Living Wills

[Sheryl]

The right to refuse treatment first recognized  by the Health Act of 2007; in 2010 a regulations was enacted sopecific to Living Wills. It took effect in mid 2011.

 

The regualtion in Thai is here:
http://www.thailawon...ion in Thai.pdf

and an English translation by Issan lawyers is here:

http://thailawonline...aan_Lawyers.pdf

Recently, a TV member was successful in executing one a Bangkok Hospital in Bangkok , and I am told that  BPH has the forms and related information.

 

As this is of great concern to all of us, please post any relevant experiences you have.

[uptheos]

I suggest anyone making a Living Will following these guidelines, should attach a copy of the guidelines to the Will.

 

If you have a GP, deposit a copy of your LW with him/her and also add it to any medical records you may have in various hospitals.

 

Make sure several people know of it's existence, just in case the person who you think will start the ball rolling, can't do it or is unable to do it when the time comes.

[TallGuyJohninBKK]

As a result of a law change that took effect in 2011, residents of Thailand now have the legal right to execute a so-called "living will" that provides direction to a hospital and physicians about to what extent, if any, you desire life-sustaining treatments to be administered in the event you become terminally ill or otherwise unable to direct your own care.

 

Some background on the issue and the law is here:

 

http://thailawonline.com/en/family/living-wills-in-thailand.html

 

What's less clear, however, even three years later now, is just what it takes to actually execute such a document at any particular hospital in Thailand. There are generic forms out there for Thailand living wills, which include the ability to check-off different treatment options. But some hospitals such as Bumrungrad in Bangkok also have their own individual/unique form, and apparently will insist you follow their particular procedure and living will document instead of any generic one.

 

So that kind of approach potentially creates some issues, since a person might not know ahead of time what hospital they might end up in as a result of some unexpected/unforeseen event, such as a serious traffic accident that leaves you in a coma. At that point, obviously, it would be a bit late for the victim to start trying to follow the hospital's own unique living will requirements. But it does kind of suggest the need to check with any local hospital you think you might use (be treated at), about what they will require/accept in terms of a living will document.

 

-----------------------------------------------------

 

Knowing of the law, my wife and I set out for Bumrungrad a few days ago with the objective of at least finding out what we needed to do to execute a living will acceptable to the hospital, since that happens to be the one closest to our home, and certainly one of the main international hospitals in Bangkok. Here's what we encountered:

 

Before heading off to the hospital I checked Bumrungrad's website and found nothing in the way of info about living wills, which was kind of what I expected. But I did find their webpage about an International Patients Center on the third floor of the main building, so I figured that would be a good place to at least start our inquiry. When we arrived to the hospital and went to the third floor, it turns out, they no longer (despite their webpage) have an International Patients Center there, and its duties, we were told, have been parceled out to various other units around the hospital. Not a good start.

 

So, at that point, we went back downstairs to the main customer service desk on the ground floor of the main building where they had a variety of English speaking reps. And I told one, slowly and clearly, that we'd like to speak to someone about Living Wills. To which the CSR lady replied in English, "You mean about taking vitamins and things like that." And I replied, "No...not Living WELL... Living WILLS." And of course, that lady and various of her peers had no idea what we were asking about. So finally after a few rounds of back and forth, I politely insisted we speak with their supervisor, another lady who was nearby.

 

Once we were talking with the CSR supervisor, she fairly quickly did know and understand what were were asking about, but she had no clue who we should talk to at the hospital, other than that she kept insisting we make an appointment to discuss the issue with a doctor, which I refused, sensing that was going to be a trip down a wrong-way street. So again after a few rounds of back and forth, she asked that my wife and I sit down and wait, while she tried to check on whom we should speak with. So, sit we did -- for almost a full hour -- before finally the CSR supervisor came back saying she had found the correct staff and they'd be down to speak with us shortly.

 

And sure enough, after a few more minutes, a delegation of about a half dozen very nice and friendly Bumrungrad staff ladies showed up, and we ended up going to sit and talk quietly in a nearby conference room on the subject of Living Wills at Bumrungrad. And despite all the delays and misdirection that preceeded them, these ladies were indeed very knowledgeable on the subject. The lead lady among the group was from their Medico-Legal Unit, which apparently helped draft their Living Wills policy, and then there also was a nurse from their Palliative Care unit, which is responsible for dealing with patients' living will instructions.

