A scale balancing medical needs and religious considerations in Saudi Arabia.

Navigating DNRs in Saudi Arabia: What You Need to Know About End-of-Life Decisions

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Soraya Malik in Health & Wellness November 2026 • 4 min read.

"A comprehensive look at do-not-resuscitate policies in Saudi Arabia, addressing cultural sensitivities and patient rights."


End-of-life care presents some of the most difficult decisions in medicine. Balancing a patient's wishes, medical possibilities, and ethical considerations requires a delicate touch. In Saudi Arabia, these decisions are further complicated by unique cultural and legal factors, particularly concerning Do-Not-Resuscitate (DNR) orders.

A DNR order, also known as 'no code' or 'allow natural death,' is a legal document instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops or they stop breathing. Given the sensitive nature of these decisions, guidelines vary significantly worldwide. In Saudi Arabia, the framework is rooted in Islamic jurisprudence, shaping how DNR orders are approached and implemented.

Understanding the perspectives of healthcare professionals on DNR policies is crucial to ensuring compassionate and ethical end-of-life care. A recent study explored the knowledge, attitudes, and beliefs of interns and residents in Saudi Arabia regarding DNR orders, shedding light on the challenges and opportunities in this evolving area of medical practice.

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Current Context

The available material does not provide current statistics on DNR orders or their effects in Saudi Arabia. Any assessment of prevalence, outcomes, or patient impact therefore requires separate, authoritative health data. Readers should avoid treating general discussion as a substitute for Saudi-specific evidence.

Terminology Matters

The listed sources use “DNR” to mean Department of Natural Resources, not Do Not Resuscitate. The Wisconsin Department of Natural Resources describes services involving permits, regulations, natural-resources management, and public input, while Indiana’s Department of Natural Resources site focuses on recreation and natural resources. Alaska’s Department of Natural Resources source similarly concerns management and protection of more than 104 million acres of state-owned land, water, and natural resources, so these materials do not establish medical DNR methods or their limitations.

Historical Background

The available material does not document the historical development of Do Not Resuscitate decisions in Saudi Arabia. It therefore cannot support specific milestones, dates, or foundational discoveries in end-of-life care. A reliable historical account would require sources focused on medicine, law, ethics, and Saudi healthcare practice.

DNR Policies in Saudi Arabia: Key Aspects

A scale balancing medical needs and religious considerations in Saudi Arabia.

In Saudi Arabia, DNR orders were first formally addressed in 1988 by a fatwa (religious edict) issued by the General Presidency of Scholarly Research and Ifta. This fatwa serves as the foundation for DNR policies across the country. According to this directive, the decision to issue a DNR order is made by three specialized and trustworthy physicians, without requiring the consent of the patient or their family.

The fatwa outlines six specific situations in which a DNR order may be granted:

  • The patient arrives at the hospital already deceased.
  • The panel of physicians determines the patient's condition is untreatable and death is imminent.
  • The patient's condition does not make them suitable for resuscitation.
  • The patient suffers from advanced heart or lung disease or repeated cardiac arrest.
  • The patient is in a vegetative state.
  • Resuscitation is considered futile.
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What a DNR Means

Verywell Health describes a Do Not Resuscitate order as a directive stating that a person does not wish to undergo life-saving measures such as CPR during a medical emergency. The source presents a DNR as a personal decision documented with a physician and connected to a person’s end-of-life preferences. It also notes that DNR orders vary by state, so this description should not be assumed to define Saudi Arabian rules.

Evidence Limits

The available material does not provide evidence about objections to DNR orders or documented failures in Saudi Arabia. It therefore cannot support claims about patient outcomes, communication problems, or implementation weaknesses. Such issues should be evaluated using clinical, legal, and patient-experience research specific to the Saudi context.

Jurisdictional Differences

The available material does not contain a comparison of DNR policies across Saudi Arabia or other jurisdictions. Because DNR requirements may depend on local medical and legal frameworks, broad comparisons would be premature here. Any meaningful analysis would need clearly identified jurisdictions and comparable sources.

