Saudis' knowledge, attitudes, and perspective toward do-not-resuscitate orders: a systematic review

Do-not-resuscitate (DNR) order is a medical decision for patients who will not benefit from resuscitation. It is considered as a prudent decision in all aspects. This systematic review aims to determine the Saudis’ knowledge, attitudes, and perspective toward DNR orders. This review identified 94 articles from a comprehensive search on PubMed academic database to recognize relevant studies from Saudi Arabia and additional 13 references through secondary search, religious books (Quran and hadith), and legal fatwas (decrees) from official websites. A total of 30 articles were included in this review. The population’s knowledge about DNR orders varies in each study. However, the majority were not adequately knowledgeable or a policy or fatwa, but there were different responses regarding Islam’s agreement on DNR orders. Healthcare workers, however, we are most familiar with DNR orders. The knowledge increased throughout the years. However, most trainees failed to acknowledge that patients with DNR orders should be managed as other patients except for resuscitation purposes. Many responders were familiar with the fatwa regarding DNR orders in other studies. Since the DNR order is legal in Islam’s laws and fatwa (decree), the Saudi population needs to have sufficient knowledge about it from and outside the medical field. Raising awareness regarding DNR order should be considered for the Saudi population and end-of-life training in residency programs. Additional studies covering other Saudi regions are needed to fully understand the Saudis’ knowledge, attitudes, and perspective toward DNR orders.