title: Awareness, knowledge and attitude toward informed consent among doctors in two different cultures in Asia: a cross-sectional comparative study in Malaysia and Kashmir, India.
abstract: BACKGROUND
  Informed consent is now accepted as the cornerstone of medical practice, with reasonable patient standards typically considered to be appropriate in the developed countries; however it is still challenged in many developing countries. The objective of this descriptive study was to evaluate the perceptions and practices among attending medical professionals in matters relating to informed consent in selected hospitals.
  
  
  METHODS
  A questionnaire-based cross sectional survey among doctors in the two tertiary care hospitals, one in Malaysia and the other in Kashmir, was performed.
  
  
  RESULTS
  Awareness on informed consent was universal with "reasonable physician standard" as the most popular choice. As compared to doctors in Malaysia, doctors from Kashmir showed a tendency to reservedly disclose medical information (p-value equals 0.051) and withhold it, if it was deemed potentially harmful (p-value is less than 0.001) or requested so by relatives (p-value is less than 0.023). They also withheld some information from female patients (p-value is less than 0.001). When consent was refused despite needing lifesaving intervention, the majority of both respondents (73 percent versus 80 percent) considered intervention without consent to be justified. Respondents from Malaysia felt that parents could refuse treatment on their children's behalf on the basis of their beliefs (p-value is less than 0.001).
  
  
  CONCLUSIONS
  Despite a very high awareness of informed consent, the model chosen reflected age-old medical paternalism. Doctors' opinions are accorded a larger role in clinical decision-making in Kashmir. The results emphasise the need for doctors to change their attitude and acknowledge the patient's autonomy, which is the basis of modern medical ethics, and yet still be aware of the cultural and religious views of the local population.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Malaysia. drmyrathor@yahoo.com
authors.forename: R M
authors.initials: RM
authors.lastname: Yousuf
authors.forename: A R M
authors.initials: AR
authors.lastname: Fauzi
authors.forename: S H
authors.initials: SH
authors.lastname: How
authors.forename: A G
authors.initials: AG
authors.lastname: Rasool
authors.forename: K
authors.initials: K
authors.lastname: Rehana
mesh_terms: D001291:Attitude of Health Personnel / Q000208:ethnology*; D002983:Clinical Competence; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003625:Data Collection; D005180:Faculty, Medical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006784:Hospitals, Teaching; D006801:Humans; D007194:India; D007258:Informed Consent; D007396:Internship and Residency; D008296:Malaysia; D008297:Male; D008505:Medical Staff, Hospital; D026706:Paternalism; D010820:Physicians