Between Cost Containment and Care Burden: Relational Conditions of End-of-Life Self-Determination

This commentary examines the relationship between reduced life-sustaining treatment expenditures and family caregiving burdens in end-of-life care. Responding to Kim et al.’s analysis of advance preference formation and barriers to implementing end-of-life choices in South Korea, it argues that health insurance savings, out-of-pocket medical expenses, paid caregiving costs, and family income loss should not be treated as interchangeable categories. Using a personal caregiving case as an analytic vignette, it illustrates how substantial burdens persist even when high-intensity life-sustaining treatment is forgone. Drawing on Korean and Japanese studies, this commentary further shows that anticipated family burden shapes end-of-life preferences, decision-making authority, and the preferred place of care. It therefore cautions that expanding patient choice without adequate hospice, home care, visiting nursing services, long-term care, public caregiving support, and income protection for family caregivers may reframe unresolved social care burdens merely as matters of individual or family choice.