The Cabinet yesterday approved a Department of Health-proposed amendment to the Hospice Palliative Medical Care Act (安寧緩和醫療條例) to make it easier for terminally ill patients to ensure they are not treated against their will.
If passed by the legislature, the law would enable terminally ill individuals with hospice and palliative medical care indicated on their health insurance cards to request that physicians do not provide cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest, even if they do not have the actual certification with them.
At present, patients have to submit original copies of such certification when requesting that emergency medical treatment such as endotracheal intubation, electric shock and drug injections be withheld.
The amendment was introduced to ensure terminally ill patients are not given emergency medical care against their wishes, Bureau of Medical Affairs Director-General Shih Chung-liang (石崇良) said.
Another aim was to encourage people to indicate whether they would prefer palliative or aggressive end-of-life care before they enter the very last stages of terminal illness, he said.
“Saving a person’s life is the first duty of a physician, but it is a reality that there are limits to medical science. For some terminal patients, emergency treatment measures might extend their lives for a few days, but they also cause suffering and discomfort,” he said.
Since hospice and palliative medical care certification was first introduced in 2006, only about 40,000 people have made use of it.
Even among terminal cancer patients — roughly 40,000 annually — only one-third have signed up for the certification, Shih said.
LACK OF INFORMATION
He said that one possible reason for the “extremely low take-up rate” was that physicians are not fully disclosing information about illnesses to patients and their families.
“Doctors are obliged to fully disclose information about any illness,” he said.
“That way, patients know they have another choice at the end of their lives and can choose to die with dignity and it would also save on medical resources spent on useless treatments,” he said.
The Hospice Palliative Medical Care Act states that individuals above the age of 20 who are deemed to be of sound mind can sign up for the certification.
Legal representatives of patients who are unconscious or unable to express intent are also allowed to sign up on their behalf.
Where a patient is unable to express intent and doctors are unable to contact family members, a certificate can also be issued, where an individual’s condition has been diagnosed as incurable by two physicians.