by Dr. Iain Corness
Medically assisted suicide and Living Wills
A poor young woman in the US just took
her own life with a medically assisted suicide, rather than face a lingering
painful death from an aggressive brain tumor. This is legal in only five
states in the USA. Was this a Living Will or not? I also received a request
from an ex-pat friend of mine to enquire as to whether euthanasia was
offered by my hospital.
Unfortunately, there is confusion in the minds of many people, as to what a
“Living Will” actually is and what it covers. Borrowing from the Mayo Clinic
in the US, it states on their website “This written, legal document spells
out the types of medical treatments and life-sustaining measures you do and
don’t want, such as mechanical breathing (respiration and ventilation), tube
feeding or resuscitation.” The important words to note are “life sustaining”
and “resuscitation”. Neither of these concepts implies medically assisted
suicide, or euthanasia.
In Thailand, I can state categorically that medically assisted suicide is
against the law. Period. No further discussion.
Once again from the Mayo Clinic, “Injury, illness and death aren’t easy
subjects to talk about, but by planning ahead you can ensure that you
receive the type of medical care you want, to take the burden off your
family of trying to guess at what you’d want done.”
Remember that we are talking about terminal situations here. Not situations
from which it would be reasonably expected that you will recover and still
have a good quality of life. A fractured hip when you are 90 is a serious
situation, but provided you are healthy otherwise, then it would be expected
that you would recover. You might need a stick for a while, but you would
still be able to have a beer with your mates or play Scrabble or whatever
your pursuits were before the incident. In other words, the expectancy of a
reasonable quality of life is there.
However, if you are in the terminal phase of metastatic cancer, which has
progressed despite treatment, the future quality of life is not there.
Artificially prolonging life under that situation is then covered by the
As an example, I ask you to note the following:
The Living Will is made while in sound mind. It is not something you
scribble out while lying in God’s waiting room. An example of a Living Will.
“Being of sound mind and understanding all the implications, I ask that this
document be brought to the attention of any medical facility in whose care I
happen to be, and to any person who may become responsible for my affairs.
“This is my ‘Living Will’ stating my wishes in that my life should not be
artificially prolonged, if this sacrifices my Quality of Life.
“If, for any reason, I am diagnosed as being in a terminal condition, I wish
that my treatment be designed to keep me comfortable and to relieve pain,
and allow me to die as naturally as possible, with as much dignity as can be
maintained under the circumstances.
“As well as the situation in which I have been diagnosed as being in a
terminal condition, these instructions will apply to situations of
permanently unconscious states and irreversible brain damage.
“In the case of a life-threatening condition, in which I am unconscious or
otherwise unable to express my wishes, I hereby advise that I do not want to
be kept alive on a life support system, and I do not want resuscitation, nor
do I authorize, or give my consent to procedures being carried out which
would compromise any Quality of Life that I might expect in the future.
“I ask that you are sensitive to and respectful of my wishes; and use the
most appropriate measures that are consistent with my choices and encompass
alleviation of pain and other physical symptoms; without attempting to
Now those are only examples. The Bangkok Hospital system has a pro forma
Living Will, which is also repeated in the Pattaya City Expats website, I
But remember that the message is that a Living Will is not euthanasia, and
that you must lodge it, before you need it!