How to Plan for Palliative Care and Advance Decisions? A Look at the Patient Right to Autonomy Act, Hospice Palliative Care Act, ACP/AD
Taiwan has two main systems related to "hospice and peaceful end": ① The Hospice Palliative Care Act – for "terminally ill patients" diagnosed by two physicians, who can sign an "Advance Directive for Hospice Palliative Care and Life-Sustaining Treatment Choices" to choose not to undergo CPR (DNR) and life-sustaining treatment, and have it noted on their health insurance card; ② The Patient Right to Autonomy Act (enforced on January 6, 2019, Asia's first patient autonomy law) – individuals with full capacity can first undergo "Advance Care Planning (ACP)" and then sign an "Advance Decision (AD)" to decide in advance whether to accept or refuse life-sustaining treatment under five clinical conditions: terminal illness, irreversible coma, persistent vegetative state, severe dementia, etc. National Health Insurance also covers hospice inpatient, home care, and shared care. The following summarizes the differences between the two systems, the signing process, and official inquiry channels. This is neutral information and does not constitute medical or legal advice.
Hospice Palliative Care Act vs. Patient Right to Autonomy Act (What's the Difference)
Both systems respect the individual's advance medical wishes and can be noted on the health insurance card, but they differ in scope and activation conditions. They can be prepared in parallel:
- Hospice Palliative Care Act: For "terminally ill patients" (diagnosed by two physicians), sign an advance directive to choose not to undergo CPR (DNR) and life-sustaining treatment.
- Patient Right to Autonomy Act Advance Decision (AD): Broader scope covering "five clinical conditions," not limited to terminal illness, but requires prior completion of Advance Care Planning (ACP).
- The two are not mutually exclusive: you can prepare both according to your needs, and wishes can be noted on the National Health Insurance card.
Five Clinical Conditions for Advance Decision (AD)
Under the Patient Right to Autonomy Act, an AD does not take effect immediately upon signing but is executed according to the individual's wishes when one of the following conditions is confirmed by professional diagnosis (Article 14):
- Terminal illness
- Irreversible coma
- Persistent vegetative state
- Severe dementia
- Other patient conditions announced by the central competent authority (unbearable pain, incurable disease with no other suitable solution given current medical standards)
How to Sign? Process and Fees
The two systems have different procedures. It is recommended to first clarify which one you want to prepare, then follow the official process:
- AD under Patient Right to Autonomy Act: First, make an appointment at a medical institution providing Advance Care Planning (ACP). The consultation involves the individual, at least one relative within the second degree of kinship, and a medical agent, along with the ACP team → Sign the AD and go through legal procedures (such as notarization) → Have it noted on the health insurance card to take effect.
- ACP consultation fees are out-of-pocket and vary by hospital; low- and middle-income households may receive free services at some demonstration hospitals. The list of hospitals providing consultations can be found on the Ministry of Health and Welfare's information system.
- Hospice Palliative Care Directive: Can be signed at hospitals or through relevant channels of the National Health Insurance Administration and noted on the health insurance card.
- Consultation channels: Social workers or hospice palliative care teams at hospitals, Ministry of Health and Welfare hospice care/Patient Right to Autonomy Act hotline 0800-008-545.
FAQ
What is the difference between the Hospice Palliative Care Act and the Patient Right to Autonomy Act?
The Hospice Palliative Care Act mainly targets "terminally ill patients" (diagnosed by two physicians), allowing them to sign an advance directive to choose not to undergo CPR (DNR) and life-sustaining treatment. The Patient Right to Autonomy Act allows individuals with full capacity to first undergo "Advance Care Planning (ACP)" and then sign an "Advance Decision (AD)", with a broader scope (five clinical conditions, not limited to terminal illness). The two systems can coexist, and wishes can be noted on the health insurance card.
Under what circumstances will an Advance Decision (AD) be activated?
According to Article 14 of the Patient Right to Autonomy Act, an AD is activated when one of the following five clinical conditions is confirmed by professional diagnosis: ① terminal illness; ② irreversible coma; ③ persistent vegetative state; ④ severe dementia; ⑤ other conditions announced by the central competent authority (unbearable pain, incurable disease with no other suitable solution given current medical standards). It does not take effect immediately upon signing but is executed according to the individual's wishes under these conditions.
How do I sign an Advance Decision? Does it cost money?
You must first make an appointment at a medical institution that provides Advance Care Planning (ACP). The consultation involves the individual, at least one relative within the second degree of kinship, and a medical agent, along with the ACP team. After completion, sign the AD and go through legal procedures (such as notarization) and have it noted on the health insurance card for it to take effect. ACP consultation fees are out-of-pocket and vary by hospital; low- and middle-income households may receive free services at some demonstration hospitals. The list of hospitals providing consultations can be found on the Ministry of Health and Welfare's information system.
Is hospice care covered by National Health Insurance?
Yes. National Health Insurance covers hospice care, including hospice inpatient care, hospice home care, and hospice shared care, helping terminally ill patients receive symptom relief and holistic care. The specific coverage and content are subject to the latest regulations of the National Health Insurance Administration.
Where should I start?
If you are preparing for a "terminal" scenario, you can learn about the advance directive under the Hospice Palliative Care Act and have it noted on your health insurance card. If you want to make advance decisions for a broader range of future clinical situations, follow the ACP→AD process under the Patient Right to Autonomy Act and make an appointment at a hospital providing consultations. In practice, you can contact the social worker or hospice palliative care team at any hospital, or call the Ministry of Health and Welfare's consultation hotline at 0800-008-545. This site provides neutral information and does not constitute medical or legal advice; official validity is subject to the regulations of the competent authority.
· This page is a neutral compilation of information for reference only, not medical, legal, tax, or admission advice. For actual regulations and services, please refer to official announcements from competent authorities and the institutions themselves.