A morbid subject - need some advice please

[KIWIBATCH]

I have an old friend 86 years old an Australian living in an apartment block in Onnut. He is dying of prostrate cancer (well advanced) He is currently taking 40ml of morphine a day to ease the immense pain he is suffering. (prescribed by a doctor at a local hospital)

He has lost the use of his legs.(Morphine related?- I have no idea) and his bodily functions are progressively shutting down.

I suggested he stop the morphine intake with the possibility that the use of his legs may return - but because of the (obvious) pain he is in he prefers to be pain free.

As I live a fair distance away from him I cannot visit him as often as I wish.

I have employed a caring thai woman who resides in the same apartment block to visit him twice a day and provide some basic care, meals etc.

As far as my friend is concerned he is (quote) "going to be history" very shortly.

He has family in Australia who **prior to this turn for the worse, had offered to medivac him back to Darwin, but he steadfastly refuses.

**His refusal at that time was not clouded by morphine use.

So he has resigned himself to dying in Thailand.

In a telephone conversation with him this morning (15/4/2014) he asked me what is the "procedure" when a foreigner dies in Thailand.

I could not answer him as I simply don't know.

So to be clinical and frank......he dies in his apartment in Onnut.......his thai caregiver will find him and is under instructions to telephone me (she speaks good english)

.....and then what? his remains would need to be dealt with in Thailand (his wish)

Sorry to sound so darned dumb about this....but any advice fromm TV members would be greatly appreciated

Thankyou

[Neeranam]

I'd ask him what kind of service he wants - Christian, Buddhist? Burial, cremation or medical science?

Also, I'd call the OZ embassy.

[NancyL]

So sorry to learn of your friend's suffering. He's fortunate to have a caring friend like you and also a kind Thai caregiver to see that he's comfortable.

Quite often prostate cancer spreads to the bones, so it's very likely that the cancer is the reason he's lost the use of his legs. I've seen several cases of advanced prostate cancer and, in every case, the poor man is not ambulatory at the end -- the cancer spreads to the bones of either the legs, pelvis and/or spine. Because of this, it's very painful cancer, it's very, very good that your friend has access to morphine for pain control.

I'll send Sheryl, the moderator of the Health Forum a message about your post. She has much more medical experience than me and will be along shortly with her wisdom I'm sure.

As for your question about what happens when a foreigner dies at home, usually the local police, manager of the building and the Embassy are called. Someone could address what specifically happens in Bangkok. In Chiang Mai, after the police come to the scene, his body would be taken to University Hospital, the Embassy would notify his family and cremation could be arranged at University hospital for a reasonable price. The Embassy could arrange for his ashes to be returned to Australia. Also, the Embassy would dispatch someone to inventory the contents of his room and seek instruction from the family on whether they want the personal items returned. The exact procedure may be different for Bangkok. Embassies are very used to dealing with the death of their citizens abroad.

Edited April 15, 2014 by NancyL

[tim armstrong]

Sorry to hear about your friend, and good for you to be helping him. He probably won't get any better medical treatment in Oz at this point, and if the cancer has metastisised he won't have long, as the options are likely to be limited to just managing his pain.

But to be proactive -I suggest that you

1.Contact the Oz embassy in advance, as in soon, to alert them to the situation

2. Contact his nearest relative and preferably one that he likes - to initiate Power of Attorney over his affairs. - A bit devious but may be useful to get him back to Oz, if he wants to die there, and will also make the finalisation of his estate much easier.

3. But his wishes to die where he wants to also have to be respected.

You didn't mention his relatives coming here ? It does seem that you are doing most of the work.

[NancyL]

Some good points, Tim. I just wanted to answer the OPs questions and not overwhelm him with too much, but your suggestions are very good. There are some things that could be done now to make the situation much easier for the OP's next-of-kin when the time comes to settle the Australian man's affairs, especially if he has bank accounts or other assets here in Thailand and doesn't have a Thai Will.

