Care of terminally-ill patients: an opinion survey among critical care healthcare providers in the Middle East.

BACKGROUND Modern medicine has allowed physicians to support the dying terminally-ill patient with artificial means. However, a common dilemma faced by physicians in general, and intensivist in particular is when to limit or withdraw aggressive intervention. OBJECTIVE To study the effect of training background and seniority on Do-not to resuscitate (DNR) decisions in the Middle East. METHODS Anonymous questionnaire sent to members of the Pan Arab Society of Critical Care. RESULTS The response rate was 46.2%. Most of the responders were Muslim (86%) and consultants (70.9%). Majority of the responders were trained in western countries. Religion played a major role in 59.3% for making the DNR decision. DNR was considered equivalent to comfort care by 39.5%. In a futile case scenario, Do Not Escalate Therapy was preferred (54.7%). The likelihood of a patient, once labeled DNR, being clinically neglected was a concern among 46.5%. Admission of DNR patients to the ICU was acceptable for 47.7%. Almost one-half of the responders (46.5%) wanted physicians to have the ultimate authority in the DNR decision. Training background was a significant factor affecting the interpretation of the term no code DNR (P< 0.008). CONCLUSION Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of terminally-ill patients. However, DNR is considered equivalent to comfort care among majority of Middle Eastern trained physicians.