 

A couple of things quickly became apparent:

1. -- Bumrungrad has their own form and format for executing a living will document, and,

2. -- their process requires a consultation with one of their physicians who has to sign and certify on the living will form that the person/patient "is fully conscious and has a sound mind while completing this Living Will."  I didn't ask specifically, but I'd presume such a consultation would incur the hospital's normal physician fee and related charges. (The physician consultation/signature is not something I've seen on other living will forms for Thailand).

 

Here's the Living Will blank document that the hospital staff at Bumrungrad provided:

 

[attachment=266162:Bumrungrad Living Will Form.jpg]

 

As I understood their process, someone wanting to file a Living Will at Bumrungrad would need to start with this version of their document, fill it out and make the appropriate choices, and have it signed by a witness, and then go to have it certified by a Bumrungrad physician. Then, according to the ladies we met with, they'll convert that document into a similar final version incorporating the person/patient's hospital ID number and various other internal stuff for the hospital, and presumably keep a copy as part of one's patient records there.

 

Noting that their form was somewhat limited in its choices and range of directions, the ladies noted that the form has a section where it says, "Others, please specify." And that's the route by which they said a person can add additional directives, including by attaching their own added sheet of instructions beyond those listed on the hospital's form.

 

From our discussion, it became clear that all of the hospital ladies sitting around the table were either from their Medico-Legal or Palliative Care Units. It's probably not appropriate for me to just post the names of the ladies we met with here, especially without their prior permission. But I'd suggest, anyone wanting to do a Living Will at Bumrungrad, upon arriving, should simply tell the front desk you need to speak with the "Palliative Care Coordinator Nurse." Or failing that, with staff in the Medico-Legal Unit. And use the Living Will form I've linked above.

 

The ladies acknowledged that the Living Wills issue wasn't something well understood and known around the hospital, noting that the law allowing them in Thailand was fairly recent. But they seemed to indicate many patients already had executed them at Bumrungrad, although I got the impression that was more likely in the context of already seriously ill patients who were already being treated as inpatients in the hospital -- as opposed to healthy, non-patients simply trying to plan ahead and be prepared. The hospital seems totally out of water in the latter category.

 

When I asked about the Medico-Legal unit's role in Living Wills, one of the things they mentioned is having to deal with the situations where patients from outside Thailand (who make up a sizable portion of Bumrungrad's patient base) may have their own Living Will document drafted in their home country, but then having to migrate that into a version that's acceptable for Bumrungrad's purposes.

 

For all the difficulties there, at least one good thing emerged. Recently in a post elsewhere here, one TV member indicated that Bumrungrad was requiring people wanting to file a Living Will to have the document drafted by an attorney, and that they wouldn't accept anything else. From our discussions, I certainly found that to NOT be the case -- no mention of attorneys needing to be involved anywhere in our discussion.

 

I probably should have asked more directly, but didn't do so at the time, whether Bumrungrad would accept a previously completed generic Thailand Living Will form. But I certainly came away with the impression that they would not, and that was reinforced by the part of their document that requires certification by one of their doctors beforehand.

 

As for doctors there who deal with the living wills subject, the group we spoke to suggested that the doctor consultation could be done with their "Dr. Lily," who they said is a member of the hospital's Palliative Care committee. In looking through the hospital's physician's directory, they appear to be referring to Dr. Lily Chaisompong, who's a specialist in geriatric medicine.

 

http://www.bumrungrad.com/doctors/Lily-Chaisompong

 

 

Edited May 10, 2014 by TallGuyJohninBKK

[Sheryl]

Merged 2 similiar threads.

 

Thanks to the above poster for info provided, extremely useful.

 

I was not aware that Bumrungrad had either a Palliative Care Unit or a Medico-Legal Unit so that alone is also great info. We had a situation posted here recently which should probably have been handled by the Medico-Legal Unit.

 

A shame that the existence of these "units" is not better publicized, one wonders how patients find their way to them - not everyone has your perserverance. And I suspect that many doctors in the hospital aren't aware of them either.

