Power and Knowledge with the Right to Refuse Treatment at the Terminal Stage of Life

Abstract

This research article derived from a qualitative research. The objectives of this research were to 1) analyze the concept of using the doctors' power and knowledge in treating patients who were at the terminal stage of life, and 2) analyze the  guidelines for treating patients who were at the terminal stage of life. The data for this research received from six key informants: an experienced physician, a physician, a nurse, a patient and a patient relative through in-depth interviews.  The phenomenological data analysis was used for data analysis. The results found that the medical culture in Thailand aimed to extend the patient’s life as long as possible.  The power and knowledge of the physicians have been conducted through specialized medical fields and through medical social institutions for a long time. Such expertise makes patients succumb to treatments that may not be needed and lead to medical futility.  All interviewees agreed with Section 12 of the National Health Act, B.E. 2550 that a person shall have the right to make a living will in writing to refuse the public health service which is provided merely to prolong his/her terminal stage of life or to make a living will to refuse the service as to cease the severe suffering from illness.  But the physicians who were interviewed in this research were in doubt and needed the clarification about the details written in the living will, for example the definition of the words "permanent unconsciousness". Therefore, in terms of the development of a palliative care system, it provided the operational definitions of the related terms, and educated patients about the right to make a living will in writing which could be the guidelines for treating patients who were in the terminal stage of life.