Euthanasia

http://islamqa.org/hanafi/askimam/4670

EUTHANASIA

The belief in Allah’s immutable decree is also revealed in the Shari’ah (Muslim law) where; not only the right to die is not recognized; the right to be assisted in dying, whether through “passive” or “active” means is also ruled out. It is important to clarify here that since the end of life decision is through divine decree, the law refuses to recognize individual right in that matter. However, it recognizes the possibility of arriving at a collective decision by those involved in providing the health care, including the attending physician and the family.

The juridical principle that states `No harm shall be inflicted or reciprocated in Islam’ (la darar wa la dirar fi’l-islam) provides the justificatory force of the ruling to that effect. Moreover, there is no immunity for the physician who unilaterally and actively decides to assist a patient to die.  

The right of individuals to end a life under certain circumstances is a critical issue in our era with many cases of terminally ill individuals where the person, his family, or the doctors need to make a decision related to medical treatments.

 This controversy is looked upon in the light of three basic criteria:

1.      We must do our best to maintain the trust given to us by Allah as he gave us life. We must do our best to maintain life.

2.      Doing our best in maintaining life is within the limits of knowledge and financial resources.

3.      We have to ensure that whatever we do does not introduce unbearable pain or suffering to the human in consideration.

In other words, if an affordable medical treatment is available, it must be administered to the patient provided it does not expose the patient to unusual pains and suffering. On the other hand, using devices or drugs aimed at ending a person’s life is not allowed in Islam no matter how extreme the illness or suffering.

Emotional factors should not be used in making the treatment decision since belief in the Will and Mercy of Allah Ta’ala should provide the patient, his family, and his friends with the needed support. Muslims look upon such hardships as tests from Allah Ta’ala. Patience, persistence, and hope in Allah’s Mercy not only are prescribed for the patient and his family and friends but also are handsomely rewarded by Allah Ta’ala.

Treatment decisions are typically discussed between the doctor and the immediate family members. The doctor is trusted to have the scientific medical knowledge. An Islamic rule which is relevant to state here is that as long as the efforts are sincere and the intentions are to abide by the Islamic rules and follow the commands of Allah, no one is held responsible for the results. No one is asked to do things beyond his true means and his true abilities.

In summary, knowing that every single one will die when Allah Ta’ala wills him to die, we all are asked to only do our best, within the Islamic regulations, in whatever treatment decisions we take.

A person is considered legally dead according to the Shari’ah when the soul has departed from the body. It is extremely difficult to pinpoint the exact moment this takes place.

Islam considers human life sacred. Life is to be protected and promoted as much as possible. It is neither permissible in Islam to kill another human being, nor even to kill one’s own self (suicide). Killing is allowed only in a declared just war situation when the enemy comes to attack, then killing of the enemy is allowed for self-defense. The court of law may pass a death sentence against a person as a punishment for some crimes such as premeditated murder or other serious crimes. However, there is no provision in Islam for killing a person to reduce his pain or suffering from sickness.

Active euthanasia, an act of commission, i.e. taking some action that leads to death like a fatal injection. Passive euthanasia, an act of omission, i.e. letting a person dies by taking no action to maintain life. Passive euthanasia can be withholding or withdrawing water, food, drugs, medical or surgical procedures, resuscitation like CPR, and life support such as the respirator. The patient is then left to die from the underlying disease. Sometimes a distinction is made between normal nutrition and hydration on one hand and medical nutritional support involving intravenous and naso-gastric feeding on the other hand. Euthanasia can be by the patient or by the health care giver. Euthanasia can be voluntary when the patient takes the decision, non-voluntary when the decision is made by another person for an unconscious patient and involuntary when the decision is made contrary to the patient’s wish.

The various types of euthanasia
Euthanasia comes in a number of different means:

1. Direct or deliberate euthanasia:

Active euthanasia, an act of commission, is taking some action that leads to death like a fatal injection. Passive euthanasia, an act of omission, is letting a person die by taking no action to maintain life.

This is done through giving the patient a lethal dose of curare or barbiturates or other derivatives of cyanide with the intention of killing. This has three cases:

a. The voluntary case, when the process is carried out at the pressing request of the patient who desires to die while he is fully conscious, or according to an already written testament.

b. The involuntary case, which is the case of a sane unconscious adult patient. The action to end his life is taken on the decision of the physician who thinks that killing him is for his or her own good, or according to the decision of the patient’s guardian or relatives who think that killing is in his or her best interests.

c. In the involuntary case where the patient is incapable of reasoning, whether a child or insane, the action is taken according to a decision made by the treating physician.

