Community-based palliative care in Taipei

Categories: Care.

He is the former superintendent of National Taiwan University Hospital Jinshan Branch and now leads the Taipei City Hospital.

Dr Huang emphasises that receiving palliative care does not mean giving up the hope to live, but rather, it means respecting the natural course of life and refusing to unnaturally prolong the process of death. 

He once thought that high-tech medicine would effectively prolong patients’ lives, but it has not so far. He knows a doctor should save lives and ease pain, but asks: when is it time to let go? And how does one explain the situation to the bereaved? What needs to be done to ensure a good death? 

With more experience gained, Dr Huang learned that a doctor’s duty is not merely saving lives, but also caring for the patients’ humanity and quality of life.

“ICU is not an outpost for death,” he says. Currently, terminally ill patients occupy ICU beds and survive with life-sustaining systems; however, they remain at the limbo of not being able to actually live and not being able to die. There are movements worldwide to raise awareness of the need for advance care planning and better care at the end of life.

Dr Huang points out that the number of ICU patients in Taiwan is higher than in many countries around the world. He suggests that the reason for this may be because Taiwanese people mistake ICU as a place for handling life threatening issues, that is, they see ICU as a place that brings people back to life from death.

Thus ICU patients are often treated with extreme procedures such as intubation, CPR, ECMO and dialysis. In the end, the patient passes away with trauma. This may be reflected on their appearance, with a dark complexion and scars, which can be traumatizing for those they leave behind. A local poll has indicated that nearly 44.6% of Taiwanese people wish to say goodbye to their families at home. However, that is very seldom the case.

The National Taiwan University Hospital Jinshan Branch is the first hospital to promote community-based palliative care in Taiwan. Under Dr Huang’s leadership, a group of community-based palliative care volunteers take the initiative to care for local elderly people and ‘walk alongside’ for the last mile of more than one hundred terminally ill patients’ lives. These volunteers have visited each corner of the villages in Jinshan for the past two years and have earned the respect and trust of the locals.

Dr Huang explained: “Most of the Taiwanese doctors are well trained and familiar with ideas of ‘life-saving’ but not of ‘well-dying’. They don’t know when to let go and cannot face the fact that a patient may die under their treatment. Being a doctor is not just about curing patients but also about sending patients off properly with a good quality of life until the end.”

In Dr Huang’s newly assigned post at Taipei City Hospital, he is drawing on his experience in Jinshang to actively prepare the palliative care team and design related training courses to develop community-based palliative care in Taipei City.

To date, more than one hundred staff members have completed palliative care training and are ready to serve. At the same time, terminally ill patients and families have been interviewed and they have expressed clearly the will to receive proper community-based palliative care at home.

Dr Huang reminds us that if you wish to walk the last mile of life with dignity and follow nature’s course, no matter whether you are healthy, suffering from chronic diseases or terminally ill, it is important to consider as early as possible what your choice will be when it comes to the last phase of your life.

Advance Care Planning (ACP) is a series of steps to help you plan your future health care in advance. During this process, it also gives you a chance to express your love, your gratitude, your regrets, your apologies and your goodbyes. Tell your family what your decision is in advance to ensure your it will be respected and honored. Together, let us bring peace of mind to both the living and the dead.