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Dilemmas surrounding passive euthanasia--a Malaysian perspective

Talib N

Med Law, 2005 Sep;24(3):605-13.
PMID: 16229394

In western societies where the principle of autonomy is jealously guarded, perhaps active euthanasia is more often the focus of public concern and debates rather than any other forms of euthanasia. However due to the advance in technology and its corresponding ability in prolonging life, in Malaysia passive euthanasia presents more of a dilemma. For those concerned and involved with end of life decision-making, it is generally agreed that this is an area fraught with not only medical but legal and ethical issues. In Malaysia where the society is not homogenous but is multi-cultural and multi-religious, in addition to medical, legal and ethical issues, religious principles and cultural norms further impact and play significant roles in end of life decision-making. This paper seeks to identify the issues surrounding the practice of passive euthanasia in Malaysia. It will be shown that despite applicable legal provisions, current practice of the medical profession combined with religious and cultural values together affect decision-making which involves the withholding and/or withdrawing of life-saving treatment.

Matched MeSH terms: Euthanasia, Passive/legislation & jurisprudence*; Euthanasia, Passive/ethics
Fulltext Attitudes toward euthanasia and related issues among physicians and patients in a multi-cultural society of Malaysia

Rathor MY, Abdul Rani MF, Shahar MA, Jamalludin AR, Che Abdullah ST, Omar AM, et al.

J Family Med Prim Care, 2014 Jul;3(3):230-7.
PMID: 25374860 DOI: 10.4103/2249-4863.141616

INTRODUCTION: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia.
MATERIALS AND METHODS: Questionnaire based survey among consenting patients and physicians.
RESULTS: The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life-sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status.
CONCLUSIONS: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine.
KEYWORDS: Attitude; euthanasia; legalization; multi-cultural; physician-assisted suicide

Matched MeSH terms: Euthanasia*
Attitudes on euthanasia and physician-assisted suicide among medical students in Athens

Kontaxakis V, Paplos KG, Havaki-Kontaxaki BJ, Ferentinos P, Kontaxaki MI, Kollias CT, et al.

Psychiatriki, 2009 Oct;20(4):305-11.
PMID: 22218231

Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide.

Matched MeSH terms: Euthanasia*
Withdrawing and withholding medical treatment: a comparative study between the Malaysian, English and Islamic law

Kassim PN, Adeniyi OB

Med Law, 2010 Sep;29(3):443-61.
PMID: 22145563

The permissibility and lawfulness of withdrawing and withholding medical treatment has attracted considerable debates and criticisms, as the legal issues are drawn into entering the slippery slope of euthanasia. Proponents of "sanctity of life" views that withdrawing and withholding medical treatment with knowledge that death would result is still within the sphere of euthanasia, whereas proponents of "quality of life" argue that it is not, as death is not intended. Their arguments maintain that for patients who are totally dependant on machines to ensure the work of some bodily functions, living may amount to little more than survival as dying is prolonged. Furthermore, the prolonging of life of the dying patient has profound implications on patients themselves, their relatives, dependants and medical providers. Thus, withdrawing and withholding medical treatment would not only respect a patient's right to self-determination, by allowing them to die in their underlying condition, but will ensure that medical providers are able to concentrate on more worthwhile treatments. This paper discusses the intractable difficulties with the moral distinction between withholding and withdrawing treatment and euthanasia, as well as makes a comparative study between the present state of law in Malaysia and England on this issue. The paper further highlights the differences between civil law and Islamic law in this controversial area.
Possible duplicate publication in: Kassim PHJ, Adeniyi OB. Withdrawing and withholding medical treatment a comparative study between the Malaysian, English and Islamic law. The University of Ilorin Law Journal. 2009;5:42-56
HTTP://WWW.UNILORIN.EDU.NG/EJOURNALS/INDEX.PHP/UILJ/ARTICLE/VIEW/988

Matched MeSH terms: Euthanasia/legislation & jurisprudence
Biofluid Markers of Equine Neurological Disorders Reviewed From Human Perspectives

Mayaki AM, Abdul Razak IS, Noraniza MA, Mazlina M, Rasedee A

J Equine Vet Sci, 2020 03;86:102907.
PMID: 32067661 DOI: 10.1016/j.jevs.2019.102907

Neurological disorders (NDs) are often fatal to horses. Thus, symptoms of equine NDs commonly indicate euthanasia. Current diagnostic approaches for equine NDs is based on clinical signs, differential diagnoses, analysis of cerebrospinal fluid (CSF), assessment of histopathological lesions, and imaging. However, advances in biofluid biomarkers in the diagnosis of human neurological diseases can potentially be applied to equine NDs. In this review, we described the established human blood and CSF neurobiomarkers that could potentially be used to diagnose equine NDs.

