Implications for End-of-Life Care: Comparative Analysis of Advance Directives Laws in Taiwan and the United States

This study explores end-of-life care decisions across cultures by comparing advance directives (ADs) laws in the United States (U.S.) and Taiwan. Specifically, it examines the U.S.'s 1991 Patient Self-Determination Act (PSDA) and Taiwan's 2019 Patient Right to Autonomy Act (PRAA). By analyzing key legal differences and similarities, the study provides insights into improving end-of-life care policies and understanding how legal frameworks shape patient autonomy globally. This review utilized the keywords "United States or Taiwan," "Patient Self-Determination Act," "Patient Right to Autonomy Act," "advance directives," and "advance care planning," with searches restricted to English or Chinese publications since 1991. The analysis shows that both the U.S. and Taiwan view ADs as crucial for healthcare autonomy, enabling individuals to make decisions in advance and allowing healthcare agents to act on their behalf if they become incapacitated. However, ADs laws differ notably in their requirements, scope, completion processes, healthcare agent eligibility, portability, and promotional efforts. In the U.S., while various types of ADs are available (e.g., MOLST, POLST, Five Wishes), stricter regulations are needed to govern interactions between patients and healthcare agents to ensure that healthcare decisions align more closely with patients' preferences. Improving AD portability, particularly in emergencies, through cross-state recognition or digital sharing, is essential. For Taiwan, recommendations include enhancing palliative care practices and expanding ADs to include emotional and spiritual preferences. Integrating psychiatric ADs into Taiwan's PRAA could provide significant benefits. Additionally, reducing the costs associated with advance care planning and increasing AD awareness through active healthcare involvement would further strengthen patient autonomy.