Content Page - Medical Ethics: An Islamic Perspective
The sanctity of human life is ordained in the Quran. "Do not take life which God has made
sacred except in the course of Justice" (6:151), and "anyone who has killed a fellow human except
in lieu of murder or mischief on earth, it would be as he slew the whole mankind" (5:32).
About suicide, Quran is very clear: "Do not kill yourselves as God has been to you very
merciful" (4:29). Taking away the life should be the domain of the One who lives life. True, there
is Pain and suffering at the terminal end of an illness, but we believe there is reward from God for
those who patiently persevere in suffering (Quran 39:10 and 31:17).
While Muslim Physicians are not encouraged to artificially prolong the misery in a vegetative
state, they are ordained to help alleviate suffering. Quran says, "Anyone who has saved a life, it is
as if he has saved the life of whole mankind" (5:32). Prophet Muhammad (PBUH) emphasized this
by saying, " O Muslims, seek cure, since God has not created any illness without creating a cure."
There is no doubt that the financial cost of maintaining the incurably ill is a factor. However,
the question is when the human machine has outlived the productive span and its maintenance
becomes a financial burden on society, should it be discarded abruptly or allowed to die naturally,
gradually and peacefully? Islamically, when individual means cannot cover the needed care, it
becomes a collective responsibility of the society. To meet this objective, the society has to reshuffle
its values and priorities and divert funds from those spent on alcoholism, drug abuse, teenage
pregnancy, and other such "pursuits of happiness" to providing health care for those who
are hopelessly ill and allowing them to live with quality and die in dignity.
The IMA endorses the stand that there is no place for euthanasia in medical management,
under whatever name or form (e.g., mercy killing, suicide, assisted suicide, the right to die, the duty
to die, etc.). Nor does it believe in the concept of a willful and free consent in this area. The mere
existence of euthanasia as a legal and legitimate option is already pressure enough on the patient,
who would correctly or incorrectly, read in the eyes of his/her family the silent appeal to go.
Although the Committee makes no explicit mention of euthanasia, the implications are too obvious
to ignore.
At the same time, the IMA holds the view that when the treatment becomes futile, it ceases
to be mandatory. This would reflect on the administration or continuation of medical treatment
(including the respirator). Adequate public debate (and education) should precede and proceed to
necessary legal adjustments.
Under such conditions, however, the basic human rights of hydration, nutrition, nursing and
pain relief cannot be withheld. These may be carried out at home or in an institution as the case
warrants. Palliative care units or institutions would answer such need, but we are not certain whether
this justifies the branching off of a full-blown medical specialty for palliative care.
It is realized that the demarcation line between futile and infutile medical treatment is often
blurred. Proximity to death cannot define futility of treatment, since near-dead patients may often
be successfully treated and revived. The gray area between futile and promising treatment should
be narrowed as much as possible, and the subjective element in it should be minimized. An
independent second opinion might be of help. However, this area open to research. Perhaps
the relation of outcomes to a battery of clinical parameters, or combinations thereof, might help the
establishment of a "futility index" with reasonable precision, that would further guide the current
clinical assessment
The IMA follows the current policy about DNR (do not resuscitate), where treatment is
deemed futile. Brain death, including the brain stem, is an acceptable definition of death, with all
the consequences pertaining to cessation of animation or the procurement of vital organs for
transplantation.
Because the emphasis in such patients is not on treating the primary disease but on
ameliorating the quality of life, research is recommended towards controlling the accompanying
symptoms like pain, weakness, excretory dysfunction, ulceration, etc. Gadgets and aids can make
a big difference.
Affective and psychological care is important, and both both care givers and family (guidelines
or brief courses) should be trained for it. Perhaps music therapy should be further looked into as a
significant addition to the management.
The spiritual dimension should be recruited to help the patient. This is not the function of
clergy only, but health professionals should have adequate training in handling patients and guiding
families. Care of the terminally ill should not belong in "rush" medicine or hurried physicians.
Care givers should have an insight into the various religious, cultural and ethnic backgrounds
pertaining to terminal illness and death. A book may be collated indicating indicating culture-specific
guidelines.
Since we live in a time when one's home is no more suitable to be born in or to die in, reliance
has become heavy on institutional care. In most cases there is no one at home to look after the
patient. This is one of the drawbacks of the industrialized society, which tremendously pushes up
the cost of the care. Encouragement of volunteerism and perhaps providing incentives might cover
part of this gap and is good for the moral health of society at large.
Of course, the issue of care for the terminally ill, as a component of health care in general,
is closely combined with the modern trends in restructuring health care.
It is regrettable to see that the business aspects of health care are expanding at the expense of the service (humane) side of health
care. A radical review is needed, but we seem to be drifting away from it. It takes a society which
is more human oriented than dollar oriented.
Some of the most critical topics for research include defining and identifying end-of-life issues
and educating physicians and the public about these issues. The third-party provider also needs to
understand that the sanctity of life is more comprehensive than a mere cost factor.
IMA makes the following suggestions: