"Right to Die?":

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Islamic Medicine
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Muslim Views About End of Life Decisions

I: Introductory Remarks

"How fortunate you are that you died while you were not afflicted with illness." Thus said the Prophet addressing the person whose funeral rites he was performing. Such an assessment of death without illness coming from the founder of Islam indicates the value attached to a healthy life in Muslim culture. To be sure, good health is God's blessing for which a Muslim, whenever asked: "How are you (lit. "How is your health?")?", must respond: "All praise is due to God!" However, this positive appraisal of good health might seem to suggest that illness is an evil that must be eliminated at any cost. No doubt illness is regarded as an affliction that needs to be cured by every possible legitimate means. In fact, the search for cure is founded upon unusual confidence generated by the divine promise that God has not created a disease without creating its cure. Hence, the purpose of medicine is to search for cure and provide the necessary care to those afflicted with diseases. The primary obligation of a Muslim physician is to provide care and alleviate suffering of a patient. Decisions about ending the life of a terminally ill patient at her/his request is beyond his moral or legal obligations. The Qur'an reminds Muslims that "it is not given to any soul to die, save by the leave of God, at an appointed time." (Q. 3:145) Moreover, "God gives life, and He makes to die. (Q. 3:156) And, hence, "A person dies when it is written." (Qadar, # 11)

Death, then, comes at the appointed time, by God's permission. In the meantime, humans are faced with the suffering caused by illness. How is suffering viewed in Islam? Is it part of the divine plan to cause suffering? With what end? These general questions about meaning and value of suffering should lead us to appraise the suffering caused by prolonged illness to an individual's personal and family life. The need to take decision to end one's life arises precisely at that critical point when the sick person is undergoing severe discomfort and desperation, and when all forms of advanced medical treatments have failed to restore her/his hope in getting better.

Closely related to such a consideration on the part of the sick person is whether the unbearable circumstances caused by one's interminable illness makes existence worthwhile at all. Does such an existence that is almost equivalent to non-existence because of intense sense of helplessness in managing one's life possess any value for its continuation? Beneath these concerns lie a deeper question about the quality of life that individuals and society regard as worth preserving.
II: Question about the Quality of Existence:

The importance attached to the quality of life question has sometimes led Muslim scholars to evaluate suicide (in Arabic expressed as qatl al-nafs = `homicide') in very ambiguous ways. On the one hand, there is a unanimity in declaring the act as an irrational behavior that human beings should not commit; on the other, their interpretation of the act being committed under situations a person is unable to cope with, indicates a factual, even condoning attitude toward suicide. The following case of an old man who committed suicide under tragic circumstances highlights the ethical and legal debate surrounding the right to end one's life under compelling circumstances:
The Case of the Shaykh Who Committed Suicide:

"Recently we saw what happened to a learned Shaykh. This Shaykh had come to live in a very reduced circumstances. Therefore, people began to avoid him more and more, and his acquaintances no longer wanted to have anything to do with him. This went on for a while until one day he entered his home, tied a rope to the roof of his room, and hanged himself, thus ending his life.

When we learned about the affair, we were shocked and grieved. We discussed his story back and forth, and one of those present said: What an excellent fellow! He acted like a man! What a splendid thing he did of his own free will! His action indicates magnanimity and a great staunchness of mind. He freed himself from a long drawn-out misery and from circumstances which were unbearable, on account of which nobody wanted to have anything to do with him, and which brought him great privations and a steady reduction of means. Everybody to whom he addressed himself turned away from him. Whenever he knocked at a door, it was closed before him. Every friend whom he asked for something excused himself.

While that person thus defended the action of the suicide, someone else replied: If the Shaykh escaped from the dreadful situation which you have just described, without getting himself into another situation which might be considerably more frightful and of a much longer duration than that which he had been in, it would indeed be correct to say that he did a splendid thing. What a noble fellow, one might then say, he was, considering the fact that he found strength and the means to commit such a deed! One would have to admit that every intelligent person should feel compelled to do the same thing, to imitate him and to arrive at the same decision of his own free will.

However, if he had learned from the sacred law (sharayi`) - no matter whether the ancient or the new one (al- shari`a) - that such and similar actions are forbidden, it would be necessary to say that he did something for which God has ordained quick punishment and disgrace in the painful fire of Hell. My God! He could surely have learned from any intelligent and judicious, learned and educated person, from anybody who has some intelligence and knows the elements of ethics - let alone him who knows what to say and to do and to choose always the best procedure of and occasion for doing things - that such actions are forbidden and that even the commission of much lesser deeds is prohibited. Why did he not suspect himself and scrutinize his motives and consult someone who might have given him good advice! And all this happened on account of a situation which was such that if he had extricated himself from it, he would thereafter have encountered many things so much worse that they would have made him forget his former hardships.

He ought to have known that it is necessary to avoid any connection with such an action, which is detested by intuitive reason, considered sinful by tradition and shunned with horror by nature; for the generally known injunctions of the religious laws and the consensus of all in each generation and region show that suicide is forbidden and that nothing should be done which might lead to it. The reason for prohibition of suicide is that it might be committed under the influence of ideas and hallucinations which would not have occurred to a person in the full possession of his mental faculties. Later on, in the other world, the person who committed suicide under such circumstances would realize the baseness of his action and great mistake he made; then, he cannot repair, correct or retract what he did.

Even if compliance with the demands of the intuitive reason, or information derived from reason and revelation would have required him to commit such a deed, he should not have handed himself over to destruction. He should not have of his own free will done something which is despised by persons who are discerning and perceptive, religious and noble. He should not have broken established customs, opposed entrenched opinions, and arrogated the rights of nature. But all the more so should he have refrained from his deed since the intuitive reason and speculation have decided, without leaving the slightest doubt, that man must not separate those parts and limbs that have been joined together (to form his body); for it is not he who has put them together, and it is not he who is their real owner. He is merely a tenant in this temple (i.e. the human body) for Him Who made him to dwell therein and stipulated that in lieu of the payment of rent for his dwelling he take care of its upkeep and preservation, its cleaning, repair and use, in a manner which would help him in his search for happiness in both this world and the next world.

We ask God in Whose hands rests the power over everything that He may guide us toward that way of life which is preferable for this world and which will lead to greater happiness in the world to come. For if we were left without His kind care and customary benevolence, we would be lost and forsaken."

(From Muqabasat of al-Tawhid)
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