8%) [7]. Patients who died following

these decisions were elderly, with malignancy and cardiac chronic underlying diseases, and neurological acute medical disorders. Clinical factors associated with such a decision are consistent with previous published studies in foreign countries [8,10]. Predicting individual outcomes from critical illnesses remains an imprecise science, but an EOL decision can more easily be justified when the physician concludes that the patient is unresponsive to treatment or has severe neurological injury [22]. Morocco is an Arab Muslim country where religious and cultural Inhibitors,research,lifescience,medical issues often play a vital role in decision making by families and physicians [27]. Islamic Inhibitors,research,lifescience,medical bioethics is an extension of Shariah (Islamic law), which is itself based on: (1) The Quran: the Holy Text believed by Muslims to be the direct word of God. (2) The Sunnah: the aspects of Islamic law based on the Prophet Muhammad’s words or acts. (3) The Ijtihad: the law of deductive logic [35]. In this, learned scholars or Ulema are charged with interpreting and disseminating religious teachings. The resolution

of bioethical issues, is left to qualified Inhibitors,research,lifescience,medical scholars of religious law, who are called upon to provide rulings on whether a proposed action is forbidden, discouraged, neutral, recommended or obligatory [36]. Islamic bioethics emphasizes the importance of preventing illness, Inhibitors,research,lifescience,medical but when prevention fails, it provides guidance not only to the practising physician but also to the patient. The physician understands the duty to strive to heal, acknowledging God as the ultimate healer [36]. In 1987 a US based Muslim thinker expressed the view that unnecessary artificial prolongation of life is not in keeping with the spirit of Islam, unless there is evidence that a reasonable Inhibitors,research,lifescience,medical quality of life will result [37]. Islamic law permits withdrawal of futile and disproportionate treatment on the basis of the consent of the immediate

family members who act on the professional advice of the physician in charge of the case [38]. The figure of research nursing involvement in 89% of the cases was surprisingly high, previous studies from Europe have much lower figures [8,22,32]. This high rates, could be related to the relatively young age of our emergency doctors (mean of age: 32 years), who benefits from the nurse experience Org 27569 50 years on average. Generally, the ED staff did not feel prepared for caring for the dying in the ED. Nursing staff relied on learning from others and experience [23]. Many US papers have recommended participation of the nursing staff in ethical decisions [21,39,40]. We observed obvious ethical limitations in the life-sustaining treatment decision-making processes. First, a substantial portion 21.7% of decisions to limit care was taken by a single physician, with no consultation with the medical or nursing staff. A second worrying finding of this study was that 29.