The choice of a living will

The choice of a living will.

The new National Health Bill may be imperfect and require work before it is acceptable as national law, but it sets excellent new principles. One of these, almost certain to occupy most of the coming debate, is the section setting out the right to die with dignity. This subject never has been seriously debated at the level of national government. The principle of a living will is sound and the Ministry of Public Health should persevere with its efforts. That is not to say that the proposed bill is acceptable in its current form. The Ministry of Public Health should listen carefully to suggestions for change, because amendments are needed. The proposed language of the law as drafted is ambiguous and raises real problems. The ministry would be wise to adopt democratic principles here. The entire law, as well as the specific section on living wills, needs strong scrutiny, because the health of the nation is at stake. The ministry, the government and the National Legislative Assembly must also resist the coming temptation to deal only with the living-wills section, and sweep the rest into law in haste.

It is almost certain that the section that deals with the so-called ''right to die'' will attract strong comments, emotional disputes and outspoken opposition. This is understandable. Legally, medical experts are trained not to be involved in the termination of a human life. Instinctively, few people want to make decisions about their own death. Ethically, even fewer wish to face the idea of making such a decision for others. These, however, are precisely the reasons to put the power of death in dignity in law, while making it entirely voluntary.

And ''voluntary'' must be the guiding provision of this proposal. Should this bill become law, as it should, it must never be used to mandate, let alone to require termination of any life. But a living will should be a choice for those who wish to use it. Under terms of the National Health Bill, such people will have to write and sign a document while they still have healthy minds, and the document must be provably written by them, with the courts to settle questions of ill intent. The living will typically directs family members and medical authorities to terminate extraordinary efforts to sustain life when there is no reasonable expectation that the patient will recover from a massively debilitating injury or disease.

Emotionally, some argue about euthanasia, although a living will is the opposite of such a revolting policy. Opponents of the living will typically argue that no human has the right to end a life. Religious opponents add that only God has such a right. These arguments are red herrings. In today's world, medical technology exists to sustain a body far beyond a natural death. Accident victims whose brains are clinically dead can be kept in a comatose, totally uncomprehending state for years. Inversely, machines can keep hearts beating long after the organs have naturally succumbed to disease. If ending machine assistance is ''playing God'' then so is using them in the first place.

In these circumstances, Thais should have the right to choose in advance to die with dignity. Many feel this would save their families the grief, expense and guilt of making a decision to ''pull the plug'' for a relative. The living will is a logical and progressive extension of the Thai desire for proper human and civil rights. Dying in dignity when all hope for a dignified life has been lost should be such a right.

The government should have no part in this process. Only the courts should intervene in case of a problem. There must be wide discussion on this, probably including public hearings. The part of the right-to-die bill which allows the Public Health Ministry to scrutinise living wills should be scrapped. In addition, medical and legal experts, religious figures and lay people all must have their say.

After such input, effort must continue to turn the right to die with dignity into law. Once it has been improved, the Public Health Ministry should press ahead with this forward-looking proposal.

Bangkok Post
Monday January 15, 2007