Advance Medical Directives in Malaysia: Issues and Challenges
Abstract
Advance Medical Directives serve as an important instrument to ensure that patients’ wishes regarding medical treatment are respected when they are no longer capable of making decisions autonomously. In Malaysia, although discourse surrounding patient autonomy has gained increasing attention, the implementation of Advance Medical Directives remains limited due to the absence of specific legal provisions and a low level of public awareness. This paper discusses the issues surrounding the practice of Advance Medical Directives and the challenges in their implementation in Malaysia in greater depth. Adopting a qualitative approach based on content analysis, the discussion highlights the need for professional guidance in the preparation of such directives and refers to legal practices in foreign jurisdictions for comparative purposes. Data were gathered from both primary and secondary sources to support the analysis. The core focus of this paper is to unravel the constraints arising from the lack of a specific legal framework governing the practice of Advance Medical Directives in Malaysia. Findings indicate that, to date, there is no dedicated legislation related to Advance Medical Directive in Malaysia. Therefore, legal reform is important in this context.
Keywords: Advance Medical Directives, patient autonomy, medical consultation, medical ethics, end of life, principle of autonomy
Full text: PDF
References
1. Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics (ed. ke-4). Oxford University Press.
2. Berliner, H., M., & Swagerty, D. L. (2012). Advance Directive. http://www.kpjdamansara.com/Advance-Directives-article-843.html. Dicapai pada 4 November 2016.
3. Bomba, P. A., & Sabatino, C. P. (2009). POLST: An improvement over traditional advance directives. Cleveland Clinic Journal of Medicine, 76(4), 219–226. https://doi.org/10.3949/ccjm.76a.08098
4. Brazier, M. (2020). Medicine, patients, and the law (ed. ke-6). Manchester University Press.
5. Brazier, M., Cave, E., & Heywood, R. (2023). Agreeing to treatment. Dlm. E. Cave, M. Brazier & R. Heywood (Pnyt.), Medicine, patients and the law (ed. ke-7, hlm. 139–170). Manchester University Press. https://doi. org/10.7765/9781526157188.00016
6. British Medical Association. (2020). Advance decisions and advance statements. https://www.bma.org.uk
7. California Probate Code § 4700 et seq. (t.t.). California Advance Health Care Directive.
8. Cantor, M. D. (2005). Advance directives and the pursuit of death with dignity. The Journal of Law, Medicine & Ethics, 33(1), 52–65. https://doi.org/10.1111/ j.1748-720X.2005.tb00207.x
9. Cogo, S. B., Lunardi, V. L., Quintana, A. M., Girardon-Perlini, N. M. O., & Silveira, R. S. (2016). Challenges to implementation of advance directives of will in hospital practice. Revista Brasileira de Enfermagem, 69(6), 969–976.
10. Cruzan lwn. Director, Missouri Department of Health, 497 U.S. 261 (1990).
11. Department of Health & Social Care UK. (2018). Mental Capacity Act Code of Practice. https://www.gov.uk
12. Fadhlina Alias, Puteri Nemie Jahn Kassim, & Muhammad Najib Abdullah. (2020). Dying wishes: Understanding advance medical directives from the Malaysian and Islamic law perspectives. Ulum Islamiyyah, 32, 18–39. https:// doi.org/10.33102/uij.vol32no.174
13. Fagerlin, A., & Schneider, C. E. (2004). Enough: The failure of the living will. The Hastings Center Report, 34(2), 30–42.
14. Farhat Moazam. (2006). Bioethics and organ transplantation in a Muslim society: A study in culture, ethnography and religion. Indiana University Press.
15. Gordy, S., & Klein, E. (2011). Advance directives in the trauma intensive care unit: Do they really matter? International Journal of Critical Illness & Injury Science, 1(2), 132–137.
