Terms of a Living Will

[elgordo38]

Has anyone had any experiences with a living will? I have tried the Lawyer section and did not receive an answer. I live with my g/f and am wondering is she considered family under Thai law? If I am in a vegitative state I want the plug pulled. Also if I have a stroke and am paralyzed I want the right to refuse food to keep me alive. Can this be added to any standard Living will form? If I take my signed will form to the Amphur will they rubber stamp it to make it legal? Would like to share any experiences that you have encountered. Any and all help is appreciated.

[NancyL]

You can name anyone you want as your Health Care Representative to act on your behalf in your Living Will. That person doesn't have to be a family member. So yes, your g/f could be your HCR and make decisions on your behalf, but whether she'd want to is another story. Thai people have a tendency to go along with what the doctors want to do and in general, they will try to prolong life. This is a Buddhist country, after all.

They will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased. But, you can specify in a Living Will/Advance Directive that you do not want these measures undertaken if you fall victim to certain conditions.

You may want to pose this question in the Health Forum where Sheryl, the moderator can address the current laws in Thailand.

Lanna Care Net/Cancer Connect-Chiang Mai are having a workshop on "Lessons Learned at the End of Life" in Chiang Mai on Friday, 27 February from 9 am - 12:00 noon at River Market Restaurant where they'll present an Advance Health Directive (sometimes called a Living Will) that has been successfully used in Chiang Mai and share tips about how your foreign Advance Directive (or Living Will) can be utilized here, along with actions you can do now to prepare for your own Happy Ending. Cost is 100 baht, light refreshments served. www.LannaCareNet.org

Edited January 25, 2015 by NancyL

[catman20]

as we all know how corrupt it is in Thailand how do we know if the lawyer you use for a will actually registers it at Amphur ?

[JAS21]

Hell ... my wife, who is Thai and myself have both discussed this subject and neither of us want out life extending when we are 'in that sort of state'. We need to do something, as we know here they prolong life even when it's hopeless.

I wonder if there will be a trans script of that meeting.

[jayceenik]

I have made my TGF my Living Will enabler. She is also my sole inheritor and I have emphasized to her that the sooner she has the hospital/doctor pull the plug if I come to a bad vegetative/hopeless case the less the hospital/doctor costs and the more money left on my bank account for her.

I have drafted the Sample 1 in Thai.

You don't need a lawyer. Just a couple of witnesses.

Sorry, I seem to have lost the links to the Thai language versions of Samples 1 and 2.

Anyway I'm sure an English version for a LOS farang would be acceptable to the LOS hospitals.

Indeed I've seen Sample 2 reprinted as is in English with the logo of a big BKK hospital.

http://en.nationalhealth.or.th/sites/default/files/Final_Ministerial_Regulation%20.pdf

http://en.nationalhealth.or.th/node/215

http://en.nationalhealth.or.th/node/214

Edited January 26, 2015 by jayceenik

[TallGuyJohninBKK]

Perhaps the OP has some confusion on this subject.

It's regular wills, those directing the disposition of your estate, that typically are registered at an Amphur office, or at least, can be.

Living wills, or advance health care directives, don't need to be registered at an amphur at all for the document to be legal and binding. Instead, you probably want to check with the local hospital where you expect you might be admitted, since different hospitals can have different policies on what they require in terms of a living will.

The Thai government not too long ago enacted a law making living wills legal and binding in Thailand. And there is a kind of standard living will form, although some hospitals use their own modified versions.

As Nancy noted above, anyone, not just a legal family member, can be designated as your representative for purposes of a living will.

And, AFAIK, there's really no reason to get an attorney involved. And yes, the standard living will form can be modified by you to include whatever specific terms/directions you would want the doctors to follow.

Also, here's a link to another recent TV thread on the subject of living wills with a lot of good info:

http://www.thaivisa.com/forum/topic/725149-living-wills/

Edited January 26, 2015 by TallGuyJohninBKK

[mesquite]

Yes, the medical establishment here will prolong life ad infinitum.

