This slide program outlines some of the end of life decisions. It explains what are the relevant directions in medical ethics. It also explains the foundations of Islamic law and its guidelines for end of life decisions.

2. • "Everyone shall taste death. And only on the day of
resurrection shall you be paid your wages in full.
And whoever is removed away from the fire and
admitted to paradise, this person is indeed
successful. The life of this world is only the
enjoyment of deception." (The Holy Qur'an:3:185)

3. Abu Hurairah (RA) reported that
Prophet (SAW) said, “ You must
remember often the killer of
pleasures ,i.e., death. “

4. Abu Huraira (RA) said that Prophet (SAW) said,” No one should desire death. If he is
righteous, he will increase his righteous deeds.
If he is sinful, perhaps he will seek forgiveness from Allah. “ (Bukhari)
Anas Ibn Malik (RA) said that Prophet (SAW) said,” No one should desire death.
If there is no other way, then one should say, ‘O’ Allah! Keep me alive as long
as living is better for me and let me die when death is better for me. “ (Bukhari)

5. Jabir (RA) said I heard from Prophet (SAW) three days before his death saying, “No
one of you should die except he must have good hope with Allah’.(Muslim)
Anas (RA) reported that Prophet (SAW) came to a young man who was at his death bed. He
asked, “ How do you feel?” He replied,” By Allah! O Prophet of Allah! I have hope with Allah
and I am afraid of my sins.” Prophet (SAW) said,” These two are not gathered at this time in a
slave’s heart except Allah grants what he hopes and protects from what he fears.” (Tirmizi)

6. • Medical interventions may save or prolong the life of
some terminally ill patients.
• Mechanical ventilation is the most common life
support treatment withdrawn in anticipation of death.
• Decisions about Cardiopulmonary Resuscitation (CPR),
• Artificial nutrition and hydration are among the most
emotionally and ethically challenging issues in end of
life
• Issues of futility
• Advance directives
• Palliative care

7. • 1-Euthanasia- X intentionally kills Y for Y's benefit
(Death which is not a benefit to a person is not euthanasia)
A-Passive Euthanasia X allows Y to die
B-Active Euthanasia X performs an action which itself results
in Y's death
• --Voluntary Y requested death himself
• --Non-voluntary Y has not expressed a preference
• --Involuntary Against Y's wishes
2- Suicide Y intentionally kills himself
3- Assisted Suicide X intentionally helps Y to kill himself
4- Murder X intentionally kills Y

8. Euthanasia is now legal in-
• Netherlands,
• Belgium,
• Luxemburg, and
• some states in Australia; while
Physician assisted suicide is legal in-
• State of Washington and
• State of Oregon in the United States of America

9. • Karen Ann Quinlan-
• Nancy Cruzan
• Schiavo-
o Was in persistent vegetative state since 1990.
o Her feeding tube was removed in March, 2005
o She died after 13 days due to dehydration

10. Proponents arguments
• Self determination &
respect for human
autonomy
• Compassion and kindness
to patient with incurable
disease
• Doctrine of double effect-
Act has beneficial and
harmful effects but
harmful effect is not
intended
Opponents arguments
• Violates moral belief that
human life should never be
taken intentionally
• Basic human right not to be
killed
• There are not enough
protections that would allow for
a just and fair practice of
euthanasia
• Risks and harms outweigh the
benefits

11. • Treatment should provide the patient with some
benefit that is sufficient to outweigh the burdens
• In resuscitation, factors to be considered :
A-Potential benefits of resuscitation
 Restoring life to the patient
 Sense of closure
 Resolution of guilt for the survivors
B-Potential risks –
 Financial and
 Resource investments,
 Resuscitation to a suboptimal quality of life

12. • Medical futility is an intervention that will not enable
the achievement of the intended goal of the
intervention
• Ethical questions surrounding the concept :
1. How to prevent futility from becoming a judgment
call made by health care staff
2- Treatments that provide a smaller benefit may be
eliminated.
3- -Necessary treatments will be labeled futile in order
to save money specially in elderly, disabled, managed
care, and socioeconomically disadvantaged populations

