Citation for Euthanasia

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MLA

Shah Haneef, Sayed Sikandar . "Euthanasia." In The Encyclopedia of Islamic Bioethics. Oxford Islamic Studies Online. Jan 27, 2022. <http://www.oxfordislamicstudies.com/article/opr/t9002/e0249>.

Chicago

Shah Haneef, Sayed Sikandar . "Euthanasia." In The Encyclopedia of Islamic Bioethics. Oxford Islamic Studies Online, http://www.oxfordislamicstudies.com/article/opr/t9002/e0249 (accessed Jan 27, 2022).

Euthanasia

Introduction

Islam attaches utmost sanctity to human life. Its inviolability is guaranteed not only against the aggression by an outside assailant but also the person himself/herself except as justified by Islamic law. Accordingly, both homicide and suicide are prohibited in Islam. Advancements in the field of medicine, however, have created a new way of ending the life of a patient either on his/her own initiative or if a treating physician deems it fit to discontinue futile medical care, which is called euthanasia. This entry aims to present a compact view of Islamic juridico-ethical stand on the issue.

Definition

Euthanasia etymologically is derived from the Greek words eu and thanatos which means good death. Its primitive forms included giving poisons to patients or abandoning the elderly in the desert to allow nature to take its course (Haneef, 1996; Bok, 1998; Brockopp, 2003; Ebrahim, 2007). Originally euthanasia was carried out either by administering a lethal injection to a terminally ill patient, called active euthanasia, or withdrawing drugs from a patient, known as passive euthanasia (Bok, 1998). With the advancement of medical technology since the 1990s, euthanasia has acquired new forms. Although unlike the pre-medical advances which classified euthanasia into active and passive types, the recent literature regards even withdrawing or withholding life support as ethically objectionable acts, termed in Islam qatl bi al-tark (commission of homicide by omission) (Narimisa, 2014; cf. Brockopp, 2003).

Euthanasia is often equated in Arabic with qatl al-raḥmah, which literally means mercy killing. However, the term “mercy killing” in English tends to be restrictive, as euthanasia not only signifies ending the life of a terminally ill patient on account of mercy/compassion, but also that of those in a permanent coma or vegetative state. Nevertheless, the underlying assumption at least in the case of ending a suffering patient’s life by a positive act (resorting to it out of compassion) may provide a semantic framework for coining it qatl al-raḥmah in Arabic as well. Aware of this, al-Qaraḑāwī defines it as: “facilitating a person’s painless death out of mercy/compassion with the purpose of alleviating his suffering either by commission (fiʿl) or omission (tark)” (2000; Ebrahim, 2007). The Islamic Fiqh Academy, based in Mecca, has adopted a broader view on this issue by allowing the discontinuation of medical treatment for a patient with no hope of recovery on the basis of a decision by three medical experts (“Islamic Fiqh Academy,” 14 May 2015).

Ethical Issues at Stake

Medical care for patients in intensive care units, including modern techniques of sustaining their heartbeat and breathing even if they are unconscious, has changed the notion of death and dying. The crucial ethical challenge that euthanasia presents from the Islamic perspective is such: because Islam approves modern medical means to save a life, can it also tolerate discontinuing these means? Incidentally, does the patient have a choice not to bear the agony of hospitalization and pain and ask for a peaceful death?

Active Euthanasia

Jonathan E. Brockopp (2003) observes that, from an Islamic perspective, active euthanasia involves hastening the appointed hour of death (ajal). This can be done either at the request of a patient (voluntary) or made without his or her explicit approval (involuntary). Though Muslim jurists use the term “mercy killing” (qatl al-raḥmah), they typically equate it with manslaughter if performed by a physician. According to the majority of Muslim jurists, neither the patient nor any third party (a physician or a near relative) has permission to euthanize a long-suffering patient. Their main argument is that suicide is prohibited, and so also is any act leading to it, which is true in the case of physician-assisted euthanasia. First, the Qurʾān prohibits suicide: self-perdition (2:195) and killing oneself (4:29). Second, the Prophet sternly warned against it in two instances. In one ḥadīth, he described the horrible tormenting of the person committing suicide in hellfire by the same means. In another ḥadīth, he also showed his disapproval of a warrior who, after receiving severe injuries, could not bear the pain and ended his life by his own arrowhead. After the warrior’s death, the Prophet refused to pray over him, saying: “This act obliterated all the reward for his good deeds done in this world” (al-Bukhārī 23: 446; Haneef, 2000). It should be noted that his Companions prayed over the body later, a fact that often comes up in the literature). Lastly, the Qurʾān emphasizes the principle of saving life, which would also include avoiding any act amounting to hastening death (5:32).

