Ethical Issues at the End of Life: Islamic perspective

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Islamic Medicine
Staff member
[FONT=&quot] الدكتور محمد علي البار[/FONT]
It is not imperative on muslims to seek remedy, except in life- saving situation, and where the illness is infectious and is going to affect the community e.g. tuberculosis or other infectious remediable diseases. The health authorities can impose certain measures like enforcing treatment or quarantine in certain highly infectious diseases, for the safe guard of the community.

The Principle of autonomy should not be over ruled except where the dangers extend to the community, but it is of paramount importance to understand that Islamic teachings holds high the principle of autonomy. The ailing person should have control over the type of remedy he is required to perform and his informed consent is mandatory. Unfortunately the freedom of choice is not always available, and in many third world countries may never exist.

The rule of autonomy entails a competent major person who can decide for himself what is best for him. In pediatrics the parents or custodian of the child usually takes the decision in the best interest of the child. If the parent or custodian is not acting in the best interest of the child, the Qhadi (The magistate) can replace a new custodian to act in the best interest of the child.

The court in Kuwait enforced renal dialysis for a child suffering from renal failure despite the parent’s wishes.

There are many Fatawas (legal Islamic decision) allowing withdrawal of all resuscitative measures when brain death is diagnosed. The respirator could be switched off, and any drugs given stopped. The decision of diagnosing brain death is always a medical one and the ensuing ending of resuscitative measures should not be left to the family. It is a medical decision.

Similarly if the treating physician finds a certain modality of treatment is useless or going to increase the suffering of the patient, that modality of treatment should not be enforced from the start. Simply that means withholding

certain useless or harmonious mode of treatment. The prophet Mohammed (PBUH) said: ”above all do no harm” and this rule of non-maleficence is the corner stone of all medical ethics.

Stopping a useless type of medication or certain measure that support life will come under the same rule, but the lifting of life support should be decided by a committee involving the treating physicians, ethical and community member. It should also be discussed with the family. Many Fatawas regarding the end of life are available. Euthanasia is not allowed. However, stopping a useless mode of treatment is another matter, and is not prohibited. The end of life should be as smooth as possible and any unnecessary management that could bring suffering to the dying patient or his relatives should never be used.
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