Originally published as JCO Early Release 10.1200/JCO.2008.21.4643 on May 26 2009

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Prevailing Ethical Dilemmas in Terminal Care for Patients With Cancer in Taiwan

From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan.

Corresponding author: Tai-Yuan Chiu, MD, MHSci, No. 7 Chung-Shan South Rd, Taipei, Taiwan; e-mail: tychiu{at}ntuh.gov.tw.

Purpose The study aimed to investigate prevailing ethical dilemmas in terminal care for patients with cancer nationwide and identify related factors after the enactment of the Natural Death Act in Taiwan.

Methods This multicenter study surveyed 800 physicians and nursing staff of oncology wards and hospices through a set questionnaire. A total of 505 respondents (63.1%) who had taken care of patients with terminal cancer were analyzed.

Results The most frequently encountered ethical dilemmas were truth-telling (mean ± SD = 1.30 ± 0.63; range [never, occasional, often], 0 to 2) and place of care (1.19 ± 0.69), both of which were related to communication issues. Dilemmas related to clinical management were artificial nutrition and hydration (1.04 ± 0.66) and use of antimicrobial agents (0.94 ± 0.70). Logistic regression analyses revealed that positive attitudes about the Natural Death Act was negatively related to the extent of ethical dilemmas (odds ratio, 0.426; 95% CI, 0.256 to 0.710].

Conclusion The enactment of the Natural Death Act in Taiwan would contribute to improving the quality of end-of-life care, which suggests that this kind of law should be adopted in other countries. Educating cancer care professionals in building positive beliefs toward the act is strongly encouraged.

Supported by National Science Council, Taiwan.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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