Debates on end-of-life care and the legalization of "natural death" in Taiwan : the practice of terminal discharge and the Hospice and Palliative Care Act

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Other Title
  • 台湾における終末期医療の議論と「自然死」の法制化 : 終末期退院の慣行から安寧緩和医療法ヘ

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Abstract

This paper explains the clinical practice of terminal discharge and how it has led to the enactment and subsequent revisions of the Hospice and Palliative Care Act in Taiwan. In this paper I divide my argument into three parts. First, I investigate the actual situation of terminal discharge by examining the regulations in the Medical Care Act and related reports from healthcare providers. The practice of terminal discharge is the discharge of a terminal patient at his or her wish so that the patient can spend the last few hours or days with his or her family at home. In my research, it is shown that the practices of discontinuing life-support-treatment after arriving at home and of family members acting as the patient's medical proxies have been tacitly accepted by clinical practitioners. Second, I focus on the relation between the practice of terminal discharge and a movement from 1995 by terminal care practitioners that advocated for the legalization of "natural death." The activists argued that terminal patients who have signed an advance directive to refuse life-support-treatment and those who have expressed their wish to be discharged from the hospital at their end-of-life have shown their will for a "natural death." Through the movement's efforts, it became clear that there had already been a public consensus for the practice of terminal discharge; as a result, a law governing terminal patients' right to self-determination, the Hospice and Palliative Care Act, was enacted in Taiwan in 2000. Third, I examine the revision of the Hospice and Palliative Care Act and identify the process of granting family members the right to act as medical proxies regarding the discontinuation of the life-support treatment. The law as enacted in 2000 only allowed family members acting as medical proxies to refuse life-support-treatment; later revisions allowed medical proxies to both refuse and discontinue life-support-treatment.

Journal

  • Bioethics

    Bioethics 23 (1), 115-124, 2013

    Japan Association for Bioethics

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