By Nawar Fakhry Ezzi
In Saudi Arabia, there is an abundance of religious books and lectures about the way we should live our lives in order to save our souls in the Hereafter. However, there is a surprising scarcity of education and awareness regarding end-of-life options and discussions among the general population as well as the medical community to save our dignity while our bodies perish. Dying without a doubt is a morbid subject that no one would like to think about, not to mention dwell on its intricate details. However, as the Holy Qur’an says: “Every human being is bound to taste death” (29:57), and even though we do not know when or where we will die, we can at least participate in choosing how we could die.
With the advancement of medical care and increased life expectancy in Saudi Arabia, more procedures and machines have become available to prolong patients’ lives even when they are in a vegetative state due to accidents or sudden health complications. Unlike terminally ill patients, in these circumstances, people lose their mental capacity suddenly making them unable to express their wishes regarding their end-of-life options whether, for example, they want to fight till the very end or refrain from all treatment and die in peace. In this case, the decision is transferred to the medical staff and the patients’ family who are already distressed with their loved one’s condition and are now burdened with this tremendous responsibility. Sadly, it is too late then to realize that despite our prayers to die peacefully in bed or on our prayer mats, many people do not do so.
End-of-life choices are considered a recent development in medicine, in general, and can still engender heated debates and discussions worldwide. In Saudi Arabia, it is a very culturally sensitive subject in addition to the fact that there is an absolute absence of national regulations regarding end-of-life options in hospitals. Instead, end-of-life options are governed by a fatwa, religious decree, issued in 1988 by the Presidency of the Administration of Islamic Research and Ifta, which states that: “If three knowledgeable and trustworthy physicians agree that the patient’s condition is hopeless, the life-supporting machines can be withheld or withdrawn. The opinion of family members is not included in the decision making as they are unqualified to make such decisions.” The fatwa includes specifications of hopeless cases and considers the option of refraining from treatment as well as do not resuscitate (DNR), which occurs when the patient’s heart stops and doctors attempt to revive it, as it is equivalent to life-supporting machines. As for euthanasia or assisted suicide, it is not an option because it is forbidden in Islam.
It is understood that regulations, in general, in Saudi Arabia are based on Islamic teachings, but there must be nationally enacted regulations in the first place to avoid confusion and misunderstandings. According to a study published in Dove Medical Press in 2015, which was conducted in four major hospitals in Jeddah, interns and residents are not familiar with the fatwa or the hospital policy regarding a DNR order, as well as misunderstand the application of the concept itself. These options should be given in order to keep the patients’ dignity and spare them unnecessary suffering if they choose to do so rather than being a death warrant that leads the patient to suffer death by neglect. To add insult to injury, doctors can sign a DNR order without the patient or the family knowing about it.
People should try to live as well and as righteously as they can, but it would also be prudent to face our mortality and plan to die well. Until national regulations are enacted and awareness is increased, patients themselves should take matters into their hands and decide their fate instead of being left out. Taking time to consider our options and communicate our wishes orally or in a written form to our loved ones could help us end our journey in this life with as much dignity as we can manage, save lives in case of deciding to be organ donors, and spare our loved ones from making the most difficult decision they might have to make in their lives.
The writer can be reached at nawar81@hotmail.com
