Skip to main content
SpringerLink
Log in

Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making

  • Original Paper
  • Published:
Journal of Religion and Health Aims and scope Submit manuscript

Abstract

Religion and spirituality have always played a major and intervening role in a person’s life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient’s religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient’s values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients’ varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.

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

Access this article

Log in via an institution

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

References

  • Agarwal, A. K., & Murinson, B. B. (2012). New dimensions in patient–physician interaction: Values, autonomy, and medical information in the patient-centered clinical encounter. Rambam Maimonides Medical Journal, 3(3), 1–11. doi:10.5041/RMMJ.10085.

    Article  Google Scholar 

  • Airedale NHS Trust v. Bland. (1993). All ER, 1, 821–896.

  • Albar, M. (2007). Seeking remedy, abstaining from therapy and resuscitation: An Islamic perspective. Saudi Journal of Kidney Diseases and Transplantation, 18(4), 629–637. http://www.sjkdt.org/article.asp?issn=1319-2442;year=2007;volume=18;issue=4;spage=629;epage=637;aulast=Albar.

  • al-Bukhari, M. (1997). Sahih al-Bukhari. (trans: Khan, M.). Riyadh: Maktaba Dar-us-Salam.

  • al-Shahri, M. Z., & Al-Khenaizan, A. (2005). Palliative care for Muslim patients. The Journal of Supportive Oncology, 3(6), 432–6. http://www.ncbi.nlm.nih.gov/pubmed/16350430.

  • Billings, J. A., & Krakauer, E. L. (2011). On patient autonomy and physician responsibility in end-of-life care. Archives of Internal Medicine, 171(9), 849–853. doi:10.1001/virtualmentor.2009.11.8.onca1-0908.

    Article  PubMed  Google Scholar 

  • Bülow, H.-H., Sprung, C. L., Reinhart, K., Prayag, S., Du, B., Armaganidis, A., & Levy, M. M. (2008). The world’s major religions’ points of view on end-of-life decisions in the intensive care unit. Intensive Care Medicine, 34(3), 423–430.

    Article  PubMed  Google Scholar 

  • Cantor, N. L. (2005). Deja vu all over again: The false dichotomy between sanctity of life and quality of life. Stetson Law Review, 35(1), 81–100. http://www.ncbi.nlm.nih.gov/pubmed/17099994.

  • Carey, S. M., & Cosgrove, J. F. (2006). Cultural issues surrounding end-of-life care. Current Anaesthesia and Critical Care, 17(5), 263–270.

    Article  Google Scholar 

  • Cavalieri, T. A. (2001). Ethical issues at the end of life. JAOA, 101(10), 616–622.

    PubMed  CAS  Google Scholar 

  • Centre for Bioethics, University of Minnesota. (2005). End of life care: An ethical overview. Centre for Bioethics, University of Minnesota. http://conservancy.umn.edu/handle/189.

  • Chater, K., & Tsai, C. (2008). Palliative care in a multicultural society: A challenge for western ethics. Australian Journal of Advanced Nursing, 26(2), 95–100.

    Google Scholar 

  • Chin, J. (2002). Doctor–patient relationship: From medical paternalism to enhanced autonomy. Singapore Medical Journal, 43(3), 152–155. http://www.psy.med.br/textos/medico_paciente/modelo-relacao1.pdf.

  • Colello, K. J., Mulvey, J., Sarata, A. K., Williams, E. D., & Thomas, K. R. (2011). End-of-life care: Services, costs, ethics, and quality of care. In S. B. Adams (Ed.), Comfort and care at the end of life (pp. 41–68). New York: Nova Science Publishers.

    Google Scholar 

  • Curran, C. E. (2008). Catholic moral theology in the United States: A history (Google eBook) (p. 368). Washington, DC: Georgetown University Press. http://books.google.com/books?id=enB4otKhEFwC&pgis=1.

  • Da Rocha, A. C. (2009). Back to basics in bioethics: Reconciling patient autonomy with physician responsibility. Philosophy Compass, 4(1), 56–68. doi:10.1111/j.1747-9991.2008.00190.x.

    Article  Google Scholar 

  • Daaleman, T. P. (2000). Placing religion and spirituality in end-of-life care. JAMA, 284(19), 2514–2517.

    Article  PubMed  CAS  Google Scholar 

  • Dorff, E. N. (2005). End-of-life: Jewish perspectives. The Lancet, 366(9488), 862–865.

    Article  Google Scholar 

  • Elsayed, D., & Ahmed, R. (2009). Medical ethics: What is it? Why is it important? Sudanese Journal of Public Health, 4(1), 284–287. http://www.sjph.net.sd/files/vol4i2/SJPH-vol4i2-p284-287.pdf.

