed by Presidential Decree, such as facilities and human resources (hereinafter referred to as "registration agency"):
1. A regional healthcare institution defined in Article 2 of the Regional Public Health Act;
2. A medical institution;
3. A non-profit corporation or non-profit organization (referring to a non-profit, non-governmental organization registered under Article 4 of the Assistance for Non-Profit Non-Governmental Organizations Act) that provides services concerning advance statements on life-sustaining treatment;
(2) Duties of a registration agency shall be as follows:
1. Affairs related to registering advance statements on life-sustaining treatment;
2. Explaining and assisting in preparing advance statements on life-sustaining treatment;
3. Counselling and providing information on advance statements on life-sustaining treatment, and publicity activities related thereto;
4. Notifying the results of the registration, amending, withdrawing, etc., advance statements on life-sustaining treatment to the Managing Agency;
5. Other duties prescribed by Ordinance of the Ministry of Health and Welfare concerning advance statements on life-sustaining treatment.
(3) The head of a registration agency shall record and keep the outcomes of the duties prescribed in paragraph (2) and report them to the head of the Managing Agency.
(4) The State and local governments may provide administrative and financial support necessary to operate registration agencies and to perform their duties.
(5) The head of a registration agency that closes or suspends operation thereof for not less than one month or resumes its operation, shall report such fact to the Minister of Health and Welfare.
(6) Where a registration agency closes or suspends operation thereof for at least one month, the head of the registration agency shall transfer related records to the head of the Managing Agency as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That where the head of a registration agency that intends to suspend the operation obtains permission from the head of the Managing Agency by the day before the scheduled date for suspending operation, he/she may directly keep the related records.
(7) Necessary matters concerning the procedures for designating registration agencies, recording, keeping and reporting the outcomes of duties, and procedures for reporting the closure of business, etc. shall be prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 12 (Preparation, Registration, etc., of Advance Statements on Life-Sustaining Treatment)
(1) A person who intends to prepare an advance statement on life-sustaining treatment (hereinafter referred to as "preparer") shall prepare it directly according to this Article.
(2) A registration agency shall fully explain the following matters to a preparer before he/she prepares an advance statement on life-sustaining treatment, and shall obtain confirmation from the preparer that he/she has understood the details thereof:
1. Matters concerning the methods of implementing life-sustaining treatment and making a determination to terminate, etc., life-sustaining treatment;
2. Matters concerning selecting and using hospice care;
3. Matters concerning the validity and invalidity of advance statements on life-sustaining treatment;
4. Matters concerning preparing, registering, keeping and notifying the advance statement on life-sustaining treatment;
5. Matters concerning amending and withdrawing advance statements on life-sustaining treatment, and subsequent measures;
6. Other matters prescribed by Ordinance of the Ministry of Health and Welfare.
(3) An advance statement on life-sustaining treatment shall include the following matters:
1. Determination to terminate, etc., life-sustaining treatment;
2. Using hospice care;
3. Date and time for preparation, and methods for keeping such statement;
4. Other matters prescribed by Ordinance of the Ministry of Health and Welfare.
(4) The head of a registration agency in receipt of an advance statement on life-sustaining treatment shall register and keep it after confirming whether it is prepared by the principal.
(5) The head of a registration agency shall notify the head of the Managing Agency of the result of the registration made pursuant to paragraph (4).
(6) A person who has prepared an advance statement on life-sustaining treatment may amend or withdraw his/her intention at any time. In such cases, the head of the registration agency shall modify or cancel the registration of his/her advance statement on life-sustaining treatment without delay.
(7) Where an advance statement on life-sustaining treatment is amended or withdrawn pursuant to paragraph (6), the head of a registration agency shall notify the result thereof to the head of the Managing Agency.
(8) An advance statement on life-sustaining treatment is invalid in any of the following cases: Provided, That in cases of subparagraph 4, it becomes invalid from that relevant time forward:
1. Where it is not prepared in person by the principal;
2. Where it is not prepared according to the principal's voluntary intention;
3. Where no explanation is provided on each matter prescribed in subparagraphs of paragraph (2) or where no confirmation is obtained from the preparer;
4. Where further advance statement on life-sustaining treatment is prepared after preparing and registering an advance statement on life-sustaining treatment.
