From 2010 to 2021, Taiwan's palliative care ranking jumped from 14th to 3rd globally, demonstrating the success of policy initiatives and a cultural shift. Moving forward, the government will continue to promote awareness of end-of-life issues, enhance the hospice and palliative care system, and foster greater public understanding and acceptance of palliative care.
The ticking clock in the elderly grandmother's hospital room filled the space with an indescribable silence. Her young grandson, holding a picture book titled Second-Oldest Brother Pig's Happiness Party, asked, "Should we also throw a happiness party for Grandma?" A simple question, yet it led the entire family to confront the upcoming farewell for the first time. Though innocent, the question created an opportunity for the family to have their first calm and natural conversation about death.
"When we first started promoting palliative care and end-of-life discussions, many people were unwilling to talk about death, even considering it an unlucky topic," said Dr. Yue-Ping Liu, Director of the Department of Medical Affairs at the Ministry of Health and Welfare. In 2010, Taiwan ranked 14th globally in palliative care. By 2021, it had risen to 3rd place worldwide and secured the top position in Asia.
Over the past decade, Taiwan has emerged as a leader in palliative care across Asia. More importantly, these achievements are gradually transforming society's attitude toward death.
From Data to Attitude: A Decade of Achievements in Taiwan’s Palliative Care
"This is an achievement we take pride in, but it's not just about improving the numbers; it reflects our efforts toward transforming society as a whole." As Yue-Ping Liu reflects on Taiwan's progress in palliative care, she emphasizes that the foundation of this advancement lies in legislative development.
The Hospice Palliative Care Act, passed in 2000, was the first of its kind in Asia, and the Patient Right to Autonomy Act, enacted in 2016, further ensured patients' rights to make end-of-life decisions. These legal frameworks not only provided the medical system with clear guidelines but also empowered patients and their families to make informed choices about end-of-life care, reducing conflicts and uncertainties.
At the same time, Taiwan's aging population has accelerated the demand for this transition. "As our society ages, we are compelled to address the increasing need for quality end-of-life care. However, with this challenge comes an opportunity for change," Liu noted. The rising elderly population has not only increased the demand for hospice care but has also fostered greater societal acceptance of the concept.
This shift has driven the government to continuously invest in expanding palliative care services, establishing hospice wards within hospitals, and integrating end-of-life care into long-term care facilities and local communities. The goal is to ensure that patients receive appropriate and dignified care, regardless of where they spend the end of their life journey.
This shift has driven the government to continuously invest in expanding palliative care services, establishing hospice wards within hospitals, and integrating end-of-life care into long-term care facilities and local communities. The goal is to ensure that patients receive appropriate and dignified care, regardless of where they spend the end of their life journey.
Diversified Media: Making Conversations about Life and Death More Natural
However, legislation alone is not enough. Yue-Ping Liu emphasized that while laws provide a formal structure, fostering open conversations about life and death requires broader societal education. She and her team discovered that the real challenge lies in encouraging people to discuss end-of-life matters and making it a topic that can be openly discussed. To address this, they sought innovative approaches, leveraging mass media and parent-child interactions as ways to open the conversation and normalize discussions about the end of life.
"We've noticed that parents and children often have their first natural conversation about death while reading graphic novels together." Liu explains that the Organ Donation and Transplantation Registration and Patient Autonomy Promotion Center (often referred to as the Organ Donation and Patient Autonomy Center) has published three graphic novels: The Little Red Robot, Second-Oldest Brother Pig's Happiness Party, and Grandpa Sloth's Wish.
By using adorable animal characters to soften the weight of the topic, these books subtly incorporate the concepts from the Hospice Palliative Care Act, the Patient Right to Autonomy Act, and the Human Organ Transplantation Act into parent-child interactions, allowing life education to take root naturally from an early age.
To reach a broader age group, the Ministry of Health and Welfare also launched the podcast series Encounter and Foresee, hosted by the highly popular Dr. Daniel Tsung-Ning Huang. Featuring students from diverse backgrounds, the podcast has now entered its third season and has gained strong popularity among young audiences.
"We hope the podcast can serve as a relaxed platform for dialogue, encouraging young people to start discussions and reflect on these issues," Liu says. Looking ahead, they plan to introduce palliative care-related content through manga and light novels, making these topics more accessible to teenagers through visually engaging storytelling.
Looking Ahead: Simplifying Patient Autonomy and Advancing Digitalization
Although Taiwan has made significant strides in palliative care, Yue-Ping Liu acknowledges that challenges remain. Beyond the societal taboo surrounding death, shifting mindset within the medical community continues to be a major hurdle.
"We need more professional training, especially for specialists who have been accustomed to focus on life-saving interventions," says Liu, who is also a pediatrician. For many doctors, letting go of a patient is a difficult psychological shift that takes time to embrace.
Looking ahead to the next decade, Liu hopes to leverage digital tools to simplify the process of signing advance medical directives, making it easier for individuals to express their treatment preferences.
"We hope that, in the future, it will be as simple as using a National Health Insurance card, ensuring that patients' healthcare wishes are easily recorded," she explained. Such technological advancements would streamline legal procedures and lower barriers to participation for the public.
World Hospice and Palliative Care Day serves as an opportunity to reflect on past progress and look toward the future, and Liu is optimistic. Taiwan strives not only to strengthen its leadership in Asia but also to secure a prominent place on the global stage of palliative care.
"Our goal is to make conversations about life and death as natural as breathing," Liu said, emphasizing that this vision is not just about the future of hospice care—it is also a testament to the maturity and inclusiveness of Taiwanese society.
