Submission of a written order to refuse public health services that would otherwise prolong living with a terminal illness preventing a natural death
Dignity, rights, liberty and body are protected by the Constitution of the Kingdom of Thailand (B.E. 2550) which is congruent with the Declaration of Lisbon on the Rights of the Patient (1981). The declaration specifically affirms the patient’s right of self-determination to make free decisions regarding his or her own body. The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and as comfortable as possible.
Section 12 of the National Health Act (B.E. 2550) asserts a person’s right to submit a written order refusing public health services that would otherwise prolong his or her terminal illness as to cease severe suffering (“Refusal of Treatment”). This written order shall take effect at the patient’s terminal stage of life, which is when the patient’s condition inevitably and progressively worsens, and their lives are temporarily prolonged by futile medical treatment that only relieves their symptoms. A persistent or permanent vegetative state also qualifies as being in the terminal stage of life. However, doctors’ opinions are also required on a case-by-case basis to determine whether a patient is considered terminally ill.
Who Can Refuse Medical Treatment
Section 12 of the National Health Act, B.E. 2550 states that any ‘person’ can refuse medical treatment. However, the National Health Commission Office of Thailand’s policy legislates that any person who is below the age of 18 is required to obtain the consent of their father, mother, guardian or legal representative. Moreover, the public health profession practitioner will consider whether such person is of sound mind by examining their ability to communicate with others, to comprehend their circumstances, to remember past events, to plan their future and to understand the consequences of refusing medical treatment.
If the person providing a written order to refuse medical treatment is pregnant, the written order shall take effect after the pregnancy.
Content of a Written Order Refusing Medical Treatment
The law does not require a form or criteria of how a person should make a written order refusing treatment. However, the Ministry of Public Health issued ministerial regulations in 2010 stating that a written order for refusal of medical treatment should provide adequate information to the extent that a person in charge can follow the patient’s intentions. Here is a list of information which a written order shall contain:
- The patient’s name, last name, age, ID card number, signature or fingerprint, current address and phone number;
- Date that the written order is made;
- A witness’s name, last name, ID card number, signature or fingerprint and how he or she is relevant to the patient;
- Undesirable medical treatment(s); and
- If the patient allows another person to write or type the living will for them, the name, last name, signature or fingerprint and ID card number of that person must be provided.
The patient may put the name of the person who will explain any point stated unclearly in the written order. Such person shall sign or fingerprint on the written order and provide personal information e.g. ID card number. The written order may include some other details, for example, where the patient desires to pass away, or the desire to be healed spiritually or through rituals according to their personal or religious beliefs. Thus the medical caregivers shall perform such wishes accordingly.
The patient, when receiving medical care, shall submit the written order refusing medical treatment to the public health profession practitioner (doctor, nurse) in that medical establishment.
Liability of Medical Practitioners
Paragraph 3 of Section 12 of the National Health Act, B.E. 2550 states that an act done by public health personnel in compliance with written order refusing treatment shall not be held liable to any actions taken whatsoever.