Matched MeSH terms: Euthanasia, Animal
Fulltext Attitudes of medical students towards euthanasia in a multicultural setting

Adchalingam K, Kong WH, Zakiah MA, Zaini M, Wong YL, Lang CC

Med J Malaysia, 2005 Mar;60(1):46-9.
PMID: 16250279

A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.

Matched MeSH terms: Euthanasia*
Islamic Considerations on the Application of Patient's Autonomy in End-of-Life Decision

Malek MM, Abdul Rahman NN, Hasan MS, Haji Abdullah L

J Relig Health, 2018 Aug;57(4):1524-1537.
PMID: 29417395 DOI: 10.1007/s10943-018-0575-5

In end-of-life situation, the need for patient's preference comes into the picture with the intention of guiding physicians in the direction of patient care. Preference in medical directive is made by a person with full mental capacity outlining what actions should be taken for his health should he loses his competency. This is based on the reality of universal paradigm in medical practice that emphasises patient's autonomy. A specific directive is produced according to a patient's wish that might include some ethically and religiously controversial directives such as mercy killing, physician-assisted suicide, forgoing life-supporting treatments and do-not-resuscitate. In the future, patient autonomy is expected to become prevalent. The extent of patient autonomy has not been widely discussed among Muslim scholars. In Islam, there are certain considerations that must be adhered to.

Matched MeSH terms: Euthanasia*
Euthanasia in Malaysia: opinions and controversies

Asma MA, Vaishnavi J, Chan L

JUMMEC, 2002;7:92-99.

Euthanasia is one of the most controversial topics of the 21st century after cloning and genetic engineering. Has this issue arisen now due to changes in attitude and perception on life of the modem society? This project was undertaken to study the opinions of 2 selected groups of people and secondly, to highlight the legal, ethical and religious controversies on euthanasia. Two groups comprising medical undergraduates and medical personnel were given a questionnaire pertaining 10 his/her opinion and altitude towards euthanasia. The second part of the project was conducted via interviews. The overall opinion from 399 respondents showed that 67.91% are against the practice of euthanasia. Religion is a powerful force against it as Malaysians in general are God-fearing people. There should be proper guidelines explaining how a doctor should respond to patients or family members of patients who request for euthanasia to be performed. It is not legal in Malaysia, but the court has the inherent power to permit it should a particular case have substantial reasoning and evidence. In conclusion, the level of awareness on euthanasia among medical staff and undergraduates is satisfactory. However, most of them do not approve euthanasia in Malaysia.

Matched MeSH terms: Euthanasia
THE LEGALITY OF EUTHANASIA FROM THE MALAYSIAN AND ISLAMIC PERSPECTIVES: AN OVERVIEW

Alias F, Muhammad M, Kassim PNJ

Med Law, 2015 Sep;34(1):509-532.
PMID: 30759949

The subject of euthanasia has generated many controversial debates, particularly on its legality. This has been primarily due to the doctrine of sanctity of life which is a predominant principle in many religions and is embedded in moral values. The underlying precept is that human life is sacred and demands respect, as all life comes from God and life can only be taken away intentionally through due process of law. Thus, ending a person's life, even upon his or her request, is considered in many jurisdictions as a criminal offence. Irrespective of humanitarian motives, a doctor who aids a patient in this act will be in breach of his unequivocal duty as a doctor and considered to have committed an unlawful act, which will subject him to legal sanctions. Countries such as the United Kingdom, Australia, New Zealand and Turkey have explicit legal provisions banning, in particular, active euthanasia, while countries such as the Netherlands, Belgium, Switzerland and certain states in the U.S have taken positive steps to legalise euthanasia in certain aspects. The ethical codes and laws in Malaysia have yet to develop to the fullest extent in dealing with these issues. Although Malaysian statutory legislation contains provisions banning active euthanasia, the legal position on passive euthanasia remains implicit. In the absence of indicative legal provisions and judicial precedents governing certain matters arising, it has been the practice of the Malaysian courts to refer to relevant legal principles inherent in English cases. As Islam is proclaimed as the country's official religion, the Islamic perspective is also an important and influential factor in the development of the legal framework in Malaysia as a whole. Thus, there is a need for the existence of a clear and comprehensive regulatory framework governing the legality of euthanasia in Malaysia.

Matched MeSH terms: Euthanasia; Euthanasia, Passive; Euthanasia, Active
Fulltext Euthanasia and physician-assisted suicide: a review from islamic point of view

Yousuf, R.M., Mohammed Fauzi, A.R.

International Medical Journal Malaysia, 2012;11(1):63-68.
MyJurnal

Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.

