What Is a Living Will in Thailand? Section 12 Advance Directives: How to Write One, Who Can Make It, and What Families Caring at Home Should Prepare

A living will is a written statement, made in advance, that a person does not wish to receive public health services that merely prolong dying in the final stage of life, or that are intended to end suffering from illness. This right is recognised in Section 12 of Thailand's National Health Act B.E. 2550 (2007), which is why Thai families often call it a "Section 12 living will". Its purpose is not to refuse care. It tells everyone what kind of care your parent wants on the day they can no longer express their wishes or communicate a decision, while they continue to receive palliative care and symptom relief as appropriate.

Many families start thinking about this when a mother or father is seriously ill and being cared for at home. One child remembers Mum saying, "When the time comes, don't drag it out." Another worries that doing anything less than everything means giving up on her. Nobody quite knows how to begin the conversation. This article is written for families in that place. It explains what a living will is, when it takes effect, who can make one, how to write it, how the e-Living Will works, and how to raise the subject without your parent feeling rushed.

Quick answer

• A living will (a Section 12 advance directive) is a document in which your parent declines, if that is their choice, public health services that merely prolong dying in the terminal phase of life (such as CPR or intubation), or declines them to end suffering from an incurable disease or injury.
• Under the 2010 Ministerial Regulation, the person who makes it continues to receive palliative care, including pain relief and comfort care as appropriate.
• The regulation covers two situations: the terminal phase of life, and suffering from an incurable disease or injury. The attending doctor assesses each real situation. It is not a way to refuse treatment for illness or accidents that can be treated.
• It must reflect your parent's own wishes, made while of sound mind. Children cannot make one on a parent's behalf after the fact, so it is worth talking while your parent can still decide and express their wishes.
• It can be made on paper (forms from the National Health Commission Office, NHCO) or as an e-Living Will, and it can be changed or revoked at any time.
• Give copies to every child, tell the attending doctor, and keep one in a folder by the bed when caring for your parent at home.

1. What a living will is, and what it is not

A living will records your parent's wishes about treatment at the end of life, made in advance for the day they cannot express their wishes or communicate a decision. Section 12 also states that when public health professionals act on that wish, their action is not to be regarded as an offence. Common Thai names include the Section 12 directive, the directive for the final stage of life, and the "life will". All refer to the same document.

What a living will is not

• It is not a will that divides property. Inheritance, houses, land and bank accounts belong in a separate document; please consult a lawyer.
• It is not hastening death. The NHCO form speaks of a peaceful, natural death, neither hastening nor prolonging dying without benefit.
• It is not abandonment. Your parent continues to receive palliative care, such as pain relief, turning, mouth care and skin care, as appropriate.

What many families don't realise: a living will is not about saying "don't treat". It is about saying "this is how I want to be cared for", including wishing to stay at home, hearing prayers, or having a particular person nearby.

2. When does a living will take effect?

The 2010 Ministerial Regulation allows the directive to apply in two situations, and your parent may cover either or both.

• The terminal phase of life: a condition caused by injury or an incurable disease which the attending doctor, based on prognosis under medical standards, diagnoses as leading unavoidably to death in the near future. It also includes permanent loss of function of the cerebral cortex, causing permanent loss of awareness and the ability to communicate, with only automatic reflex responses remaining. NHCO guidance explains that this refers to a permanent vegetative state.
• Suffering from illness: physical or mental suffering caused by an injury or a disease that cannot be cured. NHCO guidance gives examples such as complete paralysis from the neck down, dementia, cancer, or other incurable chronic diseases.

In both situations, the attending doctor assesses each real case individually.

What can be declined: the regulation defines these as methods a doctor uses to prolong dying in the terminal phase without saving the person from death or ending the suffering of illness; the person still receives palliative care. NHCO guidance lists examples your parent may choose to decline, such as surgery, chemotherapy, a tracheostomy for a breathing tube, resuscitation when the heart stops, admission to intensive care once in the terminal phase, blood transfusion and dialysis. Your parent chooses which to decline, ideally after talking with their doctor.

When the time comes, the regulation sets out these steps

1. If your parent is still aware enough to communicate, whether by speaking, writing or gestures, the doctor explains the condition and asks them to confirm or decline the directive before acting on it. Their wishes at that moment always come first: they may confirm it, pause it temporarily, or choose not to apply it at all.
2. If your parent is no longer aware enough to communicate, the doctor explains the condition and the contents of the directive to the person your parent named, or to a relative.
3. If there is a problem applying the document, the doctor consults the named person or relatives, taking your parent's wishes into account.

