Individuals experiencing old age or advanced-stage diseases may be insufficiently lucid and thus require surrogate decision-makers. The decision to use life-sustaining technologies is a crucial one for such individuals because prolonged life may lead to suffering in some cases, implicating the individual's ability to die with dignity. When it comes to making life-sustaining medical decisions for incapacitated patients, in practice, family members often function as surrogate decision-makers in Taiwan because of the low uptake of written documents about advance care plans, including "The Letter of Intent for the Choice of Hospice Palliative Care and Life-Sustaining Treatment" and "Advance Decisions." This article reviews the literature, mainly on studies outside of Taiwan, on the moral grounds, standards, and decision-making models for life-sustaining treatment decisions made by family members. This article also examines Taiwan's current regulations, offering suggestions for researchers and policymakers.

Background: Advance directives are essential to advance care planning, allowing individuals to document their end-of-life care preferences in a living, legally binding document. Cultural factors such as collectivism and family values can shape beliefs and preferences toward advance directives. Aim: This study compared beliefs and preferences toward advance directives between American and Taiwanese adults. Design: Cross-sectional survey. A multivariate logistic regression was used to quantify the differences between groups. Setting/participants: Age 18 + residing in the U.S. (n = 166) and Taiwan (n = 186). Results: Compared to the Taiwanese sample, the U.S. sample had more males (37% vs. 21%), more individuals with a graduate education (53% vs. 22%), and fewer single/unmarried participants (38.9% vs. 46.4%). In the multivariate logistic regressions, adults in Taiwan were 2.5 times more likely to value the importance of having an advance directive (aOR 2.5; 95% CI 1.27-5.12), 7.75 times more open to end-of-life care discussions (aOR 7.75; 95% CI 2.03-29.50), and 1.7 times more likely to allow family and loved ones make medical treatment and care decisions during hospitalization for a serious illness on their behalf (aOR = 1.73; 95% CI 1.08-2.78) compared to adults in the U.S. However, adults in Taiwan were less confident that their loved ones' decisions would align with their personal preferences (aOR = 0.28; 95% CI 0.16-0.47). Conclusion: Adults in Taiwan place significant importance on advance directives and demonstrate a greater propensity to engage in end-of-life discussions. They also appear more willing than adults in the U.S. to delegate healthcare decisions to their loved ones. Paradoxically, however, they express concerns about whether these decisions align with their personal preferences, a discrepancy likely influenced by cultural values of filial piety and collectivism in Taiwan.

Objectives Palliative care is emotionally demanding, yet extrinsic gratitude can improve job satisfaction. While intrinsic gratitude is effective in preventing burnout, the focus of existing research is mainly on extrinsic gratitude received by clinicians. This study aims to examine the role of intrinsic gratitude in clinicians within the emotionally demanding field of palliative care, assessing its impact on professional development and potential for broader community benefit. Methods Utilizing purposive sampling, we recruited a diverse group of palliative care professionals from 10 hospitals, focusing on full-time staff with at least two years of experience in palliative care. Of the 23 clinicians, 12 (five physicians, six nurses, and one social worker) were recruited because they spontaneously expressed profound gratitude toward others. Results Twelve of twenty-three clinicians maintained a positive outlook despite the inherent challenges of their field. Intrinsic gratitude, especially toward team members like nurses, emerged as a pivotal support mechanism. Through its transformative dimensions of empathic engagement, self-elevation, and humility, this gratitude strengthened their professional resilience and trajectory and had a ripple effect on their personal lives, influencing familial relationships and broader societal interactions. Conclusions This is the first research focusing on clinicians’ spontaneous expressions of gratitude. This study provides new insights into understanding the clinicians’ intrinsic gratitude, its impact on their professional trajectory, and harnessing its potential benefits for broader community outreach. Through a reflective process incorporating gratitude, clinicians may be empowered to develop their self-coping mechanisms and nurture inner resilience while caring.

Tissue engineering has been an integral part of regenerative medicine. Functional biomimetic structures were assembled by combining appropriate scaffolds with specific cells. The decellularization of animal tissue preserved the natural biochemical components and structural properties of the extracellular matrix (ECM) of specific organs, thereby providing a suitable niche for tissue-specific cell differentiation and growth. In this study, the extracellular matrix (ECM) of the porcine aorta was obtained through trypsin-based decellularization. The resulting porcine aortic ECM retained a favorable collagen composition, exhibited no cytotoxicity, and demonstrated chemophilic properties for mesenchymal stem cells. Human adipose-derived mesenchymal stem cells (hADSCs) and human induced pluripotent stem cell-derived mesenchymal stem cells (hiMSCs) were transplanted onto the decellularized porcine aortic ECM, where successful differentiation into a mature cartilage layer was observed. These findings suggested that the porcine aortic ECM could serve as a potential scaffold with tubular and linear structures for tissue engineering applications. Functional human iMSCs (induced-mesenchymal stem cells) were generated from human iPSCs (induced-pluripotent stem cells) and analyzed for differences compared to primary MSCs via RNA-seq. The hiMSCs were applied to decellularized porcine aortic ECM (extracellular matrix), demonstrating chondrogenic differentiation and confirming the usability of xenogeneic ECM.

Pei-Lin Lee serves as Clinical Associate Professor, School of Medicine, National Taiwan University; Consultant, Center of Sleep Disorder, National Taiwan University Hospital. Her current academic positions at international sleep societies include American Academy of Sleep Medicine Fellow and Co-Chair International Assembly; Asian Society of Sleep Medicine, Sleep Medicine Education Task Force committee member. Her current research focuses on the era of new technology and big data in sleep medicine; and intervention on sleep and metabolism in sleep disordered breathing.