The standard advice "I'll just give my friend my ATM card with instructions to clean out my account when I pass" just doesn't work. Aside from being illegal, from a practical standpoint, Thai banks have ways of finding out almost immediately when a foreigner passes and they soon freeze bank accounts.

[Sheryl]

Moving this to the health forum.

1. What you describe in terms of loss of function is a normal part of the dying process and will not change (in fact it will progress and get worse, no matter what). His morphine should continue and, if there comes a point where he can no longer take it orally and is in pain -- as there very well may -- then he may need to go into the hospital to get it intravenously. Make sure his caretaker knows to contact you at once if he is no longer able to swallow his pain meds.

2. It sounds like the caretaker is not there 24/7, understandable but he is going to get weaker and weaker and will soon require 24 hour care (pain...incontinence..etc). Should discuss with him now, while he is still able to talk, about this. Options would be either hospitalization or hiring a second caretaker for the nights shifts. If hospitalization is opted for, need to be sure it is at the hospital familiar with his condition and that there is a "do not resuscitate" order. You should ask him whether he has discussed this with his doctor.

All things being equal it is better for him to remain at home but only if 24 hour care can be arranged and he is not in unrelieved pain. In the West, IV morphine is given at home but not in Thailand, so once he cannot swallow any more, it will be necessary to put the morphine under his tongue for absorption or switch to a skin patch medication. If your friend has the financial means, should maybe talk with his hospital about arranging home care with nurses for the final days.

While you have asked about what to do after death, my concern is greatest for the days between now and then as if not properly managed there is every chance of unnecessary and severe suffering. This is usually a very slow type of death.

3. You should indeed call his family right away to let them know of is condition and that the end is near. They may wish to come to Thailand to see him one last time and it would be unfortunate if they couldn't because they didn't know. Even if not it will at least help brace them for the news. Even though they know he is terminally ill, that is not the same as being prepared to hear he has died. If they offered to help him return home, they clearly have some feeling for him. Also, it would very much help -- both with the terminal care and for the arrangements after he has gone -- to have them here.

4. When he dies, the body will have to be taken to a hospital (unless he is already in one) and the hospital will notify his embassy. If the body is at home, call the police and they will transport to a hospital. They will want his passport for Embassy notification purposes. The Embassy in turn has to notify the next of kin and there are formalities involving this, which will be much easier if they are in country. Arrangements for disposal of the body, funeral etc will be totally up top the next of kin - so if they do not come, need to find out whether he has communicated his wishes to them and whether they are on board. When you call them, discuss this. They can, if they choose to, designate someone else to manage things but would have to officially inform the Embassy accordingly.The hospital will release the body only after they have instructions from the Embassy. The Embassy in turn will act only on instructions from the next of kin or their designee.

This company specializes in arrangements for foreigners who die in Thailand, are very good and not too expensive (unless family opts for an elaborate funeral). They can arrange any type of ceremony or none, and arrange cremation and if the family wishes, rerun of the ashes home or else hand them over to whomever the family asks them to. They will also handle the considerable paperwork entailed including getting the necessary Embassy certification of death to the next of kin, who will need it to settle his affairs. I have dealt with them and found them very efficient and reasonable. Easy to deal with by phone or email, and very reliable. http://www.funeralrepatriation.com/contact (don't be put off by the url name -- they can handle simple cremation with no repatriation and no funeral if that is preferred).

Informing the Embassy now is a very good idea. They will likely want his passport details and will definitely want contact details for the next of kin. Some of the arrangements mentioned -- such as the paperwork the next of kin need to complete to be recognized as such by the Embassy, and appointment of a person or funeral company by the next of kin to take care of the arrangements - may be possible to start now.

