Experts encourage communicating end-of-life wishes with advance care planning and advance directives

Taiwan’s Patient's Self-determination Right Act was promulgated in 2016 and will take effect in 2019.

TAIPEI (Taiwan News)—Ninety-year-old Mr. Wang is a terminally-ill patient but has to receive repeated antibiotics treatments because he is also suffering from pneumonia. His family is at a loss as to whether they should proceed with active medical treatment for him or choose palliative treatment. Experts said the dilemma can be avoided by engaging in advance care planning (ACP) to complete advance directives (AD) or choosing a health care proxy (HCP).

Taiwan’s Patient's Self-determination Right Act was promulgated in 2016 and will take effect in 2019.  

The new law in essence legalizes and promotes ACP, giving capable people the rights to know about their medical conditions and available medical choices firsthand and make advance decisions about the care they would want to receive if they become unable to speak for themselves, such as the decisions to whether receive life-sustaining treatment or artificial nutrition and hydration (ANH) under certain clinical conditions. People are also given the right to choose a HCP in advance.    

Health Promotion Administration Director Wang Ying-wei (王英偉), who is also a palliative treatment specialist, said that ACP is an ongoing process in which patients and their doctors reflect on the patients’ preferences and values, discuss empirical data of all the medical care alternatives brought up by doctors, and ultimately use this information to document patients’ future health care choices.

Wang said, “Sometimes what other people feel are the best ways for patients oftentimes are not the best ways.” ACP, which clearly documents patients’ thinking and preferences of medical treatments, can serve as a guide for healthcare providers and patients’ families in difficult situations, he added.    

Capable people can proceed with ACP when they are healthy or ill, Wang said, adding that the elderly, terminally-ill patients, and people with high risk jobs especially need to consider ACP.  

According to Taipei City Hospital, which has had the experience of carrying out trial ACP, about 90% of people who have completed ADs were healthy people or people with chronic illnesses but felt they were healthy. They found it not easy to make decisions on whether to receive endotracheal intubation, cardiopulmonary resuscitation, or dialysis when they didn’t have the conditions but had to imagine they did.      

Wang also said that even though the topic of HCP is not taken seriously in Taiwan, it’s reasonable and can be important to have a HCP “who understands you very well and can make decisions for you” in a future of unpredictable medical development.  

Yao Chien-an (姚建安), who supervises hospice care wards at National Taiwan University Hospital, said that a HCP is someone who understands your values and choices and the one who can protect your medical rights and hospice rights. They usually are spouses, and it will be better to put the HCP in a document to earn the trust of the family, Yao added.