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Medicine, Health Care and Philosophy

, Volume 21, Issue 3, pp 347–361 | Cite as

Between quality of life and hope. Attitudes and beliefs of Muslim women toward withholding and withdrawing life-sustaining treatments

  • Chaïma Ahaddour
  • Stef Van den Branden
  • Bert Broeckaert
Review Article

Abstract

The technological advances in medicine, including prolongation of life, have constituted several dilemmas at the end of life. In the context of the Belgian debates on end-of-life care, the views of Muslim women remain understudied. The aim of this article is fourfold. First, we seek to describe the beliefs and attitudes of middle-aged and elderly Moroccan Muslim women toward withholding and withdrawing life-sustaining treatments. Second, we aim to identify whether differences are observable among middle-aged and elderly women’s attitudes toward withholding and withdrawing life-sustaining treatments. Third, we aim to explore the role of religion in their attitudes. Fourth, we seek to document how our results are related to normative Islamic literature. Qualitative empirical research was conducted with a sample of middle-aged and elderly Moroccan Muslim women (n = 30) living in Antwerp (Belgium) and with experts in the field (n = 15). We found an unconditional belief in God’s sovereign power over the domain of life and death (cf. determined lifespan by God) and in God’s almightiness (cf. belief in a miracle). However, we also found a tolerant attitude, mainly among our middle-aged participants, toward withholding and withdrawing (treatment) based on theological, eschatological, financial and quality of life arguments. Our study reveals that religious beliefs and worldviews have a great impact on the ethical attitudes toward end-of-life issues. We found divergent positions toward withholding and withdrawing life-sustaining treatments, reflecting the lines of reasoning found in normative Islamic literature. In our interviews, theological and eschatological notions emerged as well as financial and quality of life arguments.

Keywords

Withholding and withdrawing life-sustaining treatments Non-treatment decision End of life Islam Moroccan Muslim women Qualitative empirical research Grounded theory 

