Call to raise 'living will' awareness

Call to raise 'living will' awareness

Patients have right to refuse treatment

The crematorium of Wat Mongkhol Pracharam in Buddha Monthon district of Nakhon Pathom was colourfully painted to relieve sadness of relatives of dead people. (File photo by Patipat Janthong)
The crematorium of Wat Mongkhol Pracharam in Buddha Monthon district of Nakhon Pathom was colourfully painted to relieve sadness of relatives of dead people. (File photo by Patipat Janthong)

The Ministry of Public Health, healthcare bodies and political parties have been urged to do more to the public on patients' right to reject medical treatment and a peaceful death and reduced health care costs.

The issue was discussed on Thursday at seminar on "Accelerating Death vs Choosing Death: The last rights, and who should make it" hosted by the National Health Commission Office (NHCO).

Seminar participants said most patients with life threatening illnesses were not aware of their right to reject medical treatment, even though the Public Health Ministry has been enforcing Section 12 of the Public Health Act BE 2550 (CE 2007) for more than a decade.

Under the act, patients with life threatening illnesses can refuse further medical examination and treatment.

The participants said only a small number of patients were aware of their rights under the act. Sawang Boonchalermvipas, the NHCO's health rights adviser, said it was very difficult to raise public awareness about the right of critically ill patients to reject further medical treatment.

"So the Public Health Ministry, the National Health Security Office, the Thai Health Promotion Foundation and political parties should work together to educate the public about their rights,'' he said.

Mr Sawang said each hospital should have a consultant unit to explain and create better understanding of the issue to patients and their families.

"The intention to reject medical treatment or write a 'living will' under Thai law is totally different from the concept of a 'mercy killing'. Through a living will, a doctor will continue to take care of a patient under a palliative care system until their death. But mercy killings are a way to accelerate death by giving medicine to patients. That happens in only a few countries, such as the United States, the Netherlands and Belgium," he said.

Mr Sawang said many hospitals have recently adopted palliative care systems, and many medical schools have started establishing hospice care centres. Patients and their family members could live in the centres and spend their last moments together under the supervision of a medical team. Painkillers could also be given to patients, he said.

Thammasat Hospital in Pathum Thani has had a hospice care centre for more than three years. Siriraj Hospital in Bangkok plans to open a hospice in Nonthaburi's Bang Yai district.

Issarang Nuchprayoon, secretary-general of the Wishing Well Foundation and doctor at Chulalongkorn Memorial Hospital, said only a few patients had expressed a desire to reject treatment under the law, which meant that many patients do not know about it, and doctors do not want to tell them because it is a very complicated issue that takes time to explain.

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