[TallGuyJohninBKK]

Regarding Sheryl's comment above about Bangkok Hospital, I did find online an Adobe PDF document in English and in Thai of the Living Will forms apparently used at Bangkok Hospital Pattaya. I didn't source the document myself, so I can't say whether it's current or not. But it's certainly a good starting point.

 

And of note, unlike Bumrungrad, it doesn't appear to have any element of requiring a certification by a doctor from the hospital.

 

[attachment=266166:Bangkok Hospital Pattaya Living Will Info.pdf]

 

One of the things I'd hope to learn from this thread, is whether people here find that hospitals are willing to accept generic Thai law-compliant living wills, or are hospitals going to insist people use their unique forms and procedures. The latter approach would make planning ahead for unexpected medical events quite a bit more difficult.

[TallGuyJohninBKK]

Merged 2 similiar threads.

 

Thanks to the above poster for info provided, extremely useful.

 

I was not aware that Bumrungrad had either a Palliative Care Unit or a Medico-Legal Unit so that alone is also great info. We had a situation posted here recently which should probably have been handled by the Medico-Legal Unit.

 

A shame that the existence of these "units" is not better publicized, one wonders how patients find their way to them - not everyone has your perserverance. And I suspect that many doctors in the hospital aren't aware of them either.

 

I found no mention of either anywhere on Bumrungrad's website. But then again, I didn't find any Bumrungrad administrative departments directory listed either, other than the medical specialty ones that every hospital lists.

 

From my discussion, the main lady from their Medico-Legal unit indicated that in addition to their role in dealing with the Living Wills issue, they're also the ones that liaison with the medical staff in situations where patient care issues turn into litigation.

 

As I said above, once I got to the right staff at Bumrungrad, they were very helpful and knowledgeable on the subject. But the average Thai or farang just walking in the door and wanting to do or asking about a living will would pretty much get nowhere. The hospital staff we spoke with said a lot of farangs are familiar with the subject, but they said living wills are very unknown among most Thais.

 

 

[uptheos]

Very useful information indeed.

 

Does this mean a person has to go through the same process as Bamrungrad's to cover all possible hospitals one might be taken to?

E.g Motor Vehicle accident etc.

 

What if you have a LW deposited at BRR and have a stroke or accident that leaves you on a life support machine in Chiang Mai?

[TallGuyJohninBKK]

Re the questions you raise above:

 

That's the issue I was raising in my own post about Bumrungrad having their own unique process and form. I don't know whether other hospitals would accept it or not.

 

On the other hand, the Bangkok Hospital Pattaya living will document I attached above came from the Pattaya City Expats Club. And according to their information, that form/format is simply a reproduction of a supposed generic living will form posted online by the Thai Ministry of Public Health at the time the ministry issued its final regulation on living wills (with the BHP logo inserted at the top).

 

But as to the general recommended approach a person should take, I've seen two things mentioned:

 

1. do a generic living will document in the legal formats used above, and have it appropriately witnessed and signed as required. And then keep that document at home and with your spouse or family, in the event it's ever needed at any Thai hospital, so your relations can provide it.

 

2. if you have a main hospital or hospitals you usually use for your medical care, check with that/those hospitals about their living will procedures, and see about having them accept a copy of your document, or fill out their own form, for keeping as part of your ongoing medical record with them. That way if it's ever needed, they already have it in their system.

 

It would be great if we can, someone can, find an English version of the generic MOPH living will document, and post it here for general use.

 

PS - I had an English version at home of the Ministry of Public Health regulation on living wills, and nowhere in that is there any kind of mention or requirement about a doctor having to certify the document in order for it to be valid. So Bumrungrad appears to be going beyond what the MOPH regulation entails.

 

Edited May 11, 2014 by TallGuyJohninBKK

[seedy]

Thank you Tall Guy John. Detailed and informative post.

[Sheryl]

By law, a hospital should honor a living will made in accordance with the regulations spelled out in the links mentioned in the first post.

 

Apparently some hospitals are requiring hospital specific forms which may add additional requirements. If feasible it will be wise to comply and execute the hospital form in addition to having a generic one made in accordance with  the givernment regulations.

