More than 20 years ago, former Chinese Nationalist Party (KMT) legislator Lin Junq-tzer (林政則) and myself, a physician, tried to get legislation on the right to a good death passed. We were unsuccessful, but I am pleased to hear that the Patient Right to Autonomy Act (病人自主權利法) is to come into effect on Jan. 6 next year.
Adults with full disposing capacity may, following consultation with a medical professional, make advance planning decisions regarding their medical treatment for a time when they are unconscious or unable to clearly express their wishes, and for these decisions to be carried out by a healthcare agent.
However, some of the Ministry of Health and Welfare’s plans are problematic, and have been criticized by certain medical professionals.
First, any consultation team must undergo training in advance care planning before they can be qualified to carry out the provisions in the new law. This requirement is excessive.
For a medical professional, the difficulty is in resuscitating the patient. To decide not to resuscitate and allow the patient to slip away simply requires legal qualifications for a medical doctor, coupled with empathy.
With the exception of a minority of second-line physicians, such as radiologists or pathologists, such qualifications are quite sufficient.
If a doctor really requires ministry-approved qualifications to allow a patient to pass away without attempting resuscitation, will a patient in high-elevation areas, for example, need to be transported several hours down the mountain so that a suitably qualified doctor can be found to allow them a good death?
Would a physician who had not undertaken the designated training actually be violating the law if they allowed a patient with an appropriate medical situation, in line with legal requirements and good medical practice, to have a good death?
Second, any decisions made regarding life and death are no small matter, and any individual wanting to make advanced medical care planning decisions needs to be in good mental health to do so.
However, any one-time consultation on such matters will necessarily take time and effort. Clinics typically have to process high numbers of patients, and sometimes resemble fast-food restaurants in terms of the sheer speed at which the service must be delivered.
How many medical professionals would be able or willing to give the time and attention required for one of these consultations?
If the government wants to encourage medical professionals to embrace these advance care consultation sessions, it should provide more funds.
In addition, the shortage of time available for these sessions could lead to misunderstandings and even accusations of malpractice.
Third, the stringent regulations and the need for a healthcare agent run counter to the spirit of increasing patient autonomy.
However, none of these are insurmountable obstacles, and the legislation is moving in the right direction.
With the law in place, medical treatment for a patient when their situation applies to the new legislation becomes so much more straightforward. More often than not, a given clinical condition can be treated in many ways, each approach having its own objectives, effects and level of comfort, which individuals might find acceptable — and dignified — to differing degrees.
Of course, most people would not be aware of details such as these. The ministry could ask experts to collate information about the different kinds of psychological and physiological situations patients can expect to face when their illnesses becomes severe, as well as how these could be treated, including methods, processes, content and potential outcomes, and make short explanatory videos about these.
The videos could be posted on the ministry’s Web site for the public to view from the comfort of their homes, with their family helping them. Patients could then fill out an online form of their individual preferences by ticking boxes or leaving them blank and enter their health insurance number, so that the medical professionals would know what they require. This would offer guarantees to both doctor and patient, and would render the healthcare agent role superfluous.
Having worked for four decades in a neurology department, treating countless patients of dementia, stroke or Parkinson’s disease, and having served as a consultant for the Taiwan Motor Neuron Disease Association, I have firsthand experience of patients being insistent on obtaining the release they desire so much.
It is therefore with much anticipation that I await the implementation of this law, which will simplify the process and save considerable amounts of time, money and effort, and be of huge help to people suffering unnecessarily.
Kao Ko-pei is a consultant for the Taiwan Motor Neuron Disease Association.
Translated by Paul Cooper
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