The United Arab Emirates has just passed a federal decree that introduces substantial changes to healthcare in the Gulf state, and challenges prevailing cultural norms.

Federal Decree No. 4 permits doctors to refrain from resuscitation and to conduct sexual reassignment surgery. These amendments are one of several under Decree No. 4 that reduce doctors' criminal liability.

Under article 7 of the law governing healthcare, doctors can now perform sex change operations so long as there are "psychological" and "physiological" signs of gender and sex disparity. The law also requires that the patient undergoing sex change surgery receive mental health care to "psychologically prepare" patients for the transition. 

The UAE would be the second state in the Arabian Gulf to legalize sex reassignment surgery, after Iran. Certain schools of Islamic jurisprudence recognize transgenderism, and the laws do not necessarily fly in the face of religious teachings. Islam has a long and nuanced history with the subject, which, many argue, is not as straightforward as it might appear at the outset.

Egypt permitted sex change surgery at a watershed moment for the transgender community in 2013 when Egypt's Doctors' Syndicate officially recognized "gender identity disorder." 

A landmark ruling in Lebanon this year permitted a transgender person to change genders on their legal identity documents.

"Do Not Resuscitate"

Euthanasia is strictly forbidden in Islam, and many Muslims believe that the " Do Not Resuscitate " order falls under a form of euthanasia.

Looser conditions permit medical staff to refrain from the standard resuscitation procedures by allowing patients suffering from incurable illnesses to die naturally.

If at least three doctors advise against resuscitation, and if all treatment fails, then natural death is permitted.

"Decriminalizing the issue would help to attract the best doctors to the UAE and encourage medical tourism, one of the key elements in Dubai’s future vision for growth," said Stephen Ballantine, a medical malpractice specialist, according to The National .

The new law not only brings about a revolutionary change to the way health care works in the UAE, breaking through cultural beliefs, but also relieves doctors from criminal liability.

Prior to the new law being passed, doctors who failed to perform CPR on dying patients were liable to prosecution. However, under the new law if a patient refuses treatment or fails to follow medical advice, doctors involved will not be held responsible in court.

Ola Kseroof contributed to this report