 

However in the event someone has made a generic living will and ends up in a hospital and unable to fill out a hospital specific form, legally there is every ground to insist that the generic form be honored, and the nearest relative or someone with power of attorney should insist in such. If necessary, threaten to bring legal action, hire a lawyer. Generally speaking on this issue hospitals have 2 concerns: fear of legal risk and fear of bad publicity.  So plan you approach accordingly such that they perceive not honoring the document to be the riskiest course of action.

 

As I have said in other threads, in any country -- even those far more legalistic/law-abiding than LOS -- the wishes and actions of the next of kin or person with power of attorney count much more than any document the patient may have signed. dead people do not sue, living ones do. The provisions of a living will will be ignored if close relatives indicate they will object otherwise; even though the document may protect the hospital in court, no hospital wants to face legal charges and the costs and bad publicity associated. Conversely, even in the absence of a living will, family can effectively bring a lot of pressure to bear to have their wishes honored (and with private hospitals there is also always the leverage of threatening not to accept responsibility for the cost -- extraordinary measures being very, very expensive).

 

So it is critical that you have someone who understands your wishes and is prepared to help enforce them when the time comes. If that person is not your closest relative, best to execute a power of attorney that comes into effect when you are unable to act on your own behalf. Such powers can be limited or broad as you prefer but be sure they include medical decisions. And think through who will need to be able to access your finances/how as well so that you don't put those trying to help into an awkward position.

 

[chubby]

fwiw, the USA system,   is moving away a bit from legalistic 'medical decisions'/advance directives, and one can supplement it with this(portable-in or out of hospital, physician's standing orders), which is more helpful , the decisions paper, should not necessarily be about the form type, but whether it contains standardized language etc. 

 

https://en.wikipedia.org/wiki/Physician_Orders_for_Life-Sustaining_Treatment

[CaptHaddock]

I have thought about the living will issue, but the problem is how do I know how I will feel if I find myself in the situation, such as having a terminal illness.  Like most people I have never been in such a situation and, while I might wish that under those circumstances I would be ready to refuse treatment, in fact, I have no idea how I would actually feel.  

[Sheryl]

The living will comes into play only if you are unable to speak for yourself. You can always give indtructions to the contrary as long as you are conscious and coherent. You do not in any way forfeit the ability to change your mind or make specific choices.

if you are not conscious and coherent and you do not have a living will, other people are going to decide for you. Do you really prefer that?

need also to understand that living wills do NOT say "If anything happens just let me die" (and no one eould honor it if it did). Rather they usually say in effect "if I am terminally ill with no chance of recovery, keep me comfortable rsther than subject me to painful treatments that only prolong the dying process".

[NancyL]

The living will comes into play only if you are unable to speak for yourself. You can always give indtructions to the contrary as long as you are conscious and coherent. You do not in any way forfeit the ability to change your mind or make specific choices.

if you are not conscious and coherent and you do not have a living will, other people are going to decide for you. Do you really prefer that?

need also to understand that living wills do NOT say "If anything happens just let me die" (and no one eould honor it if it did). Rather they usually say in effect "if I am terminally ill with no chance of recovery, keep me comfortable rsther than subject me to painful treatments that only prolong the dying process".

Indeed, Sheryl. Recently, I was involved in a situation where someone who had suffered a stroke (but had an uncertain prognosis) made the decision to accept a feeding tube and ventilator, even though in her Advance Directive she had checked every box to refuse those (and all forms) of life support in every case (terminal illness, coma, advanced progressive disease, etc) Her condition worsen to where she clearly met the criteria for refusing life support, as spelled out in her Advance Directive. It was very difficult to watch her being kept alive via artificial means, knowing that's not what she would have wanted at that point.

What probably wasn't clear to her and those around her is that once life support is started in Thailand, it cannot be stopped by the hospital, the way it can be stopped in hospitals in the west. It is possible for the "family" to take a comatose patient home and for the life support to be removed as the patient is left at home by the hospital transport crew, but it cannot be done in the hospital, in a humane way with palliative care available. Edited August 3, 2014 by NancyL

[CaptHaddock]

The living will comes into play only if you are unable to speak for yourself. You can always give indtructions to the contrary as long as you are conscious and coherent. You do not in any way forfeit the ability to change your mind or make specific choices.

if you are not conscious and coherent and you do not have a living will, other people are going to decide for you. Do you really prefer that?

need also to understand that living wills do NOT say "If anything happens just let me die" (and no one eould honor it if it did). Rather they usually say in effect "if I am terminally ill with no chance of recovery, keep me comfortable rsther than subject me to painful treatments that only prolong the dying process".