The only effective way to deal with this is to pre-pay a hit man for a contract on your own life when you become terminally incapacitated. Hopefully he will get the timing right.

[smotherb]

You can name anyone you want as your Health Care Representative to act on your behalf in your Living Will. That person doesn't have to be a family member. So yes, your g/f could be your HCR and make decisions on your behalf, but whether she'd want to is another story. Thai people have a tendency to go along with what the doctors want to do and in general, they will try to prolong life. This is a Buddhist country, after all.

They will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased. But, you can specify in a Living Will/Advance Directive that you do not want these measures undertaken if you fall victim to certain conditions.

You may want to pose this question in the Health Forum where Sheryl, the moderator can address the current laws in Thailand.

Lanna Care Net/Cancer Connect-Chiang Mai are having a workshop on "Lessons Learned at the End of Life" in Chiang Mai on Friday, 27 February from 9 am - 12:00 noon at River Market Restaurant where they'll present an Advance Health Directive (sometimes called a Living Will) that has been successfully used in Chiang Mai and share tips about how your foreign Advance Directive (or Living Will) can be utilized here, along with actions you can do now to prepare for your own Happy Ending. Cost is 100 baht, light refreshments served. www.LannaCareNet.org

Is it not common practice to allow a patient to go home to die? By that, I mean discontinue all treatment but pain medication and check them out of hospital.

[Suradit69]

as we all know how corrupt it is in Thailand how do we know if the lawyer you use for a will actually registers it at Amphur ?

Oh give it a rest. As we all know, some farangs ought to be on meds for paranoia and conspiracy obsession. For an actual will, obviously your heirs will have access to a copy of the will if you have any sense at all.

There's some useful information here living wills: http://www.pattayacityexpatsclub.com/expats/docs/living%20will%20form.pdf

and if you do a forum search for "living will" I think you'll find other threads on the subject. Even with clear instructions, you'll find a reluctance on the part of most doctors here to "pull the plug" or even go along with a "Don Not Resuscitate" order.

Edited January 26, 2015 by Suradit69

[Sheryl]

You can name anyone you want as your Health Care Representative to act on your behalf in your Living Will. That person doesn't have to be a family member. So yes, your g/f could be your HCR and make decisions on your behalf, but whether she'd want to is another story. Thai people have a tendency to go along with what the doctors want to do and in general, they will try to prolong life. This is a Buddhist country, after all.

They will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased. But, you can specify in a Living Will/Advance Directive that you do not want these measures undertaken if you fall victim to certain conditions.

You may want to pose this question in the Health Forum where Sheryl, the moderator can address the current laws in Thailand.

Lanna Care Net/Cancer Connect-Chiang Mai are having a workshop on "Lessons Learned at the End of Life" in Chiang Mai on Friday, 27 February from 9 am - 12:00 noon at River Market Restaurant where they'll present an Advance Health Directive (sometimes called a Living Will) that has been successfully used in Chiang Mai and share tips about how your foreign Advance Directive (or Living Will) can be utilized here, along with actions you can do now to prepare for your own Happy Ending. Cost is 100 baht, light refreshments served. www.LannaCareNet.org

Is it not common practice to allow a patient to go home to die? By that, I mean discontinue all treatment but pain medication and check them out of hospital.

It is sometimes done but not common. A main constraint is that injectable/intravenous narcotics are not allowed in the home, even if their is a registered nurse in attendence. The patient-controlled devises used in home hospice in the west are not available here and hospitals have never heard of, let alone remotely considered, allowing parenteral analgesia outside of a hospital setting. So going home to die my mean not having adequate pain relief, especially if unable to swallow (which will come to pass in any terminal situation).

The Living Will is very recent in Thai law and there has been only limited experience with it. Most Thai doctors will have never dealt with it and some will not even have heard of it, so be prepared for a possible battle and needing to appeal to hospital administrators. Something to take into account in selection of who you give power of attorney to...it needs to be someone very assertive, sure of the law and not likely to back down in the face of authority.

