Dying In Los

jaideeguy · May 2, 2011

I know that there are lots of us in our 60's and 70's and a few in their 80's and maybe some are giving some thought to their mortality and the inevitable 'end'....will it be a 'happy ending' or not here in LOS??

This is a fresh subject in my mind, as I have just care gave [for 5 yrs] and cremated my 91+ yr old Pop and saw the pluses and minuses of dying in LOS and it has me wondering if there are better alternatives for myself and maybe others either here in Asia or back home.

I used to say with total certainty that I was here until 'the end', but having dealt with my Pop's health issues and eventual death at home, I am now having some doubts about dying here.

The positives of dying in LOS....

1] Cheap caregivers, but need constant supervision.

2] Cheap medical, but hospitals are 'corporate'.......meaning they profit by keeping you alive when you should maybe just die peacefully at home. Do you want to drain your resource$ and end up with tubes stuck in every orifice you have??

3] Family support......but can your Thai wife do it the right way?? Can she research on 'Dr Google' and find the best way to deal with all the complications that go along with old age and death?? Mine can't!!

and will your spoiled kids take on the responsibility as the Thais become more westernised and dismiss the traditional Thai custom of caring for your parents?

The negatives

1] Lack of hospice and the meds that go along with a painful end. Morphine is only available in a hospital environment according to Thai law and most drs don't even have a clue about 'hospice'. I had to explain the concept to 3 different Thai doctors. The normal Thai death is either in the hospital with tubes inserted or in pain at home with hardly any drs to make house calls.

2] There is no 'living will' in LOS now, but a knowledgeable person told me that it is in the works and may become law this year but who knows what the wording will be and will it apply to us expats, or only Thais?? My Pop had a living will from the states that was not legal here, but I tried my best to interpret and honor it.

3] Very little awareness of 'palaitave care' if you have a terminal disease and only want to be treated for symptoms and/or pain??

Then there are the many complications that I have just dealt with the legalities of death in Thailand. My Pop's death was [as per his wishes] at home with minimal pain and/or suffering, but we made one possible mistake in not calling a hospital to get a Dr to sign off the death certificate. That is a requirement with most of the larger insurance companies in the US....a dr's signature on death certificate, but here in LOS a govmt official can sign legally. That satisfied the US consulate, but may cause problems with his insurance company.

What any care giving at home in LOS requires is good management, creativity and research skills, as well as [legal] medical support if you are unable to make it into the hospital, as my Pop was during the last year or more in my care. I couldn't have done it without 'Dr Google' and a few support groups that had actual hands on caregivers sharing their experiences and techniques, as well as a very compassionate and informed member of this forum.....thanks Sh!.

That's where my Thai wife would fall short.....she is not computer literate and my kids are 100% Thai and no curiosity.

Managing my Pop's multiple health issues, especially during his last year was almost a full time job for me and we had 24 hr caregivers to do most of the routine things. If I were to choose LOS as my first choice as a place to die, I would certainly want a competent falang [or a Thai that had the same thought process as a falang....rare] to help make decisions that have to be made. During the last year of my Pop's life, he was showing more and more signs of dementia and was loosing his judgement as anyone could and often does end up in that situation near 'the end'.

And while I'm on this subject, I would like to consider other optional places to die here in Asia. Maybe some others out there can offer some suggestions/options close to LOS, as that's where my family is. Cambodia/Laos/Malaysia/Viet Nam?? for sure not Burma?? Maybe the Philippines??

LOS does have many advantages in respect to comforts and I do know the 'system' here and hopefully some western medical concepts will arrive before I have need for them, like a living will law, hospice and availability of legal R/x for pain meds at home.

My main reason for putting this out here is that I do have a fatal disease.....Hepatitis C and it doesn't have a 'happy ending', and I may be exhibiting some early signs already. Time to start thinking about a plan......

Another consideration are thoughts on the after death [Thai funeral/cremation]. In my Pop's case, I just surrendered to the insanity of an 'over the top Thai Buddhist funeral', as I was in no mood to object. It is highly likely that your Thai Buddhist wife will want to spend tens of thousands of THB on making sure your dead body and your ghosts are excorcised. Me, I won't care, as I'll be gone, but the thought of all that money and effort going up in smoke is hard to accept. I'm more concerned with the pain of dying and knowing that my family has been provided for properly than having a lavish funeral for show......

Maybe Sheryl could share her opinion, especially about Cambodia as an alternative??......what are the laws like there??

I am making a trip to the Philippines soon and will investigate the situation there and will report what I find.

Meanwhile your thoughts on this morbid, but real topic would be appreciated.