(9) The form of an advance statement on life-sustaining treatment, and matters necessary for the preparation, registration, keeping, notification, etc., of an advance statement on life-sustaining treatment, shall be prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 13 (Revocation of Designation of Registration Agencies)
(1) Where a registration agency falls under any of the following cases, the Minister of Health and Welfare may revoke the designation: Provided, That in cases falling under subparagraph 1, such designation shall be revoked:
1. Where it obtains designation by fraudulent or other illegal means;
2. Where it fails to meet any designation criterion prescribed in Article 11 (1);
3. Where it fails to perform any of the duties prescribed in subparagraphs of Article 11 (2) without any good cause;
4. Where it fails to comply with an order or cooperate in an inspection referred to in Article 34 (3) without any good cause.
(2) A registration agency whose designation is revoked under paragraph (1) shall be ineligible to be designated as a registration agency within two years from the date the designation is revoked.
(3) Where the designation is revoked under paragraph (1), the head of the registration agency shall transfer the records kept thereby to the Managing Agency, as prescribed by Presidential Decree.
<<Enforcement Date: Feb. 4, 2018>>
 Article 14 (Establishment, Operation, etc., of Institutional Ethics Committee)
(1) A medical institution that intends to perform the services concerning determination to terminate, etc., life-sustaining treatment and the implementation thereof shall establish an institutional ethics committee (hereinafter referred to as "ethics committee") as prescribed by Ordinance of the Ministry of Health and Welfare and register it with the Minister of Health and Welfare.
(2) An ethics committee shall perform the following activities:
1. Deliberation on matters requested by a patient at the end of life, his/her family or medical person regarding a determination to terminate, etc., life-sustaining treatment and the implementation thereof;
2. Deliberation on replacing doctors in charge under Article 19 (3);
3. Counseling for a patient and his/her family with respect to determination to terminate, etc., life-sustaining treatment;
4. Education of medical ethics for medical persons of the relevant medical institution;
5. Other matters prescribed by Ordinance of the Ministry of Health and Welfare.
(3) An ethics committee shall consist of at least five members including one chairperson; it shall not be limited to the persons of the relevant medical institution, but shall include at least two nonmedical persons recommended from the religious community, legal circle, ethics circle, civic organizations, etc.
(4) Members of an ethics committee shall be commissioned by the head of the relevant medical institution, and the chairperson shall be elected by and from among its members.
(5) Notwithstanding paragraph (1), a medical institution which has concluded an agreement with the ethics committee of another medical institution or a shared ethics committee referred to in paragraph (6) to entrust the affairs prescribed in subparagraphs of paragraph (2), as prescribed by Ordinance of the Ministry of Health and Welfare, shall be deemed to have established an ethics committee.
(6) In order to enable medical institutions to entrust the performance of the affairs prescribed in the subparagraphs of paragraph (2), the Minister of Health and Welfare may designate shared ethics committees.
(7) Other necessary matters for comprising, operating, etc., ethics committees and shared ethics committees shall be prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
CHAPTER III IMPLEMENTATION OF DETERMINATION TO TERMINATE, ETC., LIFE-SUSTAINING TREATMENT
 Article 15 (Persons subject to Implementation of Determination to Terminate, etc., Life-Sustaining Treatment)
A doctor in charge may implement a determination to terminate, etc., life-sustaining treatment, only if his/her patient at the end of life falls under any of the following cases:
1. Where the patient's intention is deemed to make a determination to terminate, etc., life-sustaining treatment, based upon the life-sustaining treatment plan, an advance statement on life-sustaining treatment, or statements of the patient's family under Article 17 and it is not against the intention of the patient at the end of life;
