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Good news on the right to refuse life-sustaining medical treatment in your terminal stage of life

 Good news on the right to refuse life-sustaining medical treatment in your terminal stage of life

June 15, 2011

I have not written an open letter to partners for a long time. Now I have good news. It is about the “right to refuse life-sustaining medical treatment in the terminal stage of life” that many partners and fellows have been demanding since the drafting of the National Health Act ten years ago. It took a long time for the passage of the National Health Act of 2007. The issue is written on Section 12 as follows.

A person shall have the right to make a living will in writing to refuse the public health service which is provided merely to prolong his/her terminal stage of life or to make a living will to refuse the service as to cease the severe suffering from illness. The living will under paragraph one shall be carried out in accordance with the rules and procedure prescribed in the Ministerial Regulation. An act done by public health personnel in compliance with the living will under paragraph one shall not be held an offence and shall not be liable to any responsibility whatsoever.

In fact, everyone knows well that the right to refuse medical treatment is already ours and it is not new. For example, when we fall sick, we can decide whether we will see a doctor or not. When a doctor makes a diagnosis and recommends a treatment method, we can refuse it if we do not want it. However, when we reach the terminal stage of our life, we may be too weak to refuse treatment by ourselves. This law protects the right by allowing us to write our refusal in advance. Many countries have imposed such laws for a long time.

The writing is intended to tell a doctor in advance that when we are so ill that a doctor gives a professional diagnosis that we are in the terminal stage of life and it is impossible to cure us, at that point, we will refuse any kind of treatment in order to avoid suffering, being chained to equipment and incurring unnecessary expense.

However, the law does not allow doctors to kill us by any means. Therefore, this is not mercy killing. Doctors are still duty-bound to give palliative care to relieve our pain in compliance with conventional medical ethics.

This is the right of everyone whether or not you want to exercise, it has has existed since the promulgation of the National Health Act in 2007. The right to write the living will is not compulsory. However, the law requires the execution of the will to comply with criteria and methods specified in a ministerial regulation. It took some times to issue the ministerial regulation but the process was already completed. The ministerial regulation has taken full effect since 20 May, 2011.

To prepare hospitals nationwide, both public and private ones, the National Health Commission Office of Thailand has informed the networks of professionals and service providers of the right and provided them with relevant documents to create  understanding. The office also sent lecturers to share knowledge. 

It is a great pleasure to see the networks of professionals enthusiastically preparing themselves on the issue for seeing its merits. The parties include the network of university hospitals, the Thailand Nursing and Midwife Council and its provincial branches, the network of palliative care professionals, public health inspection offices, and the network of hospitals under the jurisdiction of the Ministry of Public Health.

Therefore, it can be assured that doctors, nurses and health officials who have morals, ethics and humanitarianism will fully support people in exercising this right.

Amphon Jindawatthana 
Secretary General 
National Health Commission
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