Muslim American physicians’ views on brain death: Findings from a national survey

Abstract

Background: Biotechnology has introduced a new physiological state, “brain death,” that continues to attract controversy and confusion. While variability in diagnostic criteria for, and physician practices regarding, “brain death” has been studied, few studies examine physicians’ normative views on the significance of “brain death” and how religiosity implicates these views. Objective: The objective is to assess how Muslim physicians’ views on death, and how their religiosity and acculturation, associate with their perceptions of “brain death.” Methods: A randomized national sample of 626 American Muslim physicians completed a mailed questionnaire assessing sociodemographic characteristics, religiosity, and views about death. Measures of religious practice and acculturation were analyzed as predictors of physician views at the bivariate and multivariable levels. In conducting the multivariate analysis, P-values less than 0.05 were deemed statistically significant. Results: Two-hundred and fifty-five respondents completed the survey (41% response rate). Most participants agreed that death is the irreversible cessation of cardiac and respiratory function (90%), while half agreed or disagreed with other definitions of death, such as loss of personhood or the equivalence of cardiopulmonary and neurological criteria for death. Physicians who scored higher on the religious practice scale had significantly lower odds of agreeing with the statement; “brain death” signifies the departure of the soul from the body [odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.33–0.98]. Those who were born in the US, or immigrated to the US as a child, had greater odds of viewing death as the irreversible loss of personhood and consciousness [OR = 3.52, 95% CI: 1.62–7.63]. Conclusion: Physician characteristics such as religiosity and acculturation appear to influence their views on what constitutes death and how it should be diagnosed. In our sample of Muslim physicians, there appears to be significant reservation toward equating neurological and cardiopulmonary criteria to determine death and disquiet regarding the meaning of “brain death” in general.

