Zobraziť v EDS

End-of-life care in Moroccan ICUs: ethical challenges, practices, and perspectives of intensivists

Uložené v:
Podrobná bibliografia
Názov: End-of-life care in Moroccan ICUs: ethical challenges, practices, and perspectives of intensivists
Autori: Younes Aissaoui, Fadwa Charif, Bassam Bencharfa, Ayoub Bouchama, Ismail Myatt, Ayoub Belhadj
Zdroj: BMC Medical Ethics, Vol 26, Iss 1, Pp 1-8 (2025)
Informácie o vydavateľovi: BMC, 2025.
Rok vydania: 2025
Zbierka: LCC:Medical philosophy. Medical ethics
Predmety: End-of-life care, Intensive care, Withholding and withdrawing, Life-sustaining treatments, Ethics, Islam, Medical philosophy. Medical ethics, R723-726
Popis: Abstract Background End-of-life (EOL) care practices, particularly the withholding and withdrawing (W/W) of life-sustaining treatments (LSTs), remain underexplored in North Africa. This study examined factors that influence EOL practices in Morocco. Methods A nationwide online survey was conducted over one month (from July to August 2023) among Moroccan intensivists, assessing their perspectives on W/W LSTs, decision-making processes, and influencing factors, including ethical, cultural, and religious considerations. Univariable analyses were performed to screen for potential associations, followed by multivariable logistic regression to identify factors independently associated with W/W decisions. Results Of 351 invited intensivists, 151 completed the survey, yielding a 41% response rate. The mean age of respondents was 47 ± 9 years, and 84% were male. Most interpreted EOL care as providing palliative care (74%) or ensuring a dignified death (59%), while only 23% explicitly associated it with the cessation of life-sustaining treatment. Nearly 40% reported never having made withholding or withdrawing (W/W) decisions, and 88% made fewer than one such decision per week. While 59% considered withholding LSTs ethically acceptable, only 5% supported both withholding and withdrawing. The most frequently cited barriers were the absence of a legal framework (75%), sociocultural constraints (44%), and discomfort discussing EOL issues with families (58%). Patient wishes were considered in fewer than half of cases, whereas family preferences predominated in 66%. Documentation of W/W decisions was uncommon (27%), and formal institutional protocols were largely absent (94.5%). In multivariable analysis, practicing in a public hospital (odds ratio [OR] = 3.16, p = 0.005) and believing that Islam permits W/W decisions (OR = 3.49, p = 0.006) were independently associated with a higher likelihood of making such decisions. Conclusion Moroccan intensivists face major ethical and practical challenges in EOL care, including legal ambiguity, lack of protocols, limited patient involvement, and difficulty communicating with families. The findings highlight the urgent need for legislative reforms, standardized protocols, and improved education to support ethical, culturally sensitive, and patient-centred EOL practices.
Druh dokumentu: article
Popis súboru: electronic resource
Jazyk: English
ISSN: 1472-6939
Relation: https://doaj.org/toc/1472-6939
DOI: 10.1186/s12910-025-01271-9
Prístupová URL adresa: https://doaj.org/article/0b3955e255e747a587a4964c3dc50c7f
Prístupové číslo: edsdoj.0b3955e255e747a587a4964c3dc50c7f
Databáza: Directory of Open Access Journals
Popis
Abstrakt:Abstract Background End-of-life (EOL) care practices, particularly the withholding and withdrawing (W/W) of life-sustaining treatments (LSTs), remain underexplored in North Africa. This study examined factors that influence EOL practices in Morocco. Methods A nationwide online survey was conducted over one month (from July to August 2023) among Moroccan intensivists, assessing their perspectives on W/W LSTs, decision-making processes, and influencing factors, including ethical, cultural, and religious considerations. Univariable analyses were performed to screen for potential associations, followed by multivariable logistic regression to identify factors independently associated with W/W decisions. Results Of 351 invited intensivists, 151 completed the survey, yielding a 41% response rate. The mean age of respondents was 47 ± 9 years, and 84% were male. Most interpreted EOL care as providing palliative care (74%) or ensuring a dignified death (59%), while only 23% explicitly associated it with the cessation of life-sustaining treatment. Nearly 40% reported never having made withholding or withdrawing (W/W) decisions, and 88% made fewer than one such decision per week. While 59% considered withholding LSTs ethically acceptable, only 5% supported both withholding and withdrawing. The most frequently cited barriers were the absence of a legal framework (75%), sociocultural constraints (44%), and discomfort discussing EOL issues with families (58%). Patient wishes were considered in fewer than half of cases, whereas family preferences predominated in 66%. Documentation of W/W decisions was uncommon (27%), and formal institutional protocols were largely absent (94.5%). In multivariable analysis, practicing in a public hospital (odds ratio [OR] = 3.16, p = 0.005) and believing that Islam permits W/W decisions (OR = 3.49, p = 0.006) were independently associated with a higher likelihood of making such decisions. Conclusion Moroccan intensivists face major ethical and practical challenges in EOL care, including legal ambiguity, lack of protocols, limited patient involvement, and difficulty communicating with families. The findings highlight the urgent need for legislative reforms, standardized protocols, and improved education to support ethical, culturally sensitive, and patient-centred EOL practices.
ISSN:14726939
DOI:10.1186/s12910-025-01271-9