Exploring How to Implement the Patient Autonomy Act in Nursing Homes in Taiwan
The concept of Progressive Hospice Palliative Care has become a common trend in the medical community in Taiwan’s aging society. It upholds the patients’ will, hoping Advance Decision makers could set off to the end of life with compassion and dignity rather than living for the family’s feelings or becoming an income source for their family. Nursing Homes are important institutions in the modern aging society. Their residents are a group of aging people with chronic diseases and disabilities, who are gradually moving towards the end of life. They apply to the concept of Progressive Hospice Palliative Care. However, the currently passed Patient Right to Autonomy Act is unsatisfactory to meet the needs of the nursing home residents for their patient autonomy realization. Reasons include high threshold for Advance Decision participants, short-staffed nursing homes, long distance between nursing homes and medical centers, and insufficient regulations on affirmative defenses, which results in the executors’ refusal to perform Advance Decisions in avoidance of trouble.
The present state of resource allocation in Taiwan restraints Nursing Homes from possessing specialists in all medical categories. Even after making Advance Decisions, nursing home residents will still be transferred to hospitals for treatment or first aid under the referral system. Going through long-term recurrent referrals, the inhabitants will inevitably face ineffective first aid measures, which intensifies their physical and psychological burden. Additionally, with the interference of family members, patient autonomy realization becomes more severe. Accordingly, the content of the Patient Right to Autonomy Act is unsuitable for the nursing home residents’ present condition and realization of their patient autonomy. This paper suggests that in legislation, limitation on eligible executors of Advance Decision should be eased; as for complementary measures on evidence, Marked Health Insurance Card should be seen as the proof of Advance Decision being legally established and effective, in order to protect medical practitioners. Moreover, nursing homes should be obligated to provide relevant information to the residents, enabling their easy access to the information. Only in this way can patient autonomy of the nursing home residents be ensured.