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Treatment Refusal (by Patient)

By:
Abul Fadl Mohsin Ebrahim
Source:
The Encyclopedia of Islamic Bioethics What is This? A comprehensive reference work covering the major issues in Islamic bioethics, including medicine, clinical practice, genetics, theology, and Islamic law.

Treatment Refusal (by Patient)

Introduction

The injunctions of the Qurʾān and traditions of Prophet Muḥammad pertaining to hygiene, dietary habits, and the necessity of upholding moderation in all walks of life, encouraged Muslims in the study of medicine. There are many traditions of the Prophet which make specific reference to illnesses and their cure. In fact, the ḥadīth literature has a separate chapter entitled “Medicine of the Prophet” (Nasr, 1968).

The motivating factor behind Muslims’ quest for knowledge in the medical field had more to do with understanding God’s creation so as to be drawn closer to him than with exerting control over life and death. Hence, within the Islamic framework, biomedical technology cannot be completely divorced from ethics. Moreover, in Islam, ethics is not independent of the Shariʿah (Islamic law). In modern biomedicine there is an imperative to “conquer” death by means of life-sustaining technology, and it is especially in this field that Muslims are confronted with a series of ethical issues that have legal implications as well.

Restoration of Health: Is It Mandatory?

Ibn Sīnā (Avicenna, 980–1037) (1:3) defined medicine as the knowledge of the states of the human body in both good and declining health (conditions). The purpose of medicine is to preserve health and to endeavor to restore it whenever it is compromised. In other words, health signifies the natural state in a person’s life while illness or disease is a sort of unnatural condition that afflicts the human body and can be combatted and cured by the use of proper treatment. Illness or disease undoubtedly causes discomfort to the afflicted person, but in no way does traditional Islam view such an affliction as a curse, wrath, or punishment from God. A Muslim is therefore conditioned to view the discomfort of any sickness as a trial or ordeal which in reality brings about expiation of sins (al-Bukhārī, vol. 7, ḥadīth 545, pp. 371–372).

But at the same time Muslims are advised to seek medical attention whenever they fall ill, and this can be deduced from the broad teachings of the Qurʾān as well as the traditions of the Prophet. The importance of seeking medical attention or treatment is hinted by the Qurʾānic verse (16:69) which describes honey as having curative powers. Humans are considered to be composed of body and soul, and the Prophet alluded to two types of ailments, affecting each of these two components separately or jointly. He remarked: “You have two cures at your disposal: Honey and the Qurʾān (Ibn Mājah, 2:1142). Hence, it follows that Muslims are duty-bound to take care of their physical and spiritual health. In modern times, it has scientifically been proven that honey has curative powers both internally when consumed and externally when applied to wounds and sores. The disease of the soul to which the Qurʾān refers may either be that of doubt and uncertainty or that of submission to one’s temptation. The message of the Qurʾān is regarded as the cure for such disease (Ibn al-Qayyim, 1960: Ibn Sīnā, vol. 2).

While addressing the question pertaining to whether it is mandatory to seek medical treatment, one may wrongfully cite the following ḥadīth as evidence: “The Bedouin Arabs came to the Prophet and said, ‘O Messenger of God, should we treat ourselves [for illness]?’ He replied, ‘Yes, servants of God, make use of medical treatment for verily, God has not created a disease without providing a cure for it, except for one disease.’ They asked him: ‘Which one is it?’ He replied, ‘Old age’” (al-Sijistānī, 4:3). However, Muslim jurists typically infer from the above ḥadīth that it is permissible (mubāḥ) and recommended (mustaḥab) for Muslims to seek medical treatment when unwell, even if the ailment is simply related to old age. However, they consider resorting to medical treatment mandatory (wājib) only when it is certain that the medical intervention would assist in saving the life of a person. For example, when someone is bleeding profusely, it would become mandatory to seek medical attention (al-Mazkur, et al., 1989, pp. 216–230).

The Right to Refuse Treatment

Some may wrongfully conclude that they have a right to refuse treatment on the premise that resorting to medical treatment would be tantamount to placing one’s faith in the attending physician, medications, and/or sophisticated life support equipment, thereby compromising one’s trust (tawakkul) in God. Thus it is imperative to note that the Prophet advised his followers who came to offer their prayers in the mosque to first tie their camels and then place their trust in God. It may be inferred from this that if one is unwell, one should seek medical attention and then place one’s trust in God. Muslims are taught to say when taking any medication: “He (God) is the Ultimate Healer” (which is in line with Qurʾānic verse 26:80: “And it is He who cures me when I am ill.”)

