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In our position paper, EUTHANASIA from an Islamic perspective, we are very clear that Active Euthanasia (giving lethal injection to end life, as an example) is not just absolutely prohibited; rather it is condemned in Islam. However declining treatment is allowed in Islam. Withdrawal of treatment is considered as passive euthanasia by some Muslim scholars, no matter how futile the treatment.
In order to understand this contemporary issue of Bioethics, we need to trace the entire problem, bringing to light various issues which have stirred the entire medical community, religious and moral institutions, to deliberate on this matter.
Modern medicine has been enormously successful in saving and extending lives1. No one can disagree with it, but it has raised certain issues, namely, how to treat those who are alive, but not living lives they think worthwhile, and have no prospects for anything better. It has been argued that there is a strong prima facie case for allowing persons who are facing intractable pain or indignities in the final stages of their lives to determine for themselves when life is no longer worth living, and, where necessary, receive assistance in ending their lives. This prima facie case is constructed from the principles of liberty, autonomy and equality; from the value of preventing unnecessary suffering and preserving the dignity of the individual2. Active euthanasia is not legal. PAS is legal in the Netherlands, Belgium, and Switzerland. In the United States, Oregon legalized PAS in 1997, and the practice was legalized in Washington State in March of 2009. 3
The arguments against the ending of life include: the sanctity of life and the moral wrongness of killing; the possibility of an incorrect diagnosis or a miracle cure; the alleged inability to know that voluntary informed consent has been obtained; the "slippery slope" argument; and the ability of modern medicine to control pain.
Etymology: Gk, eu, good; thanatos, death
1. The act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection or the suspension of extraordinary medical treatment.
2. A quiet, painless death4.
Euthanasia5: It refers to the practice of ending a life in a manner which relieves pain and suffering. It is a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. It may be called intentional mercy killing.
Voluntary Euthanasia: The physician intentionally ends the patient's life at the patient's request and with the patient's full informed consent.
Non-voluntary Euthanasia: Euthanasia conducted where the consent of the patient is unavailable
Involuntary Euthanasia: Euthanasia conducted against the will of the patient.
Passive euthanasia or Euthanasia by Omission: It entails intentionally causing death by not providing necessary usual and customary care by withholding supportive treatments, such as antibiotics, nutrition and respirators necessary for the continuance of life
Active euthanasia or Euthanasia by Commission: The term euthanasia without a qualifying phrase means voluntary active euthanasia or intentionally causing a person's death by performing an action such as by giving a lethal injection.
Physician Assisted Suicide (PAS) 6: The physician provides an individual with the information, prescription, guidance, and means to take his or her own life with the intention that they will be used for this purpose.
Arguments for Euthanasia in cotemporary Bioethics7
Euthanasia and PAS may be considered no different from terminating life-sustaining treatments, which is recognized as ethically justified. In both cases, the patient consents to die, in both cases the physician intends to end the patient's life and takes some action to cause this to happen; the final result is the patient's death. If there is no difference in patient consent, physician intention, or the final result, there can be no difference in the ethical justification. To respect autonomy requires permitting individuals to decide when it is better to end their lives by euthanasia or PAS. Ending a painful life will actually relieve more suffering and thereby produce more good.