  • First International Conference on Islamic Medicine. (1981). Islamic code of medical ethics. Kuwait.

  • FLA. STAT. § 765.401(1) (2005). http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0700-0799/0765/Sections/0765.401.html. Retrieved 02 March 2014.

  • Gatrad, A. R., & Sheikh, A. (2001). Medical ethics and Islam: Principles and practice. Archives of Disease in Childhood, 84(1), 72–75.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Gillick, M. R. (2001). Artificial nutrition and hydration in the patient with advanced dementia: Is withholding treatment compatible with traditional Judaism? Journal of Medical Ethics, 27(1), 12–15.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Glover, J. (1977). Causing death and saving lives. Harmondsworth: Penguin.

    Google Scholar 

  • Huxtable, R. (2002). D(en)ying life: The sanctity of life doctrine in English law. Retfaerd, 25(3), 60–81. http://www.retfaerd.org/gamle_pdf/2002/3/Retfaerd_98_2002_3_s60_81.pdf.

  • Kahn, M. J., Lazarus, C. J., & Owens, D. P. (2003). Allowing patients to die: Practical, ethical, and religious concerns. Journal of Clinical Oncology, 21(15), 3000–3002.

    Article  PubMed  Google Scholar 

  • Kassim, P. N., & Adeniyi, O. B. (2010). Withdrawing and withholding medical treatment: A comparative study between the Malaysian, English and Islamic law. Medicine and Law, 29, 443–461.

  • Keown, D. (2005). End of life: The Buddhist view. The Lancet, 366(9489), 952–955.

    Article  Google Scholar 

  • Khan, F. (2002). Religious teaching and reflections on advance directive-religious values and legal dilemmas in bioethics: An Islamic perspective. Fordham Urb. LJ, 30(1), 267–275.

    Google Scholar 

  • Kinsella, J., & Booth, M. (2007). Ethical framework for end of life decisions in intensive care in the UK. Journal of National Institute on Public Health, 56(4), 387–392.

    Google Scholar 

  • Kuhse, H. (1981). Debate: Extraordinary means and the sanctity of life. Journal of Medical Ethics, 7(2), 74–82. doi:10.1136/jme.7.2.74.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Loike, J., Gillick, M., Mayer, S., Prager, K., Simon, J. R., Steinberg, A., & Fischbach, R. L. (2010). The critical role of religion: Caring for the dying patient from an Orthodox Jewish perspective. Journal of Palliative Medicine, 13(10), 1267–1271.

    Article  PubMed  Google Scholar 

  • Majelis Kehormatan Etik Kedokteran Indonesia. (2001). Kode Etik Kedokteran Indonesia. Jakarta. http://www.dikti.go.id/files/atur/sehat/Kode-Etik-Kedokteran.pdf.

  • Malaysian Medical Association. (2002). Code of medical ethics (MMA). Malaysia: Malaysian Medical Association.

    Google Scholar 

  • Malik, M. (2012). Islamic and Catholic bioethics of pain medication: A response to mercy argument. Journal of Islam in Asia, 9(1), 213–227.

    Google Scholar 

  • Markwell, H. (2005). End-of-life: A Catholic view. The Lancet, 366(9491), 1132–1135.

    Article  Google Scholar 

  • Mazanec, P., & Tyler, M. K. (2003). Cultural considerations in end-of-life care. AJN, 103(3), 50–58.

    Article  PubMed  Google Scholar 

  • McLachlan, H. V. (2008). The ethics of killing and letting die: Active and passive euthanasia. Journal of Medical Ethics, 34(8), 636–638. doi:10.1136/jme.2007.023382.

    Article  PubMed  CAS  Google Scholar 

  • Medical Board of Australia. (n.d.). Good medical practice: A code of conduct for doctors in Australia. http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx.

  • Medical Council of New Zealand. (2013). Good medical practice. In S. G. IM (Ed.), Cole’s Medical practice in New Zealand (12th ed., pp. 5–28). Wellington: Medical Council of New Zealand.

    Google Scholar 

  • Meisel, A. (2008). End-of-life care. In M. Crowley (Ed.), From birth to death and bench to clinic: The Hastings center bioethics briefing book (pp. 51–54). Garrison: The Hastings Center.

    Google Scholar 

  • Ms B v An NHS Hospital Trust. (2002). All ER (D), 362, 1–25.

  • Noah, B. (2006). The role of religion in the Schiavo Controversy. Houston Journal of Health Law and Policy, 6, 319–346.