Matched MeSH terms: Euthanasia
Fulltext End-of-life decision and euthanasia from the Islamic perspective

Osman A

International Medical Journal Malaysia, 2007;6(1):1-10.
MyJurnal

The developments in the technology of life support such as mechanical ventilators, dialysis machines and cardiovascular support techniques have provided the means of maintaining organ function for prolonged period of time. However, in many instances, such life-sustaining treatment in intensive care units did not result in desirable outcome where patients return to their normal state of health. Several ethical issues have surfaced from these medical advances mainly on the decision-making process, which physicians have to deal in their daily practice. Withholding and withdrawing life-prolonging treatments that allow patients to die naturally need to be differentiated from physician-assisted suicides and euthanasia that involves the active ending of life. The definition of life and death and the guiding ethical principles that one takes before embarking to a particular conclusion is a pre-requisite to good clinical practice. Islam, as a comprehensive religion provides clear definition of life and death and has guidelines that underlie its own ‘medical ethics’ that one could be guided by to assist in the decision-making process.

Matched MeSH terms: Euthanasia
Withdrawal and limitation of life support in paediatric intensive care

Goh AY, Lum LC, Chan PW, Bakar F, Chong BO

Arch Dis Child, 1999 May;80(5):424-8.
PMID: 10208946

OBJECTIVES: To compare the modes of death and factors leading to withdrawal or limitation of life support in a paediatric intensive care unit (PICU) in a developing country.
METHODS: Retrospective analysis of all children (< 12 years) dying in the PICU from January 1995 to December 1995 and January 1997 to June 1998 (n = 148).
RESULTS: The main mode of death was by limitation of treatment in 68 of 148 patients, failure of active treatment including cardiopulmonary resuscitation in 61, brain death in 12, and withdrawal of life support with removal of endotracheal tube in seven. There was no significant variation in the proportion of limitation of treatment, failure of active treatment, and brain death between the two periods; however, there was an increase in withdrawal of life support from 0% in 1995 to 8% in 1997-98. Justification for limitation was based predominantly on expectation of imminent death (71 of 75). Ethnic variability was noted among the 14 of 21 patients who refused withdrawal. Discussions for care restrictions were initiated almost exclusively by paediatricians (70 of 75). Diagnostic uncertainty (36% v 4.6%) and presentation as an acute illness were associated with the use of active treatment.
CONCLUSIONS: Limitation of treatment is the most common mode of death in a developing country's PICU and active withdrawal is still not widely practised. Paediatricians in developing countries are becoming more proactive in managing death and dying but have to consider sociocultural and religious factors when making such decisions.

Matched MeSH terms: Euthanasia, Passive*
Fulltext Antidepressant-Like Properties of Fish Oil on Postpartum Depression-Like Rats Model: Involvement of Serotonergic System

Abdul Aziz NU, Chiroma SM, Mohd Moklas MA, Adenan MI, Ismail A, Hidayat Baharuldin MT

Brain Sci, 2020 Oct 13;10(10).
PMID: 33066310 DOI: 10.3390/brainsci10100733

Pathophysiology of postpartum depression (PPD) has been associated with many factors, such as neuroendocrine, neuroinflammation and neurotransmitter changes. Fish oil (FO) improves PPD both in humans and animals. However, little is known with regards to its pharmacology on a PPD-like rat model. Hence, the current study aimed at investigating the effects of FO on a PPD-like rat model. Female rats were induced with PPD-like symptoms and then randomly divided into six groups (n = 6) for two experimental protocols. Protocol 1 consisted of PPD-like rats (2 mL distilled water), PPD-like + FO (9 g/kg/d) and PPD-like + Fluoxetine (FLX) (15 mg/kg/d) groups of rats, whereas Protocol 2 consisted of PPD-like rats (2 mL distilled water) + PCPA (p-chlorophenylalanine) 150 mg/kg, PPD-like + FO (9 g/kg/d) + PCPA 150 mg/kg and PPD-like + FLX (15 mg/d) + PCPA 150 mg/kg groups of rats, respectively. All treatments were administered orally for 10 days postpartum, except PCPA, which was given intraperitoneally. Prior to euthanasia, the antidepressant-like effect of the FO was evaluated using the forced swimming test (FST) and open field test (OFT) on day 10 postpartum. Biochemical analysis of serotonin, serotonin metabolite and serotonin turnover from their prefrontal cortex and hippocampus were also measured. The results showed that FO decreased immobility time and increased swimming time significantly, but not climbing time in FST. Further, it also decreased serotonin metabolite and turnover significantly in the hippocampus of the PPD-like rats. In contrast, administration with PCPA reversed all the outcomes. The antidepressant-like effects of FO were found to be similar with that of FLX. Thus, it can be concluded that FO exerts its antidepressant-like effects in PPD-like rats through modulation of serotonergic system.

