Abd-Ol-Hassan Kazemi, Mostafa Kazemi, Mahmood Abbasi, Mehrzad Kiyani, Nejat Feyzollahi, Sadyar Ataloo, Mahmood Massodiniya,
Volume 5, Issue 2 (4-2012)
Abstract
End stage patient control and autonomy are core principles in human bio-medical ethics and key components of end-of-life (EOL) care. Albeit, according to modern medical ethics principles the centrality of the patient as decision maker may not be relevant to culturally diverse groups of end stage people. The purpose of this article is to present results of a literature review of end stage patient control and their family position within the context of end of life support. The review revealed that the interaction between medical control and ethical values in end of life support is multifaceted and unpredictable.
According to the recommendations of American College of Physicians/American Society of Internal Medicine End-of-Life Consensus Panel and some other world class medical and ethical societies, culturally effective end of life support includes the following essential elements
• acceptance of and respect for cultural differences among all end stage patients
• willingness to negotiate and compromise when world views differ
• understanding of one's own values and biases
• contact and communication skills that enhance empathy
• information of the cultural practices of patient groups should be seen on a regular basis and
• attention that all patients are individuals and may not share the same views as others within their own ethnic group
According to the above description, applicants identified five domains of quality end of life support:
1. receiving adequate pain control
2. avoiding inappropriate prolongation of the dying process
3. achieving a sense of control
4. relieving burden on loved ones and
5. strengthening relationships
We emphasize that, despite above mentioned points and advices maintaining a sense of control is an essential element in the end of life support for some individuals, further study of the interplay between ethnicity, desire for control, and achieving a good death is needed.
Forouzan Akrami,
Volume 17, Issue 0 (12-2024)
Abstract
For many years, the question of whether or not to resuscitate periviable newborns has been a topic of debate among perinatologists, neonatologists, and ethicists. Unlike other studies that focus on the value and sanctity of human life during intrauterine development, the present study seeks to address the ethical question of what constitutes the right decision regarding life-support measures for newborns born at peri-viability ages, within the ethical norms of the Islamic tradition. This study assumes the inherent value of every moment of human life and acknowledges the human dignity of individuals from the time of conception. This multi-method study was conducted in three parts: (1) a review of the ethical frameworks presented for supporting the lives of periviable newborns, (2) an explanation of the principles of Islamic bioethics based on common Sunni and Shiite sources, and (3) the development of an Islamic bioethics framework. According to the ethical principles of the Islamic tradition—contrary to secular biomedical ethics—first and foremost, efforts should be made to preserve and prolong the life of periviable newborns regardless of their anticipated quality of life. Second, in decisions involving life and death, the priority is not the preferences of the infant's parents but rather the saving of the infant's life and its preservation by the physician and medical team. Nonetheless, parental participation in the decision-making process is essential. Preserving life, however, is not an absolute obligation; the aim of life-support measures is not merely to extend the infant's life for a short period but to do so in proportion to the prognosis and expected benefits. Specifically, these measures should be considered when there is a significant probability of the newborn’s survival. This requires a case-by-case assessment of risks, taking into account the newborn’s clinical condition, as well as regional resources and conditions. It is recommended to use the proposed Islamic bioethical framework to develop a clinical guideline that includes criteria for classifying infants born at the edge of viability based on their clinical condition. Ethical decisions to intervene should then be based on the infant's clinical state, probability of survival, and the resources available in the region.
