Abstract In 2007, Thailand enacted the National Health Act, which contains the Advance
Directive (Section 12). Even though the Act was enacted nearly sixteen years ago,
physicians have not fully adopted it, limiting the number of patients who can benefit from the
Advance Directive. Thai culture values the role of extended family in end-of-life planning,
which is frequently marked by a conspiracy of silence (inability to discuss end-of-life issues),
so patients may have limited opportunities to participate in decision-making and care …