Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia

Abstract

ObjectiveDo-not-resuscitate (DNR) orders in Saudi Arabia were first regulated by a fatwa on a national level in 1988, one that excludes the patient and their families from decision making. Although the core of this policy is taken up by all hospitals in Saudi Arabia, there is no homogeneity in implementation. Here, we appraise what interns and residents know of these policies and their attitudes toward DNR.MethodsInterns and residents in four major hospitals in Jeddah, King Abdulaziz University Hospital, National Guard Hospital, King Fahad General Hospital, and King Fahad Armed Forces Hospital, were given a questionnaire in English with four blocks of questions.ResultsA total of 140 questionnaires were included in our study. From these questionnaires, we conclude a lack of familiarity with DNR’s policies and the fatwa and also a lack of understanding when it comes to treating DNR-labeled patients. The majority opinion was to include the patient in the decision-making process who is excluded according to the fatwa. Participants considered patients’ dignity, religious concerns, and legal concerns to be important in considering resuscitation.ConclusionWe conclude a need to emphasize the issue of DNR and treatment of DNR patients in medical ethics classes in Saudi Arabia and put more effort to enact national DNR laws that include the patient in the decision-making process.

Advance directive preferences of patients with chronic and terminal illness towards end of life decisions: a sample from Saudi Arabia

“…This is the first descriptive study evaluating the preferences for resuscitation among a sample of Arab (Saudi Arabian) population with a variety of chronic and advanced terminal illnesses. Previous research from Saudi Arabia highlighted the health care provider's views on issues relating to CPR (16)(17)(18).…”

Attitude of Nurses in Intensive Care Units towards Do Not Resuscitate order

“…13 In the studies performed in Islamic countries, it was found that religion affects the decision-making of medical staff about the DNR order which shows the necessity of presence of a single and specific instruction about this order. [14][15][16] The study about Islamic view on the DNR order by Saiyad stated that we should seek treatment in life-threatening conditions and the treatment would become optional when the benefits of therapy are doubted and it is not recommended to continue the treatment if it is futile. On the other hand, Muslim patients have been encouraged to have a testament in order to make decisions regarding the continuation of their treatment process in particular conditions in which they are not able to express their desires.…”

Awareness of do-not-resuscitate orders in the outpatient setting in Saudi Arabia

“…The patient’s family or legal guardian needs not be consulted while issuing the order. The same fatwa indicates 6 situations for issuing a DNR order: if the patient arrives dead at the hospital, if the panel of physicians certifies that the illness is untreatable and death is imminent, if the patient is medically unfit for resuscitation, if the patient is suffering from advanced heart or lung disease or repeated cardiac arrest, if the patient is in a vegetative state, and if resuscitation is considered pointless 8. The local guidelines regarding issuing a DNR order entitle a DNR patient to all treatments except for cardiopulmonary resuscitation.…”

“…The local guidelines regarding issuing a DNR order entitle a DNR patient to all treatments except for cardiopulmonary resuscitation. All interventions that ensure patient’s comfort and dignity will be offered 8. In practice, all hospitals in Saudi Arabia abide by the core of this policy, namely, 3 consultants signing a DNR order.…”

“…Earlier studies from Saudi Arabia have evaluated the perspectives and practices of interns and residents toward DNR policies 4,8,10. However, the level of awareness of Saudi outpatients regarding DNR remains to be understood.…”