A Saudi family making end-of-life decisions in the PICU

In this “Ethics Rounds,” physicians must decide how far to go in respecting the wishes of a Saudi Arabian man whose infant is dying in the PICU. The man requests an approach to end-of-life decisions that is deeply rooted in both Saudi culture and the tenets of Islamic bioethics but at odds with prevailing US law and bioethics. We asked 3 physicians with expertise in cross-cultural issues to comment on the issues raised by this case. Dr Aasim Padela is an emergency medicine physician and a fellow in the Program on Medicine & Religion at The University of Chicago. Dr Sadath Sayeed is a neonatologist at Boston Children’s Hospital and on faculty in the Division of Medical Ethics at Harvard Medical School. Dr Maryam Naim is a pediatric intensivist at the Children’s Hospital of Philadelphia. ### Case Representation A 2-month-old boy was found unresponsive in his crib after his mother heard him choke shortly after feeding. His parents drove him to the emergency department, where he was apneic and pulseless. He had return of spontaneous circulation after 30 minutes of cardiopulmonary resuscitation and was transferred to the PICU. On physical examination, the infant has intermittent respiratory effort over the ventilator, no withdrawal from painful stimuli, and no pupillary response to light. Over the next few days, his neurologic examination remained limited to intermittent seizures and irregular respiratory effort. There are no other signs of brainstem function on serial examination. The parents are young and had recently emigrated from Saudi Arabia. The mother is wearing a full black burqa exposing only her face. She speaks no English. The father is wearing a tee shirt and jeans and speaks fluent English. A meeting is scheduled with both parents, the neurologists, social workers, PICU team, and an Arabic interpreter to discuss the prognosis and plans. Before … Address correspondence to John D. Lantos, MD, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64105. E-mail: jlantos{at}cmh.edu