Preserving Patient Autonomy at the End of Life: A Legal Appraisal of The Position of Advance Medical Directives in Malaysia and Indonesia

Respect for patient autonomy is a bioethical principle that has become increasingly imperative, particularly in the 21st century. However, in many Asian countries, medical paternalism to a larger degree remains prevalent in the healthcare setting. While a doctor is ethically and legally bound to respect a patient's values and wishes in administering treatment, the duty to do so is more complex in end-of-life care, where the patient is unable to partake in the decision-making process. Accordingly, it has been argued that advanced medical directives (AMDs) could ensure that the patient's right to make autonomous decisions is preserved and will not be defeated by any future incapacity. It also serves to extenuate the ethical dilemma faced by doctors in determining the course of treatment according to the incompetent patient's wishes. In turn, this facilitates healthcare providers to manage the distribution of scarce medical resources effectively. The need for AMDs is seen to be increasingly pressing in ageing countries such as Malaysia and Indonesia, where end-of-life care has yet to be integrated into mainstream healthcare services. This paper seeks to discuss the viability of integrating AMDs into the Malaysian and Indonesian regulatory frameworks on health care, by employing the qualitative method of content analysis of both primary and secondary sources of the two countries. Findings show that statutory reform is both recommended and necessary to ensure better management of medical resources, as well as to promote the delivery of a more inclusive and compassionate healthcare system.