LEGAL ASPECT OF EUTHANASIA IN THAILAND: PROBLEMS AND PROSPECTS
Assistant Professor Dr. Saratoon Santivasa**
I. INTRODUCTION
The right to death is a controversial subject in every society, guaranteed to generate heated debates whether an ill person has the right to end his life, particularly in cases whereby the patient falls into a state of irreversible coma or has long suffered from an incurable disease causing unbearable physical or mental pain. It so happens that very often, with sympathy of the family to the dying person or being influenced by medical decision, with or without the consent of the dying person, the doctors are forced to come to terms with a dilemma: whether or not to terminate the patient’s life before his natural time. Such an act is known as “euthanasia” which may either be accomplished through the suspension of life-sustaining equipment, food or the administration of high dose of lethal substance. No civilized countries, great or small, seems to be able to escape from the debate on the ethics of such a practice which provokes raging controversies owing to irreconcilable views among the general public as well as the medical professionals. Here are some of the questions that have caused major division.
Should society allow the doctor to end the life of an incurable patient even with the express consent of the latter? Must the Hippocrates’ oath, which obliges every doctor to do everything in his power to save life be respected in all circumstances or is there a threshold beyond which medical care actually turns into medical tenacity? Should patients be allowed to fix their own death? As we all know, each and every society somehow learns to find a way to accommodate conflicting opinions, taking into account its particular religious beliefs, history and social condition. Even those liberal countries which legalize euthanasia permit this practice only under extenuating circumstances.
In the case of Thailand, the subject of euthanasia has been discussed outside the academic circle because the media exposed how such a practice has been gaining current with alarming frequency. This has recently led to the introduction of a draft Act on Public Health addressing this issue for the first time. Under the current law, doctors caught practicing euthanasia will be subject to charges of murder and civil liabilities. Having said that, law and regulations relating to this subject remains quite nascent; many lacunae in the legal framework still need to be filled and more public forums to be organized and heard.
II. BUDDHISM AND EUTHANASIA
It is generally known that Thailand is a land where Buddhism thrives and people of different religious faiths coexist peacefully even though the majority of Thai people are Buddhist. As Buddhism is very influential in Thais’ thinking and way of life, it will be interesting to examine how the religion views death and euthanasia.
The themes of impermanence, decay and death are omnipresent in Buddhist teaching. In Thailand, as in many Asian countries, Buddhism is identified as the authority par excellence on matters relating to death, and is closely linked to the rites and ceremonies associated with the transition from this life to the next one. Buddhist teaching emphasizes the importance of meeting death mindfully since the last moment of one’s life can be particularly influential in determining the quality of the next rebirth. Yet, the Thai people do not necessarily have only negative views on death. Because death is not regarded as a permanent loss but is part of the cycle of existence and rebirths, Thai people seem to accept death more readily than westerners.
In Buddhism, the very first precept of admonition for good living is the abstention from destruction of life. This prohibition applies to life of all forms, human and animal. And the precept is equally binding on both monks and laypersons. In discussing the issue of euthanasia, we are essentially concerned with the death of human beings.
At a very basic level, death may be defined as the termination or cessation of life. It can come about through a number of causes. Failure of life-sustaining forces at any point of time in life brings about what we term death through natural causes. Here no agency of persons or processes is involved. On the contrary, we have death of persons through killing: suicide and murder or culpable homicide not amounting to murder, including euthanasia. Termination of life or unnaturally bringing about death, whether by oneself or another, is regarded as killing. In law, the intensity of the offense or crime, committed under serious provocation or in self-defense, may be judged differently. Yet, from Buddhist teaching’s point of view, killing, regardless of the motives, is prohibitive because it is a sin, even though that life is one's own.
III. DIFFERENT TYPES OF EUTHANASIA
The word euthanasia which means “good death” is derived from the Greek word eù signifying “good” and thanatos signifying “death”. From the beginning, the word associated dying with the art to die and the quality of the last instant of life. The second and contemporary meaning is introduced at the end of the 19th century. From then on, the word euthanasia has been commonly used in the sense of ending a patient’s life by a doctor in order to relieve him of the suffering. In the process, the intentional intervention to shorten the life of someone who has suffered a serious and incurable sickness has given rise to an ethical deliberation and come to acquire a criminal connotation. Those who support euthanasia contend that patients have the right to end life, rather than to continue it at all costs.
It is worth noting that euthanasia is always used with various adjectives which qualify different types of euthanasia: active, passive, voluntary and involuntary euthanasia.
-Active and passive euthanasia
The distinction between active and passive euthanasia is based on the nature of the involvement of the health professional or other person in control of the patient’s care. Therefore, the difference to be drawn is that between acting so as to cause death and omitting to act so that death is allowed to occur. Active euthanasia corresponds to the deliberate administration of lethal substance with the intention to provoke death, requested by the patient or decider by a relatives or a medical person in case where the patient can no longer give consent. As for passive euthanasia, it relates to the withdrawal of the necessary treatments to maintain life .
The distinction between these two terms gives rise to confusion. The question is what conduct, in the context of medical care, will be regarded in law as an omission (passive euthanasia) rather than an act (active euthanasia). According to some writers, passive euthanasia is a nonsensical term because it is actually a non therapeutic intervention which cannot be perceived as euthanasia in the sense that it provokes death. In such case, the disease is the principal cause of death whereas in the case of active euthanasia the doctor’s conduct is the primary cause of death . Moreover, this distinction in criminal law is relative. If the material element of voluntary homicide is subordinate to the existence of an act of commission, the qualification of an involuntary homicide does not depend on active or passive character of the fact generating the damage. In some cases, it is difficult to decide whether stopping the treatment is an omission or an act of commission. If it is an act of omission, it needs to be determined whether that omission was a failure to act, in which case it will be considered illegal. In the Bland Case Lord Goff points out that what the doctor did when he switches off a life support machine which “is in substance not an act but an omission to struggle”, and that “the omission is not a breach of duty by the doctor, because he is not obliged to continue in a hopeless case”. It is clear that health professionals have a duty to look after the patients. They risk being prosecuted for homicide if their patients die after a negligent failing to treat them. In other words, passive euthanasia by omission to act is equivalent to a breach of duty to take appropriate steps that are normally required by the responsible body of profession, and its legal consequence is not different from that of active euthanasia.
-Voluntary, non-voluntary and Involuntary Euthanasia
Since the distinction between active and passive euthanasia leads to confusion, it seems more judicious to opt for the classification of euthanasia which is based on the will of the patient. This may fall into one of three categories .
Firstly, voluntary euthanasia is described as the fact that the doctor puts an end to a patient’s life according to the will of competent patient or to the patient’s advance directive.
Secondly, non-voluntary euthanasia concerns cases whereby the doctor decides, with or without consultation with the patient’s family, on behalf of the patient who has not expressed the will on this matter because the patient is either incompetent or has ignored to do so. The doctor often decides whether certain patients should be required to be artificially resuscitated or not.
Thirdly, involuntary euthanasia means euthanasia which is administrated against the wish of the patient.
IV. SILENCE ON EUTHANASIA IN CURRENT THAI LAW
In many countries, including Thailand, the law does not provide any specific offense in the case of the euthanasia. Therefore, existing legislations can be applied to the conduct of euthanasia.
-Criminal Law
In Thailand, laws concerning this matter are yet to be developed. In fact, the Thai Criminal Code concerning medical activities ignores completely the word “euthanasia”. The laws provide neither specific offense nor reduction of punishment. The lack of specific law on euthanasia means that punishment will