Skip to main content
SpringerLink
Log in

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

  • Scientific Contribution
  • Published:
Medicine, Health Care and Philosophy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Notes

  1. We adopt Prof. Mohamed Fadel’s usage of the English term moral theology to refer to the Islamic science of uṣūl al-fiqh. (M. Fadel, “The True, the Good and the Reasonable: The Theological and Ethical Roots of Public Reason in Islamic Law.” Canadian Journal of Law and Jurisprudence, vol. 21/1, 2008). As Prof. Fadel notes in so far as uṣūl al-fiqh is concerned with the scriptural sources of moral obligation, the processes of moral assessment, and moral epistemology it is a moral science. And since uṣūl al-fiqh is primarily concerned with how God judges human acts and strives to reach the truth regarding moral propositions it is a theological discipline. Consequently the mapping of terms is apropos even if not precise. I use the terms “Islamic ethico-legal tradition” and “Islamic law” to refer to the notions of fiqh and aḥkām taklīfiyya interchangeably.

  2. This gradient ranges from obligatory (farḍ or wājib) to recommended (mandūb or mustaḥab) to permitted (mubāḥ) to discouraged (makrūḥ) and, finally, to prohibited (ḥarām).

  3. For a classification schema of the different types of fatāwā see Skovgaard-Petersen, J. (2015). A Typology of Fatwas. Die Welt des Islams, 55(3–4), 278–285, and for insights into legal manuals used for seminary instruction in Islamic law see Fadel, M. (1996). The Social Logic of Taqlīd and the Rise of the Mukhataṣar. Islamic Law and Society, 3(2), 193–233.

References

  • 20652: Commentary on the hadeeth, "Allaah created Adam in His image". IslamQA. https://islamqa.info/en/20652. Accessed 29 Dec 2015.

  • Alahmad, Ghaith. 2016. Human dignity and its application to medical issues (Arabic). http://www.cilecenter.org/ar/articles-essays/الكرامة-الإنسانية-وتطبيقاتها-في-القض/. Accessed 19 June 2016.

  • Albar, M.A. 2007. Seeking remedy, abstaining from therapy and resuscitation: An Islamic perspective. Saudi Journal of Kidney Diseases and Transplantation 18(4): 629–637.

    Google Scholar 

  • Albar, M.A., and H. Chamsi-Pasha. 2015. Contemporary bioethics Islamic perspective. Berlin: Springer.

    Book  Google Scholar 

  • Ali, Abdullah Yusuf. 1999. The Quran translation. New York: Tahrike Tarsile.

    Google Scholar 

  • Arozullah, A.M., and M.A. Kholwadia. 2013. Wilayah (authority and governance) and its implications for Islamic bioethics: A Sunni Maturidi perspective. Theoretical Medicine and Bioethics 34(2): 95–104. doi:10.1007/s11017-013-9247-3.

    Article  Google Scholar 

  • Arozullah, A. M., M. V. Stodolsky, A. I. Padela, and M. A. Kholwadia. 2015. The Role of Muslim Ontology in Defining a Schema of Causes and Means of Healing. Paper presented at the 4th annual conference on medicine and religion, Cambridge, MA.

  • Atighetchi, Dariusch. 2007. Islamic bioethics: Problems and perspectives, vol. 31., International library of ethics, law, and the new medicine New York: Springer.

    Book  Google Scholar 

  • Attia, Gamal E. 2007. Towards realization of the higher intents of Islamic law. Herndon, VA: The International Institute of Islamic Thought.

    Google Scholar 

  • Auda, Jasser. 2008. Maqasid Al-Shariah: A beginner’s guide. In Occasional papers series. London.

  • Bakar, Osman. 2008. An Introduction to the Philosophy of Islamic Medicine. In Tawhid and science, 103–130. Selangor: Arah Publications.

  • Balboni, T.A., M. Balboni, A.C. Enzinger, K. Gallivan, M.E. Paulk, A. Wright, K. Steinhauser, T.J. VanderWeele, and H.G. Prigerson. 2013. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Intern Med 173(12): 1109–1117. doi:10.1001/jamainternmed.2013.903.

    Article  Google Scholar 

  • Bedir, A., and S. Aksoy. 2011. Brain death revisited: It is not ‘complete death’ according to Islamic sources. Journal of Medical Ethics 37(5): 290–294. doi:10.1136/jme.2010.040238.