Keywords

Doctors - end-of-life - ethics - Islam - personhood

Publikationsverlauf

Artikel online veröffentlicht:
06. August 2021

• References

• 1 Braksick SA, Robinson CP, Gronseth GS, Hocker S, Wijdicks EFM, Rabinstein AA. Variability in reported physician practices for brain death determination. Neurology 2019; 92: e888-94
• 2 Goila AK, Pawar M. The diagnosis of brain death. Indian J Crit Care Med 2009; 13: 7-11
• 3 Pandey A, Sahota P, Nattanmai P, Newey CR. Variability in diagnosing brain death at an Academic Medical Center. Neurosci J 2017; 2017: 6017958
• 4 Wijdicks EF. Brain death worldwide: Accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58: 20-5
• 5 Olick RS. Brain death, religious freedom, and public policy: New Jersey’s landmark legislative initiative. Kennedy Inst Ethics J 1991; 1: 275-92
• 6 Grodin MA. Religious exemptions: Brain death and Jewish law. J Church State 1994; 36: 357-72
• 7 Kosieradzki M, Jakubowska-Winecka A, Feliksiak M, Kawalec I, Zawilinska E, Danielewicz R. et al. Attitude of healthcare professionals: A major limiting factor in organ donation from brain-dead donors. J Transplant 2014; 2014: 296912
• 8 Yılmaz Ferhatoglu S, Yapici N. Brain death and organ donation rates in a city hospital: A retrospective study. Cureus 2019; 11: e4006
• 9 Khalid I, Hamad WJ, Khalid TJ, Kadri M, Qushmaq I. End-of-life care in Muslim brain-dead patients: A 10-year experience. Am J Hosp Palliat Care 2013; 30: 413-8
• 10 Hot I, Vatanoğlu E, Dirican A, Dogan H. Attitudes toward death and brain death among Turkey’s physicians: A brief research report. Omega (Westport) 2009; 59: 339-49
• 11 Chung GS, Yoon JD, Rasinski KA, Curlin FA. US physicians’ opinions about distinctions between withdrawing and withholding life-sustaining treatment. J Relig Health 2016; 55: 1596-606
• 12 Wenger NS, Carmel S. Physicians’ religiosity and end-of-life care attitudes and behaviors. Mt Sinai J Med 2004; 71: 335-43
• 13 Koenig HG, Hooten EG, Lindsay-Calkins E, Meador KG. Spirituality in medical school curricula: Findings from a national survey. Int J Psychiatry Med 2010; 40: 391-8
• 14 Balboni TA, Balboni M, Enzinger AC, Gallivan K, Paulk ME, Wright A. et al. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Intern Med 2013; 173: 1109-17
• 15 MacLean CD, Susi B, Phifer N, Schultz L, Bynum D, Franco M. et al. Patient preference for physician discussion and practice of spirituality. J Gen Intern Med 2003; 18: 38-43
• 16 Berner D, Gaeta S. Religion based non-acceptance of brain death, an end-of-life ethical dilemma. Crit Care Med 2012; 40: 1-328
• 17 Brockopp JE. Islamic Ethics of Life: Abortion, War, and Euthanasia. Columbia, SC: University of South Carolina Press; 2003: 177
• 18 Rady MY, Verheijde JL. A response to the legitimacy of brain death in Islam. J Relig Health 2016; 55: 1198-205
• 19 Padela AI, Adam H, Ahmad M, Hosseinian Z, Curlin F. Religious identity and workplace discrimination: A national survey of American Muslim physicians. AJOB Empirical Bioethics 2016; 7: 149-59
• 20 Dillman DA. Mail and Internet Surveys: The Tailored Design Method. 2nd ed. New York: John Wiley & Sons, Inc.; 2000
• 21 Padela AI, Arozullah A, Moosa E. Brain death in Islamic ethico-legal deliberation: Challenges for applied islamic bioethics. Bioethics 2013; 27: 132-9
• 22 Koenig HG, Büssing A. The Duke University Religion Index (DUREL): A five-item measure for use in epidemological studies. Religions 2010; 1: 78-85
• 23 Curlin F, Lantos JD, Roach CJ, Sellegren SA, Chin MH. Religious commitments and clinical practices: A National Physician Survey. J Gen Intern Med 2005; 20: 629-34
• 24 Cranford RE, Smith DR. Consciousness: The most critical moral (constitutional) standard for human personhood. Am J Law Med 1987; 13: 233-48
• 25 Padela AI, Basser TA. Brain death: The challenges of translating medical science into Islamic bioethical discourse. Med Law 2012; 31: 433-50
• 26 Padela AI. The perspectives of Islamic jurists on the brain death as legal death in Islam. J Relig Health 2016; 55: 1215-7
• 27 Rady MY, Verheijde JL, Ali MS. Islam and end-of-life practices in organ donation for transplantation: New questions and serious sociocultural consequences. HEC Forum 2009; 21: 175-205
• 28 Sarbey B. Definitions of death: Brain death and what matters in a person. J Law Biosci 2016; 3: 743-52
• 29 Joffe AR, Anton NR, Duff JP, Decaen A. A survey of American neurologists about brain death: Understanding the conceptual basis and diagnostic tests for brain death. Ann Intensive Care 2012; 2: 4
• 30 Qazi F, Ewell JC, Munawar A, Asrar U, Khan N. The degree of certainty in brain death: Probability in clinical and Islamic legal discourse. Theor Med Bioeth 2013; 34: 117-31
• 31 Yang Q, Fan Y, Cheng Q, Li X, Khoshnood K, Miller G. Acceptance in theory but not practice—Chinese Medical Providers’ perception of brain death. Neuroethics 2015; 8: 299-313
• 32 Johnson LSM. The case for reasonable accommodation of conscientious objections to declarations of brain death. J Bioeth Inq 2016; 13: 105-15
• 33 Curlin FA, Chin MH, Sellergren SA, Roach CJ, Lantos JD. The association of physicians’ religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Med Care 2006; 44: 446-53
• 34 Yoon JD, Rasinski KA, Curlin FA. Moral controversy, directive counsel, and the doctor’s role: Findings from a national survey of obstetrician-gynecologists. Acad Med 2010; 85: 1475-81