16. Ibn ‘Abd al-Salam. (t.t.). Qawa‘id al-ahkam fi masalih al-anam (Jld. 1, hlm. 4).
17. Ishwara Bhat, P. (2020). Idea and methods of legal research. Oxford University Press.
18. Jackson, E., & Keown, J. (2019). Debating euthanasia. Hart Publishing.
19. Jackson, M., & Keown, J. (2019). The legal and ethical boundaries of advance directives. Medical Law Review, 27(3), 312–328. https://doi.org/10.1093/ medlaw/fwz017
20. Kass-Bartelmes, B. L., & Hughes, R. (2003). Advance care planning: Preferences for care at the end of life. Agency for Healthcare Research and Quality Issue Brief No. 8.
21. Kohn, N. A. (2008). Outliving advance directives: The unpredictability problem. Georgia Law Review, 46(3), 593–667.
22. Krippendorff, K. (2004). Content analysis: An introduction to its methodology (ed. ke-2). SAGE.
23. Lama Zopa Rinpoche. (2018). The four noble truths: A guide to everyday life. Wisdom Publications.
24. Malaysian Medical Council. (2013). https://hq.moh.gov.my/medicalprac/wp-content/uploads/2022/01/Consent-Guidelines-Adopted-20131126-2-A.pdf (23 November 2024).
25. Malaysian Medical Council. (2019). Code of Professional Conduct 2019. https://mmc.gov.my/wp-content/uploads/2022/04/Code-of-Professional-Conduct-2019.pdf
26. Malaysian Medical Council. (2025). Consent for treatment of patients by registered medical practitioners, Versi 3/2025.
27. McCormick, A. J. (2013). Buddhist ethics and end-of-life care decisions. Journal of Social Work in End-of-Life & Palliative Care, 9(2–3), 209–225. https://doi. org/10.1080/15524256.2013.794060
28. Ministry of Health Singapore. (2021). Advance medical directive. Ministry of Health Singapore. https://www.moh.gov.sg/seeking-healthcare/advance-medical-directive
29. Ministry of Health Singapore. (2024). Advance medical directive. Ministry of Health Singapore. https://www. moh.gov.sg/seeking-healthcare/advance-medical-directive
30. Ministry of Health Singapore. (2008). Advance medical directive. Ministry of Health Singapore. https://www.moh.gov.sg/content/dam/moh_web/Publications/Educational%20 Resources/2008/AMD%20Booklet-final.pdf
31. Mohd Zamre Mohd Zahir, Tengku Noor Azira Tengku Zainudin, Haniwarda Yaakob, Ramalinggam Rajamanickam, Husyairi Harunarashid, Ahmad Azam Mohd Shariff, Zainunnisaa Abd. Rahman, & Muhammad Hatta. (2019). Hak pesakit bagi melaksanakan arahan awal perubatan: Suatu gambaran umum. Sains Malaysiana, 48, 353–359.
32. Mohd Zamre Mohd Zahir, Tengku Noor Azira Tengku Zainudin, Ramalinggam Rajamanickam, & Zainunnisaa Abd. Rahman. (2019). Arahan Do Not Resuscitate (DNR) dalam sektor kesihatan dari perspektif undang-undang. Akademika. 89, 143–154.
33. Nasir Majeed, N., Amjad Hilal, & Arshad Nawaz Khan. (2023). Doctrinal research in law: Meaning, scope and methodology. Bulletin of Business and Economics (BBE), 12(4), 559–563. https://doi.org/10.61506/01.00167
34. National Institute on Aging. (2023). Advance care planning: Health care directives. National Institute on Aging. https://www.nia.nih.gov
35. National Institute on Aging. (2023). Advance care planning: Healthcare directives. https://www.nia.nih.gov/health/advance-care-planning
36. Nurul Hidayat Ab Rahman, Mohd Zamre Mohd Zahir, & Nabeel Mahdi Althabhawi. (2023). Repercussions of COVID’19 lockdown on implementation of children’s rights to education. Children, 10, 474. https://doi.org/10.3390/ children10030474
37. Nurul Hidayat Ab Rahman, Salawati Mat Basir, & Mohd Zamre Mohd Zahir. (2022). Discrimination of street children’s rights to development and sustainable development goals 2030 (SDG 2030). Res Militaris, 12(2) 7041– 7056.
