Patient racism toward nurses in a divided society: The case of Jews and Arabs in Israel.

AIM: This study examines whether racism exists among Jewish and Arab patients in Israel, as reflected in patient preference for receiving treatment from a nurse with the same ethnic background. BACKGROUND: We examine the relationship between racism and the level of trust in a nurse from a different ethnic group than the patient, as well as the preferred level of social distance, in the context of ongoing conflicts between the Jewish majority and the Arab minority in Israel. METHODS: A cross-sectional study was conducted using a unique study questionnaire that asked 534 Jewish and 478 Arab respondents to express their preference for an Arab and a Jewish nurse. RESULTS: Among both the Jews and the Arabs, there is a similar tendency of racism toward nurses of the dissimilar ethnic group. This racism was also prevalent among participants who live in a mixed environment or those who studied or are studying and worked or work in a mixed environment. As the trust in nursing staff members from the other group increases, the level of racism decreases. The greater the social distance the participants felt from the members of the other group, the more racist the attitudes they expressed. CONCLUSIONS: Both Jews and Arabs preferred to be treated by nurses of their own ethnic group. In contrast to the contact hypothesis theory, participants who live in a mixed environment did not express fewer racist preferences. We conclude with some useful practical suggestions aimed at decreasing racism in health care. CLINICAL RELEVANCE: Findings imply that prospective patients prefer to receive nursing care from nurses of their own ethnic group and trust these nurses more than they trust nurses of different ethnic group.

The impact of relationship status on IVF patients' quality of life.

Infertility treatments are emotionally taxing and include invasive and time-consuming procedures over extended periods of time. In light of the growing numbers of single mothers by choice, the objective of this study was to apply the Conservation of Resources Theory in the context of infertility care and examine whether relationship status constitutes a psychological resource that buffers the decline in quality of life during IVF treatments. We used the FertiQol questionnaire to compare the quality of life of IVF patients between 422 patients who are involved in a couple relationship ("attached") and 117 patients who are not ("unattached"). Results show that the total FertiQol was significantly higher among the attached participants; the Core FertiQol and the Treatment FertiQol were rated higher by the "attached." No significant differences were found between the attached and unattached for the Emotional and Social subscales. "unattached" participants report significantly lower levels of quality of life in the "mind-body" and "treatment tolerability" subscales than the "attached" participants. It is concluded that being involved in a long-term couple relationship is to be seen as a resource that buffers the decline in quality of life of infertile women undergoing IVF treatments.

Who do you Prefer to Take Care of you: A Jewish or an Arab Nurse? Nationality and Religion Preferences in Israeli Hospitals.

Studies show that there are patients who refuse treatment or demand that treatment be provided by a professional belonging to their ethnic group. We investigated whether patients have preferences for nationality and religion of nurses (PFNR), and which factors impact these preferences. The study included 1012 Jews and Arabs. Results show that Arabs and Jews prefer that a nurse of their own nationality and religion treat them. Trust is the most important factor that influences this preference. In the Israeli healthcare system, the patient-nurse encounter is affected by the strong bias that Jews and Arab Muslims hold against each other.

Parent-initiated posthumous-assisted reproduction revisited in light of the interest in genetic origins.

A rich literature in bioethics argues against the use of anonymous gamete donation in the name of the 'interest in knowing one's genetic origins'. This interest stems from medical as well as psychosocial and identity reasons. The term 'genealogical bewilderment' has been coined to express the predicament of those deprived of access to information about their origins. Another rich body of literature in bioethics discusses arguments for and against posthumous-assisted reproduction (PAR), with a recent focus on PAR that is initiated by the parents of a deceased man (rather than his partner). This paper revisits arguments against PAR, in light of arguments regarding the interest in knowing one's genetic origins. Limiting the discussion to the specific context of parent-initiated PAR (PIPAR), we argue that the use of cryopreserved sperm from a deceased identifiable man in the context of PIPAR may be ethically preferable when compared with the use of anonymous donor sperm, since it allows genealogical certainty, that is, giving the prospective child access to information about the identity, life story and ancestry of the genetic progenitor as well as genealogical embeddedness, that is, close relationship with extended family members.

