Cultural sensitivity in palliative care

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Published: 14 Dec 2011
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Dr Deena Aljawi - King Faisai Specialist Hospital, Riyadh, Saudi Arabia

Dr Deena Aljawi discusses issues that must be considered when providing palliative care for Islamic cancer patients. It is important that clinicians consider the expectations of not just the patients but also their families and the community as a whole. Dr Aljawi outlines cultural issues related to practices such as morphine use and explains how fatwa (a juristic ruling from Islamic scholars) can be used to reassure that such practices are acceptable under Islamic law.

AORTIC 2011, Cairo, Egypt 30 November–2 December 2011


Cultural sensitivity in palliative care


Dr Deena Aljawi – King Faisai Specialist Hospital, Riyadh, Saudi Arabia


When it comes to palliative care, it’s a really sensitive issue. We need to put in our consideration all the cultures and the culture sensitivity when we deliver care for the patients.


What are some of the specific issues with Islamic patients?


The specific issues in regard to palliative care, which is towards the end of life care, being Muslim they have specific consideration when we deal with them towards impending death or towards to the end of their lives. So we need to consider the culture and what is the patient’s and the family’s expectations at the hospital settings and also at the community. Especially for us, in my hospital, we have lots of nurses from everywhere, almost: 29% from the US, Canada and the rest are from Australia, New Zealand, UK, Saudi Arabia. So the minority is from Saudi Arabia or from the Middle East, let’s say, while the majority are Westerners and we need to train them how to deal with the family and how to deal with the patient with regard to the culture and their spirituality.


How does the training differ?


We actually train them to know more about the culture, what is the family’s expectation towards the end; how to clean the patient, how to do the shrouding. Also it’s very important to know how to talk and the disclosure about the death itself. It’s different from the Arabic or the Western culture and the Arabic culture. It’s mainly the families of the patients in Saudi Arabia or in the Middle East who are going to disclose this topic with the nurses or the doctors so we teach them how to communicate, so we give teaching about the communication with regard to the culture. We teach them how to apply some issues in regard to the spirituality, call the sheikh or to call the spiritual advisor and when those patients or the family needed this help, something like that.


Are there any issues around the use of morphine?


Not only in the Middle East, it’s everywhere we have a barrier of using the opioid or morphine. If you look at many studies that morphine use is not the same as Australia or European countries, it’s very much a low percentage using morphine and the opioids. Also, from the Middle East cultures, the family and the patient sometimes, it’s also a cultural issue of using the morphine for them. Some of the patients, themselves, they refuse to take morphine or the opioids, thinking because it’s haraam to take morphine. For me and the other doctors, especially in Saudi Arabia or some countries in the Middle East, we provide the family and the patient with something called fatwa which is like an official statement done by the higher scholar people telling the patients it’s OK to use morphine and it’s not haraam, whenever you need it, because you’re ill you can take it. Then we’re doing now much education to the doctors, to the nurses and also the family about morphine and in particular about all the opioids and how to use them. Sometimes it’s not only the patients that say it, it’s the doctors’ or the nurses’ fear of giving the morphine or administering it so that’s why we still need more education all the time in regards to those patients.