In the Name of Allah,
Most Gracious, Most Merciful.
In our lives, we often face difficult decisions. Sometimes these decisions are a matter of life and death. Should I donate a kidney so that another may live? Should I turn off life support for my brain-dead child? Should I mercifully end the suffering of my terminally ill, elderly mother? If I am pregnant with quintuplets, should I abort one or more so that the others have a better chance of surviving? If I face infertility, how far should I go in treatment so that I might, Allah-willing, have a child? As medical treatment continues to expand and advance, more ethical questions come up.
For guidance on such matters, Muslims turn first to the Qur'an. Allah gives us general guidelines to follow that are constant and timeless.
The Saving of Life
"...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 anyone saved a life, it would be as if he saved the life of the whole people...." (Qur'an 5:32)
Life and Death is in Allah's Hands
"Blessed be He in whose hands is the Dominion, and he has Power over all things. He who created death and life that He may test which of you are best in deed, and He is Exalted in Might, Oft-Forgiving." (Quran 67: 1-2)
"No soul can die except by Allah's permission." (Quran 3:185)
Human Beings Should Not "Play God"
"Does not man see that it is We who created him from sperm. Yet
behold! He stands as an open adversary! And he makes comparisons for Us, and
forgets his own creation. He says who can give life to (dry) bones and
decomposed ones? Say, 'He will give them life who created them for the first
time, for He is versed in every kind of creation.'" (Quran 36:
77-79)
Abortion
"Kill not your children on a plea of want. We will provide sustenance for you and for them. Come not near shameful deeds whether open or secret. Take not life which God has made sacred except by way of justice and law. Thus He commands you that you may learn wisdom." (Quran 6:151) "Kill not your children for fear of want. We shall provide sustenance for them as well as for you. Verily the killing of them is a great sin." (Quran 17:31)
Medical Ethics is not an exercise between all black or all white, or
absolute right or all wrong but, in gray areas, when it is not clear, in
Medical Ethics we try to find a better answer over the worse one. The
difference between what can be done and what should be done is the reason for
Medical Ethics. The objectives of Islamic Shariah (Laws) is for the protection
of individual life, religion, mind, property and family. In difficult cases,
the rules are: a) take the lesser of the two evils; b) necessity overrides the
prohibition.
Q.1. Is CPR (Cardio Pulmonary Resuscitation) part of the mandate to maintain
life. What is the status of DNR and code "C"?
A. When the treatment becomes - scientifically - futile (i.e. hopeless), it is
no more mandatory, and DNR would be acceptable.
Q.2. Is it OK to withdraw the life support system for example: (A Ventilator
for a patient who has no cerebral function and is in a vegetative state)?
A. Same answer as questions 1. If there is no hope of treatment, you may
withdraw the life support equipment. In an attempt to prolong life without
quality, one must not prolong the misery at a high cost.
Q.3. When a terminally ill patient and their families reject medical treatment
saying that "it is God's will", what should a physician do? In the
same context, if the physician suggests DNR, then what should the families do?
A. a.) Rejecting treatment; Tell them that treatment is also God's will, that
Jesus said, "I cure the sick with the leave of God"; That Mohammed
said "your body has right on you, and said: seek treatment, servants of
God, for every illness God created, he created a treatment for=2E (B.) The
family should comply because the physician is one who knows best. But the
decision is theirs.
Q. 4. What is the definition of "dead" when do you say it is OK to
turn the machine off when the patient is dead? Is brain death and brain stem
death the same thing?
A. Bra in death is no synonymous with brain stem death and does not mean death.
Brain death including brain stem death, means death. The brain stem contains
the centers for breathing and the heart. Thus brain stem death fulfills the
requirements of Cardio-pulmonary death.
Q. 5. If a person is in a vegetative state on artificial life support but he is
not brain dead but his survival chances are minimal, are physicians' allowed to
turn off the machine at this point?
A. If "minimal" means hopeless upon scientific assessment, one may
turn off and withdraw life support.
Q.6. Should cancer patients' requiring heavy pain medication take the
medication or be in pain patiently and remember God.
A. They must be given pain medication, remember God, and be patient about
residual inevitable pain that cannot be relieved medically. A heavy dose of is
permitted if necessary, provided the intention (niyyah) is not to kill the
patient.
Q.7. Should a Muslim patient with terminal cancer or parents of a newborn with
a congenital defect with a poor chance to survive seek the most invasive and
most expensive treatment and do whatever that can be done to save lives or
submit to God's will and accept death?
