Mohamad Iqhbal Bin Kunji Mohamad, Aimi Nadia Mohd Yusof, Hazdalila Yais Haji Razali, Julina Azimah Md Noor, Muhammad Aidil Idham Bin Sharom
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引用次数: 0
Abstract
Third-party consent, while common in medical practice, presents complex ethical dimensions and intricate legal connotations. In Malaysia, the absence of comprehensive legislation governing third-party consent for adults lacking decision-making capacity due to temporary conditions creates profound dilemmas for healthcare professionals. This article critically examines these challenges through a compelling case study of an 18-year-old female with respiratory failure who required immediate invasive intervention but did not receive consent from her mother. Despite medical urgings and a favourable prognosis, the mother's refusal highlights the difficulties healthcare providers face when navigating between their ethical obligations to act in the patient's best interests and the patient's family's wishes. Employing a dual analysis from ethical and Malaysian legal perspectives, the study explores the tensions between universal medical ethics-particularly the principles of autonomy, beneficence, and non-maleficence-and the existing Malaysian legal framework. It reveals contradictions between the Malaysian Medical Council's guidelines, which appear to grant decision-making authority to family members, and English common law principles that emphasise acting in the patient's best interests, especially in emergency situations. This inconsistency generates significant uncertainty for healthcare professionals, potentially compromising patient care and exposing physicians to litigation when acting without explicit consent. Through systematic examination of both emergency and non-emergency scenarios, the article underscores the urgent need for comprehensive legislation in Malaysia to address third-party consent, particularly for patients not covered by the Mental Health Act 2001. It advocates for laws that clearly differentiate between emergency and non-emergency situations, delineate the authority of relatives and legal guardians, and align with international practices and fundamental medical ethics principles. By harmonising legal statutes with ethical imperatives, Malaysia can resolve the contradictions that currently jeopardise patient welfare and physician security. These findings have important implications for healthcare policy development and clinical practice, emphasising the necessity for ethical and legal coherence in medical care in Malaysia.
第三方同意虽然在医疗实践中很常见，但却呈现出复杂的伦理层面和复杂的法律内涵。在马来西亚，由于临时条件而缺乏决策能力的成年人缺乏关于第三方同意的全面立法，这给保健专业人员造成了深刻的困境。本文通过一个引人注目的案例研究，批判性地审视了这些挑战，该案例研究了一名18岁的呼吸衰竭女性，她需要立即进行侵入性干预，但没有得到母亲的同意。尽管有医学上的敦促和良好的预后，这位母亲的拒绝凸显了医疗服务提供者在为患者的最大利益和患者家属的愿望行事的道德义务之间进行导航时所面临的困难。该研究从伦理和马来西亚法律的角度进行了双重分析，探讨了普遍医学伦理之间的紧张关系，特别是自主、慈善和非恶意的原则，以及现有的马来西亚法律框架。它揭示了马来西亚医学委员会（Malaysian Medical Council）的指导方针与英国普通法原则之间的矛盾，前者似乎将决策权授予了家庭成员，而后者强调以病人的最佳利益为出发点，尤其是在紧急情况下。这种不一致给医疗保健专业人员带来了很大的不确定性，可能会损害患者的护理，并使医生在未经明确同意的情况下采取行动时面临诉讼。通过对紧急情况和非紧急情况的系统审查，该条强调马来西亚迫切需要制定全面立法，处理第三方同意问题，特别是2001年《精神卫生法》未涵盖的患者。它倡导制定法律，明确区分紧急情况和非紧急情况，界定亲属和法定监护人的权力，并与国际惯例和基本医疗道德原则保持一致。通过协调法律法规和道德规范，马来西亚可以解决目前危及患者福利和医生安全的矛盾。这些发现对医疗保健政策制定和临床实践具有重要意义，强调了马来西亚医疗保健中道德和法律一致性的必要性。
期刊介绍：
Health Care Analysis is a journal that promotes dialogue and debate about conceptual and normative issues related to health and health care, including health systems, healthcare provision, health law, public policy and health, professional health practice, health services organization and decision-making, and health-related education at all levels of clinical medicine, public health and global health. Health Care Analysis seeks to support the conversation between philosophy and policy, in particular illustrating the importance of conceptual and normative analysis to health policy, practice and research. As such, papers accepted for publication are likely to analyse philosophical questions related to health, health care or health policy that focus on one or more of the following: aims or ends, theories, frameworks, concepts, principles, values or ideology. All styles of theoretical analysis are welcome providing that they illuminate conceptual or normative issues and encourage debate between those interested in health, philosophy and policy. Papers must be rigorous, but should strive for accessibility – with care being taken to ensure that their arguments and implications are plain to a broad academic and international audience. In addition to purely theoretical papers, papers grounded in empirical research or case-studies are very welcome so long as they explore the conceptual or normative implications of such work. Authors are encouraged, where possible, to have regard to the social contexts of the issues they are discussing, and all authors should ensure that they indicate the ‘real world’ implications of their work. Health Care Analysis publishes contributions from philosophers, lawyers, social scientists, healthcare educators, healthcare professionals and administrators, and other health-related academics and policy analysts.
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