Stef Van den Branden

The Ongoing Charity of Organ Donation. Contemporary English Sunni Fatwas on Organ Donation and Blood Transfusion

BACKGROUND Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject. METHOD We analysed 70 English Sunni e-fatwas and subjected them to an in-depth text analysis in order to reveal the key concepts in the Islamic ethical framework regarding organ donation and blood transfusion. RESULTS All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation. CONCLUSION Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity.

The Attitudes of Indian Palliative-care Nurses and Physicians to Pain Control and Palliative Sedation

Aim: We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death. Conclusion: Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms.

Can curative or life-sustaining treatment be withheld or withdrawn? The opinions and views of Indian palliative-care nurses and physicians

Introduction: Decisions to withdraw or withhold curative or life-sustaining treatment can have a huge impact on the symptoms which the palliative-care team has to control. Palliative-care patients and their relatives may also turn to palliative-care physicians and nurses for advice regarding these treatments. We wanted to assess Indian palliative-care nurses and physicians’ attitudes towards withholding and withdrawal of curative or life-sustaining treatment. Method: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programmes in New Delhi, using a semi-structured questionnaire. For the interviews and analysis of the data we followed Grounded-Theory methodology. Results: Withholding a curative or life-sustaining treatment which may prolong a terminal cancer patient’s life with a few weeks but also has severe side-effects was generally considered acceptable by the interviewees. The majority of the interviewees agreed that life-sustaining treatments can be withdrawn in a patient who is in an irreversible coma. The palliative-care physicians and nurses were of the opinion that a patient has the right to refuse life-saving curative treatment. While reflecting upon the ethical acceptability of withholding or withdrawal of curative or life-sustaining treatment, the physicians and nurses were concerned about the whole patient and other people who may be affected by the decision. They were convinced they can play an important advisory role in the decision-making process. Conclusion: While deciding about the ethical issues, the physicians and nurses do not restrict their considerations to the physical aspects of the disease, but also reflect upon the complex wider consequences of the treatment decisions.

The operationalisation of religion and world view in surveys of nurses’ attitudes toward euthanasia and assisted suicide

Most quantitative studies that survey nurses’ attitudes toward euthanasia and/or assisted suicide, also attempt to assess the influence of religion on these attitudes. We wanted to evaluate the operationalisation of religion and world view in these surveys. In the Pubmed database we searched for relevant articles published before August 2008 using combinations of search terms. Twenty-eight relevant articles were found. In five surveys nurses were directly asked whether religious beliefs, religious practices and/or ideological convictions influenced their attitudes, or the respondents were requested to mention the decisional basis for their answers on questions concerning end-of-life issues. In other surveys the influence of religion and world view was assessed indirectly through a comparison of the attitudes of different types of believers and/or non-believers toward euthanasia or assisted suicide. In these surveys we find subjective religious or ideological questions (questions inquiring about the perceived importance of religion or world view in life, influence of religion or world view on life in general, or how religious the respondents consider themselves) and objective questions (questions inquiring about religious practice, acceptance of religious dogmas, and religious or ideological affiliation). Religious or ideological affiliation is the most frequently used operationalisation of religion and world view. In 16 surveys only one religious or ideological question was asked. In most articles the operationalisation of religion and world view is very limited and does not reflect the diversity and complexity of religion and world view in contemporary society. Future research should pay more attention to the different dimensions of religion and world view, the religious plurality of Western society and the particularities of religion in non-Western contexts.

The Diverse Influence of Religion and World View on Palliative-Care Nurses’ Attitudes towards Euthanasia

Studies assessing the influence of religion and world view on palliative-care nurses’ attitudes towards euthanasia, have reached diverging conclusions. We decided to use data from a qualitative study undertaken among palliative-care nurses in Flanders (Belgium) in 2006 to reassess the influence of religion and world view on palliative-care nurses’ attitudes towards euthanasia. A highly significant association was observed between religious or ideological clusters and euthanasia clusters (p < 0.001). Nurses belonging to religious or ideological clusters, characterised by a more frequent attendance of religious services, seem to be less likely to support euthanasia. Yet, religious beliefs such as belief in a God who actively intervenes in human lives were also more typical of these clusters. Such beliefs could influence attitudes towards euthanasia. The comparison of euthanasia clusters with religious and ideological factors showed that the ideological dimension, among palliative-care nurses in Flanders, most strongly determines euthanasia attitudes.

Purification of Body and Soul for the Next Journey. Practices Surrounding Death and Dying Among Muslim Women

This study aims, first, to compare normative Islamic practices toward death and dying and actual practices of Moroccan Muslim women. Second, it seeks to compare the views and practices of middle-aged and elderly women. Qualitative empirical research was conducted with 30 middle-aged and elderly Moroccan Muslim women living in Antwerp (Belgium) and with 15 experts in the field. Our study shows that religious beliefs and worldview have a great impact on Muslims’ practices surrounding death and dying. More specifically, practices are strongly shaped by their eschatological beliefs. The rituals are perceived as preparations for the hereafter, entailing purification of both soul and body, and demonstrate the belief in a continued existence of the soul. We found striking similarities between our participants’ views and normative Islamic views. We did not find a more secular understanding of death and dying among the middle-aged women.

Euthanasia and Palliative Care in Belgium: The Attitudes of Flemish Palliative Care Nurses and Physicians Toward Euthanasia

Little research has been carried out to determine the attitudes of palliative care professionals to euthanasia. This research aimed to find out how Flemish palliative care nurses and physicians think about euthanasia. An anonymous questionnaire was sent to all physicians (147) and nurses (589) employed in palliative care teams and institutions in Flanders (Belgium). The questionnaire contained a demographic part, and an attitudinal part, consisting of a long series of ethical statements using a 5-point Likert-scale. Four hundred fifteen nurses (response rate 70.5%) and 99 physicians (67.3%) responded. A cluster analysis of the euthanasia questions resulted in three clusters: (moderate) opponents of euthanasia (n = 105, 23%), moderate advocates of euthanasia (n = 161, 35.2%), and staunch advocates of euthanasia (n = 191, 41.8%). A majority in all clusters believe that as soon as a patient experiences the benefits of good palliative care, most requests for euthanasia disappear and that all palliative care alternatives must be tried before a euthanasia request can be considered. Being a member of the cluster of the (moderate) opponents of euthanasia is associated with being male (p = .01), being older (p = .05), increasing years of experience in palliative care (p = .02), and being a physician (p = .02). Since most Flemish palliative care nurses and physicians are not absolutely against voluntary euthanasia, their attitudes seem to differ from the attitudes of their palliative care colleagues elsewhere. However, the attitudes of the Flemish palliative care nurses and physicians are largely contextual. For a very large majority, euthanasia is an option of last resort only.