Since "death & dying" are taboo topics in modem Taiwanese culture, it is very rare for people having Living Will and Durable Power of Attorney. When patients become incompetent, and also there are different opinions among family members, it is very difficult for hospice palliative care team to make a medical decision. Usually, we would run a family conference to help family members communicate and negotiate each other. If the decisions made by the families violate patient's will, what should we do? Sometimes the patient has no written document about his/her will but oral expression to the hospice staff. The hospice staff should listen to whom if the patients' will differ from their relative's will? It seems no doubt about the ethical decision because of the principle of patient's automy. In reality, some hospice staff would listen to the relatives since there is no legal protection.
Case Report 3: Advance Directives
A sixty-nine years old lung cancer patient wrote down his living will when he knew he had cancer two years ago. He wrote that he was not afraid of death but afraid of pain and dyspnea. Therefore, if he was in a state of suffering, he did not want his dying process to be prolonged. He also requested hospice palliative care to alleviate his suffering. One day he had pneumonia and sent to the hospital's emergency room with endo-trachea tube and respirator on. The patient was angry and tried to pull out the tubes. The nurses then restrained his hands to bedrails. The patient's condition was down hill and became coma. The patient's wife asked the doctor to execute the patient's will but their children asked the doctor must rescue their father.
