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Vol. XIII No.23 - Sunday November 16, 2014 - Saturday November 29, 2014


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Doctor's Consultation  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 Living Will.
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 prolong life.”
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 believe.
But remember that the message is that a Living Will is not euthanasia, and that you must lodge it, before you need it!


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Medically assisted suicide and Living Wills
 

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