Background Little is known about the attitudes and practices of intensivists working in Lebanon regarding withholding and withdrawing life-sustaining treatments. The objectives of the study were to assess the points of view and practices of intensivists in Lebanon along with the opinions of medical, legal and religious leaders regarding withholding withdrawal of life-sustaining treatments in Lebanese intensive care units. Methods A web-based survey was conducted among intensivists working in Lebanese adult ICUs. Interviews were also done with Lebanese medical, legal and (...) religious leaders. Results Of the 229 survey recipients, 83 intensivists completed it, i.e. a response rate of. Most respondents were between 30 and 49 years old, Catholic Christians, anesthesiologists, working in Beirut. Ninety-two percent of them were familiar with the withholding and withdrawal concepts and 80% applied them. Poor prognosis of the acute and chronic disease and futile therapy were the main reasons to consider withholding and withdrawal of treatments. Ninety-five percent of intensivists agreed with the “Principle of Double Effect”. The main withheld therapies were vasopressors, respiratory assistance and CPR. Most of the respondents reported the decision was often to always multidisciplinary, involving the family, and the patient, or his advance directives or his surrogate and the nurses. The interviewees agreed there was a law governing withholding and withdrawal decisions/practices in Lebanon. Christians and Muslim Sunni leaders declared accepting those practices. Conclusion Withholding and withdrawal of LSTs in the ICU are known concepts among intensivists working in Lebanon and are being practiced. Our results could be used to inform and optimize therapeutic limitation in ICUs in the country. (shrink)

BackgroundPeople say it is hard to stay truly positive in Lebanon. Studies showed that 63% of Lebanese young adults are highly dissatisfied with their country. In fact, young adults are the most vulnerable population to stressors in Lebanon since their future is at stake and it is their time to shape their lives in a country that cripples them. This study aimed to assess factors associated with positivity among a sample of Lebanese university students despite the various stressors they are (...) facing on top of the economic collapse and the COVID-19 pandemic.MethodsThis cross-sectional study was conducted between November and December 2021. A total of 333 participants was recruited through convenience sampling and snowball technique through several areas in Lebanon’s governorates. A linear regression taking the positivity score as the dependent variable was adopted and all variables that showed a correlation > │0.24│ in absolute value were entered in the final model as independent.ResultsA linear regression taking the positivity score as the dependent variable showed that more positive experiences in life, more flourishing, living in rural area compared to urban, and female gender were significantly associated with more positivity.ConclusionThis study demonstrated that the youth’s positivity is strongly affected by age, gender, residency, and the country they live in that will both directly and indirectly shape their life experiences and their ability to flourish and prosper. Along with all the efforts done to help during this collapse and alleviate the stress that young adults are enduring, follow-up studies are still needed to determine accurate coping techniques that pushes these young adults to think positively in a country where negativity reigns and all else fails. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)