Dying Wishes: Understanding Advance Medical Directives from the Malaysian and Islamic Law Perspectives

Fadhlina Alias,Muhammad Najib Abdullah,Puteri Nemie Jahn Kassim

doi:10.33102/uij.vol32no.174

Abstract

The respect for patient autonomy is a bioethical principle that has acquired a compelling degree of prevalence in modern medical practice. While a doctor is ethically and lawfully bound to respect a patient’s preference and personal values in administering the requisite treatment, the duty to do so is more intricate in end-of-life care, when most patients are unable to partake in the decision-making process. An advance medical directive thus provides an assurance that the patient’s right to make autonomous decisions is preserved and will not be defeated by any future incapacity. It also serves to alleviate the ethical dilemma faced by doctors and assist them to determine the course of treatment according to the incompetent patient’s wishes. In turn, this facilitates healthcare providers to effectuate a more functional allocation of resources, which include costly life-sustaining equipment. In Malaysia, although advance care planning and advance medical directives are fairly novel concepts, there have been recent calls by certain sectors to increase awareness among the public and incorporate such measures into the delivery of healthcare services. This paper seeks to discuss the viability of integrating advance medical directives into the Malaysian regulatory framework on the provision of healthcare. Accordingly, this will also include deliberation on the Islamic standpoint with regard to the subject matter, in view of Malaysia’s religious demography and the position of Islam as the official religion of the country.

Highlights

Since the turn of the 20th century, the increase in the degree of medical prevalence at the end of life, has shifted the dimensionality between life and death
Advance medical directives were developed as a response to address this concern, providing a means for patients to preserve their right to self-determination in situations where they might lose the ability to decide on the course of their medical treatment
The importance of implementing advance medical directives has been mooted by Malaysian doctors as the constructive mechanism to resolve the ethical dilemmas in end-of-life decisions, following the practice by countries who have advanced palliative care systems

Summary

Introduction

Since the turn of the 20th century, the increase in the degree of medical prevalence at the end of life, has shifted the dimensionality between life and death. Medical treatment and equipment are able to prolong the life expectancy of patients suffering from life-limiting illnesses even in the absence of any brain activity. Advance medical directives were developed as a response to address this concern, providing a means for patients to preserve their right to self-determination in situations where they might lose the ability to decide on the course of their medical treatment. As an embodiment of a patient’s anticipatory medical decisions, as well as his or her values in relation thereto, advance medical directives enhance patient autonomy, and serve to facilitate doctors in performing their ethical obligations towards the patient at a time when the latter might not be able to participate in the decision-making process. In Malaysia, the use of advance medical directives is still in its infancy, and to date, the matter has yet to be properly legislated

The Significance of Advance Care Planning and Advance Medical Directives

Legislating Advance Medical Directives

The Current Position on Advance Medical Directives in Malaysia

The Validity of Advance Medical Directives in Islam

Findings

Conclusion