In contrast, Brockopp (2003) argues that equating euthanasia with suicide is questionable on the grounds that the verse regarding the prohibition of suicide (4:29) is not explicit in its indication. For example, al-Ţabarī notes that it means, “You should not kill each other, since you belong to one nation.” Moreover, the anecdote of the warrior is not categorical on suicide since the Prophet still allowed others to perform funeral prayers over him, which is the view of the majority of the legal schools. Additionally, it is reported that, in another battle, one of the Prophet’s companions (ʿĀmir ibn Sinān) accidently killed himself while assaulting an enemy. The Prophet ruled that his reward would be doubled. Brockopp’s argument, however, may be contested on the grounds that the verse on suicide, wa lā taqtulū anfusakum, though sometimes broadly construed to include homicide, is clear on outlawing suicide when read alongside the verse on self-perdition (wa lā tulqū bi aydīkum ilā al-tahlukah), as maintained by Ibn Kathīr, to provide a basis for the prohibition of active voluntary euthanasia. Moreover, some scholars have argued that the funeral prayer for the injured warrior who killed himself does not reduce the heinousness of the sin of suicide. Indeed, the majority of the jurists (with the notable exception of eighth-century scholar al-Awzāʿī) argue that a funeral prayer can still be performed for those committing major sins. These scholars focus instead on the refusal of the Prophet to participate in the prayer, which they consider cogent proof that suicide is such a despicable act that even if done by a religious warrior it cannot be decriminalized (al-Nawawī, 1989). With regard to the warrior who accidentally killed himself, the Prophet approved because of the absence of mens rea (knowledge of wrongdoing).

Passive Euthanasia

Passive euthanasia normally involves stopping treatment, or removing a life-support machine from a patient in a coma. To Brockopp (2003), it should not be objectionable in Islam as it is a means of allowing God’s plan to run its course. According to this view, some contemporary fatwas, such as the one by the rector of al-Azhar Muḥammad Sayyid Ţanţāwī (1928–2010), support passive euthanasia by allowing the removal of life support from a patient in a state of irreversible brain death. However, he concedes the fact that the majority of Muslim scholars not only dismiss the “brain death” criterion as an indicator of death in such cases, but also reject the claim of a scientific consensus regarding death, since such a claim is tantamount to encroaching upon a domain which squarely belongs to God (Krawietz, 2003). Beyond the details of the juristic and theological debate regarding brain death, it suffices to say that the exact moment of death, which, in theological terms, marks the separation of the soul from the body, cannot be empirically ascertained (Haneef, 2015). Nevertheless, several contemporary scholars allow the discontinuation of medical treatment in the case of a patient in vegetative state, who otherwise would have been buried long before, had the heartbeat and respiration not been sustained by life support machines.

The “Right to Die”

The “right to die” has emerged as one of the arguments by supporters of euthanasia to address difficult clinical cases, such as a patient’s refusal of treatment or asking to be relieved from excruciating suffering. Proponents of euthanasia have advocated for its acceptance on the grounds that human life is a “finite quantity without any connection to transcendental connection with the life after death” (Brockopp, 2003), or that suffering is a cause of “depersonalization” (Ebrahim, 2007). Opponents of this view perceive life as a trust from God, and regard human suffering as a measure of atonement in the life to come and death as a transitional stage from this temporary world to the everlasting abode (Qurʾān 3:156; 67:1–2; 3:145; 39:10). Opponents of euthanasia often quote the ḥadīth that states: “None of you should wish for death because of a calamity befalling him; but if he has to wish for death he should say: ‘O God keep me alive as long as life is better for me and let me die if death is better for me’”(al-Bukhārī, 2003).

According to this view, although death is inevitable, defining it as a “right” contravenes the notion of God as the sole author of life and death (Qurʾān 36:51–58).

Still other scholars, including Arshad Taqi (2012) have focused less on the theological debates, and more on the contexts in which patients consider euthanasia an option. Sissela Bok (1998) contends that the main underlying cause as to why a patient pleads for euthanasia is the pressure of feeling isolated due to the lack of adequate care by both relatives and medical caregivers. Bok describes this phenomenon as one element of the slippery slope that results in performing active euthanasia in practice.

Conclusion

Though some debate continues, many Muslim scholars allow passive euthanasia if the next of kin of the patients so choose. On the other hand, Muslim legal responses tend to reveal categorical censure for actively ending a suffering patient’s life. Accordingly, Muslim jurists, while maintaining faith in the power of God over life and death, have been pragmatic in striking a balance between medical necessity and religious determination of death by allowing the discontinuation of medical care for a patient in a state of irreversible coma.

Bibliography

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