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Taipei City Came First in Autonomy over Life for Advance Care Planning

The first law in Asia to provide full security for patients’ exercising their rights in autonomy 《Patient Right to Autonomy Act》 has been officially carried out since January 6, 2019. The law is stipulated to respect patient autonomy in healthcare, to safeguard their rights to a good death, and to promote a harmonious physician-patient relationship. Under the active promotion of signing advance decisions by the Department of Health (DOH), Taipei City Government, currently there are 14 hospitals providing services for “advance care planning”. Through "advance care planning”, the declarant provides in writing an “advance decision” to express their medical care wishes during critical conditions. This does not only safeguard their rights to a good death, but also allows loved ones and friends to understand their decision during critical moments, as well as reducing the pain and dispute that need be faced.
Up to the end of November 2019, the total number of people who had signed advance decisions nationwide was 10,116 people. Taipei City Hospital alone had achieved 3,493 signatures, ranking first among the other cities and counties. Cases of signing the advance decisions were mostly patients in hospital. There were also more females signing the advance decisions, at a male: female ratio of 1:2. Up to 2,140 people were over the age of 60 years old, taking up 60% of the total number of people that had signed the advance decision, indicating that elderly people are more aware of the importance of this issue compared to the younger generation.
According to the 《Patient Right to Autonomy Act》, those who had established advance decisions, under 5 types of special clinical criteria, they can choose to accept or refuse “life-sustaining treatment”, and full or partial “artificial nutrition and hydration”, which includes being “terminally ill, in an irreversible coma, permanent vegetative state, having severe dementia, and other disease conditions that are announced by the central competent authority”. At current, 11 diseases and clinical criteria were announced by the central competent authority and disclosed in advance by the Ministry of Health and Welfare in advance on November 19, 2019. These included multiple system atrophy, Duchenne's muscular dystrophy, hereditary epidermolytic vesicular disease, Huntington's disease, limb girdle muscular dystrophy, Nemaline linear muscle disease, degenerative coordination of spinal cerebellum, spinal muscular atrophy, amyotrophic lateral sclerosis, cystic fibrosis, primary pulmonary hypertension, and so forth. There shall be more diseases included into the criteria premises in the future to allow more patients to choose their medical management decisions and care.
Taipei City has posted the information for medical care institutions providing service and fee standards on the DOH website advance decision section. Relevant information over the priorities and exemptions can be found on the website and is free for download. Taipei City Hospital provides an “advance care planning clinic” for those who would like to gain further understanding in the Patient Right to Autonomy Act or services related to rights to a good death. Please contact Taipei City Hospital Social Work Office; Telephone: (02)2555-3000, ext. 2175.