Bio Ethics: Question of Life and Death

Nor take life - which Allah has made sacred - except for just cause. And if anyone is slain wrongfully, We have given his heir authority (to demand Qisas or to forgive): but let him not exceed bounds in the matter of taking life; for he is helped (by the law). (Quran Al-Isra' 17:33)

Say: "Come, I will rehearse what Allah has (really) prohibited you from": join not anything as equal with Him; be good to your parents; kill not your children on a plea of want - We provide sustenance for you and for them - come not nigh to shameful deeds, whether open or secret; take not life, which Allah hath made sacred, except by way of justice and law: thus does He command you, that you may learn wisdom. (Quran Al-An'am 6:151)

Islam considers human life sacred. Life is to be protected and promoted as much as possible. Since the Florida woman Terri Shiavo's case came in the news, there is a lot of discussion on the issue of life and death. It is important for us as Muslims to understand our position and also to prepare ourselves in case we or our dear ones confront such a situation. There are a number of important questions:

1. What is the Islamic position on euthanasia?

2. Is it permissible to prolong life artificially and at what point it is allowed for doctors to "pull the plug"?

3. In case of dispute who makes the final decision, doctors, parents, spouse, children or government? 

4. When does the death occur?

5. How important is it for us Muslims to prepare a will explaining our position in this matter?

1. Euthanasia or "Mercy Killing": There is no provision in Islam for killing oneself or another person to reduce his/her physical or emotional pain or suffering from sickness or injury. It is the duty of the doctors, patients' relatives, and the state to take care of the sick and to do their best to reduce the pain and suffering of the sick, but they are not allowed under any circumstances to kill the sick person. The sick person also should patiently endure the pain and should pray to Allah. Faith and patience bring both comfort and blessings in this life and in the eternal life. 

If, however, a number of medical experts determine that a patient is in a terminal condition, there is no hope for his/her recovery and all medications have become useless, then it permissible for them, through a collective decision, to stop the medication. Under no condition it is permissible to induce death. As long as a person is alive, it is his/her right to be fed. Medical experts and relatives should not withhold nutrition from a living person. They should do their best to provide him/her with necessary nutrition by whatever method it is possible. 

2. Prolonging life artificially: The Shari'ah favors life and emphasizes that life should be protected as much as it is possible. According to the Quran "saving one life is like saving the whole humanity" (Quran Al-Ma'idah 5:32). Thus the Shari'ah scholars are in favor of using all methods, including artificial resuscitation to protect life. 

If a patient is placed on life support and the doctors see no improvement in the patient's health conditions, and the doctors indicate that the artificial resuscitation has become useless, then with due consideration and care and by collective decision of medical experts, family members and religious scholars, it would be permissible, to decide to switch off the life support machine and to allow the nature to take its course. 

3. In case of dispute who makes the final decision? Shari'ah would prefer a consensus and collective decision in this matter. The decision should be made with compassion and by bringing all the family members together by explaining the whole situation and consequences. It is better that courts should not interfere in this matter unless there is a suspicion that, for example, the doctor belongs to an organ transplant group or the family member is interested in the inheritance or bequeath or any one in the team is accused of professional misconduct. It is better to make error and save life rather than err and lose life.

4. When is a person dead? Muslim medical experts have defined death in the following way: An individual is considered dead in one of the following two situations:

A) Complete irreversible cessation of respiratory and cardiovascular systems.

B) Complete irreversible cessation of the functions of the brain including the brain stem.

This should be confirmed by the accepted medical standards. In case of brain death it is required to have the presence of a reliable medical specialist well experienced in the clinical diagnosis of brain and brain stem death and the various implications of such diagnosis. 

5. Preparing the will: The Prophet urged all Muslims to prepare their will. It is always good to have an Islamic will. The way the situation is changing and the increasing involvement of the governments and courts in this matter, makes it even more urgent and necessary that we carefully think how to preparer our Islamic will, not only for the distribution of inheritance, but also for our medical treatment in case of coma or other complications and also our proper Islamic burial. 