 

In such an extremity the issue is hardly about asserting one's self since that option will have been lost forever.  It is about getting treatment or not.  I have no idea what I would want because I have never been even near to such a condition myself.  What I do understand from doctor friends who have been around dying people is that they typically cling to life.  Therefore it is reasonable for me to expect that I will also cling to life in such a situation, although not certain.  Since I have no idea how I would feel I have no basis on which to decide in advance. 

[chubby]

in reality, the stomach /PEG feeding tubes seem to be placed, more often than not , as family don't want "to starve" their family member, and have not realized what the most likely  CVA/stroke outcome may be,  sadly.     there are exceptions,  I know a 89yo F  on HD with a PEG fully oriented, walking w/o walker and good family at home.

 

I think the PEGs, while they seem benign and "comfort" interfere, with folks whom are going to probably be dependent,  everyone seems to focus  more  on CPR  and maybe intubation.

 

 

the forms are really for people who have a strong feeling about it,  if one wants all treatment, then  no need to make one 

[NancyL]

CaptHaddock, I've been around people at end-of-life, all them over age 70 and I wouldn't necessarily agree with your doctor friends about dying people clinging to life. Yes, it can take a while to die, but I've seen people who received a terminal diagnosis beg to be given "something to end it all", I've seen them refuse all medications, even pain medications because they don't want to be given anything to keep them alive any longer, and (more commonly) I've seen them engage in major negotiations with the nurses to make sure that medication was only for pain control and not for treatment purposes. Of course, this was in situations where the patient was still able to communicate. And of course, I've seen people refuse to eat anything because that is the only way they can bring about their own death.

[CaptHaddock]

I am aware of those possibilities, also, but in my experience predicting how I will feel in the future in a wholly new experience (new girlfriend, new university, new job, etc.), I can't help but notice how often my actual feelings were not what I had expected despite the very good basis I may have had for my expectations previously.  How it looks from the outside (e.g. life not worth living) may not be how we experience from the inside when that day comes.  I certainly have no objection to you or anyone else making your decision now, but neither am I persuaded that you won't regret it.

 

 

CaptHaddock, I've been around people at end-of-life, all them over age 70 and I wouldn't necessarily agree with your doctor friends about dying people clinging to life. Yes, it can take a while to die, but I've seen people who received a terminal diagnosis beg to be given "something to end it all", I've seen them refuse all medications, even pain medications because they don't want to be given anything to keep them alive any longer, and (more commonly) I've seen them engage in major negotiations with the nurses to make sure that medication was only for pain control and not for treatment purposes. Of course, this was in situations where the patient was still able to communicate. And of course, I've seen people refuse to eat anything because that is the only way they can bring about their own death.

 

[dddave]

Is there any non-governmental association of hospitals and medical facilities in Thailand?  This would seem to be an issue that such an association could be very useful in formulating and disseminating universal guidelines in Thailand.

[Sheryl]

Not to my knowledge.

[seedy]

Imagine - live your whole life on your own terms and then, at the end, to be told that the choice is no longer yours to make.

 

Must make sure to sort this out when my work cycle ends and I return home.

 

[BlackJack]

There is a lot of info that is partly right however it is best to ask someone that actually acts as the Surrogate for the Testator of the Living Will - How to deal with the hospital, family, friends.

After all this is a very emotional time for everyone and making decisions is difficult.

First in drafting the Living Will I have seen that the format is wrong - there should be an English line and then translated into Thai on the next line. However what I see is separate documents and a either one could be changed or mistranslated. So its best practice to have one document so that there is no misunderstanding.

Passports and IDs should be attached as well. Tick the boxes in the LV that you feel apply to you. Maybe there should be more boxes to tick? If not write down your added request.

Die at home or in ICU - this is a difficult decision as ICU is expensive and they have many machines to prolong life. If you die in the hospital a death certifcate may be issued whereas die at home an autopsy is required.

