Taiwan Grapples with Dignity in Dying: Majority Support Physician-Assisted Dying

A new study reveals shifting attitudes toward end-of-life care in Taiwan.

Taipei, Taiwan – A groundbreaking study from National Taiwan University's College of Public Health sheds light on evolving perspectives regarding end-of-life care in Taiwan, revealing significant support for physician-assisted dying among the population.

The research indicates that a substantial majority of Taiwanese adults favor physician-assisted dying in cases of terminal illness, persistent physical suffering, and severe cognitive impairment.

"While many diseases remain incurable, advances in medical technology have made it possible to delay their progression, resulting in prolonged life," stated Chen Duan-rung (陳端容), a professor at the college's Institute of Health Behaviors and Community Sciences, during a press conference.

She further explained, "However, such life extension often leaves patients in long-term pain, disability, or even a state lacking dignity," highlighting the growing international recognition of an individual's right to self-determination at the end of life.

The study distinguishes between euthanasia, where medical professionals administer the final act, and physician-assisted dying, where the patient takes the final action. Both practices are currently illegal in Taiwan, as noted by Chen.

To gauge public opinion, Chen and her team conducted an online survey of 3,992 Taiwanese adults in 2022. The results, published in the medical journal BMJ Open in January, paint a clear picture of widespread support.

The survey presented three scenarios: 86.2% of respondents supported physician-assisted dying for patients with terminal illness and unbearable long-term pain; 79.6% for patients with incurable illnesses causing prolonged pain; and 72.6% for patients with severe cognitive impairment and incurable diseases. Overall, 67.6% of respondents supported the right to request physician-assisted dying across all three scenarios.

The study also revealed that support for physician-assisted dying was more prevalent among younger adults (aged 20-39), males, those without religious beliefs, and caregivers.

"Caregivers are on the front lines caring for patients or the elderly," Chen noted, adding that their empathy, developed through close patient interaction, may contribute to their heightened support.

Conversely, healthcare professionals, including doctors and nurses, exhibited less support, likely due to ethical and legal considerations associated with their roles.

The study also examined participants' awareness of the Patient Right to Autonomy Act (PRAA), which allows patients with terminal illnesses to refuse life-prolonging treatments and opt for a "natural death." Only 37.3% of respondents were aware of the PRAA, and those who were tended to be less supportive of physician-assisted dying.

Chen noted that "The PRAA grants terminally ill patients, as well as those in a deep coma or with advanced dementia, the right to a natural death, but does not permit them to choose an accelerated one," suggesting that greater awareness of the PRAA may influence support for physician-assisted dying.

Individuals with a higher level of Advance Care Planning (ACP) were found to be more open to end-of-life decisions and, consequently, more accepting of physician-assisted dying.

Chen emphasized that the research aims to serve as a "foundation" for future public and ethical discussions on physician-assisted dying. "It reflects that many people in Taiwan fear a life worse than death, are willing to accept 'end-of-life autonomy,' and are becoming more open to the idea of 'dying with dignity,'" she concluded.