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Year : 2020  |  Volume : 4  |  Issue : 5  |  Page : 104-105

End-of-life guidelines: Iran confronts COVID-19

1 Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Managing Director of the Oxford International Development Group, A Health Research and Project Management Consulting Company in Oxford, Mississippi, USA

Date of Submission13-Jun-2020
Date of Acceptance15-Jul-2020
Date of Web Publication13-Aug-2020

Correspondence Address:
Dr. Seyed Mohammad Reza Hashemian
Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bbrj.bbrj_127_20

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How to cite this article:
Hashemian SM, Miller J. End-of-life guidelines: Iran confronts COVID-19. Biomed Biotechnol Res J 2020;4, Suppl S1:104-5

How to cite this URL:
Hashemian SM, Miller J. End-of-life guidelines: Iran confronts COVID-19. Biomed Biotechnol Res J [serial online] 2020 [cited 2022 Aug 11];4, Suppl S1:104-5. Available from: https://www.bmbtrj.org/text.asp?2020/4/5/104/292077


Health-care professionals are under increased stress as the COVID-19 pandemic encircles the globe. As of July 12, 2020, the coronavirus is affecting 213 countries and territories around the world.[1] The United States, with over 3,321,000 cases, is ranked first.[1] Iran, initially one of the hardest hit countries, currently has 255,000 cases, ranking it tenth.[1] At a time of increased demands on critical care resources and limitations in staff and life-saving equipment, physicians also face urgent end-of-life decisions (EOL), and comprehensive guidelines are needed to ensure equitable care and allocation of increasingly scarce resources. Many national health systems are updating policies to assist their front-line critical care doctors with EOL issues in the face of finite critical care support such as staff, beds, and equipment.[2]

A team of experts from World Health Organization (WHO) traveled to Islamic Republic of Iran on March 10, during a COVID-19 mission, after five days of extensive meetings and field visits they announcing that Iran was using a strong and integrated national health system to respond to this outbreak. Also, health officials and health workers are clearly working very hard and are committed to controlling this outbreak and saving people's lives.[3] However, despite the heroic efforts of individuals and teams of physicians, nurses, and medical personnel in Iran, the impact of current U.S. sanctions policy initially impeded access to drugs and medical equipment needed to confront the pandemic and save the lives of its people. Policy decisions by the current U.S. administration also resulted in delay of testing of its own citizens and left Americans unprepared for a looming public health catastrophe.[4] American and Iranian physicians share similar challenges; In the face of the COVID-19 pandemic, US administration policies are having a negative impact on their health care system.

The U.S. federal government has provided one of the world's worst responses to the pandemic, with sheer lies and incompetence,[5] leaving states to compete for resources and interfering with national directives led by its science community, which has caused an exponential increase in the number of cases and deaths in the U.S. It also placed its health-care workforce at risk as hospitals are overwhelmed by COVID-19 patients and has crippled the ability of other countries to respond to the crisis by blocking medical supplies and other humanitarian aid.[5]

Given the unprecedented and unfolding global situation, and expected future pandemics, Iran also should consider establishing EOL guidelines, which currently do not exist. In the UK, the “COVID-19 Rapid Guidance for Critical Care” was published in response to the pandemic and places the focus on how and when to use frailty on admission to help patients, clinicians, and families make rapid and timely admission decisions.[2] In France, guidelines written at the request of Paris-area health-care authorities are intended to help provide conceptual support to all health-care teams currently engaged in the frontline management of the COVID-19 pandemic.[6] In the U.S., the California Health Care Foundation is providing an online COVID-19 resource for serious illness and end-of-life care.[7]

A study of intensive care units in Asia indicated that, absent this guidance, individual Iranian physicians are less likely than peers in other countries to withhold active therapy or withdraw active therapy in cases where patients had no real chance of recovering for a meaningful life.[8] Such guidelines are needed to provide a structure to stratify care for the COVID-19 and other pandemics and take into account EOL beliefs of Iran's Sunni, Shia, Jewish, Christian, and Zoroastrian populations.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

COVID-19 Coronavirus Pandemic. Available from: https://www.worldometers.info/coronavirus/#countries.  Back to cited text no. 1
Pattison N. End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic. Intensive Crit Care Nurs 2020;58:102862.  Back to cited text no. 2
WHO. WHO and public health experts conclude COVID-19 mission to Islamic Republic of Iran. Available from: http://www.emro.who.int/irn/iran-news/delegation-of-who-and-public-health-experts-concludes-covid-19-mission-to-iran.html.  Back to cited text no. 3
Shear MD, Goodnough A, Kaplan S, Fink S, Thomas K, Weiland N. The Lost Month: How a Failure to Test Blinded the US to COVID-19. The New York Times; 2020.  Back to cited text no. 4
Dalglish SL. COVID-19 gives the lie to global health expertise. Lancet 2020;395:1189.  Back to cited text no. 5
Azoulay É, Beloucif S, Guidet B, Pateron D, Vivien B, Le Dorze M. Admission decisions to intensive care units in the context of the major COVID-19 outbreak: Local guidance from the COVID-19 Paris-region area. Crit Care 2020;24:293.  Back to cited text no. 6
COVID-19 Resources: Serious Illness and End-of-Life Care March 27, 2020. Available from: https://www.chcf.org/publication/covid-19-resources-serious-illness-end-of-life-care/.  Back to cited text no. 7
Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med 2015;175:363-71.  Back to cited text no. 8


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