Why it matters. The debate over whether patient autonomy is enough applies far beyond Korea, as aging populations worldwide shift the burden of healthcare from acute cures to lifelong chronic-disease management.
Background. South Korea's healthcare has historically been paternalistic and physician-led, so the push to grant patients more decision-making power is relatively recent. The country also legalized the withdrawal of life-prolonging treatment in 2018 and is actively debating broader "death with dignity" rules, making end-of-life autonomy a live policy issue. Hankyoreh is a left-leaning national daily known for social-affairs commentary.
What to watch next. Expect bioethics debate in Korea to widen from informed-consent rules toward the longer-term question of how the health system supports patients living with chronic disease.
The argument
In a column for the South Korean daily Hankyoreh, Yonsei University professor and medical ethicist Kim Jun-hyuk argues that “patient choice” — long treated as the top priority for fixing modern medicine — is no longer enough to describe the reality of chronic illness, where what happens after a decision matters more than the decision itself.
Kim, who specializes in medical ethics and the medical humanities, notes that when patients are angry at doctors, the complaint is usually that they “were not given enough explanation.” Behind that frustration, he says, is a desire to know what choices are available to them. Much of modern bioethics — covering end-of-life care, abortion, research participation, mental health treatment and genetic information — has been built around a single question: can the person concerned decide, rather than the system or the expert?
Where choice falls short
Kim says he still values that principle, especially in South Korea, where medicine has traditionally been delivered top-down and is often stingy about giving patients a say. But he sees two problems.
First, the nature of illness has changed. Modern medicine made its name on acute conditions — trauma, infections, emergencies — where you find a cause, treat it, and expect recovery. Today doctors increasingly grapple with chronic, long-term conditions: diabetes, high blood pressure, dementia, life after cancer, depression and chronic pain. These are not solved by a single choice.
Second, he warns that “giving patients choice” is often misused to shift blame. When medicine is treated like shopping, the logic becomes: you chose it, so you bear the consequences — the same way a buyer is responsible for a product they picked.
The logic of care
To explain the gap, Kim turns to The Logic of Care by Dutch medical anthropologist Annemarie Mol. Mol studied diabetes, once a fatal disease but, since the discovery of insulin, now a managed one — though never “cured” the way an infection is.
In such illnesses, Kim writes, the time after a choice is far longer than the moment of choosing. A diabetic patient does not pick a treatment once and stop. They measure blood sugar, recall what they ate, switch medications and dosing, watch how the body responds, and readjust when something fails. That, he argues, is less a choice than an experiment, a training, an ongoing adjustment — because the body, the daily routine, the disease and the treatment all keep shifting.
Kim closes by warning that society — and even experts in his own field — still views every medical problem through the lens of acute illness. The same applies to dying: whether to continue life-prolonging treatment is one decision, but in real end-of-life care, where, with whom, and with how much pain relief one spends the remaining time often matters more. Our perceptions, he concludes, are failing to keep pace with reality.
