• "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)

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

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)

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)

• 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• Mechanical ventilation is the most common life support treatment withdrawn in anticipation of death.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

• 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 dieB-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

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

• 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

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

• 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

• 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

• 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

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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

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Category Arabic Do it Not do it

Obligatory

(Prescribed)

Fard

Wajeb Reward Punishment

Recommended

(Desirable)

MustahabMandub 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

• 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

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• 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.”

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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).

• "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

• 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.

• 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).

• “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)

• 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

• 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).

• "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

• 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

• 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

• 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)

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• 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.

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• 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

• 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

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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.

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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

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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

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Contraception: Islam approves all methods of contraception between husband and wifewhich 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

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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

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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

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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

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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.

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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.

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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.

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)

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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.

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 MasihDajjal. “ (Bukhari)

• 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.