  • Olsen, M. L., Swetz, K. M., & Mueller, P. S. (2010). Ethical decision making with end-of-life care: Palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clinic Proceedings, 85(10), 949–954.

    Article  PubMed  PubMed Central  Google Scholar 

  • Orentlicher, D. (1998). The alleged distinction between euthanasia and the withdrawal of life-sustaining treatment: Conceptually incoherent and impossible to maintain. U. Ill. L. Rev., (3), 837–860. http://heinonlinebackup.com/hol-cgi-bin/get_pdf.cgi?handle=hein.journals/unilllr1998&section=29.

  • Padela, A. (2006). Medical ethics in religious traditions: A study of Judaism, Catholicism, and Islam. JIMA, 38, 106–117.

  • Padela, A. (2007). Islamic medical ethics: A primer. Bioethics, 21(3), 169–178.

    Article  PubMed  Google Scholar 

  • Queensland Health and Islamic Council of Queensland. (2010). Health care providers’ handbook on Muslim patients (2nd ed., pp. 1–21). Brisbane: Queensland Health and Islamic Council of Queensland.

    Google Scholar 

  • Queensland Health and Islamic Council of Queensland. (2011). Health care providers’ handbook on Hindu patients (2nd). Brisbane: Division of the Chief Health Officer, Queensland Health. http://www.health.qld.gov.au/multicultural/support_tools/hbook-hindu.pdf.

  • Queensland Health and Islamic Council of Queensland. (n.d.). Health care providers’ handbook on Sikh patients. Division of the Chief Health Officer, Queensland Health. http://www.health.qld.gov.au/multicultural/health_workers/hbook-sikh.asp.

  • Rabiu, A.-R., & Sugand, K. (2014). Has the sanctity of life law “gone too far”? Analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not “gone too far”. Philosophy, Ethics, and Humanities in Medicine: PEHM, 9(1), 1–6. doi:10.1186/1747-5341-9-5.

    Article  Google Scholar 

  • Sachedina, A. (2005). End-of-life: The Islamic view. The Lancet, 366, 774–779.

    Article  Google Scholar 

  • Schiavo ex rel. Schindler v. Schiavo. 404 F.3d 1270 (11th Circuit 2005).

  • Steinberg, A. (2003). Encyclopedia of Jewish medical ethics: A compilation of Jewish medical law on all topics of medical interest (trans: Rosner, F.). Jerusalem: Feldheim Publishers.

  • Sulaiman, A. D. (2008). Sunan Abu Dawud (trans: al-Khattab, N.). Riyadh: Maktaba Dar-us-Salam.

  • Talib, N. (2002). Euthanasia: A Malaysian perspective. Petaling Jaya: Sweet and Maxwell Asia.

    Google Scholar 

  • Tallon, C. (2012). Ethics and end of life care. Journal of Observational Pain Medicine, 1(1), 1–7.

    Google Scholar 

  • UK Department of Health. (2003). NHS chaplaincy: Meeting the religious and spiritual needs of patients and staff. http://www.nhs-chaplaincy-spiritualcare.org.uk/dh_MeetingtheReligiousNeeds2003.pdf.

  • UK Department of Health. (2008). End of life care strategy: Promoting high quality care for all adults at the end of life. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/136431/End_of_life_strategy.pdf.

  • UNESCO Cairo Office. (2011). Ethics and law in biomedicine and genetics: An overview of national regulations in the Arab states (p. 82). Cairo: UNESCO. http://unesdoc.unesco.org/images/0021/002152/215207e.pdf.

  • World Health Organisation. (n.d.). WHO definition of palliative care. World Health Organization. http://www.who.int/cancer/palliative/definition/en/. Retrieved 01 March 2014.

  • Zahedi, F., Larijani, B., & Bazzaz, J. T. (2007). End of life ethical issues and Islamic views. Iran Journal of Allergy Asthma and Immunology, 6, 5–15.

    Google Scholar 

Download references

Acknowledgments

This paper was funded by the Ministry of Higher Education Malaysia and presented at the Asian Conference on Ethics, Religion and Philosophy 2014 (ACERP—Osaka 2014).

Author information

Authors and Affiliations

  1. Civil Law Department, Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, 53100, Kuala Lumpur, Malaysia

    Puteri Nemie Jahn Kassim

  2. Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, 53100, Kuala Lumpur, Malaysia

    Fadhlina Alias

Authors
  1. Puteri Nemie Jahn Kassim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fadhlina Alias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Puteri Nemie Jahn Kassim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jahn Kassim, P.N., Alias, F. Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making. J Relig Health 55, 119–134 (2016). https://doi.org/10.1007/s10943-014-9995-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10943-014-9995-z

Keywords

Search

Navigation