End of life decisions in Malaysia: adequacies of ethical codes and developing legal standards

End-of-life decision making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments, rather they involve wider considerations such as patient’s religious and cultural beliefs, financial constraints, and the wishes of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore, it is imperative that clear ethical codes and legal standards are developed to guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia

Advance healthcare directives: The emerging global trends and shari’ah perspectives

Advance Healthcare Directives emerged due to the enhancement of patient autonomy which ideals have been firmly embedded in the development of modern medical decision making. An advance healthcare directive is a document that seeks to preserve the patient’s right of self-determination by representing his values and wishes in the event he becomes incapacitated and no longer able to fully partake in the decision-making process. Particularly, when life sustaining measures are required in making end of life decisions, clear instructions embodied in the advance healthcare directives will serve as guidance to healthcare providers in respecting patient’s wishes, managing healthcare resources and reducing the likelihood of disputes with patient’s family members. Subsequently, the growth and popularity of these directives has led to the enactment of legislations by many countries in clarifying the legitimacy of such directives when employed in healthcare settings. The legal development of advance healthcare directives is seen to be more prominent in the United States, Australia and parts of Europe while countries in other jurisdictions may not specifically address the legal status of such directives in their legislations but treat them as being legally persuasive. Nevertheless, for Muslim patients, the use of advance healthcare directives to determine their health destiny must abide by the Shari’ah as the right and ability to make their own choices and decisions about medical care and treatment must be within the defined limitations of the Shari’ah. This paper seeks to discuss the legal development of advance healthcare directives in selected countries around the globe and the legitimacy of these directives from the Shari’ah perspectives

Managing end-of-life care in Malaysia: The economic considerations from the ethical and Islamic perspectives

Since the turn of the 20th century, the increase in the degree of medical prevalence particularly at the end of life, has redefined the dimensions between life and death. Medical treatment and equipment are now able to prolong the life expectancy of patients suffering from life-limiting illnesses even in the absence of any brain activity. This has impacted upon the delivery of end-of-life care, which focuses on providing a comfortable environment for patients who are suffering from incurable diseases and for whom death is imminent. The emergence of sophisticated medical devices and interventions has raised ethical issues relating to end-of-life decisions especially in withholding or withdrawing life sustaining treatments. In such a situation, economic considerations constitute an important factor in the provision of end-of-life care due to the costly and limited resources which are required for providing such life-sustaining treatment. Healthcare providers need to grapple with issues justifying resource allocation amongst patients, which are in turn contingent upon deliberations on medical futility. This paper seeks to discuss the economic considerations involved in the management of end-of-life care from the ethical and Islamic standpoints and ultimately, to provide recommendations for the promotion of a comprehensive national policy that is suitable and viable for the Malaysian healthcare environment

Religious, ethical and legal considerations in end-of-life issues: fundamental requisites for medical decision making

Religion and spirituality have always played a major and intervening role in a person’s life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient’s religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient’s values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients’ varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions

End of life decisions in Malaysia: adequacies of ethical codes and developing legal standards

End of life decisions constitute one of the areas in medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. As continuous technological and pharmacological advances prolong life expectancy of those suffering from terminal illnesses, the medical profession is constantly confronted with difficult decisions on whether to forego or limit care. Such decisions are presently no longer confined to mere clinical assessments but involve wider considerations such as patient’s religious and cultural beliefs, financial constraints, wishes and needs of family members, healthcare providers and members of the community. Therefore, it is imperative that ethical codes and legal standards are developed comprehensively to provide guidance for the medical profession in deciding on the best possible actions for such patients. Medical decisions that are in congruent with the highest ethical values and adhering to legal standards will inevitably solve the inherent ethical dilemmas that are very pronounced in this area. Although there are available Malaysian ethical codes and relevant legal provisions governing some aspects of end of life decisions, but the development of the law and ethical codes have yet to reach its fullest extent. Similarly, end of life decisions are still within the unchartered judicial terrain in Malaysia and the use of advance directives in planning end of life decisions appears to be a novel concept amongst patients in Malaysia. Thus, the development of comprehensive ethical codes in tandem with developing legal standards is considered a significant necessity for Malaysia in order to promote a holistic decision making in end of life issues