Most hospitals seem to have developed their own LW forms and it is not clear they will accept anything else, so if there are specific hospitals you tend to use, should go to them and fill out their forms. Even having done so, cannot expect that doctors treating you will notice it in your file - because this is so new and as yet rarely used in Thailand it is not something routinely checked for. So you will need an advocate to point it out to them.

Moved to health forum.

[12DrinkMore]

You can name anyone you want as your Health Care Representative to act on your behalf in your Living Will. That person doesn't have to be a family member. So yes, your g/f could be your HCR and make decisions on your behalf, but whether she'd want to is another story. Thai people have a tendency to go along with what the doctors want to do and in general, they will try to prolong life. This is a Buddhist country, after all.

They will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased. But, you can specify in a Living Will/Advance Directive that you do not want these measures undertaken if you fall victim to certain conditions.

You may want to pose this question in the Health Forum where Sheryl, the moderator can address the current laws in Thailand.

Lanna Care Net/Cancer Connect-Chiang Mai are having a workshop on "Lessons Learned at the End of Life" in Chiang Mai on Friday, 27 February from 9 am - 12:00 noon at River Market Restaurant where they'll present an Advance Health Directive (sometimes called a Living Will) that has been successfully used in Chiang Mai and share tips about how your foreign Advance Directive (or Living Will) can be utilized here, along with actions you can do now to prepare for your own Happy Ending. Cost is 100 baht, light refreshments served. www.LannaCareNet.org

Is it not common practice to allow a patient to go home to die? By that, I mean discontinue all treatment but pain medication and check them out of hospital.

Once the cash runs out that is what happens..........

[NancyL]

You can name anyone you want as your Health Care Representative to act on your behalf in your Living Will. That person doesn't have to be a family member. So yes, your g/f could be your HCR and make decisions on your behalf, but whether she'd want to is another story. Thai people have a tendency to go along with what the doctors want to do and in general, they will try to prolong life. This is a Buddhist country, after all.

They will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased. But, you can specify in a Living Will/Advance Directive that you do not want these measures undertaken if you fall victim to certain conditions.

You may want to pose this question in the Health Forum where Sheryl, the moderator can address the current laws in Thailand.

Lanna Care Net/Cancer Connect-Chiang Mai are having a workshop on "Lessons Learned at the End of Life" in Chiang Mai on Friday, 27 February from 9 am - 12:00 noon at River Market Restaurant where they'll present an Advance Health Directive (sometimes called a Living Will) that has been successfully used in Chiang Mai and share tips about how your foreign Advance Directive (or Living Will) can be utilized here, along with actions you can do now to prepare for your own Happy Ending. Cost is 100 baht, light refreshments served. www.LannaCareNet.org

Is it not common practice to allow a patient to go home to die? By that, I mean discontinue all treatment but pain medication and check them out of hospital.

It is sometimes done but not common. A main constraint is that injectable/intravenous narcotics are not allowed in the home, even if their is a registered nurse in attendence. The patient-controlled devises used in home hospice in the west are not available here and hospitals have never heard of, let alone remotely considered, allowing parenteral analgesia outside of a hospital setting. So going home to die my mean not having adequate pain relief, especially if unable to swallow (which will come to pass in any terminal situation).

The Living Will is very recent in Thai law and there has been only limited experience with it. Most Thai doctors will have never dealt with it and some will not even have heard of it, so be prepared for a possible battle and needing to appeal to hospital administrators. Something to take into account in selection of who you give power of attorney to...it needs to be someone very assertive, sure of the law and not likely to back down in the face of authority.

Most hospitals seem to have developed their own LW forms and it is not clear they will accept anything else, so if there are specific hospitals you tend to use, should go to them and fill out their forms. Even having done so, cannot expect that doctors treating you will notice it in your file - because this is so new and as yet rarely used in Thailand it is not something routinely checked for. So you will need an advocate to point it out to them.

Moved to health forum.