38. Puteri Nemie Jahn Kassim, & Fadhlina Alias. (2015). Religious, ethical and legal considerations in end-of-life issues: Fundamental requisites for medical decision making. Journal of Religion and Health, 55(1), 119–134. https:// link.springer.com/article/10.1007/s10943-014-9995-z
39. Ramalinggam Rajamanickam, Mohd Safri Mohammed Naaim, Tengku Noor Azira Tengku Zainudin, Zainunnisaa Abd. Rahman, Mohd zamre mohd zahir, & Muhammad Hatta. (2019). The assessment of expert evidence on DNA in Malaysia. Academic Journal of Interdisciplinary Studies (SCIENDO) 8(2), 51–57. https://doi.org/10.2478/ajis-2019-0016
40. re Quinlan in 70 N.J. 10, 355 A.2d 647 (NJ 1976)
41. Searight, H. R., & Gafford, J. (2005). It’s like playing with your destiny: Bosnian immigrants views of advance directives and end-of-life decision-making. Journal of Immigrant Health, 7(3), 195–203.
42. Shaikh Mohd Saiffuddeen Shaikh Mohd Salleh. (2015). Persoalan berkaitan Advance Medical Directive (AMD) dalam Kerangka Bioetika Islami [Pembentangan Kertas]. Muzakarah Pakar Bioetika Islami mengenai Isu Advance Medical Directive (AMD), Kuala Lumpur.
43. Soren, C. (2021). Legal research methodology: An overview. Journal of Emerging Technologies and Innovative Research, 8(10). https://www.jetir.org/papers/ JETIR2110354.pdf
44. Teno, J. M., Gruneir, A., Schwartz, Z., Nanda, A., & Wetle, T. (2007). Association between advance directives and quality of end-of-life care: A national study. Journal of the American Geriatrics Society, 55(2), 189–194. https://doi. org/10.1111/j.1532-5415.2007.01045.x
45. The Death of Nancy Cruzan, Frontline. (1992, 24 Mac). PBS.
46. Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical principles and practice, 30, 17–28. https://doi/org/10.1159/000509119
47. Watch Tower Bible and Tract Society. (2008). Keep Yourself in God’s Love.
48. Zaki Morad Mohammad Zaher. (2015). Ethical considerations in the preparation of advanced medical directives [Pembentangan Kertas]. Muzakarah Pakar: Bioetika Islami mengenai Isu Advance Medical Directive (AMD). Institut Kefahaman Islam Malaysia (IKIM).
2. Berliner, H., M., & Swagerty, D. L. (2012). Advance Directive. http://www.kpjdamansara.com/Advance-Directives-article-843.html. Dicapai pada 4 November 2016.
3. Bomba, P. A., & Sabatino, C. P. (2009). POLST: An improvement over traditional advance directives. Cleveland Clinic Journal of Medicine, 76(4), 219–226. https://doi.org/10.3949/ccjm.76a.08098
4. Brazier, M. (2020). Medicine, patients, and the law (ed. ke-6). Manchester University Press.
5. Brazier, M., Cave, E., & Heywood, R. (2023). Agreeing to treatment. Dlm. E. Cave, M. Brazier & R. Heywood (Pnyt.), Medicine, patients and the law (ed. ke-7, hlm. 139–170). Manchester University Press. https://doi. org/10.7765/9781526157188.00016
6. British Medical Association. (2020). Advance decisions and advance statements. https://www.bma.org.uk
7. California Probate Code § 4700 et seq. (t.t.). California Advance Health Care Directive.
8. Cantor, M. D. (2005). Advance directives and the pursuit of death with dignity. The Journal of Law, Medicine & Ethics, 33(1), 52–65. https://doi.org/10.1111/ j.1748-720X.2005.tb00207.x
9. Cogo, S. B., Lunardi, V. L., Quintana, A. M., Girardon-Perlini, N. M. O., & Silveira, R. S. (2016). Challenges to implementation of advance directives of will in hospital practice. Revista Brasileira de Enfermagem, 69(6), 969–976.