13. • Advance directives or living wills may avoid the ethical
conflicts associated with withholding and withdrawing
medical treatment
• Advance directives aim to honor individual autonomy
and respect individual choice.
• Ethical concerns-
1- May improperly influence health care providers to
limit care
2- Person frightened of becoming disabled may use
advance directives to limit treatment
3- This approach may not be useful if a medical
treatment decision requires an immediate answer

14. 14
The Holy Book Quran
(Hadith), words or actions
of the prophet
Sunnah
(Ijma) of the Jurists Consensus
(Ijtihad) personal study
and research of Mujtahid
Wisdom

15. 15
Category Arabic Do it Not do it
Obligatory
(Prescribed)
Fard
Wajeb Reward Punishment
Recommended
(Desirable)
Mustahab
Mandub Reward No Punishment
Permitted
(Allowed)
Mubah
Halal No Reward No Punishment
Discouraged
(Disliked)
Makruh
Manboth No Punishment Reward
Forbidden
(Prohibited)
Haraam
Mahd’ur Punishment No Reward

16. • Based on Islamic laws—the Sharia's—in place to
benefit humans
• Major goals of Sharia's—protection and
preservation of:
• Life
• Intellect
• Progeny
• Property
• Religion
16

17. • First Principle (from the Qur’an):
“Whosoever saves a human life, saves the life of
the whole mankind.”
• Second Principle (from the Hadith):
“There is no disease that God has created, except
that He also has created its treatment.”
17

18. 18
 Necessity overrides prohibition (insulin from
pork, medications with alcohol).
 Remove harm at every cost if possible (quit
smoking, risk factors, disease therapy).
 Accept the lesser of two harms if both cannot
be avoided (abortion in risk to the pregnant
woman).
 Public interest overrides individual interest
(blood and organ donation).

19. • "The angel of death, who is given charge of you,
shall cause you to die, then to your Lord you will
be returned. (32:11)".
• Absolute belief in divine destiny
• Resulting in trust in Allah
• Puts an end to the fear of death, devastation,
poverty and helplessness.
• It rectifies the biggest weakness of man, which is
fear of annihilation or wretched existence

20. • Death is a rebirth and a gate for entering another
world, and
• It is better to call it life rather than death.
• Rumi uses the words ‘dying’ or ‘being reborn in
stages’ to refer to the change of the human embryo
from spiritless matter into the vegetative form, then
into the animal form, and finally into the human
form.
• Man can turn into an angel by death, or even go
higher than angels.

21. • Death does not happen except by God’s
permission, as dictated in the Quran:
• “it is not given to any soul to die, but with the
permission of Allah at an appointed time” (3:145).
• 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)
• “whoever slays a soul, unless it be for manslaughter
or for mischief in the land, it is as though he slew
whole mankind…” (5-32).

22. • “We ordained for the Children of Israel that if any
one slew a person - unless it be for murder or for
spreading mischief in the land - it would be as if he
slew the whole people: and if any one saved a life,
it would be as if he saved the life of the whole
people”
(Chapter 5, verse 32).
• “Demolishing the Kaaba completely is much more
preferred to Allah Almighty than shedding the
blood of a Believing Muslim"
(Words of Prophet Mohammad,2013)

23. • Surely We will try you with something of fear and
hunger, and diminution of goods and lives and
fruits; yet give good tidings to the patient who,
when a misfortune befalls them, say, ‘Surely we
belong to God, and to Him we return’; upon those
rest blessings and mercy from their Lord, and those;
they are the truly guided” (2:153–57).
• Pain reveals God’s purpose for humanity and in
reminding us that ultimately we belong, and will
return to, God.
• Pain is a means to self-purification after sinful
behavior

24. • Suicide is absolutely prohibited, be it as a
voluntary act or out of necessity
• Life is a divine trust and cannot be terminated by
any form of active or passive human intervention
• Its term is fixed by an unalterable divine decree
• “…and do not kill yourselves; surely Allah is Merciful
to you”(4:29).

