A request for euthanasia from a terminally ill patient -- a controversial practice that remains illegal in Thailand -- inspired Dr Isaree Siriwankulthon, a palliative care physician-cum-author, to write a popular novel in 2023.
Now, a book-to-screen adaptation of the novel has ignited a debate on the right to "good death". Despite growing calls for euthanasia, experts say palliative care needs more support and should be prioritised.
Produced by oneD Original, Spare Me Your Mercy follows the story of Pol Capt Vasan (Krissanapoom Pibulsonggram) and Dr Kantapat (Thanapob Leeratanakajorn) in a rural village. Following the deaths of seriously ill patients, including his cancer-stricken mother, Pol Capt Vasan suspects his partner of committing euthanasia.
"This series has started a conversation about death, which is a taboo subject in Thai society. I am not for or against euthanasia, but it should be thoroughly discussed," said Sirilux Srisukon, a screenwriter. "Before rushing to euthanasia, please make sure that palliative care is accessible. I prefer having end-of-life choices to taking a shortcut."
(Photo: Peaceful Death)
A seminar titled "Assisted Dying And The Promotion Of Well-Being At The End Of Life" was recently organised by Channel One 31, Peaceful Death, the Thai Health Promotion Foundation and the Committee on Public Health. It was held to exchange and gather public opinion about end-of-life arrangements. People's Party MP Kalyapat Rachitroj, vice-chair of the Committee on Public Health, plans to submit the Good Living and Dying Draft Act to the cabinet in 2026.
Ekkapop Sittiwantana, a knowledge manager at Peaceful Death, a non-governmental organisation raising public awareness about end-of-life preparations, said palliative care focuses on improving the quality of life of patients in critical conditions, while assisted dying, a better term than euthanasia and mercy killing, is when they request life termination. Palliative care accepts natural death, while assisted dying hastens it to end suffering.
"It is concerning that without strong palliative care, patients will jump to assisted dying," he said.
Lack of support for palliative care
Ekkapop said some countries oppose assisted dying because it diminishes government support for palliative care. Meanwhile, countries like Belgium and Canada have found ways to make both practices mutually supportive. In Thailand, assisted dying is illegal. Patients in need of life termination have three options under palliative care -- denial of food and water, withdrawal from treatment and palliative sedation.
(Photo: Peaceful Death)
"Assisted dying is on the top of a pyramid. It can be considered when palliative care is strong. As a result, it requires an overhaul of the country's health system," he said.
Practitioners stressed lack of support for palliative treatment at hospitals.
"Staff are fulfilling the requirement for palliative services, but the lack of a palliative care department means no position and no career path," said Dr Isaree. "At some point, workload and lack of job prospects force staff to withdraw from the palliative care team."
Dr Jirapa Kotchawat, a palliative care physician at Sirindhorn Hospital, added that palliative care teams are buckling under the strain. "No staff, no resources and no future," she summed up the situation. Limited education about palliative medicine also leads to fewer service providers and inaccessibility.
Piwat Suppawittaya, a policy researcher and medical student, said existing research on palliative medicine is also falling behind other countries, for instance, Singapore and Malaysia. It is conducted in a haphazard manner and focuses more on views than systemic issues, such as demand for palliative care and assessment of effectiveness.
Wanna Jarusomboon, founder of Peaceful Death, has campaigned for end-of-life preparation for two decades. She said despite the growth of palliative care, it is not available at medical university. In addition, it is not accessible at every hospital.
(Photo: Peaceful Death)
Palliative care is challenging for carers as well. Dr Isaree recounted cases of family members leaving terminally ill patients to die at hospital because they have full-time job or live in rented houses. But even if families can look after them at home, communities may be unable to provide support. For example, nobody knows how to administer subcutaneous morphine.
"Once, a patient expressed a wish to die at home, but because of complicated procedures involved, she told me that it would be okay to die at hospital. It would be better if the system was seamless," she said.
Wanna highlighted the growing number of adult workers in cities who are unable to look after senior parents in provincial homes. Many of her friends in their 50s end up having to resign from jobs to care for them.
"Lack of carers and resources stresses the urgent need for government support, for example, paid caregiver leave," she said.
Not ready for assisted dying
Dr Jirapa said despite growing enthusiasm for assisted dying, it will diminish much-needed support for palliative care. After treating thousands of patients, she said only a small percentage request assisted dying, but upon getting morphine, they no longer want to end their life.
"We are not ready for assisted dying," she said. "I think patients may not even have heard of palliative treatment."
Dr Isaree expressed concern that lack of resources will force people to choose assisted dying. Her palliative care unit is now overwhelmed with patients, some of whom are left in her ward because families are unable to bring them home.
"If the pyramid's base is already cemented, I am okay with assisted dying. It is a matter of choice," she said.
Wanna said assisted dying "is a long way away". From her experience, patients in need of it are denied access to palliative care or suffer intense pressure to stay longer.
"People are worried who will care for them in their death throes. Who will be that person? Without money, is care accessible? It is a much larger question than assisted dying. How can we live well and have access to high-quality care?" she concluded.
