Precaution (Ihtiyāt): Do Not Proceed

Islamic Goals for Clinical Treatment at the End of Life: The Concept of Accountability Before God (Taklīf) Remains Useful: Response to Open Peer Commentaries on “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)”

“…Several commentators disagreed with our proposal for mukallaf potential as a therapeutic end goal for end-of-life care treatment (Al-Khafaji et al 2015;Alnakshabandi and Fiester 2015;Emran 2015;Rady and Verheijde 2015). We suggest that treatments that restore a patient's mukallaf potential should be classified as lifesaving because we view mukallaf potential to represent a life with optimal quality.…”

“…This latter position appears to unsettle several commentators (Al-Khafaji et al 2015;Alnakshabandi and Fiester 2015;Emran 2015). We must clarify that our framework does not state that the Muslim physician must not apply advanced therapeutics; rather it asserts that there is no obligation (it is not wajib or fard ̣) to do so.…”

“…Recall that a mukallaf becomes liable for religious obligations, chief among them being ritual acts of worship. Referring to Qur'anic verses that indicate that the entire cosmos glorifies God (17:44, 24:41, 59:24, 61:1, 62:1, 64:1), several commentators suggest that a broader understanding of worship would counter our reliance on the mukallaf construct as an indicator of optimal quality of life because even non-mukallafs, and in this case the inanimate, "worship" God (Al-Khafaji et al 2015;Emran 2015;Rady and Verheijde 2015). Drs.…”

“…Because we argue that a life of optimal quality is one with the potential to volitionally affect one's afterlife, represented by mukallaf potential in our framework, commentators suggest that the posited basis for using the mukallaf construct is flawed given that non-mukallafs can also gain afterlife rewards. Three commentaries cite narrations of the Prophet Muhammad that describe rewards for the ill because of the pain and suffering they experience as evidence for their claim that a patient whose mental capacity cannot be restored to enable mukallaf potentiality can still benefit her afterlife (Al-Khafaji et al 2015;Alnakshabandi and Fiester 2015;Emran 2015). While the Prophetic statements do not address mukallaf status and how that relates to the rewards received on account of being ill, we nonetheless agree that a non-mukallaf individual can gain afterlife rewards.…”

“…First, several commentators pointed out that a person without the cognitive capacity to be a mukallaf may nonetheless gain afterlife rewards (Al-Khafaji et al 2015;Alnakshabandi and Fiester 2015;Emran 2015). Because we argue that a life of optimal quality is one with the potential to volitionally affect one's afterlife, represented by mukallaf potential in our framework, commentators suggest that the posited basis for using the mukallaf construct is flawed given that non-mukallafs can also gain afterlife rewards.…”