The prohibition of direct active euthanasia, the prohibition of suicide and assisting in bringing it about, for according to the Shari`ah killing a patient suffering from a terminal illness is not permissible for the physician, the patient’s family, or the patient himself. The patient, whatever his illness, and however sick he (or she) is, shall not be killed because of desperation and loss of hope in recovery or to prevent the transfer of the patient’s disease to others, and whoever commits the act of killing will be a deliberate killer. The Qur’an confirms without a shadow of a doubt that homicide is absolutely forbidden, as Allah Almighty says:

(And take not life, which Allah has made sacred, except by way of justice and law.)
(Al-An`am 6: 151)

We ordained for the Children of Israel that if anyone killed a person not in retaliation of murder or for spreading mischief in the land—it would be as if he killed all mankind.)
(Al-Ma`idah 5: 32)

 2. Assisted suicide:

In this case the patient ends his (or her) life by himself according to instructions given to him by another person that provides him with the information and devices that help him to die.

It is unlawful for the patient to kill himself (or herself) and it is unlawful for somebody else to kill him (or her) even if he is given leave to kill him. The former case will be suicide and the latter will be aggression against the other by killing him, for his permission does not render the unlawful act lawful. The patient does not posses his own soul to permit somebody else to take it. The Prophetic hadith is known regarding the prohibition of suicide in general. The person who commits suicide will be tortured in the Hellfire in the same way he (or she) killed himself. If he believes that suicide is lawful, he will be a disbeliever and will abide in the Hellfire forever; otherwise, he will be severely punished.

3. Indirect euthanasia: 

This is done through giving the patient doses of tranquilizers or sedatives to abate the severe pain. With time the doctor will have to increase the doses to control the pain. It is a procedure preferred by therapists, but large doses may lead to difficulties in breathing and dysfunction of the cardiac muscle, which will result in death that was intended though anticipated beforehand.

It is impermissible to kill the patient for fear that his (or her) disease may transfer through contagious infection, even if he is terminally sick (such as one suffering from AIDS). It is not permissible to kill him to prevent the spread of the disease, for there are many other means to do so, such as quarantine. On the contrary, the patient must be protected as a human being and be provided with the required food and medicine till his or her life comes to its natural end.

The Prophet (Sallallaaahu ‘alayki wassalam) is reported to have said, “Allah created no disease but created something to cure it.” (Reported by Al-Bukhari and Muslim)

In another hadith narrated in Tirmidhi:

“O Allah’s Servants! Seek treatment, for Allah does not create a disease but creates a treatment for it.”

The hadith in Muwatta Imaam Ahmad: “Allah created no disease but created something to cure it. Some may know it and some may not.” So these Prophetic hadiths give us hope of discovering cures for what we term today as ‘incurable’ diseases.

Indeed, we have witnessed the discovery of cures for what people considered at one time incurable diseases. Therefore, it is impermissible to kill the carrier of the disease because it is incurable, nor on the pretext of protecting the healthy people from it.

4. Passive euthanasia 

This is achieved by refusing to treat the patient or interrupting the treatment necessary for his survival, including the removal of the apparatus of artificial breathing from the patient in the resuscitating room when it is confirmed that his (or her) brain is dead and there is no hope of restoring his consciousness.

As for facilitating death by withdrawing artificial resuscitating apparatus from the patient who is clinically regarded as “dead” or “practically dead” because of the damage to the brainstem or brain, with which human beings live and feel; if the action of the physician is merely stopping the treatment instruments, it will be no more than giving up the treatment, in which case his action is legal and permissible, bearing in mind that these instruments can preserve the apparent life of the patient – represented by breathing.

And Allah Ta’ala Knows Best

Wassalaamu `alaykum

Ml. Mohammad Ashhad bin Said

Correspondence Iftaa Student, Mauritius

Checked and Approved by:

Mufti Ebrahim Desai
Darul Iftaa, Madrassah In’aamiyyah

http://islamqa.org/hanafi/askmufti/81775

Q: Is euthanasia/mercy killing allowed in Islam?

A: The definition of euthanasia is: a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering.  There are two types of euthanasia: Passive and Active

Passive euthanasia is the withholding of common treatments (such as antibiotics, drugs, or surgery) or giving a medication (such as morphine) to relieve pain, knowing that it may also result in death.