The muslim patient and medical treatments based on porcine ingredients.

Porcine-derived products serve as an effective solution for a wide range of human ailments; however, there may be objections to their use due to Islamic religious prohibitions on consuming products derived from pigs. In order to enhance the cultural competence of medical practitioners who treat Muslim individuals, which constitute about one fifth of the world population, this study aimed at evaluating the knowledge and positions of Muslim patients on this subject. A questionnaire presenting 15 uses of porcine-derived materials was filled out by 809 Muslims. The level of knowledge about the permissibility of these uses and participants' position on whether it should be approved was assessed. Findings show that Muslims are not familiar with Islamic religious jurisprudence that permits the use of porcine products to save lives after it has undergone an essential transformation known as Istihala. The respondents expressed a negative attitude towards the medical use of porcine-derived substances based on imprecise knowledge about the permissibility of use of porcine-derived materials, devices and treatments. We offer recommendations for improving the informed consent obtained from Muslim patients prior to conducting porcine-based treatments.

Does racism toward nurses increase as treatment invasiveness rises?

One of the unspoken issues in public discourse in most countries is the racism of patients toward nurses who originate from a different ethnic group than theirs. The aim of the present study is to examine whether patients' racism toward nurses increases as the invasiveness of treatment rises. This study was conducted in Israel, a highly conflictual society where Jews and Arabs live together and meet in the same health facilities. Despite the tension and sometimes animosity caused by the political situation, members of each group regularly encounter members of the other group during the provision of health-care, both as patients and as medical and nursing staff. A study questionnaire which presented nine nursing treatments of diverse levels of invasiveness was filled out by Arab and Jewish participants. They were asked to convey their preference for an Arab or a Jewish nurse for each treatment. Results of Logistic Regression Analyses reveal that in both sectors, racism toward nurses increases as the treatment invasiveness rises. These findings are discussed in light of the concept of social distance, and serve as an empirical basis for several proposed practical recommendations for eradicating racism against nurses.

Christianity, Islam, Judaism, and unwillingness to donate organs post-mortem.

Willingness to donate organs is contingent upon knowledge about and attitude toward organ donation. In order to explore differences between members of the three monotheistic religions: Christianity, Islam, and Judaism, a nation-wide survey was conducted in Israel. Members of all three religions expressed a very low willingness to donate organs postmortem. They had similar levels of knowledge regarding organ donation and similar negative attitudes toward organ donation. The public feels negative regarding the issue, therefore education campaigns should be designed and implemented in order to refute potential misconceptions and hence increase the number of people who sign donor cards.

The Ethical Standards of Sunni Muslim Physicians Regarding Fertility Technologies that are Religiously Forbidden.

This research project is pioneering in that it is the first to provide empirical data regarding the ethical standards of Sunni Muslim physicians toward religiously prohibited reproductive technologies, a topic which is considered taboo in Muslim society. A total of 689 Sunni Muslim physicians rated their acceptance of 14 fertility treatments. They expressed objections to assisted reproductive technologies entailing gender selection, egg, sperm and embryo donation, and surrogacy. The findings show that the Sunni Muslim medical establishment avoids fertility options that are considered in violation of Islamic law, and Sunni Muslim physicians tend to obey religious law.

Underground Gamete Donation in Sunni Muslim Patients.

