Doctors urge ‘living will’ to ease pain in final stage of life

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Doctors urge ‘living will’ to ease pain in final stage of life

By Pratch Rujivanarom 
The Nation 

 

 

EVERYBODY HAS the right to die a good death by choosing palliative care in their last years, but nobody can opt for euthanasia, medical experts said.
 

The widely publicised story of a young Thai man, who was in the fourth stage of brain cancer and decided to end his agony with medically assisted suicide in Switzerland, has fuelled debate over whether Thailand is ready to legalise such action. 

 

 

Panellists at the National Health Commission Office’s seminar on people’s right to choose the way they want to die, said recently that everybody has the freedom to choose a good natural death according to law.

 

However, they agreed that speeding up the end of life medically is a form of suicide. 

 

Dr Issarang Nuchprayoon, a medical lecturer at Chulalongkorn University, said most people view end-of-life medical care as both painful and expensive, with doctors focused only on keeping the patient alive as long as possible. 

 

This is not entirely true, Issarang said, pointing to the medical treatment offered by palliative care, in which the primary objective is to allow patients the highest quality end-of-life experience and let them die naturally and peacefully. 

 

“Palliative care does not focus on extending the patient’s life, but ensures that the terminal-stage patient is as comfortable as possible, maintains good mental health in the last days of their life, and has a good peaceful death at the end,” Issarang added.

 

Living will can dictate palliative care

 

Mercy killing is another story, he said, as it seeks to rush a person’s death by ending their life to avoid illness-related pain. 

 

This is not only illegal in most countries, he said, but can also be considered a serious breach of medical ethics.

 

Sawaeng Boonchalermwipat, National Health Commission Board member, said mercy killing was not a legal option in the Kingdom. 

 

Yet, he noted, Article 43 of the National Health Act allows each person to choose how they want to be treated in the final period of their life and avoid painful medical treatment that might extend their life. They can instead write a “living will” and choose to get palliative care. 

 

“Despite the National Health Act having already been in use for 11 years, the majority of people still do not know that under this law they can choose what kind of medical care they prefer to receive at the end of their life. 

 

“Most people are afraid of the agony of modern medical techniques to keep their heart beating, so it is not beyond expectation that many people are supporting the legalisation of mercy killing,” Sawaeng said.

 

“But these people can avoid a painful and expensive death by writing a living will, so others know how they should be treated when their final period of life has come.”

 

He said a living will is easy to write, as it can be written in any form and only needs to include a date and the person’s signature. 

 

He suggested that everybody write a living will to prepare for their inevitable final period. 

 

Source: http://www.nationmultimedia.com/detail/national/30368390

 

-- © Copyright The Nation 2019-04-26

[gunderhill]

Companies  like those in Switzerland  (Dignitas)should be able to provide their services in all countries of the world and keep religion out of it entirely.

[canopy]

Here is a translation of the young Thai man's last post:

 

I have been in switzerland for 10 days

The sky is clear and the sun comes out everyday

Today I am leaving the earth

Just checked out of the hotel

The sky is dark and the rain is out just in time (laughing)

 

Today I will die in this place.

 

[mikebell]

Thailand already has a form of dying a slow, painless death; it's called Getting a Retirement Visa.

[bkk6060]

17 minutes ago, mikebell said:

Thailand already has a form of dying a slow, painless death; it's called Getting a Retirement Visa.

For you maybe.

For many of us who have our act together,  it is totally painless.

 

[justin case]

they don't even put down rabies dogs that maim children / adults for life ... 

[HOAX]

1 hour ago, bkk6060 said:

For you maybe.

For many of us who have our act together,  it is totally painless.

 

The balcony-way?

[jaltsc]

"...nobody can opt for euthanasia..."

 

Nothing says "totalitarian fascist" more than: "We own your body, and say what you can and cannot do with it."

 

My body. My choices. Just as long as I don't physically harm anyone else in the process. If someone else's feelings are hurt by the actions I inflict upon myself. Not my problem. Get on with your own life.

[Brickbat]

2 hours ago, canopy said:

Here is a translation of the young Thai man's last post:

 

I have been in switzerland for 10 days

The sky is clear and the sun comes out everyday

Today I am leaving the earth

Just checked out of the hotel

The sky is dark and the rain is out just in time (laughing)

 

Today I will die in this place.

 

“Dust thou art and unto dust thou shall return.” Bible.

 He ain’t leaving anywhere. Death is just transient.

[meinphuket]

The language used in the article is a little unclear. Would there be a suggested format/text to successfully making this palliative living will, and does it need to be in the Thai language ? Thanks to all....

[hansnl]

49 minutes ago, jaltsc said:

"...nobody can opt for euthanasia..."

 

Nothing says "totalitarian fascist" more than: "We own your body, and say what you can and cannot do with it."

 

My body. My choices. Just as long as I don't physically harm anyone else in the process. If someone else's feelings are hurt by the actions I inflict upon myself. Not my problem. Get on with your own life.

I agree with you, 100%

 

But only with the second part, the first part is, by your definition a statement that nearly all countries of the world are totalarian and fascist because of existing laws regarding assisted or even unassisted euthanasia.

 

However, the issue is the "assisted" part of euthanasia which is frown upon.

Understandably seen the doctor's oath and existing laws.

And yes, even in certain countries where euthanasia is more or less accepted or tolerated, it is up to the "patient" to take the final step like opening the drip, drinking the solution, or whatever.

[Orton Rd]

Thai palliative care, paracetamol

[hansnl]

2 minutes ago, Orton Rd said:

Thai palliative care, paracetamol

Not true, at all!