It's important to note that a DNR order in Saudi Arabia doesn't mean the withdrawal of all care. Patients still receive treatments to ensure comfort and dignity, with the exception of CPR. While the core principles of the DNR policy are generally adopted by hospitals, the application can vary, particularly regarding patient autonomy and family involvement.

Moving Forward: Enhancing DNR Practices in Saudi Arabia

The study underscores the necessity of strengthening education on DNR policies and ethical treatment of DNR patients within Saudi Arabia's medical schools and residency programs. There is a clear call for national DNR laws that prioritize patient involvement in decision-making, aligning with global ethical standards while respecting cultural and religious values. By addressing these issues, Saudi Arabia can ensure that end-of-life care honors both patient dignity and the principles of Islamic jurisprudence.

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Evidence-Based Interpretation

The available sources support only a limited synthesis: a DNR is described as a physician-documented personal directive concerning CPR and other life-saving measures. They do not provide Saudi-specific expert commentary or establish how such decisions operate within Saudi healthcare institutions. Conclusions beyond that description should be presented cautiously.

Future Evidence Needs

The available material does not project how DNR practice may develop in Saudi Arabia. Future discussion would need evidence on policy, clinical communication, documentation, and culturally informed decision-making. Without those sources, specific forecasts would be speculative.

System-Level Context

The available material does not describe systemic challenges affecting DNR decisions in Saudi Arabia. It cannot establish the roles of hospitals, clinicians, families, regulators, or health-record systems in implementing such decisions. These broader issues require dedicated Saudi healthcare and policy sources.

Personal Decision-Making

The available medical source characterizes a DNR as a personal decision documented with a physician and reflecting end-of-life preferences. That framing highlights the importance of connecting the order with the individual’s wishes, but the source does not describe real-world experiences in Saudi Arabia. Claims about family dynamics, emotional effects, or patient outcomes therefore require additional evidence.

What a Jeddah survey can establish

Observational study (level 4 of 8)

The 140 included questionnaires came from trainees at four Jeddah hospitals, so the results characterize that sample, not all clinicians or hospitals in Saudi Arabia.[1] [2]

Questionnaire returns and the analyzed sample

  • 174 of 200; 87%Of 200 questionnaires sent, 174 were returned, an 87% response rate.[1]
  • 34Of the returned questionnaires, 140 were complete and included; 34 were not included in the analysis.[1]

What the responses say about DNR understanding

The authors report that respondents were unfamiliar with local DNR policies and the fatwa, and did not fully understand care for patients labeled DNR. This points to gaps in both policy knowledge and understanding of care, not evidence about patient outcomes.[1] [2]

Participants regarded dignity, religious concerns, and legal concerns as important considerations in resuscitation decisions. The study therefore captures ethical considerations alongside reported knowledge, but does not establish how those considerations shape decisions in practice.[2]

Where the survey's reach narrows

  • Because the sample included hospitals only in western Saudi Arabia, its findings may not reflect views elsewhere in the country.[1]
  • The authors cautioned that DNR rules cannot simply be imported from other countries because Saudi jurisprudence has a distinct Islamic legal basis.[1]

Questionnaires completed by Jeddah interns and residents

Study designObservational study[2]
PopulationInterns and residents in four major hospitals in Jeddah[2]
Sample size140 questionnaires[2]
SettingFour major hospitals in Jeddah, Saudi Arabia[2]
Main outcomeKnowledge and attitudes of interns and residents toward DNR and its implication on patient care[2]
Times cited35[2]

How later work placed the 2016 survey

The same later paper invoked the 2016 work when discussing limited understanding of ethical care for DNAR patients, and noted that some people associate DNAR with receiving no care. This frames the survey finding as relevant to care perceptions, but does not show how often that misunderstanding occurred in the surveyed group.[1] [3]