10. Cruzan lwn. Director, Missouri Department of Health, 497 U.S. 261 (1990).
11. Department of Health & Social Care UK. (2018). Mental Capacity Act Code of Practice. https://www.gov.uk
12. Fadhlina Alias, Puteri Nemie Jahn Kassim, & Muhammad Najib Abdullah. (2020). Dying wishes: Understanding advance medical directives from the Malaysian and Islamic law perspectives. Ulum Islamiyyah, 32, 18–39. https:// doi.org/10.33102/uij.vol32no.174
13. Fagerlin, A., & Schneider, C. E. (2004). Enough: The failure of the living will. The Hastings Center Report, 34(2), 30–42.
14. Farhat Moazam. (2006). Bioethics and organ transplantation in a Muslim society: A study in culture, ethnography and religion. Indiana University Press.
15. Gordy, S., & Klein, E. (2011). Advance directives in the trauma intensive care unit: Do they really matter? International Journal of Critical Illness & Injury Science, 1(2), 132–137.
16. Ibn ‘Abd al-Salam. (t.t.). Qawa‘id al-ahkam fi masalih al-anam (Jld. 1, hlm. 4).
17. Ishwara Bhat, P. (2020). Idea and methods of legal research. Oxford University Press.
18. Jackson, E., & Keown, J. (2019). Debating euthanasia. Hart Publishing.
19. Jackson, M., & Keown, J. (2019). The legal and ethical boundaries of advance directives. Medical Law Review, 27(3), 312–328. https://doi.org/10.1093/ medlaw/fwz017
20. Kass-Bartelmes, B. L., & Hughes, R. (2003). Advance care planning: Preferences for care at the end of life. Agency for Healthcare Research and Quality Issue Brief No. 8.
21. Kohn, N. A. (2008). Outliving advance directives: The unpredictability problem. Georgia Law Review, 46(3), 593–667.
22. Krippendorff, K. (2004). Content analysis: An introduction to its methodology (ed. ke-2). SAGE.
23. Lama Zopa Rinpoche. (2018). The four noble truths: A guide to everyday life. Wisdom Publications.
24. Malaysian Medical Council. (2013). https://hq.moh.gov.my/medicalprac/wp-content/uploads/2022/01/Consent-Guidelines-Adopted-20131126-2-A.pdf (23 November 2024).
25. Malaysian Medical Council. (2019). Code of Professional Conduct 2019. https://mmc.gov.my/wp-content/uploads/2022/04/Code-of-Professional-Conduct-2019.pdf
26. Malaysian Medical Council. (2025). Consent for treatment of patients by registered medical practitioners, Versi 3/2025.
27. McCormick, A. J. (2013). Buddhist ethics and end-of-life care decisions. Journal of Social Work in End-of-Life & Palliative Care, 9(2–3), 209–225. https://doi. org/10.1080/15524256.2013.794060
28. Ministry of Health Singapore. (2021). Advance medical directive. Ministry of Health Singapore. https://www.moh.gov.sg/seeking-healthcare/advance-medical-directive
29. Ministry of Health Singapore. (2024). Advance medical directive. Ministry of Health Singapore. https://www. moh.gov.sg/seeking-healthcare/advance-medical-directive
30. Ministry of Health Singapore. (2008). Advance medical directive. Ministry of Health Singapore. https://www.moh.gov.sg/content/dam/moh_web/Publications/Educational%20 Resources/2008/AMD%20Booklet-final.pdf
31. Mohd Zamre Mohd Zahir, Tengku Noor Azira Tengku Zainudin, Haniwarda Yaakob, Ramalinggam Rajamanickam, Husyairi Harunarashid, Ahmad Azam Mohd Shariff, Zainunnisaa Abd. Rahman, & Muhammad Hatta. (2019). Hak pesakit bagi melaksanakan arahan awal perubatan: Suatu gambaran umum. Sains Malaysiana, 48, 353–359.
32. Mohd Zamre Mohd Zahir, Tengku Noor Azira Tengku Zainudin, Ramalinggam Rajamanickam, & Zainunnisaa Abd. Rahman. (2019). Arahan Do Not Resuscitate (DNR) dalam sektor kesihatan dari perspektif undang-undang. Akademika. 89, 143–154.