    Article  Google Scholar 

  • Bishop, Jeffrey Paul. 2011. The anticipatory corpse: Medicine, power, and the care of the dying., Notre Dame studies in medical ethics Notre Dame: University of Notre Dame Press.

    Google Scholar 

  • Brockopp, Jonathan E. 2008. Islam and bioethics: Beyond abortion and euthanasia. Journal of Religious Ethics 36: 3–12.

    Article  Google Scholar 

  • Doi, Abdur Rahman I. 1984. Sharīʻah: The Islamic law. London: Ta Ha Publishers.

    Google Scholar 

  • Doig, C., H. Murray, R. Bellomo, M. Kuiper, R. Costa, E. Azoulay, and D. Crippen. 2006. Ethics roundtable debate: Patients and surrogates want ‘everything done’—What does ‘everything’ mean? Critical Care 10(5): 231. doi:10.1186/cc5016.

    Article  Google Scholar 

  • Dugdale, L. 2010. The art of dying well. Hastings Center Report 40(6): 22–24.

    Article  Google Scholar 

  • Dugdale, L.S. 2014. Therapeutic dying. Hastings Center Report 44(6): 5–6. doi:10.1002/hast.379.

    Article  Google Scholar 

  • Dugdale, Lydia S. 2015. Dying in the twenty-first century: Toward a new ethical framework for the art of dying well., Basic bioethics Cambridge, MA: The MIT Press.

    Book  Google Scholar 

  • Dāmād Afandī, ʿAbd al-Raḥmān. 1910. Majmaʿ al-anhur sharḥ multaqā al-abḥūr. Istanbul: Dār al-Ṭibāʿah al-ʿĀmirah.

    Google Scholar 

  • Ebrahim, A.F.M. 1998. Islamic jurisprudence and the end of human life. Medicine and Law 17(2): 189–196.

    Google Scholar 

  • Ebrahim, A.F.M. 2008. An introduction to Islamic medical jurisprudence. Durban: The Islamic Medical Association of South Africa.

    Google Scholar 

  • Fadel, M. 2008. The true, the good, and the reasonable: The theological and ethical roots of public reason in Islamic law. The Canadian Journal of Law and Jurisprudence 21(01): 5–69.

    Article  Google Scholar 

  • Farah, Samir, and Ashraf Al-Kurdi. 2006. Brain death: Definition, medical, ethical and islamic jurisprudence implications. In FIMA year book 2005–2006, ed. Hossam E. Fadel, Muhammed A.A. Khan, and Aly A. Mishal, 33–48. Amman: Jordan Society For Islamic Medical Sciences.

    Google Scholar 

  • Ghaly, Mohammed. 2010. Islam and disability: Perspectives in theology and jurisprudence. Routledge Islamic studies series. London: Routledge.

    Google Scholar 

  • Gordon, M. 2015. Rituals in death and dying: Modern medical technologies enter the fray. Rambam Maimonides Med J 6(1): e0007. doi:10.5041/RMMJ.10182.

    Article  Google Scholar 

  • Hamdy, S. 2013. Not quite dead: Why Egyptian doctors refuse the diagnosis of death by neurological criteria. Theoretical Medicine and Bioethics 34(2): 147–160. doi:10.1007/s11017-013-9245-5.

    Article  Google Scholar 

  • Ibn Ḥajar al-Haytamī, Aḥmad ibn Muḥammad. 2008. al-Fatḥ al-mubīn bi-sharḥ al-Arbaʻīn. Jeddah: Dār al-Minhāj.

    Google Scholar 

  • Ibn Mufliḥ al-Maqdisī, Muḥammad. 1996. al-Ādāb al-sharʻīyah. Beirut: Muʼassasat al-Risālah.

    Google Scholar 

  • Ibn Qudāmah, Muwaffaq al-Dīn ʻAbd Allāh ibn Aḥmad. 2007. al-Mughnī. Riyadh: Dār ʻĀlam al-Kutub.

    Google Scholar 

  • Inthorn, J., S. Schicktanz, N. Rimon-Zarfaty, and A. Raz. 2015. “What the patient wants…”: Lay attitudes towards end-of-life decisions in Germany and Israel. Medicine, Health Care and Philosophy 18(3): 329–340. doi:10.1007/s11019-014-9606-5.

    Article  Google Scholar 

  • Islamic Development Bank. 2000. Resolutions and Recommendations of the Council of the Islamic Fiqh Academy. Jeddah: Islamic Development Bank.

    Google Scholar 

  • Kamali, Mohammad Hashim. 2002. The dignity of man: An Islamic perspective. Cambridge: Islamic Texts Society.