Sheryl's very right about Living Wills/Advance Directives being new, but I've watched a case at Suan Dok hospital in CM -- the teaching hospital for Chiang Mai University where an Advance Directive was present and a major decision had to be made about whether to purse a certain course of treatment. The major professor involved used the opportunity to convene impromptu teaching session for all the residents and medical students who could be rounded up and lectured in the hallway outside the patient room about the concept of a Living Will and the nature of the decision that had to be made. The patient was unable to communicate and the prognosis was very uncertain.

It was gratifying to see the major professor take the concept of the Living Will so seriously and also want to teach the doctors-in-training about it. Hopefully, in time it will be something widely accepted in Thailand.

[TallGuyJohninBKK]

Perhaps if the Thai medical establishment eventually comes to accept the value in allowing people who wish to die to do so in peace and with as little pain as possible, instead of making that wish nearly insurmountable, Thailand would stop having so many of these kinds of sad episodes, as was in the news the other day.

BANGKOK: -- A 69-year-old American school teacher jumped to his death on Saturday afternoon from his condo in the Prakanong area of Bangkok.

Police at the Klongton police station were alerted around 4.30pm that a man had jumped from the 4th floor of a condo building on Sukhumvit 71 Soi Pridipanomyong 14. Upon arrival the two officers found the man, identified as Mr Thomas Edward, laid face down dressed in a black t-shirt, white shorts and wearing an adult diaper.

Upon investigation of Mr Edward’s condo, it was concluded there was no sign of a struggle and a handwritten note to his son was found saying he had left 3,900,000 baht in the bank for him. A respirator and medication were also found during the search.

It emerged that the 15 year Bangkok veteran, who taught at a school in the Ratchathewi area, had been suffering ill health and had only returned home from Ramathibodi Hospital the day before.

http://www.thaivisa.com/forum/topic/794592-american-teacher-jumps-to-his-death-from-bangkok-condo/

Somehow, I can't help but thinking there really ought to be a more humane way/option available than jumping out of a building for people like this man who didn't wish to go on.

[smotherb]

You can name anyone you want as your Health Care Representative to act on your behalf in your Living Will. That person doesn't have to be a family member. So yes, your g/f could be your HCR and make decisions on your behalf, but whether she'd want to is another story. Thai people have a tendency to go along with what the doctors want to do and in general, they will try to prolong life. This is a Buddhist country, after all.

They will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased. But, you can specify in a Living Will/Advance Directive that you do not want these measures undertaken if you fall victim to certain conditions.

You may want to pose this question in the Health Forum where Sheryl, the moderator can address the current laws in Thailand.

Lanna Care Net/Cancer Connect-Chiang Mai are having a workshop on "Lessons Learned at the End of Life" in Chiang Mai on Friday, 27 February from 9 am - 12:00 noon at River Market Restaurant where they'll present an Advance Health Directive (sometimes called a Living Will) that has been successfully used in Chiang Mai and share tips about how your foreign Advance Directive (or Living Will) can be utilized here, along with actions you can do now to prepare for your own Happy Ending. Cost is 100 baht, light refreshments served. www.LannaCareNet.org

Is it not common practice to allow a patient to go home to die? By that, I mean discontinue all treatment but pain medication and check them out of hospital.

It is sometimes done but not common. A main constraint is that injectable/intravenous narcotics are not allowed in the home, even if their is a registered nurse in attendence. The patient-controlled devises used in home hospice in the west are not available here and hospitals have never heard of, let alone remotely considered, allowing parenteral analgesia outside of a hospital setting. So going home to die my mean not having adequate pain relief, especially if unable to swallow (which will come to pass in any terminal situation).

The Living Will is very recent in Thai law and there has been only limited experience with it. Most Thai doctors will have never dealt with it and some will not even have heard of it, so be prepared for a possible battle and needing to appeal to hospital administrators. Something to take into account in selection of who you give power of attorney to...it needs to be someone very assertive, sure of the law and not likely to back down in the face of authority.

