The Legislative Yuan recently held a hearing on the Patient Right to Autonomy Act (病人自主權利法) and Hospice Palliative Care Act (安寧緩和醫療條例), calling for experts to make recommendations for improvements.
Enacted in 2019, the patient autonomy act stipulates that with advanced written directive, people with one of a list of clinical conditions — including terminal illness, an irreversible coma, permanent vegetative state and severe dementia — can request partial or full withdrawal of life-sustaining treatment, artificial nutrition and hydration. However, as of last month, only 45,621 people had signed an advance decision. The latter act gives people diagnosed with a terminal illness by two doctors the right to refuse life-sustaining treatment or cardiopulmonary resuscitation.
At the hearing, Fu Chun-hao (傅俊豪), the son of late sports anchor Fu Da-ren (傅達仁), took to the podium to push for the passing of a “dignified end of life act” (尊嚴善終法) for euthanasia. He said his father, who had pancreatic cancer, endured much pain and suffering before passing away by assisted suicide in Switzerland in 2018. He asked the legislature to revive the bill so that critically ill people can make the choice to live or die with dignity.
The hearing has rekindled the debate surrounding voluntary euthanasia, and exposed the lackluster adoption of advance directives as Taiwan becomes a super-aged nation. Although experts have said the cost is a major impediment to the promotion of advance directives, the main issue could be cultural values and ideology.
There are a number of reasons why Taiwanese generally feel that the autonomy of sick people is limited. Due to the high regard for medical authorities, familial paternalism and the inability to speak for oneself after becoming ill, a proactive attitude is difficult to maintain.
Furthermore, death remains a taboo topic in Taiwan, and the social pressure of “filial piety” makes it difficult not to use all means to “save” an older family member from dying. It means few people have given thorough thought to the complexities around death, let alone considered a proposal like the “dignified end of life act,” which calls for personal control over how one’s life can be ended.
Many Taiwanese prioritize issues concerned with living over the rumination of death, so they have a vague sense about their autonomy to live or die.
Unlike existing rules, the “dignified end of life act” would allow people to actively seek death and shorten life with help, rather than withholding medical care in a way that leads to natural death. The different approaches have sparked moral, ethical and religious debates not only in Taiwan, but across the globe.
Belgium, Canada, Luxembourg, the Netherlands and Switzerland permit assisted suicide under tight regulations. Taiwan should not fall behind the prevailing view that people with terminal illnesses should be allowed to die with dignity. As euthanasia is a practice based on the idea of empathy and human dignity, legislation of euthanasia would ensure that those who are in irreversible pain can shorten their suffering, while bringing relief to family members.
Life and death are two sides of the same coin. Although euthanasia leads to death, it does so with the intention of living with dignity. If it is no longer possible to live with dignity, people should be given the right to leave the world in a peaceful, controlled way. The government and the public should not shun the topic of death, and should work together to pass the legislation for euthanasia.
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