May Allah keep us on the right path and save us from difficulties in this life and in the life to come.

Ameen. 

Dr.Muzammil Siddiqi is a world renowned Islamic Scholar and a pioneer of several Muslim organizations in North America. He was educated at Aligarh Muslim University and Darul Uloom Nadwatul Ulama, Lucknow, India and graduated from Islamic University of Medinah in Saudi Arabia in 1965 with a higher degree in Arabic and Islamic Studies. He received a M.A. in Theology from Birmingham University in England and Ph.D. in Comparative Religion from Harvard University in USA.

It was narrated that Usaamah ibn Shurayk (may Allaah be pleased with him) said: The Bedouin said: �O Messenger of Allaah, should we not treat sickness?� He said, �Yes, O slaves of Allaah, treat sickness, for Allaah did not send down any disease but He also sent down its cure, except for one disease.� They said, �O Messenger of Allaah, what is it?� He said, �Old age.� Narrated by al-Tirmidhi, 2038; classed as saheeh by al-Albaani in Saheeh al-Tirmidhi. 

It was narrated from Abu Hurayrah (may Allaah be pleased with him) that the Prophet (peace and blessings of Allaah be upon him) said: �Allaah has not sent down any disease but He has also sent down a cure for it.� 

Narrated by al-Bukhaari, 5678.

Ibn al-Qayyim said: 

The basic principles of medicine are three: prevention, maintaining good health, and removing harmful substances from the body. 

Allaah has mentioned them all together, to His Prophet and his ummah in three places in His Book. 

He prevented the sick person from using water lest it harm him, as He says (interpretation of the meaning): 

�And if you are ill, or on a journey, or one of you comes after answering the call of nature, or you have been in contact with women (by sexual relations) and you find no water, perform Tayammum with clean earth and rub therewith your faces and hands (Tayammum)�

[al-Nisa� 4:42] 

Allaah allowed the sick person to do tayammum to protect him, just as He permitted it to the one who has no water. 

Allaah says concerning the maintenance of good health: 

�and whoever is ill or on a journey, the same number [of days which one did not observe Sawm (fasts) must be made up] from other days�

[al-Baqarah 2:185] 

The traveller is allowed to break his fast during Ramadaan, to protect his health lest the combination of fasting and the difficulties of travel weakens him and affects his health. 

Ibn al-Qayyim said:

In the saheeh ahaadeeth there is the command to use medicine, and these ahaadeeth state that this does not contradict the idea of putting one�s trust in Allaah, just as warding off hunger, thirst, heat and cold by means of their opposites does not contradict it. Rather the reality of Tawheed cannot be perfected without following the means which Allaah has created in order to reach ends, both by His universal will and in His laws that He has prescribed. Ignoring this matter undermines the very essence of putting one�s trust in Allaah, just as it undermines the concept of Allaah�s command and wisdom, and weakens it so that the one who does not use the means to an end thinks that not using them is a stronger form of putting one�s trust in Allaah. But not using the means to an end is a sign of weakness which contradict the idea of putting one�s trust in Allaah, the essence of which is the reliance of the heart on Allaah to provide that which will benefit a person in this world and in the Hereafter, and to ward off that which will harm him in this world and in the Hereafter. But it is essential to depend on use of the means, otherwise one is denying the wisdom of Allaah and the laws which He has prescribed. So the slave of Allaah should not call his helplessness dependence on Allaah, or call his dependence on Allaah helplessness.

Zaad al-Ma�aad, 4/15.

abuayisha wrote: It was narrated that Usaamah ibn Shurayk (may Allaah be pleased with him) said: The Bedouin said: �O Messenger of Allaah, should we not treat sickness?� He said, �Yes, O slaves of Allaah, treat sickness, for Allaah did not send down any disease but He also sent down its cure, except for one disease.� They said, �O Messenger of Allaah, what is it?� He said, �Old age.� Narrated by al-Tirmidhi, 2038; classed as saheeh by al-Albaani in Saheeh al-Tirmidhi.    It was narrated from Abu Hurayrah (may Allaah be pleased with him) that the Prophet (peace and blessings of Allaah be upon him) said: �Allaah has not sent down any disease but He has also sent down a cure for it.�  Narrated by al-Bukhaari, 5678.