25. • "Do not kill yourselves, for verily Allah has been to
you most merciful" (Chapter 4, verse 29).
Abu Huraira (RA) reported that Prophet (SAW) said, “ One whow kills
himself by falling from a mountain shall be in Hell and shall continue
to fall from heights. One who kills himself by poisoning shall continue
to poison himself in Hell for ever. One who killed himself with a
weapon, shall continue to assault himself with the same weapon in
Hell for ever. (Bukhari

26. • In another occasion, Prophet Mohammad (SAW)
mentioned that there was a man among those who
were before you received a wound. It became
unbearable. Then he took a knife and cut off his
hand therewith. Whereupon blood began to ooze
out, so much that he died. The Almighty Allah said:
My servant hastened himself to me and so I made
Paradise unlawful for him

27. • Spirit in each one’s body does not belong to that
person,
• We are only trusted to take care of it for our time
on Earth.
• He/she has a duty to preserve and to keep that
trust and that spirit.
• Muslim religious scholars believe that active
euthanasia is unacceptable in Islam
• It is considered as a sin, even though it has a
merciful intent by hastening the death of the ill
person

28. • Two Different Views:
• Person considered alive; withdrawal of life support
forbidden if endangers life of patient (ING View)
• Should not prolong misery of dying patients; imam
should be included in decision-making process (IMANA
View)
28

29. • General consensus on DNRs in Islamic community
is still evolving; decision of medical futility to be
determined by doctors on the case.
• In the absence of terminal illness or futile care
situations, the Muslim patient should seek
medical treatment, including resuscitation, until
recovery or stage of terminal illness or vegetative
state is reached.
• Encouraged to have a written living will and to be
“full code”—agreement to use all recognized
therapies, given reasonable chance of recovery.
29

30. • Some scholars believe that seeking treatment is a must.
• A group of people came to Prophet Mohammad and asked
him: Shall we seek treatment? He replied: Yes, you slaves of
Allah seek treatment. Allah did not create any disease
without creating a treatment for it.”
• Some scholars think it is not must to seek treatment.
• It was mentioned that a woman who had seizure came to
Prophet Mohammad (PBUH) and asked him to pray to Allah
to cure her. Prophet Mohammad (PBUH) told her if she
wants to be patient and therefore go to Paradise or if she
wants him to pray to Allah to cure her and Allah will cure her.
The woman chose to be patient

31. • Withdrawing mechanical ventilation, hydration ,
nutrition off such patients is permissible, especially
those diagnosed with brain death or being in a
persistent vegetative state
• The physician who stops mechanical ventilation and/or
the family member who decides to stop it are not
considered sinners.
• It is better and preferred not to seek medical
treatment in such cases (Al-Kardawi)
• Use of overzealous treatment is reprehensible when
physicians are certain about the futility of treatment
and inevitability of death

32. 32
 When death is inevitable, Islam directs that
the patient be allowed to die without heroic
measures.
 Muslims disapprove of any medical care that
may hasten the death of a patient.
 Muslims prefer to die at home if possible with
the family providing comprehensive physical
and spiritual support.
 Death is not prepared for with prior funeral
arrangements and viewed as an interference in
God’s will.

33. 33
 Blood and organ donation. (giving and
receiving, with consent and no
commercialism).
 Circumcision of male infants
 Breast feeding (two years).
 Human skin bank: Lawful for medical
grafting (e.g. after burns) and unlawful for
cosmetics and misleading others.
Other issues-
Recommended

34. 34
 Autopsy: if for medically or by law indicated.
 Do Not Resuscitate order: when the treatment
becomes futile.
 Withdrawal or withheld therapy is permitted
in brain death.
 Genetic Engineering: to alter or cure diseased
genes.
 Abortion: pregnancy that risk the mother’s
health, physically or mentally.
Permitted

35. 35
Contraception: Islam approves all methods of
contraception between husband and wife
which are not harmful, are reversible and are
not causing abortion.
Artificial insemination: when using the
husband’s sperm and the wife’s ovaries and
uterus.
Death of one of the spouse terminates the
marriage contract on earth, thus frozen sperm
from husband can not be used.
Permitted