This qualitative study focuses on the "underground" practices of Sunni Muslim physicians and patients who are performing and undergoing religiously prohibited third-party gamete donation. It is based on face-to-face interviews with two Sunni Muslim gynecologists and 25 Sunni Muslim women who underwent third-party gamete donation treatments and gave birth to a baby. The analysis of the interviews sheds light on patients' experiences regarding donation and explores the experiences of the gynecologists. The patients shared with us their inner conflict regarding childbearing using either donated sperm or a donated egg. They expressed a subversive attitude toward the religious authorities and the Islamic fatwa (religious ruling) that prohibits third-party gamete donation. The gynecologists provide fertility care involving third-party gamete donation despite Islamic religious prohibitions; in consequence, they suffer feelings of guilt for their actions. The study participants challenge accepted binary conceptions regarding the boundaries between religious laws and the desire to produce offspring, between what is allowed and what is forbidden, between guilt and happiness, and between the desire to maintain a marital relationship and the desire to comply with cultural-religious rules. Based on Gloria Anzaldua's theory of the borderlands, and the context-informed approach, this study underscores the importance of giving voice to Sunni Muslim patients who underwent third-party gamete donation treatments and contributes to a deeper understanding of their dilemma of finding a reproductive solution that does not run counter to religious values.

The View of the Three Monotheistic Religions Toward Cadaveric Organ Donation.

Religious concerns regarding the legitimacy of cadaveric organ donation have been found to be major inhibiting factors for people to consent to donate organs post-mortem for transplantation; this constitutes a major cause for the grave shortfall of available organs for transplantation. The purpose of this review is to explore the view of the three monotheistic religions, namely Christianity, Islam, and Judaism, toward cadaveric organ donation. The literature review reveals that all three monotheistic religions support cadaveric organ donation but within certain restrictions. We provide a detailed description of the approach of each religion and the inhibiting considerations as interpreted by religious authorities. Health professionals need to collaborate with faith leaders in order to optimize the education of the public of believers with regard to the benefits stemming from organ donation. Developing transplantation medicine does not depend solely on technical capabilities and expertise; rather, this development should go hand in hand with religious, traditional and cultural beliefs and rituals. Providing a believer with a religious authority about cadaveric organ donation is very effective in helping families and individuals cope with difficult and critical decisions.

Evaluating health-related quality of life and emotions in Muslim and Jewish kidney transplant patients.

BACKGROUND: The scholarship on the impact of the source of the donated kidney (living donor (LD) or deceased donor) and the ethnoreligious background on the quality of life post-transplantation have received little scientific attention. The purpose of the present research is to evaluate health-related quality of life and psychological feelings among kidney transplant (KT) recipients. OBJECTIVE: To compare the health related quality of life and psychological feelings between kidney transplant (KT) recipients who received a graft from a living versus a deceased donor, and between Muslim and Jewish patients. METHODS: Two hundred and sixty-two renal recipients completed the health-related quality of life (HRQOL; World Health Organization Quality of Life Brief Version (WHOQOL-BREF)) questionnaire and answered the Transplant Effects Questionnaire assessing their post-transplantation emotional and psychological responses. RESULTS: KT recipients reported medium levels of physical, psychological, social and environmental dimensions of HRQOL. Muslim recipients reported significantly higher levels of physical, psychological and social dimensions of HRQOL than Jews. Recipients of kidneys from LD reported higher levels of HRQOL and reported significantly higher levels of guilt and responsibility to be healthy. CONCLUSIONS: Our findings indicate that receiving a graft from an LD contributes to the HRQOL in the physical, psychological and environmental dimensions. Hence, donations from LD should be encouraged, by investing efforts in promoting public awareness of the importance of donating kidneys by LDs. Muslim KT recipients enjoy better physical, social and psychological HRQOL; this difference can be explained by the supportive and embracing familial and social networks characterizing traditional Arab communities. Post-transplantation support programs should be designed in order to provide further support and improve emotional and psychological responses to postoperative reality.

The Gendered Body Work of Muslim Arab Mothers Who Donate a Kidney to Their Children.

