Between "Right to Life" and "Medical Autonomy": Progressive Course of Hospice Palliative Care, Patient Autonomy and Euthanasia in Taiwan / 中国医学伦理学

With the development of medical technology, terminal stage patients rely excessively on medical equipment to prolong their lives, but this aggravates the pain of dying patients. The current situation drives the Taiwanese people to think deeply about the following issues: Does the quality of life before death outweigh the ineffective medical treatment at the end of life? Is the patient's autonomy higher than the right to life? This article started with several cases that triggered the discussion of euthanasia in Taiwan, such as the case of Mr. Fu Daren, a sports anchor in Taiwan, who wished to pass legislation on euthanasia. Meanwhile, this paper reviewed the revision process of the "hospice palliative care rules" in Taiwan, and introduced the spirit of "patient autonomy rules" to be implemented in 2019. From the perspective of the revision of the regulations, the current trend was further explored. The awareness of Taiwanese people on the right of self-determination in their final life was improved, and the pursuit of the quality of their final life was more than the extension of their lives.

Current Status and Tasks of Bereavement Services in Japanese Hospice and Palliative Care Units: Comparison of Survey Data in 2002 and 2012

Objectives: The purposes of this study are to assess the prevalence and tasks of bereavement services in Japanese hospices/PCUs and to explore these changes through comparison of survey data in 2002 and 2012. Methods: A postal survey of all government-approved hospice and care units in Japan was conducted in 2012. Two hundred twenty-seven questionnaires were dispatched, of which 156 were retuned (response rate, 68.7%). Results: The results of 2012 survey showed that 78% of respondents sent memorial cards, and 73% provided memorial services. The ratios of hospices/PCUs offering diverse bereavement serveces in general decreased over the last decade. “Organizational support” was perceived by 71% of respondents as one of the tasks of bereavement services in 2012 survey. The responses of “caregiver training” and “research on the demands of bereaved individuals” as perceived tasks were declined significantly over the past decade from 2002. Conclusion: These findings in 2012 survey revealed present status of bereavement services in Japanese hospices/PCUs, and suggested that some perceived tasks has been slightly dealt with through comparison with results of 2002 survey.

Effects of Holistic Hospice Nursing Intervention Program on Self Esteem and Spiritual Well-being for Inpatients of Hospice Palliative Care Unit / 한국호스피스완화의료학회지

PURPOSE: This study was to testify the effects on self esteem and spiritual well-being of holistic hospice nursing intervention program ("Rainbow program") for inpatients of hospice palliative care unit. This was designed as a preliminary experimental study with one-group pre-post test. METHODS: A total of 27 patients who were over 18 years old, and admitted in hospice palliative care unit of S hospital in P city, submitted informed consent for this study, participated in holistic hospice nursing intervention program(total 10 sessions and 1,200 minutes for 2 weeks) from April 6, 2004 to April 20, 2005. To test the effects of this intervention, Self Esteem Questionnaire (SEQ) and Spiritual Well-being Questionnaire were used. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. RESULTS: (1) Hypothesis No. 1 "The experimental group which received Rainbow program will have a higher degree of self esteem than before" was supported (t=11.554, P<0.001). (2) Hypothesis No. 2 "The experimental group which received Rainbow program will have a higher degree of spiritual well-being than before" was also supported (t=6.387, P<0.001). CONCLUSION: This Holistic Hospice Nursing Intervention Program was effective in increasing self-esteem and spiritual well-being of patients in hospice palliative care unit. Therefore, it can actively be used and also applied to hospice palliative care practice, research, and education as a useful model of interdisciplinary team approach by hospice professionals.

Hospice-Palliative Care and Social Strategies for Improvement of the Quality of End-of-Life

Despite of various efforts for high quality care at the end-of -life (EOL), there are still gaps between hope and reality of patients with terminal illness and their caregivers. Together with establishment of hospice-palliative care, we need to make strategies to reduce burden and suffering among the patients and their family members, such as social consensus on ideal dying, practice guideline for care of a dying patient, comprehensive governmental plan for EOL care, and the enactments of necessary laws. These efforts would make people accept the process of dying as a completion of life.

Clinical considerations about terminally ill cancer patients who died in hospice unit / 대한내과학회지

BACKGROUND: Although physicians state that patients ideally should receive hospice palliative care for 3 months before death, the majority of patients survive less than one month in hospice palliative care. This is too short to do effective hospice palliative care. Therefore, we figured out the problems through the clinical considerations about terminally ill cancer patients who had died in hospice unit. METHODS: From July to December in 2003, 107 patients with terminally ill cancer who had died in Sam Anyang Hospice Unit were enrolled in this study. For getting the informations about patients characteristics, we reviewed the medical records and interviewed the patients on the first visit. RESULTS: There were 70 males (65%) and 37 females (35%), and median age of patients was 60 years (range 23-93). The most common cancer was stomach cancer (18 patients, 17%). Forty seven patients (44%) took analgesics, the others 60 (56%) not. The most common symptom was pain (75 patients, 70%) and the most prevalent reason for admission was also pain (60, 56%). The most prevalent physician specialty who transferred patients or referred to local hospital was other internal medicine (48 patients, 44%), followed by hemato-oncology (38, 36%), surgery (12, 11%) and others (9, 9%). The median duration between the day when the patients were diagnosed as terminally ill cancer patient and the day when they were referred to hospice center is 48 days. The median survival in hospice palliative care is 30 days. The median hospitalization is 19 days. CONCLUSION: We found that lack of recognition about hospice palliative care of physicians, patients and families made the length of hospice palliative care too short. To do effective hospice palliative care, it needs education and promotion for them constantly.

The Establishment of Hospice and Palliative Care System from the Cancer Patients and Families' Point of View

BACKGROUND: Many terminal cancer patients and families are affected with physical, emotional, and social problems. Many people claim that a type of medical services is needed to manage them such as hospice palliative care. There have not been many studies of cancer patients and families with respect to their opinions and attitudes on hospice palliative care for terminal cancer patients, although their views on it is important. METHODS: We surveyed 687 in-patients, out-patients and their families with cancer in 8 hospitals. The self-administered questionnaires included the following; 1) socio-demographic and clinical variables; 2) opinions on hospice palliative care; 3) attitudes on ethical issues associated with hospice palliative care; 4) factors associated with withholding futile care at the end-of-life. The data were analyzed with x2-test, Mantel-Haenszel x2-test, and multiple logistic regression. RESULTS: Almost 90% of the subjects agreed to the need of obtaining hospice palliative care with health care insurances and reaching a social consensus on the contents of its programs. Five hundred and seventy six (83.8%) subjects agreed to the need of using advanced directives. Two hundred and eighty five (72.2%) cancer patients and 200 (68.5%) families agreed to the need of withholding futile care at the end-of-life and of people accepting their cancer diagnosis with insight and living in the metropolis as they were more likely to do. In the multivariate analysis, the attitudes on withholding futile care at the end-of-life was significantly different only by insight of cancer diagnosis (OR; 1.09-3.15). CONCLUSION: This study showed that hospice palliative care should be established through social consensus on the issues related to ethics and insurances, and that cancer patients and families must have a right to choose such services with informed decision-making.