Mohamad Mohamad Iqhbal Bin Kunji, Yusof Aimi Nadia Mohd, Razali Hazdalila Yais Haji, Md Noor Julina Azimah, Sharom Muhammad Aidil Idham Bin
Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor Branch, 47000, Jalan Hospital, Selangor, Sungai Buloh, Malaysia.
Health Care Anal. 2025 Jul 10. doi: 10.1007/s10728-025-00531-4.
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.
第三方同意在医疗实践中很常见，但它呈现出复杂的伦理层面和错综复杂的法律内涵。在马来西亚，由于缺乏针对因临时状况而缺乏决策能力的成年人的第三方同意的全面立法，这给医疗保健专业人员带来了深刻的困境。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。该案例是一名18岁的呼吸衰竭女性，她需要立即进行侵入性干预，但未获得其母亲的同意。尽管有医疗方面的敦促且预后良好，但母亲的拒绝凸显了医疗保健提供者在履行以患者最佳利益行事的伦理义务与患者家属意愿之间进行权衡时所面临的困难。该研究从伦理和马来西亚法律角度进行双重分析，探讨了普遍医学伦理（特别是自主、有益和不伤害原则）与马来西亚现有法律框架之间的紧张关系。它揭示了马来西亚医学委员会的指南（似乎将决策权授予家庭成员）与强调以患者最佳利益行事的英国普通法原则之间的矛盾，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极大的不确定性，可能会损害患者护理，并使医生在未经明确同意行事时面临诉讼风险。通过对紧急和非紧急情况的系统审查，本文强调马来西亚迫切需要全面立法来解决第三方同意问题，特别是针对2001年《精神健康法》未涵盖的患者。它主张制定明确区分紧急和非紧急情况、界定亲属和法定监护人权限且与国际惯例和基本医学伦理原则相一致的法律。通过使法律法规与伦理要求相协调，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伦理和法律一致性的必要性。