A 2020 review of pediatricians’ perceptions cited the 2016 survey’s finding that most interns and residents favored patient participation in decisions, despite the fatwa’s exclusion of patients from that process. This highlights a tension between respondents’ stated preferences and the policy framework described in later citations.[2] [4]

What the survey leaves unresolved

  • Would clinicians in hospitals outside western Saudi Arabia report similar familiarity with local policy?[1] [2]
  • How do respondents’ stated views about patient participation relate to decision-making in clinical practice?[2] [4]

Sources

  1. Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia (Europe PMC, 2016)
  2. Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia (Informa UK Limited, 2016)
  3. Deaths in the Emergency Department: An Assessment of Patient's End-of-Life Trajectory and Quality of Care (2020)
  4. Pediatricians’ Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review (2020)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/amep.s99441, Alternate LINK

Title: Perspectives Of Interns And Residents Toward Do-Not-Resuscitate Policies In Saudi Arabia

Subject: Education

Journal: Advances in Medical Education and Practice

Publisher: Informa UK Limited

Authors: Abdullah Amoudi, Mohammed Albar, Amjed Bokhari, Sultan Yahya, Anas Merdad

Published: 2016-03-01

Everything You Need To Know

1

What exactly does a Do-Not-Resuscitate (DNR) order mean in the context of healthcare in Saudi Arabia?

In Saudi Arabia, a Do-Not-Resuscitate (DNR) order, sometimes referred to as 'no code' or 'allow natural death,' is a legal instruction to healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops or they stop breathing. This order doesn't mean that all treatment is withdrawn; the patient continues to receive care focused on comfort and dignity, but CPR is not administered.

2

Who makes the decision regarding a Do-Not-Resuscitate (DNR) order for a patient in Saudi Arabia, and is patient or family consent required?

In Saudi Arabia, the decision to issue a Do-Not-Resuscitate (DNR) order, according to a 1988 fatwa, rests with a panel of three specialized and trustworthy physicians. Unlike many other countries, neither the patient's nor the family's consent is legally required for the order to be issued. This process reflects the influence of Islamic jurisprudence on medical decision-making within the country.

3

Under what specific medical conditions can a Do-Not-Resuscitate (DNR) order be issued in Saudi Arabia according to the established fatwa?

According to the established fatwa in Saudi Arabia, a Do-Not-Resuscitate (DNR) order can be issued under six specific conditions: when a patient arrives at the hospital already deceased, when the patient's condition is determined to be untreatable and death is imminent, when the patient's condition is unsuitable for resuscitation, when the patient suffers from advanced heart or lung disease or repeated cardiac arrest, when the patient is in a vegetative state, or when resuscitation is considered futile. These conditions provide a framework for when a DNR order is deemed appropriate by the medical professionals.

4

Are Do-Not-Resuscitate (DNR) policies consistent across all hospitals in Saudi Arabia, or are there variations in their application?

While the core tenets of Do-Not-Resuscitate (DNR) policies are generally consistent across hospitals in Saudi Arabia, variations can occur, especially in the areas of patient autonomy and family involvement in the decision-making process. This highlights the ongoing need for standardized national DNR laws that respect both cultural and religious values while aligning more closely with global ethical standards regarding patient participation in end-of-life decisions.

5

Why is there a push for enhanced education and national laws regarding Do-Not-Resuscitate (DNR) orders in Saudi Arabia, and what impact is it expected to have?

The emphasis on strengthening education about Do-Not-Resuscitate (DNR) policies and the ethical treatment of DNR patients in Saudi medical schools and residency programs seeks to address gaps in understanding and implementation. Furthermore, the push for national DNR laws aims to prioritize patient involvement in decision-making, promoting compassionate and ethical end-of-life care that respects both patient dignity and the principles of Islamic jurisprudence. This evolution is crucial for aligning Saudi Arabia's practices with global ethical standards.

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