2. Where a determination to terminate, etc., life-sustaining treatment is deemed made pursuant to Article 18.
<<Enforcement Date: Feb. 4, 2018>>
 Article 16 (Diagnosing whether Patient Is in End-of-Life Process)
Before implementing a determination to terminate, etc., life-sustaining treatment, a doctor in charge shall diagnose, in cooperation with one medical specialist, whether his/her patient is in end-of-life process and shall record the outcome thereof as prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 17 (Verification of Patient's Intention)
(1) A doctor of a patient who wishes to make a determination to terminate, etc., life-sustaining treatment shall make verification by any of the following methods:
1. Where there is a life-sustaining treatment plan prepared at a medical institute, it shall be construed as the patient's intention;
2. Where the doctor in charge verifies the details of an advance statement on life-sustaining treatment from the patient, it shall be construed as the patient's intention. The same shall also apply where the doctor in charge and one medical specialist in the relevant field verify all of the following matters:
(a) Medical judgement that the patient lacks mental capacity to verify details of the advance statement on life-sustaining treatment;
(b) The fact that the advance statement on life-sustaining treatment has been prepared within the scope defined in subparagraph 4 of Article 2;
3. In cases not falling under subparagraph 1 or 2, if a patient who is at least 19 years of age is in a medical condition that prevents him/her from expressing his/her intention and if there are two or more identical statements of the members of the patient's family (referring to any of the following persons who are at least 19 years of age; where the patient has only one family member, referring to the state of such family member) regarding the patient’s intention to make a determination to terminate, etc., life-sustaining treatment consistently expressed for a period sufficient to construe it as the patient's intention to make a determination to terminate, etc., life-sustaining treatment, such statements shall be construed as the patient's intention following verification by the doctor in charge and one medical specialist in the relevant field: Provided, That the same shall not apply where any other family member has made a statement of the patient or objective evidence prescribed by Ordinance of the Ministry of Health and Welfare, the details of which are contrary to such statements:
(a) The spouse;
(b) A lineal descendant;
(c) A lineal ascendant;
(d) Where no person falls under any of item (a) through (c), a sibling.
(2) A doctor in charge may inquire about the registration of a life-sustaining treatment plan or an advance statement on life-sustaining treatment to verify it pursuant to paragraph (1) 1 or 2.
(3) A doctor in charge and a medical specialist in the relevant field who have verified the patient's intention pursuant to paragraph (1) 2 or 3 shall record the outcome of the verification as prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 18 (Determining to Terminate, etc., Life-Sustaining Treatment Where It Is Impossible to Verify Patient's Intention)
(1) Where it is impossible to verify a patient's intention because the case does not fall under Article 17 and the patient is in a medical condition that prevents him/her from expressing his/her intention, determination to terminate, etc., life-sustaining treatment shall be deemed made on behalf of the relevant patient in any of the following cases: Provided, That this shall not apply if the doctor in charge and one medical specialist in the relevant field verify that the patient did not intend the determination to terminate, etc., life-sustaining treatment:
1. A legal representative (limited to a person of parental authority) of a patient who is a minor has expressed an intention to make a determination to terminate, etc., life-sustaining treatment and the doctor in charge and one medical specialist in the relevant field have verified such intention;
2. Where all members of the patient's family (excluding those who fall under any ground prescribed by Presidential Decree, such as missing persons, etc.) have unanimously expressed an intention to make a determination to terminate, etc., life-sustaining treatment and the doctor in charge and one medical specialist in the relevant field have verified such intention.
(2) A doctor in charge and one medical specialist in the relevant field who have verified determination to terminate, etc., life-sustaining treatment pursuant to paragraph (1) 1 or 2 shall record the outcome of the verification as prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 19 (Implementation, etc., of Determination to Terminate, etc., Life-Sustaining Treatment)
(1) A doctor in charge shall immediately implement determination to terminate, etc., life-sustaining treatment for a patient who falls under any subparagraph of Article 15.
(2) In implementing determination to terminate, etc., life-sustaining treatment, the medical care for relieving pains and simple provision of nutrients, water, and oxygen, shall be provided without ceasing.
(3) When a doctor in charge refuses to implement determination to terminate, etc., life-sustaining treatment, the head of the relevant medical institution shall replace the doctor in charge following deliberation by the ethics committee. In such cases, the head of the medical institution shall not dismiss the doctor in charge or accord any other unfavorable treatment on the grounds of his/her refusal to implement the determination to terminate, etc., life-sustaining treatment.
(4) A doctor in charge who implements determination to terminate, etc., life-sustaining treatment shall record the process and the outcome thereof.
