Attitudes towards euthanasia and physician-assisted suicide among physicians and patients in a multi-cultural society in Malaysia. *ARM Fauzi , *MY Rathor , **JM Zain *Department of Internal Medicine, International Islamic University Malaysia, Malaysia
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*ARM Fauzi, *MY Rathor, **JM Zain
*Department of Internal Medicine, International Islamic University Malaysia, Malaysia
**University Malaysia Pahang, Malaysia
Euthanasia is in the public domain Kluge EH. Doctors, death and Sue Rodriguez. Can Med Assoc J 1993; 148:1015-7.
“physician taking active steps to end the life of another person, at that person’s request, for what they see as their best interests”
In physician-assisted suicide (PAS), the physician only provides the means
Controversy on ethical, moral, social and religious grounds, made worse by definitions of "passive“ and "indirect" euthanasia
EAS is incompatible with professional obligation and challenges our primary duty (WMA’s position representing the medical profession and the Supreme Court of US)
EAS is illegal in most countries
Europe is more flexible in allowing PAS.
In Asia the debate is ongoing (? attempts tolegalize it in India and Japan)
Malaysia is a developing country with multi-ethnic and multi-faith communities
The concept of EAS is not much debated
No laws or legislations
Views likely quite personal and faith based
The position in Islam is quite clear and all other faiths in the country
International data show public opinion tends to favour its legalization than medical opinion(Patelarou E et al. Euthanasia in Greece: Greek nurses’ involvement and beliefs. International Journal of Palliative Nursing, 2009, 15:242–248.
InghelbrechtE et al. Nurses’ attitudes towards end-of-life decisions in medical practice: a nationwide study in Flanders, Belgium. Palliative Medicine, 2009, 23:649–658.
Data on chronically ill patients is limited.
Few cross-cultural, international collaborative studies on the subject to explore the differences among countries and the reasons behind these differences.
Attitudesof physicians and chronically ill patients towards euthanasia and related issues.
Frequency of requests for assistancein active euthanasia.
Attitudesof patients, their socio-demographic characteristics and state of health.
Samplesa population of patients and physicians who are multi-racial and multi-faith.
Questionnaire based survey conducted by a trained Research Assistant
-knowledge/views or practice/response about EAS
Chronic Patients (cancer on palliative care, HIV/AIDS, ESRF on chronic haemodialysis, severe COPD, diabetics with obvious multiple medical complications and stroke victims)
Physicians were personally approached or via email
Physician: 192/250 (77 %), email (3/70), overall response rate 61%
Patients: 727/812 (90%)
Physicians were younger (32 versus 53; p-value <0.001].
Most of the respondents were believers
70%physicians 60% patients opposed EAS regardless of circumstances
62% patients and 70 % physicians agree to withholding/withdrawing futile intervention/treatment
64% physicians agreed adequate painkiller was important despite risks
62 % agreed comfort over prolonging life in a terminal patient.
Hypothetically:16% physicians for euthanasia while 23% might agree to a request
91.2% patients and 86% physicians said patients have no right to die regardless of any cause or suicide assisted to reduce suffering
Only 15.4% physicians reported ever asked to assist in dying
Religion is significant inattitude towards euthanasia <0.001
Higher Malay/Muslim patients/physicians explains why majority opposed EAS, no matter what the circumstances may be
Both physicians and patients overwhelmingly agreed withholding or discontinuing artificial life support to a patient with no chances of survival
Hypothetically, 1/6 physicians supported euthanasia and 1/5 might comply with a request
Our findings are similar to data from other studies and a local survey on medical students
Active euthanasia is the focus of public concern while in Malaysia passive euthanasia presents more of a dilemma.
Lack of health care facilities/economic problems might unduly influence patients and their families towards EAS.
patients with long-standing chronic illnesses.
a single centre
opinions do not predict behaviours.