The number of Taiwanese patients kept on extracorporeal membrane oxygenation (ECMO) machines accounts for half the world’s total, National Yang-Ming University Hospital doctor Chen Hsiu-tan (陳秀丹) said.
The number of Taiwanese patients kept on ventilators is also remarkably high at 5.8 times the number of US patients, Chen said.
“If there is no way for the patient to recover and no way to reduce their pain, then [the machines] just interfere with natural death,” Chen said, adding that European nations discourage long-term life support for irrecoverable patients, using life-sustaining machines for two weeks on average.
Last year, NT$11.31 billion (US$369 million) was spent to keep patients on ventilator machines — 2 percent of annual health insurance spending — with 16,902 patients kept on the machines for an average of at least 20 days, according to National Health Insurance Administration (NHIA) data.
The average cost of keeping a patient on ventilation was about NT$700,000, the data showed.
According to the NHIA, 1,701 patients relied on ECMO machines to sustain cardiorespiratory functions last year, spending an average of 7.9 days connected to the machines.
Chen said life support systems play an important role in saving patients undergoing emergency surgery, but added that the machines cannot help irrecoverable patients other than maintaining their pulmonary functions.
Chen cited a case in which an irrecoverable patient was kept on an ECMO machine for 116 days, costing the NHIA NT$2.02 million.
“Many patients end up with a mess of tubes attached to them. It is as though we are holding back a life that is slowly slipping away and they all repeat the same phrase: ‘I am in great pain,’” he said.
Chen said doctors and the public should be better educated about human life and learn how to best help patients at the final stages of their lives.
Chen said health insurance policies should also be revised to curb the about NT$10 billion spent every year on life support systems, adding that the use of the machines fails to help patients in pain.
The machines should be considered ineffective treatment when it is known that a patient has no hope of recovering, National Yang-Ming University Hospital superintendent Tang Kao-chun (唐高駿) said.
In most cases the doctor is driven by a desire to help the patient, the family is unwilling to let their relative go or there is some other motivation, such as collecting health insurance compensation, Tang said.
Tang said the use of advance medical directives should be promoted and families should be encouraged to abandon the idea that letting an irrecoverable relative die does not mean failing to practice filial piety.
It is normal for people to have difficulty letting their relatives go, NHIA Medical Affairs Division head Parng I-ming (龐一鳴) said.
“If it were your relative at that stage of their life could you let them go?” Parng said.
The number of patients kept on ventilators fell from 22,902 in 2014 to 16,902 last year, Parng said, adding that it showed the public’s approach to the issue is changing.
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