(5) Where determination to terminate, etc., life-sustaining treatment is implemented pursuant to paragraph (1), the head of the medical institution shall report the outcome thereof without delay to the head of the Managing Agency as prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 20 (Preservation of Records)
The head of a medical institution shall preserve the following records concerning each determination to terminate, etc., life-sustaining treatment and the implementation thereof for ten years after implementing each determination to terminate, etc., life-sustaining treatment:
1. A life-sustaining treatment plan prepared under Article 10;
2. The outcome of diagnosis made by the doctor in charge and one medical specialist as to whether a patient is in the end-of-life process, which is recorded pursuant to Article 16;
3. The outcome of verification conducted by the doctor in charge and the medical specialist in the relevant field concerning the life-sustaining treatment plan or the advance statement on life-sustaining treatment pursuant to Article 17 (1) 1 or 2;
4. Data and documents concerning the statements of the patient's family under Article 17 (1) 3 and the outcome of verification conducted by the doctor in charge and the medical specialist in the relevant field;
5. Data and documents concerning the expression of intention under Article 18 (1) 1 or 2 and the outcome of verification conducted by the doctor in charge and the medical specialist in the relevant field;
6. The outcome of implementation of the determination to terminate, etc., life-sustaining treatment recorded pursuant to Article 19 (4);
7. Other matters prescribed by Presidential Decree, as important records concerning the determination to terminate, etc., life-sustaining treatment and the implementation thereof.
<<Enforcement Date: Feb. 4, 2018>>
CHAPTER IV HOSPICE AND PALLIATIVE CARE
 Article 21 (Hospice Projects)
(1) The Minister of Health and Welfare shall implement the following projects for hospice care:
1. Developing and disseminating guidelines for controling symptoms, including appropriate pain management for terminal patients, etc.;
2. Establishing and operating hospital, counsel, and home hospices, and development and dissemination of policies on various other types of hospices;
3. Research and development projects for developing hospice care;
4. Fostering institutions specialized in hospice care under Article 25 and training of human resources specializing in hospice care;
5. Developing and disseminating hospice education programs for terminal patients and their families;
6. Projects supporting medical expenses taking the ability to bear economic burden of patients using hospice care;
7. Projects for registering, managing, and surveying for statistics (hereinafter referred to as "registration statistics projects") by collecting and managing data on the status and management status of terminal patients and hospice care on a continuous and systematic basis;
8. Publicity activities concerning hospice care;
9. Other projects deemed necessary by the Minister of Health and Welfare.
(2) The Minister of Health and Welfare may entrust the projects prescribed in subparagraphs of paragraph (1) to related specialized institutions and organizations, as prescribed by Presidential Decree.
 Article 22 (Cooperation, etc. in Provision of Data)
Where necessary for registering statistics projects referred to in Article 21 (1) 7, the Minister of Health and Welfare may request related institutions or organizations to submit data, written opinions, etc. In such cases, persons in receipt of a request to submit, etc., data shall comply therewith, except in extenuating circumstances.
 Article 23 (Designation of Central Hospice Center)
(1) The Minister of Health and Welfare may designate a general hospital referred to in Article 3 (2) 3 (e) of the Medical Service Act (hereinafter referred to as "general hospital") that meets the criteria prescribed by Ordinance of the Ministry of Health and Welfare as the Central Hospice Center (hereinafter referred to as the "Central Center") in order to assign the following duties. In such cases, priority shall be given to a national or public medical institution:
1. Researching the status, diagnosis, treatment, management, etc., of terminal patients;
2. Collecting, analysing, and providing information and statistics on hospice projects;
3. Formulating plans for hospice projects;
4. Development and dissemination of new technologies on hospice care;
5. Provision of hospice care to terminal patients, etc.;
6. Evaluation and utilization of outcomes of hospice projects;
7. Other projects prescribed by Ordinance of the Ministry of Health and Welfare as those necessary for the management of terminal patients.
(2) Where the Central Center fails to perform or inadequately performs a project prescribed in subparagraphs of paragraph (1), the Minister of Health and Welfare may issue a corrective order.
(3) Where the Central Center falls under any of the following cases, the Minister of Health and Welfare may revoke designation:
1. Where it fails to meet any of the designation criteria referred to in paragraph (1);
2. Where it fails to perform or inadequately performs a project prescribed in subparagraphs of paragraph (1) l;
3. Where it fails to comply with a corrective order issued under paragraph (2).
(4) Necessary matters concerning the criteria, methods, and procedures for the designation and revocation of designation of the Central Center, and the operation thereof under paragraphs (1) and (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
 Article 24 (Designation, etc., of Regional Hospice Center)
(1) The Minister of Health and Welfare may designate a general hospital that meets the criteria prescribed by Ordinance of the Ministry of Health and Welfare as a Regional Hospice Center (hereinafter referred to as "regional center") in order to assign the following affairs. In such cases, priority shall be given to a national or public medical institution:
1. Research on the current state, diagnosis, treatment, management, etc., of terminal patients;
2. Provision of support to hospice projects in the relevant region;
3. Provision of medical support to and evaluation of institutions specialized in hospice care in the relevant region;
4. Provision of hospice care to terminal patients, etc.;
5. Affairs related to education, training and providing support related to hospice projects of the relevant region;
6. Publicity activities concerning hospice care in the relevant region;
7. Collecting, analysing and providing statistics on registration of terminal patients;
8. Other projects prescribed by Ordinance of the Ministry of Health and Welfare as those necessary for managing terminal patients.
(2) Where a regional center fails to implement or inadequately implements the projects prescribed in subparagraphs of paragraph (1), the Minister of Health and Welfare may revoke designation.
(3) Where a regional center falls under any of the following cases, the Minister of Health and Welfare may revoke designation:
1. Where it fails to meet the designation criteria referred to in paragraph (1);
2. Where it fails to perform or inadequately performs the projects prescribed in subparagraphs of paragraph (1);
3. Where it fails to comply with a corrective order issued under paragraph (2).
(4) Necessary matters concerning the criteria, methods, and procedures for the designation and revocation of designation of a regional center, and the operation thereof under paragraphs (1) and (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
 Article 25 (Designation, etc., of Institutions Specialized in Hospice Care)
(1) The Minister of Health and Welfare may designate medical institutions that meet the criteria for facilities, human resources, equipment, etc., prescribed by Ordinance of the Ministry of Health and Welfare as specialized in hospice care, among the medical institutions that intend to establish and operate institutions specialized in hospice care for terminal patients, etc., by classifying them into hospital, council, and home hospices.
(2) A medical institution that intends to be designated under paragraph (1) shall submit an application to the Minister of Health and Welfare as prescribed by Ordinance of the Ministry of Health and Welfare.
(3) The Minister of Health and Welfare may fully or partially subsidize expenses incurred for hospice services of institutions specialized in hospice care designated under paragraph (1) (hereinafter referred to as "institutions specialized in hospice care") differentially, by reflecting the outcome of the evaluation conducted under Article 29.
(4) Except as otherwise expressly provided for in paragraphs (1) and (2), matters necessary for designating institutions specialized in hospice care shall be prescribed by Ordinance of the Ministry of Health and Welfare.
 Article 26 (Reporting on Changes, Business Closure, etc.)
(1) The head of an institution specialized in hospice care who intends to change important matters prescribed by Ordinance of the Ministry of Health and Welfare, such as human resources, facilities and equipment, shall report the matters to be changed, to the Minister of Health and Welfare.
(2) The head of an institution specialized in hospice care who intends to close or suspend business shall file a pre-report thereon with the Minister of Health and Welfare.
(3) Matters necessary for the reporting procedures, etc., under paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
 Article 27 (Medical Persons' Duty to Explain)
(1) A medical person of an institution specialized in hospice care shall explain to a terminal patient, etc., or his/her family, etc., the selection and procedures for using a hospice.
(2) A doctor or an oriental medical doctor of an institution specialized in hospice care shall explain a treatment plan to a terminal patient, etc., or his/her family, etc., before providing hospice care; and shall explain the status of the disease when a terminal patient or his/her family wishes to know regarding the same.
 Article 28 (Application for Hospice Care)
(1) Where a terminal patient, etc., intends to use hospice care at an institution specialized in hospice care, he/she shall submit an application to the institution, appending written consent to use hospice care and a doctor's note indicating that the applicant is a terminal patient, etc.
(2) When a terminal patient, etc. lacks decision-making ability, the application may be filed by a pre-designated representative; and where no representative is designated, the application may be filed by a person in the order set forth in items of Article 17 (1) 3.
(3) A terminal patient, etc. may withdraw his/her application for hospice care at any time, in person or through his/her representative.
(4) Matters necessary for applications, withdrawing, etc., hospice care shall be prescribed by Ordinance of the Ministry of Health and Welfare.
 Article 29 (Evaluation of Institutions Specialized in Hospice Care)
(1) In order to improve quality of hospice care, the Minister of Health and Welfare may evaluate institutions specialized in hospice care with respect to the following matters:
1. Quality and level of facilities, human resources, equipment, etc.;
2. Current state of the management of quality of hospice care;
3. Other matters prescribed by Ordinance of the Ministry of Health and Welfare.
(2) Matters necessary for the timing to evaluate institutions specialized in hospice care, the scope, methods, procedures, etc., for the evaluation shall be prescribed by Ordinance of the Ministry of Health and Welfare.
