Elective Bursary Report: How Does Medical Consent Vary in Surgery in an Islamic Country When Compared to the UK?

Introduction 

I completed a four-week elective at Pantai Hospital in Ipoh, Malaysia, a private hospital, where I gained exposure to General Surgery and Trauma and Orthopaedics. Given that my elective took place in a private hospital, my surgical exposure was largely confined to elective procedures, including hernia repairs, mastectomies, knee replacements and hip replacements. Furthermore, I also shadowed doctors in clinics, allowing me to observe the differences between clinics in the NHS and Malaysia, as well as gain insight into how public and private healthcare systems differ.  

The primary objective of my elective was to explore how surgical consent practices differ between an Islamic Country like Malaysia and the UK(1). Through observations of pre-operative assessments involving doctors, patients and their families for varying procedures, I gained insight into the Malaysian approach to informed consent. While I was unable to gain local ethics approval for formal patient interviews, I conducted informal discussions with Consultant Surgeons about informed consent practices and their perceptions of how these processes varied from the UK, with a particular emphasis on how the influences of Islam and Malaysian culture play into this. To further facilitate my project, I reviewed and the hospitals’ consent documents to allow for a comparison with established UK practices based on GMC guidance.  

Findings  

Before my elective, I anticipated significant differences between the two healthcare systems, but instead discovered various similarities in surgical consent procedures, with both systems emphasising informed decision-making and a documentation of risks. Upon informally interviewing surgeons in Malaysia, I found that this similarity may partly stem from the private hospital setting. The rising number of medical negligence cases in Malaysia has created a legal environment where thorough informed consent serves as essential protection against malpractice claims(2). Consequently, surgeons have adopted rigorous consent protocols, mirroring those of the NHS. Pantai Hospital used pre-prepared procedure-specific forms for common surgical procedures to facilitate their consent processes. This was done to ensure the most common and the most dangerous complications were always discussed with the patient, thus aiming to remove any communication errors which may take place, thereby reflecting the same comprehensive approach advocated by the GMC(3). 

However, I also identified some differences in the consent process, one of which was the greater role that family influence played in the consent process in Malaysia. This was more notably recognised for major surgeries, such as patients undergoing mastectomies, where female patients would often seek the approval of their partners or the eldest member of the family before making any decisions regarding surgery. Surgeons demonstrated cultural sensitivity towards this by allowing extended time for patients attending with their families so that these considerations could be incorporated into the decision-making process. This approach reflects both religious and cultural influences, where in Malaysia, it is often the head of the house who makes the decisions on behalf of all of the family members(4). This poses a direct contrast to the UK, where autonomy, above all else, is prioritised when faced with patient health interventions(5). While Malaysia’s approach promotes strong family support, it may also raise ethical concerns if the family’s wishes oppose individual patient preferences. 

Another difference I noted in the surgical consent process was in situations where a translator was required. Given Malaysia’s diverse demographic, surgeons would often meet patients with whom they are unable to converse in their first language. As a result, most surgeons would hire nurses who spoke multiple languages to facilitate doctor-patient communication. Typically, when consenting these patients for surgery, the procedure was explained by the doctor to the nurse, who would then translate this information to the patient, similarly to how a third-party interpreter is used in the UK. However, at the end of each of these pre-operative assessments, the nurse answered any patient questions without translating for or consulting the doctor.  I observed that it was often the case that the doctor would not be aware of any of the questions which the patient had posed. Whilst this may be due to the medical experience of the nurses, this diverges from UK practice, where the doctor would be aware of any concerns or extra information the patient provides during this consent process, given that an unbiased and non-medical professional is required to act as an interpreter. This method could serve to impact patient safety, as it is imperative that the doctor is aware of patients’ concerns before surgery.  

Achievement of Learning Aims  

Ultimately, this project helped to identify key themes affecting Muslim patient views in Malaysia concerning informed consent in surgery; these include family involvement, gender-sensitivity and patient autonomy. In identifying these themes, I gained further insight into how these factors impact the consent process as well as how these differed between patients of different faiths.  

In terms of my personal development aims, I also reflected on any previous biases I had, whilst successfully organising an elective and gaining experience in a different healthcare system.  

Benefits  

This experience has improved my cultural competence, equipping me with skills to apply in my practice when interacting with patients from diverse cultural backgrounds. Furthermore, I am now more aware of different cultural nuances that affect patient beliefs, decision-making processes and healthcare expectations,  allowing me to tailor my approach to consent discussions based on individual patient preferences, whilst remaining within the UK guidelines, thereby enabling more sensitive and effective patient care. This approach will be particularly valuable when caring for patients from Islamic or other collectivist cultural backgrounds within the UK’s increasingly diverse healthcare environment. 

Moving forward, I intend to advocate for enhanced cultural competence training for healthcare professionals within the NHS, with a particular focus on being aware of cultural and religious influences which may impact patient behaviours. In doing so, HCPs can build a better rapport with patients, thereby improving patient care. I also hope to pursue further opportunities in gaining insight into different cultures with the view to identifying how these can also impact patient behaviours and influence their medical opinions.  

References 

1. Malaysia [Internet]. United States Department of State. [cited 2025 Jan 9]. Available from: https://www.state.gov/reports/2023-report-on-international-religious-freedom/malaysia/
2. Medical Negligence and Medico-Legal Litigation In Malaysia [Internet]. 2024 [cited 2025 May 17]. Available from: https://mahwengkwai.com/medical-negligence-and-medico-legal-litigation-in-malaysia/
3. GMC [Internet] Guidance for doctors decision making and consent. 2020 [cited 2025 Jul 24]. Available from: https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors—decision-making-and-consent-english_pdf-84191055.pdf
4. Attum B, Hafiz S, Malik A, Shamoon Z. Cultural Competence in the Care of Muslim Patients and Their Families. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jul 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499933/
5. Varkey B. Principles of Clinical Ethics and Their Application to Practice. Med Princ Pract. 2021 Feb;30(1):17–28.

Mohammed Shoaib Sheraz