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Standard of Care for Disclosure of Risks in Medical Procedures/Surgery in Malaysia

Foo Fio Na Principle

  • Malaysian courts follow Rogers v. Whitaker as adopted in Foo Fio Na v. Dr. Soo Fook Mun, establishing that the standard of care for disclosing risks is a judicial determination, not deferred to medical opinion; Bolam test applies only to diagnosis/treatment, not risk disclosure: Thus, it is our judgment that in respect of the standard of care in medical negligence cases, a distinction must be made between diagnosis and treatment on the one hand and the duty to advise of risks on the other. ["

    DR CHANDRAN GNANAPPAH vs GAN SEE JOE & ANOR AND ANOTHER APPEAL - Court Of Appeal

    "]; Whitaker and followed by this Court in Foo Fio Na in regard to standard of care in medical negligence is restricted only to the duty to advise of risks associated with any proposed treatment and does not extend to diagnosis or treatment. ["

    JUWARIYAH SAL HAMID @ AHMAD vs DATO DR SHAHRUDIN MOHD DUN - High Court

    "] ["

    JAYSHREE LC DOSHI vs AHMAD FAIZAL MOHAMAD ALI & ORS - High Court

    "] ["

    MOHD SAUFI SAMAN & ORS vs DATO DR AHMAD MURTAZAM & ORS - 2024 MarsdenLR 853

    "] ["

    DR CHANDRAN GNANAPPAH vs GAN SEE JOE & ANOR AND ANOTHER APPEAL - Court Of Appeal

    "]; The courts would no longer look to what a body of respectable members of the medical profession would do as the yardstick to govern the standard of care expected in respect of the duty to advise. ["

    JAYSHREE LC DOSHI vs AHMAD FAIZAL MOHAMAD ALI & ORS - High Court

    "]
  • Duty requires disclosure of inherent and material risks the patient ought to know, including real risks of misfortune or ineffectiveness, especially in major surgery: That said, we are of the opinion that the Bolam Test has no relevance to the duty and standard of care of a medical practitioner in providing advice to a patient on the inherent and material risks of the proposed treatment. ["

    DR CHANDRAN GNANAPPAH vs GAN SEE JOE & ANOR AND ANOTHER APPEAL - Court Of Appeal

    "] [](https://supremetoday.ai/doc/judgement/MYS_MARSDENLR_2007_2757) ["

    FOO FIO NA vs SOO FOOK MUN

    "] ["

    FOO FIO NA vs DR SOO FOOK MUN & ANOR - Federal Court

    "]; Relevant information includes disclosure of possible risks which the patient ought to know and/ or should know. ["

    KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

    "] ["

    - High Court

    "] [](https://supremetoday.ai/doc/judgement/MY_MLRH_2023_1_MLRH_419)

Informed Consent Requirements

  • Consent must cover nature/purpose, benefits, risks/side effects, alternatives, and success likelihood; standard forms alone insufficient if risks not verbally explained in understandable terms (e.g., layman's language): The purpose of the procedure and the risk relating to the said procedure as seen in the standard form was explained to the Plaintiff by Dr Benjamin.; I have been informed of - The nature and purpose of care, treatment, services, medications, interventions or procedure. - Potential benefits, risks, or side effects, including potential problem related to recuperation. - The likelihood of achieving care, treatment or service goals. ["

    DAYALAN SATHIAMUTTY vs GLENEAGLES HOSPITAL (KUALA LUMPUR) SDN BHD & ORS - 2023 MarsdenLR 1911

    "]; DW3 further admitted that the risks of the surgery were not spelt out on the consent form, as it was a standard consent form and the consent form was only a procedure prior to surgery. [](https://supremetoday.ai/doc/judgement/MY_MLRA_2015_3_MLRA_327) ["

    NORAZLEEN MOHAMMED MUSTAFFA vs DR OMAR MD ISA & ANOR - Court Of Appeal

    "]; It is in evidence that the SD1 had explained to the plaintiff the risks of surgery in simple layman's Bahasa Malaysia language capable of been understood. ["

    ARULAPPAN KANNAN vs DR SURESH CHOPRA & ORS - High Court

    "]
  • Fully registered practitioners typically obtain consent; failure to disclose material risks breaches duty, potentially leading to negligence claims or MMC inquiry: Failure to obtain a patient's consent or disclose material risks may be interpreted as a failure of the standard of care resulting in a disciplinary inquiry by the Medical Council or may even be construed as a breach of duty of care and legal action instituted. ["

    KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

    "] ["

    - High Court

    "] [](https://supremetoday.ai/doc/judgement/MY_MLRH_2023_1_MLRH_419) ["

    MOHD SAUFI SAMAN & ORS vs DATO DR AHMAD MURTAZAM & ORS - 2024 MarsdenLR 853

    "]

Breach and Consequences

  • Non-disclosure of risks (e.g., bile duct stricture, paralysis, pain) constitutes breach if below reasonable competent standard, even if surgery follows protocol: His expert opinion can be summarised as follows: ... f) The development of a bile duct stricture was likely related to the surgery and inadequate post-op follow-up. g) SP4 concludes that the care provided by the defendant did not meet a reasonably competent standard. ["