    Google Scholar 

  • Kamali, Mohammad Hashim. Human dignity in Islam.

  • Kamali, Mohammad Hashim. 2003. Principles of Islamic jurisprudence. 3rd rev. and enl. Aufl. Cambridge: Islamic Texts Society.

  • Karman, Karen-Lise Johansen. 2011. The role and the work of the European Council for Fatwa and research. In Yearbook of Muslims in Europe, 655–693. Brill.

  • Khalid, I., W.J. Hamad, T.J. Khalid, M. Kadri, and I. Qushmaq. 2013. End-of-life care in Muslim brain-dead patients: A 10-year experience. The American Journal of Hospice and Palliative Care 30(5): 413–418. doi:10.1177/1049909112452625.

    Article  Google Scholar 

  • Khaṭīb al-Tibrīzī, Muḥammad ibn ʻAbd Allāh, and James Robson. 1981. Mishkat al-Masabih. Lahore: Sh. Muhammad Ashraf.

    Google Scholar 

  • Krawietz, B. 2003. Brain death and Islamic traditions: Shifting borders of life? In Islamic ethics of life: Abortion, war, and euthanasia, ed. Jonathan E. Brockopp, 195–213. Columbia: University of South Carolina Press.

    Google Scholar 

  • De Kruif, Paul. 1932. Men against death. New York: Harcourt.

    Google Scholar 

  • Mapping the Global Muslim Population. 2009. Pew Research Center.

  • Mattson, Ingrid. 2002. Dignity and patient care: An Islamic perspective. Yale Journal for Humanities in Medicine.

  • Miller, A.C. 2015. Opinions on the legitimacy of brain death among Sunni and Shi’a scholars. Journal of Religion and Health. doi:10.1007/s10943-015-0157-8.

    Google Scholar 

  • Miller, A.C., A. Ziad-Miller, and E.M. Elamin. 2014. Brain death and Islam: The interface of religion, culture, history, law, and modern medicine. Chest 146(4): 1092–1101. doi:10.1378/chest.14-0130.

    Article  Google Scholar 

  • Moazam, F. 2005. Islamic perspectives on abortion. Bioethics Links 1(2): 3–4.

    Google Scholar 

  • Mohiuddin, Afshan. 2012. Islamic Perspectives on Withdrawing or Withholding Life Support: Ethico-Legal Responses to moral conundrums. Paper presented at the Islamic Bioethics and Shari’ah Law: The Role of Traditional Scholarship in Modern Times. The 11th Annual Critical Islamic Reflections Conference, Yale University.

  • Moosa, E. 1999. Languages of change in Islamic law: Redefining death in modernity. Islamic studies 38(3): 305–342.

    Google Scholar 

  • Niẓām, Shaykh. 2009. al-Fatāwā al-hindiyyah. Beirut: Dār al-Fikr.

    Google Scholar 

  • Orr, R.D., and L.B. Genesen. 1997. Requests for “inappropriate” treatment based on religious beliefs. Journal of Medical Ethics 23(3): 142–147.

    Article  Google Scholar 

  • Padela, A.I., A. Arozullah, and E. Moosa. 2013. Brain death in Islamic ethico-legal deliberation: Challenges for applied Islamic bioethics. Bioethics 27(3): 132–139. doi:10.1111/j.1467-8519.2011.01935.x.

    Article  Google Scholar 

  • Padela, A.I., and T.A. Basser. 2012. Brain death: The challenges of translating medical science into Islamic bioethical discourse. Medicine and Law 31(3): 433–450.

    Google Scholar 

  • Padela, A.I., S.W. Furber, M.A. Kholwadia, and E. Moosa. 2014. Dire necessity and transformation: Entry-points for modern science in Islamic bioethical assessment of porcine products in vaccines. Bioethics 28(2): 59–66. doi:10.1111/bioe.12016.

    Article  Google Scholar 

  • Padela, A.I., A. Killawi, J. Forman, S. DeMonner, and M. Heisler. 2012. American Muslim perceptions of healing: Key agents in healing, and their roles. Qualitative Health Research 22(6): 846–858. doi:10.1177/1049732312438969.

    Article  Google Scholar 

  • Padela, A., and A. Mohiuddin. 2015a. 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 (taklif). Am J Bioeth 15(1): 3–13. doi:10.1080/15265161.2014.974769.

