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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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Attitudes towards euthanasia and physician-assisted suicide among physicians and patients in a multi-cultural society inMalaysia

*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

study rationale
Study Rationale

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.

study objectives
Study Objectives

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

-demographic variables

-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.

Our strength

local view

patients with long-standing chronic illnesses.


a single centre

information bias

opinions do not predict behaviours.