The Right To Die At Home

[billd766]

I saw a bit in the Nation this morning where Thai patients will not be given treatment to prolong their life provided that they make a declaration in advance that they do not wish to stay in hospital at a high cost to their relatives.

This is something that I have been wanting to be able to do legally for a long time.

A Thai friend a long time ago looked after her 84 year old mother in the last few years of her life at her home and sometimes her elder sister would help or not as the mood struck her. Eventually the old lady went into an modern hospital in Bangkok for the last few weeks of her life where she was given every care. There was no problem with her treatment as she had the best things she would need including an electric bed so that she would be comfortable, satellite TV, not much use as she was nearly bling and deaf, tubes running to most parts of her body to improve the quality of her last few weeks of life.

The final bill came to between 500,000 and 1,000,000 baht and whilst it didn't bankrupt her family it was certainly a large chunk of money.

I have told my Thai wife that when I am that close to dying I would be much happier to be at home with my family and use the money for their future and not prolong the quaility of my life by a month or so at a high cost because I will be dead soon enough anyway.

Save the medical costs for my wife and sons future as they will need it more than me.

Now all I have to do is to persuade her.

I had a similar discussion with my UK wife long before we divorced and she agreed with me.

[Goldenbead]

It is an easier thing to ask than to give. My father spent a long time dying and it was very difficult for everyone, especially my mother. He had expressed a want to die long before he got to the very bad stage but once he was there, it couldn't be done. Not that we would have done it.

Even though I knew he had a horrible life, it was not ours to take away. It is easy to say I don't want it but much harder to actually carry out that wish. Even though I knew it was better off for my father to have passed on, it was very hard coming to terms with his death.

[Erwin1011]

It is an easier thing to ask than to give. My father spent a long time dying and it was very difficult for everyone, especially my mother. He had expressed a want to die long before he got to the very bad stage but once he was there, it couldn't be done. Not that we would have done it.

Even though I knew he had a horrible life, it was not ours to take away. It is easy to say I don't want it but much harder to actually carry out that wish. Even though I knew it was better off for my father to have passed on, it was very hard coming to terms with his death.

It is always more difficult for those left behind than for the individual going or wanting to go. But it is also very difficult to accept and let go.

The decision to avoid long suffering and sometimes high (almost ruinous) financial cost for the family, is one that must be taken after serious discussions within the immediate family group. As a cancer patient, I know that somewhere in the near future me and my family will have to face that situation.

For me personally the decision is simple: I don't see why I should live either beyond the point where pain becomes unmanageable or where the financial cost endangers the future of my family. Getting my family to accept and let go is a far more difficult proposition than I thought and I hope I have sufficient time and resources left to bring that to a conclusion.

[backflip]

My brother-in-law developed cancer and, after several months of treatment, he decided to throw in the towel. Fortunately, there was a nearby hospice - they made it possible to spend his final days at home, and to die with dignity. These wonderful folks provided him with sufficent pain medication, a hospital-style electric bed, weekly checkups at home, and 24-hour/day counseling - all for no charge. When he passed away, they arranged for his cremation, and grievance counseling for my sister. God bless them. I have no idea whether Thailand has the same type of service

[Sheryl]

I too have often wondered about hospice care in Thailand (I have done hospice nursing in the West) but as far as I know it hasn't made its way here yet..anyone have different info?

I certainly hope it does before it comes my time to go.

Goldenhead: There is a difference between helping a person die and simply refraining from treatments that are not going to make a difference to the outcome other than to make the dying process slower and often more painful. (and of course, costly). The former is euthenasia and without getting into a debate about it, clearly it is a serious step and easier as you say to ask for than to give. The other is just plain good medical care, compassion and common sense. My condolences on your loss. It hasn't happened to me with a family member but as a nurse I had to face requests for euthanasia from dying people and that was agonizing enough...I can just imagine how wrenching it would be coming from a loved on. No one should have to be put into that dilemma.

The painful dilemma of euthanasia would be rarer if unnecessary death-prolonging treatments for terminally ill people were avoided in the first place and better pain management routinely provided.

[DragonQuest]

Its up to the person laying in the bed at the hospital thats sick if they want to decide or not(familys opinion always counts too). I dont know why hospitals are always trying to get the most money, personally Hospitals are a god-send but the bills can be enormous.

[jaideeguy]

A search for 'hospice' led me to this old thread that I would like to revive......