33. Nasir Majeed, N., Amjad Hilal, & Arshad Nawaz Khan. (2023). Doctrinal research in law: Meaning, scope and methodology. Bulletin of Business and Economics (BBE), 12(4), 559–563. https://doi.org/10.61506/01.00167
34. National Institute on Aging. (2023). Advance care planning: Health care directives. National Institute on Aging. https://www.nia.nih.gov
35. National Institute on Aging. (2023). Advance care planning: Healthcare directives. https://www.nia.nih.gov/health/advance-care-planning
36. Nurul Hidayat Ab Rahman, Mohd Zamre Mohd Zahir, & Nabeel Mahdi Althabhawi. (2023). Repercussions of COVID’19 lockdown on implementation of children’s rights to education. Children, 10, 474. https://doi.org/10.3390/ children10030474
37. Nurul Hidayat Ab Rahman, Salawati Mat Basir, & Mohd Zamre Mohd Zahir. (2022). Discrimination of street children’s rights to development and sustainable development goals 2030 (SDG 2030). Res Militaris, 12(2) 7041– 7056.
38. Puteri Nemie Jahn Kassim, & Fadhlina Alias. (2015). Religious, ethical and legal considerations in end-of-life issues: Fundamental requisites for medical decision making. Journal of Religion and Health, 55(1), 119–134. https:// link.springer.com/article/10.1007/s10943-014-9995-z
39. Ramalinggam Rajamanickam, Mohd Safri Mohammed Naaim, Tengku Noor Azira Tengku Zainudin, Zainunnisaa Abd. Rahman, Mohd zamre mohd zahir, & Muhammad Hatta. (2019). The assessment of expert evidence on DNA in Malaysia. Academic Journal of Interdisciplinary Studies (SCIENDO) 8(2), 51–57. https://doi.org/10.2478/ajis-2019-0016
40. re Quinlan in 70 N.J. 10, 355 A.2d 647 (NJ 1976)
41. Searight, H. R., & Gafford, J. (2005). It’s like playing with your destiny: Bosnian immigrants views of advance directives and end-of-life decision-making. Journal of Immigrant Health, 7(3), 195–203.
42. Shaikh Mohd Saiffuddeen Shaikh Mohd Salleh. (2015). Persoalan berkaitan Advance Medical Directive (AMD) dalam Kerangka Bioetika Islami [Pembentangan Kertas]. Muzakarah Pakar Bioetika Islami mengenai Isu Advance Medical Directive (AMD), Kuala Lumpur.
43. Soren, C. (2021). Legal research methodology: An overview. Journal of Emerging Technologies and Innovative Research, 8(10). https://www.jetir.org/papers/ JETIR2110354.pdf
44. Teno, J. M., Gruneir, A., Schwartz, Z., Nanda, A., & Wetle, T. (2007). Association between advance directives and quality of end-of-life care: A national study. Journal of the American Geriatrics Society, 55(2), 189–194. https://doi. org/10.1111/j.1532-5415.2007.01045.x
45. The Death of Nancy Cruzan, Frontline. (1992, 24 Mac). PBS.
46. Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical principles and practice, 30, 17–28. https://doi/org/10.1159/000509119
47. Watch Tower Bible and Tract Society. (2008). Keep Yourself in God’s Love.
48. Zaki Morad Mohammad Zaher. (2015). Ethical considerations in the preparation of advanced medical directives [Pembentangan Kertas]. Muzakarah Pakar: Bioetika Islami mengenai Isu Advance Medical Directive (AMD). Institut Kefahaman Islam Malaysia (IKIM).
Published
2026-01-30
How to Cite
MOHD ZAHIR, Mohd Zamre.
Advance Medical Directives in Malaysia: Issues and Challenges.
Kanun: Jurnal Undang-undang Malaysia, [S.l.], v. 38, n. 1, p. 59-82, jan. 2026.
ISSN 2682-8057.
Available at: <http://jurnal.dbp.my/index.php/Kanun/article/view/9156>. Date accessed: 30 jan. 2026.
Section
Articles
