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Public hospital management in Taipei

On 27 January 2016 the ECCT's Healthcare Enhancement committee hosted a lunch with speaker Dr Chu Da-chen, Deputy Superintendent of Taipei City Hospital (TPECH). TPECH is a full-service medical institution that is the result of a merger of ten municipal hospital branches in Taipei City into one unit, making it the largest healthcare organization in Northern Taiwan. Dr Chu spoke about the subject of public hospital management in Taipei, with a special focus on palliative care.

Taiwan's aging society is placing increasing strain on hospitals. Community-based healthcare is the focus of reform and TPECH is actively encouraging citizens to first seek out local clinics and pharmacies to treat minor illnesses and discomfort. Another important development in Taiwan is palliative care for elderly and frail patients and end-stage sufferers of terminal illnesses. This approach allows for referrals to higher level treatment if necessary and reduces the strain on hospitals and specialty-care institutions. In so doing, the aim is to ensure that a higher level of quality healthcare is provided to all citizens.

Chu spoke about the need for people to be open and proactive about planning for the end stage of their lives and final arrangements. In an ideal world, people should take a holistic approach to life and death that focuses on keeping healthy as long as possible but also considers the best way to deal with terminally illness that is the least stressful and reduces suffering as far as possible. Far too many patients in the end stages of terminal illness are rushed to intensive care units (ICUs) and suffer intense agony as doctors try to revive them. Most of them, if given the choice, would probably prefer to made as comfortable as possible and pass away in relative peace at home. This is the best option for patients and their families because it is the least stressful. It also reduces the burden on healthcare facilities such as ICUs.Addressing this issue is of course easier said than done given that talking about death is always a sensitive matter, especially given cultural taboos in society like Taiwan's. Moreover, even among medical professionals, it is difficult to reach a consensus on the definition of "end stage", the relapse period and a patient's prospects for improvement. As long as there is technical or moral uncertainty, doctors tend to maintain an interventionist mind-set. Unless a patient has provided formal consent, such as a Do Not Resuscitate (DNR) form, doctors are obliged to do everything in their power to keep them alive, including using aggressive and painful procedures and life-support machines.

According to Chu, there is a general global consensus that ICUs should be used to save lives as a result of trauma and should not be a place for terminal patients' to suffer pain and end their lives. There is also general consensus that patients have the right to a natural death. Most people, if given the choice, would not want to be kept on life support if there was no hope being able to live a meaningful life. There is also general consensus that medical professionals should not only be responsible for saving lives but also for easing suffering of all kinds. This means that the best treatment should aim to ease both a patient's physical and emotional suffering through medicine, psychological or spiritual care.

TPECH is one of several institutions in Taiwan that is providing treatment for terminal patients in their homes. It has teams comprising doctors, nurses, social workers and volunteers that help families to discuss and reach agreement on how to deal with every possible eventuality and specify what should be done in each instance and every stage of a patient's illness. They even provide support to families during their bereavement.

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