Defense Date


Graduation Date

Summer 8-11-2018


Immediate Access

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Henk ten Have

Committee Member

Gerard Magill

Committee Member

Joris Gielen

Committee Member

James Swindal


Bioethics, Euthanasia, Assisted suicide, Voluntary euthanasia, Involuntary euthanasia, Passive euthanasia, Active euthanasia, Palliative, Hospice care, Living Will, Do No Resuscitate Order



This dissertation examined the similarities and differences between the end-of-life care strategies employed in the United States and Saudi Arabia. End-of-life care has emerged in recent decades as a medical practice specialty. It has taken on enhanced significance in the United States in tandem with the aging of the Baby Boomer generation, but it is also a significant focus of practice and research in other countries as well. In the context of Saudi Arabia, however, end-of-life care is still very much an emerging phenomenon that is being shaped and informed by Saudi culture, tradition and the Islamic faith.

This study compares and contrasts the approaches taken to end-of-life care in the United States and Saudi Arabia. It is essential a case study using two cases. It moves from an assessment of the state of such practice in the United States to a point-by-point analysis of how such aspects of end-of-life care as delivery of palliative care, hospice care and end-of-life counseling are addressed in each country’s medical system. Issues of how physicians in each context approach the questions raised by perceived futility of treatment, informed consent, patient and family education, decision-making, withdrawal and withholding of care, and Do Not Resuscitate/Advanced Directives/ Living Wills are explored.

The study demonstrates that whereas end-of-life care practices in the United States are an artifact of a strong focus on patient autonomy, in Saudi Arabia physicians are more likely to make decisions on behalf of their patients. Culture and religious influences in the form of Islam and its mandatory submission to the will of God are the dominant influences operating in the Saudi medical system, which nevertheless emphasizes the ethics of benevolence, non-maleficence, and compassion. The study concludes with a recommendation that the Saudi system be modified to provide greater emphasis on patient education and participation in end-of-life decision making.