Physician-assisted suicide (PAS) and euthanasia can be debated from ethical and legal perspectives, and there are a variety of views regarding their acceptability and usefulness. Religion is considered an important factor in determining attitudes towards such practices. This narrative review aims to provide an overview of the Islamic perspective on PAS and euthanasia and explore the Islamic approach in addressing the related issues. The PubMed database was searched to retrieve relevant articles, then the references listed in the selected articles were checked for additional relevant publications. Additionally, religious books (Quran and hadith) and legal codes of selected countries were also consulted from appropriate websites. The Islamic code of law discusses many issues regarding life and death, as it considers any act of taking one's life to be forbidden. Islam sanctifies life and depicts it as a gift from God (Allah). It consistently emphasises the importance of preserving life and well-being. Therefore Muslims, the followers of Islam, have no right to end their life. All Islamic doctrines consider PAS and euthanasia to be forbidden. However, if the patient has an imminently fatal illness, withholding or withdrawing a futile medical treatment is considered permissible. From a legal perspective, Islamic countries have not legalised PAS and euthanasia. Such practices are therefore considered suicides when patients consent to the procedure, and homicides when physicians execute the procedure.
Objectives: Euthanasia, i.e. Physician Assisted Suicide, is a highly taboo topic, which has grown unusually over the past decade in concomitance with swift advancement in medical care of terminally ill patients. The aim of this study was to assess the knowledge, awareness and attitude of Health Professions Students (HPSs) towards Euthanasia.
Methods: This cross-sectional study was carried out in all Colleges of King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah Campus was conducted from November & December 2019. A predesigned questionnaire written in English containing essential elements about Euthanasia was adopted to achieve the purpose of the study.
Results: A total of 522 students responded positively to the dispensed survey. 290 (55.6%) of respondents were males while 232 (44.4%) were females with a ratio of 1:1.25. We found that majority of HPSs (57%, n=298) were aware of the term euthanasia and the concept behind it. 65.1% (340) of the HPSs understood the accepted definition of euthanasia as “Physician Assisted Suicide”. However, only 19.9% (104) of HPSs agreed to ever favor euthanasia if given a choice while 47.9% (250) of them disagreed. Also, majority of them (61.4% among males and 51.7% among females) agreed that practicing religion influenced their responses to this survey.
Conclusions :The awareness about the euthanasia was fairly good among HPSs of KSAU-HS however this study identifies a dire need of introducing the bioethical concepts of practicing euthanasia and the legal issues surrounding it within the curriculum.
Background: Advance directives towards end of life decisions are seldom used among Arabs.
Aims: This study aimed at investigating advance care preferences among a sample of Arab patients.
Method: This cross-sectional study was undertaken over the period March 2012-March 2013 on a sample of 300 patients with chronic illness in King Fahad National Guard Hospital, Riyadh, a major tertiary care hospital in Saudi Arabia.
Results: Mean age of patients in the study was 48.7 years (standard deviation 16.4). There were 104 patients on haemodialysis, 73 with advanced malignancy, 81 with chronic liver disease and 35 with chronic respiratory disease. More than 80% of the respondents felt that the physician should make the decision about cardiopulmonary resuscitation. Over 60% wished to remain at home when their condition deteriorated to impending death. There were no significant correlations between the patients' end of life decision preferences and religiosity, quality of life, disease duration, or other demographic characteristics.
Conclusion: Despite a significant lack of knowledge among our participants regarding resuscitation, a majority of patients with chronic illness were willing to discuss the options and were capable of making advance directive plans regarding their health status.
OBJECTIVES: To assess communities' basic knowledge of palliative care by developing a questionnaire.
METHODS: This prevalence study, an anonymous online questionnaire, was answered by 326 individuals living throughout Saudi Arabia over one month. The questions concerned the basic principles and knowledge of palliative care. We collected the data between February and May 2019.