5. There is also the question of how the arrangements will be paid for. As well as final payment to the caretaker(s) and, if it was necessary, hospital, and any other outstanding bills (rent, utilities etc). As Nancy said, do not count on being able to get money out of his bank account after he passes. And it will take quite some time for his family to get through all the formalities necessary to access his bank account.

he best thing would be for him a trusted person -- perhaps the Executor named in his will if he has one -- with a sum of money sufficient to pay the caretakers, other bills and cover his funeral /cremation etc now, while he still can -- either in cash or as a bank account transfer. If you are the one to receive the money, to avoid problems I suggest you write up a receipt or short agreement stating the amount he has given you, date and purpose of the funds, have him sign it in the presence of a witness and have the witness sign as well, and provide his family with a copy of this immediately so it is all transparent and no room for suspicion or doubt later on.

While at it, if he has any significant amount of money in the bank he should consider whom he wants to inherit it and if possible transfer it to them now, or at least most of it. Will save a lot of time and trouble later.

Please feel free to contact me by PM if I can be of further help.

[KIWIBATCH]

I am truly grateful for the sound, intelligent advice, and kind thoughts that you have all posted. Sincerely.

I am presently reading through (in detail) the posts made and will be implementing and acting upon them.

Strange thing isn't ...I feel so darn stupid ..in that ....I have a good friend on his way to heaven......yet living here in Thailand I really did not have a clue what the local procedures were.

Thankyou again...I am so proud of my fellow men and women

[KIWIBATCH]

Sorry to hear about your friend, and good for you to be helping him. He probably won't get any better medical treatment in Oz at this point, and if the cancer has metastisised he won't have long, as the options are likely to be limited to just managing his pain.

But to be proactive -I suggest that you

1.Contact the Oz embassy in advance, as in soon, to alert them to the situation

2. Contact his nearest relative and preferably one that he likes - to initiate Power of Attorney over his affairs. - A bit devious but may be useful to get him back to Oz, if he wants to die there, and will also make the finalisation of his estate much easier.

3. But his wishes to die where he wants to also have to be respected.

You didn't mention his relatives coming here ? It does seem that you are doing most of the work.

Hello Tim,

I contacted his immediate family this morning in Australia to relay his current worsening condition. (I forgot to mention that in my initial post)

I expect an email/telephone call any time now from them...and I know they will be organising flights to Bangkok.

My friend Robert has been backwards and forwards 3 times to Australia (Darwin) over the past 9 months getting treatment for his cancer.

The minute he "feels better" (his words)...he darn well books a ticket back to Bangkok and resumes where he left off. It upsets his family no end . He lives alone here in Bangkok. He is retired (of course)

I have spoken to him over the past 6 months until I was blue in the face to "get the hell back to Australia" and spend his last days with his family close by...but it falls on deaf ears sadly.

His family love him to bits....he has 8 grandchildren all in Australia.....but no... he steadfastly refuses to return to live out his last days there.

All I can do for him is exactly what I am doing right now complimented and helped by yourself and others who have posted advice

Thankyou so much

[NancyL]

Oh Kiwibatch, such good news to learn that your friend's family is coming here. As Sheryl said, the real concern shouldn't be about the "procedure" of what happens when a foreigner dies, but rather how to keep your friend Robert comfortable and cared for.

Unfortunately, end-of-life care here is about two generations behind what it is in the west. It's good that members of his family will be here to act as his advocates. Please encourage them to execute an Advance Directive (sometimes called Living Will) immediately. Unfortunately, I've seen situations where elderly end-of-life patients were subject to all sorts of medical procedures (really torture) here if the hospital thought they had money. Check out the page on our website about "Lessons Learned at the End of Life" for an Advance Directive used successfully in Chiang Mai: www.LannaCareNet.org

On the other end of the spectrum, if a foreigner has limited financial resources, then it can be difficult or impossible to obtain adequate pain management, esp. if the person wants to remain at home without proper round-the-clock nursing support.

Kiwibatch, don't kick yourself for feeling so stupid. How many people really know how to handle this type of situation -- helping a close friend near death -- even in their home country? You're very special because you're taking on this task in a foreign country. As my Aussie friends say "Good on you!"

