ORIGINAL ARTICLE

Do Not Resuscitate orders and ethical decisions in a neonatal intensive care unit in a Muslim community

D E da Costa, H Ghazal, Saleh Al Khusaiby

Department of Child Health, Royal Hospital, Ministry of Health, Sultanate of Oman

Correspondence to:
Correspondence to:
Dr D E da Costa, PO Box 110, Postal Code 111, CPO Seeb, Sultanate of Oman;
apgarten{at}omantel.net.om

Aims: To evaluate the need for Do Not Resuscitate (DNR) orders in a tertiary referral centre for neonatal intensive care, the criteria used in making these decisions, and the applicability of the Muslim ethical stance among parents in an Islamic community.

Methods: A prospective evaluation of all DNR decisions in the neonatal intensive care unit at the Royal Hospital in Oman, over a one year period between November 1999 and October 2000. This included decision criteria, and parental responses and expectations.

Results: Of 659 admissions to the neonatal intensive care unit during this period, DNR orders were written in 39 (6%) instances. Most related to congenital malformations (24/39, 62%). In those in whom ventilation was commenced (19/39, 49%) withdrawal was not culturally acceptable and expressly permitted in only 11%. For those in whom ventilation was not commenced (20/39, 51%), 70% agreed not to put their child on the ventilator if they did require it. Presence of extended family support (grandparents) and clergy was extremely useful.

Conclusions: Asking parents alone to be explicitly involved or take full responsibility for decisions involving life and death is not culturally or socially acceptable in this community. Presence of extended family, and indirectly sounding out and taking into account their wishes, is more appropriate after assessing the resources and support services available.

Keywords: Do not resuscitate; Muslim; ethics

Abbreviations: DNR, Do Not Resuscitate; NICU, neonatal intensive care unit

---

 

Commentary

A R Gatrad

Walsall Hospitals NHS Trust, Manor Hospital, Moat Road, West Midlands WS2 9PS, UK

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Verhagen, A. A. E., de Vos, M., Dorscheidt, J. H. H. M., Engels, B., Hubben, J. H., Sauer, P. J. (2009). Conflicts About End-of-Life Decisions in NICUs in the Netherlands. Pediatrics 124: e112-e119 [Abstract] [Full Text]  
• Samaan, M C, Cuttini, M, Casotto, V, Ryan, C A (2008). Doctors' and nurses' attitudes towards neonatal ethical decision making in Ireland. Arch. Dis. Child. Fetal Neonatal Ed. 93: F217-F221 [Abstract] [Full Text]  
• Partridge, J. C., Martinez, A. M., Nishida, H., Boo, N.-Y., Tan, K. W., Yeung, C.-Y., Lu, J.-H., Yu, V. Y.H. (2005). International Comparison of Care for Very Low Birth Weight Infants: Parents' Perceptions of Counseling and Decision-Making. Pediatrics 116: e263-e271 [Abstract] [Full Text]  

eLetters:

Read all eLetters

Do not resuscitate orders are universally difficult

Charles Essex

Fetal Neonatal Ed. Online, 25 Mar 2002 [Full text]