A. Heroic treatment with poor prognosis is not an Islamic requirement, if
scientifically it has no promise of cure.
Q.8. Is organ donation permitted in Islam?
A. Certainly with the juridical safeguards. "An whoever saves a soul it
would be as if he had saved all mankind". It should be given as a gift.
The sale of an organ is prohibited. (Quran 5:32)
Q.9. Is receiving organs for transplantation from an animal source permitted
and especially if the animal is a pig?
A. Certainly permitted. Necessity overrules prohibitions in the juridical rule.
Q.10. is it necessary to have the permission from the donor or a relative to
receive the organ?
A. Definitely yes.
Q.11. What is the Islamic position on fetal tissue transplant?
A. As long as the procurement of the fetal tissue is legitimate, it is all
right. It is not permissible to conceive or to induce abortion of a fetus for
the sole purpose of taking its tissues for therapeutic use.
Q.12. What types of contraception are allowed in Islam?
A. As long as they are not harmful; they are not abortifacient; or they do not
cause sterility.
Q.13. How come contraception is allowed and abortion is not?
A. Contraception is a prevention of pregnancy; abortion extinguishes an
existing human life.
Q.14. If the fetus is diagnosed with a genetic disease such as Down's Syndrome;
can the mother have an abortion?
A. Islamically not but, also Islamically society should support the life of the
child if the parents cannot.
Q.15. Would you allow an abortion for pregnancy resulting from rape?
A. No. Why kill an innocent life? But the baby should be the responsibility of
society if the mother cannot support it. Coverage, care and sympathy are
amongst her rights. I acknowledge a different position taken by other notable
jurists. Why commit one crime because of another crime.
Q.16. Is giving medication like RU 486 "the morning after pill" which
prevents the formation of zygote equal to causing an abortion?
A. No; unless the pregnancy has already formed or implanted.
Q.17. Is the conception without implantation an abortion?
A. I tend to take it as a different form of abortion.
Q.18. If a mother is fertile but cannot carry the child for medical reasons, is
surrogacy allowed?
A. Not in Islam. Procreation emanates from a marriage contract, and a marriage
contract accommodates two persons; husband and wife. Thus, assisted
reproduction is allowed only between husband and wife while they are married.
Q.19. When a woman is not able to have a baby; the man has the option of
marrying another woman. What happens if the man is sterile, does the woman have
any options?
A. She has the legitimate option of procuring a divorce and marrying another
man.
Q.20. What is your view about permanent sterilization?
A. Only for permanent medical indication or for the porous woman approaching
her menopause.
Q.21. When does life begins? At inception or at 120 days "when the spirit
is blown"?
A. Life and spirit are not synonymous. Life begins at the inception, fusion of
sperm and egg. Abortion in both stages is a crime however; it is a more severe
crime in the second stage.
Q.22. Is cloning permissible or not?
A. A short answer is no. A cell from a sterile husband to be cloned and
incubated in his wife's uterus requires independent consideration but the
"sliding slope" factor should be taken very seriously. However,
genetic engineering deletion of a gene to cure a disease is acceptable.
Q.23. Is homosexuality genetic or inborn?
A. Please clarify the difference between genetic and inborn. Whatever its
cause, its practice is prohibited. In Islam, the key is not "Be what you
are" but "Be what you should be", irrespective of moods and
inclinations. Sometimes inborn conditions can have a genetic expression later
on.
Q.24. Are Muslims allowed consuming medications, which contain alcohol or pig
by-products?
A. Only if it is a life saving necessity, when non-alcoholic and non-pork
medicines ate not available.
= Q.25. If a Muslin doctor who is apposed to abortion and euthanasia is asked
by his non-Muslim patient to perform such procedures, which is also acceptable
in the States, should he refuse because of his personal convictions?
A. Yes. There is room for the conscientious objector in our system.
Q.26. I am a medical student and I would like to know if it is OK for a female
doctor to examine male patients private areas, or is it OK for a male doctor to
be a Gynecologist?
A. It is all right, early jurists allowed it. Medical Figh Conference in Kuwait
in the 80's allowed it for the purposes of diagnosis, treatment and medical
education. The Niyyah, (intention) however, is of crucial importance in the
individual case. Patients' preferences should be respected.
Q.27. Do Medical Ethics slow down medical research and progress?
A. It should not. Safeguards and regulations are necessary if medicine is to
remain medicine.