Salaam,

I am used to sticking up for myself, so your opinions do not hinder me. 

Please do not think I am against medicine (& maintaining one's good health), the above Hadith clearly state - �Allah has not sent down any disease but He has also sent down a cure for it.�

For me, this is clear & means a 'natural cure', the Ahadith I stated mention natural medicines, and not 'man-made remedies�.

You are implying that, we have a duty to rely on technology that is imperfect � when I was a child and I caught a common cold, I �stuck it out� for a few days, until my body overcame it. Now my younger sister goes to the Dr�s and comes back with antibiotics, she tells me she has a chest infection.

If you rely on medicine every time you become sick, your body will not be able to build up a strong immune system, hence you in fact will only become weaker as a result.

If Allah (swt) had truly decreed that we should use the technology you speak of, then why has He created MRSA, a �hospital super bug� that is immune to any antibiotics???????

If you think medicine � can save your life, maybe you should offer Salah to the medicine!

If you think a machine - can save your life, maybe you should offer Salah to a machine!

If you think a man - can save your life, maybe you should offer Salah to a man!

Do you believe Isa (pbuh) cured lepers? And if so, how did he do so without medicine?

Allah�s word - �Be, and it is�

I am aware of the Hadith that says, Prophet did tell his companions not to pour medicine in his mouth but the other part I haven�t read that he ordered the medicine to be poured in everyone�s mouth present at that time. Anyhow, first we have to analyze that, does this mean that Holy Prophet did not took medicine ever in his life? I don�t think that is the case because the next Hadith which you have quoted indicates that in fact he did recommended some medicines like honey and cumin seeds etc. I have a book in Urdu by Dr Khalid Ghaznavi with a title �Medicines of Holy Prophet and the Modern Science�. He has narrated over 200 medicines which the Holy Prophet prescribed for his companions during the illness so once we consult hadith it can not be an isolated one from one book but we have to consult the remaining 5 as well and in those there are prescriptions from the Holy Prophet. In fact my mother is still using one of Prophet�s medicines for treating asthma, and has gradually improved in last about 5 years.

So I take it that way that he didn�t want to have medicine at that time and people around him should have obeyed him and perhaps that was the message he wanted to give by ordering the medicine to be poured in everyone�s mouth that, �Prophet must be obeyed at all the times, whether ill or healthy.� As his message was not only meant for his companions but for the rest of the human kind as well therefore it had to be intimated in clear terms.

God has created this universe governed by the Physical Laws or the laws what we call as nature. But God Himself is not governed by these laws rather He governs these laws and he do changes them only when he intends. Like in the times of Prophet Dawood the sign of acceptance of sacrificed animal was a fire receding from sky and burning it down, similarly the children of Israel were served with �manna and quails� descended from heavens and cloud used to serve the purpose of shade for them in Sinai Peninsula, Prophet Ibrahim came out of fire alive etc.

But God decided to have none of these physical laws to be broken in the Ummah of Prophet Muhammad (PUBH). Like Prophet himself lived in the valley of Shaib-ibe-Talib for about 3 years in state of drought and hunger but nothing came from heavens, he got severe injuries in his face during the battle of Uhad, He had to dig the ditch for the battle of Ahzaab, so he did not bring any miracle abstaining the physical laws except for The Quran.  The splitting of moon was not a challenging miracle in its classical sense as it was presented by the Prophet to a limited gathering by the Will of Allah.

