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Sheryl

Living Wills

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The right to refuse treatment first recognized  by the Health Act of 2007; in 2010 a regulations was enacted sopecific to Living Wills. It took effect in mid 2011.

 

The regualtion in Thai is here:
http://www.thailawon...ion in Thai.pdf

and an English translation by Issan lawyers is here:

http://thailawonline...aan_Lawyers.pdf

Recently, a TV member was successful in executing one a Bangkok Hospital in Bangkok , and I am told that  BPH has the forms and related information.

 

As this is of great concern to all of us, please post any relevant experiences you have.

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I suggest anyone making a Living Will following these guidelines, should attach a copy of the guidelines to the Will.

 

If you have a GP, deposit a copy of your LW with him/her and also add it to any medical records you may have in various hospitals.

 

Make sure several people know of it's existence, just in case the person who you think will start the ball rolling, can't do it or is unable to do it when the time comes.

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Merged 2 similiar threads.

 

Thanks to the above poster for info provided, extremely useful.

 

I was not aware that Bumrungrad had either a Palliative Care Unit or a Medico-Legal Unit so that alone is also great info. We had a situation posted here recently which should probably have been handled by the Medico-Legal Unit.

 

A shame that the existence of these "units" is not better publicized, one wonders how patients find their way to them - not everyone has your perserverance. And I suspect that many doctors in the hospital aren't aware of them either.

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Regarding Sheryl's comment above about Bangkok Hospital, I did find online an Adobe PDF document in English and in Thai of the Living Will forms apparently used at Bangkok Hospital Pattaya. I didn't source the document myself, so I can't say whether it's current or not. But it's certainly a good starting point.

 

And of note, unlike Bumrungrad, it doesn't appear to have any element of requiring a certification by a doctor from the hospital.

 

[attachment=266166:Bangkok Hospital Pattaya Living Will Info.pdf]

 

One of the things I'd hope to learn from this thread, is whether people here find that hospitals are willing to accept generic Thai law-compliant living wills, or are hospitals going to insist people use their unique forms and procedures. The latter approach would make planning ahead for unexpected medical events quite a bit more difficult.

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Merged 2 similiar threads.

 

Thanks to the above poster for info provided, extremely useful.

 

I was not aware that Bumrungrad had either a Palliative Care Unit or a Medico-Legal Unit so that alone is also great info. We had a situation posted here recently which should probably have been handled by the Medico-Legal Unit.

 

A shame that the existence of these "units" is not better publicized, one wonders how patients find their way to them - not everyone has your perserverance. And I suspect that many doctors in the hospital aren't aware of them either.

 

I found no mention of either anywhere on Bumrungrad's website. But then again, I didn't find any Bumrungrad administrative departments directory listed either, other than the medical specialty ones that every hospital lists.

 

From my discussion, the main lady from their Medico-Legal unit indicated that in addition to their role in dealing with the Living Wills issue, they're also the ones that liaison with the medical staff in situations where patient care issues turn into litigation.

 

As I said above, once I got to the right staff at Bumrungrad, they were very helpful and knowledgeable on the subject. But the average Thai or farang just walking in the door and wanting to do or asking about a living will would pretty much get nowhere. The hospital staff we spoke with said a lot of farangs are familiar with the subject, but they said living wills are very unknown among most Thais.

 

 

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Very useful information indeed.

 

Does this mean a person has to go through the same process as Bamrungrad's to cover all possible hospitals one might be taken to?

E.g Motor Vehicle accident etc.

 

What if you have a LW deposited at BRR and have a stroke or accident that leaves you on a life support machine in Chiang Mai?

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Re the questions you raise above:

 

That's the issue I was raising in my own post about Bumrungrad having their own unique process and form. I don't know whether other hospitals would accept it or not.

 

On the other hand, the Bangkok Hospital Pattaya living will document I attached above came from the Pattaya City Expats Club. And according to their information, that form/format is simply a reproduction of a supposed generic living will form posted online by the Thai Ministry of Public Health at the time the ministry issued its final regulation on living wills (with the BHP logo inserted at the top).

 

But as to the general recommended approach a person should take, I've seen two things mentioned:

 

1. do a generic living will document in the legal formats used above, and have it appropriately witnessed and signed as required. And then keep that document at home and with your spouse or family, in the event it's ever needed at any Thai hospital, so your relations can provide it.

 

2. if you have a main hospital or hospitals you usually use for your medical care, check with that/those hospitals about their living will procedures, and see about having them accept a copy of your document, or fill out their own form, for keeping as part of your ongoing medical record with them. That way if it's ever needed, they already have it in their system.

 

It would be great if we can, someone can, find an English version of the generic MOPH living will document, and post it here for general use.

 

PS - I had an English version at home of the Ministry of Public Health regulation on living wills, and nowhere in that is there any kind of mention or requirement about a doctor having to certify the document in order for it to be valid. So Bumrungrad appears to be going beyond what the MOPH regulation entails.

