Islamic perspectives on clinical intervention near the end-of-life: We can but must we?

Abstract

The ever-increasing technological advances of modern medicine have increased physicians' capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new "types" of living where a patient's cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care. For some patients and clinicians, religious teachings about the duty to seek medical care and the care of the dying offer ethical guidance when faced with such choices. Accordingly, this paper argues that traditional Sunni Islamic ethico-legal views on the obligation to seek medical care and Islamic theological concepts of human dignity (karāmah) and inviolability (ḥurmah) provide the ethical grounds for non-intervention at the end-of-life and can help calibrate goals of care discussions for Muslim patients. In closing the paper highlights the pressing need to develop a holistic ethics of healthcare of the dying from an Islamic perspective that brings together multiple genres of the Islamic intellectual tradition so that it can meet the needs of the patients, clinicians and Muslim religious leaders interacting with the healthcare system.

Implementation of Palliative Care in Palestine: Cultural and Religious Perspectives

“…Otherwise, the patient will commit a sin if he does not pursue treatment for serious illness. 25,26 However, using opioids as pain killers to reduce the level of pain, and not as a medication, is permissible, but not mandatory. On the contrary, if a Muslim decides to tolerate the pain and not take pain killers, he will be rewarded more in the hereafter.…”

When can Muslims withdraw or withhold life support? A narrative review of Islamic juridical rulings

“…We speculate that jurists may be unaware that medical prognostication near the end-of-life is a tricky science, however the impact of medical uncertainty upon the juridical assessment needs to be studied. In other areas, for example in determining the moral status of seeking medical care, jurists comment that since medical treatment is not certainly curative, one cannot morally obligate patients to seek it (Padela & Qureshi, 2016). In this case it would seem that uncertainty about the restorative potential of clinical treatment would further bolster an argument that forgoing care is permissible.…”

“…For example, would concern for a believer experiencing intractable pain renouncing their faith be an indication for the withholding/withdrawal of treatment? How far if at all do such fatwās involve consideration of Islamic theological concepts of human dignity (karāmah) and inviolability (hurmah) (Padela & Qureshi, 2016) as additional parameters of evaluating harm within the Islamic ethico-legal framework and as a justification or the withholding and withdrawal of treatment? An additional finding is that "harm" within such fatwās is distinct to quality-of-life considerations.…”

Study Protocol for ‘Informing American Muslims about Organ Donation (I AM a LD)’

“…This new tool will offer a representative and malleable set of beliefs, as well group norm and perceived control, and will allow for assessing whether our intervention changed the way in which American Muslims conceive of living organ donation. Lastly, the change in religious ethics knowledge regarding end-of-life care items were, similar to the organ donation religious knowledge scale, formulated based upon our in-depth studies of the Islamic ethico-legal rulings on the topic and reviewed for accuracy by religious leaders in the CAB (Padela & Qureshi, 2016;Padela, Shanawani, & Arozullah, 2011;Padela, Arozullah, & Moosa, 2011)…”