Arguments against permitting euthanasia and/or PAS in cotemporary Bioethics 8
The exercise of autonomy cannot include the ending of one's life because that would mean ending the possibility of exercising autonomy. The principle of beneficence does not necessarily mean that euthanasia and/or PAS are acceptable as a means of improving well being. The quality care for the dying is not provided to many patients, leading to needless pain and suffering. There is a reasonable distinction between intentionally ending a life and terminating life-sustaining treatments. The actual acts are different - injecting a life ending medication or providing a prescription for one is not the same as removing or refraining from introducing an invasive uncomfortable medical intervention. By terminating or withholding life-sustaining treatments, the physician's intention is not to expressly end the patient's life but to remove or avoid invasive treatments that adversely impact quality of life and offer no meaningful chance of benefit. By allowing euthanasia we will open a door and euthanasia would not only be for people who are terminally ill. People who are very old and it's difficult to look after them, invalid, disable children all will be given up for euthanasia which will cause moral injustice in the society at large. People to get property of an old or ill relative will subject them to euthanasia. Spouses to get rid of their ill partners and to avoid stress of looking after them will give them for euthanasia as a way out of their circumstances
Islamic view against Euthanasia in the light of Shariah
Life is an Amanah of God as in Quran it is said "To Allah (Almighty God) we belong, and to Him is our return." (Qur'an 2:156).One thing that we must remember is that death is inevitable 9, and everything except the Almighty God of course, will perish. Signs of death can be seen all around us. At funerals we see people who were once walking among us being buried in their graves. In the fall we see the leaves turn from green to yellow and fall one at a time, and in the winter we see trees, lifeless. In this way, all things in this world will wither away and die. However, we as humans have no right to take another human's life as it is God who decides for the life and death; and a human being 10 is a very respectable creature of God. Allah (S.W.T.) says in Surat Al-Isra', (Verse 70), what can be translated as, "We have honored the children of Adam and carried them on earth and in the sea and provided to them the good sustenance. And We made them better than many of what we created." Then Allah (S.W.T) clarified that He (S.W.T.) made the whole universe in the service of man. He says in Surat Lu-Qman, (Verse 20), what can be translated as, "Do you not see that Allah made available for you what is in the skies and on earth and flooded you with many blessings known and unknown." So it is evident that Human being is the best creature of God so how come one take his/ her life as in Quran it is said "...and (Allah) is the one who gave you life, then shall He ordain you to die, then shall He give you your life again, truly mankind is ungrateful" (Chapter 22, verse 66) .The sanctity of human life is a basic concept in Islam"] moreover , it is said "....take not life which Allah has made sacred" (Chapter 6, verse 151) furthermore , it is also mentioned "Do not kill yourselves, for verily Allah has been to you most merciful" (Chapter 4, verse 29) . Now the point comes, if God has made the life of Human, sacred how Islam can permit mercy killing 11. In addition to that Islam has always emphasized on natural death (according to God's plan and not according to a doctor's, judge's or the family's plan or decision) in the patient's best interests and is the most dignified death for a Muslim believer. Now if we look into the issue of mercy killing in Islamic perspective, it is quite evident that God has not permitted us to take any body's life. In fact Allah has guided us on treatment. Illnesses and infirmities in life are facts of life that must be met with patience. Such adversities ought to be regarded as challenges to be faced with fortitude 12. And afflicted person should regard his suffering as a test from Allah and should exercise patience (Al - Saber) Allah states "He test the believers with calamities" Al-Quran 2.153.
Prophet Mohammad (PBUH) said: "Whoever kills himself with an iron instrument will be carrying it forever in hell. Whoever takes poison and kills himself will forever keep sipping that poison in hell. Whoever jumps off a mountain and kills himself will forever keep falling down in the depths of hell." (Sahih Bukhari)
The Prophet (PBUH) said:"I find it strange on the part of a man of faith that he should grieve at his ailment; if he knew what goodness is in his illness, he would love to be ill until he meets his Lord." (Sahih Bukhari)
The Prophet (PBUH) said: "Amongst the nations before you there was a man who got a wound and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' "Sahih Bukhari 4.56.669
The Prophet (PBUH) is reported to have said: Allah (S.W.T) descends diseases and for each ailment He facilitates cures, therefore you should seek treatment 13, but never seek cure from a malignant and harmful substance like poison. 14
The extension of Hukm or legal ruling of an established case to a new case by analogy, when the effective cause is the same in both is Qiyas. We opt for it in biomedical issues. In case of unintentional killing, the relatives of deceased can opt for Qisas, diyah or can forego their right. The consent given by relatives to stop a drug or life support in case of brain dead person. Qiyas is invalid, since the right to pardon presupposes the death of the deceased. Juristic preference Istihsan, according to Hanafi School. Such consent is valid because the effective cause of death was present at that time. There is rejection of this view by Hanbalis and Shafie.
Islamic Code of Medical Ethics
Issued by the first international conference on Islamic Medicineâ€¦it states, "A doctor is well advised to realize his limit and not transgress it. If it is scientifically certain that life cannot be restored, then it is futile to keep a patient in a vegetative state by heroic means or on artificial methods. It is the process of life that the doctor aims to maintain and not the process of dying. In any case, he should not take a positive measure to take a patient's life.
Handling Requests for Euthanasia
Doctors must listen to the person's request and affirm that they understand that a great deal of suffering underlies the request. Being heard and affirmed can remedy some of the major sources of psychosocial suffering that tend to accompany such requests. In addition doctors need to conduct a comprehensive assessment to understand the nature and sources of the entire patient's physical, psychological, spiritual and social suffering. Physicians should determine what social relationships and supports the patient has, and encourage interactions with family and others. Most pain and other physical causes of suffering can be reduced to acceptable levels. Much of the depression, anxiety and other psychological suffering can be minimized. Spiritual suffering can be addressed, as can social issues. With skilled use of palliative care, most experts find that a great majority of cases are resolved and the request goes away. Decisions about life and death matters should never be made in isolation.
