Few data are available concerning this type of decision in the emergency departments (ED) [4,9,23,24]. However, to our knowledge, there are no studies concerning WH/WD life-sustaining therapy in ED from Arabic countries where religious and ethical values, medical resources are see more different from those in Western countries [25-27]. There Inhibitors,research,lifescience,medical are no guidelines in Morocco, where social traditions are rather conservative. Moreover, relations among family members are close, and religious issues often play a vital role in decision-making by families and physicians [27]. We undertook

an observational study of practices in WH/WD in a Moroccan ED to assess the frequency of such practices, the therapies withheld Inhibitors,research,lifescience,medical or withdrawn, and the processes leading to these decisions. Methods Study design and setting This was an observational study conducted in the Emergency Department (ED) of Rabat University Hospital, from November 2009 to March 2010. Ibn Sina university hospital in Rabat is the referral for habitants in Western-North Morocco, it is a 1028 bed tertiary Inhibitors,research,lifescience,medical – stage hospital that opened in 1955. The bed occupancy

rate is of 76% to 85%. The hospital comprises 24 departments (12 surgical, 9 medicals, and 3 intensive care units), and admits adult patients. Gynecology-obstetric and pediatric patients are treated in other structures. The mean of ED visits (including consultation and admission) per day is 176. The Inhibitors,research,lifescience,medical ED comprises two units (medical and surgical). The medical staff is constituted by 4 senior doctors (greater than 2 years experience in the unit) and 5 juniors (emergency physicians, and resident juniors with less than 2 years experience in the emergency unit). All staff members who belonged to the ED were not aware of the progress of the study. Definitions Withdrawal was defined as discontinuation of treatments that had previously been implemented, and withholding was defined as a predetermined decision not to implement Inhibitors,research,lifescience,medical therapies that would

otherwise be deemed necessary: endotracheal intubation, mechanical ventilation, intravenous (IV) fluid expansion, massive transfusion (more than three red cell packs), vasopressor infusion, cardiopulmonary resuscitation, renal replacement Liothyronine Sodium therapy [28]. Data collection We surveyed all adult patients who died on stretchers after their admission to the ED. Patients with brain death were excluded and those who died during transit to the ED. Data were collected by a single senior member who was never involved in the decision of withholding and withdrawal of life-sustaining treatment. He interviewed every day the doctor (who documented specifically his action) about all patient who died in emergency department in the last 24 hours.