Caregiving my 90 yr old father with osteoporosis, [probable Alz/dem], colapsed lungs and recovering from fractured verterbrae and looking like he is at 'death's door' is makeing me reach out for recent info on hospice and living wills. I'm located near Chiang Mai and wondering if there are any [hopefully English speaking] hospice services up here.

Pop does have a living will that he brought from the US, but don't know if it is valid here. He has made it clear that he wants to fade away at home and not a hospital. .......me too!

I'll ost on the CM forum about hospice up here, but if anyone has any fresh input, please share.

[bubblegum]

I have been thinking about this a lot. My father dies a few years back after suffering from cancer. A friendly docter gave him a deadly shot at his request. He had the time to say goodbye to his beloved and that was it. For me as only child is was very strange to say goodbye knowing I would never see his again.

For the last few years my mother has a braintumor and she does not recognise me, actually the last few times I visited she was very upset and thought I was a burgler. Togheter with trusted friends we decided that I would not viset her again and we contacted our incurens ?( Sorry not native English) compagny and now my mother has 24/7 care by a team of proffesionals who take really good care of her. Ofcause not all is free and I'm paying thru my mothers bank. It is not my money, it is my mothers and fathers since I refused my inheretens when my dad died so all the money could go to my mum. Now I'm paying out of her funds and when she eventually dies it will only mean that my inherentans will not be like it was before.

I think that I will not like the same thing happening to my Thai wife, I rather die quickly so she can enjoi wathevr I can leave her.

[jaideeguy]

while 'googling', I found the following that may be of interest to some..........

http://www.nursingcenter.com/library/Journ...ticle_ID=939561

Hospice Care: A Cross-cultural Comparison Between the United States and Thailand

Yaowarat Matchim MS, RN

Myra Aud PhD, RN

Journal of Hospice and Palliative Nursing

September/October 2009

Volume 11 Number 5

Pages 262 - 268

would appreciate feedback from others that would like to know.

sounds to me like there is some lite at the end of the tunnel.

[jaideeguy]

I've asked my father's doctor about honoring living wills and his reply was that they do have to by Thai medical/legal ethics have to resucutate [sp?] and extend life by machines and the only thing they can do is [with family permission] is stop medication. Sounds like it could be a slow and painful way to go......probably dictated by Buddhist beliefs that we are put here to suffer, as well as the fact that private hospitals are corporations and have to show profits and they don't make profits on healthy people or dead people.

But, what if the person was not taken into the hospital to begin with?? Would the caregiver [honoring the patient's wishes] be held liable for neglect??

And I read a post elsewhere on thaivisa that a family member can take the patient out of the hospital.

Can anyone confirm the above???

[Sheryl]

JDGuy,

Your doctor's understanding of both law and medical ethics is incorrect and I would urge you to change doctors.

Patients have an absolute right to refuse any and all treatment, even if the treatment in question is life saving and they will otherwise die, and most certainly have the right to refuse treatments that will not alter their prognosis. this is as true in Thailand as anywhere else. Conventionally, the wishes of family members are heeded if the patient is unable to speak for themselves. Life support is not always used and plenty of elderly and/or terminally ill people are allowed to die without such measures in Thailand, always have been. Doctors do vary greatly though in how they handle this.

And yes, family members can take a patient out of a hospital. Announcing there is no more money to pay the bill generally facilitates the hospital's coopertaion in this regard

There is a draft law pending that will require doctors to honor a "living will" in cases where patients are no longer able to speak for themselves and guranatee them (the doctors/hospital etc) immunity from lawsuits or other legal action in so doing. This is because there seems to be a widespread concern among Thai doctors that failing to do "everything" for a patient could leave them open to legal action although I have never heard of that actually occurring.

Change doctors NOW, before the situation arises. It would also be best to simply never let your dad get admitted to a hospital to start with.

There is virtually no hospice care to be found in Thailand and in particular not the home hospice care common in the West, one has to sort of patch it togther on one's own. In your particular case this will not be as difficult as it is for some since your father's condition is not likely to require much if anything in terms of pain medication, it is a great deal harder (not impossible, but difficult) in cases such as terminal cancer where a person wants to die at home and needs strong medications to control severe pain.

[Khonwan]

It appears to me that the draft law referred to by Sheryl has already come into law via the Health Act 2007: http://www.thailawforum.com/database1/Impo...the-Health.html

A sample Living Will can be found here: http://www.thailawforum.com/database1/tran...to-english.html

[MJo]

Some if not all European countries you can refuse treatment. My grandmother, at the end, allowed only non-intrusive treatment (is that correct term?) anyways meaning no operations of any kind, just medication. Not even a drip. Also no cpr or anything like that to bring her back.

