Living Will in Thailand (Section 12): What It Is and How to Make One

A question I often hear from families outside the ICU is, "Would Dad want a breathing tube?" Then everyone looks at each other, because no one ever asked him. A living will solves this problem. It isn't about dying sooner; it's about making sure your final days go the way you want, and that the people you love don't have to carry a decision that is too heavy.

What is a living will?

A living will is known in Thai law as a written statement of intent not to receive public health services that merely prolong dying at the end of life, or to end suffering from illness. It is part of advance care planning, stating what treatment you do or don't want on a day when you can't communicate for yourself, for example if you are unconscious, have severe dementia or are in the final stage of an illness.

A living will has nothing to do with dividing property, which is an ordinary will under the Civil and Commercial Code.

How Thai law recognizes it

Section 12 of the National Health Act B.E. 2550 (2007) has two key parts:

1. A person has the right to make a written statement of intent not to receive public health services that merely prolong dying at the end of life, or to end suffering from illness.
2. When health professionals act according to the intent in that statement, it is not considered an offence, and they are released from all liability.

The practical details are set out in the Ministerial Regulation on the rules and procedures for acting on such statements, B.E. 2553 (2010), for example presenting the document to the doctor, explaining the intent, and the doctor having to assess that the person really has reached the end of life.

It isn't euthanasia, and it isn't abandonment

What it does

• Refuses life-prolonging treatment, e.g. CPR, breathing tube, ICU
• Comfort care, pain and breathlessness control continue
• Applies when doctors judge you to be at the end of life

What it is not

• Not euthanasia, which remains illegal in Thailand
• Not stopping care or abandoning the patient
• Not for illnesses that can be cured

vs

Under Section 12 of the National Health Act B.E. 2550 (2007).

What should you write?

There is no compulsory form; it can be handwritten or typed. The National Health Commission Office (NHCO) and many hospitals have sample forms. The content should include:

1. Your full name, national ID number (or passport number if you are not Thai), address and the date
2. Treatments you don't want, such as resuscitation, intubation, tracheostomy, tube feeding, dialysis or ICU admission
3. Care you do want, for example enough pain relief, dying at home, having a monk or religious leader present, or having your loved ones with you
4. The name of a person you trust to explain your wishes when you can't communicate
5. Your signature, ideally with witnesses' signatures. If someone else writes it for you, their name and the witnesses must also be stated.

Who should make one, and when?

• Every adult of sound mind; you don't need to be ill first
• People recently diagnosed with a serious illness or a progressive condition such as early dementia should do it soon, before decisions become harder
• Older people, especially those living alone
• Couples who aren't legally married, or families whose views may differ; naming a trusted person helps a lot. Spouses of any gender now have equal legal status in Thailand; see Marriage equality: your rights and better health

If you are a foreigner living in Thailand, ask the hospital where you are treated how they record an advance directive, and consider whether you also need one that is valid in your home country.

What to do after writing it

1. Talk with your family. Explain your reasons so everyone knows the document exists and understands it the same way. This matters more than the paper itself.
2. Give a copy to your regular doctor or hospital so it is recorded in your medical file.
3. Keep the original somewhere easy to find, and tell your trusted person where it is.
4. Review it from time to time as your health or thinking changes. You can amend or cancel it at any time; the latest version is the one that applies.

1. 1Talk to familyExplain your reasons; this matters more than the paper
2. 2Give your doctor a copyRecorded in your regular hospital's medical record
3. 3Keep the originalSomewhere findable, and tell someone you trust
4. 4Review periodicallyYou can amend or cancel it at any time; the latest version applies

When the family doesn't agree

Sometimes children feel guilty about not prolonging life, or fear others will see them as ungrateful. Talking together with a doctor in advance, or holding a family conference, helps everyone see that respecting the patient's wishes is a form of love. See Family therapy and family conferences and Palliative care.

Consulting at Dr. Kris Clinic

I can explain end-of-life treatment options in plain language, help you think about what matters to you, help you write an advance directive, and arrange a conversation with your family, at the clinic or online, in English or Thai. For complex legal questions, such as property or inheritance, you should also consult a lawyer. See the bigger picture of a family doctor's work in Family medicine.