Why live in agony on borrowed time?

“If children ask why do we have to die, what will be our answer?”

“At what age do you think you will die?”

“What are things you want to do before you die?”

“Who do you want to be by your side when you are dying?”

“What will happen if everyone on Earth becomes immortal?”

Many people may have pondered over these questions during the Happy Death Day exhibition several years ago. The event, hosted by the Buddhika Network and allies, was organised to educate Thais about death in various dimensions so that they would be brave enough to face it.

At that time, Phra Paisal Visalo, the abbot of Wat Pasukato in Chaiyaphum province, who has initiated a project to put people at ease about death for nearly 13 years, unveiled his own living will to the public for the first time despite his strong physical health. The monk hoped that it would raise awareness among Thais to plan the last days of their life.

A living will – or an advance directive – is a legal document that explains how you want medical decisions about you to be made if you cannot make the decisions.

The 64-year-old Phra Paisal, who was born on May 10, 1957, wrote his living will and submitted it in a sealed envelope to his deputy abbot for safekeeping. He instructed the deputy, “If I am terminally sick, please open this envelope and follow the will instruction.”

“We should think about life’s terminal phase. Nowadays, people suffer a lot due to the lack of advance care and planning... Some people, who initially wish to cling on to life on borrowed time, might change their minds when that terminal state is full of agony.”

When a terminally ill patient is placed under palliative care, he/she might not be able to communicate, while doctors may not go over the overall pros and cons about the use of medical equipment. The decision, therefore, is left to that patient’s next of kin.

“Being kept alive by such medical machines may give the patients a few more weeks or months, but some patients, who suffer much agony in that state, may beg for removal of the machine. However, no one would dare to do so. At the same time, such patients’ relatives may struggle financially to pay the huge medical bills as they believe they are doing what they think is best for their loved one. But maybe that was not what the loved one wanted.” said Phra Paisal.

Making a living will before falling terminally ill is as important as writing an inheritance management will for your children, the monk emphasised. He advised that before making one’s living will, the person must discuss it with his/her children and relatives.

“There was a case in which a patient didn’t have a living will and three of his children voted not to put him on medical aid while one child disagreed with them. The minority opinion prevailed as none of the other children wanted the public stigma of being ungrateful to their parents. In such a case, the doctor could help by explaining the pros and cons of both states,” he added.

Phra Paisal cited another case in which a patient was in much agony, lying in a hospital bed and kept alive through multiple medical equipments worth millions of baht to survive. A visitor noticed that the patient’s gaping mouth was extremely dry. But when the patient’s lips were dabbed with petroleum jelly and covered with a medical mask to retain moisture, the patient’s agony ended. Some terminally ill patients go through much pain and suffering that they need morphine jabs to reduce the pain, he added.

Doctors could help in explaining the reasons to convince relatives to let go, but the abbot noted that most doctors – focusing on using knowledge and technology to prolong life – didn’t have sufficient knowledge about reducing the patients’ agony so they should learn more about it.

“Doctors who have specialised in palliative care know there is no need to put the patients on borrowed time, and it is better to let them go in peace. So, it is important to make time to talk with the patients about their medical wishes before their condition worsens and prevents them from talking.”

Many terminally ill patients’ children often assumed that everything – be it tracheostomy, hemodialysis and multiple tube insertion into the body – must be done as it was an expression of gratitude to parents. “But how are you sure that is what the patient wants and that is what is best for the patient?” he asked.

He recalled another case told by the late Dr.Sumalee Nimmanmit about a 70-year-old woman who was gravely ill from kidney failure and was admitted to hospital. The patient’s daughter instructed the doctors to do everything to keep her alive despite the doctor’s warning that such things wouldn’t be of much help as the comatose mother’s organs were collapsing.

The doctor told the family that the mother would want peace and they talked to her to make her mother happy, the monk said. The children had never heard such advice from a doctor, but they followed it and got a favourable response from the mother, the monk said.

“The best thing is not to cling onto life with medical devices. Loved ones can make them happy and at peace so their physical suffering can lessen,” he added.

Paisal said some cardiac arrest patients who were resuscitated told of what they saw during that physically unconscious state, which turned out to be true. “One man whose heart had stopped while in coma claimed to see his father drinking from an automatic water fountain at night time – which was confirmed by the father as it had happened at the exact moment the son’s heart stopped.”

After a person’s heart stops, his/her mind can still perceive things because the body shuts down first followed by the soul, according to an explanation in Buddhism. In Tibetan belief, a soul takes three days to shut down after the heart stops beating, hence the deceased person can still hear, “see”, and know things, he said.

 

THE LIVING WILL OF PHRA PAISAL VISALO

“When I am in palliative care due to an incurable ailment and I am unable to make medical decisions for myself, I prohibit the following procedures to be performed on me:

1. Major surgery

2. Use of respiratory aid (in case of inability to breathe by myself)

3. Use of cardiopulmonary resuscitation (CPR) in case of cardiac arrest

4. Use of technology merely to keep me alive on borrowed time without life quality

“In case I am put on respiratory aid because doctors are unaware of my wish, it shall be removed once the doctors are informed so my body could be in its natural state.

“I have named one doctor and two laypersons as the decision-makers on my behalf because they have known me for more than a decade and understand my views.

“I also wrote on the will’s fifth page that I didn’t want CPR, tracheostomy or respiratory tube insertion, hemodialysis in case of kidney failure, or tube feeding for nutrition or antibiotics (in case it won’t cure the ailment).

I also want to donate my body to the Thai Red Cross or Khon Kaen University’s Faculty of Medicine for education and research purposes. After a three-day funeral prayer ritual at Wat Pasukato, a cremation – with only one-day notice – would be held. While the cremated bones would be kept at the temple’s Hin Khong yard, the ashes would be sprinkled in Phu Luang forest.