(3) The Minister of Health and Welfare may disclose the findings of evaluation performed under paragraph (1) as prescribed by Ordinance of the Ministry of Health and Welfare, and reflect it in providing assistance and supervision.
(4) The Minister of Health and Welfare may outsource duties of evaluation to be performed under paragraph (1), to a related institution or organization, as prescribed by Presidential Decree.
 Article 30 (Revocation, etc., of Designation of Institutions Specialized in Hospice Care)
(1) Where an institution specialized in hospice care falls under any of the following cases, the Minister of Health and Welfare may revoke the designation or order the hospice to suspend its services: Provided, That the designation shall be revoked in cases falling under subparagraph 1:
1. Where it obtains the designation by fraudulent or other illegal means;
2. Where it fails to meet any of the designation criteria prescribed in Article 25 (1);
3. Where it refuses to undergo evaluation referred to in Article 29 without good cause.
(2) Matters necessary for the criteria for revoking designation, and the methods, procedures and operation thereof under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
(3) An institution specialized in hospice care, designation of which is revoked under paragraph (1), shall be ineligible to be designated as a registration agency within two years from the date such designation is revoked.
CHAPTER V SUPPLEMENTARY PROVISIONS
 Article 31 (Management of Personally Identifiable Information)
The Managing Agency, registration agencies and medical institutions may manage the data containing resident registration numbers, if it is essential to perform the affairs related to making decisions on life-sustaining treatment.
<<Enforcement Date: Feb. 4, 2018>>
 Article 32 (Prohibition of Disclosure of Information)
No person who serves in or has served in the Managing Agency, a registration agency or medical institution shall disclose any information learned in the course of making a determination to terminate, etc., life-sustaining treatment and the implementation thereof, or performing hospice service.
 Article 33 (Inspection, etc., of Records)
(1) A patient's family member (whose age shall not be limited in this Article) may request the head of the Managing Agency or the head of the relevant medical institution to allow an inspection of the records on making a determination to terminate, etc., life-sustaining treatment or the implementation thereof, as prescribed by Ordinance of the Ministry of Health and Welfare; and in such cases, a person in receipt of such request shall issue a copy of the relevant record or allow him/her to verify the details thereof except in extenuating circumstances.
(2) Necessary matters concerning the scope of and the procedures for the inspection of records under paragraph (1), refusing inspection, and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.
<<Enforcement Date: Feb. 4, 2018>>
 Article 34 (Report, Inspection, etc.)
(1) Where deemed necessary in connection with implementing a determination to terminate, etc., life-sustaining treatment, hospice care, etc., the Minister of Health and Welfare or the head of the Managing Agency may issue an order necessary for such affairs to the head or an employee of a registration agency or medical institution or order such person to submit a report or related documents.
(2) The Minister of Health and Welfare or the head of the Managing Agency may require a related public official to inspect related documents, etc., referred to in paragraph (1). In such cases, a related public official in charge of the inspection shall carry a document verifying his/her authority and show it to relevant persons.
(3) The head or any employee of a registration agency or medical institution shall comply with the order and inspection referred to in paragraphs (1) and (2) except in extenuating circumstances.
 Article 35 (Hearings)
Where the Minister of Health and Welfare intends to take any of the following dispositions, he/she shall hold a hearing:
1. Revoking designation of a registration agency under Article 13;
2. Revoking designation of an institution specialized in hospice care under Article 30.
 Article 36 (Prohibition of Use of Similar Names)
No person other than the Managing Agency or a registration agency under this Act shall use the name “National Agency for Management of Life-Sustaining Treatment,” “agency for registering the advance statements on life-sustaining treatment,” or similar name.
<<Enforcement Date: Feb. 4, 2018>>
 Article 37 (Prohibition of Disadvantages in Insurance, etc.)
No person who died upon a decision on and implementation of terminating, etc., life-sustaining treatment, or a beneficiary of insurance or a recipient of a pension shall be treated unfavorably at the time of payment of the insurance proceeds or pension benefit.
