JEDDAH, 19 December 2005 — In many parts of the world, terminally ill patients or their families make the decision whether doctors should resuscitate them in the event of a catastrophic health situation. In Saudi Arabia, physicians make the decision, following a ruling by the religious authorities.
The so-called DNR (Do Not Resuscitate) patients can fall under a range of categories, including those with advanced stages of cancer, brain damage, irreversible heart and lung diseases, multiple severe organ dysfunctions or other non-treatable diseases in their advances stages.
Dr. Javed Khan, a pulmonologist at King Fahd Armed Forces Hospital, explained to Arab News the details of how DNR patients are determined in Saudi Arabia.
“A panel of three trusted specialist consultants, including the treating physician, makes the decision on DNR cases. They base the decision on their judgment that the continuation of current measures will not alter the course of disease,” said Dr. Khan.
“Here, unlike Western countries, most families do not inform their patients that they are DNR, and that they cannot be treated anymore. This is especially true for the elderly who rarely ask about their diagnosis or outcome.”
Like in the West, DNR patients continue to receive treatments that help mitigate the symptoms, minimize discomfort and pain, such as administering antibiotics for infection, full nutritional support and fluids. Unlike the West, families of the patient, or even the patient, have no say whether to apply a DNR decision or not.
Dr. Khan outlined six circumstances in which a patient is considered as “DNR”: If the patient arrives dead at the hospital; if the panel of physicians determines that the condition is untreatable and death is imminent; if the patient’s condition doesn’t make him or her fit for resuscitation; if the patient suffering from advanced heart or lung disease or repeated cardiac arrest; if the patient is in a vegetative state; and if resuscitation is considered futile.
Some people, especially if they have no knowledge of medicine, find it cruel not to resuscitate a dying patient. Others find it merciful to end a patient’s suffering.
“If a patient’s disease is terminal and can never be cured, why would he be resuscitated if he was near death? The treatment itself is harmful and causes depression. Death might be a relief,” said Asma Muhammad, a medical student.