Edited April 15, 2014 by NancyL

[Robby nz]

Fantastic advice and worth pinning as we will all at some time be in a near death situation.

Something that was only just touched on is a will.

Does your friend have one ?

If not it would be very advisable to arrange one ASP.

Not just for disposing of assets but things like no resuscitation and special funeral arrangements.

[NancyL]

Yes, as you can tell Sheryl and I have been close to people at the End of Life and, frankly, we don't worry too much about about what happens after. There's plenty of time to sort everything out then about someone's property. We're more concerned with someone being comfortable up until the end.

A Living Will, Advance Directive - whatever you want to call it, can be put together without a lawyer in Thailand, provided all parties agree on the terms of the document. In this case, it would be Robert, his heath care advocate, his children, doctors and hospital. So, unless Robert has a wife, the chances of anyone coming forward and wanting something contrary to the terms of the Advance Directive are not very likely. So, if Robert doesn't have a Final Will, and it seems like a huge task to put one together at this time, I'd still encourage the parties to do an Advance Directive. I've found Thai doctors and hospitals very open to Advance Directives -- they want guidance about how to proceed in situations like this.

As for special funeral arrangements. Robert can make his wishes known verbally to whomever is going to have to make those arrangements, unless, again, there is someone with legal standing like a wife who is likely to over-rule his wishes. No need to get too hung up on documents unless it's likely someone will come in and overrule his wishes.

The most likely "person" who will overrule his wishes at this time is a hospital, which is why an Advance Directive is so important.

[lungbing]

His local immigration office will need a copy of his passport when he does pass away, plus the original departure card and current 90 day report. As far as I know Embassies do not issue death certificates, but the British Embassy does issue a body release form....at a cost! The hospital should issue the death certificate which will obviously be in Thai, and it will need to be officially translated for the Australian authorities, pensions, insurance, banks etc. multiple copies will be needed.

[Sheryl]

The death certificate will be issued by the Thai hospital which receives the body, but most Embassies based on this will issue a document that can be used in lieu of a death certificate back in the home country. The US Embassy calls it something like "certificate of death of a US citizen abroad". This is important if he had any assets back in Oz, was receiving a government pension and so on.

[tim armstrong]

Hi Kiwi batch,

Good to here there is some progress, but a sad situation for the family. I guess the priority is to ensure that his death, wherever he is located, will be as painfree as possible. Sheryl's advice is definitely gold, and should be pinned. I hope your own difficult journey through this time is not too hard. It is indeed tough to lose close friends.

[taiping]

I also have prostate cancer but nowhere near advanced as your friend's. I live on Soi Ekamai and have a condo on Soi On Nut so if I can provide practical assistance please contact me off TV, then please let me know. I have no intention of telling him to go back to Australia or saying he should do this or that - that's up to him - just someone to talk to who might offer some practical help.

[Jack Mountain]

How can the bank freeze the account when there are no official papers to demand that? Just by rumours?

It's important to me to know that because i was always thinking that when i am dead that scheduled payments (to my longtime GF) will be executed.

[Minnehaha]

Some good points, Tim. I just wanted to answer the OPs questions and not overwhelm him with too much, but your suggestions are very good. There are some things that could be done now to make the situation much easier for the OP's next-of-kin when the time comes to settle the Australian man's affairs, especially if he has bank accounts or other assets here in Thailand and doesn't have a Thai Will.

The standard advice "I'll just give my friend my ATM card with instructions to clean out my account when I pass" just doesn't work. Aside from being illegal, from a practical standpoint, Thai banks have ways of finding out almost immediately when a foreigner passes and they soon freeze bank accounts.

Actually I have seen it done this way a few times - here is the ATM card and here are instructions what to do with the cash - and understand it is illegal, but I have never seen any authorities make a big deal out of it. In one case the amount of money was THB 300,000 + and in 2 accounts. Several withdrawls were made within a week after death, not the same day. So, at least in these cases, the embassy / Thai authorities were not that fast to contact the banks. I was surprised that it worked so smoothly, to be honest.

