A couple of weeks ago, the Lower House of Parliament in Spain approved a bill to legalise euthanasia and physician-assisted suicide. Prior to that, The Netherlands, Switzerland, Belgium, Luxembourg, Canada and Colombia had also legalised euthanasia and assisted suicide. In Thailand, euthanasia has been discussed as well but more discussions are scheduled to be held in the future since the country is fast becoming an ageing society.
In 2020, the Department of Older Persons (DOP) of the Ministry of Social Development and Human Security reported that of a total population of 66 million people, 11 million people (16.73%) were above the age of 60. Bangkok is home to the largest elderly population followed by Nakhon Ratchasima (453,000 people) and Chiang Mai (333,000 people). The National Statistical Office has forecast that Thailand will transition into an ageing society sometime between 2022 and 2030 and that the share of the elderly population will increase to 26.9% of the total population. This is problematic because when people become old, they cannot avoid illnesses. According to petcharavejhospital.com, the most common illnesses seen in the elderly in Thailand is cancer, heart disease, stroke, Alzheimer's disease and osteoporosis. These diseases require long-term treatment and financial support, however, not every old person can afford treatment which means many of them will have to end up living their final days suffering for a prolonged period.
In Thailand, there is no law that allows active euthanasia and physician-assisted suicide. Yet, under Section 12 of the Public Health Act, patients in the terminal stages of life have the right to refuse treatment. Patients can prepare their "living will" which express their desires to reject treatment in advance and submit a copy of the document to the hospital, so they do not have to suffer hooked to artificial support machines. With this law, patients can pass painlessly and peacefully. I believe if people can choose, everyone would choose to die peacefully. However, anyone who prepares a "living will" should discuss it with their parents, relatives, or children first because they are the ones taking care of them when they are unconscious or in the operation room. Moreover, some relatives may disagree with the concept of "living will" and may not want to honour the person's "living will".
When an online programme, Thok Tham (Open Questions) on YouTube recently brought the issue of euthanasia up for discussion and presented different viewpoints from a doctor, a monk, an agnostic and a teacher, young people showed their interest because most of them are still single. They may have to spend the rest of their lives alone and they are worried about what they will do when they are old and sick. Meanwhile, the show, Open Questions raised the following question: "We can't choose how we are born. Can we choose how to die?". Many people commented that they wanted to have a right to choose how to die and I agree with them. However, since I am a Buddhist, euthanasia is considered a sin because the first rule of the five precepts in Buddhism, which are a basic code of conduct for Buddhists, prohibits taking a life. Some Buddhists also believe that the spirit of the person who commits suicide will suffer for a long time.
On Open Questions, a monk mentioned a story from Tripitaka. He said there was an arhat or enlightened Buddhist monk who suffered from a terminal illness and eventually decided to commit suicide but that arhat's suicide was not a sin. The monk explained that Buddhism focuses on the mind. If a person commits suicide while in a mood of despair, that person will go to hell. On the contrary, if a person does not have any feelings of despair and grief, she/he will go to a good place. However, this arhat was a special case because he had attained enlightenment before passing away. To avoid ending up in hell, it seems Buddhists will need to practise finding spiritual peace if they want to consider euthanasia.
Another question is that if euthanasia is available in Thailand, who will be the person to carry it out? Let's take the case of patients who have terminal illnesses and suffer severely even though they receive proper treatment. A doctor on Open Questions pointed out that euthanasia is not suicide but that a physician makes it happen. Since the objective of euthanasia is to avoid pain, patients need medical practitioners to assist them. In Switzerland, there is a process before a patient is allowed to undergo euthanasia but in the end, the patient is the one who pulls the plug on his or her life. Videos on YouTube have shown how patients in Switzerland were the ones who took their own lives by drinking liquid medication or injecting medication through a drip and passed away in their sleep. The patients looked peaceful during their death.
I believe euthanasia will never be allowed in Thailand in my lifetime. It is pity that not all Thai patients can choose the way they die, especially, when they want to stop living painfully. However, at least some people who can afford the expenditure abroad can have more choice. In the meantime, we can start from "living will" which is something to help us prepare for that final stage.
Suwitcha Chaiyong is a feature writer for the Life section of the Bangkok Post.