A majority of Taiwanese support physician-assisted death in cases involving terminal illness, long-term physical pain or severe cognitive impairment, a study by National Taiwan University’s College of Public Health showed.
“While many diseases remain incurable, advances in medical technology have made it possible to delay their progression, resulting in prolonged life,” Institute of Health Behaviors and Community Sciences professor Chen Duan-rung (陳端容) said on Thursday.
“However, such life extension often leaves patients in long-term pain, disability or even a state lacking dignity,” Chen said, adding that more Western countries are beginning to recognize a person’s right to decide when and how to end their own life.
Photo: CNA
Those methods include euthanasia, a process that requires medical personnel to carry out the final act — such as administering a lethal injection — and physician-assisted dying, in which the patient takes the final action themselves, she said, adding that both are illegal in Taiwan.
To understand whether the public in Taiwan supports the right to physician-assisted dying and what factors might influence their views, Chen and her team conducted an online survey of 3,992 adults in 2022, the results of which were published in the medical journal BMJ Open in January.
Respondents were asked whether they supported allowing people to request physician-assisted dying under three scenarios: 86.2 percent supported it for patients with terminal illness and unrelievable long-term physical pain, 79.6 percent for patients with non-terminal but incurable illness causing prolonged pain, and 72.6 percent for patients with severe cognitive impairment and incurable diseases.
Among all respondents, 67.6 percent supported granting people the right to request physician-assisted dying in all three scenarios, the study showed.
Support for physician-assisted dying was higher among young adults (aged 20 to 39), males, those without religious beliefs and people who work as caregivers, Chen said.
“Caregivers are on the front lines caring for patients or the elderly,” Chen said, adding the higher level of support for physician-assisted dying among caregivers might stem from their “empathy and understanding of patients’ suffering” through long-term interactions with them.
However, healthcare professionals tended not to support physician-assisted dying in any of the three scenarios, likely due to ethical concerns and legal considerations tied to their professional responsibilities, she said.
The study also assessed participants’ awareness of the Patient Right to Autonomy Act (病人自主權利法, PRAA) — which allows people with conditions such as terminal illness the right to refuse futile life-prolonging treatments and opt for a “natural death” — as well as their preparedness for Advance Care Planning (ACP), a proactive approach to making end-of-life care decisions in advance.
Only 37.3 percent of respondents were aware that the PRAA had been implemented, and those who were aware tended to be less supportive of physician-assisted dying, Chen said, adding that in contrast, most physician-assisted dying supporters were unaware that the law was already in place.
“The PRAA grants terminally ill patients, as well as those in a deep coma or with advanced dementia, the right to a natural death, but does not permit them to choose an accelerated one,” she said.
Greater awareness of the PRAA might reduce public support for physician-assisted dying she said.
People with a higher level of ACP awareness are “more open to discussions about death and end-of-life decisions,” and thus more accepting of physician-assisted dying, she said.
The research team hopes it can serve as a “foundation” for public and ethical discussions on physician-assisted dying, she said.
“It [the study] reflects that many people in Taiwan fear a life worse than death, are willing to accept end-of-life autonomy, and are becoming more open to the idea of ‘dying with dignity,’” she added.
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