Duty of candour in the healthcare: a comparative study of Malaysia, the United Kingdom and Australia

The duty of candour emphasises openness, honesty, and transparency with patients following adverse events. It involves acknowledging errors, explaining what occurred, apologizing, and detailing remedial actions to prevent recurrence. Jurisdictions such as the UK and the Australian state of Victoria have codified organisational duty of candour in legislation along with professional codes, reflecting the importance and its role in enhancing patient safety and rights. In contrast, Malaysia lacks a formal framework, relying solely on ethical codes and fragmented non-explicit legal frameworks in both private and public healthcare organisations. This gap raises concerns about transparency and highlights the need for a clear legal and ethical framework to guide open and transparent communication in healthcare. This study examines legal and ethical duty of candour frameworks in Malaysia, the UK, and Australia, addressing three research questions: analysing their structures, comparing frameworks across jurisdictions, and proposing reforms for Malaysia. Findings reveal that Malaysia’s framework partially aligns core element of duty of candour through the Private Healthcare Facilities and Services Act 1998 (PHFSA 1998), guidelines by Ministry of Health (MOH) and ethical code, mainly the Code of Professional Conduct (CPC) and Good Medical Practice (GMP). These frameworks lack a structured mechanism to operationalize transparency and ensure consistency in practice. By contrast, the UK’s and Victoria statutory framework ensures consistency and enforceability, while Australia Open Disclosure Framework approach offers flexibility and systemic readiness. Both systems emphasise structured disclosure, apology protections, and learning from adverse events. The comparative analysis identifies significant gaps in Malaysia that underscoring the need for reform. A hybrid model is proposed, beginning with a voluntary open disclosure framework under a central authority and transitioning to a statutory system. Recommendations include updating ethical guidelines on professional duty of candour, codifying organisational duty of candour, introducing apology protection laws, establishing standardized protocols, and fostering a culture of transparency through education and training. These reforms aim to enhance patient trust, accountability, and safety, aligning Malaysia’s healthcare system with global best practices and ensuring a transparent, patient-centred approach in the future.