Living Wills

[Nurseynutcase]

Thanks for the post Sheryl and all the informative replies.

I have a living will made out in 2011 in the UK and witnessed by nurse practitioner.

I resign it every couple years - will this still be valid here?

I have only one brother in the uk who would not agree with the terms I have set out - he believes life should always be prolonged as long as possible.

I do have friends here in Thailand would it be ok for one of them to sign and carry out my wishes - I am thinking of a Thai girl I know very well.  But looking at some of the posts would I have to make a new one each time I moved within Thailand.

Many thanks everyone.

[BlackJack]

17 hours ago, TallGuyJohninBKK said:

 

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:

 

 

Like I said you are up for some resistance when activating the Living Will - many excuses will be used and so this is why you need someone with a strong personality. Also to save issue use Thai and English. All hospitals must accept your Lw as many tourists/long stay have international LW and this must be accepted

Edited January 24, 2019 by BlackJack

[BlackJack]

30 minutes ago, Nurseynutcase said:

Thanks for the post Sheryl and all the informative replies.

I have a living will made out in 2011 in the UK and witnessed by nurse practitioner.

I resign it every couple years - will this still be valid here?

I have only one brother in the uk who would not agree with the terms I have set out - he believes life should always be prolonged as long as possible.

I do have friends here in Thailand would it be ok for one of them to sign and carry out my wishes - I am thinking of a Thai girl I know very well.  But looking at some of the posts would I have to make a new one each time I moved within Thailand.

Many thanks everyone.

yes there are your opinions, the law, the doctors and the family and friends - pick a friend with a strong ability to carry out your wishes - if you move around then people should be aware that you have a LW - if you stay in an area for long periods your "friend" should be aware and the hospital should be aware of your plan and LW

[TallGuyJohninBKK]

I have no idea how the Thai govt hospitals deal with this issue for foreigners, especially since EN language capability there is likely to be limited.

 

But at a lot of the private hospitals, they have THEIR own living will form that they want patients to fill out and complete, even if they already have some form of living will from their own country. Keep in mind, Thailand passed its own law and Public Health Ministry regulations on this, so ideally, you want a local document here -- one way or another -- that's in accord with the local law.

 

Ideally, if you live in a particular area and have a hospital you'd likely be treated at were something to happen, you'd want to go there in advance, check on their living will situation, and arrange to have a LW document put into your medical records there with them. And then give a copy of the same document to your spouse or other surrogate for them to be aware of, in the event you're not conscious if the need should arise.

 

 

[Sheryl]

Thanks for the post Sheryl and all the informative replies.
I have a living will made out in 2011 in the UK and witnessed by nurse practitioner.
I resign it every couple years - will this still be valid here?
I have only one brother in the uk who would not agree with the terms I have set out - he believes life should always be prolonged as long as possible.
I do have friends here in Thailand would it be ok for one of them to sign and carry out my wishes - I am thinking of a Thai girl I know very well.  But looking at some of the posts would I have to make a new one each time I moved within Thailand.
Many thanks everyone.

You need a document in the Thai language and executed hete.

Re asking a Thai to be yoyr surrogate/health care proxy, be aware that it is ptetty contrary to Thai culture to he assertive with doctors or argue with them, and both are often necessary. In addition Thai authority figures react more negatively to a Thai doing this than to a foreigner. It would be a rare Thai indeed (and likely need to he a well connected/high status one) who can pull this off.

I'd suggest you look for a farang also living in Thailand. Might make a reciprocal arrangement with one, each agreeing to be the other's health care proxy.

Too bad about your brother. People who want "everything" done to prolong life have, in my experience, never seen what "everything" really looks like in practice.


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[JimmyJ]

23 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.

 

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).

 

 

 

 

Sheryl - Is that your Living Will for both the USA and Thailand?

 

I guess it's necessary to get a translator to make a Thai version.

 

What happens if you end up in a Thai hospital which has their own form which as TallGuy puts it, is not as nuanced as your form?

Your surrogate will have to argue it out with them?

 

 

Edited January 24, 2019 by JimmyJ

[TallGuyJohninBKK]

40 minutes ago, JimmyJ said:

Sheryl - Is that your Living Will for both the USA and Thailand?

 

I guess it's necessary to get a translator to make a Thai version.

 

What happens if you end up in a Thai hospital which has their own form which as TallGuy puts it, is not as nuanced as your form?

Your surrogate will have to argue it out with them?

 

 

 

What I suggested earlier was, instead of trying to debate with the hospital over whether or not to use their form, to simply use their form in as much as possible, and then note on their form that you're adding additional instructions as an addendum, and attach your own document to their form.

[Sheryl]

I have a separate one for the US (same essential content...but in English only and notarized by US Embassy as opposed to a Thai notarization).

If I develop a serious health condition or am admitted to a hospital for anything major I will sign the relevant hospital form. If I was unable to do so then yes, my surrogate/ health care proxy will have to fight it out. To my understanding under Thai law the general Living Will is valid and binding, it is just that the hospitals want their own signed. So I think one would prevail but it might be more difficult/take longer. Especially since these directives are something very new to Thailand.

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[JimmyJ]

On 1/22/2019 at 10:32 PM, BlackJack said:

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!

 

 

Excellent idea.

[TallGuyJohninBKK]

3 hours ago, JimmyJ said:

 

Excellent idea.