    JUWARIYAH SAL HAMID @ AHMAD vs DATO DR SHAHRUDIN MOHD DUN - High Court

    "]; This conduct I find falls below the standard expected of a competent medical practitioner. ["

    DAYALAN SATHIAMUTTY vs GLENEAGLES HOSPITAL (KUALA LUMPUR) SDN BHD & ORS - 2023 MarsdenLR 1911

    "]; post surgery was due to the SD1 and SD2 breach of duty of care in not disclosing the risks involved. [](https://supremetoday.ai/doc/judgement/MY_MLRH_2010_2_MLRH_571)

Analysis and ConclusionMalaysia's standard for risk disclosure rejects Bolam (peer medical judgment) per Foo Fio Na, mandating objective judicial assessment of material risks disclosure for informed consent; courts evaluate if doctors informed patients of inherent risks in comprehensible terms, distinct from treatment standards. Breach occurs without such disclosure, risking liability even if procedure is standard. ["

DR CHANDRAN GNANAPPAH vs GAN SEE JOE & ANOR AND ANOTHER APPEAL - Court Of Appeal

"] ["

JUWARIYAH SAL HAMID @ AHMAD vs DATO DR SHAHRUDIN MOHD DUN - High Court

"] ["

JAYSHREE LC DOSHI vs AHMAD FAIZAL MOHAMAD ALI & ORS - High Court

"] ["

KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

"] ["MY_MLRA_2015_3_MLRH_327"]
Medical Negligence in Malaysia: Duty of Disclosure and Informed Consent Standards

Standard of Care: Disclosing Medical Risks in Malaysia

In the realm of healthcare, patient trust hinges on transparency. Imagine undergoing surgery only to later discover undisclosed risks that could have swayed your decision. What is the standard of care for disclosure of risks of a medical procedure or surgery in Malaysia? This question strikes at the heart of informed consent, balancing medical expertise with patient autonomy. Malaysian law imposes a clear duty on doctors to provide comprehensive information, distinct from treatment standards. This post delves into guidelines, case law, and practical implications to help patients and practitioners navigate this vital area.

The Core Duty: Informed Consent Beyond Bolam

Malaysian courts and the Malaysian Medical Council (MMC) mandate that registered medical practitioners inform patients in an understandable manner about the condition, investigation and treatment options, benefits, all material risks, possible adverse effects or complications, residual effects, and likely outcomes if untreated. This enables patients to make an informed choice.

KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

Failure to disclose material risks breaches the standard of care, potentially leading to negligence liability.

NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

Unlike diagnosis and treatment, which follow the Bolam test (whether a responsible body of medical professionals would act similarly), disclosure focuses on the patient's right to decide. It's not dictated by prevailing medical practices.

NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

ZULHASNIMAR HASAN BASRI & ANOR vs DR KUPPU VELUMANI P & ORS - 2017 MarsdenLR 2301

KS SIVANANTHAN vs GOVERNMENT OF MALAYSIA - 2000 MarsdenLR 1746

DR KS SIVANANTHAN vs THE GOVERNMENT OF MALAYSIA & ANOR - 2000 MarsdenLR 973

Courts emphasize: It is the duty of a doctor to warn the patient of any material risk, particularly if the patient, if warned of the risk, consider it to be significant.

KS SIVANANTHAN vs GOVERNMENT OF MALAYSIA - 2000 MarsdenLR 1746

DR KS SIVANANTHAN vs THE GOVERNMENT OF MALAYSIA & ANOR - 2000 MarsdenLR 973

Key requirements include:- Disclosing material risks and comprehensive details beyond broad procedure descriptions.

KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

- Only fully registered practitioners bear primary responsibility for consent and explaining risks.

MOHD SAUFI SAMAN & ORS vs DATO DR AHMAD MURTAZAM & ORS - 2024 MarsdenLR 853

- Courts hold doctors liable even for accepted procedures if risks aren't disclosed.

NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

MMC Guidelines: The Baseline Standard

The MMC Guideline Adopted on 26 November 2013 explicitly states: A medical practitioner is obliged to disclose information to the patient and to warn the patient of material risks before taking consent. Failure may trigger disciplinary action or legal claims.

KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

Disclosures must cover:- Condition details- Investigation options- Treatment options and benefits- All material risks, adverse effects, complications- Residual effects- Outcomes if untreated

KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

Only fully registered practitioners can take consent, as they explain procedures, unexpected findings, risks, complications, and remedies.

MOHD SAUFI SAMAN & ORS vs DATO DR AHMAD MURTAZAM & ORS - 2024 MarsdenLR 853

Patient forms typically confirm explanations of nature, purpose, benefits, risks or side effects, alternatives, and their risks/benefits.

DAYALAN SATHIAMUTTY vs GLENEAGLES HOSPITAL (KUALA LUMPUR) SDN BHD & ORS - 2023 MarsdenLR 1911

This framework protects patient safety, as seen in aesthetic practice cases where unauthorized procedures breached care standards partly due to inadequate disclosure of limitations.

