Waiting for a miracle or best medical practice? End-of-life medical ethical dilemmas in Bahrain

Waiting for a miracle or best medical practice? End-of-life medical ethical dilemmas in Bahrain

Background and objectivesIn Bahrain, maintaining life support at all costs is a cultural value considered to be embedded in the Islamic religion. We explore end-of-life decision making for brain dead patients in an Arab country where medical cultures are dominated by Western ideas and the lay cultur...

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Bibliographic Details
Published in:Journal of medical ethics Vol. 45; no. 6; pp. 367 - 372
Main Authors: Alwadaei, Sayed, Almoosawi, Barrak, Humaidan, Hani, Dovey, Susan
Format: Journal Article
Language:English
Published: England BMJ 01-06-2019
BMJ Publishing Group LTD
Subjects:
Bioethics
Brain death
Brain research
Clinical decision making
Clinical medicine
Consultants
Decision making
Health care
Hospitals
Interviews
Islamic law
Jurisprudence
Medical ethics
Medicine
Original research
Palliative care
Physicians
Religion
Researchers
Values
Bahrain
religious ethics
legal aspects
ethics
moral and religious aspects
palliative care
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Summary:Background and objectivesIn Bahrain, maintaining life support at all costs is a cultural value considered to be embedded in the Islamic religion. We explore end-of-life decision making for brain dead patients in an Arab country where medical cultures are dominated by Western ideas and the lay culture is Eastern.MethodsIn-depth interviews were conducted from February to April 2018 with 12 Western-educated Bahraini doctors whose medical practice often included end-of-life decision making. Discussions were about who should make withdrawal of life support decisions, how decisions are made and the context for decision making. To develop results, we used the inductive method of thematic analysis.ResultsInformants considered it difficult to engage non-medical people in end-of-life decisions because of people’s reluctance to talk about death and no legal clarity about medical responsibilities. There was disagreement about doctors’ roles with some saying that end-of-life decisions were purely medical or purely religious but most maintaining that such decisions need to be collectively owned by medicine, patients, families, religious advisors and society. Informants practised in a legal vacuum that made their ethics interpretations and clinical decision making idiosyncratic regarding end-of-life care for brain dead patients. Participants referred to contrasts between their current practice and previous work in other countries, recognising the influences of religious and cultural dimensions on their practice in Bahrain.ConclusionsEnd-of-life decisions challenge Western-trained doctors in Bahrain as they grapple with aligning respect for local culture with their training in the ethical practice of Western medicine.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0306-6800
1473-4257
DOI:10.1136/medethics-2018-105297