RESULTS: The results showed that 72% of the respondents had neither heard nor knew about palliative care. Those who know about palliative care assess their knowledge as the following: 17.8% of the respondents reported that they knew the meaning and could explain it to others. As well, 10.5% knew the meaning but could not explain it to others; 9.3% had heard of it but did not know the meaning, and 62.4% had never heard of it.
CONCLUSION: The research showed that there is a lack of knowledge about palliative-care among the population of Saudi Arabia. Data shows that there should be more efforts toward providing the community with better knowledge about palliative care.
This study aimed to measure the quality of palliative care from the perspective of healthcare professionals at a tertiary hospital in Riyadh, Saudi Arabia. A cross-sectional survey was distributed to 80 healthcare professionals working at the palliative care department. The questionnaire assessed the dimensions that measure the quality of palliative care (Structure and Aspects of Care, Cultural Aspects of Care, Care of the Imminently Dying Patient, Ethical Issues), overall quality of care, ethical Processes of Care, Physical Aspects of Care, Psychological/Psychiatric Aspects dilemmas occurring in the practice setting, and barriers to the provision of optimal end-of-life care. The total mean for the quality for care was 4.26 (SD = 0.45), indicating that all participants’ perceptions regarding all dimensions tended to skew toward agree and strongly agree. However, the score on the psychological/psychiatric aspects of care was the lowest compared to other dimensions, with a mean of 3.7, which means it needs more consideration. Moreover, participants’ mean rate of agreement on the quality of palliative care services was 4.62 out of 5. The majority of the participants agreed that they and their colleagues provided high-quality end-of-life care. Regarding barriers to the provision of optimal end-of-life care, with a mean score of 3.22 out of 5, participants agreed that such barriers existed in the palliative department. The present findings indicate that healthcare providers considered the overall quality of palliative care to be high, but the psychological/psychiatric aspects of care needed further consideration. Further, the occurrence of ethical dilemmas and barriers to the provision of optimal end of life needs to be managed appropriately.
OBJECTIVES: To assess knowledge and attitudes about do not resuscitate (DNR) among patients and their relatives visiting outpatient clinics at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia.
METHODS: A cross-sectional study conducted between March and April 2018 with a self-administered questionnaire among patients and their relatives visiting outpatient clinics at KAUH. A systematic random selection of individuals every other day.
RESULTS: The questionnaire was filled by 400 participants. Fifty-four percent were patients' relatives, and approximately 60% were female. Out of 105 (26.3%) who were familiar with DNR term, 44.8% chose the correct definition, 5.2% had previous experience with the DNR term, and 34.3% of them had DNR-related knowledge from social media. Out of the 400 participants, 169 (42.3%) disagreed with DNR. The majority of responders did not know if there is DNR policy or fatwa (a legal opinion on the point of Islamic law).
CONCLUSION: There is a lack of knowledge regarding DNR among participants.
The Do-Not-Resuscitate (DNR) directive has provided a major leap in end-of-life care. To demonstrate the factors influencing physicians' DNR decisions in King Fahd University Hospital in the Eastern Province of Saudi Arabia, 42 physicians from the medical and surgical departments of the same center were requested to participate in a cross-sectional survey. Thirty-six questionnaires were completed and returned from a total of 42 distributed among physicians, making a response rate of 85.7%. Certain diagnostic categories increase the likelihood of issuing a DNR order for a patient. Neurological (58.3%) and cardiovascular (41.7%) diseases were the highest response among other diseases in influencing physicians' decisions. In addition, other factors like lack of comorbidities (55.5%), age (52.7%), and previous intensive care unit (ICU) admissions and resuscitation (44.4%) showed an effect on the directive decisions of DNR among investigated physicians. However, weak palliative care in the hospital (11.1%), religious beliefs (5.5%), and gender (2.7%) were the least associated factors affecting physicians' DNR decisions. This study addresses the influencing factors of DNR orders issuance among King Fahd Hospital of the University physicians. Physicians noted that cultural standards and religious beliefs do play a role in their decision-making but had less of an effect as compared to other clinical data such as comorbidities, age, and previous ICU admissions.
