The purpose of this paper is to examine service quality, perceived value, overall satisfaction and future intention among medical tourists who seek treatment in Malaysian private hospitals. Self-administered questionnaire was the main method of data collection. Respondents comprised foreign patients who seek medical treatment, and/or related medical services such as tests and medical check-ups. Expatriates and foreign nationals residing in Malaysia were excluded. Altogether 173 responses were received and analysed by SPSS 17. Three dimensions of medical tourism service quality were identified, namely, medical staff quality, supporting services quality and administrative services quality. Medical staff quality was found to predict all three variables of patient satisfaction, perceived value and future intention for treatment. Very limited empirical research has been carried out with actual data from patients due to difficulty in getting access to international patients, and patients' reluctance to participate. This study is among the first few which examines medical tourism service quality with actual patient data. The research identifies important constituents of medical tourism which may assist policy-makers and hospital managers in better understanding the industry.

Purpose -The study seeks to explore the perception of international patients on Malaysia as a medical tourism destination country, as well as overall patient satisfaction, perceived value and future intention for repeat treatment and services. Design/methodology/approach -Self-administered questionnaire was the main method of data collection. The survey covered major private hospitals in medical tourists' states in the country, namely, Penang,

Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.

The respect for patient autonomy is a bioethical principle that has acquired a compelling degree of prevalence in modern medical practice. While a doctor is ethically and lawfully bound to respect a patient’s preference and personal values in administering the requisite treatment, the duty to do so is more intricate in end-of-life care, when most patients are unable to partake in the decision-making process. An advance medical directive thus provides an assurance that the patient’s right to make autonomous decisions is preserved and will not be defeated by any future incapacity. It also serves to alleviate the ethical dilemma faced by doctors and assist them to determine the course of treatment according to the incompetent patient’s wishes. In turn, this facilitates healthcare providers to effectuate a more functional allocation of resources, which include costly life-sustaining equipment. In Malaysia, although advance care planning and advance medical directives are fairly novel concepts, there have been recent calls by certain sectors to increase awareness among the public and incorporate such measures into the delivery of healthcare services. This paper seeks to discuss the viability of integrating advance medical directives into the Malaysian regulatory framework on the provision of healthcare. Accordingly, this will also include deliberation on the Islamic standpoint with regard to the subject matter, in view of Malaysia’s religious demography and the position of Islam as the official religion of the country.

The duty of medical confidentiality has been one of the core duties of medical practice as information created, disclosed, acquired directly or indirectly during the doctor-patient relationship is considered confidential and requires legitimate protection. Further, preserving confidentiality on the premise that the relationship between doctor and patient has been built on trust and confidence renders the duty to be seen as sacrosanct. The source for this duty can be found not only in the Hippocratic Oath, codes of ethics, religious tenets but also in the common law, principles of equity and statutory provisions. Nevertheless, technological advancements and the growth of social networks have contributed to the difficulties in preserving confidentiality as the information gathered tends to become vulnerable in unsecure environments. However, the duty of medical confidentiality is by no means absolute as it can be breached in situations in which there are stronger conflicting duties. This article discusses the rules governing the duty of medical confidentiality and the exceptions in which infringements to this duty become justified. It also gives an overview of the duty of confidentiality under Islamic law. It concludes that the inviolability of this duty may be without doubt but circumstances warranting its disclosure are crucial to serve the interests of justice.