Most hospitals seem to have developed their own LW forms and it is not clear they will accept anything else, so if there are specific hospitals you tend to use, should go to them and fill out their forms. Even having done so, cannot expect that doctors treating you will notice it in your file - because this is so new and as yet rarely used in Thailand it is not something routinely checked for. So you will need an advocate to point it out to them.

Moved to health forum.

Sheryl's very right about Living Wills/Advance Directives being new, but I've watched a case at Suan Dok hospital in CM -- the teaching hospital for Chiang Mai University where an Advance Directive was present and a major decision had to be made about whether to purse a certain course of treatment. The major professor involved used the opportunity to convene impromptu teaching session for all the residents and medical students who could be rounded up and lectured in the hallway outside the patient room about the concept of a Living Will and the nature of the decision that had to be made. The patient was unable to communicate and the prognosis was very uncertain.

It was gratifying to see the major professor take the concept of the Living Will so seriously and also want to teach the doctors-in-training about it. Hopefully, in time it will be something widely accepted in Thailand.

And, if the patient can amass no more money to pay the bills?

[KarenfromAus]

Maybe you have children that will carry out you needs, these need to be expressed to the full extent. I came to thailand in November to nurse my elderly father at home, he had brain cancer, bowel cancer and other issues with his health, I met up with him at Siriraj hospital in Bangkok, couldn't walk, his wife was feeding him in the hospital, because he had travelled there in an ambulance from Khon Kehn (mis-spelt i know) I had to get him home again in a taxi, prior to this he had stressed that he did not want to live like this in constant pain and confusion. When we arrived back home (Surin) I took care of him to give his wife some respite, and to be able to catch up on her work with the government. After a month of heavy lifting, toileting, showering, then bed baths, and linen changes after he became incontinent, also with massive amounts of pain, with no adequate pain relief, I convinced his wife that he needed to go to hospital as I couldn't manage him at home anymore on my own.

We took him to surin hospital to A&E where we waited for four hours for a doctor to see him, eventually they admitted him to a ward and then to a private room.

He deteriorated rapidly, but they were still trying to feed him with a tube, he was on O2, and intravenous saline for fluid. I was beside myself as my dad was suffering they wouldn't give him any morphine or narcotic to ease the pain. I took the doctor aside one day and I insisted that he write up an order for pain meds, very reluctantly he agreed, but only one dose! then I phoned my sister in Australia in desperation as this had been going on for a week, she flew over and was with me 36 hours later. Then together we removed the oxygen tube, the saline drip,and demanded the nurseing staff remove the feeding tube. They called a meeting with the doctor who argued that my father would probably die without nourishment, we told him that this was his request and to remove the tube.

We then cornered him and insisted that he wrote up an order for analgesic to be administered every 4 hours at a higher dose than it had been. it was no higher than a person would receive in hospital with a broken leg or post op pain relief. But we had to fight tooth and nail for all this to happen, we also had to sign a waver from the hospital, stating we had refused life sustaining treatment.

My father was much more settled after that and no longer screaming out with pain. He looked peaceful and remained like that, until he gently passed away twenty four hours later, with his wife myself and my sister beside him.

I know this is long winded, but you have to make your wishes very clear and put it in writing if you can, also get a very strong person to be able to stand up to the hospital staff. Word was, afterwards I was known as the father killer. I could'nt give a shit, I was fighting for my dad's right to end his pain, because he couldn't do it for himself. And because I loved him. And I hope someone will do the same for me one day.

[TallGuyJohninBKK]

Karen, thanks for posting that account here. It very well helps illustrate the challenges that both terminally ill patients and their families face here in Thailand.

I think it matters not in the least whatever the hospital staff thought of you. What really matters and is important is that you did your best to try to allow your father to pass in peace, and based on your account, in accords with the wishes he had expressed to you previously.

Sorry for your loss.

PS - Interesting to note that, based on your account, it seems as though your father didn't have a living will document that formally expressed his wishes???

