Moral grounds, standards, and decision-making models for surrogate life-sustaining treatment decisions by family members: a reflection on Taiwan's hospice and palliative care policy

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.