There is a document in Thailand that most people have never heard of and almost no one thinks about until it is too late. It is called a หนังสือแสดงเจตนา, formally translated as a Declaration of Intent, though most people refer to it as a Living Will. It lets you write down, while you are still healthy and able to speak for yourself, what you do and do not want doctors to do if you reach the final stage of a terminal illness.
Thai law has protected this right since Section 12 of the National Health Act B.E. 2550 (2007). When medical personnel act in accordance with a validly written declaration, they are legally protected from liability. This right applies to Thai nationals and legal residents in Thailand.
Why this document exists
Consider a situation that plays out in hospitals across Thailand every year. A 78-year-old man with terminal cancer loses consciousness. The doctor comes out to speak to his three children in the emergency room hallway and asks whether to intubate, whether to attempt CPR.
The eldest child says his father once mentioned he did not want to suffer. The youngest, who has just flown back from another province, says to keep trying.
Nobody actually knows what the father wanted. Everyone has to make a decision on behalf of someone they love in the space of a few minutes, and carry that weight for years afterwards.
The Living Will exists so that situation does not fall on the people left behind. With a valid document in place, the family does not have to guess and does not have to argue in a hospital corridor.
This is not euthanasia, and it is not abandonment
Euthanasia means actively causing a patient to die sooner to relieve their suffering. That remains illegal under Thai law. A Living Will is something different: it is a refusal to have the dying process artificially extended by procedures that cannot cure the illness. The body is allowed to follow the natural course of the disease.
Many people worry that signing a Living Will means being left to die in pain. The ministerial regulations are clear on this point. Anyone who has made a declaration of intent continues to receive palliative care. Pain medication is still provided. Oxygen is still provided.
Comfort care continues, and what is refused is treatment that prolongs the dying process without offering recovery or relief from suffering.
When does a Living Will take effect?
The ministerial regulations define two situations in which the document becomes operative.
The first is when a person has an injury or illness that cannot be cured, and the attending physician has diagnosed, according to medical standards, that the condition will inevitably lead to death within a short period.
The second is when a person has suffered permanent loss of cerebral cortex function, leaving them permanently unable to perceive or communicate, with only automatic responses remaining.
Outside these two situations, the document has no effect. If someone is in a car accident and there is a realistic chance of survival, the emergency team will provide full resuscitation, regardless of what the document says. A sudden emergency and the final stage of a progressive terminal illness are legally and medically distinct situations.
Who can write one
Any person aged 18 or over who is of sound mind can write a Living Will. You do not need to be ill. You do not need to be elderly. You do not need to have a diagnosed condition.
People who already have a chronic illness are advised to speak with their treating physician before writing the document, so they understand how their condition is likely to progress and what treatment options exist, and can make an informed decision based on real information.
What the document must contain
The ministerial regulations specify the following required elements:
- Full name, age, national identification number, and contact address or phone number of the person making the declaration
- The date the document is made
- Full name, national identification number, and relationship to the maker of at least one witness
- A clear description of the types of medical treatment or healthcare services being refused
- If someone else writes or types the document on the maker’s behalf, their name and national identification number must also be included
The maker, the witness, and the person who wrote or typed the document must all sign, or provide a fingerprint, at the conclusion.
Two additional elements can be included but are not required. The first is the name of a person authorised to explain the maker’s true intentions if any part of the document is unclear. That person must also sign and provide their identification number.
The second is a description of the maker’s preferences for end-of-life care: where they wish to die, what kind of emotional or psychological support they want, and any religious or cultural practices they wish to be observed. Medical facilities are required to cooperate with these preferences to a reasonable degree.
What to actually write
The document should be specific enough for a reader to act on it. Write it as a list of individual items and sign next to each one.
Examples of the kind of choices that can be documented include: whether to receive CPR, whether to accept intubation through the throat or a tracheotomy, whether to accept dialysis if the kidneys fail, whether to accept treatment for new complications that arise, whether to receive nutrition through a feeding tube, and whether to receive antibiotics or intravenous fluids that offer no clinical benefit.
The list above is only illustrative. Each person’s choices will be different. Some people are willing to accept mechanical ventilation but not CPR. Others feel the opposite. If you are uncertain what a particular procedure involves or how much discomfort it causes, ask a doctor before writing anything down.
Practicalities after writing
Once the document is written, tell the people close to you where it is kept. Tell your children, your spouse, your siblings. If you have a chronic illness, tell your treating physician as well. When you are admitted to the hospital, whoever holds the document must present it to staff as quickly as possible so it can be entered into your medical record.
The document can be updated at any time. A person’s wishes can change with age and with illness. Whichever version is most recent will be the one followed, which means anyone who updates the document needs to inform every person who was told about the previous version.
Why it matters beyond the individual
Writing a Living Will removes an impossible burden from the people who love you. Deciding whether someone lives or dies is not a weight that ordinary people can reasonably carry. A written document means the family does not have to guess, does not have to argue, and does not have to wonder for the rest of their lives whether they made the right call.
It also reduces conflict between families and medical teams. When everyone can see the same written instructions, the treatment plan can proceed without disagreement.
Dr Thakoon Kanjanopart, an internal medicine physician specialising in palliative care who was interviewed by The MATTER, has described how at least two or three beds in a typical ICU are often occupied by patients who will certainly die but are being kept alive artificially, while other patients who still have a chance of survival cannot access those beds because the unit is full.
In the same interview, Dr Thakoon described a case in which a patient had written clearly that they did not wish to receive CPR, but family members who had been working in another province and had never discussed the matter came back and asked for every possible measure.
The patient died in the ICU anyway. He also described a contrasting case in which a teacher with pancreatic cancer had spoken openly with his wife and his medical team while still able to communicate, written a declaration of intent, and ultimately died at home with the appropriate medications and oxygen arranged in advance by his care team, exactly as he had requested.
The physician’s view is that the Living Will document is a tool, but the larger process it supports is Advance Care Planning: an ongoing conversation with the people close to you so that when you can no longer speak for yourself, they are not confused, not uncertain, and not left feeling guilty about the decisions they had to make on your behalf. The document gives that conversation a record. The conversation is what makes the document mean something.
Downloadable template forms in PDF and Word, as well as an electronic e-Living Will system operating under the Electronic Transactions Act B.E. 2562, are available through the National Health Commission Office of Thailand.
For context on what end-of-life medical care costs in Thailand and how the private hospital system works, the expat healthcare guide for 2026 covers the financial realities that make advance planning worth doing well before it becomes urgent.
Anyone on a long-stay visa considering their healthcare options as they age in Thailand may also find the retirement visa Thailand 2026 guide useful context for understanding the broader framework of long-term residency and medical access.
The story The living will in Thailand: your legal right to refuse life-prolonging treatment as seen on Thaiger News.