Contemporary dilemmas in the integration of ethics, medicine and law: a need for legal solutions

The disciplines of medicine, ethics and law have always shared a close and strong connection. This can be seen from the early ages, where the cohesion between these three disciplines were infused in the functions of the medical doctor who was portrayed not just as a healer but as a judge and the law maker. The fact that doctors were able to heal the wounded and prolong death made them infallible as they appeared to possess supernatural powers with the ability to communicate with demons and divinity. However, as society transformed to become more vociferous and egalitarian, the predominance of law as an instrument of social regulation has become considerably evident. Legislative enactments and judicial interventions are currently social norms in defining the boundaries of rights and wrongful conducts in the practice of medicine. Self-regulation within the medical profession is perceived as a thing of the past and respectable medical opinion is no longer treated with excessive deference. Furthermore, the discipline of ethics in which principles on respecting autonomy, justice and dignity permeate the field of medicine, is also facing ongoing ethical conflicts which require solutions in the form of legal interventions. Accordingly, it can be seen that the interface between medicine, ethics and law has expanded rapidly and presents a very intricate area. It is therefore imperative that various socio-legal measures are introduced to assist the medical profession in facing these contemporary challenges and consequently, provide a more harmonious interface between medicine, ethics and law

Corruption or Corporate Hospitality: An Analytical Discourse of Section 17A of the Malaysian Anti-Corruption Commission Act 2009

Commercial organisations practise corporate hospitality to develop loyalty and trust, keep in touch with clients, and weather business. A challenge exists where corporate hospitality may camouflage corruption. One of the pertinent issues is addressing the obscuring boundaries of corporate hospitality to ensure commercial organisations in Malaysia are not trapped in the labyrinth of corruption affecting business sustainability. This research employs a doctrinal study and content analysis approach that utilises library-based research to procure primary and secondary sources. The research outcome may assist the government, policymaker, and commercial organisations' stakeholders in combating corrupt practices within their organisations. Keywords: commercial organisations; corporate corruption; corporate hospitality; guidelines eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6iSI6.305

The doctrine of sanctity of life from Islamic perspective

Muslims believe that only Allah swt has the ultimate will and power over life and death. Life is merely a gift and a loan entrusted to mankind until death takes place. It is therefore forbidden for any person to intentionally end a life; to do so would be to commit a grievous transgression against Allah. Islam holds life in the highest esteem to the extent that the duty to preserve life forms one of the core principles in maqasid al-shari’ah. Protection of one’s life includes taking care of one’s body, health and mind from that which would lead to harm and death. All lives are equally inviolable; Islam does not discriminate one’s life on the basis of nationality, race or religion. In order to ensure a just order that protects both individual and public interests at large, Islam prescribes certain legitimate situations where the dimensions of sanctity of life are qualified, for example, by permitting to end life in self-defence or in due course of law. There is thus a need to understand the wisdom behind the sanctity of life principle in Islam, not only by studying its importance, but also the overall scope in which it operates

Kepentingan arahan perubatan awal menjelang negara tua 2030: beberapa isu dari sudut perundangan dan perspektif syariah