36. 36
 Surgical contraception: (Sterilization:
Vasectomy & tubal ligation). Permitted for
mentally sick or when another pregnancy risks
mother’s life.
 Sperm or ova donation.
 Elective abortion in a healthy mother 120 days
after fertilization.
 Human cloning (permitted for tissues and
organs).
Forbidden

37. 37
 Surrogacy Uterus:
Surrogacy involving a third person is not
permissible. (even if the woman involved is
another wife of the husband).
 Cosmetic surgery:
Changing the creation of Allah.
Forbidden

38. 38
 Active Euthanasia: voluntary, non-voluntary
and Involuntary are not permissible under
any circumstances.
 Passive euthanasia: treatment is not obligatory
when there is no hope of survival (brain
death). Patient should be provided with food,
drink, nursing, and relief from pain until
death.
 Suicide: include assisted suicide and
physician’s assisted suicide.
 Murder. "take not life which Allah has made sacred" Qur’an 6:151.
Forbidden

39. 39
 Death definition: when spirit leave’s the body.
 Death is Inevitable: “ Every soul shall have a taste of
death: In the end to Us shall you be brought back." Qur’an 29:57
 The dying person: should lie with their face
towards Mecca. Ideally one should die with
the Declaration of Faith on the lips (Shahada).
 When death occur: eyes should be closed; all
connected tubes removed; all limbs flexed and
the body straightened.

40. 40
 Washing and burying the body as soon as
possible (same day). On the right side, facing
Mecca.
 Respect for the body and prayers over the
dead.
 Recitation of the Quran.
 Mourning should not be excessive, as this
would disturb the dead as well as show lack
of acceptance of God’s will and purpose
regarding death.

41. 41
 Funeral is simple and every human is equal.
 Deceased buried in a white shroud (men 3 pieces,
women 5 pieces) without a coffin.
 Islam forbids cremation.
 Non-Muslims may attend.
 Mourning period 3 days.
 Widow mourns her husband 4 months and 10
days. She is not to remarry, leave her home, or
wear decorative clothing.
 Pregnant widow may remarry 42 days after
childbirth.

42. Ummi Habiba (RA), wife of the Prophet (SAW) said that
she heard Prophet (SAW) saying, “ It is not permissible for
a woman who believes upon Allah and the Day of
Judgment to mourn upon dead more than 3 days except
upon her husband when she can mourn for 4 months and
10 days. (Agreed)

43. 43
 Angels visit the dead in grave during the first
night and question the person regarding his
religion, his Lord and Prophet Mohammad (SAW)
 Believers are comfortable waiting till judgment
day.
 Judgement Day: resurrection of bodies. The good
cross to Paradise, The bad fall off into Hell.
 Child is regarded sinless until the age of maturity.
The soul /spirit of the child is automatically
transferred to paradise.

44. Abu Huraira (RA) said Prophet (SAW) used to
make dua, “ O’ Allah! I seek your protection
against punishment of grave and fire, from
trials of life and death and from trial of Masih
Dajjal. “ (Bukhari)

46. • Ali A. (1992). The meaning of the Holy Qur’an. Bretwood,
Maryland: Amana Corporation.
• Al-Kardawi Y. (1992). Recent formal legal opinions .)Cairo:
Dar Al-Wafa for Publishing.)
• Athar, S. (1996). Euthanasia and physician-assisted suicide:
Testimony of the Islamic Medical Association. October 29,
2013 from
http://www.consciencelaws.org/religion/religion005.aspx..
• Hedayat K, Pirzadeh R. Issues in Islamic biomedical ethics. A
primer for the pediatrician. Pediatrics 2001; 108:965-971.
• Kasule, O.H. (2008). Legal ruling on life support in terminal
care. Retrieved November 29, 2013 from http://omarkasule-
tib1.blogspot.co.uk/2011/06/legal-rulings-on-life-support-
in.html.