Sun, Mar 17, 2019 - Page 2 News List

Living wills not yet finding wide adoption

ADVANCE CARE PLANNING:Most would not want to be intubated and fed through the nose, but 90% of those in long-term care have received such treatment, advocates said

By Lee I-chia  /  Staff reporter

A presenter explains the Patient Right to Autonomy Act, which grants adults the right to register advance healthcare directives, at Taitung Mackay Memorial Hospital on Jan. 15.

Photo: Wang Hsiu-ting, Taipei Times

Two months after the enactment of the Patient Right to Autonomy Act (病人自主權利法), only about 1,000 people have registered their medical wishes in the event they would be unable to communicate their preferences, the Taiwan Health Reform Foundation said yesterday.

The act, made into law on Jan. 6, grants adults the right to register advance healthcare directives (AHD), sometimes called a living will, setting medical preferences or putting another person in charge of healthcare decisions in case they are incapable of making such decisions.

People who wish to register an AHD are required to apply for and receive advance healthcare consultations at one of 77 healthcare facilities approved by the Ministry of Health and Welfare before their decision is validated.

Since the law’s implementation, the foundation has held 12 open lectures at senior care facilities to explain the regulation, as well as advance care planning (ACP) consulting services, it said.

At a session in Taipei yesterday, physician Hsu Li-an (許禮安) shared his clinical experience with hospice and palliative care.

“There are only two ways of dying —prepared and unprepared,” Hsu said.

Most audience members at the lectures said that they do not wish to ever receive nasogastric tube feeding, but a survey last year showed that more than 90 percent of people in long-term care facilities have been fed through a nasogastric tube, often after a decision by family members, he said.

Advance care planning simply means “making preparations for the inevitable future” and making decisions by yourself, Hsu said.

Family members are now usually asked to make decisions for their relatives, which leads to patients unwillingly receiving nasogastric tube feeding, he said, adding that some even have their arms restrained so that they cannot pull out the tube.

Only 1,076 people have registered AHDs to date, the foundation said, adding that it is both happy and concerned.

It is happy that people can finally decide in advance how they want to bid farewell to life, but also worried that many local health departments and hospitals are not yet prepared to implement the policy, it said.

About 64 percent of hospitals that provide advance care planning consulting services do not publish the cost of the service on their Web site, the foundation said, adding that 43 percent do not allow people to make appointments online and 13 percent have no information about the service on their Web site.

Although the health ministry has announced a standard service fee, the foundation urged the government to offer a subsidy and promote the policy to increase people’s willingness to register an advance healthcare decision.

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