Notes

Compliance with ethical standards

Conflict of interest

Chaïma Ahaddour, Stef Van den Branden and Bert Broeckaert declare that they have no conflict of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Albar, M. 2007. Seeking remedy, abstaining from therapy and resuscitation: An islamic perspective. Saudi Journal of Kidney Diseases and Transplantation 18 (4): 629–637.Google Scholar
  2. Al-Bar, M., and H. Chamsi-Pasha. 2015. Contemporary bioethics. New York: Springer. https://link.springer.com/book/10.1007%2F978-3-319-18428-9. Accessed 20 Dec 2016.
  3. Al-Jahdali, H., S. Baharoon, A. Al Sayyari, and G. Al-Ahmad. 2013. Advance medical directives: A proposed new approach and terminology from an Islamic perspective. Medicine, Health Care, and Philosophy 16 (2): 163–169.CrossRefGoogle Scholar
  4. Atighetchi, D. 2007. Islamic bioethics: Problems and perspectives. International library of ethics, law, and the new medicine. New York: Springer.CrossRefGoogle Scholar
  5. Ayuba, M. A. 2016. Euthanasia: A Muslim’s perspective. Scriptura 115 (0): 1–13.CrossRefGoogle Scholar
  6. Babgi, A. 2009. Legal issues in end-of-life care: Perspectives from Saudi Arabia and United States. American Journal of Hospice & Palliative Medicine 26 (2): 119–127.CrossRefGoogle Scholar
  7. Baeke, G. 2012. Religion and ethics at the end of life. A qualitative empirical study among elderly Jewish and Muslim women in Antwerp (Belgium). Leuven: Katholieke Universiteit Leuven.Google Scholar
  8. Baeke, G., J. P. Wils, and B. Broeckaert. 2012. It’s in God’s hands: The attitudes of elderly Muslim women in Antwerp (Belgium) toward active termination of life. AJOB Primary Research 3 (2): 36–47.CrossRefGoogle Scholar
  9. Berger, J. T. 2011. Redefining the domains of decision making by physician and patient. International Journal of Clinical Practice 65 (8): 828–830.CrossRefGoogle Scholar
  10. Bloomer, M. J., and A. Al-Mutair. 2013. Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care. Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses 26 (4): 193.CrossRefGoogle Scholar
  11. Brockopp, J. E. 2004. Islamic ethics of life. Abortion, war and Euthanasia studies in comparative religion. Columbia: University of South Carolina Press.Google Scholar
  12. Broeckaert, B. 2008. Treatment decisions at the end of life. A conceptual framework. In Palliative care nursing principles and evidence for practice, eds. S. Payne, J. Seymour, and C. Ingleton, 2nd edition, 402–421. Berkshire: Open University Press.Google Scholar
  13. Broeckaert, B. 2009a. Euthanasia and physician assisted suicide. In Palliative medicine, eds. T. Walsh, A. Caraceni, R. Fainsinger, K. Foley, P. Glare, C. Goh, M. Lloyd-Williams, J. Olarte, and L. Radbruch, 110–115. Amsterdam: Elsevier.CrossRefGoogle Scholar
  14. Broeckaert, B. 2009b. Treatment decisions in advanced disease: A conceptual framework. Indian Journal of Palliative Care 15 (1): 30–36.CrossRefGoogle Scholar
  15. Broeckaert, B., and Flemish Palliative Care Federation. 2006. End of life decisions: A conceptual framework. Brussels: FPZV.Google Scholar
  16. Brown, E. 2014. Ethnic and Cultural challenges at the end of life: Setting the scene. Journal of Renal Care 40 (1): 2–5.CrossRefGoogle Scholar
  17. Cohen, J., I. Marcoux, J. Bilsen, P. Deboosere, G. van der Wal, and L. Deliens. 2006. European public acceptance of Euthanasia: Socio-demographic and cultural factors associated with the acceptance of Euthanasia in 33 European countries. Social Science & Medicine (1982) 63: 743–756.CrossRefGoogle Scholar
  18. Cohen, J., P. Van Landeghem, N. Carpentier, and L. Deliens. 2014. Public acceptance of euthanasia in Europe: A survey study in 47 countries. International Journal of Public Health 59 (143): 156.Google Scholar
  19. Corbin, J., and A. Strauss. 2015. Basics of qualitative research. Techniques and procedures for developing grounded theory. 4th ed. California: SAGE Publications.Google Scholar
  20. da Costa, D. E., H. Ghazal, and S. al-Khusaiby. 2002. Do not resuscitate orders and ethical decisions in a neonatal care unit in a Muslim community. Archives of Disease in Childhood. Fetal and Neonatal Edition 86: F115-F199.CrossRefGoogle Scholar
  21. Damghi, N., J. Belayachi, B. Aggoug, T. Dendane, K. Abidi, N. Madani, A. Zekraoui, A. Belabes, A. A. Zeggwagh, and R. Abouqal. 2011. Withholding and withdrawing life-sustaining therapy in a Moroccan Emergency Department. An observational study. BMC Emergency Medicine 11 (12): 1–8.Google Scholar
  22. Ebrahim, A. F. M. 2001. Organ transplantation, Euthanasia, cloning and animal experimentation. An Islamic view. Leicester: The Islamic Foundation.Google Scholar
  23. Fitzpatrick, S., I. Kerridge, C. Jordens, L. Zoloth, C. Tollefsen, K. Tsomo, M. Jensen, A. Sachedina, and D. Sarma. 2016. Religious perspectives on human suffering: Implications for medicine and bioethics. Journal of Religion and Health 55 (1): 159–173.CrossRefGoogle Scholar
  24. Ghaly, M. 2015. Euthanasia. In Encyclopedia of Islam, eds. K. Fleet, G. Krämer, D. Matringe, J. Nawas, and E. Rowson., London: Brill Online.Google Scholar