Withholding artificial life support, such as breathing, feeding tubes, respirators, or other life-sustaining machinery is also referred to as passive euthanasia or non-aggressive euthanasia. This is often termed the ‘right to die.’

Another common form of passive euthanasia is to give the patient large doses of morphine to control pain, which usually suppress respiration and causes the patient to die much earlier. These procedures are performed on terminally ill, so that natural death will occur sooner.

In Islam all forms of euthanasia are Haraam and forbidden because this procedure is designed to bring the life of a human being to an end. In the case of active euthanasia, as well as the passive form where large doses of morphine are ministered to the patient, such actions are akin to murder. Whereas in other forms of this procedure the sin will not be equal to murder, there is however, sin incurred because of the intentional termination of a sacred life. It is still, therefore, a major sin. The prohibition will apply even if the patient requested such a procedure.

As for the removal of life-supporting apparatus, this will be permitted on condition that doctors believe these systems will serve no purpose other than to keep the heart or respiratory system functioning. If there is unanimity among the doctors on this matter, then the patient’s family may ask for these systems to be disconnected. This will not be sinful, for at the end death will come at its appointed time. Nothing can expedite death, nor prolong it.

Mufti Siraj Desai

http://islamqa.org/hanafi/daruliftaa/8474

A dilemma facing many in my profession. I am a doctor, currently working in the intensive care unit with children. Although it is not a daily event, the question of withdrawing treatment in patients where further treatment is futile often arises.

In the past where technologies such as ventilators, equipments and drugs such as inotropes (keeping the heart going) were not available these issues would have not risen as these groups of patients would (Allah willing) soon die.
However, with modern technologies so far, a small albeit significant group can be sustained on the above treatment despite a futile outcome that results in the inevitable slow death.

My questions are:

1) What is the Islamic ruling on withdrawing or limitations of treatment?

2) As a corollary to the above, what is the Islamic stand to the concept of ‘living will’? (A living will is a legal document that a sound-minded adult makes to set out the circumstances under which they could wish withdrawal of treatment, in the event that they cannot make the decision at such time).

ANSWER

In the name of Allah, Most Compassionate, Most Merciful,

When a patient is severely ill in a way that further treatment is futile and apparently there is no chance of survival, then in such a case, in order to ease and hasten the death there are normally two procedures taken:

a) Using of certain drugs and other methods that cause death,

B) Withdrawing treatment in order to allow the patient to die naturally,

As far as the using of certain drugs in order to hasten the death of the patient is concerned, there is no doubt that this is unlawful (haram) in Shariah.

The human body is a trust (amanah) given by the Almighty Creator to the human being which he himself does not own. As such, according to Islam, it is impermissible for an individual to tamper with even his own body that was given to him as a trust. Islam regards human life as sacred.

Allah Most High says:

“And verily we have honoured the children of Adam.” (Surah al-Isra, V.70)

It light of the above, it becomes evident that it is unlawful (haram) to use methods and means that would actively cause a person do die.

The Messenger of Allah (Allah bless him & give him peace) said:

“Whoever intentionally throws himself from a mountain and kills himself, will be in the (Hell) Fire falling down into it and abiding therein eternally forever; and whoever drinks poison and kills himself with it, he will be carrying his poison in his hand and drinking it in the (Hell) Fire wherein he will abide eternally forever; and whoever kills himself with an iron weapon, will be carrying that weapon in his hand and stabbing his abdomen with it in the (Hell) Fire wherein he will abide eternally forever.” (Sahih al-Bukhari & Sahih Muslim)

The Messenger of Allah (Allah bless him & give him peace)) also said:

“There was amongst those before you a man who had a wound. He was in (such) anguish that he took a knife and made with it a cut in his hand, and the blood did not cease to flow till he died. Allah the Almighty said: “My servant has himself forestall me; I have forbidden him Paradise.”

Therefore, in order to save oneself from undue pain and hardship, it will not be permissible to use methods that will cause death. If the medical expert did carry this out, it will be tantamount to murder. If the patient gave his consent to this, it will be regarded as suicide.

With regards to withdrawing treatment from patients in order for them to die naturally and in a dignified way, it should be remembered that according to the majority of scholars medical treatment is not something that is necessary (wajib) upon the person inflicted with a illness. It is merely something that is permissible. Some scholars went to the extent to say that it is preferable to abstain from treatment and have patience (sabr) rather than treating the illness or disease.

