Reconciling the Science of Medical Advancements at the End of Life with the Art of Dying Well- Advocating for Legislation on Advance Decisions in Malaysia

Making decisions regarding care at the end-of-life is difficult for everyone involved because most patients rarely communicate their wishes for treatment beforehand. Sometimes, decisions taken by the medical team may be in conflict with the wishes of the patient or their families. This situation is more challenging in multi-cultural and multi-religious societies like Malaysia. How can we know what treatment patients want and how are we able to be sure that we are really acting in their best interests? The answer lies in planning for our death, which firstly requires patients to have a conversation with someone else about this topic, and secondly to have it in some recorded form. This dissertation seeks to reconcile the science of medical advancements at the end- of-life with the art of dying well by advocating for the introduction of legislation on advance decisions in Malaysia. It commences by looking at some different forms of Advance Decisions (AdvDecs) currently available. These include the Living Will, Advance Directives, the Lasting Power of Attorney and the Physician Orders for Life-Sustaining Treatment (POLST) form. Unfortunately, there is currently no legislation pertaining to AdvDecs in Malaysia. As such, our discussion then moves on to consider current legislations on AdvDecs in the United Kingdom and Singapore, and includes some relevant legislations and guidelines in Malaysia. An analysis of some of the medical, legal, ethical and social aspects of end-of-life care in Malaysia is then undertaken in order to help our subsequent evaluation of how AdvDecs can be of use. This sets the scene for us to determine the best possible approach to implementing AdvDecs in Malaysia. The focus then shifts to describing the recommended step-wise approach to overcome this problem. Firstly, this is done by encouraging people to talk about their wishes and life values and secondly, to simultaneously improve the communication skills of all parties involved in end-of-life care, before the third step of legislating provisions for AdvDecs takes place. The concluding chapters seeks to identify and examine how legislating AdvDecs in Malaysia may impact decision-making practices on end-of-life issues including the vision of shared decision-making approach and the prediction of an increase in demand for palliative care services.