The Patient Autonomy Act (病人自主權利法), which gives adult patients the right to create advance healthcare directives (AHD) regarding their preferences for medical care in the event they are rendered incapable of making such decisions, was passed by the Legislative Yuan late on Friday night.
The main focus of the legislation is to allow people with full capacity for civil conduct to create an AHD — a legal document stipulating their decisions regarding treatment they would want or not want to receive if unable to communicate their wishes — through advance healthcare consultation with physicians.
The Ministry of Health and Welfare said it was the first patient self-determination legislation passed among Asian nations, which should be a significant improvement for patients’ rights, and is to come into effect three years from now.
Photo: Chen Chih-chu, Taipei Times
In the meantime, the ministry plans to launch a pilot program and gather medical professionals to discuss the details of the act.
The legislation stipulates that before a decision can be reflected on a person’s National Health Insurance card — officially validating their AHD — the person must accept advance healthcare consultation services provided by healthcare facilities and obtain the notarized signatures of two witnesses with full capacity for civil conduct and the medical professionals on the consultation team recorded in the AHD.
Five incapacitating medical conditions can trigger the use of an AHD: a terminal disease prognosis; an irreversible coma; a permanent vegetative state; severe dementia; and government-stipulated medical conditions that result in unbearable pain or are incurable diseases with no alternative treatment.
Photo: Chen Chih-chu, Taipei Times
At least two physicians specializing in the exhibited condition and a palliative care team must confirm the condition before the AHD goes into effect.
To protect healthcare professionals that might be worried about the law, the ministry said the act stipulates that healthcare facilities or physicians can choose not to enforce the AHD based on their professional opinion, and those who terminate treatment or life-sustaining measures in accordance with an AHD would not bear criminal or civil liabilities.
In addition, the law stipulates that a patient’s family members cannot interfere with treatment provided in accordance with an AHD, the ministry said.
Chinese Nationalist Party (KMT) Legislator Yang Yu-hsin (楊玉欣), who proposed the legislation, said the act protects patients’ right to know, choose and refuse medical treatment, but does not validate euthanasia, because medical professionals are still prohibited from providing substances that would kill a patient.
While patients often need family members to consent to medical treatment in their stead, the act allows unmarried people, same-sex couples and people without families to commission an individual they trust to provide guidance on their wishes in extreme situations.
However, the opinions of healthcare professionals regarding the act are polarized, said Taiwan Medical Association director-general and KMT Legislator Su Ching-chuan (蘇清泉), who urged the ministry to discuss the details of AHD enforcement rules with specialists before the act goes into effect.
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