Thanks

Mario2008 · May 2, 2011

Language will be an important factor.

Especially when people get older, it might be more difficult to speak another language other than your mother language. Meaning that if you are not a native English speaker, you might have more difficulty communicating with care givers, including Thai family members. Especially for people who develop alzhaimers/dementia it will be problematic and a return to the home country might be the best solution.

cardholder · May 2, 2011

I think this thread has two aspects:-

Death itself, and the act/means of disposal.

This part is simple and be thought through beforehand. I had a conversation about this with my daughters only last week. My wishes are clear in that I want to be cremated in the country in which I die. I will submit to whichever cremation procedure is applicable with my remains disposed of in accordance with local practise.

Less straight-forward is the process of 'dying' and the OP has identified a number of different situations. This needs careful consideration but I think much will depend on the specific condition.

I, for one, do not want to rush back to my own country but in Jaideeguy's position, with Hepatitis C, it is important to have a plan.

saraburioz · May 2, 2011

By the time I die(let's assume 70), I'll have lived here much longer than my native Australia.

Surely retired folks have enough time to learn the language.

lovelomsak · May 2, 2011

This is something that has been nagging at the back of my mind also. I am single and live alone. When I die I am sure none of my family will be able to fly over and get my body(if anyone here knows who to contact in the first place). I would like some thai here to take charge get me cremated and send the ashes home.But how to organize this is just beyond me. I donot even know where to start. I used to joke when i die just throw me in a dtch by the road. That is maybe where I will end up. I have absolutlely no one to take care of this for me. and have no idea how to arrange it.. Seems to me to be an impossible task.

jaideeguy · May 2, 2011

Not sure where you are from Lovelomsak, but the US consulate is there for us Americans when it comes to dealing with death and remains. Go to the website of your country's embassy/consulate and they should have a procedure. It does cost, so hopefully your next of kin can help with that.

Yes, language is the biggest problem and multiplied when your mind is failing. My Pop was lucky in having me to do all the translation, even with English speaking drs.....which most are, but you have to know Taigenlnish. I was the only human in this country that knew what he was saying.

And yes, every death is unique except fot the ending. I may be lucky enough to get run over by a bus and be spared the longer pain of a failing liver.......but death is a fact of life that we will all have to endure and I'm just looking for the best place if I start manifesting symptoms of my condition and the dr gives me 6 months to live.

Mario2008 · May 2, 2011

Yes, but that abbility you can also lose. With dementia it is likely that you lose the ability to speak other languages. We don't all age the same way, with a sound mind.

cardholder · May 2, 2011

Why would you want the ashes sent 'home'. Do your family want them - have they every expressed a desire to have them ?

This is what sparked the conversation with my daughters - what are they going to do with them ?

We decided that I would make provision in my Will for a sum to be spent locally (UK) on a suitable memorial IF my daughters so decided at the time.

Your wishes can be set out in a Will - as long as someone knows what to do with it. I have lodged mine with a friend who provides such a service.

PM me if you require details.

jaideeguy · May 2, 2011

Sending ashes home [legally] is a problem unto it's self. We had Pop's ashes here and I sent my share of them into the Maekong [which is illegal], then I have a portion for both my brother and sister and checked on line and found that CANNOT do with Fedex/ups or any private carriers as well as postal and only some airlines will allow them to be hand carried.....never could find which ones did alow.

In short, I found no legal way, so I just put them into a box of gift items and hope that they make it.....won't say how, yet.

And yes, with dementia, you loose the ability to even speak your native language, as my Pop did and he was a retired editor for a newspaper and it was really sad to see a 'man of words' loose his words.

ballbreaker · May 2, 2011

If you want to die without all the tubes but with comfort care only then stay away from private and larger government hospitals. The doctors at rural government hospitals seem willing to follow your instructions provided an affidavit stating those wishes is signed by family members.

Your right about pain drugs being a problem. I know both morphine tabs and oral liquid morphine are prescribed by doctors at hospitals for administering at home but when the person becomes unconscious you have nothing you can administer. Your only option is transport person to hospital or watch them suffer. If you do not want to prolong their life or watch them suffer then transport to small hospital where they can be instructed to provide comfort care only.