Matched MeSH terms: Euthanasia
Fulltext The formulation of classification for Islamization in medicine: review on 15 years of publications from Kulliyyah of Medicine

Mohammad Arif Shahar, Mohd Faiz Idris, Che Anuar Che Mohamad, Zul Azlin Razali

International Medical Journal Malaysia, 2018;17(101):43-48.
MyJurnal

The Kulliyyah of Medicine of IIUM has pioneered the Islamization of Medicine in Malaysia since its establishment in year 1994. Therefore, it is timely to review publications on Islamization by the kulliyyah and also to propose a classification system in the field of researches to promote an organized, comprehensive, inclusive and relevant Islamization process. The aim is to review and classify publications on Islamization performed by the members of Kulliyyah of Medicine, International Islamic University Malaysia (IIUM). All researches and publications deposited in the IIUM Repository (IREP) under the Kulliyyah of Medicine between 1st of January 2000 and 31st of August 2016 were reviewed. Journal articles, posters and proceedings with Islamization themes were identified. These publications were classified based on common themes to either of the following; 1) "Islamic Principles and Related Rulings in Medicine"; 2) "Medical Treatment for Muslim Patients"; 3) "Islamic Input in Medical Practices"; 4) "Ruqyah and Tibb an-Nabawi in Contemporary Medicine". A total of 1616 items (journal articles, abstracts and proceedings) were reviewed. Sixty-one (3.8%) of them were related to Islamization. The major contributors to writings in Islamization are the Orthopaedics, Traumatology and Rehabilitation Department (10%) followed by the Internal Medicine Department (7.9%), from their total deposits in the IREP database. Majority (36.5%) of work were done in "Islamic Principles and Related Rulings in Medicine", which dwells in subjects such as euthanasia, autonomy and doctor-patient relationship followed by "Islamic Input in Medical Practice" (28.6%) which was related to topics in the medical curriculum such as Fiqh Ibadah for the sick. Twenty-three point eight percent (23.8%) of work were in the "Medical Treatment for Muslim Patients" which focuses on Ramadan and diabetes and joint problems and Solat. Minimal work (7.9%) was done in the "Ruqyah and Tibb an-Nabawi in Contemporary Medicine" category. Low number of publications on Islamization was deposited in the IREP database for the past 15 years. Based on the proposed classification system, majority of publications were on "Islamic Principles and Related Rulings in Medicine" and "Islamic Input in Medical Practice". More work is required on the theme of "Medical Treatment for Muslim Patients" and "Ruqyah and Tibb an-Nabawi in Contemporary Medicine".

Matched MeSH terms: Euthanasia
Fulltext Acute oral toxicity of the ellagitannin geraniin and a geraniin-enriched extract from Nephelium lappaceum L rind in Sprague Dawley rats

Moorthy M, Khoo JJ, Palanisamy UD

Heliyon, 2019 Aug;5(8):e02333.
PMID: 31508523 DOI: 10.1016/j.heliyon.2019.e02333

Despite the lack of its toxicity evaluation, traditional herbal products are being widely used for various health indications. Geraniin, an ellagitannin, is a bioactive compound found in many traditional herbal medicines. In spite its numerous health benefits ranging from anti-inflammatory, anti-hyperglycaemic, hepatoprotective, anti-cancer and anti-microbial, no toxicity data on geraniin is available. The objective of this study is to evaluate the acute oral toxicity of geraniin and an enriched geraniin-extract of Nephelium lappaceum L rind. This study followed the guidelines of the OECD 423 acute oral toxicity test. Subsequent to a single oral administration of the test compounds, the rats were observed for 14 days for signs of toxicity and mortality. Following euthanasia, full blood count, biochemistry of blood and histopathology assessment of organs were carried out. All parameters analysed indicated insignificant difference compared to control. The LD50 cut-off values for both geraniin and geraniin-enriched extract was established to be 2000 mg/kg b. w., following a single oral dose. It was however observed that the hepatocytes of three geraniin-administered rats exhibited a 'foamy appearance'. As such, the no-observed-adverse-effect level of geraniin is below 2000 mg/kg, while that of geraniin-enriched extract is up to 2000 mg/kg. Further detailed toxicity studies are required to establish geraniin or its enriched extract from Nephelium lappaceum L rind safe for human consumption.

Matched MeSH terms: Euthanasia
Fulltext An international survey of medical ethics curricula in Asia

Miyasaka M, Akabayashi A, Kai I, Ohi G

J Med Ethics, 1999 Dec;25(6):514-21.
PMID: 10635508

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries.
OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools.
DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand.
PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country.
MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties.
RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics.
CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse.

Matched MeSH terms: Euthanasia, Active

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