Everyone dies but this topic should not die.

[watcharacters]

I sincerely thank Sherly, NancyL, TallGuyJohninBKK and the others who have contributed to this sensitive topic on various threads.

Dying is a natural process of life.

I’m alarmed and concerned to read the below link posted on TV and learn some doctors in Thailand feel comfortable to refute the instructions of the Ministerial directives of the government. The desire and wishes of the patient under their care seems to be a secondary concern.

Thoughts??

I especially appreciate Sherly’s suggestion to advise in advance to one’s POA to inform the hospital that the situation will end up in a court of law if the patient’s wishes are not fully followed. My Missus will certainly have the available funds to follow though with that threat/promise and I fully believe she will act in accordance to my stated wishes.

On a personal note, I’m going to the local Bangkok Hospital and clarify to the best of my ability that there will not be a misunderstanding about anything pertaining to a living will. I’ll ask the Missus to video everything.

Additionally, for those with a vehicle, I’m think it could be a good idea to keep a copy of a living will in one’s vehicle in case an event happens a distance from one’s local hospital.

http://news.thaivisa.com/thailand/commission-to-raise-awareness-of-living-wills/99743/

[inbangkok]

To be completely honest, I have tried to figure this out myself and it is not easy. In America, I have a "do not resuscitate" (DNR) on file with my health provider and attorney.

Here in Thailand, it does not seem that simple. From my understanding, my main hospital (Bumrungrad) allows you to set up a DNR after a consultation with the staff. However, if you end up in a hospital other than the one where such a form is filed, it is very probable the Dr providing you care is going to do everything possible to keep you alive. This is mainly of concern after a serious accident that will not allow you to communicate such wishes with your Dr.

The bottom line is that my wife knows that if I am ever in an accident that will leave me with permanent brain damage or incapacitate me to the point of no return, I want the Dr's to let me die. Unfortunately, it will be on her at such a point to ensure that happens.

Forgot to add..... In the USA, it is not unusual to see dying patients with red wristbands that say "DNR". That being said, if something happens and you are hospitalized knowing it will probably be the end, seeing if the hospital has any procedure such as this would be wise. Again though, in the case of a serious accident or mishap, this probably is not possible given the fact you may already be unconscious or of limited brain capacity.

If anyone knows a better way to go about this, I definitely would like to know. People don't think about these things until it's too late. My wife's grandma spent 4 years paralyzed and dying in a hospital bed. I for one don't want to live if that's how my life is going to be.......

This is honestly one of my biggest fears in life (and being buried alive..... Lol).

[Sheryl]

I share your concerns.

By law, you can make an advanced directive that any hospital would be obligated to respect. it is a good idea to have a lawyer assist with this to be sure the language etc is as needed, and of course the document has to be in Thai.

Enforcing it is another matter. The large international hospitals have indeed set up their own forms so if being treated at a particular hospital, should complete their form. Even having done so, no guarantee it will even be noticed in your file let along followed unless the family raise the issue and insist. And of course, you could easily in an emergency end up in a different hospital altogether, which is where having executed a general Advance Directive is important.

So best advice I can give is to both execute an Advanced Directive through a lawyer and fill out the hospital specific forms.

This is a very new area for Thailand.

Make sure your spouse or other next of kin knows that a hospital cannot legally hold you or provide treatment against your will and to be aggressive in seeking legal redress if necessary. With private hospitals, a clear statement, in writing, that the family does not agree to the treatment and will not pay for it often works wonders.

Also, if in a hospital which has a pain management/palliative care specialist, should transfer out of the other doctor's care into their care.

[inbangkok]

I share your concerns.

By law, you can make an advanced directive that any hospital would be obligated to respect. it is a good idea to have a lawyer assist with this to be sure the language etc is as needed, and of course the document has to be in Thai.

Enforcing it is another matter. The large international hospitals have indeed set up their own forms so if being treated at a particular hospital, should complete their form. Even having done so, no guarantee it will even be noticed in your file let along followed unless the family raise the issue and insist. And of course, you could easily in an emergency end up in a different hospital altogether, which is where having executed a general Advance Directive is important.

So best advice I can give is to both execute an Advanced Directive through a lawyer and fill out the hospital specific forms.

This is a very new area for Thailand.

Make sure your spouse or other next of kin knows that a hospital cannot legally hold you or provide treatment against your will and to be aggressive in seeking legal redress if necessary. With private hospitals, a clear statement, in writing, that the family does not agree to the treatment and will not pay for it often works wonders.

Also, if in a hospital which has a pain management/palliative care specialist, should transfer out of the other doctor's care into their care.

Considering you are a nurse, have you ever seen a Dr directly violate a patients end of life directive here in Thailand? I am under the impression that the vast majority of Thai people don't have such directives (or even plan for end of life procedures) thus leading me to believe lots of Dr's probably don't run into this situation too often.

