Reframing End-Of-Life Ethical Decision-Making in Nursing: Towards an Integrated Islamic Bioethical Framework

Abstract

Background: End-of-life (EOL) decision-making in nursing involves complex ethical challenges, particularly in critical care settings where decisions regarding life-sustaining treatment, medical futility, patient dignity, and family involvement are frequently encountered. While Western bioethical principles provide an important ethical foundation, they may not fully address the spiritual, cultural, and communal dimensions that influence healthcare decision-making in Muslim contexts. This review explores how an integrated Islamic bioethical framework may support ethical decision-making in EOL nursing care. Methods: A narrative review was conducted to synthesise literature related to EOL ethical challenges, nursing roles, Islamic bioethics, Maqasid al-Shariah, and Islamic legal maxims (Qawa'id Fiqhiyyah). Relevant literature published between 2016 and 2026 was identified through PubMed, ScienceDirect, SpringerLink, and ProQuest. The literature was analysed using a thematic narrative synthesis. Results: The review identified six key themes: ethical dilemmas in life-sustaining treatment, moral distress among nurses, nurses' roles in decision-making, differences between Western and Islamic bioethical perspectives, the relevance of Maqasid al-Shariah, and the limited integration of Islamic ethical principles into nursing practice. The findings suggest that Maqasid al-Shariah, together with selected Islamic legal maxims, provides a practical ethical framework that complements existing bioethical principles by promoting benefit (maslahah), preventing harm (mafsadah), and supporting holistic, patient-centred decision-making. Conclusion: An integrated Islamic bioethical framework may complement existing ethical approaches by supporting holistic and culturally responsive end-of-life nursing care. Further research is needed to translate this framework into clinical practice.