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Palliative care... a window of opportunity has opened

National Health Commission Office (NHCO)  in collaboration with the Health Laws and Ethics Center, Law Faculty, Thammasat University have been translating the National Health Act - particularly  on Article 5-12  which stipulate the rights and duties of an individual on health -  into action.  Both organizations begin with building knowledge and understanding on these matters to the public.

Article 12 : The rights to deny life saving medical treatment at the terminal stage of life.

This right is the basic right that all patients possess. However, this right is mostly in the hand of doctors and their relatives, but not the patients especially ones at the terminal ill stage. 

Some decisions of doctors and the relatives could lead to other problems such as unnecessary treatments and expenses as well as family conflicts. The decision, whether to deny and accept the further medical care for the terminal ill patients, is hard to make.

As a result, NHCO and the Health Laws and Ethics Center have been pushing forward the ministerial regulation to support Article 12.

Palliative care... a window of opportunity has opened 

Along with the movement on the rights to deny life saving medical treatment at the terminal stage of life, the Thai Palliative Care Society (THAPS) has led campaigns for systematic palliative care in Thailand since 2009. In 2013, concerned partners at the national level namely the Ministry of Public Health, the National Health Security Office, the Thai Health Promotion Foundation, the Health Systems Research Institute, the Healthcare Accreditation Institute, THAPS and the National Health Commission Office developed the National Strategic Plan on Health Promotion for Good Death 2014-2016. The plan was approved in 2014 by an issue-based health assembly and the National Health Commission in compliance with the National Health Act B.E. 2550 (2007).

The national strategic plan is the first of its kind. It paves the way to realize the vision of everyone in Thailand having well-being in the terminal stage of their life and good death. The realization needs one obligation to develop, drive and integrate social and health service systems to push for good death and three following important strategies:

  1. To develop knowledge and positive attitudes about terminal well-being, good death and palliative care
  2. To create and systematize quality, standard and comprehensive palliative care to promote well-being in the terminal phase of life and support good death; and
  3. To establish logistic systems to support the provision of care.

 From now on the strategic plan will be implemented so that concrete solutions will emerge within 2016. A project was initiated to push for the implementation of the strategic plan. Activities are being conducted to create participation among networks including social, service and academic ones. For example, they have exchanged views and experiences and drawn lessons for public education. They have proposed ideas on systems and forms. There have been strategic communications, the production of media to facilitate work and researches on strategies for the next stage of development.

 Regarding an international movement, the 67th World Health Assembly in Geneva, Switzerland, reached a resolution on the strengthening of palliative care as a component of comprehensive care throughout the life course. It is the first resolution directly concerning palliative care. It urges member states to formulate and implement palliative care policies and offer funds, personnel and basic supplies to volunteers, families and communities to enable them to participate in palliative care.

 The resolution also calls for the education and development of human resources at different levels, the assessment of demands for medicines – especially those essential to handle pain, the provision of medical equipment, legal support, and promotion for sectors to take part in developing service systems and following up activities as specified in the action plan of the World Health Organization concerning the prevention and control of non-communicable diseases.

 The health policy of the current government opens a window of opportunity for the development of systematic services that have been demanded by people but have never existed in Thailand. The policy will play important roles in implementing the strategic plan. It states that “systems to promote the well-being of the elderly, dependents and patients in the terminal phase of their life will be established in a year and continue to function in a sustainable manner. This focuses on care by communities and families supported with close cooperation between health services facilities and local administrative organizations.”

 Under the policy, palliative care units will be set up to function as administrative and coordinative units at all advance-level, standard-level and mid-level referral hospitals within December 2014. Each palliative care unit will be manned by at least one trained nurse on a full-time basis and a dedicated ward for palliative care is optional. In addition, palliative care units will be set up at 300 community hospitals in the service networks of the bigger hospitals within September 2015.

 The policy has prompted concerned organizations to take actions to achieve the goals. For example, the policy has been introduced to hospital executives. Training is prepared and guidelines are developed for service provision. Concerned partners have conducted activities including academic conferences and workshops to support the government in implementing the policy. There have been researches to find out strategic solutions. Handbooks, guidelines, recommendations, curriculum, books and textbooks have been issued. Forms of services have been developed and lessons of successful operations have been drawn.

 Therefore, it can be expected that palliative care in various dimensions including medical and spiritual ones as well as attitudinal changes in the society will develop rapidly to respond well and swiftly to upcoming demographic, health, economic and social changes and that the care will be efficient, comprehensive and sustainable for all people in Thailand who are approaching the final stage of their life so that they can pass away naturally and peacefully without any suffering and their human dignity is guaranteed.

Updated on November 2014

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