[khunPer]

If it can help OP, in the book ”Thai Law for Foreigners” (Paiboon Publishing) the two Thai lawyers writes about will:

Page 78:

»Foreigners should definitely have a written will. It can be a simple document written in either Thai or your native language or both.«

»The is no inheritance tax (coming now for assets over 50 million baht, kP) or death tax in Thailand. However if land or buildings and certain assets are to be transferred to beneficiaries, the Land Department will charge fees for the transfer.«

I.e. OP’s GF can be named for inheritance.

Page 77:

»You may designate the executor and indicate who should take of any minor children in your will. While the Thai courts are not bound by these, it is your best opportunity to inform them and your heirs of your desires and intent. Without such instructions, others will make these decisions after your death without the benefit of your intent.«

Nothing is mentioned in the book about “vegetative state” or the like, but I presume you better write it – or consult a lawyers about your possibilities, for example a kind of proxy or...?

Also worth to notice from page 78 about keeping the will at a safe place, or with a lawyer, or in a bank deposit box:

»You should also inform the appropriate people that you have a will and where it is located. If it is not known that you have a will, nobody will be able to execute your wishes.«

And about “A Regular Will”:

»This kind of will is written in the form of a letter that can be handwritten or typed. It needs to be dated and the testator must sign it at the presence of two witnesses.«

The lawyers mention “A Civil Document Will” where you go to the amphur with two witnesses. An official there can write the will (the lawyers says), then it shall be signed by testator and witnesses, and stamped or sealed. »The testator may sign to receive the will has been recorded, or it can be left at file at the district office.« The same procedure applies with a so-called “Secret Will” in a sealed envelope, bring it to amphur with two witnesses, »testator and the witnesses sign their names on an appropriate place on the envelope, that can be kept by testator or on file in the district office.«

I presume, from what I read, that you can do a will as a letter and go to amphur with two witnesses and get I recorded (verified). I have prepared my own Thai will that way – I also cannot afford sin sot so have GF only – but unfortunately not been to the amphur yet.

[Sheryl]

This thread is not about that type of will but rather what is called a "Living Will" or "Advanced Directive". Very different things.

[Sheryl]

.....

He deteriorated rapidly, but they were still trying to feed him with a tube, he was on O2, and intravenous saline for fluid. I was beside myself as my dad was suffering they wouldn't give him any morphine or narcotic to ease the pain. I took the doctor aside one day and I insisted that he write up an order for pain meds, very reluctantly he agreed, but only one dose! then I phoned my sister in Australia in desperation as this had been going on for a week, she flew over and was with me 36 hours later. Then together we removed the oxygen tube, the saline drip,and demanded the nurseing staff remove the feeding tube. They called a meeting with the doctor who argued that my father would probably die without nourishment, we told him that this was his request and to remove the tube.

We then cornered him and insisted that he wrote up an order for analgesic to be administered every 4 hours at a higher dose than it had been. it was no higher than a person would receive in hospital with a broken leg or post op pain relief. But we had to fight tooth and nail for all this to happen, we also had to sign a waver from the hospital, stating we had refused life sustaining treatment.

My father was much more settled after that and no longer screaming out with pain. He looked peaceful and remained like that, until he gently passed away twenty four hours later, with his wife myself and my sister beside him.

I know this is long winded, but you have to make your wishes very clear and put it in writing if you can, also get a very strong person to be able to stand up to the hospital staff. Word was, afterwards I was known as the father killer. I could'nt give a shit, I was fighting for my dad's right to end his pain, because he couldn't do it for himself. And because I loved him. And I hope someone will do the same for me one day.

Dear Karen,

You did a wonderful and loving thing.

Thank you for describing so clearly just how hard this can be in Thailand. It is not always quite this hard, but it often is, and people need to take this into account when they decide whom it is they entrust to have power of attorney for health care matters on their behalf. There are very, very few Thais who would be able to stand up to entrenched resistance from doctors land hospital staff ike this.