PURPOSE: Previous studies showed that among the pediatric ESRD patients who receive a kidney donation from a parent, in most cases the mother is the one that agrees to donate her kidney to the sick child, whereas fathers are less willing to donate. The present study sought to explore decision making regarding which parent would donate a kidney to their child among Muslim Arab parents of pediatric ESRD patients. DESIGN AND METHODS: The study design is a cross sectional qualitative study. We conducted semi-structured interviews with thirty-one parents: twenty-five mothers and six fathers, who donated a kidney to their child. RESULTS: Parents tended to refrain from donating a kidney to a sick daughter; mothers were more willing to donate than fathers. Our findings imply that culturally constructed notions of gender and motherhood are mobilized to the realm of health and illness, and mothers' body work is an influential factor in determining survival chances of pediatric ESRD patients and their quality of life. CONCLUSIONS: Our study shows that kidney donation made by mothers to their children represents a gendered body work and powerfully demonstrate gender relations in Arab society. Cultural artefacts shape parents' differential propensity to donate organs for a female or a male offspring. PRACTICE IMPLICATIONS: It is recommended that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney for their offspring, and also to encourage both parents to donate a kidney to a sick daughter. Education campaigns are needed to raise awareness and encourage changes in the attitudes of the Muslim families of pediatric ESRD patients toward parental kidney donation.

The double gender bias in parental kidney donation among Muslim Arab patients.

Previous studies showed that it is usually the mother who agrees to donate her kidney to a child with an end-stage renal disease, while the fathers tend much less to donate. The present study sought to explore decision-making regarding which parent would donate a kidney to their child. Interviews were conducted with twenty-five mothers and six fathers who donated a kidney to their child. Analysis of the narratives reveals unwillingness to donate a kidney to a sick daughter and five reasons why mothers are more willing to donate than fathers. Our study shows that parents' patterns of kidney donation to their children powerfully demonstrate gender relations in Arab society and that culturally related matters have a significant impact on human organ transplantation, hence on quality of life and the chances of survival of nephrological pediatric patients. We recommend that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney, for sons as well as for daughters. We call for designing education campaigns aimed at raising awareness and encouraging changes in the attitudes of the families of pediatric ESRD patients as well as of physicians.

Forbidden medically assisted sex selection in Sunni Muslims: a qualitative study.

RESEARCH QUESTION: Son preference is a phenomenon typically prevalent in traditional societies in the Middle East and in East and South Asia. Hence, various sex-selection practices, either natural or medically assisted, have emerged. Islamic law forbids medically assisted sex selection for social reasons. Our aim was to examine the narratives of Sunni Muslim couples who underwent sex selection treatment by using sperm sorting and to understand their reasons for doing so. DESIGN: A qualitative phenomenological study involving in-depth, face-to-face interviews with 31 women who gave birth to a male baby after undergoing sperm-sorting treatment, preimplantation genetic testing sex selection, or both, in a private clinic. RESULTS: Interviewees spoke about the ethical dilemma they faced in choosing to violate the religious prohibition against sex selection; they explained the reasons why they opted to undergo sperm-sorting treatment and why the utmost secrecy surrounded it. CONCLUSIONS: Some Sunni Muslim couples privately defy the Sunni Muslim orthodoxy on their way to becoming parents to male offspring. Sons are preferred over daughters because of the traditional value attached to male offspring in Muslim culture. Therefore, couples who have only daughters may face an ethical dilemma of whether to obey the religious prohibition against sex selection or to violate it and enjoy societal acceptance and recognition for having a son.

Health-related quality of life of transplant recipients: a comparison between lung, kidney, heart, and liver recipients.

BACKGROUND: Quality of life and psychological responses to transplantation are constructs used to assess various psychosocial aspects after organ transplantation. The purpose of this study is to compare physical, psychological, social, and environmental quality of life between recipients of four organs: liver, lung, heart, and kidney. METHODS: In order to compare the four types of quality of life and emotional responses post-transplant, HRQOL and TxEQ questionnaires were administered to 427 transplant recipients. RESULTS: Heart and liver recipients report significantly higher health-related quality of life than lung and kidney recipients. Heart and lung patients report significantly fewer concerns and worries than liver and kidney patients. New additional variables were explored in our study: psychological connection to the living donor/deceased donor's family and commitment to them. We also found that heart recipients feel their personality traits changed, postoperative. CONCLUSIONS: The contribution of our study was the finding that ethno-religious and psychosocial variables have a positive effect on four dimensions of HRQOL. It may be useful to design psychological support interventions specifically adapted to patients after organ transplantation that aim at enhancing patients' HRQOL and alleviating negative emotional responses.

