Less than 1 percent of 19.6 million adults in Taiwan have signed a living will, the Patient Autonomy Research Center (PARC) said yesterday as it marked the fifth anniversary of the enactment of the Patient Right to Autonomy Act (病人自主權利法).
The legislation was the first special act in Asia to protect patient autonomy and dignity of life, allowing adults of sound mind to go through a process of advance care planning (ACP) and sign an advance decision for instructions for treatment or refusal of treatment when facing medical situations including terminal diseases, irreversible comas and dementia.
Even though in fewer than 360 days, Taiwan is expected to become a super-aged society, only 68,000 people have signed an advance decision as of last year, which includes about 24,000 people last year, showing that there is a lot of room for improvement, PARC marketing division head Chiu Yu-chen (邱宇晨) said.
Photo: Chiu Chih-jou, Taipei Times
ACP teams consist of physicians, nurses, psychologist and social workers, and each team has different working methods, Chiu said, adding that heavy administrative work is one of the obstacles that is keeping the coverage rate low.
Regardless of whether consultations are conducted in groups or one-on-one, the team must make sure the individual has communicated with their family and clearly understand the contents of the documents they are to sign, so they usually take one to two hours.
For special cases, such as when people with dementia give inconsistent decisions, it might take even longer, she said, adding that as the outpatient sessions take a long time and so few people go through them, they do not garner a lot of National Health Insurance (NHI) points and income for health workers, so physicians are less willing to do them.
If there were greater incentives for ACP teams, they would be more motivated to provide high-quality services, which would boost the coverage rate, Chiu said.
Fees of NT$2,000 to NT$3,500 for the process also deter people, she added.
NHI Administration Director-General Shih Chung-liang (石崇良) said that people who are terminally ill, have mild dementia or an “unbearable or incurable disease” and are under home-based medical care would be eligible for a one-time NHI-funded ACP outpatient visit.
Many people are unwilling to go through the process because they must pay extra fees, so NHI funds this year would be reserved to cover ACP, with the policy taking effect from the middle of the year at the earliest, Shih said.
People with terminal illness have NHI coverage for hospice and palliative care, and family medical consultations, and the one-time ACP consultation would be covered as a family medical consultation, he said.
People with profound dementia cannot undergo the process, so the second eligible group are those with mild dementia who have some independence and a clinical dementia rating of 1 or below, he said.
Another group to be eligible for the coverage is those in the Home-based Medical Integration Program, including those with reduced mobility or disabilities, but who clearly have the awareness to undergo the process, he said.
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