Edited May 2, 2011 by ballbreaker

deejah · May 2, 2011

very important topic thanks

dare i say i would like a DIY back up plan if mobile enough to do so

and perhaps a backup for my backup

i know this is not for some so spare me the preaching

i really haven't much of clue now

but this like finacial planning and planning for other catastrophes should be a high priority for me

sidebar: if morphine effects are anything like the other opiates, i will not be able to tolerate them, as they make me sick, dizzy and nauseous

Panhandler007 · May 3, 2011

Several years ago there was a fellow from California who settled in Kampot, Cambodia. He set up a cafe selling drinks and baked goods. He also set up a website called www.euthanasiacambodia.com(I beleive). It has since closed down. The site stated that since Cambodia does not have laws against euthanasia, he though he would be doing the world a favour by providing assisted suicides! One English lady took up the offer after finding out she had been diagnosed with cancer.

There was a write up bout this guy in the NYT.

Here is link from a local Cambodia news site.

http://www.khmerfuture.com/index.php/index.php?name=News&file=article&sid=648

Panhandler007 · May 3, 2011

It sad to not have anyone to fall back on.

But the situation is not imposwsible. I m kinda thinking all you would have to do would be to hook up with even a HALF decent local girl or befriend of decent local guy who would take care of cremation and sending your remains off to OZ. Leave some cash to help ease things along. It sounds like you have or will have been in LOS for a number of years. Surely you mush have had some decent relations with at least some locals who can help you out in this regard. I really can t think of a Thai who would not help out in this regard, once a relationship has been created...

cardholder · May 3, 2011

The issue is not their willingness, but their ability to help.

dddave · May 4, 2011

A friends grandfather emigrated to the US from Armenia in the '20s when he was a young man. He became a successful business man and a power in local politics. He spoke English with almost no accent yet when he was in his late 80's and dementia set in, he reverted back to Armenian and his family was unable to communicate with him. Even crueler, he began to relive the horrors he had witnessed in Armenia as a young man and was tormented by them.

Dementia is hell on earth and is what I fear the most.

Sheryl · May 4, 2011

There are really 2 separate issues here.

one is the bureaucratic mechanics/red tape etc involved in death of a foreigner in Thailand. When time permits we'll compile various posts and info on this topic and post. it is a great deal more involved than when a Thai national dies. And, as the OP mentioned, aside from legal procedures there may be requirements linked to home country insurance policies/retirement funds/estate settlement etc that following the required legal procedures at this end will not necessarily address.

The other and much harder problem is that palliative care medical services here are almost non-existant and the "hospice" concept (a main stay of palliative care in the west for decades now) hasn't yet arrived, although there is starting to be at least a few stirrings of interest and discussion. And no, Cambodia is not any better in that regard.

I have my fingers crossed that this will change by the time I have need of it. The sort of "do it yourself" hospice care the OP managed to provide is not something any Thai could pull off and was far from easy, even with technical advice from western health professionals and experienced care-takers.

jaideeguy · May 4, 2011

Agree with you Sheryl that there are 2 separate issues here, but they both deal with 'Dying in LOS' and disapointed [but not surprised] to hear that Cambodia is not an option. I also hope that Thailand gets it's act together before I need it, as you know what I am facing from our previous discussions and with my probable painful end, I still find it ironic that we are in the golden triangle, but getting morphine outside of a hospital enviornment is legally impossible.

The Thais can be so compationate except when it comes to releiving pain and with their strong family ties and responsibility to parents, you would think that they would have some basic hospice and/or palliative care. Not only in my Pop's case, but I hear of many sad stories in our small moobaan where the hospital just discharges their terminal patients with very little follow-up Tx and they just suffer at home until they die with the most minimum of relief from pain.

I am planning a trip to the Philippines soon [where I lived before LOS] and will investigate the situation there and report on this thread. Google has already informed me that they do have awareness of hospice and there are several orginizations up and running.

Thanks [again] for your input....

J

Sheryl · May 5, 2011

Yes, do let us know re the Philippines, I'll be interested.

Morphine can be legally given outside of hospitals in Thailand but only in sustained release oral form (and of course on prescription, obtained from a hospital pharmacy). Unfortunately this does not suffice in the later stages of dying when people can no longer swallow, and it may also not be sufficient in cases of severe pain.

Intravenous morphine is the mainstay of hospice care as it not only relieves pain but also alleviates the anxiety and discomfort associated with trouble breathing as the end nears. Small battery-operated computerized pumps suitable for use in the home have been around for decades now and make it possible to administer morphine drips safely in the home without risk of overdose or other misuse. The correct dose is entered via a code known only to the medical staff, along with permission for a limited number of extra doses by the patient if necessary, ("patient controlled analgesia"). A nurse goes to the home when the cartridge needs changing or the IV blows, otherwise it is self-operating and pretty much fool-proof and tamper proof. These devices revolutionized hospice care in the west when they came out maybe 15 years back but along with the entire concept of palliation remain unknown here. Hopefully not for too much longer. I'd hate to have to leave my home and go back to farang-land when my time comes to die but under the present circumstances I'd have to seriously consider it

deejah · May 6, 2011

just curious

if the side effects of morphine are intolerable

what are the general alternatives

here and in the west

thanks

Sheryl · May 6, 2011

In what context are you speaking?

