Advance Directives and Medical POAs in Thailand: Between Legal Rights and Hospital Practice

As Thailand continues to attract retirees from around the world, many foreigners are realizing the importance of preparing a Medical Power of Attorney (POA) or advance directive — documents that authorize a trusted person to make healthcare decisions if they become incapacitated. These legal instruments are not merely administrative formalities; they are safeguards for autonomy, dignity, and family’s peace of mind.

However, the practical application of these instruments in Thailand remains inconsistent. While the law provides a framework protecting patients’ rights to both emergency care and refusal of life-prolonging treatment, many hospitals continue to rely on upfront consent from the patient or their family or hesitate to act without written and locally recognized authorization, due to fear that treatment may go unpaid or be deemed unlawful.

Legal Background

Thailand’s legal framework already outlines clear obligations on healthcare providers to treat emergency patients without delay or concern for payment.

• Section 28 of the Emergency Medical Act B.E. 2551 (2008) requires hospitals and emergency operators to provide prompt care to all patients, regardless of their ability to pay or their registration under a specific health scheme.

• Section 36 of the Medical Facilities Act (No. 4) B.E. 2559 (2016) reinforces this duty, prohibiting hospitals from refusing or delaying emergency treatment.

• Section 3 of the Declaration of Patient’s Rights B.E. 2558 (2015) further protects the right of patients in critical condition or near death to receive urgent and immediate relief, regardless of whether they explicitly request assistance.

• Supreme Court Case No. 11332/2555 further affirmed that hospitals must provide immediate emergency care, emphasizing that financial or administrative factors cannot override a patient’s right to timely treatment.

Meanwhile, Section 12 of the National Health Act B.E. 2550 (2007) grants individuals the right to make a written declaration refusing medical treatment that merely prolongs the terminal stage of life. This section forms the legal foundation for advance directives and living wills in Thailand. To make this right practical, the Thai Standard for Advance Care Planning B.E. 2565 (2022) provide current guidance and reinforce the legal basis for advance directives.

In theory, these laws and policies together protect two key rights:

1. The right to receive emergency medical care without delay, and

2. The right to refuse treatment that does not align with a patient’s wishes or medical ethics.

The Reality: A Gap Between Law and Practice

In practice, however, the implementation of these rights is far from uniform. Many hospitals, both public and private, remain hesitant to act in the absence of explicit written consent from the patient or their immediate family.

This reluctance is often driven by two fears:

• Financial liability: That the hospital might not be reimbursed if the treatment is later disputed or unpaid.

• Legal liability: That withdrawal or withholding of treatment could be interpreted as negligence or an unauthorized act.

Such caution, while understandable from an institutional standpoint, can lead to violations of the very rights the law seeks to protect, particularly the right to emergency care and the right to self-determination at the end of life.

A Real Case Example

I recently encountered this issue firsthand while assisting a foreign retiree living in Thailand. My client asked me to draft a detailed bilingual durable POA for both finances and healthcare, covering every possible medical scenario. Her request stemmed from a previous incident in which, during a sudden medical emergency, her caretaker had to contact her spouse to sign multiple consent forms and provide proof of their marriage translated into Thai, even though she was clearly unfit to do so at the time. The hospital’s hesitation, driven by concerns about consent and payment, resulted in a delay of critical care, which was a situation that contradicts Thailand’s legal duty to provide emergency treatment.

This case reflects a broader systemic challenge: while Thai law acknowledges both patient autonomy and the right to urgent medical care, many healthcare institutions remain uncertain about the enforceability of advance directives and POAs, particularly when such documents are executed abroad or not in Thai.

 Legal Commentary

The ongoing tension between law and medical practice highlights the need for clearer regulatory guidance and greater awareness among healthcare institutions. While the legislative framework is well established, the challenge lies in its practical enforcement and institutional interpretation.

From a legal standpoint, three key points emerge:

1. Hospitals have a statutory duty to provide emergency care. Refusing or delaying emergency treatment due to payment, insurance, or consent concerns may expose hospitals and medical professionals to liability for negligence or violation of statutory duties under the Emergency Medical Act B.E. 2551 (2008) and the Medical Facilities Act (No. 4) B.E. 2559 (2016). Hospitals cannot rely on financial or procedural uncertainties as a defense when a patient’s condition is urgent.

2. Advance directives and Medical POAs are legally recognized but inconsistently applied. Under Section 12 of the National Health Act B.E. 2550 (2007) and the Thai Standard for Advance Care Planning B.E. 2565 (2022), individuals are entitled to make advance declarations concerning medical treatment. However, due to limited institutional awareness, healthcare providers may hesitate to act solely on these documents, particularly when they are drafted in a foreign language or executed abroad. This uncertainty often leads to reliance on family consent even when a valid directive exists.

3. Localization of documents enhances enforceability. Foreign-issued POAs or advance directives may not be readily accepted by Thai medical staff unless translated and authenticated. Preparing a bilingual version executed before a Thai lawyer, properly witnessed, and optionally notarized ensures that both Thai and foreign authorities can recognize the document. This not only minimizes potential disputes but also provides hospitals with legal reassurance when acting according to the patient’s wishes.

Ultimately, the gap between Thailand’s legal provisions and medical practice underscores a broader policy issue: while the law supports patient autonomy and the right to emergency care, the lack of consistent institutional compliance continues to undermine these protections. Bridging this gap will require greater coordination between legal and healthcare sectors, as well as proactive legal preparedness by patients and their families.

Practical Takeaways

• A well-drafted bilingual POA covering healthcare decisions, or integrating an advance directive and living will, can often be sufficient for hospitals to act without delays. The document should clearly identify the authorized agent and be executed before a Thai lawyer with proper witnessing.

• Combine healthcare and financial powers when possible. A single comprehensive POA ensures trusted individuals can make medical and financial decisions, such as paying hospital bills or managing accounts, without delays, costly court appointments, or family disputes.

• Use plain and clear language. Ensure the POA is easily understandable for the grantor, agent, and Thai authorities. Everyone involved should fully understand the scope, powers, and limits, especially in urgent or emotional situations.

• Inform both hospitals and family members in advance. Keep copies accessible and provide them to your primary healthcare provider to minimize delays during emergencies.

• Encourage awareness among healthcare staff. Educating medical staff and families on patients’ legal rights can prevent unnecessary hesitation and disputes.

• Consult a lawyer experienced in medical law. Legal advice ensures the document complies with Thai law, aligns with international standards if the patient holds foreign citizenship, and maximizes enforceability in practice.

 Conclusion

Thailand’s legal framework already supports the principles of patient’s autonomy and universal access to emergency care, yet real-world implementation often lags behind the law. Until hospitals uniformly recognize and honor Medical POAs and advance directives, patients and families, especially foreign retirees, must take proactive legal steps to make their wishes known, respected, and enforceable. This type of foresight can save time, stress, and legal uncertainty during emergencies.

By bridging the gap between law and medical practice, Thailand can move closer to a healthcare system that upholds both compassion and legality, ensuring that no patient is left waiting for consent when every second counts.  

Disclaimer and Contact

This article is provided for general information only and does not constitute legal advice. While I strive to keep my legal insights accurate and practical, changes in law or other factors may affect your decisions.

For tailored advice or assistance with preparing a living will, advance directive and/or health or financial POA that works across Thai and international settings, please contact me at: osa.chaichit@gmail.com

By: Osaris Chaichit