Legal Issues in End-of-life Care: Perspectives from Saudi Arabia and United States

Abstract

There are many differences, and some commonalities between the laws practiced in both countries which help explain medical and nursing practice at the end of life.

Brain Death and Islam

“…28,29 Other sources include (3) ijmā ˆ , or consensus of religious scholars ( ulamā ), and (4) qiyās , or precedent-based analogy. [28][29][30][31][32][33][34] Th e primacy of place within the hierarchy of all these sources is given to the Qur'an, followed by the Sunnah, which elucidates (the Qur'an's) unclarity. 33 Although second in the order of importance, the Sunnah has provided the greatest bulk of material from which law was derived during the formative period.…”

“…32 On issues where the primary legal sources are ambiguous, rulings may arise from human reasoning and intellect ( ijtihād ) as exercised by a qualifi ed religious scholar ( muftī ). 28,33,34 The role of ijtihād in modern society has itself become a source of controversy within the Sunni sect, whereas it is used more commonly within Shī'a sects. Ijtihād applies only to gray areas of law and holds no role where primary textual sources (the Qur'an and the Sunnah) or scholarly consensus ( ijmā ˆ ) are unambiguous.…”

“…28,69 Th erefore, the determination of valid religious practice and resolution of bioethical issues surrounding end-of-life care is left to qualifi ed scholars of religious law who are called to provide ruling on whether a proposed action is obligatory ( wajib or fardh ), recommended ( mustahabb ), permitted ( mubah ), discouraged ( mukruh ), or prohibited ( haram ). 28,70 We have summarized the available evidence as it pertains to important ethical dilemmas in clinical practice. Th us, for a Muslim physician who does not accept brain death as true death yet is faced with making the diagnosis, there are a number of ways to acceptably and professionally fulfi ll the meaning of this Кadīth .…”

End-of-Life Care

“…Patients not capable of making healthcare decisions can call upon an authorized representative to express his or her wishes and make treatment decisions on behalf of their best interests [48].…”

Knowledge and Attitude of ER and ICU Physicians towards DNR in a Tertiary Care Center in Saudi Arabia: A Survey Study

“…There is lack of research about The DNR area in most of the Arab and Muslim countries and the attitude of Muslim physicians for DNR is not very well known in spite of the presence of Fatwa (a legal opinion or ruling issued by an Islamic scholar) [8,9].…”