EDITORIAL

The right to die in dignity

New law grants patients the right to make a living will to refuse treatment of terminal illness

The codification of the patient's right to make the decision to refuse medical treatment in order to die with dignity, under the National Health Bill passed by the National Legislative Assembly on Thursday, is to be welcomed. Once the bill receives royal endorsement and becomes law, terminally ill individuals will get to choose whether to be kept alive by artificial life support or to die a more natural death.

It has taken years for Thai society to overcome the social taboos and squeamishness associated with death. Finally we have come around to making this landmark decision.

Section 10 of this bill says: "A person has the right to make an advance directive stating his or her decision not to receive medical treatment in a way that serves only to delay his or her death during the terminal stage of his or her life. Compliance with the said advance directive shall be conducted in line with procedures and criteria required by ministerial regulations. Health professionals shall be required to honour the advance directive, and by doing so they shall not be held responsible for any resulting consequence."

It must be made clear that the provision has nothing whatsoever to do with euthanasia, mercy killing or assisted suicide. In no way does the patient's right-to-refuse-treatment provision compel physicians to break the Hippocratic oath, which states: "To please no one will I prescribe a deadly drug, or give advice which may cause his death."

The passage of the law will serve to promote awareness among members of the public, regardless of the current state of their health, about the importance of preparing an advance directive or a living will - to make known their wish regarding the course of action their doctors should take in the event they can no longer communicate.

Although death is inevitable, most people avoid talking, or even thinking, about it until the very end, which sometimes is too late. So when the body finally succumbs and consciousness goes, many become helpless victims in the hands of commercially motivated hospitals and distraught family members who are either unwilling or feel too guilty to let the dying go.

This provision will enable individuals to plan ahead to avoid a prolonged, undignified and slow journey from a brain-dead vegetative state to eventual death. Such drawn-out deaths can often take many years given the level of sophistication of today's medical technology. With an advance directive or living will, every person can decide what level of medical intervention they wish to have in order to prolong life, or not, as the case may be. This is vital when we lose the ability to make such a decision ourselves.

To be fair, many people with limited means would not want to receive costly medical treatment to prolong their life for a little while longer. In the case of a terminal illness it could result in financial ruin for surviving loved ones. By making an advance directive a patient can also prevent unscrupulous physicians and hospitals from profiteering by offering unnecessary or costly medical procedures based on the false hopes of distraught relatives.

In general, the National Health Bill emphasises increased citizen participation in the country's public-health planning and decision-making process - to counterbalance the unfettered commercialisation of healthcare by profit-oriented private medical providers. A citizen's right to enjoy good health and access to quality medical services and the right to die in dignity are part and parcel of this important law.

The right to refuse treatment is a deeply personally matter and every individual should be encouraged to make a decision in writing on how to be treated in the final stages life. At least this course of action spares loved ones the burden of guilt in having to make the difficult decision.

A living will facilitates decision-making by medical professionals so they no longer need to ask the awkward question of whether to pull the plug on a brain-dead person with no chance of regaining consciousness, thus allowing the patient to pass away with dignity.

Nobody should be denied prolonged intensive care if they desire it, but neither should anyone have invasive medical procedures forced on them against their will.

The Nation

Very emotive and controversial subject, but at least it`s being brought out into the open more.

Quote:Very emotive and controversial subject, but at least it`s being brought out into the open more.

Which is great to see here in Thailand. Thai's often like to keep things inside and don't discuss issues like this.