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Advance Directives ProfNorchaya

Advance Directives ProfNorchaya

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8th Malaysian Hospice Congress presentation
8th Malaysian Hospice Congress presentation

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Published by: malaysianhospicecouncil6240 on Dec 27, 2008
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12/07/2012

 
 Advance Directives.In Malaysia?
8th Malaysian Hospice CongressBayview Hotel, Penang13-15 June 2008
Professor Norchaya TalibFaculty of LawUniversity of Malaya15 June 2008
Outline
Definition
Underlying rationale/philosophy
Selected case law
Which way forward for Malaysia?
2
Definition
 A written, legal document, completed andsigned by a person above 18, explaininghis wishes for medical care, should he beunable to make treatment decisions at afuture time.
3
Definition/Form
It may include wishes to start or stop life-sustaining treatment.
4
Forms of Advance Directives
Written (living will)
Oral
By proxy –granting a Power of Attorneyto someone else
5
Rationale/philosophy Autonomy
6
 
(Modified) Rationale/philosophy
Responsibility (self-accountability)
For easy medical decision-making
Utilitarian (?)
7
Selected case law
HE v A Hospital Trust [2003]
Patient 24 years old, born and brought up a Muslim. Upon parents’ separation she and her mother became Jehovah's Witnesses.Congenital heart problem.In February 2001, signed AD refusing blood and primary bloodcomponents. Revocation to be in writing. In 2002, she saw a doctorand surgery was planned without the use of blood products. In2003, patient was seriously ill. As she was leaving home in anambulance she had said to her brother and aunt 'I don't want to die‘Septic shock secondary to bacterial endocarditis. Requireddebridement .She was sedated and thereafter remainedunconscious.
8
Selected case law (cont)
patient's condition further deteriorated. Prognosis -death within 36hours without a blood transfusion.
The patient's father applied for the court to intervene, to permit atransfusion, on the grounds that had she been conscious the patientwould have consented herself in light of above facts and herengagement to be married to Muslim fiance.
Patient stopped attending Jehovah Witness congregation afterengagement.
Held –treatment including blood transfusion, would belawful
9
Selected case law (cont)
Re AK [2001]
 AK is 19 1/2 years old. Motor neurone disease since 17 yrs old. Lostall limb movements, unable to speak for about 2 years. He cannotswallow and has for a long time been fed through a tube.For a while, some minimal movement in one great toe. That enabledhim to operate a computer and to communicate. Then thatmovement was also lost. Thereafter he was able to communicate bymeans of a device known as an 'E transboard' which involved thepainstaking spelling out of words letter by letter by a process linkedto the line of sight.For past 3 months communication was via one eyelid movement, 1mm. In weeks, to lose that and be ‘locked in’.
10
Selected case law (cont)
 At a time when he was plainly very ill, a conclusive diagnosis of motor neurone disease had not yet been made, and he suffered arespiratory arrest. An emergency invasive procedure was carried outand a tracheostomy tube inserted. He was kept breathing byartificial ventilation. He has remained on the ventilator ever since.
That happened something like 2 years ago. This kind of invasivetreatment is not generally practised in this country upon patientswith motor neurone disease, the condition being irreversible. Ithappened in AK's case because at that stage it was not known forsure that his condition was motor neurone disease and wasirreversible. It is clear that if he were not on the ventilator naturalfailure of breathing would have caused him to die some time agonow, at the latest about a year ago, and probably much earlier thanthat.
11
Selected case law (cont)
By means of eyelid movement AK communicated that he would wishhis ventilation to be discontinued 2 weeks after communication hadceased. His breathing would stop and he would die.
Held –AKis competent to make his own decision. There isno issue of the court deciding for a patient, in the bestinterests of that patient.
12

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