    Article  Google Scholar 

  • Padela, A., and A. Mohiuddin. 2015b. Islamic goals for clinical treatment at the end of life: The concept of accountability before God (taklif) 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 (taklif)”. The American Journal of Bioethics 15(1): W1–W8. doi:10.1080/15265161.2015.983353.

    Article  Google Scholar 

  • Padela, A.I., H. Shanawani, and A. Arozullah. 2011. Medical experts & Islamic scholars deliberating over brain death: Gaps in the applied Islamic bioethics discourse. Muslim World 101(1): 53–72.

    Article  Google Scholar 

  • Padela, A.I., H. Shanawani, J. Greenlaw, H. Hamid, M. Aktas, and N. Chin. 2008. The perceived role of Islam in immigrant Muslim medical practice within the USA: An exploratory qualitative study. Journal of Medical Ethics 34(5): 365–369.

    Article  Google Scholar 

  • Qasmi, Mujahidul Islam Contemporary Medical Issues in Islamic Jurisprudence. New Delhi: Islamic Fiqh Academy.

  • Qazi, F., J.C. Ewell, A. Munawar, U. Asrar, and N. Khan. 2013. The degree of certainty in brain death: Probability in clinical and Islamic legal discourse. Theoretical Medicine and Bioethics 34(2): 117–131. doi:10.1007/s11017-013-9250-8.

    Article  Google Scholar 

  • Rady, M.Y., and J.L. Verheijde. 2013. Brain-dead patients are not cadavers: The need to revise the definition of death in Muslim communities. HEC Forum 25(1): 25–45. doi:10.1007/s10730-012-9196-7.

    Article  Google Scholar 

  • Riyad as-Salihin. Sunnah.com. http://sunnah.com/riyadussaliheen.

  • Sachedina, A. 2006. “No harm, no harassment”: Major principles of health care ethics in Islam. In Handbook of bioethics and religion, ed. D.E. Guinn, 265–289.

    Chapter  Google Scholar 

  • Sachedina, A. Brain Death in Islamic Jurisprudence. http://people.virginia.edu/~aas/article/article6.htm. Accessed 5 Jan 2009.

  • Sahih Muslim. Sunnah.com. Accessed 9 Sept 2014.

  • Saifuddeen, S.M., N.N. Rahman, N.M. Isa, and A. Baharuddin. 2014. Maqasid al-shariah as a complementary framework to conventional bioethics. Science and Engineering Ethics 20(2): 317–327. doi:10.1007/s11948-013-9457-0.

    Article  Google Scholar 

  • Sartell, E., and A.I. Padela. 2015. Adab and its significance for an Islamic medical ethics. Journal of Medical Ethics 41(9): 756–761. doi:10.1136/medethics-2014-102276.

    Article  Google Scholar 

  • Shinall Jr., M.C., J.M. Ehrenfeld, and O.D. Guillamondegui. 2014. Religiously affiliated intensive care unit patients receive more aggressive end-of-life care. Journal of Surgical Research 190(2): 623–627. doi:10.1016/j.jss.2014.05.074.

    Article  Google Scholar 

  • Shinall Jr., M.C., and O.D. Guillamondegui. 2015. Effect of religion on end-of-life care among trauma patients. Journal of Religion and Health 54(3): 977–983. doi:10.1007/s10943-014-9869-4.

    Article  Google Scholar 

  • Snyder, L., D.P. Sulmasy, and Ethics, and American College of Physicians-American Society of Internal Medicine Human Rights Committee. 2001. Physician-assisted suicide. Annals of Internal Medicine 135(3): 209–216.

    Article  Google Scholar 

  • Sulmasy, D.P. 2013. The varieties of human dignity: A logical and conceptual analysis. Medicine, Health Care and Philosophy 16(4): 937–944. doi:10.1007/s11019-012-9400-1.

    Article  Google Scholar 

  • Sulmasy, D.P. 2016. Death and dignity in Catholic Christian thought. Medicine, Health Care and Philosophy. doi:10.1007/s11019-016-9690-9.

    Google Scholar 

  • Sunan Ibn Majah. Sunnah.com http://sunnah.com/ibnmajah.

  • Sunnah.com. http://sunnah.com/search/?q=breaking+AND+bone. Accessed Dec 29 2015.

  • Tavakkoli, S.N. 2008. A comparison between brain death and unstable life: Shi’ite perspective. Journal of Law and Religion 23: 24.

    Article  Google Scholar 

  • Wehr, Hans, J. Milton Cowan, and Thomas Leiper Kane Collection (Library of Congress. Hebraic Section). 1979. A dictionary of modern written Arabic: (Arab.-Engl.). 4. Aufl. Wiesbaden: Harrassowitz.

