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Taiwan: Provisions on “Do Not Resuscitate” Orders Amended

(Feb. 16, 2011) On January 26, 2011, an amendment to Taiwan's Hospice Palliative Care Act was promulgated. The most significant change is that the amended law enables doctors to observe, without the need for the original signed document, the advance directives such as do-not-resuscitate (DNR) orders that are indicated on national health insurance (NHI) cards. (Amendment to Statute for Palliative Care, 6959 THE GAZETTE OF THE OFFICE OF THE PRESIDENT 47-49 (Jan. 26, 2011), Global Legal Information Network [GLIN] No. 243030, available at; An-ning huan-he yi-liao t'iao-li [Hospice Palliative Care Act] (Jan. 26, 2011), Laws and Regulations Database [LRD] of the Republic of China,; Text of the Act as amended on Dec. 12, 2002, Taiwan Hospice Organization [THO] website,

Under the amendment, article 1 of the Act is shortened to state the purpose alone – to respect the wishes of the incurably, terminally ill and to safeguard their rights and interests, removing the phrase “for any matters not stipulated in this Act, the relevant provisions of other relevant laws apply.” (LRD & THO, supra.)

The new article 6-1 is on the inclusion of advance health care directives on the NHI card. It states that if the person of intent – i.e., a dying patient who establishes a letter of intent choosing hospice palliative care, or a person over 20 years of age, with full capacity to act, who establishes an advance directive – or his agent has expressed agreement in the letter of intent, the central authority should place the person's DNR instruction on the NHI card; the effect of that instruction will be considered the same as that of the letter of intent itself. However, if the person of intent or the agent withdraws such intent, the central authority must be notified to abolish the said instruction from the card. Only after the signed letter of intent has been scanned as an electronic file and stored in the central authority's database by the medical treatment organization or the health agency will it be recorded on the NHI card. (LRD, supra.)

Three new paragraphs expand article 7. Before the closest relatives become involved in a doctor's administering CPR, where a letter of intent had been issued in the case of a terminally ill patient who is unconscious or who cannot clearly express his or her wishes, the originally administered CPR can be terminated or removed by means of the patient's agent, or through the cosigning by the relatives (i.e., the spouse, adult children, adult grandchildren, and the parents) of a letter of agreement for termination or removal of CPR and after examination and approval by the given care facility's medical ethics committee. If the relatives who can lawfully sign the letter of intent are dead, missing, or unable to express their wishes, the remaining relatives are to jointly sign. The medical ethics committee should be comprised of medical, ethics, and legal experts and public figures, and the proportion of ethics and legal experts and public figures cannot be less than one-third. (GLIN, LRD, & THO, supra.)

Finally, the amendment repeals article 13, which stated that fines imposed in accordance with the Hospice Palliative Care Act would be subject to compulsory execution by the court for failure to make payment within the due date. (Id.)

According to Shih Chung-liang, Director of the Taiwan Department of Health's Bureau of Medical Affairs, “[t]he new law will help reduce physical and psychological harm to patients and family members, as well as resolve legal and ethical dilemmas.” (June Tsai, Taiwan's Legislature Mulls NHI Card Living Will Bill, TAIWAN TODAY (Dec. 31, 2010), Shih stated that only 34,000 of the more than 60,000 persons in Taiwan with living wills have the information stored on their NHI cards. (Id.)