The Ministry of Health and Welfare indicates that the Act is the first patient self-determination act published in statutory form and will begin to take effect in three years’ time.
The purpose of PSDA is to re-emphasise the importance of patients’ rights when it comes to medical decision making, especially when it is a matter of life or death.
Patients can make their own Advance Directive via Advance Care Planning by stating whether they wish to accept or refuse any kind of medical treatments when diagnosed with the following conditions: being terminally-ill, in a coma or persistent vegetative state, or with advanced dementia or incurable diseases that include unbearable pain.
The highlight of PSDA is it gives Advance Directives a legally binding nature, which occurs when patients receive Advance Care Planning consultation provided by approved medical institutions.
The result is the patients’ own Advance Directive, which then needs to be notarised or witnessed by two fully capable adults, stamped by the institution, and be registered in the National Health Insurance system.
Additionally, two specialist physicians are required to confirm if patients meet the five definitions stated in the act.
In order to minimise the skepticism of medical staff, immunity is introduced to this act. This means that medical institutions and physicians are freed from criminal liability when they do not completely fulfill the patients’ Advance Directive based on the staff’s own judgment or willingness; or when they perform according to the patients’ Advance Directive to suspend, remove or refuse life sustaining treatments.
When it comes to the all-too-familiar scenario where patients and family members are inconsistent, this act allows the medical institution and staff to focus on the patients’ will and prevents family members from interfering.
For now, the passing of this act is considered a major step forward and a milestone for holding high values on patients’ self-awareness and autonomy in Taiwan.
As criminal liability is excluded from PSDA, it is intended to encourage medical staff to respect the patients’ own decisions when it fits certain circumstances as stated in the act.
As Advance Directives will be made by different individual with various religious or moral backgrounds and values, the Ministry of Health and Welfare has invited representatives from all interest groups, especially from the medical association, to openly discuss the enforcement of this Act.
Once the enforcement rules are finalised and published by the authorities, a public awareness campaign will soon follow.
This article originally appeared in the Hospice Foundation of Taiwan newsletter. It is reprinted with permission.