To uphold patients' autonomy, safeguard their right to a "good death," and foster harmonious doctor-patient relationships, Taiwan passed the Patient Right to Autonomy Act in 2015, which was implemented in 2019. This Act ensures patients' rights to be informed and to choose, accept, or refuse treatments. In line with respecting patients' autonomy and wishes, patients, their families, and their medical teams may conduct advance care planning (ACP) in medical facilities.
ACP is a communication process involving the declarant, a trained ACP professional, at least one first or second-degree relative, or an affinity relative of the declarant, and a medical appointed agent. Together, they discuss the patient's options for receiving or refusing life-preserving treatments, artificial nutrition, and hydration under specific clinical conditions. After completing ACP, an Advance Decision (AD) must be signed. The AD is deemed valid when signed in front of two witnesses or notarized by a notary public. Additionally, the seal of the medical institution where the AD is signed must be affixed, and relevant information registered on the patient's NHI card.
Starting July 1, 2024, ACP has been covered by the NHI for hospitalized patients with full decision-making capacity who meet the following criteria:
- Patients aged over 65 years with catastrophic illnesses and diseases listed in the palliative care program.
- Patients with mild dementia (scoring 0.5 to 1 on the Clinical Dementia Rating).
- Patients with diseases listed in Subparagraph 5, Paragraph 1, Article 14 of the Patient Right to Autonomy Act.
- Patients qualified for the integrated home-based health care program.