Attitudes towards euthanasia and physicianassisted 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
**University Malaysia Pahang, Malaysia
Introduction
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 to legalize it
in India and Japan)
Malaysia is a developing country with multiethnic 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
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.
Inghelbrecht E 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
Attitudes of physicians and chronically ill patients
towards euthanasia and related issues.
Frequency of requests for assistance in active
euthanasia.
Attitudes of patients, their socio-demographic
characteristics and state of health.
Samples a population of patients and physicians
who are multi-racial and multi-faith.
Methodology
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
Result
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 in attitude towards euthanasia <0.001
Discussions
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
Discussions
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.
Limitations:
a single centre
information bias
opinions do not predict behaviours.