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Protection of the right to self-determination at the end of life – the law on the patient’s right to autonomy

The Patients’ Right to Autonomy Act came into force on January 6, 2019. The purpose of this legislation is to protect the patient’s right to information, decision-making and choice, and to ensure that the patient’s wishes for palliative care are protected by law within a predetermined period. way when it is unconscious and unable to express itself clearly, and to carry out with dignity the wishes of the person in the last stages of life.

Therefore, this legislation focuses on the “advance directive” (AD), that is, once a person is faced with five clinical conditions, including (1) terminal illness; (2) in an irreversible coma; (3) in a permanent vegetative state; (4) suffering from severe dementia; and (5) other conditions declared by the central competent authority to be unbearable, incurable or otherwise unsuitable for treatment by medical professionals according to the standards and knowledge in force at the time. Through prior consultation with the care team, the family and care worker will talk with the person and help them determine whether they want to have a “medical intervention” or choose palliative and palliative care. AD will also reduce stress for loved ones and healthcare workers, allowing them to make medical decisions in the most respectful way.

Here is a summary of the most frequently asked questions about this legislation.

(i) Are foreign nationals entitled to execute an AD?

Yes. All foreign nationals at full capacity (Note: under current civil law, age 20 or older, but as of January 1, 2023, age 18 or older is the age of majority, with full capacity), enrolled in the National Health Insurance (NHI) scheme and possessing a valid NHI card are eligible to perform an AD.

(ii) How to execute an advance directive?

Beforehand, the person must go to a licensed medical facility and attend an Advance Care Planning (ACP) session.

The decision to accept, terminate, withdraw or not administer life-sustaining treatment or artificial nutrition or fluid feeding, in whole or in part, when the person is in one of the five conditions above, must be taken after consultation in the PCA session between the person himself, at least one relative in the second degree (or closer) of the person requesting the execution of an DA (with just cause, the presence of that parent may be waived), a healthcare worker (if one does not wish to designate one, the presence of that worker may also be waived), and healthcare professionals from the licensed medical facility .

After consultation with all participants, the person wishing to perform an AD can decide whether or not to do so. If so, an AD can be signed in the presence of two witnesses and affixed with the official seal of the licensed medical facility. The person’s NHI card will also be linked to the executed and effective DA.

(iii) Can one attend an ACP session if he does not have a second degree (or closer) relative?

Yes. As long as there is a written explanation of why a second degree (or next of kin) relative cannot attend or cannot participate, the ACP session can still take place.

(iv) Can same-sex couples attend the ACP session and register as a health worker? Is there a restriction on health worker status?

Yes, a person who has full capacity (note: according to the Civil Code in force, a person is 20 years old or more, but since January 1, 2023, a person is 18 years old or more), and with the exception of heirs of the declarant, is not legatee of the declarant, legatee of the remains or organs of the declarant, or beneficiary of the declarant’s death, can participate in the ACP session and register as a health worker.

Other than the above restrictions, there are no other restrictions on health worker status.

(v) What happens if more than two agents are appointed and there is a conflict of decision?

When appointing health workers, the applicant must first decide on the order of appointment. When the hospital performs an DA, the opinion of the agent who is on the front line will serve as the medical decision. If the first line officer is unavailable or does not provide an opinion, the second line officer may express an opinion on the medical decision.

(vii) Is there an AD document template?

Yes. It is available here on the Ministry of Health and Welfare (MOHW) website.

(viii) Does this mean that the health care provider will not actively treat the person who has signed an DA?

No. An AD will be activated and executed only when one of the five specific clinical conditions mentioned above occurs. Otherwise, medical personnel should follow medical protocols and take the necessary emergency measures without undue delay.

(ix) Can a DA be withdrawn or modified after it has been signed?

Yes, an DA can be withdrawn or modified in writing to medical institutions. Upon receipt of the withdrawal or modification, the institution will proceed with the corresponding modification or withdrawal of the rating in the NHI system.

(x) What happens if a medical decision is made by the fully conscious person during a medical procedure other than AD?

An AD may be withdrawn or amended in writing at any time. Thus, during medical treatment, the person can at any time modify the content of his DA in writing.

(xi) Is there a list of authorized medical institutions for CPA and advance directive purposes?

Yes. It is available here on the MOHW website.