[Balance]

In Chiang Mai we have Lanna Care Network, www.lannacarenet.orrg. Perhaps there is a similar group in BKK. LCN is a group of farang with ties to the American consulate whose purpose is to provide the services that you and your friend need. If he has any assets in Thailand, he should have a will.

[maswov]

Find out what his will says. Ask him for it or the name of the lawyer who prepared it.

[NancyL]

With regard to the bank issues -- it really depends on the "rules" at the specific bank, how the account was set up, and whether a Thai Will exists, how well the local bank manager knows the people involved, how much money is involved, etc.. It's been my experience that, in general accounts are frozen, even joint accounts with husband/wife, until a Will is presented. Remember, in Thailand, children inherit at the same level as a spouse in the absence of a Will. Joint ownership of a bank account doesn't mean that the survivor is entitled to the entire account.

But, this isn't the thread to get started on a discussion on what happens to a Thai bank account in the event of death of the account owner. We don't even know if 86 year old Robert has a Thai bank account. All I wanted to do was issue a caution that if he did, the local bank manager needs to be consulted now to be sure everything is in place to be sure his final wishes are carried out if he doesn't have a Final Will in Thailand. He can't count on any "tricks" involving joint ownership, ATM-card clean-out after death, etc to see that his final wishes are carried out with his bank account -- as obviously some others are planning.

Edited April 16, 2014 by NancyL

[Jip99]

How can the bank freeze the account when there are no official papers to demand that? Just by rumours?

It's important to me to know that because i was always thinking that when i am dead that scheduled payments (to my longtime GF) will be executed.

All mandates cease on death (or notification of death).

[Jip99]

Some good points, Tim. I just wanted to answer the OPs questions and not overwhelm him with too much, but your suggestions are very good. There are some things that could be done now to make the situation much easier for the OP's next-of-kin when the time comes to settle the Australian man's affairs, especially if he has bank accounts or other assets here in Thailand and doesn't have a Thai Will.

The standard advice "I'll just give my friend my ATM card with instructions to clean out my account when I pass" just doesn't work. Aside from being illegal, from a practical standpoint, Thai banks have ways of finding out almost immediately when a foreigner passes and they soon freeze bank accounts.

Nancy, the banks don't. They are oblivious to the death of an account holder until someone presents a death certificate or probate.

This is not the thread on which to debate it but feel free to PM me with any questions you may have.

A friend died 6 months ago and Kasikorn are still operating a joint account.

[Konini]

I think it is great that to be reminded that there still are some good people in the world. and the OP is certainly one of them. Of course, most of the people in the world are good, but we forget, and sometimes we tend to only notice the bad or uncaring ones.

While the subject may be morbid, it's something we should all be discussing now while we still are able. Both of our families flat out refuse to discuss anything to do with death, so it makes it difficult for us, all we can do is hope they will respect our wishes of a non-religious local cremation, but I doubt that they will. At least we've made our wishes known, when we're gone our next of kin will make the decisions.

This thread should serve as a reminder both to there being good people around, and to make sure that there are people who know what we want when we go, especially if you are single.

[Showbags]

Surely he must be somewhat lonely and in pain of sorts, at least in some way not able to do or get things in the hours that he is there alone ?

Why not get him into a Thai gov hospital if possible to at least have company and care.

Good to have mates....hope his family come across and stay to help out immediately.

[jpeg]

Surely he must be somewhat lonely and in pain of sorts, at least in some way not able to do or get things in the hours that he is there alone ?

Why not get him into a Thai gov hospital if possible to at least have company and care.

Good to have mates....hope his family come across and stay to help out immediately.