In some cases the Testator is out when an attack happens, the ambulance is called and they take emergency action - they not know that you have a do not resuscitate DNR - so you can expect after the ambulance ride and care that you land in ER - more tubes and machines and IV lines - 

If the person(s) with you do not know you have a DNR then the big medical machine will keep going until someone tells them to stop.

Suggest you tell your friends and relatives that you have an advanced care directive.

In your passport have a card or your directive as this is where people go to find out who you are. If you have an attack at home then they will look for your passport - on the street you must be carrying a copy in your wallet and so write on it DNR. And who to contact!

Most Living Wills are written by people that know they have a terminal illness and dont want to waste away on a machine and or be a burden to others that are obliged to look after them, some have family overseas and this makes things very difficult - some have a family history of illness and their LW preempts a stroke or other debilitating decease.

When you have a LV then scan it and send to friends and have a copy at the hospitals you frequent. A copy should be with the Surrogate.

The Surrogate you name in your LV must be strong as they are the ones that tell the hospital to deny treatment except for pain killers. 

The Surrogate has to deal with the hospital and gather info that says you are terminal and or brain dead. That you have an advanced care directive LV and to adhere to the parts that the Testator ticked as "do not".

Also there is a many forms of Power of Attorney POA - a Living Will is a form of POA, the USA has an Enduring Power of Attorney EPA, however in most cases this is for a blood relative to do things that you cannot ie go to the bank for you or other matter, there is the appointment of Guardian or Custodian, in case you are old or have dementia - this must be done in advance and so the Grantor mus be competent when signing, POA for purchase of land or applying for Probate, usually needs to be Notarised or Legalised in the country where the Grantor is domiciled.

 

Do not be mistaken, foreigners dying in Thailand is a legal issue that has the Embassy, Police, Hospitals, Morgue, Family, Courts, Banks

More and more are looking for advance directive care with Wills and Funerals, Probate are planning for the future - however there is only one company in Pattaya that is a one stop for Living Will, Last Will, Funeral/Cremation, apply for a Grant of Probate and winding up the estate and sending money to the Beneficiaries. English speaking too.

 

Just Google Wills and Probate Pattaya and they pop up

 

[malagateddy]

Hi All..does anyone have a standard draft re a Living Will that they could post..NancyL Sheryl
Whilst I have a Will..I obviously do not have a Living Will.
I'd like to have one, without being " tied " to a specific hospital..I live in the Chaiyaphum Province.
Thanks in advance for any help.
Cheers

Sent from my SM-G7102 using Thailand Forum - Thaivisa mobile app

[Sheryl]

Note that many hospitals have their own specific forms that they requiore be used, so if hospitalized or under care for a serious condition yo ushould also execute form at the relevant hospital(s) even if you laready have made a Living Will.

 

This is how my Living will, drawn up by lawyers, reads (English translation):

 

I, (name), a citizen of the (Country)  currently holding (Nationality)  Passport with the number XXXX expiring on (date) , having my permanent address at XXXXXXXX being of sound mind and currently X years of age, would like to make known the wishes in this Living Will and Health Care Declaration (hereinafter referred to as the “Declaration”).

 

I direct that my family, physician, health care provider, and all others follow the directions I am writing down in this Declaration. If the time comes when I can no longer take part in decisions for my own future, let this Declaration stand as the testament to my wishes.

 

I understand that this Declaration will only be valid and enforceable if I am not able to speak for myself.

 

1.   Choice Not to Prolong Life

 

I do not want my life to be prolonged with life sustaining treatment if (a) I am permanently unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness; (b) I have an incurable or irreversible condition which is terminal, or (c) I have irreversible brain damage and will never regain the ability to make decisions and express my wishes.

 

Life sustaining treatment shall include, without limitation, intubation, use of ventilator, B-PAP or other breathing devices, tube feeding or parenteral nutrition, dialysis or any other measure that would keep me alive but would not cure me.

 

Permanent unconsciousness is when my physician and another physician are of the expert, considered opinion, after full examination of my case, that within a reasonable degree of medical certainty I can no longer think, feel, move, or be aware of being alive.

