The practice of withholding and withdrawing life-support measures among patients with cancer in Jordan

Abstract

In Jordan, an Arabic Islamic country, decisions around withholding and/or withdrawing life support measures still present both moral and professional dilemmas. The purpose of this study was to explore the use of such measures among patients with cancer in Jordan. The medical records of 436 patients with cancer who were at least 18 years old and who died at a specialized cancer centre in Jordan in 2008 were reviewed retrospectively. Of those, 212 (48.6%) had a written decision to withhold or withdraw life support measures. Among the 436 charts reviewed, only 7 patients (1.6%) had treatment withdrawn, while 212 (48.6%) had treatment withheld. Resuscitation was the most common treatment withheld, followed by medication, and poor prognosis was the most common reason for the decision. The time period between a decision being made and the death of the patient was short, indicating that treatment plans are not being made well in advance. A cultural and religious consensus regarding such decisions is needed to help ensure that a greater proportion of terminally ill people plan their care in advance, and to aid health-care providers in advising their patients and acting in the patients' best interests.

Current Situation and Associated Factors of Withdrawing or Withholding Life Support to Patients in an Intensive Care Unit of Cancer Center in China

“…It was reported that critically ill patients with malignancy or ultimately fatal underlying diseases were more likely to have their life-sustaining therapy withheld or withdrawn than those without malignancy or fatal diseases [15]–[16]. A study of a specialized cancer center in Jordan demonstrated a high proportion (48.6%) of adult cancer patients making decisions to withhold or withdraw life support measures [17], which was even higher than the result of our center.…”

Nurses' perceived knowledge and benefits of artificial nutrition and hydration for patients nearing death: A survey among Jordanian nurses

“…Moreover, it is suggested that the in-service education office in hospitals focuses more on this topic. In addition, Jordanian legal guidelines and policies to assist healthcare providers in their decisions in the area of palliative care are absent (Khater et al, 2011). Therefore, clear legal guidelines and policies should be established in Jordan regarding the provision of ANH.…”

“…Previous studies found that nurses have insufficient information about the ANH potential complications such as worsening of peripheral oedema, aspiration pneumonia, intestinal ischaemia and catheter sepsis (Hiesmayr, 2012; Morita et al, 2005). Other studies found that despite nurses' perceptive that ANH cannot prolong a patient's life or improve the quality of life or mental status, they still believe in the importance of providing all supportive measures for patients with advanced cancer (Ke et al, 2008a; Khater et al, 2011; Stiles, 2013).…”

End of Life-Decisions: An Islamic Perspective

“…Keeping them on mechanical ventilation will increase their pain and slow their death rather than letting them die in peace and dignity (Khan, 1986;Khater, 2011).…”