American Muslim Health Disparities: The State of the Medline Literature

Background: While religious beliefs and values influence health behaviors, conventional health disparities research rarely examines health outcomes by religious affiliation particularly within multi-ethnic minority communities. Methods: Using a systematic strategy we searched the Medline literature to identify empiric studies that report on health disparities between American Muslims and non-Muslim groups residing in America. In addition to use religious affiliation descriptors for Muslim groups we utilized geographic and ethnicity terms such as “South Asian” or “Pakistani” as proxy terms to help uncover studies of American Muslims. Results: 171 empirical studies were captured. South Asians and Arabs were the most commonly studied groups, and mental health was the most common studied health condition. The overwhelming majority of studies did not assess connections between the Islamic faith and health outcomes. Conclusion: Healthcare disparities among American Muslims remain under-investigated. The few empirical studies of American Muslim groups, or of ethnic groups with large numbers of Muslims, rarely examine relationships between Islam-related factors and health outcomes and thereby miss an opportunity to understand the relationships between religion and health disparities

Faculty of responsibility: a key concept to cope with the ethical challenges medical students face

During their educational life, medical students encounter several challenges, the origins and causes of which vary. This paper explores and attempts to scrutinize two of these challenges, before eventually introducing the concept of responsibility. First, this paper describes the general characteristics of medical schools, medical students, and medical education. Second, two different ethical challenges that medical students confront are then delineated: the anxiety of continuously questioning ‘while being trained, do I cause patients to receive suboptimal health care?’ and occasionally feeling obligated, consequently, to breach the ethical boundaries to practice procedures on patients. Finally, the faculty of responsibility and its components are introduced and discussed as a model that can overcome these ethical challenges

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

Response to Letter to the Editor

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89557/1/j.1399-0012.2011.01437.x.pd

Study Protocol for ‘Informing American Muslims about Organ Donation (I AM a LD)’

Background: American Muslims tend to hold more negative attitudes towards organ donation than other American populations, and these attitudes are contributed to by gaps in biomedical and religious knowledge. As a result, there is significant need for religiously-tailored health education on organ donation within this community. Thus our study sought to test the effectiveness of a mosque-based, religiously-tailored health education program that addressed biomedical and religious knowledge gaps regarding living organ donation amongst Muslim Americans. Methods: A randomized, controlled, cross-over trial of religiously-tailored educational workshops held at four mosques in Washington D.C. and Chicagoland. Mosques are randomized into early and late intervention arms and participants are recruited at worship services and other mosque events. The primary study outcomes are changes in biomedical and religious knowledge regarding living organ donation. Secondary outcomes include change in procedural knowledge about the process and types of living organ donation, beliefs regarding organ donation, and religious knowledge regarding end-of-life care. Funding and Ethics: This study is supported by a grant from the U.S. Human Services Health Resources and Services Administration and received ethics approval from the University of Chicago’s Biological Sciences Division Institutional Review Board

Factors associated with positive attitudes toward organ donation in Arab Americans

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86866/1/j.1399-0012.2010.01382.x.pd

Religio-ethical discussions on organ donation among Muslims in Europe: an example of transnational Islamic bioethics

This article analyzes the religio-ethical discussions of Muslim religious scholars, which took place in Europe specifically in the UK and the Netherlands, on organ donation. After introductory notes on fatwas (Islamic religious guidelines) relevant to biomedical ethics and the socio-political context in which discussions on organ donation took place, the article studies three specific fatwas issued in Europe whose analysis has escaped the attention of modern academic researchers. In 2000 the European Council for Fatwa and Research (ECFR) issued a fatwa on organ donation. Besides this “European” fatwa, two other fatwas were issued respectively in the UK by the Muslim Law (Shariah) Council in 1995 and in the Netherlands by the Moroccan religious scholar Muṣṭafā Ben Ḥamza during a conference on “Islam and Organ Donation” held in March 2006. The three fatwas show that a great number of Muslim religious scholars permit organ donation and this holds true for donating organs to non-Muslims as well. Further, they demonstrate that transnationalism is one of the main characteristics of contemporary Islamic bioethics. In a bid to develop their own standpoints towards organ donation, Muslims living in the West rely heavily on fatwas imported from the Muslim world

Improving uptake of breast, bowel and cervical cancer screening among Muslim women: protocol for a non-randomised feasibility study of a peer-led, faith-based intervention (IMCAN project)

Background: Cancer screening and early detection save lives, but Muslim women are less likely to participate in screening than white-British women. This is concerning as incidence rates of cancer appear to be increasing in ethnic minority groups. Faith-based cancer communications provide a culturally acceptable strategy to addressing barriers to screening. This study investigates the feasibility, effectiveness, and implementation of a co-designed, faith-based, and peer-led intervention to improve breast, bowel, and cervical screening uptake among Muslim women in the UK, which we co-designed in 2021 with ten Muslim women. Intervention: The intervention includes a health education component delivered by a GP explaining what is involved in cancer screening and potential risk factors, such as diabetes; personal testimonials reflecting Muslim women’s experiences with cancer and screening; and an Islamic perspective on cancer screening delivered by an Alimah, a female religious scholar. Methods: Underpinned by the Integrated Screening Action Model, we will conduct a non-randomised, two-arm feasibility trial with 200 Muslim women (aged 25-74 years, living in Glasgow or North-East England, not or partially up-to-date with screening). Participants will be allocated to either face-to-face or online delivery of the intervention. To identify opportunities for modification of the interventions, we will conduct semi-structured interviews with key stakeholders (n=6), including Muslim scholars and community liaison, and focus groups with intervention participants (4 groups with n=6-8/group) and peer-educators involved in intervention delivery (n=10). Expected results: An assessment of the suitability of the trial’s parameters will inform the development of a large-scale trial using pre-specified progression criteria and a traffic light system for evaluation of STOP-AMEND-GO criteria. To gain a preliminary indication of intervention effectiveness we will capture knowledge, attitudinal change to screening, and behavioural outcomes, such as intention to screen at baseline, 6, and 12 months follow-up, and NHS screening attendance at 12 months. Conclusion: The development of a co-designed faith-based, peer-led intervention has the potential to improve engagement with cancer screening among Muslim women. Our project represents a rigorous feasibility and process evaluation of a theory-driven and co-designed intervention for Muslim women. The inclusion of religious messages can support cancer screening uptake in this underserved group. We aim to further test intervention effectiveness in a fully powered randomised controlled trial. This would guide the development of cancer control communications for religious minorities in the UK and other countries with existing screening programmes

“Being Guided”: What Oncofertility Patients’ Decisions Can Teach Us About the Efficacy of Autonomy, Agency, and Decision-Making Theory in the Contemporary Critical Encounter

Recent research on patient decision-making reveals a disconnect between theories of autonomy, agency, and decision-making and their practice in contemporary clinical encounters. This study examines these concepts in the context of female patients making oncofertility decisions in the United Kingdom in light of the phenomenon of “being guided.” Patients experience being guided as a way to cope with, understand, and defer difficult treatment decisions. Previous discussions condemn guided decision-making, but this research suggests that patients make an informed, autonomous decision to be guided by doctors. Thus, bioethicists must consider the multifaceted ways that patients enact their autonomy in medical encounters