This affirmation that God is the Ultimate Healer conditions one to accept the fact that some forms of treatment may not necessarily bring about the desired results. Hence it follows that one has the right to refuse treatment if the prognosis is poor according to the opinion of ahl al-khibrah (the experts in the field of medicine) (Ebrahim, 2001, p. 102). Likewise, one also has the right to refuse to take medication if one feels that one is not deriving any form of benefit from it, as is evident from the following ḥadīth in which ʿĀʾishah, the wife of Prophet, describes an incident before the death of the Prophet: “We put medicine in one side of his mouth, but he started waving us not to insert the medicine into his mouth. We said: ‘He dislikes the medicine as a patient usually does.’ But when he came to his senses he said: ‘Did I not forbid you to put medicine (by force) in the side of my mouth…” (al-Bukhārī, vol. 7, ḥadīth 610, p. 410).

Making Use of Extraordinary Means to Sustain Life

Any attempt to save life in general is indeed a noble task and this is evident from the following verse of the Qurʾān (5:32).: “…and whoever saves the life of a human being, it is as if he has saved the life of all humankind…” This verse is typically used to make a case sustaining human life even if it involves placing a patient on a respirator or other life-sustaining devices. On the basis of analogy (qiyās) then, not to make use of extraordinary means to remove the distress of the patient would be in contravention of the above Qurʾānic imperative pertaining to the importance of saving lives. According to Motlani (2011, p. 6), some Muslim scholars consider withdrawing of extraordinary treatment as passive euthanasia. Still, resorting to extraordinary means to sustain life does not in any way “prolong” life, as Islam teaches that death is inevitable and will occur at the time decreed for it by God. The Qurʾān (63:11) states: “And for all people a term has been set. And when the end of the term approaches, they can neither delay it by a single moment, nor can they hasten it.” Referring to the inevitability of death, Ibn Sīnā (vol. 1, p. 149) states: “It should be remembered that knowledge of health preservation helps neither in avoiding death nor in escaping from external afflictions. It also does not provide the means of extending life indefinitely.” Hence, the legal maxim “harm must be eliminated but not by means of another harm” would justify Muslim families not to opt for overzealous treatment of their loved ones if it would result in draining their financial resources.

Request Not to Resuscitate the Patient

Resuscitation is a medical procedure that seeks to restore cardiac and/or respiratory function to individuals who have sustained a cardiac and/or respiratory arrest. Do not resuscitate (DNR) is a medical order to provide no resuscitation to individuals for whom it is not warranted. This order is generally given by the patient in an advance medical directive, or it may be provided by family members of patients who are terminally ill and have a short life expectancy with a relatively slim chance of surviving cardiopulmonary resuscitation (CPR). In other words, such a request is made to let nature take its course in the face of an impending cardiac arrest (The Cleveland Clinic Department of Bioethics, 2005). The legal maxim “no harm and no harassment” justifies the request of family members not to have their loved resuscitated who, in the opinion of ahl al-khibrah (experts in the field of medicine), has little chance of surviving CPR, or is suffering from a terminal illness. According to Shaykh ʿAbd al-ʿAzīz bin Bāz and Shaykh ʿAbd al-Razzāq ʿAfīfī (Fatāwa al-Lajnah al-Dāʾimah 25/80) “if reviving the heart and lungs is of no benefit and is not appropriate because of a certain situation according to the opinion of three trustworthy specialist doctors, then there is no need to use resuscitation equipment.”

Conclusion

There are numerous Prophetic reports that suggest that Muslims should seek medical help whenever they fall ill, but in general Muslim jurists are of the view that it is not obligatory for Muslims to seek treatment for their medical condition if the apparent cure would not be of any benefit to them. However, medical or surgical intervention would become obligatory in such situations where one’s life would be in danger if one were not to receive medical attention. Moreover, Muslims are not obliged to make use of extraordinary means to sustain life in patients with poor prognosis if that would entail placing them in financial difficulties. Furthermore, Muslim family members have the right to request that their relative with poor prognosis of recovery should not be resuscitated. The aim is not to hasten death, but to avoid harassing the patient and allow nature to take its course.

Bibliography

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  • Ebrahim, Abul Fadl Mohsin. Organ Transplantation, Euthanasia, Cloning and Animal Experimentation—An Islamic View. Leicester, U.K.: The Islamic Foundation, 2001.
  • Ibn Bāz, ʿAbd al-ʿAzīz, and ʿAbd al-Razzāq ʿAfīfī. “Cases in which it is permissible not to use resuscitation equipment.” Islam Question and Answer. https://islamqa.info/en/115104.
  • Ibn Mājah, Abū ʿAbd Allāh Muḥammad Ibn Yazīd. Sunan Ibn Mājah. 2 vols. Cairo: Dār Iḥyāʾ al-Kutub al-ʿArabiyah, n.d.
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  • Mottlani, R. R. “Islam, Euthanasia and Western Christianity: Christian Thinking to Develop an Expanded Western Sunni Muslim Perspective on Euthanasia.” Thesis, University of Exeter, 2011.
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  • The Cleveland Clinic Department of Bioethics. Policy on Do Not Resuscitate. 2005. www.clevelandclinic.org/bioethics/policies/dnr.html.
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