Ethical Obligations and Clinical Goals in End-of-Life Care: Deriving a Quality-of-Life Construct Based on the Islamic Concept of Accountability Before God (Taklīf)

Abstract

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives (especially Christian and Jewish), little work has been done from an Islamic point of view. To fill the gap in the literature around Islamic bioethical perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God (taklīf) to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or continue clinical treatment when patients who were formerly of, or had the potential to be, mukallaf (the term for a person who has taklīf), are now not expected to regain that status by means of continued clinical treatment.

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

“…In both cases, however, the reliance is on medical knowledge and physician expertise. Again, there is little offered within the fatwās, regarding the evaluation of depressed neurological status being reliant on religious ends, for example, the inability of the individual to affect their afterlife (Padela & Mohiuddin, 2015).…”

“…In this way, Muslim patients, families, and physicians carry their beliefs and values into the clinical encounter and may seek to negotiate healthcare pathways that align with their religious values, and at the same time, cohere with the conventions, professional standards, and expectations of clinical care. Thus when negotiating clinical care goals at the endof-life, and when making decisions about withholding and withdrawing of life-sustaining care, clinicians, patients and families may look to the ethical guidelines sourced within their faith tradition (Padela & Mohiuddin, 2015).…”

“…This is particularly true in the arena of end-of-life care where Muslim physicians, families, and patients struggle with decision-making. They struggle in finding actionable guidance, in part, because there are few papers that analyse the various juridical positions on end-of-life care ethics and present them in an accessible fashion (Padela & Mohiuddin, 2015). In particular, there has been no summative review that we are aware of that covers the various Islamic bioethical views on withholding and withdrawal of interventions near the end-of-life.…”

Muslim physicians and palliative care: attitudes towards the use of palliative sedation

“…Still largely absent is a normative Islamic perspective on death and dying as a process , a step which seems essential to developing an Islamic understanding of palliative care and quality of life as death approaches. Despite its absence, Muslim physicians have to come to terms with this form of comfort-orientated care, as it is part of their daily medical professional practice [ 30 ].…”

On Strengthening Compassionate Care for Muslim Patients

“…The [Arabic] religious term used to define such individuals is mukallif, which is taken to mean a person who is burdened to bear the weight of religious dictates (Padela & Mohiuddin, 2015). Therefore, infants, those with mental illness, and people who have lost cognitive ability (such as those who are unconscious or in coma) are excluded from the requirement to observe religious dictates.…”