Though euthanasia is still illegal in Thailand, the conversation around end-of-life care is shifting. Terminally ill patients now have the choice of palliative care or a living will that asserts their right to refuse life-prolonging treatments.
Dr Isaree Siriwankulthon, whose novel inspired a TV series on the theme of mercy killing, has expressed hope that Thailand will focus on high-quality care for terminal-stage patients, before debating the legality of euthanasia.
The doctor-cum-writer addressed the sensitive topic in her novel after encountering numerous patients pleading for death. “If you can, please end my life mercifully,” wrote one terminal-stage patient, recording a common wish in her living will.
Dr Isaree recalled the first time a patient asked her to help them to die, saying it had affected her deeply. Since then, she has been haunted by the arguments surrounding assisted dying.
What can doctors do?
Dr Isaree works at Nakornping Hospital in Chiang Mai, where she specialises in care for terminal-stage patients and has met numerous people in the final stage of their lives.
Under Thai law, doctors cannot end a patient’s life even if they are pleading for release from pain caused by a terminal condition.
“What doctors can do, under current law, is to respect a patient’s living will,” Isaree said. “This could mean refraining from actions like intubation or resuscitation when the patient chooses to forgo life-prolonging treatments.
Understanding living wills
Living wills gained legal recognition in Thailand in 2007. Under Article 12 of the National Health Act BE 2550 (2007), a person can issue a living will to declare their decision to not receive medical services that will extend their life. A living will is also recognised when patients wish to end the suffering associated with their illness.
Doctors who comply with living wills face no legal action for not trying to save the patient’s life.
However, matters can get complicated if a terminal-stage patient has not signed a living will. This is because most doctors believe their duty is to keep their patients alive for as long as possible. Also, when a patient reaches a stage where they can no longer make decisions for themselves, their children or relatives are often left to make choices regarding their treatment.
Dr Suthep Petchmark, secretary-general of the National Health Commission Office (NHCO), explained that while living wills have been available for nearly two decades now, they remain underutilised.
“It’s difficult for both patients and relatives to prepare a living will at the last stage of their lives. Cultural beliefs often lead families to push for life-extending treatments, even if they prolong suffering,” Dr Suthep said. “This is why it is so important for individuals to prepare their living wills in advance.”
To simplify the process, the NHCO has launched an online platform to assist in writing an e-living will (https://e-livingwill.nationalhealth.or.th/). Of the 1,000-plus people who have used it so far, most (918) are aged over 60, though 12 are children under the age of 18.
“Patients are also given the option of drafting a living will at the place where they are receiving treatment,” Suthep said.
To date, living wills are mainly drawn up by seriously ill patients, he added. Currently, of the 181,294 patients receiving palliative care in Thailand, almost two-thirds (107,122) have prepared living wills.
In a bid to encourage more people to recognise their importance, the NHCO has partnered with the Interior Ministry to help people draft a living will via the ThaiID application.
“This app also allows you to amend your living will anytime, anywhere,” Suthep explained.
A living will can be prepared by an individual alone, but adding a witness increases the credibility of stipulations on how they want to receive treatment in case they fall ill and are unable to make decisions.
Benefits of a living will
Living wills are more than just a declaration of personal choices when it comes to end-of-life care. They also serve to alleviate emotional and financial burdens on families, reduce unnecessary medical costs and prevent conflicts over treatment decisions.
“They reflect a person’s preparation for the inevitable,” Dr Suthep said. “When families know their loved one’s wishes, it eases tension and provides clarity during a difficult time.”
Plus, he said, living wills enable medical professionals to fully understand a patient’s needs, reducing the risk of them receiving treatment that does not align with their beliefs and values.
Bridging the gap with palliative care
Dr Pinyo Sriveerachai, a specialist at the Siriraj Palliative Care Centre, hopes to raise public awareness of palliative care and living wills, highlighting their crucial role in shaping the quality of life for terminal-stage patients.
“We should prepare a living will before we fall ill. This is important for anyone who values their independence and peace of mind,” he said.
Hoping to boost public awareness of the issue, the Siriraj Palliative Care Centre has published several novels addressing the issue, including the one written by Dr Isaree. It is also promoting the TV adaptation of her book, as well as plays and films addressing the same theme.
A personal perspective
“K”, a 50-year-old man, said he had already issued an e-living will despite not suffering any serious health conditions.
“I want to make things easier for my children, grandchildren and carers,” he explained.
When asked about assisted dying, K expressed support for its legalisation in Thailand. “If this choice were available, I would consider it,” he said.
Euthanasia has been legalised in several countries, including Switzerland, where anyone with a terminal-stage condition or severe physical or mental illness can seek assisted death. Euthanasia is also legal in Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, Spain and Australia, albeit with tighter conditions. In the United States, assisted suicide is available in 10 states, including Washington.
A path forward
Dr Isaree, however, says Thailand’s focus should not be on whether or not to legalise euthanasia. Instead, she said, the country should make greater efforts to deliver inclusive and quality palliative care for all those who need it.
“Only after we have done our very best on the palliative care front, and cannot ease our patient’s suffering, should we consider pushing for the legalisation of euthanasia,” she said.
By Thai PBS World’s General Desk