Unjuran Jabatan Perangkaan Malaysia telah menganggarkan bahawa 15 peratus daripada penduduk Malaysia terdiri daripada warga emas menjelang tahun 2030. Peralihan kepada status “negara tua” bakal memberikan implikasi terhadap pelbagai aspek pengurusan sesebuah negara seperti perkembangan ekonomi, pengurusan kewangan dan keselamatan sosial. Pertambahan jumlah penduduk warga emas juga akan turut memberikan impak yang signifikan kepada perkhidmatan perubatan dan penjagaan kesihatan. Apabila berlakunya peningkatan tersebut bererti lebih ramai pesakit yang perlu diberikan penjagaan paliatif di pusat-pusat penjagaan kesihatan seperti hospital dan pusat hospis. Penjagaan paliatif terutama bagi pesakit-pesakit di akhir hayat akan melibatkan kos yang tinggi dengan sumber yang terhad. Rentetan itu, penyedia perkhidmatan akan berhadapan dengan isu-isu kewajaran pengagihan sumber kepada pesakit, dan ini berkait rapat dengan pertimbangan tentang rawatan perubatan yang tidak membawa apa-apa manfaat (futile treatment). Maka arahan perubatan awal merupakan satu cadangan penyelesaian terhadap dilema ini. Mekanisme ini berfungsi sebagai jaminan bahawa hak individu untuk membuat keputusan berautonomi tentang rawatan perubatan tidak akan terlucut berikutan sebarang ketidakupayaan yang berlaku selepas itu. Dalam erti kata lain, arahan perubatan awal mengekalkan autonomi pesakit untuk menentukan rawatan perubatan untuk dirinya sendiri, walaupun pada ketika pesakit tersebut bukan lagi seorang yang kompeten. Keputusan ini dapat membantu para doktor mengenal pasti kehendak pesakit dan nilainilai yang dipegang apabila perlu membuat keputusan di pengakhiran hayat, seterusnya memudahkan pengagihan sumber rawatan kepada pesakit yang lebih memerlukan. Kertas kerja ini bertujuan menjelaskan kepentingan pelaksanaan arahan perubatan awal di Malaysia, terutamanya dalam persediaan untuk menghadapi “negara tua”, serta mengupas isu-isu yang berkaitan berdasarkan sudut pandangan undang-undang dan syariah

PENGLIBATAN WANITA SEBAGAI PENENTU DASAR DARI SUDUT PANDANG AL SIYÄ€SAH AL-SYARcIYYAH: KAJIAN KES SEKTOR PERBANKAN ISLAM DI MALAYSIA: WOMEN INVOLVEMENT IN DECISION-MAKING FROM THE VIEWPOINT OF AL SIYÄ€SAH AL-SYARcIYYAH: A CASE STUDY ON THE ISLAMIC BANKING SECTOR IN MALAYSIA

Kerajaan Malaysia telah menggubal Dasar Wanita Negara (DWN) dan pelancaran pertamanya adalah pada tahun 1989 sehingga ke tahun 2020. Antara matlamat DWN, ialah perkongsian saksama antara wanita dan lelaki dalam memperoleh dan mengawal sumber dan peluang penyertaan serta menikmati manfaat pembangunan. Ini adalah peluang yang amat baik untuk menampilkan keupayaan wanita dalam semua sektor ekonomi negara. Kertas ini cuba menggariskan keserasian usaha ini dengan prinsip-prinsip al SiyÄsah al Syarciyyah.yang memartabatkan tadbir urus yang baik, penglibatan holistik, keperluan manusia dan kepentingan bersama.   Kertas ini mengutarakan satu kajian kes yang meneliti lantikan wanita yang menganggotai lembaga pengarah bank dan badan penasihat Syariah bank di 16 buah institusi bank Islam di Malaysia dari tahun 2012 sehingga tahun 2018, suatu lantikan yang penting dan melibatkan pembuatan keputusan dalam sektor tersebut.  Kajian mendapati bahawa sungguhpun tenaga kepakaran Malaysia di dalam sektor perbankan Islam telah diiktiraf di persada antarabangsa, penglibatan wanita sebagai penentu dasar dalam tempoh masih tidak mencapai sasaran minima 30%. Kertas ini mencadangkan peningkatan penglibatan wanita dalam sektor ini. Penglibatan wanita secara umum dalam penentuan dasar juga adalah selari dengan semangat al SiyÄsah al Syarciyyah untuk tadbir urus yang baik, penglibatan menyeluruh dan kelestarian pembangunan