Article Text

Download PDFPDF
Waiting for a miracle or best medical practice? End-of-life medical ethical dilemmas in Bahrain
  1. Sayed Alwadaei1,
  2. Barrak Almoosawi1,
  3. Hani Humaidan1,2,
  4. Susan Dovey2
  1. 1 Department of Medicine, Salmaniya Medical Complex, Manama, Bahrain
  2. 2 Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
  1. Correspondence to Dr Barrak Almoosawi;{at}


Background and objectives In Bahrain, maintaining life support at all costs is a cultural value considered to be embedded in the Islamic religion. We explore end-of-life decision making for brain dead patients in an Arab country where medical cultures are dominated by Western ideas and the lay culture is Eastern.

Methods In-depth interviews were conducted from February to April 2018 with 12 Western-educated Bahraini doctors whose medical practice often included end-of-life decision making. Discussions were about who should make withdrawal of life support decisions, how decisions are made and the context for decision making. To develop results, we used the inductive method of thematic analysis.

Results Informants considered it difficult to engage non-medical people in end-of-life decisions because of people’s reluctance to talk about death and no legal clarity about medical responsibilities. There was disagreement about doctors’ roles with some saying that end-of-life decisions were purely medical or purely religious but most maintaining that such decisions need to be collectively owned by medicine, patients, families, religious advisors and society. Informants practised in a legal vacuum that made their ethics interpretations and clinical decision making idiosyncratic regarding end-of-life care for brain dead patients. Participants referred to contrasts between their current practice and previous work in other countries, recognising the influences of religious and cultural dimensions on their practice in Bahrain.

Conclusions End-of-life decisions challenge Western-trained doctors in Bahrain as they grapple with aligning respect for local culture with their training in the ethical practice of Western medicine.

  • ethics
  • palliative care
  • religious ethics
  • moral and religious aspects
  • legal aspects

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • SA and BA contributed equally.

  • Contributors All authors of the manuscript are the guarantors of this research work and accept full responsibility for the work and the conduct of the study. We had access to the data and controlled the decision to publish this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The ethics committee of the hospital where this research was undertaken approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

Other content recommended for you