 

The past few years, I've taken to carrying a double-sided, laminated card in my wallet of my own making....

 

One side in English and the other side in Thai, basically saying.....

 

"In event of emergency, please contact XXXXXXXXXX at phone XXX-XXX-XXXX."

 

I carry that card in my wallet right next to my Thai health insurance coverage card.

 

I'm not doing that for Living Will surrogate purposes. I'm just doing for emergency contact purposes (mine being my wife) just in case I'm incapacitated for some reason.

 

Edited January 24, 2019 by TallGuyJohninBKK

[BlackJack]

17 hours ago, TallGuyJohninBKK said:

 

What I suggested earlier was, instead of trying to debate with the hospital over whether or not to use their form, to simply use their form in as much as possible, and then note on their form that you're adding additional instructions as an addendum, and attach your own document to their form.

I will be discussing this with the hospitals and then asking them to supply me with the Section that state that a customer is required to use their form - as there is no legal requirement to do so. I was presented with the 2 pages form from a well know hospital and the hospital suggested to the customer that there be the legal one written and witnessed in a Law office and their form - really?

 

Edited January 25, 2019 by BlackJack
mispelled

[Sheryl]

I will be discussing this with the hospitals and then asking them to supply me with the Section that state that a customer is required to use their form - as there is no legal requirement to do so. I was presented with the 2 pages form from a well know hospital and the hospital suggested to the customer that there be the legal one written and witnessed in a Law office and their form - really?

 

While you are technically correct (obviously mothing in the law mandates hospital specific form,) do you really want to make this harder and requiring more arguments? Just sign their form keeping a copy and supply your surrogate with copies of both hospital form and your own form.

 

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[BlackJack]

3 minutes ago, Sheryl said:

While you are technically correct (obviously mothing in the law mandates hospital specific form,) do you really want to make this harder and requiring more arguments? Just sign their form keeping a copy and supply your surrogate with copies of both hospital form and your own form.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

the issue is that the form is specific for that hospital and in my experience if someone has an attack the ambulance comes to the rescue and there are only a few hospitals with them. They do emergency care by law, no matter who you are. Normally the patient is transported to their hospital. The patient might be from overseas with a LW in place and the hospital insists on their form? To save legal issues the hospital should accept any LW that notes the right criteria for action it if necessary. This should be in Thai and English as it is possible that the Thai partner is with the patient and do they read and understand English? Can they make informed decisions based on the English form? At least this forum has generated debate on a very important subject.

[BlackJack]

I have contact the hospital for answers and specifically under what section of Law do they not accept legal LW and insist on using their own. Updates soon

[BlackJack]

In the past few weeks I have attended patients in various hospitals and they have acknowledged Living Wills and have enforced them

Unfortunately one poor chap is in hospital unconscious and cannot make a Will - the costs are rising daily! What to do? The hospital has a duty of care however money is running out. Even they admit that if he wakes he will not be functioning.

[blackcab]

@Sheryl is away for a few days. I have tagged this message so she will see this and reply on her return.

[Speedo1968]

After I had had the first TIA once I understood the situation with my health I prepared my first DNR – Right to Die document.    Since that time I have had numerous TIA’s of various severity and two strokes.

 

Along with the DNR I prepared a separate document listing all medications I had taken and, typed in red those I was highly allergic to, some of which were given whilst I was in hospital for treatment ( antibiotics for acute bacterial lung infection, stroke and for example a spider bite ).

 

These documents, including contact details for those who should be contacted are stapled together.    There is a copy in clear view on a wall in my house, I carry a copy with me wherever I go, even when just out for a short walk, a copy has been placed with my local government hospital and my hospital in Khon Kaen.    The documents have been discussed with a doctor in both hospitals.    The medication list has been updated as appropriate.    Whenever I visit the hospitals I check that the documents are on file.

 

Fortunately a 1669 call is responded to rapidly and the local hospital is only 15 minutes away.

When suffering a major stroke complicated by rhabdomyolysis I was taken to my local hospital where they gave emergency treatment for massive levels of creatine kinase ( 133,000 ) which saved my life, before being transferred to KK.

 

In both hospitals I was asked, when conscious, if my DNR requests etc. were still requested and had to resign the document I had made.    No attempt was made to try and coerce me in to changing my mind.      The only time this was done was by another doctor who was involved in wanting to give me dialysis’s for acute kidney failure due to the stroke, which I declined.

 

Whether or not you have had an emergency admittance to hospital be prepared and make things easier for those around you.    Of course a DNR etc. can be made at any time in your life.

[Sheryl]

On 9/16/2019 at 1:20 PM, BlackJack said:

In the past few weeks I have attended patients in various hospitals and they have acknowledged Living Wills and have enforced them

Unfortunately one poor chap is in hospital unconscious and cannot make a Will - the costs are rising daily! What to do? The hospital has a duty of care however money is running out. Even they admit that if he wakes he will not be functioning.

 

You need to contact his family, can ask the relevant Embassy to help find out who the next of kin are.

 

Talk to them and explain the situation. Even without a LW, if the next of kin make a firm request to stop life support in a terminal situation, it may take some discussion but the hospital will often agree. Telling them there is no money to pay will usually expedite this. But it will usually need to be done in person, i.e. if they are back in his home country they will need to come in person to discuss with the doctors.

 

If Next of Kin are unwilling then I'm afraid no other options.