BANGKOK – In Thailand, death is still a taboo subject, but the topic of palliative care has recently come under the spotlight after a widely shared farewell post by a young doctor with terminal lung cancer.
On Nov 2, Dr Krittai Tanasombatkul, 29, announced that he “should be going” in mid-December.
“I won’t be able to stay long. If anyone has something they want to say, please tell me,” wrote Dr Krittai on his Facebook page. He had earlier in 2023 released a memoir about his battle with cancer.
His Facebook post and other similar posts on social media platforms have since garnered more than 300,000 views and been shared about 60,000 times. Besides showing support for Dr Krittai, many netizens also revealed their thoughts about the fragility of life and having a dignified death.
Mr Ekkapop Sittiwantana, a co-founder of Peaceful Death, a non-governmental organisation which aims to raise public awareness about end-of-life preparations and palliative care, calls this a positive moment for the conversation about death.
“If you do not talk about death, you cannot plan, and that creates a lot of complications for the patient, family and doctors,” he said.
As Thailand becomes one of the fastest-ageing populations in the world, with nearly one-fifth of its 70 million citizens above 60, the demand for geriatric medicine as well as elder and palliative care has grown.
Compared with five years ago, the field of palliative care has grown as more medical workers and hospitals focus on this area of medicine, said palliative care physician Itthipon Wongprom.
However, the level and quality of care can differ greatly, and not all hospitals have the bandwidth for eldercare home visits or for doctors to specialise in palliative treatment. Thailand, which has about 50,000 doctors, still faces a shortage of medical personnel, especially at public hospitals.
In 2014, the Thai government introduced the Palliative Care Policy, paving the way for palliative care units to be established in provincial and community hospitals.
In 2021, advance care planning, in which people make plans for their future healthcare, including their treatment preferences in a medical emergency, was rolled out on a national level. This included a common national form for advance care planning and standard operating procedures implemented across the board.
Still, end-of-life care remains a difficult subject to broach.
A 2018 survey by the Thailand Development Research Institute, a think-tank, found that only 37 per cent of 2,394 respondents had ever had a discussion about the end of life. The survey found that culture and tradition, the perceived difficulty of raising the topic and the negative emotions it might trigger were the main barriers to such dialogue.
Broaching the touchy topics is not just about confronting the complicated emotions surrounding death and life, or religious and spiritual beliefs. Such discussions ensure that patients receive their desired treatment, and that suffering is not prolonged against their wishes.
