ArticleBMC medical ethics2025
End-of-life care in Moroccan ICUs: ethical challenges, practices, and perspectives of intensivists.
Article in BMC medical ethics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Public Perceptions of Ethical and Professional Practice in Jordanian Community Pharmacies: A Cross-Sectional Study.Patient preference and adherence · 2026Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEnd-of-life (EOL) care practices, particularly the withholding and withdrawing (W/W) of life-sustaining treatments (LSTs), remain underexplored in North Africa. This study examined factors that influence EOL practices in Morocco.
methodsA nationwide online survey was conducted over one month (from July to August 2023) among Moroccan intensivists, assessing their perspectives on W/W LSTs, decision-making processes, and influencing factors, including ethical, cultural, and religious considerations. Univariable analyses were performed to screen for potential associations, followed by multivariable logistic regression to identify factors independently associated with W/W decisions.
resultsOf 351 invited intensivists, 151 completed the survey, yielding a 41% response rate. The mean age of respondents was 47 ± 9 years, and 84% were male. Most interpreted EOL care as providing palliative care (74%) or ensuring a dignified death (59%), while only 23% explicitly associated it with the cessation of life-sustaining treatment. Nearly 40% reported never having made withholding or withdrawing (W/W) decisions, and 88% made fewer than one such decision per week. While 59% considered withholding LSTs ethically acceptable, only 5% supported both withholding and withdrawing. The most frequently cited barriers were the absence of a legal framework (75%), sociocultural constraints (44%), and discomfort discussing EOL issues with families (58%). Patient wishes were considered in fewer than half of cases, whereas family preferences predominated in 66%. Documentation of W/W decisions was uncommon (27%), and formal institutional protocols were largely absent (94.5%). In multivariable analysis, practicing in a public hospital (odds ratio [OR] = 3.16, p = 0.005) and believing that Islam permits W/W decisions (OR = 3.49, p = 0.006) were independently associated with a higher likelihood of making such decisions.
conclusionMoroccan intensivists face major ethical and practical challenges in EOL care, including legal ambiguity, lack of protocols, limited patient involvement, and difficulty communicating with families. The findings highlight the urgent need for legislative reforms, standardized protocols, and improved education to support ethical, culturally sensitive, and patient-centred EOL practices.
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