  25. Gielen, J. 2010. Ethical attitudes and religious beliefs at the end of life. A study of the views of palliative-care nurses and physicians in Flanders (Belgium) and New Delhi (India). Leuven: Catholic University Leuven.Google Scholar
  26. Glaser, B. G., and A. L. Strauss. 1967. The discovery of grounded theory. Strategies for qualitative research. New York: Aldine Publishing Company.Google Scholar
  27. Hedayat, K. M., and R. Pirzadeh. 2001. Issues in Islamic biomedical ethics: A primer for the pediatrician. Pediatrics 108 (4): 965–971.CrossRefGoogle Scholar
  28. Hertogen, J. 2016. Marokkaanse-, Turkse-en islamachtergrond per gemeente. http://www.npdata.be/. Accessed April 2016.
  29. Ilkilic, I. 2014. End-of-life decisions at the beginning of life. In Health, culture and the human body. epidemiology, ethics, and history of medicine, perspectives from Turkey and Central Europe, I. Ilkilic, ed. et al., 433–444. Istanbul: Betim Center Press.Google Scholar
  30. Islamic Code for Medical and Health Ethics. 2004. http://islamset.net/ioms/code2004/index.html. https://link.springer.com/book/10.1007%2F978-3-319-18428-9. Accessed 20 Dec 2016.
  31. Iyilikçi, L., S. Erbayraktar, N. Gokmen, H. Ellidokuz, H. C. Kara, and A. Gunerli. 2004. Practices of anaesthesiologists with regard to withholding and withdrawal of life support from the critically ill in Turkey. Acta Anaesthesiologica Scandinavica 48 (4): 457–462.CrossRefGoogle Scholar
  32. Khalid, I., W. J. Hamad, T. J. Khalid, M. Kadri, and I. Qushmaq. 2012. End-of-life care in Muslim brain-dead patients: A 10-year experience. American Journal of Hospice and Palliative Medicine 30 (5): 413–418.CrossRefGoogle Scholar
  33. Kristiansen, M., T. Irshad, A. Worth, R. Bhopal, J. Lawton, and A. Sheikh. 2014. The practice of hope: A longitudinal, multi-perspective qualitative study among South Asian Sikhs and Muslims with life-limiting illness in Scotland. Ethnicity & Health 19 (1): 1–19.CrossRefGoogle Scholar
  34. Lundqvist, A., T. Nilstun, and A. K. Dykes. 2003. Neonatal end-of-life care in Sweden: The views of Muslim women. The Journal of Perinatal & Neonatal Nursing 17 (1): 77–86.CrossRefGoogle Scholar
  35. Padela, A. I., and O. Qureshi. 2016. Islamic perspectives on clinical intervention near the end-of-life: We can but must we? Medicine, Health Care, and Philosophy. doi: 10.1007/s11019-016-9729-y.Google Scholar
  36. Padela, A. I., H. Shanawani, and A. Arozullah. 2011. Medical experts & Islamic scholars deliberating over brain death: Gaps in the applied Islamic bioethics discourse. MUSLIM WORLD 101 (1): 53–72.CrossRefGoogle Scholar
  37. Padela, A. I., A. Arozullah, and E. Moosa. 2013. Brain death in islamic ethico-legal deliberation: Challenges for applied islamic bioethics. Bioethics 27 (3): 132–139.CrossRefGoogle Scholar
  38. Qureshi, O., and A. Padela. 2016. When must a patient seek healthcare? The perspectives of Islamic jurists and clinicians into dialogue. Zygon 15 (3): 592–625.CrossRefGoogle Scholar
  39. Rahman, F. 1998. Health and medicine in the Islamic tradition. Chicago: Kazi Publications.Google Scholar
  40. Rispler-Chaim, V. 1993. Islamic medical ethics in the twentieth century. Social: Brill.Google Scholar
  41. Sachedina, A. 2009. Islamic biomedical ethics: Principles and application. Oxford: Oxford university press.CrossRefGoogle Scholar
  42. Saiyad, S. 2009. Do not resuscitate: A case study from the Islamic viewpoint. Journal of the Islamic Medical Association 41 (3): 109–113.Google Scholar
  43. Schultz, M., K. Baddarni, and G. Bar-Sela. 2012. Reflections on palliative care from the Jewish and Islamic tradition. Evidence-Based Complementary and Alternative Medicine. doi: 10.1155/2012/693092.Google Scholar
  44. Strauss, Anselm, and Juliet Corbin. 1998. Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks (Calif.): SAGE.Google Scholar
  45. Ur-Rahman, M., S. Abuhasna, and F. M. Abu-Zidan. 2013. Care of terminally-ill patients: An opinion survey among critical care healthcare providers in the Middle East. African Health Sciences 13 (4): 893–898.CrossRefGoogle Scholar
  46. Van den Branden, S. 2006. Islamitische ethiek aan het levenseinde. Een theoretisch omkaderde inhoudsanalyse van Engelstalig soennitisch bronnenmateriaal en een kwalitatief empirisch onderzoek naar de houding van praktiserende Marokkaanse oudere mannen in Antwerpen. onuitgegeven doctoraatsproefschrift. Leuven: Katholieke Universiteit Leuven.Google Scholar
  47. Van den Branden, S., and B. Broeckaert. 2010. Living in the hands of god. English Sunni E-Fatwas on (non-)voluntary Euthanasia and assisted suicide. Medicine, Health Care, and Philosophy 14 (1): 29–41.CrossRefGoogle Scholar
  48. Yazigi, A., M. Riachi, and G. Dabbar. 2005. Withholding and withdrawal of life-sustaining treatment in a Lebanese intensive care unit: A prospective observational study. Intensive Care Medicine 31 (4): 562–567.CrossRefGoogle Scholar
  49. Zahedi, F., B. Larijani, and J. Tavakolly Bazzaz. 2007. End of life ethical issues and Islamic views. Iranian Journal of Allergy, Asthma and Immunology 6 (5): 5–15.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics)KU LeuvenLeuvenBelgium

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