When can Muslims withdraw or withhold life support? A narrative review of Islamic juridical rulings.

When it is ethically justifiable to stop medical treatment? For many Muslim patients, families, and clinicians this ethical question remains a challenging one as Islamic ethico-legal guidance on such matters remains scattered and difficult to interpret. In light of this gap, we conducted a systematic literature review to aggregate rulings from Islamic jurists and juridical councils on whether, and when, it is permitted to withdraw and/or withhold life-sustaining care. A total of 16 fatwās were found, 8 of which were single-author rulings, and 8 represented the collective view of a juridical council. The fatwās are similar in that nearly all judge that Islamic law, provided certain conditions are met, permits abstaining from life-sustaining treatment. Notably, the justifying conditions appear to rely on physician assessment of the clinical prognosis. The fatwās differ when it comes to what conditions justify withdrawing or withholding life- sustaining care. Our analyses suggest that while notions of futility greatly impact the bioethical discourse regarding with holding and/or withdrawal of treatment, the conceptualization of futility lacks nuance. Therefore, clinicians, Islamic jurists, and bioethicists need to come together in order to unify a conception of medical futility and relate it to the ethics of withholding and/or withdrawal of treatment

Burden Of Oral Diseases Among Children And Early Adolescents Belonging To Upper And Lower Middle Class Schools

ABSTRACT Objective: This study aimed to determine the burden of oral health parameters such as dental caries, dental plaque, gingivitis, periodontitis, mouth opening, and dental fluorosis among children and early adolescents belonging to upper and lower-middle-class private schools of Karachi.  Methods: A cross-sectional study with 550 study subjects was conducted among schools to assess dental caries, the presence of dental plaque, gingivitis, dental fluorosis, and mouth opening. The sample was selected through a nonprobability sampling technique. The inclusion criteria were male and female students from class 6 to class 10, students present on the day of the examination, and students given verbal consent for the study; the exclusion criteria included students with dental anomalies such as amelogenesis imperfecta, dentinogenesis imperfecta, supernumerary teeth, congenitally absent teeth or teeth missing due to fracture or trauma. An open epi was used to calculate the sample size. The study was performed in private schools belonging to various localities near Ziaud-din University. Dental examination was carried out using a disposable dental examination kit. SPSS version 20 was used for data analysis, and the nonparametric Mann-Whitney test was used to analyse the variables. Results: The mean age of the study sample is 12.96 ± 2.30, the mean DMFT (Decayed missing and filled tooth) score is 1.07 ± 2.04, the mean plaque score is 0.38 ± 0.90, and the gingival index is 0.21 ± 0.79, the mean mouth opening is 36.16±8.65. The gender-wise distribution of oral health parameters presented the statistically significant difference in mean mouth opening among male and female study subjects p<0.0001, whereas mean decayed tooth and mean DMFT scores were statistically insignificant p<0.44 and p<0.36, respectively. The comparison of oral health parameters of study subjects among upper and lower class shows statistically significant differences among mean mouth opening, mean plaque index, mean decayed teeth, mean DMFT score, and mean dental fluorosis. Whereas the mean gingival index, mean missing teeth and mean filled teeth were statistically insignificant. Conclusion: The current study concludes that children and early adolescents suffer from oral diseases such as dental caries, plaque, and limited mouth opening. There is a need to conduct oral health intervention studies among schools and local communities to spread oral health awareness and disease prevention. As well as to introduce preventive measures among high-risk subject