[NancyL]

Here in Chiang Mai I've not seen any problem hospitals or doctors accepting Advance Directives written in the English language. There was one problem where a patient's Thai wife over-ruled the patient's wishes and banned his "health care representative" (his best friend) from the hospital and continued with treatment that the patient wouldn't have wanted. And the doctor supported the wife fully in these actions. But, in many more cases, the doctor serves as an ally with the patient and health care representative in following the patients wishes as stated in the advance directive and helping to "manage" the Thai wife.

I've also seen problems, more commonly, where doctors here won't stop a life-saving procedure once started. In other words -- they won't "pull the plug" unless it appears at all brain function has stopped. This can be especially heart-wrenching in the case where someone has had a stroke. Sometimes it makes sense to start a respirator but then the patient can have another stroke or heart attack and their condition declines. Had they been admitted in this condition, their health care representative may not have authorized the life support. But, the Thai medical staff will not remove a breathing tube once started in these situations.

[Sheryl]

It is only a year or so that the law for this came into effect in Thailand so there have been few instances in which the issue even arose.

But I can tell you that what Nancy describes -- the Directive being ignored at the request of a relative - is common even in the West where they are well known and common. The thing is, dead people don't sue or otherwise make trouble, live ones do. So the relatives carry more weight than the patient in reality even though not by law.

[elgordo38]

To be completely honest, I have tried to figure this out myself and it is not easy. In America, I have a "do not resuscitate" (DNR) on file with my health provider and attorney.

Here in Thailand, it does not seem that simple. From my understanding, my main hospital (Bumrungrad) allows you to set up a DNR after a consultation with the staff. However, if you end up in a hospital other than the one where such a form is filed, it is very probable the Dr providing you care is going to do everything possible to keep you alive. This is mainly of concern after a serious accident that will not allow you to communicate such wishes with your Dr.

The bottom line is that my wife knows that if I am ever in an accident that will leave me with permanent brain damage or incapacitate me to the point of no return, I want the Dr's to let me die. Unfortunately, it will be on her at such a point to ensure that happens.

Forgot to add..... In the USA, it is not unusual to see dying patients with red wristbands that say "DNR". That being said, if something happens and you are hospitalized knowing it will probably be the end, seeing if the hospital has any procedure such as this would be wise. Again though, in the case of a serious accident or mishap, this probably is not possible given the fact you may already be unconscious or of limited brain capacity.

If anyone knows a better way to go about this, I definitely would like to know. People don't think about these things until it's too late. My wife's grandma spent 4 years paralyzed and dying in a hospital bed. I for one don't want to live if that's how my life is going to be.......

This is honestly one of my biggest fears in life (and being buried alive..... Lol).

Medicine is big business throughout the world. As long as you have a financial pulse they keep you alive. After the money runs out I wonder what happens.

[Speedo1968]

Regarding Living Wills. My situation is that I have a host of allergies including all antibiotics and other "useful ??? tools" to keep one alive.

Some 4 years ago I was admitted to hospital in Khon Kaen ( 45Km from where I live ) when I was having what turned out to be my first 2 TIA's.

I was completely out of it on arrival so recall little if anything of what happened

I am told I had gone in to spasms and the situation was complicated by acute and allergic bronchitis. No chemical treatments were possible ( due to drug allergies ) and I am told I fought like a madman to stop a breathing tube being forced down my throat ( comes from surfing accident years ago ). The doctors finally admitted to my friend there was nothing they could do.

A friend who was at my bedside knew of an alternative therapy that may or may not work and, asked the specialist doctor if she could use it. She had to wait until I was in a conscious state to ask my permission, once given the doctor let her go ahead. Eventually the alternative therapy was given and it saved my life.

This does rather confuse the issue of DNR - see NOTE below.

Following the experience I discussed my thoughts with my children ( one of whom had flown out from the UK with emergency status to go to the hospital ).

My intention was not to allow the bystanders or myself to suffer again. Both children agreed to this and I made out a Living Will. I also discussed with the person most likely to be with me ( close long term friend but not a partner ) and they, having been with me the first time understood and agreed.

Further, I discussed with the specialist doctor at my hospital in Khon Kaen and he verbally agreed a Do Not Resuscitate ( DNR ) letter / form would, if I was in the same condition again and in his presence be honoured. I have stated that urine therapy may be used but NO form of artificial breathing or heart restart may be. NOTE - I used the term artificial. I did include a paragraph stating that the same "Alternative therapy" may be used. On regular check-ups to my specialist I check that my files still contain the DNR form and all updates to new allergies etc are registered.

I took time to check various countries DNR information and forms they may have. Checked with UK Age Concern etc and UK Embassy in Bangkok.

Eventually I found suitable wording in a form available online. I have shown this to everyone concerned and placed on file with all of them.

Because of my allergies ( many fatal such as antibiotics ) I carry all relevant information with me at all times, have given signed copies to all concerned, have placed on file at all hospitals I am registered with, and a copy is prominent in my house.

Sorry if this is too long to read and understand but Living Wills can be a very emotive subject. Fortunately for me, experience, discussion and understanding went a long way.