Families should share one understanding: the document does not mean every event leads to withholding treatment. If your parent falls and breaks a bone, chokes, or has a treatable infection while not yet in the terminal phase, decisions follow the doctor's assessment of that situation.

3. Who can make one, and when?

The person making it must be your parent, and they must be of sound mind at the time. The latest NHCO form opens with a declaration of exactly this. There is no need to wait for serious illness; healthy people can make one too.

Good moments to start the conversation

• When the doctor says your parent's condition is gradually declining, or starts talking about focusing on comfort.
• Before bringing your parent home after a long hospital stay, while the medical team is still available to ask (see questions to ask before leaving hospital).
• When your parent begins to become forgetful. Talk early, while they can still decide for themselves.

Can children make one on a parent's behalf? Not retrospectively in your parent's name, because it must be their own wish. If writing is difficult, a child may write or type it as your parent dictates, and that helper then adds their name and ID number. If your parent is already unconscious and never made one, the family can tell the doctor what your parent used to say, to inform discussions with the medical team. The NHCO manual suggests seeking advice from a doctor, nurse or a lawyer who understands this area before making one.

4. How to write a living will, and what goes in it

Use language clear enough for health professionals to follow, and include the key details. The law sets no fixed form, and it can be made anywhere. Clause 3 of the 2010 regulation lists guiding details: the maker's full name, age, ID number and address or phone number; the date; the name, ID number and relationship of any witness; the types of service refused; the name and ID number of anyone who wrote or typed it on their behalf; and the signatures or fingerprints of those involved.

The NHCO's 2026 sample form is divided into sections that help your parent set out their wishes systematically

1. What matters most to your parent, such as quality of life, not suffering, or living as long as possible even with machines (all options are offered without steering).
2. Conditions they would find unacceptable, such as lifelong ventilation or permanently not recognising loved ones.
3. Scope of treatment, from full treatment to symptom care without life support, or "I can't decide yet".
4. CPR, intubation and ventilation in the terminal phase: wanted or not.
5. Place: where they would like to spend their final days and to die (home, hospital or elsewhere).
6. A proxy decision-maker, someone they trust to discuss things with the medical team if the document is unclear, guided by their wishes. This person also signs.

About witnesses: NHCO guidance on this regulation says a directive should have a witness, to help confirm its contents if questions arise, but having no witness does not make it incomplete. That is why the latest form says witnesses are optional. A witness is required in one case: if your parent uses a fingerprint instead of a signature, two witnesses must sign to certify it.

• If there is a witness, record their full name, ID number and relationship to your parent, and have them sign.
• If made in hospital, the guidance recommends witnesses from both the family and the care team, but your parent's attending doctor and nurse case manager should not sign as witnesses. If made at home, have witnesses as appropriate.

Your parent can also add other wishes, such as where they would like to die, inviting monks, or holding a rite according to their beliefs.

5. How the NHCO e-Living Will works

The e-Living Will is the NHCO's electronic version of the directive, made under Thailand's Electronic Transactions Act. It keeps another copy in the NHCO system, but do not assume every hospital can see it automatically, so still tell your parent's usual hospital and keep a paper copy.

1. Search for "National Health Commission Office" and open the e-Living Will section. Three sample forms can be downloaded (form 3 is the latest, 2026 version).
2. Print the form, sit with your parent, fill it in according to their own answers, then have your parent, the proxy and any witnesses sign.
3. A note at the end of the form says you can photograph the document and upload it to create an e-Living Will in the NHCO system.
4. The form includes consent for health professionals to access the information electronically and share it with other facilities. Read this part with your parent before signing.

The paper copy matters because in an emergency at home, paper you can hand over immediately is often quicker. If the system is difficult to use, the same page lists an NHCO LINE channel for questions.

6. Where to keep it, who should know, and how to change it

Keep the original somewhere easy to find, and give copies to everyone who may need it. The NHCO manual suggests the maker keeps it or entrusts it to someone close, with copies for relatives, witnesses, the proxy and doctors who have treated them.

• Keep the original in the same folder as your parent's ID card and medication list.
• Give a copy to every child, including those who live far away, and keep a photo on the proxy's phone.
• Place a copy in the file at your parent's usual hospital. The regulation asks that it be given to the hospital's health professionals without delay on admission.
• If a caregiver or nurse comes to the home, show them where the folder is.

It can be changed or revoked at any time. If there are several versions, the most recent one applies. When your parent changes their mind, make a new, dated version and promptly tell everyone holding a copy, including the doctor. Review it together whenever their condition changes significantly.

7. How to raise the subject without your parent feeling rushed

Start by asking what matters to them, not with the form. Many older adults are not afraid of the document; they fear the feeling that their children are preparing for them to go. What matters most is listening closely to them, rather than trying to persuade.