Given the need to recite a confession before death, Islam stresses the importance of retaining consciousness until this has been accomplished. The Qur'an is unclear about whether the body "dies" when the soul is removed by the Angel of Death, since it does not favor the Greek-inspired mind-body dualism of the person's makeup. Rather, death is most analogous to sleep; indeed, Rahman contends that "sleep is a sort of lesser death." The Muslim view is, that the life principle resides in God's hands and the absence of it cannot be established just through a lack of brain-wave activity.
From a religious point of view, mechanical intervention at the time of death is of limited value, since death is considered a moment of destiny involving supernatural forces. However, in 1986, the International Collective of Islamic Jurists of the Organization of Islamic Conference rendered an opinion in Amman, Jordan, saying that an individual would be considered dead in either of the following situations: 1. If the heart and breath stop completely, and the physicians are convinced that this condition is irreversible: 2. If all the mental functions of the mind have ceased, and the physicians decide such a condition is irreversible. In either of these scenarios, it is legitimate to disengage all machines, even if some parts of the body are still functioning with their assistance. It is also legitimate to stop all medical intervention. While these guidelines carefully define death, they have also validated decisions to maintain people who are brain dead on life support systems, since such sustenance allows the physician to keep the person alive until body parts can be harvested. The justification for this modification of the body's integrity is the "greater good" of the community. Saudi Arabia has become a leader in this field in the Muslim world.
The general thrust of Muslim belief is that the community must sustain an individual until it is obvious that the believer must face God. Prolonging that moment will serve no religious purpose. Intravenous feeding for the sole purpose of sustaining the mechanical functions of the body runs counter to Islamic notions of death.
Ultimately Muslims believe medicine cannot change the destiny of the human, and attempts to bypass the inevitable may be interpreted as an obvious lack of trust in God.
Killing and its Liability:
In Quran it's been said:
"On that account We ordained for the children of Israel that if anyone slay a person -unless it be for murder or 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).
Saving of one person life is next to saving a whole human race in terms of greatness of its reward. (Al Quran)
To violate it is a serious crime therefore, to kill someone deliberately because he is suffering from an unbearable painful illness or injury or because he is too old and has lost all usefulness and praise for living or his illness is incurable comes under culpable homicide and punishable by Qisas (Quran Ayah 2.178)
Intentional Killing of someone with incurable disease & unbearable pain: Not Allowed in Islam.
In case of a Murdered victim:
Heirs of a murdered victim can forgive a victim after the victim has died.
Heirs cannot allow killing or remove life saving support before victim's death.
In Islam anything done by doctor to cause heart, lung or brain death is considered to be Euthanasia which is not permissible in Islam.
If a doctor or a surrogate decision maker does euthanasia then he has to pay compensation (Al-DIYAH) to the relatives.
He would be deprived of any benefit from inheritance or any reward from the victim in his favor
He has to pay AL-Kaffarah as well. This depends on type of euthanasia and intention behind it.
The Quran is forthright about death as a major passage to another life. In Islam, it is not quite true to say that death is the cessation of life, but rather, that the life one receives at birth is preparatory for the life after death.
Islam is against euthanasia. Human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam.16
Islam strongly condemns ending of human life on grounds of mercy and human sympathy. Life is a great gift from Allah and is to be cherished and protected at all times. Muslim doctors, nurses and patients should have this basic positive attitude towards human life. They are considered to be life savers and not killers. Islam strongly urges the afflicted person to exercise patience, and strongly exhorts his relatives and community to help relieve his sufferings.
Active euthanasia is islamically forbidden for it encompasses a positive role on the part of the physician to end the life of the patient and hasten his death. This is an act of killing, and, killing is a major sin and thus forbidden in Islam, the religion of pure mercy. As for the declining of medical treatment which is, from a medical perspective, thought to be useless, this is permissible and sometimes it is even recommended. Passive euthanasia, which is withdrawal of treatment, remains controversial, requires expiation, even though pardoned by the relatives.12
Only ALLAH has the attributes of AR-REHMAN and AR RAHIM. He is the most Gracious and the most Merciful more than any human being can ever be so we all should pray to ALLAH in difficult situations instead of thinking ourselves to be more merciful by allowing euthanasia for ourselves or for others.