Life is the gift of God and we do not know as to when we will die. So we must try to preserve life with whatever means available. Indeed if one has to die he will not survive with whatever equipment or machinery we use except for the Will of Allah. But Allah has devised ways for us. As Allah says in Sura Sohraa 26 (The Poets) � verses 79 � 81 �And He Who gives me to eat and gives me to drink: And when I am sick, then He restores me to health: And He Who will cause me to die, then give me life:� there can be numerous causes of death like disease, accident, poison, hunger etc but that doesn�t mean that Allah physically kills someone. Similarly He says in Sura Najam 53 (The Star), �43. And that He it is Who makes (men) laugh and makes (them) weep; 44. And that He it is Who causes death and gives life- 45. And that He created pairs, of the male and the female 46. From the liquid when it is lodged. 47. And that on Him is to bring forth a second time; 48. And that He it is Who enriches and contents;�. So does this mean that Allah physically comes to make someone laugh or weep? No certainly He creates conditions which cause someone to weep and someone to laugh and be happy. Indeed we all must all love to meet Allah, but then should we pray to die in order to meet Allah? Or should someone take the course of suicide in order to meet Allah? No in fact Holy Prophet has forbidden all that. And do we really meet Allah once we die? No we will meet Allah only in Heavens. So lets not mix up things here. I often refer to a common saying in the military, �There is a hair line difference between bravery and stupidity like of having faith or trust in God and be lazy.� Like if someone jumps from tower or stand outside a trench just for nothing or to receive a bullet in the chest is indeed not bravery but at the same time advancing towards enemy under intense fire or firing on to them while taking appropriate position even once they are advancing with great momentum is indeed a courageous act. Studying hard, praying for good position in exams and leaving the rest on God is indeed having faith in Him, but by merely praying and not working hard is and act of laziness.

So should we take medicine or not? Well I think we should but leave the cure part for God. He may create conditions where a patient may recover from a simple glass of water and may create conditions where an artificial respiratory machine fails. He just has to say BE and it happens. But he does tell us to use our mind and struggle. As said in Sura Najam (The Star-53) verse 39 �And that man shall have nothing but what he strives for.�

The side effects of medicines mean that after administering the medicine to its maximum permitted dose these effects were found in the patients. It doesn�t mean that all effects will appear on a single medicine. There normally are 3 possibilities: (1) One or more effects may appear in most of the patients (2) At least one contraindication is likely to be experienced in most of the patients. (3) No side effect is likely to be experienced in most of the patients. And there are other alternatives as well if some one observes more side effects as a result of these allopathic medicines he may switch over to Herbal or Homeopathy which has least side effects. If we can�t eat rice in crude form what we do?? We cook it. So we have to find other appropriate ways rather to leave it altogether.

Similarly Allah is Raazak (sustainer and provider of food) be he does not go from door to door to deliver food. He has created ways and means to search and get ones� share how much someone gets? Well its all up to Allah. As He says in the following verses:

�And there is no animal in the earth but on Allah is the sustenance of it, and He knows its resting place and its depository all (things) are in a manifest book�.(Sura Hood-11 Verse-6).

�Or, Who originates the creation, then reproduces it and Who gives you sustenance from the heaven and the earth. Is there a god With Allah? Say: Bring your proof if you are truthful�. (Sura Nimal (The Ant 27)- Verse 64).

�And how many a living creature that does not carry its sustenance: Allah sustains it and yourselves; and He is the Hearing, the Knowing�. (Sura Ankboot(The Spider 29) verse 60).

�Allah is He Who created you, then gave you sustenance, then He causes you to die, then brings you to life. Is there any of your associate-gods who does aught of it? Glory be to Him, and exalted be He above what they associate (with Him)�. (Sura Roam (The Romans-30) verse 40).

So indeed Allah is the sustainer and provider of food but he doesn�t provides it to us while we sit in our home waiting it to fall from the heavens it will not happen in the Ummah of Prophet Muhammad we will have to strive for it until Allah intends so. Similarly we will not be treated without medication until Allah commands it to be so and Allah usually doesn�t break his laws. As said in Quran:

�This is Our course with regard to those of Our apostles whom We sent before you, and you shall not find a change in Our course.� (Bani Israel -17:77)

�(Such has been) the course of Allah with respect to those who have gone before; and you shall not find any change in the course of Allah.� (Ahzaab � 33:62)

So whether someone like Terri Shiavo should live artificially or not? Well I will 100% agree with Dr. Muzammil Siddiqi.   

Shams Zaman [email protected]

Pakistan