Background: To the best of our knowledge, the change in opioid prescription patterns upon referral to a palliative care team (PCT) was not previously investigated in the Middle East.
Objective: This study aimed to explore the change in the pattern of opioid prescription and the pain scores before and after referring inpatients to a PCT.
Methods: We conducted a retrospective review of patients’ records including all inpatients =15 years newly referred to the PCT over a period of 21 months at King Faisal Specialist Hospital and Research Center, Riyadh.
Results: Of 631 patients, 52.3% were females, the median age was 54 years, and 96.7% had cancer. The proportion of patients on opioids before referral (83.4%) increased to 93.3% in the postreferral period, P < .0001. Patients receiving opioids on a regular basis increased from 31.9% before referral to 49.9% after referral to the PCT, P < .0001. Morphine was the most commonly prescribed opioid on a regular basis pre- and postreferral. Upon referral, the administration of opioids through the subcutaneous route increased from 3.7% to 10.9%, P < .0001. On average, pain scores were reduced by 1 point on a 0 to 10 numeric scale within 48 hours of seeing a patient by the PCT, P < .0001.
Conclusion: Patients referred to a PCT are likely to get their opioid prescription optimized and pain scores improved shortly after the PCT involvement. Patients with cancer-related pain requiring opioids should be referred to a PCT as early as possible.
BACKGROUND: Spirituality has been recognised as an essential aspect of patient care.
AIM: To assess the greatest facilitators that would help to provide spirituality for paediatric end of life. Methods: Two hundred and fifty oncology nurses were surveyed using a spirituality and spiritual care rating questionnaire.
FINDINGS: The greatest facilitators perceived by nurses were: believe in spirituality as a unifying force that enables one to be at peace with oneself and the world; listening and allowing patients time to discuss and explore their fears; and using art, creativity and self-expression; respect for privacy, dignity and religious and cultural beliefs of a patient.
CONCLUSIONS: Many nursing-related facilitators to spirituality care were found. They need to be addressed and supported through education and training.
Introduction: Do not resuscitate (DNR) is a medical procedure for patients who are suffering from critical, untreatable, and irreversible disease where the patient's life is predicted to end. DNR is considered a sensitive decision for patients and their relatives, as well as physicians.
Aim: This study is aimed to assess the knowledge and attitude of medical students and interns toward the DNR order and the factors affecting their attitude at the King Abdulaziz University Hospital (KAUH) in Jeddah.
Methods: Nonintervention cross-sectional study was conducted among 429 medical students (preclinical and clinical years) and interns who were given an online questionnaire between May and June in 2016 at KAUH in 18 Kingdom of Saudi Arabia.
Results: Our study indicates that most of the participants (73.2%) were familiar with DNR order; however, more than half of them (58.3%) did not take any lecture or session on DNR. Large proportion of medical students had the opinion that attending a lecture or session on DNR would help them discuss it more skillfully with the patients and their relatives. More than half of the participants (55%) believed that there is a Fatwa that regulates DNR on the Islamic level.
Conclusion: Participants, who were interns, were more familiar with the term DNR, whereas the 2nd-year medical students were less familiar with DNR. Considering the variation in the knowledge of participants about DNR, we conclude that additional lectures and sessions about DNR should be added to the medical school curriculum to make the students more confident and able in handling the DNR discussions.
As part of the health care reforms and transformation project of the Vision 2030, a group of expert healthcare professionals was tasked with the development of a model of care for patients with life-shortening illnesses in Saudi Arabia. This Care Design Group (CDG 1-3) held a series of workshops and conducted surveys and online discussions to systematically document and develop a model of care. These interventions were aimed at achieving a national standard of care. This short article is a description of this very successful process of development.
Introduction: Palliative care is a medical specialty, which focuses on relieving the suffering and improving the quality of life for patients who are facing life-threatening illnesses and their families. Looking after dying patients is inseparable from our responsibility as physicians. However, dealing with the dying patients is challenging for the majority of physicians.