Dear God, the last thing you'd want is to spend what remaining time you have here, is in the 'terminal ward' of a government hospital. Virtually no palliative care. You're simply left to die midst all the other poor souls who've been found not to have a healthy credit card, and therefore wanting. Bloody awful sadistic (scrap heap = don't care, any of them) soulless places. In his condo, as per his wishes, with visits by friend/family (don't overwhelm them, they need space/peace to come to terms with that which is happening to them and sobbing relatives don't help) better.

When he does pass, simply call the local police who will arrange for his corpse to be transported immediately to his local hospital and cleansed (optional, oddly) for the funeral rites. A certificate of death must first be issued by the local police also (due to so many taking out Life Insurance and faking demise, apparently), and then on to Provincial Government Office for issuance of final certificate.

BTW, not morbid, 'death' is simply a part of 'life'. Which applies to all of us.

Edited April 16, 2014 by jpeg

[connda]

Fantastic advice and worth pinning as we will all at some time be in a near death situation.

Something that was only just touched on is a will.

Does your friend have one ?

If not it would be very advisable to arrange one ASP.

Not just for disposing of assets but things like no resuscitation and special funeral arrangements.

I agree. Wonderful info from both NancyL and Sheryl. I'd like to see this pinned. It's a wealth of needed information. Thanks to both!!!

[stevoboy]

I wish we all could have friends like you mate.Sorry for your forthcoming loss.Best wishes.

Sent from my GT-S5830i using Thaivisa Connect Thailand mobile app

[DekDaeng]

So sorry to learn of your friend's suffering. He's fortunate to have a caring friend like you and also a kind Thai caregiver to see that he's comfortable.

Quite often prostate cancer spreads to the bones, so it's very likely that the cancer is the reason he's lost the use of his legs. I've seen several cases of advanced prostate cancer and, in every case, the poor man is not ambulatory at the end -- the cancer spreads to the bones of either the legs, pelvis and/or spine. Because of this, it's very painful cancer, it's very, very good that your friend has access to morphine for pain control.

I'll send Sheryl, the moderator of the Health Forum a message about your post. She has much more medical experience than me and will be along shortly with her wisdom I'm sure.

As for your question about what happens when a foreigner dies at home, usually the local police, manager of the building and the Embassy are called. Someone could address what specifically happens in Bangkok. In Chiang Mai, after the police come to the scene, his body would be taken to University Hospital, the Embassy would notify his family and cremation could be arranged at University hospital for a reasonable price. The Embassy could arrange for his ashes to be returned to Australia. Also, the Embassy would dispatch someone to inventory the contents of his room and seek instruction from the family on whether they want the personal items returned. The exact procedure may be different for Bangkok. Embassies are very used to dealing with the death of their citizens abroad.

Suggest you tell the Thai lady to call you first - she should not call police - when you get there, you call 1) embassy 2) the police. (Ask emb. for a/hrs #)

Video entire apt 1st.

Have been cases where BIB get there first, then little to inventory.

[NancyL]

The advice to photograph everything is good, although in my experience it's not the police who can cause problems, but the staff of the building/moo baan, neighbors, relatives, friends or former/current employees who help themselves to possessions before a proper inventory is taken and possessions are secured. It's an ugly subject to bring up at a time like this and it's my hope that the OP's friend is surrounded by his loving family up from Australia when the time comes.

Edited April 17, 2014 by NancyL

[Greg Nixon]

My Thai wifes mother recently died of cancer. She was scrabbling around in the corner on the floor of her farm house ( shack). She wanted to die at her home but since she was bleeding from both ends and there were no proper care givers present, I suggested that she be taken to the nearest large government hospital. The family confered with each other and were uncertain as to what to do. I suggested that at least she could die in a more comfortable surroundings with proper care.

This was agreed upon. She had good care at the hospital for two or three more days where she died. I cannot even envision how the family would have managed otherwise. Mopping up off the floor without any clear access or egress would have been a nightmare for untrained care givers.

You must obtain a death certificate and notify the local authorities that a faring has died. I believe there is always an investigation if a faring dies. When you notify the diseased persons embassy they will have the local police come.