Towards Distributive Justice in Life-Sustaining Care: Navigating the Structural Determinants of Patient Preference

The featured article claims that although most South Korean citizens prefer to have life-sustaining interventions withdrawn or withheld near the end of life, these preferences often remain unfulfilled due to several constraints. The article concludes that since life-sustaining interventions cause patients and the public to experience physical, mental, and economic harm, barriers to realizing patients’ end-of-life preferences should be eliminated. While we agree that such barriers should be minimized, we find the featured article’s conclusion overly simplistic and potentially misleading. We provide two main points for further discussion. First, the authors’ linear account of preference formation overlooks the complex and structural factors influencing clinical decision-making. Second, determining how to manage and enhance individual decision-making regarding life-sustaining care is a matter of distributive justice, rather than merely one of utility or preference.