[Column] How outcome absolutism and punitive thinking are undermining Kor...

Ahn Duck-sun, Director of the Research Institute for Healthcare Policy under the Korean Medical Association

In a recent debate over medical disputes, a civic group leader argued, quite plausibly, that “someone must be held accountable when a person dies,” openly advocating for the criminalization of medical practice. Modern organized healthcare -- encompassing healthcare systems and institutions -- emerged and evolved after World War II. Processes once handled within families, such as childbirth and death at home, gradually became socialized and institutionalized within healthcare systems.

Ahn Duck-sun

Death was once accepted as a natural part of human life that everyone must eventually face. However, as modern organized healthcare developed, both birth and death became increasingly medicalized. With advances in science and medical technology, death is now often viewed not as a natural phenomenon but as something potentially preventable. In this climate, when a patient dies, society increasingly asks: “Why did the patient die?” “Who failed to notice?” “Whose fault was it?” and ultimately, “Who should be held responsible?”

Families and patient advocacy groups no longer readily accept death as the result of disease or fate, particularly in high-risk situations such as severe trauma or medical emergencies where timely care may not have been provided. Instead, they tend to regard such deaths as failures of physicians or of the healthcare system itself.

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That does not mean accountability for patient deaths resulting from medical care should automatically lead to criminal punishment of individual physicians based on their competence or morality. Rather, organized healthcare systems should focus on preventing similar incidents, improving institutional frameworks, and determining whether responsibility lies with the state or medical institutions. Such discussions and reforms are inherent characteristics of modern healthcare systems.

Yet the simplistic and dangerous notion that “someone must be blamed whenever a patient dies” reflects the mistaken assumption that every death necessarily has a perpetrator.

From this perspective, the healthcare system itself quietly disappears from the discussion. Modern medicine inherently involves uncertainty; survival can never be guaranteed in every situation. Institutional limitations also exist. Even with the best available treatment, cancer may progress unpredictably, sepsis may rapidly worsen despite antibiotics, and elderly patients with multiple underlying conditions may die unexpectedly.

The statement “a patient died” is not equivalent to “someone committed wrongdoing.” If healthcare represents the socialization of medicine, then responsibility for patient deaths should also move from individualized blame toward social responsibility. Otherwise, if society attempts to resolve these issues solely through criminal punishment of physicians, defensive medicine will intensify, and doctors will increasingly avoid high-risk patients.

Essential medical fields such as emergency medicine, trauma care, and obstetrics -- areas already burdened with significant legal risks -- could become increasingly unsustainable. Even the remaining workforce struggling to sustain these services may eventually leave. In the end, access to healthcare across society could deteriorate significantly.

Unless society establishes appropriate mechanisms to address adverse medical outcomes, healthcare systems themselves cannot endure. Recognizing this, some advanced countries have adopted no-fault compensation systems for medical injuries, while others have gone even further by prohibiting certain forms of medical litigation altogether.

In contrast, Korea currently maintains a highly punitive legal culture that even subjects unavoidable outcomes to criminal punishment, running counter to advances in medicine. The dangers of "outcome absolutism" have reached alarming levels, and the normal functioning of the healthcare system is already severely eroding.

Death remains an inevitable part of human life. Korea already imposes one of the world’s harshest criminal punishments for medical practice. Yet it remains questionable whether Korea also has the world’s highest rate of patient deaths caused by medical care. To what extent should death be interpreted as an individual’s fault? The growing tendency to pursue accountability even in unavoidable or no-fault medical accidents suggests that Korean society is becoming unsafe for both patients and physicians, while also becoming increasingly hostile to the practice of medicine itself.

A healthcare crisis driven by outcome-based thinking

Many countries that value social solidarity and public safety have introduced systems such as no-fault compensation programs, state-funded compensation mechanisms, medical dispute mediation systems, restrictions on criminal punishment, and system-focused investigative frameworks.

The extreme belief that “justice cannot be achieved unless someone in healthcare is punished” is a dangerous idea that could ultimately harm society as a whole. Tragedies can occur even without malicious intent. The real challenge for society is how to distribute such risks fairly through "risk pooling" and collective responsibility.

Many advanced nations have already accepted adverse medical outcomes as matters of social responsibility and have developed healthcare systems accordingly.

In Korea, however, an especially strong culture of outcome-oriented judgment has merged with healthcare, making death all too easily a trigger for politicized blame. One contributing factor appears to be the inadequacy of mediation and compensation systems. Another may be the tendency to reduce the concept of a healthcare system merely to a health insurance system.

A healthcare system encompasses everything from physician training to compensation mechanisms. Social solidarity lies at the core of organized healthcare, yet a coherent national philosophy supporting that principle appears either absent or insufficient.

The provocative and irrational claim that “a patient died, yet no one is being held accountable” ultimately fuels broader distrust toward society and public institutions. Meanwhile, physicians increasingly fear that they could become criminals at any time, even after doing their best and committing no negligence.

This issue is not simply a conflict between doctors and patients. Rather, it raises profound questions about how the state organizes healthcare, how Korean society understands death, and how the risks inherent in modern social insurance-based healthcare systems can be collectively shared and socialized. Ultimately, it reflects the unfinished task of building a truly modern healthcare system.

Ahn Duck-sun