It also emphasizes the importance of having a Living Will - will not guarantee no hassles but will certainly give those advocating on your behalf more ammunition.

[Jip99]

Is it not common practice to allow a patient to go home to die? By that, I mean discontinue all treatment but pain medication and check them out of hospital.

It is sometimes done but not common. A main constraint is that injectable/intravenous narcotics are not allowed in the home, even if their is a registered nurse in attendence. The patient-controlled devises used in home hospice in the west are not available here and hospitals have never heard of, let alone remotely considered, allowing parenteral analgesia outside of a hospital setting. So going home to die my mean not having adequate pain relief, especially if unable to swallow (which will come to pass in any terminal situation).

The Living Will is very recent in Thai law and there has been only limited experience with it. Most Thai doctors will have never dealt with it and some will not even have heard of it, so be prepared for a possible battle and needing to appeal to hospital administrators. Something to take into account in selection of who you give power of attorney to...it needs to be someone very assertive, sure of the law and not likely to back down in the face of authority.

Most hospitals seem to have developed their own LW forms and it is not clear they will accept anything else, so if there are specific hospitals you tend to use, should go to them and fill out their forms. Even having done so, cannot expect that doctors treating you will notice it in your file - because this is so new and as yet rarely used in Thailand it is not something routinely checked for. So you will need an advocate to point it out to them.

Moved to health forum.

Sheryl's very right about Living Wills/Advance Directives being new, but I've watched a case at Suan Dok hospital in CM -- the teaching hospital for Chiang Mai University where an Advance Directive was present and a major decision had to be made about whether to purse a certain course of treatment. The major professor involved used the opportunity to convene impromptu teaching session for all the residents and medical students who could be rounded up and lectured in the hallway outside the patient room about the concept of a Living Will and the nature of the decision that had to be made. The patient was unable to communicate and the prognosis was very uncertain.

It was gratifying to see the major professor take the concept of the Living Will so seriously and also want to teach the doctors-in-training about it. Hopefully, in time it will be something widely accepted in Thailand.

And, if the patient can amass no more money to pay the bills?

They die.

[TallGuyJohninBKK]

As Sheryl says and as I believe I mentioned above:

--A regular will governing the disposition of your estate, and who will inherit what, is what can be recorded at the local amphur office -- which is one of several ways of creating a valid and legally binding will under Thai law.

--A "Living Will" or advanced health care directive is an entirely different thing that only governs your wishes about the medical care you do or don't desire in the event you're incapacitated, and who you wish to speak for you if you cannot. A Living Will not does need to be recorded at the local amphur office in order to be valid, and I'd expect, they wouldn't do anything with one if you presented one there.

Unfortunately, the similarity of the naming between the two different documents tends to create some confusion.

[TallGuyJohninBKK]

Kind of an interesting question:

As Nancy L noted above:

They [the doctors] will not "pull the plug" if life support, such as ventilation or a feeding tube has been started unless brain activity has ceased.

And, if the patient can amass no more money to pay the bills?

They die.

So, I wonder...

If the patient is still showing any sign of life and doctors have already begun life support, they won't/don't want to cease providing life support for all the "good" doctor reasons.

But, if the patient is barely lingering on, on life support, and suddenly the family or individual no longer has the resources to foot the bills, then what does your typical private Thai hospital do?

--Keep the patient on life support indefinitely while getting no payment for services? I think not.

--Pull the plug for non-payment? I wonder.

--Transfer the patient to a government hospital? I wonder.

--Tell the family or whomever that the patient needs to be taken out of the hospital and to home or wherever? I wonder???

Maybe Sheryl or NancyL have some experience on this question.

Edited January 26, 2015 by TallGuyJohninBKK

[NancyL]

Everyone should go back and read Karen's post no. 15 very carefully. Her father may very well have had money (and just been in an area with poor access), but unfortunately the situation she described is often how foreigners without money die here -- but without a strong-willed daughter advocating for them. Imagine how much more agony he would have endured if he hadn't had his daughter here.