[55Jay]

A simple Transfer on Death system would be nice.  Sign some documents so when you pop your clogs, Thai bank accounts and/or Thai investment portfolios transfer to designated survivor(s).

[Orton Rd]

The last place I would want to be receiving palliative care is here, from what I have seen they are years behind the west, still unwilling to give proper pain relief.

[marcusarelus]

10 minutes ago, Orton Rd said:

The last place I would want to be receiving palliative care is here, from what I have seen they are years behind the west, still unwilling to give proper pain relief.

Have you discussed this with your long time Thai physician?  Or are you relying on Thai Visa for your medical expertise? 

[Kasane]

4 hours ago, mikebell said:

Thailand already has a form of dying a slow, painless death; it's called Getting a Retirement Visa.

I hope it is not terminal.

[Orton Rd]

I'd rely on what Sheryl has to say over a Thai Doctor

[moonseeker]

I will in the near future face the decision picking the right moment to fly to Europe to end my life, before suffering gets unbearable. 8 years of C fighting and i am tired. I can't get clear answers in top hospitals where i spent huge amounts of money, about end of life pain management. Some even warn me not to expect too much? 

I know what is coming and first time i am a little scared. Would prefer to end it all here. But not much of a jumper etc. and want to do it right and decent when the time has come. 

Many must be in similar situation. MS>

[Ctkong]

4 minutes ago, moonseeker said:

I will in the near future face the decision picking the right moment to fly to Europe to end my life, before suffering gets unbearable. 8 years of C fighting and i am tired. I can't get clear answers in top hospitals where i spent huge amounts of money, about end of life pain management. Some even warn me not to expect too much? 

I know what is coming and first time i am a little scared. Would prefer to end it all here. But not much of a jumper etc. and want to do it right and decent when the time has come. 

Many must be in similar situation. MS>

In Thailand, going the way of the charcoal burning is better than jumpers. Less of a mess and no victims.  

[Krataiboy]

From what I can gather, palliative care for ordinary Thais routinely means a terminal cancer sufferer being sent home from hospital with a bottle of paracetamol.

 

You sometimes wonder whether these academics ever leave their ivory towers long enough to discover how the rest of actually live - and die.

[Pond Life]

Good palliative care is available in Thailand.

My friend recently died at McKean hospital Chiang Mai after receiving fantastic care at home & then at the hospital.

They gave him very strong pain meds when it was required.

They honoured his living will, they also said they could accept a living will verbally.

I think if you contacted McKean hospital they could probably recommend other hospitals around Thailand that offer similar care.

[TallGuyJohninBKK]

3 hours ago, Orton Rd said:

Thai palliative care, paracetamol

 

There's some truth to that...even though people will think you're joking...

 

There have been lots of reports here over the years of Thai hospitals and doctors being very resistant or flatly unwilling to provide enough and strong enough pain killing medicines to provide those with fatal illnesses some real form of pain relief.

[TallGuyJohninBKK]

3 minutes ago, Pond Life said:

Good palliative care is available in Thailand.

My friend recently died at McKean hospital Chiang Mai after receiving fantastic care at home & then at the hospital.

They gave him very strong pain meds when it was required.

They honoured his living will, they also said they could accept a living will verbally.

I think if you contacted McKean hospital they could probably recommend other hospitals around Thailand that offer similar care.

 

I contacted Bumrungrad Hospital in BKK some years ago after Thailand updated its law on living wills, and had an extended discussion there with a pertinent group of their staff on living wills...

 

At least at that time -- I can't say whether or not it's changed since then -- they'd only accept a living will AFTER you'd made an appointment with and been seen by one of their doctors, and then the living will had to be on a Bumrungrad specific version that the hospital itself created.

 

Their whole focus on living wills seemed to be on people who were already inpatients in the hospital with serious/fatal conditions, and not at all conducive to healthy people wanting to do advance planning just in case they ever ended up there.

 

[marcusarelus]

2 hours ago, Orton Rd said:

I'd rely on what Sheryl has to say over a Thai Doctor

Sheryl has mentioned a number of pain clinics in Thailand as I remember it and ways to get proper pain medication in Thailand.  Although I think Sheryl would be the first one to tell you to see a doctor, yes, even in Thailand. 

[Liverpudlian]

A member of this board an ozzy mate of mine was given opium here Surin hospital to ease his bone cancer pain, he passed a short time later back in oz .

[Thailand]

Wife and I have our living wills lodged with a local hospital signed off by the CMO,copies with a friend and copies with our important documents and references in wallets/purses.

[gunderhill]

6 hours ago, Brickbat said:

“Dust thou art and unto dust thou shall return.” Bible.

 He ain’t leaving anywhere. Death is just transient.

I did  say leave religion out of it.

[gunderhill]

3 hours ago, moonseeker said:

I will in the near future face the decision picking the right moment to fly to Europe to end my life, before suffering gets unbearable. 8 years of C fighting and i am tired. I can't get clear answers in top hospitals where i spent huge amounts of money, about end of life pain management. Some even warn me not to expect too much? 

I know what is coming and first time i am a little scared. Would prefer to end it all here. But not much of a jumper etc. and want to do it right and decent when the time has come. 

Many must be in similar situation. MS>

I  think its  disgusting that you are  not  allowed to choose your time and  way of death, I  too  will  plan in advance a Dignitas trip this is  the most humane way to go and although healthy and still fairly  young after seeing my Fathers agonising death I do  not wish that on anyone.

[Brickbat]

Doctors routinely end lives by overdosing patients on opiates IF a Health Directive states " under no circumstances am I to be in pain" 

A few Endone tablets can also allow one to end his or her life. Pain free.