ADAM HAMIL vs DR CHIAM TEE KIANG

The court noted: Medical practitioners must adhere strictly to their qualifications and licensing; performing unauthorized procedures constitutes a breach of duty of care. Undisclosed limitations undermined consent.

ADAM HAMIL vs DR CHIAM TEE KIANG

Judicial Precedents: Applying the Duty in Court

Malaysian courts rigorously enforce this, drawing from influential cases like Australia's Rogers v Whitaker. In a percutaneous disc coagulation therapy (PDCT) case, the doctor was liable for not informing the plaintiff of risks, despite the treatment being accepted practice. Informed consent demands full risk disclosure; non-disclosure equals negligence.

NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

The Australian High Court, cited approvingly, distinguishes: There is a fundamental difference between, on the one hand, diagnosis and treatment and, on the other hand, the provision of advice or information to a patient. Disclosure requires no special skill and isn't bound by professional norms.

ZULHASNIMAR HASAN BASRI & ANOR vs DR KUPPU VELUMANI P & ORS - 2017 MarsdenLR 2301

Regional cases reinforce this. For instance, Indian consumer courts stress expert evidence on non-disclosure, noting: An issue whether non-disclosure of a particular risk... should be condemned as a breach of the doctor's duty of care is an issue to be decided primarily on the basis of expert medical evidence.

HARISH KUMAR CHADHA VS INDRAPRASTHA APOLLO HOSPITALS

SULOCHANA LAD - APPELLANT VS MOHAN GERRA

2009 0 Supreme(SC) 1431 Similarly, failure to obtain consent for procedures like blood transfusions led to liability for assault and battery.

SULOCHANA LAD - APPELLANT VS MOHAN GERRA

In aesthetic negligence, breaching qualifications tied to poor disclosure caused RM341,770 in damages.

ADAM HAMIL vs DR CHIAM TEE KIANG

These align with Malaysia's patient-centric approach.

Exceptions and Practical Limitations

Guidelines imply exceptions for emergencies or necessity, where immediate action overrides full disclosure.

ZULHASNIMAR HASAN BASRI & ANOR vs DR KUPPU VELUMANI P & ORS - 2017 MarsdenLR 2301

Adjustments may apply for unusually nervous patients if full info could harm, but this is narrow.

ZULHASNIMAR HASAN BASRI & ANOR vs DR KUPPU VELUMANI P & ORS - 2017 MarsdenLR 2301

Delegation is limited; the consenting practitioner bears vicarious liability.

MOHD SAUFI SAMAN & ORS vs DATO DR AHMAD MURTAZAM & ORS - 2024 MarsdenLR 853

Courts may consider if a responsible body of medical opinion approved non-disclosure, but patient-significant risks demand warning regardless. 2009 0 Supreme(Raj) 993

Recommendations for Compliance

Practitioners should:- Use MMC-compliant forms for documented disclosures.- Ensure understandable explanations, tailored to patients.- Obtain written consent from registered doctors only.

In litigation, plaintiffs prove non-disclosure caused harm, but courts uphold the duty strictly. Patients: Always ask for risks, alternatives, and outcomes.

Key Takeaways

  • Material risks must be disclosed for valid consent, separate from Bolam.

    KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

    NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

  • MMC sets the standard; breaches invite liability.

    KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

  • Courts prioritize patient choice, as in PDCT and aesthetic cases.

    NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

    ADAM HAMIL vs DR CHIAM TEE KIANG

  • Document everything to mitigate risks.

This outlines general principles in Malaysia; laws evolve, and specifics vary. Consult a qualified lawyer for advice tailored to your situation. Stay informed to protect your rights.

References1.

KOAY ENG OON vs DR WONG TWEE JUAT & ANOR - 2022 MarsdenLR 1580

: MMC consent guidelines.2.

NUUR IMAN RAHMATULLAH KHAN DR vs AMPANG PUTERI HOSPITAL SDN BHD & ANOR - 2023 MarsdenLR 1464

: PDCT negligence case.3.

MOHD SAUFI SAMAN & ORS vs DATO DR AHMAD MURTAZAM & ORS - 2024 MarsdenLR 853

: Practitioner consent rules.4.

ZULHASNIMAR HASAN BASRI & ANOR vs DR KUPPU VELUMANI P & ORS - 2017 MarsdenLR 2301

: Disclosure vs. treatment distinction.5.

KS SIVANANTHAN vs GOVERNMENT OF MALAYSIA - 2000 MarsdenLR 1746

DR KS SIVANANTHAN vs THE GOVERNMENT OF MALAYSIA & ANOR - 2000 MarsdenLR 973

: Rogers v Whitaker principles.6.

DAYALAN SATHIAMUTTY vs GLENEAGLES HOSPITAL (KUALA LUMPUR) SDN BHD & ORS - 2023 MarsdenLR 1911

: Consent form standards.7.

ADAM HAMIL vs DR CHIAM TEE KIANG

: Aesthetic procedure liability. #MedicalLawMY, #InformedConsentMY, #PatientRightsMY
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