JMIR Publications

ABSTRACT

Background:

Public discourse plays an important role in shaping how end-of-life care and medical decision-making are understood within society. In South Korea, the implementation of the Life-Sustaining Treatment Decision Act in 2018 established a legal framework for withholding or withdrawing life-sustaining treatment for patients at the end of life. However, relatively little is known about how public discourse surrounding life-sustaining treatment has evolved over time, particularly before and after its implementation.

Objective:

This study aimed to examine how online discourse related to life-sustaining treatment in South Korea evolved using large-scale social media data, by identifying dominant themes, tracing their temporal changes from 2014 to 2025, and assessing shifts in sentiment before and after the Act.

Methods:

A total of 16,191 documents were collected from Naver blogs, Naver cafes, and YouTube comments using keywords related to life-sustaining treatment and end-of-life decision-making. Text was preprocessed using the Kiwi tokenizer for Korean morphological analysis, and Latent Dirichlet Allocation topic modeling was applied to extract underlying themes. The optimal number of topics was determined using coherence scores, resulting in six topics. Temporal changes in topic prevalence were examined across the study period, and topic distributions were compared between the pre-law (2014–2017) and post-law (2018–2025) periods. Sentiment analysis was conducted using the KNU Korean Sentiment Lexicon to classify documents into positive, neutral, and negative categories. A net sentiment improvement score was calculated to assess changes following policy implementation.

Results:

Six major themes were identified: death with dignity, hospice and palliative care, aging and social care, end-of-life decision making, euthanasia debate, and withdrawal of treatment. Discourse volume increased more than 17-fold over the study period. Prior to 2018, discussions were dominated by end-of-life decision making (44.5%) and withdrawal of treatment (31.1%). Around the time of policy implementation, ethical and legal debates became more prominent. In subsequent years, discourse increasingly reflected care-oriented perspectives, including hospice and palliative care and aging and social care. Sentiment improved most markedly for end-of-life decision making and hospice and palliative care following the Act, whereas aging and social care showed minimal change and death with dignity exhibited a decline in net sentiment.

Conclusions:

Public discourse on life-sustaining treatment in South Korea evolved from a clinical focus to ethical debate and, more recently, to care-oriented perspectives, consistent with a policy-triggered discourse model. These findings suggest that the Life-Sustaining Treatment Decision Act played a role in shaping not only the thematic focus but also the emotional tone of public discourse, highlighting the broader societal impact of end-of-life legislation.