Euthanasia and living wills in Malaysia - two sides of the coin

PETALING JAYA: A 75-year old man lies on a bed he hasn't left in over five years. He wants to get up and walk around in the garden with his grandchildren - but his cancer-ravaged body is just too weak.

He is unable to even sit up without gasping for air, relying on caregivers to change his diapers and pyjamas before there are drenched through with urine. His caregivers have to turn him every few hours to prevent bed sores.

Day-in, day-out he takes heavy doses of medication that leave him barely lucid. Most of the people he grew up are dead and buried, and at this stage of his existence there is no quality of life, no recovery for his terminal illness.

Simply a long drawn-out painful death

There are no other alternatives, for a patient must endure this suffering for as long as the body keeps breathing. At least as far as Malaysia is concerned.

Growing legislative action

On Feb 6, Canada joined the ranks of nations like Switzerland, Belgium, Luxembourg and the Netherlands in legalising physician-assisted suicide, or euthanasia.
Multiple sclerosis patient Gloria Taylor, 89, won the right to terminate her life.
Canada’s Supreme Court ruled; “by leaving people like Ms. Taylor to endure intolerable suffering, it impinges on their security of person."

Ms Taylor incidentally died of natural causes before the euthanasia could be implemented.

It’s very unlikely however that we could see such legislation in Malaysia. In fact the strength of religious belief preclude rational discussion of the topic.

If the sentiments of the immediate past president of the Malaysian Medical Association (MMA), Datuk Dr. NKS Tharmaseelan are anything to go by, it will be a long time before euthanasia of any form, let alone physician-assisted euthanasia is legalised in Malaysia.

"I personally feel nobody has a right to take a life when he cannot create one. Miracles do happen, what may be considered incurable today may become curable in the near or distant future. We should realise that medical science is still an imperfect and incomplete science," said Tharmaseelan in an email to The Star Online.

Addressing passive euthanasia, such as the removal of life support, Tharmaseelan added measures such as withholding life support measures in a brain-dead patient who is already dependent on a life support system may be justified after considering social and religious sensitivities and taking into confidence the next of kin.

Lawyer Andrew Khoo has a different view.

Andrew Khoo

"As a matter of principle, a person must have the right to terminate their own life, this is a fundamental principle of the right to life. The question is whether society is ready to accept that," said Khoo, who serves as Bar Council Human Rights Committee chair but emphasises that he is speaking in a personal capacity. 

He pointed out that currently suicide is an offence in Malaysia under the Penal Code.

"If there are compelling medical reasons for assisted suicide, then I would agree with the concept," said Khoo. 

"What constitutes quality of life has to be established, but will it be objective or subjective criteria. Quality of life has to go to life and death issues, it cannot simply be about quality of life, it has to be quality of life in comparison to something that is life-threatening," said Khoo.

Cultural objections

One point that Khoo and Tharmaseelan agree on is that Malaysia seemed to not be ready for legalizing euthanasia.
Malaysian Medical Association (MMA), Datuk Dr. NKS Tharmaseelan

"In nearly all Western countries a significantly higher proportion of people are for euthanasia but in Asian Countries and culture it is taboo. In a democracy, it is the wishes of the majority also taking into account religious, cultural and traditional beliefs. Legislation should reflect the will of the people," said Tharmaseelan.

"Many Malaysians still believe in a Creator and the sanctity of life given by that Creator. I can well see religious institutions stepping in to say this is not allowed as the sanctity of life is being removed by tampering with creation. And as the state feels duty-bound to uphold Islamic values, they will not allow this," added Khoo.

Tharmaseelan also pointed out there were other, more personal hurdles that have to be overcome if euthanasia can be allowed, such as the mental competence of the patient desiring euthanasia.

"Euthanasia  is only voluntary if the patient has a lucid understanding of available options and consequences. Determining or defining competence is not straightforward," said Tharmaseelan.

"Patients may also feel that the burden - financially, emotionally, mentally - on their family is overwhelming. Even if the costs of treatment are provided by the state, there is a risk hospital personnel may have an economic incentive to encourage consent to euthanasia."

Living wills

But how about advanced directives, or "living wills" - written documents where patients express their desires or consent for further medical procedures should they become mentally incapacitated?

Khoo feels this is a concept that needs to be examined to see how it can be introduced in a legally-binding manner in Malaysia.

He pointed out that the tension with living wills is between respecting the wishes of the patient when that patient can no longer express their view or opinion and whether there are overriding medical circumstances. 

Khoo said that if a living will was legally recognised, it would mean that the law recognises  the right of a person to decide for themselves and to give effect to their decisions regarding their treatment.

"Now a doctor can choose to respect the desires of the person, but if a person is brought to a doctor, how can they verify the wishes of the patient when they are voiced by a third party," added Khoo.

He added that he feels living wills should become part and parcel of Malaysian legal practice, as there is no way for Malaysians to draw one up at this point.

"I certainly think it should be part and parcel of Malaysian legal practice, and we have to prepare the public through education, just like how we educate people right now about organ donation. We need to educate people about the decisions that can be made which will be legally binding," said Khoo.

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