If (as is the theme of this thread) you mean the final stages of a terminakl illness, there are no drugs that work as well (in terms of relieving the discomfort of agonal breathing as well as pain) as morphine and morphine-related drugs, and I have never encountered a case where side effects at that point in time weren't manageable. Sedation at this stage of the game isn't a major issue (may even be a plus), nausea/vomiting respond well to appropriate medication, constipation is of no importance in the final days of life and prior to that can be managed with laxatives/suppositories/enemas etc.

If you are talking about morphine in another context, such as pain management in someone who is either not terminally ill or is still some time away from the final stages, then that's a whole other matter and depending on the type of pain there are a wide range of options.

Suradit · May 8, 2011

Embassies are notified in the case of a death of a non-Thai. If you want your embassy to contact someone back home, that information should be on record with them.

The US embassy normally holds up "disposal" while waiting for a response from family back home. I checked with them about circumventing this and was told that if clear instructions regarding allowing someone locally to arrange the funeral etc. were included in your Thai will, they would accept that as your decision and not hold things up. My Thai friend, however, is not very eager to discuss anything that begins, "When I die ..." I suppose that's more comforting than if he were to appear overly enthusiastic.

More generally, a Thai will is a good idea especially if you're not married since your assets in Thailand go into limbo (and/or disappear) if there is no definite heir.

I recently checked out buying a burial plot in the Eternal Peace Garden and found out that you were in fact getting a 30 year lease. Obviously "eternity" is relative.I wonder what happens after 30 years, but didn't ask.

Edited May 8, 2011 by Suradit

arrowsdawdle · May 8, 2011

Looks like you may soon have plenty of "volunteers" (with emergencies of their own) ready to help you take care of everything, take care you long time, now that you have put the word out.

Anyse · May 8, 2011

To me, it is not a matter of managing one's health at the "hospice" stage at all. It is more the idea that one can more easily choose what is called "self deliverance" by the former "Hemlock Society." To suffer to the end and to create all of the problems that go with it for the literate person, such as you, or the illiterate and not up to it Thai wife or whomever, is such a burden to place on a family anywhere in the world. Have you considered this at all? There is a place to look this up at www.finalexit.org. You may want to read up on this. I know of many friends who have taken this option when they knew that their final days, months or years would not bring them a dignified death or ending of their lives.

Hermes100 · May 8, 2011

I am very grateful for this topic.

Although I am not that old I am planning on spending my last year's here in this wonderful country. I am single and have a modest amount tucket away. I suffer bady from the bad winter's back in my native europe and I dislike the long dark day's.

I have some mild health issue's but seem to have sorted all that now, in part thank's to the wonderful advice and assistence of one particularly helpful lovely young staff member at the bumigrad hospidal, Miss Pear. She epitomized everything I love about this country.

I have travelled around the world and think this is one of the best place's a older happy person like myself could end his day's. It's not really a morbid subject.

When I finally settle down here I will immerse myself in various charity work and that will certainly keep me postively busy.

All in all, thailand is wonderful place to peacefully enter one's last year's.

jaideeguy · May 30, 2011

Reviving this depressing topic I started as I have just returned from Philippines and have confirmed with several Drs there that they do have Hospice and palliatave care there in major cities and it is a non profit The head hospice dr at a major hospital and med school informed me that meds and services were free even to foreigners.

This does have me rethinking my situation [slowly progressing hep C] and where and how do I want to go out when my 'time bomb' goes off??

The Medical system there [outside of Manila] is a few years behind LOS in terms of advanced equipment but drs there do 'think outside the box' and all speak much better English....some have interned and or practiced abroad.

For the best TX, there is the equivilant of Bumrungard [sp?] in Manila [saint Lukes] that is equally expensive........ people tell me that it is 'world class', but in my case, I am choosing not to treat and simply want to go out at home with the proper meds that are unavailable here outside the hospital enviornment.

Also confirmed that Phil honors a living will, which LOS doesn't have yet.

Conclusions from my comparison trip are that LOS maybe has better surgery and more modern equipment, but when it comes to a terminal condition, the Philippines has more compationate drs and a more western system. Also access to affordable nurses and caregivers, if needed.

Sheryl · May 30, 2011

Thanks for the update

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