Ethico-legal considerations and best practices for implementing perioperative advance care planning in the Malaysian healthcare setting / Wan Ahmad Hakimi Wan Azlan

As the number of the global elderly population continue to increase, the demand in surgical procedures to be carried out in the high-risk population continue to rise. The combination of the surgery along with the adverse effects of anaesthesia is known to increase the risk of perioperative complications in the elderly population. Hence, there is a need to develop a platform for this high-risk group to express their preferences in future medical treatment and end-of-life expectations should they lose capacity due to perioperative complications. Advance care planning (ACP) is among the methods available for patients without capacity to voluntarily share their preference in future medical treatment, including during the perioperative stage. Currently, there is no legislation to regulate general or perioperative ACP practices in Malaysia. In order to implement perioperative ACP in the Malaysian healthcare setting, this research compares the current ethical and legal landscape as well as ACP practices in the UK, US, Singapore, and Malaysia with the aim of constructing a list of recommendations in proposing best perioperative ACP practices that can applied to Malaysian hospitals. Important details that need to be highlighted during perioperative ACP discussion include the appointment of a surrogate decision maker, information surrounding the current disease and the surgical intervention needed, the possible outcomes of the treatment, preference in future medical treatment and the patient’s life goals and values. Effective governance, efficient clinical application and satisfactory quality control measures are found to be essential in introducing perioperative ACP in the Malaysian healthcare setting.