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Face the End of Life With Dignity and Autonomy: Understanding the Patient Right to Autonomy Act

       The “Patient Right to Autonomy Act” will be formally implemented on January 6, 2019. It is Asia’s first specialized legislation that offers complete protection of the patient’s right to autonomy. This Act stipulates that patient autonomy is respected in healthcare, to safeguard their rights to a good death, and to promote a harmonious physician-patient-relationship. What sets it apart from the “Hospice Palliative Care Act” is that it ensures that patient has the right to be informed regarding their treatment options and decisions regarding the treatment. It expanded the target scope to include terminally ill patients, patients in irreversible comas, permanent vegetative patients, patients suffering from severe dementia, and other disease conditions or states of suffering that are unbearable, incurable and for which no other appropriate treatment options are available given the medical standards at the time of the disease’s occurrence, as announced by the central competent authority. Through advance care planning (ACP), patients may sign advance directions (AD) and exercise the special right to refuse treatments.

       Individuals with full disposing capacity (at least 20 years of age or juvenile but legally married) may sign the AD through ACP. The declarant, trained medical professionals, at least one relative of first or second degree of affinity (the relative may opt to not participate with cause, but the declarant must elaborate on the situation in writing) and declarant’s healthcare agent (may not be specified by the declarant; if yes, the agent must be at least 20 years of age, by capable of full disposition and have provided written consent) must be present during the ACP to discuss the acceptance, termination, withdrawal or withholding of life-sustaining treatment, artificial nutrition and hydration in part or in full, when the declarant is in the position of the aforementioned five clinical conditions. There is a specific format to the drafting of AD; a written document must be signed, witnessed or notarized by two notaries, affixed with the official seal of the medical institution, and registered in the declarant’s National Health Insurance IC card. The declarant may directly sign the AD during ACP, or choose to sign after consideration. The signed AD may be withdrawn, amended and re-registered with written application.