 

Terminal condition is when my physician and another physician are of the expert, considered opinion, after full examination of my case, that I have a condition that is incurable and irreversible and will result in my death within a relatively short time.

 

2.   My Directions

 

In circumstances such as those mentioned above, I shall not be subjected to any medical intervention or life sustaining treatment aimed at prolonging my life. I hereby direct that all such orders be placed in my medical record.

 

Any distressing symptoms occurring in the aforementioned circumstances shall be fully and aggressively controlled by appropriate palliative care, ordinary nursing care, analgesic or other treatments, even though some of these treatments may have secondary effect of shortening my life.

 

Giving intensive care to me is to be allowed only on the condition that reliable reasons exist for the possibility that such treatment will have a better result than merely short prolongation of life. In the event that a treatment with prospect of recovery has been started but proves to be futile, it has to be discontinued immediately.

 

3.   Health Care Proxy

 

I hereby appoint the following person as my health care proxy:

  (

XXXXXX name, address, telephone, nationality )

 

I want my health care proxy to follow my directions as listed on this Declaration and to make any decisions about things I have not covered in this form.

 

 

4.   Severability

 

Should any specific directions be held to be invalid, the invalidity shall not affect other directions in this Declaration which can be given effect without the invalid direction, and to this end the directions in the Declaration are severable.

 

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this Declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment, and I accept the consequences from such refusal.

 

I understand the full import of this Declaration and I am emotionally and mentally competent to make this Declaration.

 

In the presence of two witnesses, I hereby execute this Declaration as my free and voluntary act, on this XXXX (date) in (place).

 

 

[BlackJack]

There are standard Living Will templates however as I said it should be English Thai on the same page in alternate paragraphs. Therefore there is a need for translations as your details and address and check boxes are in Thai English. Having 2 separate docs defeats the purpose of the document and it should state as per the Thai Health Law Section 12 that you are using your rights to have life sustaining treatment with drawn. 

As a few examples one hospital was treating a man with prostate cancer and he was in incredible pain and terminal. Also they were injecting him with a "new" drug. After showing the Living Will and meeting with Admin they removed everything except the morph drip. When the bill was finalised they requested money for the drug as they "had already bought it". This was refused and accepted. 

 

Second example where the man was being treated with esophageal cancer. He was terminal with a 4 year history. The Living Will was known to the hospital. In fact he had 2. He was also in ICU and hooked up with drips and machines. One drip had vitamins. All was withdrawn except the morph pain killers. The question of remaining in ICU was one for the family and they said if hes comfortable let him stay. The bill was settled minus all the extras they had given him as they were aware of the Living Will. 

 

Doctors, the Law, religious conviction all play a roll in this decision making process. 

[malagateddy]

Many Many Thanks Sheryl

Note that many hospitals have their own specific forms that they requiore be used, so if hospitalized or under care for a serious condition yo ushould also execute form at the relevant hospital(s) even if you laready have made a Living Will.
 
This is how my Living will, drawn up by lawyers, reads (English translation):
 

I, (name), a citizen of the (Country)  currently holding (Nationality)  Passport with the number XXXX expiring on (date) , having my permanent address at XXXXXXXX being of sound mind and currently X years of age, would like to make known the wishes in this Living Will and Health Care Declaration (hereinafter referred to as the “Declaration”).

 

I direct that my family, physician, health care provider, and all others follow the directions I am writing down in this Declaration. If the time comes when I can no longer take part in decisions for my own future, let this Declaration stand as the testament to my wishes.

 

I understand that this Declaration will only be valid and enforceable if I am not able to speak for myself.
 

1.   Choice Not to Prolong Life

 

I do not want my life to be prolonged with life sustaining treatment if (a) I am permanently unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness; (b) I have an incurable or irreversible condition which is terminal, or © I have irreversible brain damage and will never regain the ability to make decisions and express my wishes.

 

Life sustaining treatment shall include, without limitation, intubation, use of ventilator, B-PAP or other breathing devices, tube feeding or parenteral nutrition, dialysis or any other measure that would keep me alive but would not cure me.

 

Permanent unconsciousness is when my physician and another physician are of the expert, considered opinion, after full examination of my case, that within a reasonable degree of medical certainty I can no longer think, feel, move, or be aware of being alive.