  • Yacoub, A. 2001. The Fiqh of medicine. London: Ta-Ha Publishers Ltd.

    Google Scholar 

  • al-Bukhari, Muḥammad ibn Ismāʻīl. 2002. Ṣaḥīḥ al-Bukhārī. Damascus: Dār Ibn Kathīr.

    Google Scholar 

  • al-Būṭī, Muḥammad Saʻīd Ramaḍān. 2000. Ḍawābiṭ al-maṣlaḥa fī al-sharīʻa al-islāmiyya. Beirut: Muʼassasat al-Risāla.

    Google Scholar 

  • al-Dardīr, Aḥmad ibn Muḥammad, and Aḥmad ibn Muḥammad Ṣāwī. 1972. al-Sharḥ al-ṣaghir ʻalā Aqrab al-masālik ilā madhhab al-Imām Mālik. Egypt: Dār al-Maʻārif.

    Google Scholar 

  • al-Khadīm, Muḥammad. 2011. Ishrāq al-qarār (al-kishkār); Naẓm ʻīyādat al-marīḍ; Naẓm al-tafakkur; Naẓm ẓiyārat al-qubūr. Nouakchott: Maʻhad al-Taysīr lil-ʻUlūm al-Sharʻīyah wa-al-ʻArabīyah.

    Google Scholar 

  • al-Mawṣilī, Abū al-Faḍl ˁAbd Allāh b. Maḥmūd. al-Ikhtiyār li-taˁlīl al-mukhtār. Damascus: Dar Qubāˀ.

  • al-Ramlī, Muḥammad ibn Aḥmad. 1967. Nihāyat al-muḥtaj ila sharḥ al-Minhāj fī al-fiqh ʻala madhhab al-Imām al-Shāfiʻī. Egypt: Muṣṭafa al-Bābī al-Ḥalabī.

    Google Scholar 

  • al-Shirwānī, Abd al-Hamīd, and Aḥmad Ibn Qāsim al-ʻAbbādī. 1972. Hawāshī al-Shirwānī wa-Ibn Qāsim al-ʻAbbādī ʻala Tuḥfat al-muḥtāj. Beirut: Dār Ṣadr.

    Google Scholar 

  • al-Sijistānī, Abū Dāʼūd Sulaymān Ibn al-Ashʻath. 2009. Sunan Abī Dāʼūd. Damascus: Dār al-Risāla al-ʻAlamiyya.

    Google Scholar 

  • ʻAlwānī, Ṭāhā Jābir Fayyāḍ, and A. A. Shamis. 2010. Towards a fiqh for minorities: Some basic reflections. New rev. Aufl. Richmond, Surrey, UK; Herndon, VA.: The International Institute of Islamic Thought.

Download references

Acknowledgments

AIP’s time-effort and research support for OQ was supported by a grant from the John Templeton Foundation (#39623) entitled “Scientific Discoveries & Theological Realities-Exploring the Intersection of Islam and the Human Sciences.” Additional time-effort funding for AIP and symposium support was provided by the Doha International Center for Interfaith Dialogue. This paper was presented in partial form at Bayan Claremont College at a symposium entitled “Dignity and Healthcare at the End-of-Life: Abrahamic Faiths in a Bioethics Conversation.” The authors acknowledge the support of Dr. Muhammed Volkan Stodolsky who researched Ḥanafī sources. We would also like to thank Drs. Ahsan Arozullah, Faisal Qazi, and Katherine Klima, and Shaykh Mohammad Amin Kholwadia and Jihad Hashim-Brown who were key interlocutors and partners in the working group project that motivated some of the work presented herein.

Author information

Authors and Affiliations

  1. Initiative on Islam and Medicine, Program on Medicine and Religion, University of Chicago, 5841 S. Maryland Ave, MC 5068, Chicago, IL, 60637, USA

    Aasim I. Padela

  2. Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA

    Aasim I. Padela

  3. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA

    Aasim I. Padela

  4. Islamic Foundation School, Villa Park, IL, USA

    Omar Qureshi

Authors
  1. Aasim I. Padela
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omar Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aasim I. Padela.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Padela, A.I., Qureshi, O. Islamic perspectives on clinical intervention near the end-of-life: We can but must we?. Med Health Care and Philos 20, 545–559 (2017). https://doi.org/10.1007/s11019-016-9729-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11019-016-9729-y

Keywords

Search

Navigation