Attitudes towards euthanasia and physician- assisted 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: “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 multi- ethnic 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

Result Physician: 192/250 (77 %), (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.