 

Terminal condition is when my physician and another physician are of the expert, considered opinion, after full examination of my case, that I have a condition that is incurable and irreversible and will result in my death within a relatively short time.

 

2.   My Directions

 

In circumstances such as those mentioned above, I shall not be subjected to any medical intervention or life sustaining treatment aimed at prolonging my life. I hereby direct that all such orders be placed in my medical record.

 

Any distressing symptoms occurring in the aforementioned circumstances shall be fully and aggressively controlled by appropriate palliative care, ordinary nursing care, analgesic or other treatments, even though some of these treatments may have secondary effect of shortening my life.

 

Giving intensive care to me is to be allowed only on the condition that reliable reasons exist for the possibility that such treatment will have a better result than merely short prolongation of life. In the event that a treatment with prospect of recovery has been started but proves to be futile, it has to be discontinued immediately.

 

3.   Health Care Proxy

 

I hereby appoint the following person as my health care proxy:

  (

XXXXXX name, address, telephone, nationality )

 

I want my health care proxy to follow my directions as listed on this Declaration and to make any decisions about things I have not covered in this form.

 

 

4.   Severability

 

Should any specific directions be held to be invalid, the invalidity shall not affect other directions in this Declaration which can be given effect without the invalid direction, and to this end the directions in the Declaration are severable.

 

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this Declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment, and I accept the consequences from such refusal.

 

I understand the full import of this Declaration and I am emotionally and mentally competent to make this Declaration.

 

In the presence of two witnesses, I hereby execute this Declaration as my free and voluntary act, on this XXXX (date) in (place).

 
 

Sent from my SM-G7102 using Thailand Forum - Thaivisa mobile app

[TallGuyJohninBKK]

3 hours ago, Sheryl said:

Note that many hospitals have their own specific forms that they requiore be used, so if hospitalized or under care for a serious condition yo ushould also execute form at the relevant hospital(s) even if you laready have made a Living Will.

 

 

Last time I checked with Bumrungrad Hospital in BKK a couple years ago as a non-patient (just trying to plan ahead), that was exactly the case with them -- they had their own form they wanted you to use AND they wanted you to make a (paid) appointment to consult with one of their doctors before completing and accepting the document.

 

I haven't checked back with them lately as to whether that's still their policy or it's been changed in more recent years... But I probably should!

 

I didn't remember originally, but now I do, that I did a LONG post on this issue and Bumrungrad earlier in this very thread, as follows:

 

 

Edited January 23, 2019 by TallGuyJohninBKK

[TallGuyJohninBKK]

It looks like some of the links to the documents I posted earlier in this thread have been disappeared over time. So let me repost them here again.

 

 

 

 

Bangkok Hospital Pattaya Living Will Info.pdf

 

Living_Will_Samples 1_Final.pdf

 

[BlackJack]

15 hours ago, TallGuyJohninBKK said:

It looks like some of the links to the documents I posted earlier in this thread have been disappeared over time. So let me repost them here again.

 

 

 

 

Bangkok Hospital Pattaya Living Will Info.pdf

 

Living_Will_Samples 1_Final.pdf

 

where is the Surrogates info? the person that will activate the LV?

 

[TallGuyJohninBKK]

34 minutes ago, BlackJack said:

where is the Surrogates info? the person that will activate the LV?

 

 

I didn't write or compose the above documents... Just shared them here.

 

I should have mentioned and made clear, the first doc I posted above was the version from Bumrungrad Hospital from a couple years back. It apparently doesn't have any language re surrogates.

 

However, the next documents -- one from Bangkok Hospital Pattaya and the other a generic one -- both have language in them about surrogates.

 

Some of the hospitals seem to want to force people via these forms into their own package of directions, which can be pretty limited and inflexible. By comparison, the living will example that Sheryl posted earlier is much more nuanced, allowing for the notion of short term care if the prospect is that someone is likely to/expected to recover, but withholding of that care if the prospects for recovery are unlikely.

 

The hospital versions above don't really incorporate those kinds of nuanced instructions, but they should!  The option, I think, in dealing with one of those kinds of hospitals, is to use their form to keep them happy, and then add your own addendum with more detailed instructions of your own making.