<<Enforcement Date: Feb. 4, 2018>>
 Article 38 (Bearing of Expenses Incurred in Making Decisions on Life-Sustaining Treatment, etc.)
Expenses for preparing a life-sustaining treatment plan under Article 10, judgment on whether a patient is in end-of-life process under Article 16, and issuance of a doctor's note for application for hospice care and use, etc., of hospice care under Article 28, shall be governed by the National Health Insurance Act: Provided, That expenses not prescribed in the National Health Insurance Act shall be governed by Ordinance of the Ministry of Health and Welfare.
CHAPTER VI PENALTY PROVISIONS
 Article 39 (Penalty Provisions)
Any of the following persons shall be punished by imprisonment with labor for up to three years or by a fine not exceeding 30 million won:
1. A person who implements a determination to terminate, etc., life-sustaining treatment to a person not subject to the determination to terminate, etc., life-sustaining treatment, in violation of Article 15;
2. A person who makes a false record of any of the matters prescribed in subparagraphs of Article 20;
3. A person who discloses information, in violation of Article 32.
<<Enforcement Date: Feb. 4, 2018>>
 Article 40 (Penalty Provisions)
(1) Any person who performs any of the affairs related to registering an advance statement on life-sustaining treatment, without being designated by the Minister of Health and Welfare, in violation of Article 11 (1), shall be punished by imprisonment with labor for not more than one year or by a fine not exceeding ten million won:
(2) A person who fails to preserve records of the matters prescribed in subparagraphs of Article 20 shall be punished by a fine not exceeding three million won.
<<Enforcement Date: Feb. 4, 2018>>
 Article 41 (Concurrent Imposition of Suspension of Qualification)
Where a person who has violated this Act is punished by imprisonment for a limited term, his/her qualification may concurrently be suspended for a period not exceeding seven years.
 Article 42 (Joint Penalty Provisions)
Where the representative of a corporation, or an agent, employee or other servant of a corporation or individual violates any of Article 39 or 40 with respect to the duties of the corporation or individual, not only shall such violator be punished accordingly, but the corporation or individual also shall be punished by a fine prescribed in the relevant provisions: Provided, That this shall not apply where such corporation or individual has not neglected to take due care concerning and supervised the relevant duties in order to prevent such violation.
 Article 43 (Administrative Fines)
(1) Any of the following persons shall be subject to imposition of an administrative fine not exceeding five million won:
1. A person who fails to establish an ethics committee, in violation of Article 14 (1);
2. A person who fails to inform the head of the Managing Agency of the outcome of implementing a determination to terminate, etc., life-sustaining treatment, in violation of Article 19 (5).
(2) Any of the following persons shall be subject to imposition of an administrative fine not exceeding three million won:
1. A person who fails to record, keep, or report the outcome of his/her duties, in violation of Article 11 (3);
2. A person who fails to comply with an order issued under Article 34 (3) without any good cause.
(3) Any of the following persons shall be subject to the imposition of an administrative fine not exceeding two million won:
1. A person who fails to report matters changed or to be changed, such as closure or suspension of business, in violation of Article 11 (5) or 26;
2. A person who fails to perform the duty to transfer records pursuant to Article 11 (6) or 13 (3);
3. A person who uses the name “National Agency for Management of Life-Sustaining Treatment,” “agency for registering the advance statements on life-sustaining treatment,” or similar name, in violation of Article 36.
(4) Administrative fines under paragraphs (1) through (3) shall be imposed and collected by the Minister of Health and Welfare as prescribed by Presidential Decree.
<<Enforcement Date: Feb. 4, 2018>>
ADDENDA
Article 1 (Enforcement Date)
This Act shall enter into force one year and six months after the date of its promulgation: Provided, That the provisions of Articles 9 through 20, 25 (1) (limited to intermediate care hospitals among medical institutions), 31, 33, 36, and 37, subparagraph 1 and 2 of Article 39, and Articles 40 and 43 (1), (2) 1 and (3) 2, shall enter into force two years after the date of its promulgation.
Article 2 Omitted.
Article 3 (Transitional Measures concerning Amendment of other Acts)
A person designated as an institution specialized in providing palliative care under the Cancer Control Act as at the time this Act enters into force, shall be deemed designated as an institution specialized in hospice care under this Act: Provided, That such person shall obtain designation under Article 25 (1) within one year from the date this Act enters into force, after fulfilling the requirements under this Act.