As to the question of what happens when someone runs out of money in a private hospital -- they don't "pull the plug" -- no they keep pressuring family, friends, anyone around the patient. They'll refuse to release the body after death unless the bill is paid. They'll transfer the patient to a nearby public hospital. Whatever. But, they won't pull the plug.

I've seen people with money die horrible deaths because they don't have an on-going relationship with a doctor. They waited too long to seek treatment. They never received a proper diagnosis of the cause of their pain. That may have come into play with Karen's father. While it was obvious that he was in pain, without a proper diagnosis as the the cause of the pain, and the knowledge that the condition was terminal, the doctors may have been reluctant to prescribe narcotics.

This is one reason it's important to have an annual health screening -- both to catch conditions and diseases at an early stage, but also to build an on-going relationship with a hospital and a health professional. That way, when you're lying in pain screaming for morphine, there's someone you know in a position to prescribe it.

[Maestro]

I have removed an off-topic post and the replies to it. Please stop making off-topic posts about a "regular will" or last will and testament giving instructions how to dispose of the assets after death.

[TallGuyJohninBKK]

Just to be clear, my question above about what Thai private hospitals would do with a patient on life support, if they or their family no longer had the resources to pay, was not in any way related to Karen's account and personal situation above.

Rather, it was just a general question on this broader topic of living wills, that arose in the course of the ensuing posts by different contributors here, including Nancy's comment above about the Thai hospitals being unwilling to cease life support once it's been begun.

BTW, thanks for that answer above, Nancy, as to what might happen when the money runs out.

[NancyL]

It's worth noting that there are important cultural differences as to how we westerners view pain vs. many Thai people. It's tied into the Buddhist concept of suffering, acceptance, meditation. All concepts many of us westerners don't understand, especially when we know a jab will make us feel better.

Sheryl, maybe you could comment, too. I believe you've written how Thai people seem to be more sensitive to pain killing medications than us westerners and it can't be fully explained by a difference in body weight.

[TallGuyJohninBKK]

Just a contrast of here vs the west and the U.S. specifically:

My mother suffered from a debilitating illness in the later years of her life. Ultimately, that led from her being awake but very physically disabled to finally lapsing into unconsciousness/a coma at home. At that point, she was taken to her hospital, where the doctors examined her and ran tests, and after a couple days, told her husband/my father that they didn't think she was likely to ever regain consciousness. But also, that her physical condition did not necessarily mean she would die imminently.

The doctors asked my father what he wanted them to do. And, in keeping with my mother's wishes as expressed in her living will, he told the doctors that she didn't wish to have any life saving measures undertaken, given her medical condition and prognosis. There was no fighting or arguing with the doctors, or rather, them arguing with my father. They simply honored his wishes. So, the next day, my mother was taken back home by ambulance and put in her bed at home. Fortunately, she was in no pain, being unconscious, but also did not receive any nutrition or fluids after arriving back home. Mercifully, she died in her sleep about two days later.

Given the choice between that and having to jump out of a building, I certainly know which way I would choose. Unfortunately, not everyone gets, for lack of a better term, the easy way out... being unconscious and oblivious to it all. Were only it so.

Edited January 27, 2015 by TallGuyJohninBKK

[Maestro]

Removed a flame.

[CM4Me]

I know of a situation here in Chiang Mai where a Westerner was admitted to hospital, and into an ICU. After close on a week, his partner knowing almost nothing about his financial position, was unable to satisfy the hospital authorities as to how the costs incurred so far would be paid.

As a result the hospital sent him home.

A day or two later he was visited by friends, found him in a dreadful state, they sorted out his finances, contacted his embassy and had him re-admitted (back to ICU).

This was only a couple of years ago, the patient is still alive, well and living in a respite centre.

The real message here is that someone very trustworthy (and not necessary your Thai partner) needs to know, and in an emergency maybe have access, to your finances, that is if you don't have hospital insurance.

[TallGuyJohninBKK]

Government or private hospital?