This understanding is based on a Hadith narrated by the Companion Sayyiduna Abd Allah ibn Abbas (Allah be pleased with him) that a girl was inflicted with the disease of epilepsy, thus she came to the Messenger of Allah (Allah bless him & give him peace) and asked him to supplicate to Allah for her. The Messenger of Allah said to her: “If you wish you may exercise patience and receive paradise in return or if you want I can ask Allah to cure you.” She said: “I would like to remain patient on this severe illness (and receive the rewards), but the only thing is that at times due to this illness, parts of by body become exposed, so please ask Allah that it does not open up. The Prophet (Allah bless him & give him peace) made Dua for her. (Recorded by Imam al-Bukhari & Imam Muslim in their respective Sahih collections)

Imam Abu Hamid al-Ghazali (Allah have mercy on him) mentions in his famous Ihya uloom al-Din that the majority of the scholars hold medical treatment to be merely something that is permissible, whilst others regard it as recommended (mustahab) and a very few number of scholars consider it to be necessary (wajib).

Generally, Medical treatment is thought to be a means that may cure a patient. It is not something that guarantees restoring of health for the person using medication, for the fact that many times despite using medication an individual is not cured.

It is stated in the Hanafi Fiqh reference book al-Fatawa al-Hindiyya:

Means used for the removing of harms are of three types.

1) Those that remove potential harm for certain (maqtu’) such as the drinking of water in order to quench thirst and eating of food in order to remove hunger.

2) Those that by exercising them, it is presumed health will be restored such as medical treatment.

3) Those that may cure (but less significant than the second situation) such as the using of amulets, etc…

As far as the first set of means are concerned, abstaining from using them is no way considered as part of reliance and trust in Allah (tawakkul), rather it is unlawful to refrain from using these means. If a person was to die due to not drinking water, he will be sinful.

The last category of means is not essential in that complete reliance in Allah is only achieved by abstaining from using them.

With regards to the middle category such as using medication, using it is not contrary to the concept of Tawakkul, and abstaining from its usage is not a sin also. It is in between the two categories.” (al-Fatawa al-Hindiyya, 5/355)

It becomes clear from the above excerpt that to abstain for medical treatment is not unlawful in Shariah, and if an individual did die due to this, he/she will not be sinful.

However, the Messenger of Allah (Allah bless him & give him peace) did himself use medication and also encouraged the Companions to resort to medication.

In a Hadith it is stated:

“O servants of Allah! Use medication, for Allah Almighty has not created any illness except that He has also produced its cure, besides one thing. The Companions asked: “What is that?” He replied: “death”. (Tirmidhi 2039, Abu Dawud 3855, Ahmad 4/278 & Ibn Majah 3436)

In light of the above, it would generally be advisable to resort to medication and use the means provided by Allah Almighty. However, in a situation where further treatment is futile and there is no apparent hope for the patient to be cured, then it would be permissible to withdraw treatment with the consent of the patient or his immediate relatives. Also, it will be permissible for the patient to make a living will that gives permission to withdraw treatment in such situations.

And Allah knows best

[Mufti] Muhammad ibn Adam
Darul Iftaa
Leicester , UK

http://islamqa.org/hanafi/daruliftaa-birmingham/19594

DNR

In the name of Allah, the most Beneficent, the most Merciful. 

Answer

A Do Not Resuscitate or DNR order is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest.  Such an order may be instituted by the patient or his immediate relatives.

DNR is considered to be a form of medical treatment and the majority of scholars agree that medical treatment is not something which is obligatory but something which is mustuhub (desirable).  (Nizamul Fatawa p.350 v.1)

It is stated in Fatawa Hindiyyah that there are three means used for removing harms:

1. Those that remove harm for certain such as drinking water to quench thirst and eating food to remove hunger.  In this category abstaining from eating and drinking is not considered as putting trust in Allah, rather it is unlawful to refrain from using these means.
2. Those means where it is presumed ones health will be restored such as medical treatment.  In this category, using medication is not against putting trust in Allah and abstaining from it is not a sin.
3. Those means which may cure like amulets, taweez.  In this category complete reliance in Allah is only achieved by abstaining from using them.  (p.355 v.5)

The conclusion we can come to is that in a situation where further treatment is futile then to pass a DNR order over the patient with the consent of the patient or his immediate relatives is permissible.  Also, it will be permissible for the patient to make a will that gives permission to withdraw treatment in such situations.

Only Allah Knows Best

Mohammed Tosir Miah

Darul Ifta Birmingham