This meeting, with several medical law experts, policy makers, specialists, and volunteers, aimed to advocate the concepts of advance directives and dissolve any myths regarding living will documents within the general population and healthcare workers.
Even though a law about advance directives has been in place since 2007, dispute and unrest are still high among those who work in palliative care, partially due to the lack of knowledge and practical guidelines on the subject.
A national survey showed that only a handful of people had already signed a living will, less than one percent in total.
Living will document
Section 12 of the Thai National Health Act made it clear that: “A person shall have the right to make a living will in writing to refuse the public health service which is provided merely to prolong his/her terminal stage of life or to make a living will to refuse the service as to cease the severe suffering from illness,” and: “An act done by public health personnel in compliance with the living will under paragraph one shall not be held an offence and shall not be liable to any responsibility whatsoever.”
Despite this law, some health providers are still convinced that it is another form of euthanasia whilst others believe that it is against the fundamental medical bioethics; to do no harm.
Professor Sawang Boonchalermwipas, a law professor from Thammasat School of Law, clarified the importance of the living will, noting that under no circumstances is this document a violation of patients’ rights, hastening their death in process.
Rather, it is a way to help everyone realise patients’ wishes. The Supreme Court also made a verdict regarding a lawsuit against this document not so long ago that the law still hold true and is not euthanasia as some people had accused it to be.
Factors to promote advance directive
Dr Chantana Mokcharernpong from the National Cancer Institute also expressed her opinion that in other countries such as the USA, the number of people who had signed the documents rose up to more than 30%. In order to achieve that in Thailand, we need to improve in many aspects of care, including:
- Advance Care Planning between patients, family members, and doctors; and
- adequate symptom control.
During the terminal phase, patients could develop numerous symptoms. And doctors are able to provide adequate care to alleviate these symptoms, such as pain, breathlessness, and delirium.
We also need to stop futile treatment that could only bring harm to them, such as intravenous fluid and nutrition, intubation, or any other aggressive procedures that would only bring further suffering.
Nowadays, due to various restrictions, such as legal restrictions or hospital policies, morphine is still not widely available in Thailand. But the situation is getting better.
Spirituality is another aspect that needs to be explored in order to provide comprehensive care to our patients. Dr Mokcharernpong gave an example of one of her patients, an indigenous person, whose cultural belief make it a necessity for them to pass away at home and she, as her doctor, facilitated just that.
Achieving a Good Death
Mrs Wanna Jarusomboon, a volunteer from Buddhika Foundation, also stated her opinion on this matter.
Since majority of Thai are Buddhist, most of the patients would prefer the concept of a ‘good death’. But there will be times that patients would be unresponsive and living will would act as a tool to help them communicate between the family and doctors.
She also emphasised that taking care of palliative care patients requires a multitude of help from everyone, including the family and healthcare team.
Apart from that, it was also the fundamental right for patients to know about their disease and could express what they do or do not want so that the patients could depart from this world without any unfinished business.
During the closing session, Professor Emeritus Dr Withoon Ungprapan remarked that death was one chapter of our life and we, our family and also doctors, were all abided to prepare for that.
Even if we are trying to conquer death, as what doctors did in the past, it was, and always will be, inevitable.