From Do No Resuscitation to Advance Care Planning

Abstract

As a result of the heroic by physicians, many people suffered from painful in hospitals, inserted with variable tubes and surrounded by different medical devices. In order to improve our quality of and quality of hospice palliative care, Taiwan passed a Hospice Palliative Care Act (Natural Death Act) in 2000 which gives people the right to choose cardiopulmonary resuscitation or do no resuscitation at the end of life. We are now working forward to the advance care planning to establish a Patient Self Determination Act. In this new Act, people can choose to refuse the terminal painful life sustaining treatments. Hope this will further improve our quality of terminal care. Birth, aging, sickness and death are natural course of life. However, with the relentless advancement of medical science and technology, physicians now tend to fight for lives against all the odds. As a result of the heroic by physicians, many people suffered from painful in hospitals, inserted with variable tubes and surrounded by different medical devices. Our life span may have increased; however, it appears reasonable to suggest that the quality of life at its end may not have improved (1) .In order to improve the quality of life at end and to ensure good and peaceful passing, modern hospice care (St. Christopher's Hospice) was started by Dame Cicely Saunders in London in 1967 (2,3). In 1990 the first hospice ward was opened in Taipei's Mackay Memorial Hospital by Dr. David CH Chung in Taiwan (4) .In 2000 Taiwan passed a Natural Death Act (NDA), named Hospice Palliative Care Act (HPCA) to allow patient to have the right of choosing terminal cardiopulmonary resuscitation (CPR) or do no resuscitation (DNR) (3,4). In order to further improve the quality of terminal care, we need to step forward from terminal DNR to advance care planning (ACP) and patient self determination act (PSDA).