Aim: To document the knowledge and attitudes of palliative care among residents from major specialties, Eastern Province, Saudi Arabia.
Methodology: A cross-sectional study was carried out using a self-administered questionnaire to a convenient sample of residents from major specialties from various training centers in Eastern Province, Saudi Arabia, during 2015-2016. A total of 433 residents have been participated in the study.
Results: About 46% of the residents showed lack of overall palliative care knowledge, and almost half of them had negative views toward palliative care. Almost 60% of them achieved good score in pain management. The majority of respondents had never received training in palliative medicine (91.7%). It was observed that higher training level has a positive effect on the overall knowledge, including basic concept, pain, and psychiatric symptoms' management. Also, previous exposure to patients who would benefit from palliative care has a direct effect on overall knowledge and attitude scores.
Conclusion: The results indicate a low level of knowledge and attitude regarding palliative medicine among sampled residents. Also, it highlights the importance of exposing the residents to palliative medicine field to improve their knowledge and attitude.
BACKGROUND: The death of a child is regarded as one of the most devastating events for a family. Families are reliant on nurses to not only provide end-of-life care but also to support and care for grieving families in a way that is sensitive to their cultural and religious needs and preferences.
AIMS: The aim of this study was to explore the perceived impact and influence of cultural diversity on how neonatal and paediatric intensive care nurses care for Muslim families before and after the death of infants/children.
DESIGN: A qualitative descriptive approach was used in this study, conducted in Saudi Arabia.
METHODS: Semi-structured interviews were used to gather data from a convenience sample of registered nurses working in neonatal and paediatric intensive care, with experience in providing end-of-life care. Interviews were conducted between July and November, 2018. Interviews were audio-recorded and transcribed for analysis.
RESULTS: Thirteen registered nurses participated; all were born overseas, identified with various faiths and spoke English in the workplace. A respect for diversity and care of the family was prioritized yet impacted by communication challenges. Caring and respect was demonstrated by facilitating important cultural and religious practices important in the Muslim faith. Self-care was identified as important, transcending the culturally diverse nature of the nursing workforce.
CONCLUSIONS: Significant challenges exist for a culturally diverse nursing workforce in providing care to a Saudi Muslim population of infants/children and families, before and after a death. Their overriding commitment to respect for others, and an openness to cultural diversity and difference, aided in overcoming the inherent challenges in providing culturally sensitive end-of-life care that meets the needs of Muslim families. These findings provide valuable insights for intensive care clinicians in other countries to address challenges associated with cultural diversity.
The aims of this study were to assess the palliative care knowledge among nurses in Saudi Arabia and to identify the demographic factors influencing such knowledge. A convenience sample of 365 nurses working in 2 hospitals in Saudi Arabia was surveyed using the Palliative Care Quiz for Nursing in this cross-sectional study. The mean score of the respondents in the Palliative Care Quiz for Nursing was 8.88 (SD, 1.75), which is interpreted as low knowledge. In terms of the theoretical categories of the scale, 9 of the 13 items in the category pain and symptom management were answered correctly by the majority of the respondents, whereas all the items in the psychosocial and spiritual care category were answered incorrectly by the majority of the respondents. Type of hospital, age, and attendance to palliative care education in the last 6 months were revealed as significant factors that influence the nurses’ palliative care knowledge. Continuing education on palliative care should be implemented by hospital administrations, and palliative care education should target the weakness of the nurses, especially those revealed in the study, such as on the psychosocial and spiritual care, some aspects of pain and symptom management, and philosophy and principles of palliative care.
This study aimed to investigate physicians' and nurses' knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions, and the main outcome variables were the total scores for knowledge and attitudes toward ADs. This study included 281 physicians and nurses (60.5%). Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08-2.97). Other significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27-3.13) and education level (master's versus bachelor's: 1.26, 95% CI; 0.30-2.33 and Ph.D. versus bachelor's: 2.22, 95% CI; 0.16-4.52). Nurses' attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for physicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57-6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.