 

Edited by TallGuyJohninBKK
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Thank you Tall Guy John. Detailed and informative post.

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By law, a hospital should honor a living will made in accordance with the regulations spelled out in the links mentioned in the first post.

 

Apparently some hospitals are requiring hospital specific forms which may add additional requirements. If feasible it will be wise to comply and execute the hospital form in addition to having a generic one made in accordance with  the givernment regulations.

 

However in the event someone has made a generic living will and ends up in a hospital and unable to fill out a hospital specific form, legally there is every ground to insist that the generic form be honored, and the nearest relative or someone with power of attorney should insist in such. If necessary, threaten to bring legal action, hire a lawyer. Generally speaking on this issue hospitals have 2 concerns: fear of legal risk and fear of bad publicity.  So plan you approach accordingly such that they perceive not honoring the document to be the riskiest course of action.

 

As I have said in other threads, in any country -- even those far more legalistic/law-abiding than LOS -- the wishes and actions of the next of kin or person with power of attorney count much more than any document the patient may have signed. dead people do not sue, living ones do. The provisions of a living will will be ignored if close relatives indicate they will object otherwise; even though the document may protect the hospital in court, no hospital wants to face legal charges and the costs and bad publicity associated. Conversely, even in the absence of a living will, family can effectively bring a lot of pressure to bear to have their wishes honored (and with private hospitals there is also always the leverage of threatening not to accept responsibility for the cost -- extraordinary measures being very, very expensive).

 

So it is critical that you have someone who understands your wishes and is prepared to help enforce them when the time comes. If that person is not your closest relative, best to execute a power of attorney that comes into effect when you are unable to act on your own behalf. Such powers can be limited or broad as you prefer but be sure they include medical decisions. And think through who will need to be able to access your finances/how as well so that you don't put those trying to help into an awkward position.

 

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fwiw, the USA system,   is moving away a bit from legalistic 'medical decisions'/advance directives, and one can supplement it with this(portable-in or out of hospital, physician's standing orders), which is more helpful , the decisions paper, should not necessarily be about the form type, but whether it contains standardized language etc. 

 

https://en.wikipedia.org/wiki/Physician_Orders_for_Life-Sustaining_Treatment

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I have thought about the living will issue, but the problem is how do I know how I will feel if I find myself in the situation, such as having a terminal illness.  Like most people I have never been in such a situation and, while I might wish that under those circumstances I would be ready to refuse treatment, in fact, I have no idea how I would actually feel.  

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The living will comes into play only if you are unable to speak for yourself. You can always give indtructions to the contrary as long as you are conscious and coherent. You do not in any way forfeit the ability to change your mind or make specific choices.

if you are not conscious and coherent and you do not have a living will, other people are going to decide for you. Do you really prefer that?

need also to understand that living wills do NOT say "If anything happens just let me die" (and no one eould honor it if it did). Rather they usually say in effect "if I am terminally ill with no chance of recovery, keep me comfortable rsther than subject me to painful treatments that only prolong the dying process".


Indeed, Sheryl. Recently, I was involved in a situation where someone who had suffered a stroke (but had an uncertain prognosis) made the decision to accept a feeding tube and ventilator, even though in her Advance Directive she had checked every box to refuse those (and all forms) of life support in every case (terminal illness, coma, advanced progressive disease, etc) Her condition worsen to where she clearly met the criteria for refusing life support, as spelled out in her Advance Directive. It was very difficult to watch her being kept alive via artificial means, knowing that's not what she would have wanted at that point.

What probably wasn't clear to her and those around her is that once life support is started in Thailand, it cannot be stopped by the hospital, the way it can be stopped in hospitals in the west. It is possible for the "family" to take a comatose patient home and for the life support to be removed as the patient is left at home by the hospital transport crew, but it cannot be done in the hospital, in a humane way with palliative care available. Edited by NancyL

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The living will comes into play only if you are unable to speak for yourself. You can always give indtructions to the contrary as long as you are conscious and coherent. You do not in any way forfeit the ability to change your mind or make specific choices.

if you are not conscious and coherent and you do not have a living will, other people are going to decide for you. Do you really prefer that?

need also to understand that living wills do NOT say "If anything happens just let me die" (and no one eould honor it if it did). Rather they usually say in effect "if I am terminally ill with no chance of recovery, keep me comfortable rsther than subject me to painful treatments that only prolong the dying process".

 

In such an extremity the issue is hardly about asserting one's self since that option will have been lost forever.  It is about getting treatment or not.  I have no idea what I would want because I have never been even near to such a condition myself.  What I do understand from doctor friends who have been around dying people is that they typically cling to life.  Therefore it is reasonable for me to expect that I will also cling to life in such a situation, although not certain.  Since I have no idea how I would feel I have no basis on which to decide in advance. 

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