Moral distress and moral residue experienced by transplant coordinators.

Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for more than 20 years in this job were recruited by using a purposive sampling technique. The transplant coordinators spoke of negative feelings and moral distress with regard to futile care of family members of deceased donors as well as of living donors. Transplant coordinators experience moral distress on a daily basis; being compelled to compromise their integrity causes moral distress and moral residue, hence, training and support should be offered to them.

Grave new world: The conspiracy of silence surrounding non-voluntary euthanasia.

The scholarship of euthanasia indicates that in most cases, to date, non-voluntary euthanasia has been studied where euthanasia is legalized. Findings of these studies demonstrate the 'slippery slope' and reveal that non-voluntary euthanasia is pervasive in these countries. The research is aimed at answering two questions: (1) What are the common death hastening methods? (2) Is the acceptance of active non-voluntary euthanasia related to the legal status of euthanasia? A qualitative study was conducted in ICUs with 15 nurses. All of the interviewees refused to take part in the death hastening cases and did not obey any doctor's instruction that could hasten or cause death. Therefore, doctors who conducted NVE did it by themselves. The present study provides evidence of the phenomenon of illegal non-voluntary euthanasia as a routine practice by physicians in palliative care units in Israel. Interviews with 15 nurses employed in these units shed light on the means and methods used by these doctors to hasten terminal patients' death. We conclude that Nurses in various end-of-life care units persist in preserving their professional integrity and refuse to obey doctors' instructions for non-voluntary euthanasia. The slippery slope argument has been refuted in this context.

Between health and death: The intense emotional pain experienced by transplant nurses.

While extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant co-ordinators. Semi-structured face-to-face interviews conducted with ten transplant co-ordinators who have worked for more than 20 years in this job. The transplant co-ordinators spoke of negative feelings and moral distress with regard to futile care of deceased donor family members as well as of living donors. Transplant co-ordinators experience intense negative feelings, emotional pain, and moral distress on a daily basis. Transplant co-ordinators play a pivotal role in the process of obtaining consent for live or dead donation of organ; however, their well-being and job satisfaction are impaired by contradictions between their moral values and the tasks they are instructed to perform. The study exposes the silent emotional suffering of transplant co-ordinators; main findings show that the transplant co-ordinators are torn between contradictory expectations and a gap between values and praxis. It is recommended to offer them training and support for the sake of their retention.

Religious observance and perceptions of end-of-life care.

This study examines the impact of the level of religious observance on the attitudes toward end-of-life (EOL) decisions and euthanasia of Jews in Israel-where euthanasia is illegal-as compared to Jews living in the USA, in the states where euthanasia is legal. A self-reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.

The experience of being an in vitro fertilization (IVF) patient in a pro-natalist society - a form of emotional labor.

Israel is known as a highly pronatalist society. We conceptualize the pro-natalist state as the employer of in vitro fertilization (IVF) patients in the labor of procreation. We characterize the unique Israeli religio-cultural environment regarding infertility using the concepts of emotional labor, surface acting, deep acting, emotional dissonance, and burnout. One hundred and forty-two women and 62 men undergoing IVF in eight public IVF units were asked to describe their emotions on the Positive and Negative Affect Schedule (PANAS). We discuss the patients' emotional responses in light of the religio-cultural and the emotional labor context. Evidence was found for gender differences whereby women suffer more negative emotional outcomes than male partners of IVF patients. The pro-natalist state poses greater emotional stress for female IVF patients in comparison with that experienced by the male spouses of IVF patients. Consulting professionals should offer psycho-social care if necessary, focusing on strategies taken from emotional labor theory.