A legislative committee approved amendments to a law on Monday that would allow the next of kin of terminally ill, non-cognitive patients to jointly decide to end life support.
The amendments to the Hospice Palliative Medical Care Act (安寧緩和醫療條例), which were passed in the legislature’s Social Welfare and Environmental Hygiene Committee, will provide the basis for a three-phase process of carrying out such a decision.
First, family members must make the request, then an ethics committee would be required to review the request and finally two medical doctors must determine that the patient would have no chance of surviving for more than two to four weeks even on life support.
Under the amendments, the spouse, adult children, adult grandchildren or parents of a terminally ill patient who can no longer express his or her wishes, can jointly sign a request to stop all efforts to keep the patient alive by artificial means.
ETHICS COMMITTEE
The request will then be forwarded to an ethics committee composed of medical, ethics and legal experts or people of reputable -social standing. At least one-third of the committee members must have a background in ethics and law.
Finally, an assessment by two medical doctors will be required to determine that the patient cannot survive under any circumstances for another two to four weeks.
The resolution by the legislative committee has to clear two more legislative sessions before it can become law.
The act, which has been in force for many years in Taiwan, gives people the right to sign in advance a request not to be given CPR (cardiopulmonary resuscitation) or be put on life support in the final stages of illness.
Since July 2006, people in Taiwan have had the right to place a DNR (do not resuscitate) instruction on their health insurance cards. To date, some 34,000 people have done so, while about 60,000 people have signed DNR documents.
CONFUSION
However, there has been some confusion among patients, family members and medical professionals on the legal aspects of the signed DNRs and health card instructions.
The amendments address this problem by stating clearly that health insurance card instructions are as effective as original signed DNRs.
Chang Chia-fang (張嘉芳), CEO of the Palliative Care Foundation, lauded the amendments as the latest effort by lawmakers to help ease the burden of caregivers. However, the stringent “three-step” process would make it difficult for family members, doctors and ethics experts to make a decision, he said.
For instance, if a patient has not been in contact with any family members for some time and the hospital cannot reach any of them, it will be virtually impossible to meet the “three-step” requirement, he said.
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