For the same reason, she did not want to make it any longer than necessary and i can understand that even if it is hard to deal with after they are gone.

[robblok]

Some if not all European countries you can refuse treatment. My grandmother, at the end, allowed only non-intrusive treatment (is that correct term?) anyways meaning no operations of any kind, just medication. Not even a drip. Also no cpr or anything like that to bring her back.

For the same reason, she did not want to make it any longer than necessary and i can understand that even if it is hard to deal with after they are gone.

Some countries like holland are even better they can actively help you to die. I just hate the idea of dying painfuylly when terminally ill. The idea of having to struggle in pain when life support is turned off is just so bad it should not be like that. Its much better when they give you a shot of sedative to send you on your way. Of course after all the paperwork is done to make sure they dont send people on their way who dont want to die. But i think its much more humane then the way it goes in for instance the USA where they just turn down the machines and it could take up hours to die.

[CTO]

In the village pretty much everyone comes home to die, which I think is a good thing. My father died at home - life time medical man, he preferred it, though to quote his nurse - "we wouldn't let dogs suffer the way we let people suffer" She wasn't being cruel - just realistic.

[jaideeguy]

Thanks Khonwan and Sheryl......

I will show a copy of the example to our local attourney and have him come out and sign both me and my Pop up....the wording seems perfect to me.

And Sheryl, I have made contact with [who I think] is a good dr that has experience with alz/dem and the elderly and he seems like a very compationate dr. He even offered to make a house call to see my Pop, as he is confined to bed at this point and dragging him around CM chasing doctors is no fun.

Maybe now that we finally have the living will here in LOS, it should be pinned for others to refer to.......just a suggestion.

JDG

[Sheryl]

It appears to me that the draft law referred to by Sheryl has already come into law via the Health Act 2007: http://www.thailawforum.com/database1/Impo...the-Health.html

A sample Living Will can be found here: http://www.thailawforum.com/database1/tran...to-english.html

The Health Act of 2007 established the right of patients to execute a Living Will (AKA Advanced Directive) and the obligation of health professionals to honor such a document, but subject to the provisions set forth in Ministerial Regulations which have not yet been enacted. That (the Ministerial regulations which will specify how this law is to be implemented) is what has recently been approved in draft and is expected to soon be approved.

Until it is, there is no legal framework as to what such a document should contain/how it should be prepared etc etc.

Hopefully it iwll not be long before the regulations are finalized and issued.

I have included a link to the full text of the 2007 Health Act in a new pinned notice.

Some "how to" posts regarding suicide or euthenasia have been deleted. It's fine to talk about the right to refuse treatment, die at home etc...but not to start discussing ways and means of actively killing oneself or others.

[jaideeguy]

Even tho the law is not yet official, I will take the sample letter and still have the lawyer notorize it just to let my father's wishes be known while he is of [semi] sound mind. The impression that I get from most doctors is that they will try to honor the wishes of the patient and it will be up to me to not let my Pop get caught in the clutches of 'Thai Corperate Medicine'.

Too bad we can't discuss the topic of 'youth in asia' [say it fast] on this forum. Does anyone know of any other web boards that will let you discuss this topic??

[Sheryl]

We can certainly discuss ethanasia as an issue. But not give "how to" instructions as that amounts to advice on how to commit a crime. Euthanasia is illegal in Thailand, as it is in most places.

It should be understood though that

(1) witholding treatments that are not going to change the ultimate outcome and/or that the patient does not want is not considered euthanasia.

(2) providing adequate pain and anxiety relief to terminally ill persons -- adequate being defined as enough to achieve comfort -- is not considered euthanasia even if it has the effect of hastening death. The key distinction, both ethically and legally, is the intent. In one case the drugs are given to a person who is otherwise suffering with the intent of making them comfortable and the amount given is the amount necessary to achieve that aim. In the other case the intent is to immediately end the person's life and amount is according to that and the person may or may not have been suffering, they may even have been unconscious.

One of the ethical problems with euthanasia, as opposed to pain relief, is that it is very easy for to confuse the discomfort of watching someone die or endure major disability with the patient's own suffering and to believe that one is acting out of compassion for the dying person when in fact one is primarily driven by a need to end one's own suffering at the spectacle. It can be impossible for an emotionally involved person to separate out these two things.

Which is why even in those countries which allow euthanasia there are very tight controls in place.