Openers that work

• "If one day you were too ill to tell us yourself, how would you want to be cared for? I want to get it right for you."
• "What matters most to you right now, Mum? Staying at home? Seeing someone in particular?"

What to avoid

• Opening with "no life support" or "no CPR" in the first sentence. Your parent may feel the decision has already been made for them.
• Talking when they are tired, in pain, or have just had bad news.
• Having one child talk alone and report back. Gather all the children together at least once.

If your parent isn't ready, say "That's fine, we can talk another time." The first conversation doesn't have to end with a signature, and the NHCO form even includes an "I can't decide yet" option.

8. When your parent is seriously ill at home: making the directive work

A living will only helps if the doctor knows about it and whoever is at the bedside can find it when it matters. Prepare these four things.

1. Tell the attending doctor that your parent has a living will, ask for it to be recorded in the hospital file, and ask whether there is a palliative care team or home-visit unit that can follow your parent.
2. Ask for a written care plan: symptoms to watch, medicines, phone numbers for day and night, and which situations you have agreed will mean going to hospital.
3. Keep a document folder by the bed containing the ID card, a copy of the living will, a medical summary and the medication list, and tell everyone in the house where it is.
4. Agree in advance who to call in which situation. On an emergency night, everyone should know who to call first and who the proxy is.

Separate two situations clearly from today. NHCO guidance says that in an emergency or accident, health professionals have a duty to save life promptly under professional ethics, and once they learn of a living will they consider respecting it alongside palliative care. So talk with the doctor in advance about who to call in which case.

1. An expected decline from the illness in the terminal phase, such as gradually becoming drowsier, eating and drinking less, or breathing changes the medical team explained beforehand: contact the doctors or nurses caring for your parent, using the numbers in the plan you agreed.
2. A new event that may be fixable, or when the family is unsure, such as a fall, choking, bleeding or sudden difficulty breathing: call 1669, as listed below.

Continue care at home · watch closely

• Gradually increasing drowsiness and eating and drinking less, as the medical team said might happen.
• Pain or breathlessness at a level the doctor's plan still controls.

Call a nurse for advice today

• Pain increasing beyond what the usual medicine controls, or no longer able to swallow medicines.
• Restless and unable to sleep all night, a fever, or a new pressure sore. For other warning signs, see fever, phlegm and drowsiness in bedridden older adults.

Go to hospital or call 1669 immediately

• A new event that may be fixable, such as a fall with a head injury, a broken bone, choking, heavy bleeding or sudden difficulty breathing.
• A first-ever seizure, a seizure lasting longer than 5 minutes, or repeated seizures without recovering in between (criteria from NHS guidance in the United Kingdom).
• Severe distress when you cannot reach the medical team and the family cannot cope, or the family is unsure whether a change is the expected decline or a new event.
• When calling 1669, say that your parent has a living will and a care plan from their doctor, and hand a copy to the responders. Decisions at the scene rest with the medical personnel according to the actual situation. See how to prepare information before calling in a 1669 emergency plan for older adults.

9. Comfort care at home in the final days: what families can do

The family's role is to observe, keep notes, help keep your parent comfortable day to day, and tell the medical team when things change. Choosing medicines and doses is the doctor's job. This section draws on guidance from the NHS in the United Kingdom.

• Pain: give medicine only as prescribed. If your parent cannot tell you how they feel, watch for a furrowed brow, moaning when moved, or tensing, and note the times for the team.
• Eating and drinking less is common near the end. There is no need to force food. If swallowing is no longer safe, moisten the lips with a damp cotton swab instead. For tube feeding, any change in volume is the doctor's decision.
• Breathing changes: breathing may become irregular, with pauses or a rattling sound in the throat. Raise the head if that seems more comfortable, and let the team know.
• Cold hands and feet, confusion: use a light blanket, keep lights soft, keep familiar people close, and tell the team if your parent is very restless, as there may be a cause that can be eased.

What matters most is being close, holding their hand, speaking in a normal voice, and letting the people they want to see come and visit, as they wrote in their living will.

Common mistakes families make

• Waiting until your parent can no longer decide or express their wishes. By then they cannot make the document themselves, and children are left guessing in an emergency room at night.
• Only one child knows. On the day it's needed, siblings argue at the bedside. Talk together and share copies with everyone.
• Thinking a living will means "no more care". Your parent may miss out on symptom relief, even though the regulation states that the person continues to receive palliative care.
• Not telling the attending doctor. A document missing from the hospital file is often not found in time.
• One main carer shouldering everything until they run out of strength just when their parent needs them most. See signs of caregiver burnout.

