Old notions of family are putting lives at risk

Not long ago, a surgeon at a university hospital in Seoul faced a troubling situation. His patient, a man in his 70s, was suffering from severe diabetic complications, with his leg deteriorating each day. To save what was left below the knee, immediate amputation was necessary. But the patient showed signs of dementia, making it difficult to secure his consent. Because it was major surgery, written approval from a guardian was required, yet the patient’s son could not be reached. After repeated attempts, the hospital obtained the phone number of a nephew, but he ignored calls for days. The infection risk grew, raising the possibility that amputation would need to extend to the thigh. Only after a social worker intervened did the nephew respond. He reluctantly signed the form, warning staff not to contact him again.

Hospitals place great importance on surgical consent. Hospitals often say that no patient can enter the operating room without a signed consent form. Explaining the procedure and its risks and obtaining consent is both a legal obligation and a protection against malpractice claims. Competent patients can sign for themselves, but in emergencies—when patients are unconscious or suffering from dementia—the responsibility falls to a guardian. The law’s definition of guardian is narrow. Only parents, children, spouses, or cohabiting relatives qualify. Even long-term partners or relationships closer than family have no standing when every minute counts.

The system assumes family members will take responsibility, but reality often proves otherwise. Even without estrangement, situations where no legal guardian is available are common. In one case, a woman in her 70s, who had long cared for her husband with dementia, collapsed from a cerebral hemorrhage and required surgery. Her children lived in the United States, leaving her closest friends powerless in the hospital. As more elderly couples care for each other in old age, such cases will only grow.

The problem is sharper for single-person households, which now make up 42 percent of all households in Korea. For many, the greatest fear is who will sign in an emergency. Because guardianship is limited to legal family, painful measures sometimes follow. Author Eun Seoran, for instance, legally adopted a close friend as her daughter after living together for five years, saying it was the only way to ensure one could help the other in illness. Younger people sometimes find such workarounds, but the largest share of single-person households is among those over 70. These older Koreans are the first to be hit by the outdated system.

Most countries in Europe and the United States allow not only family but also close friends to make medical decisions. In 2022, South Korea attempted to revise the law to let patients designate a trusted person in advance, but questions about how to verify such relationships and who would be liable in malpractice cases stalled the effort. Another proposal, the Life Partnership Act, would have granted family-like rights to any two adults by mutual agreement, but opposition from groups that saw it as a backdoor to same-sex marriage blocked its passage. The broader issue of expanding the definition of family to include supportive relationships has since faded from view.

In medicine, time often determines survival. Delays in obtaining consent can cost patients their golden hour, cause families unnecessary suffering, and prevent doctors from delivering optimal care. The state, in turn, faces higher welfare costs. By excluding those who act as de facto family, rigid consent rules leave everyone worse off.