BACKGROUND: Societal aging, a concern in many countries worldwide, is increasing the demand for quality palliative care in Saudi Arabia. Nursing education is responsible for providing nursing students with high levels of knowledge and competency related to palliative care.
PURPOSE: The aim of this study was to investigate the predictors of palliative care knowledge among nursing students in Saudi Arabia.
METHODS: A convenience sample of 409 nursing students from one public academic institution and one private academic institution in Saudi Arabia was surveyed from November to December 2017 in this descriptive, cross-sectional study. The 20-item Palliative Care Quiz for Nursing was used to collect the data. Descriptive statistics were used to fully describe the demographic characteristics and palliative care knowledge of the participants. One-way analysis of variance and t test were used to examine the associations between palliative care knowledge and the demographic characteristics. Multiple regression analysis was conducted to identify the significant demographic predictors of this knowledge.
RESULTS: The mean score of the participants was 5.23 (SD = 3.24, range = 0-12), indicating poor palliative care knowledge. The participants lacked palliative care knowledge in terms of palliative care principles and philosophy, management of pain and other symptoms, and psychosocial and spiritual care. Being enrolled in a private university, being in the second year of a nursing program, having attended palliative care education sessions outside a university setting, and attending a palliative care course in the nursing program were identified as significant predictors of higher palliative care knowledge.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study may be used as a basis for formulating education policies and interventions to enhance palliative care education and clinical training among nursing students and ensure the quality of palliative care not only in Saudi Arabia but also in other countries.
The purpose of the current study was to examine the association between prolonged grief disorder, perceived social support, and severity of depression among Saudi Arabian university students after the death of a significant individual. A cross-sectional design was used to examine descriptive characteristics, correlational relationships, and statistical mean differences between male and female participants on prolonged grief disorder (PGD) scores in a convenience sample of Saudi Arabian college students. The Prolonged Grief Disorder-13 tool, Multidimensional Scale of Perceived Social Support, and the revised Beck Depression Inventory® were completed by 226 Saudi Arabian undergraduate students. Students reported moderate perceived social support from family, friends, and significant others. Only 13 (5.8%) individuals reported perceived support from academic staff. Students with the highest PGD scores were the least well-supported and most depressed. The need for academic staff and social workers to provide more social support to grieving students is discussed. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
Proper completion of death certificates is of vital importance. This study assessed the accuracy of death certification at one major hospital in Riyadh, Saudi Arabia. We collected all certificates from 1997 to 2016 and scored them on the degree of accuracy. We found no errors of incompleteness or missed contributors to death. However, in all certificates (100%), cause of death was either incorrect or absent; 75% provided no cause of death. Further large-scale studies should be conducted in other hospitals to determine the exact prevalence of these serious errors.
The aim of this study was to identify the needs, beliefs, and practices of Muslim family members during the end-of-life care for a family member in the intensive care unit (ICU) in Saudi Arabia. This was a phenomenological study using in-depth individual interviews to gather data. Ten family members of adult ICU patients receiving end-of-life care were interviewed. The experiences of family members during end-of-life care were reflected in four major themes: (a) the spirituality of death, (b) family's need for information, (c) being there, and (d) the ICU environment. Participants placed high value on religious practices such as prayer, and appreciated when these practices could be accommodated in the ICU. Family participants also detailed their need for frequent communication and opportunities to ask questions about the care of their critically ill loved one. Being able to spend as much time as desired in close proximity to the critically ill patient particularly as the end of life approaches was also important, with participants suggesting that visitation times should be waived. Finally, family participant suggested that changes were needed to the ICU environment to make accommodating large families easier and more comfortable particularly when they wish to spend significant time at the bedside of their loved one. Family should be prioritized as an extension of the care provided to critically ill ICU patients, particularly those approaching end of life. A model of care should be introduced to deliver supportive and holistic care during the end-of-life care journey, supported by appropriate education regarding family care at the end of life.