What is the e-Living Will? Why is it Important?
Source Policy Watch: https://policywatch.thaipbs.or.th/article/life-86
The ‘e-Living Will,’ also known as a letter of intent, is gaining attention in Thai society. Rooted in the principle of individual rights, it allows people to articulate their preferences for medical treatment at the end of life.
What is the e-Living Will system?
Under Section 12 of the 2007 National Health Act, individuals have the right to issue a written declaration declining public health services designed solely to prolong life during terminal illness or to alleviate suffering from a critical condition. The Electronic Transactions Act of 2019 further facilitates the legal execution of e-Living Wills.
The system enables individuals to electronically create, store, and share their letters of intent with healthcare providers. This digital platform ensures efficient access for medical professionals, enabling them to adhere to patients’ wishes when making treatment decisions.
Why is the e-Living Will necessary?
The e-Living Will serves as a vital communication tool for families and healthcare providers, clearly outlining preferences for end-of-life care. This system improves accessibility for hospitals, enhances decision-making, and ensures security and convenience for users.
How secure is the e-Living Will system?
The e-Living Will system, developed by the National Health Commission Office *(NHCO), operates on the Government Central Cloud (GDCC) platform. It verifies user identities via the Department of Provincial Administration’s ThaiID system and connects seamlessly with hospitals and registered healthcare networks.
*The NHCO, the government agency promoting the adoption of Living Wills, ensures data security through these official channels, safeguarding users’ sensitive information.
Where can an e-Living Will be created?
The e-Living Will system allows individuals to create their Living Wills online conveniently, anytime and anywhere with internet access.
Expected outcomes:
- Citizens can prepare a letter of intent, ensuring their wishes are recorded, accessible, and followed during medical care.
- Hospitals can deliver end-of-life care that aligns with patients’ expressed intentions, preserving their dignity.
- Network partners provide care and advisory services to support preparation for a dignified and peaceful end of life.
- The NHCO promotes the adoption of the e-Living Will, emphasizing efficiency, security, and reliability.
Benefits to society:
- Reduces unnecessary healthcare costs without compromising quality and standards of care.
- Fosters a society that values intellectual health by encouraging individuals to plan for a dignified end of life.
Dr. Netnapis Suchonwanich, an advisor to the NHCO, highlighted that over 15 years, efforts to implement Section 12 in collaboration with partners across various sectors, over 200,000 Living Wills have been created, representing 0.3% of Thailand’s 65-million population.
She pointed out that currently, relevant departments operate independently, with no integration in document numbering, record-keeping, and retrieval systems.
Additionally, variations in documentation formats and the absence of centralized data standards often require subjective interpretation. This can hinder physicians from fully adhering to patients’ expressed wishes.
Moreover, the Living Will system lacks an organized framework for sharing information during emergencies.
Dr. Netnapis emphasized the importance of developing information management systems to facilitate data linkage, exchange, and sharing of expressed intentions among service providers. Such improvements would enhance accessibility and allow patients to navigate the service system more conveniently.
What is the Right to Die Under Section 12?
Section 12 of the National Health Act guarantees the following rights:
- Patient Autonomy: Patients have the right to make informed decisions about their own healthcare, in accordance with legal and internationally accepted medical practices.
- Right to Refuse Treatment: Individuals have the right to decline medical treatments aimed solely at prolonging life in the final stages of terminal illness or alleviate suffering. The implementation of the Living Will shall adhere to the criteria and procedures outlined in ministerial regulations.
- Living Will as a Communication Tool: The Living Will serves as a crucial communication tool for patients, their families, and healthcare providers in end-of-life care planning. It is an integral component of Advance Care Planning and Palliative Care.
The National Health Commission Office (NHCO) and the Ministry of Public Health (MOPH) have been assigned the lead role in implementing end-of-life care initiatives, in line with Section 12 of the National Health Act, 2007.
Their key missions include:
- Developing an IT system for managing Letters of Intent under Section 12, known as the “e-Living Will.” This system will enable individuals to easily, conveniently, and quickly prepare their Letters of Intent anytime, anywhere. The system was successfully launched in May 2024.
- Collaborating with relevant agencies to incorporate end-of-life care policies into the Area Health Board (AHB) mechanism and Provincial Administrative Organization (PAO) health development plans.
- Encourage local agencies to collaborate with health sector organizations to provide end-of-life care through various appropriate models, including networks with hospitals, comprehensive home care services, or community hospice units that serve as central hubs for supporting terminally ill patients within the community.