When to bring in professional help

KIN HomeCare does not prepare or certify living wills. Please arrange the document with the attending doctor, the hospital or through the NHCO. What our team can do is care for your parent at home in line with the doctor's plan and your parent's wishes.

Signs a family may need help: your parent needs turning and nappy changes around the clock, the main carer hasn't slept properly for several nights, there are procedures the family isn't confident with, or everyone works full time. For palliative-stage cancer, KIN HomeCare provides continuing care according to the treatment plan of the main hospital. The attending doctor still sets the plan and all medicines.

• Home caregivers (nursing assistants) help with turning, bed baths, nappy changes, feeding by mouth or tube, giving medicines as prescribed, and companionship. 12-hour shift 1,800 baht per day (minimum 3 days), including a night shift 20:00–08:00; 24-hour live-in 2,500 baht per day; monthly from 30,000 baht. See elderly home care.
• Registered nurse home visits for procedures under the doctor's plan, such as wound care, feeding-tube changes and urinary catheter changes, from 1,200 baht per visit, or a 12-hour registered nurse shift at 3,500 baht per day. See what a home nurse can do and home nursing.
• If your parent has just left hospital and you hire a monthly caregiver, our "Home with Care" offer includes one registered nurse home visit within the first 3 days to assess your parent and write up a care plan. Bangkok and surrounding provinces only; contracts signed by 31 December 2026.

Frequently asked questions

What is a living will?

A living will is a Section 12 directive under Thailand's National Health Act B.E. 2550 (2007), made in advance, stating that a person does not wish to receive public health services that merely prolong dying in the final stage of life or to end suffering from illness. The person continues to receive palliative care and symptom relief as appropriate.

Is a living will legally binding in Thailand?

Yes. The right is recognised in Section 12, and the 2010 Ministerial Regulation sets out how it is carried out. It applies to the terminal phase of life, or to suffering from an incurable disease or injury, as assessed by the attending doctor. If your parent is still aware enough to communicate, the doctor asks for their current wishes first.

Does a living will need witnesses?

NHCO guidance recommends having a witness, but having none does not make the document incomplete, which is why the latest form says witnesses are optional. A witness is required in one case: if a fingerprint is used instead of a signature, two witnesses must sign to certify it. Any witness should give their full name, ID number and relationship, and sign.

How old must someone be to make a living will?

The law sets no age. NHCO guidance recommends 18 full years; anyone younger needs consent from a parent, guardian or carer first.

What if relatives or the care team disagree with the document?

The attending doctor consults the person named in the directive, or close relatives if no one was named. If no agreement can be reached, NHCO guidance says the doctor should give priority to the maker's wishes and the principles of palliative care. Some hospitals have an ethics committee that can advise. Prevention starts with the whole family talking together now.

What happens if the person who made it is pregnant?

The regulation allows the directive to be carried out once the pregnancy has ended. During pregnancy, the doctor suspends it temporarily.

Can children make a living will for a parent who is already unconscious?

No. It must reflect your parent's own wishes, made while of sound mind. A child may write it down as the parent dictates, but cannot make one in the parent's name afterwards. If none exists, the family can tell the doctor what the parent used to say, to inform the discussion.

How do I make an e-Living Will?

Download the form from the e-Living Will page of the National Health Commission Office, fill it in and sign it, then photograph it and upload it to the NHCO e-Living Will system as the note on the form explains. Keep the paper copy as well.

Will my parent still get pain relief and care after making a living will?

Yes. The regulation states that the person continues to receive palliative care. What the document declines is services that merely prolong dying, or treatment beyond what is necessary that causes suffering, not symptom relief. Each medicine and type of care follows the doctor's assessment and plan.

Talk to the KIN HomeCare team

If your family is about to bring your mother or father home while they are seriously ill and you want to know how much help you'll need, call us for a chat first. There's no need to decide on the phone. If you have a care summary from the hospital, send it via LINE and our team will help you work out where to start.

• Call 061-881-9399 (+66 61 881 9399) (caregivers · registered nurses · equipment rental)
• LINE @KINHOMECARE
• Get a caregiver or nurse estimate yourself with our service request form
• Free consultation; caregivers and nurses come to homes nationwide; travel costs depend on the area and staff confirm them before booking.

Legal information as of October 2026 · This article is general information for families. It is not legal advice and does not replace advice from your parent's doctor.

Written by Orrathai Boontuang, RN (licence 5311192883) · Medically reviewed by Dr. Kamolchat Choktanomsup (licence 40854) · Prices as of October 2026; please confirm with our staff before booking.