Title: Saying yes to DNR from a Arab Muslim patient/family perspective
Abstract:
Background/Problem Statement: Patients, families and care providers face a difficult situation when care options are no longer curative. The efforts are directed towards palliative care goals of care. As care providers and patient/family negotiate to address an advanced directive plan, DNR decision becomes a pivotal point of discussion. But DNR is never an easy discussion to navigate, and all subsequent decisions of care will be affected by acceptance or reject of DNR. Furthermore, DNR will influence what patient/family think of quality of life and how healthcare providers interpret than in terms of aggressive treatments limits. Despite vast literature regarding DNR decision-making originating from the west, but it is not quite clear how Muslims specifically interpret DNR and incorporate that understanding in decision-making process. DNR decision is a complex decision that has multiple dimensions to consider. Ethical aspects regarding life/death dilemmas, legal concerns when it comes to clearly define what is DNR and when to implement it, cultural aspects as family is an impartial party in making decisions in some cultures like Arabs. Additionally, Islam is a religion that is considered a way of life for committed Muslims, adds an extra dimension to the complexity. All of these dimensions are part of the decisions-making process to accept or reject DNR, and health care professionals working with Muslims need to consider and understand as they navigate the end-of-life discussions and in many instances nurses who work the closest with patients and their family members have the opportunity to know the belief system, or deal with educational needs and questions imposed on them from the patient and/or family after the difficult conversation with the attending physicians.
Objective: To understand how Arab-Muslim patient/ family members interpret and understand DNR decisions religiously, which can be a facilitator or inhibitor to the DNR decision-making process. How and why do they perceive it the way they do.
Methods/Process: A mixed method research was conducted. The first stage was a cross-sectional online survey on Arab-Muslim populations from Jordan and UAE to identify the extent of religious influence and religious commitment on their daily life decisions, and how do they categorize DNR orders in terms of permissiveness Islamically. Followed by a focused interview with a sub sample, were these personal ideations and points of view were explored in depth to understand why and how did such perception evolve.
Findings: There is a clear lack of knowledge regarding existing Fatwa (religious ruling on DNR), with varied degrees of misconceptions around it. Personal interpretations of religious scriptures displayed the need for awareness and educational sessions that address the root reasons for these misunderstandings.
Conclusion/Implications for Nursing Practice: Arab-Muslims populations do not accurately understand the meaning of DNR orders nor its correct indications. Furthermore, personal interpretations of religious scriptures led to faulty decisions towards accepting DNR. Healthcare professionals can benefit from the results yielded from the focused interviews conducted by utilizing recommendations/guidelines in DNR discussions and seeking consent to achieve end-of-life goals. While staying considerate to the religious beliefs that their clients hold. Additionally; the results can be used for patient/family education sessions to help them balance their personal desires to seek quality of life without being burdened by the idea of unclear religious regulations.
