Palliative Medicine and Hospice Care · Vol. 9, No. 1 · 2023 · pp. 7–8 · e-ISSN 2377-8393

Reflection on Complexity at the End-of-Life—More Nuanced than Simply Treating Patients the Way We Would Want to be Treated

Neil A. Nijhawan

Department of Palliative and Supportive Care, Burjeel Medical City, Abu Dhabi, UAE; Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, UAEUnited Arab Emirates

DOI: https://doi.org/10.17140/pmhcoj-9-152 · Published 2023-04-26 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2023 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

I relocated to the United Arab Emirates (UAE) just over three years ago, to start a new palliative care service in Abu Dhabi. Palliative care remains a relatively unknown medical specialty here in the UAE both among clinicians and the public.

References

consistent with clinical, cultural, and ethical standards. Like many

things in life, everyone’s perception of a good death and suffering is

subjective. Although there have been studies conducted within the 1. The Presidential Court in Abu Dhabi. Federal Decree Law No.

Middle East region about what constitutes a good death, none of (4) of 2016 on Medical Liability. https://www.dha.gov.ae/up-

these specifically included a cohort of patients from the UAE. loads/112021/d759f988-571f-43b3-87ab-877e770b31ca.pdf. Ac-

cessed April 10, 2023.

Although palliative care in the UAE remains one of the

lesser-known medical specialties, my experience has been that 2. Approaching death: Improving care at the end of life--a report

most patient families respond positively to our input. Published of the Institute of Medicine. Health Serv Res. 1998; 33(1): 1-3.

data from our unit3 showed that 76% of patients referred for pal-

liative and end-of-life care (EoLC) accepted a Do Not Attempt 3. Nijhawan NA, Al-Shamsi HO. Experiences and challenges of a

Resuscitation (DNAR) status, with 65.6% of UAE families acceptnew palliative care service in the United Arab Emirates. Palliat Med

ing the DNAR status. There are two typical responses following a Hosp Care Open J. 2022; 8(2): 30-34. doi: 10.17140/PMHCOJ-8-150

discussion about a patient’s anticipated death and this has already

been documented in a previous publication.4 The more common 4. Al-Alfi N. Cultural thoughts on palliative care in UAE. Palliat

response is total acceptance and submission to Allah`s will, be- Med Hosp Care Open J. 2017; SE(1): S51-S55. doi: 10.17140/PMH-

cause of the belief that everything is pre-destined and comes from COJ-SE-1-111

Allah. The alternative response is a total emphasis on utilizing ev-

ery medical intervention available to prolong the patient’s life. For 5. Chochinov HM. The platinum rule: A new standard for per-

the latter response, the rationale is that “at least we know that we did son-centered care. J Palliat Med. 2022; 25: 854-856. doi: 10.1089/

our best, we tried everything” and “whatever happens next is as per Allah’s jpm.2022.0075

will”. This case stood out for me because the family’s perception

References

  1. The Presidential Court in Abu Dhabi. Federal Decree Law No. Middle East region about what constitutes a good death, none of (4) of 2016 on Medical Liability. https://www.dha.gov.ae/upthese specifically included a cohort of patients from the UAE. loads/112021/d759f988-571f-43b3-87ab-877e770b31ca.pdf. Accessed April 10, 2023. Although palliative care in the UAE remains one of the lesser-known medical specialties, my experience has been that
  2. Approaching death: Improving care at the end of life--a report most patient families respond positively to our input. Published of the Institute of Medicine. Health Serv Res. 1998; 33(1): 1-3. data from our unit3 showed that 76% of patients referred for palliative and end-of-life care (EoLC) accepted a Do Not Attempt
  3. NijhawanNAAl-ShamsiHO. Experiences and challenges of a Resuscitation (DNAR) status, with 65.6% of UAE families acceptnew palliative care service in the United Arab Emirates. Palliat Med ing the DNAR status. There are two typical responses following a Hosp Care Open J. 2022; 8(2): 30-34. doi: 10.17140/PMHCOJ-8-150 discussion about a patient’s anticipated death and this has already been documented in a previous publication.4 The more common10.17140/pmhcoj-8-150 https://doi.org/10.17140/pmhcoj-8-150
  4. Al-AlfiN. Cultural thoughts on palliative care in UAE. Palliat response is total acceptance and submission to Allah`s will, be-Med Hosp Care Open J. 2017; SE(1): S51-S55. doi: 10.17140/PMHcause of the belief that everything is pre-destined and comes from COJ-SE-1-111 Allah. The alternative response is a total emphasis on utilizing every medical intervention available to prolong the patient’s life. For10.17140/pmhcause https://doi.org/10.17140/pmhcause
  5. ChochinovHM. The platinum rule: A new standard for perthe latter response, the rationale is that “at least we know that we did son-centered care. J Palliat Med. 2022; 25: 854-856. doi: 10.1089/ our best, we tried everything” and “whatever happens next is as per Allah’s jpm.2022.0075 will”. This case stood out for me because the family’s perception