Do Not Resuscitate: A Case Study from the Islamic Viewpoint

Abstract

Case Scenario Mrs. M. was a 56-year-old woman whose care I took over from a physician friend who cared for her in the hospital for 145 consecutive days. He stated that he had some disagreements with her family and, therefore, would like to pass on the case to someone else. In addition, this patient was Muslim, and he thought my being a Muslim physi-cian would place me in a better position to under-stand and manage the social issues that had become challenging in the care of this patient. The reason she was in hospital for so long was that she had developed multiple complications after being admitted initially for abdominal pain and ane-mia. She used to be an otherwise alert and function-al woman, although she did have a previous stroke. After being admitted, she had a bout of sudden hypotension that probably was triggered by a gas-trointestinal (GI) bleed secondary to erosive gastri-tis. She then received blood transfusions and aggres-sive hydration that triggered fluid overload, respira-tory failure, and then nosocomial pneumonia. She subsequently had multiple other infections with full-blown sepsis that led to acute renal failure requiring dialysis. She finally ended up having a tracheotomy, peg tube feeding, and continued hemodialysis. She appeared to have recovered her mental function to some extent, and was often able to follow com-mands. She still persisted to have Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Escherichia (VRE) coli colonizations after recovering from recurrent pneumonias and, therefore, no nursing home or extended care facility would admit her. The challenges I faced as the new attending were multiple but predominantly concerned the proper disposition of this patient. I had to wait until she showed progress with weaning from the tracheoto-my and for cessation of dialysis, as these were inter-fering with her placement. Hospice consultation and code status discussions were initiated many times, but the family insisted on continuation of all treat-ments and refused to further discuss hospice or pal-liative care. She was clearly not in a vegetative state, nor did she have a terminal condition, unless we consider D Do o N No ot t R Re es su us sc ci it ta at te e: : A A C Ca as se e S St tu ud dy y f fr ro om m t th he e I Is sl la am mi ic c V Vi ie ew wp po oi in nt t