Early Human Development 88 (2012) 83–85

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Early Human Development

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Best practice guidelines

Islamic law and the limitations of medical intervention

Mufti Mohammed Zubair Butt ⁎Muslim Chaplain, The Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom

⁎ The Islamic Medical Ethics Advisor, The Muslim CoLondon E1 2WJ, United Kingdom. Tel.: +44 113206593

E-mail address: zubair.butt@leedsth.nhs.uk.

0378-3782/$ – see front matter © 2011 Published by Eldoi:10.1016/j.earlhumdev.2011.12.010

Contents

1. Sources of Islamic ethical and legal opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 832. Sanctity of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 833. Sickness, ill health and death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 844. Is medical treatment mandatory? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 845. Withdrawal of life sustaining treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

1. Sources of Islamic ethical and legal opinion

Islamic ethical and legal opinion guides, rules and regulates allpublic and private behaviour and is drawn from a number of sources:

∎ The primary source is the Qur'an, which is believed to be the di-vine revelation to the Prophet Muhammad, peace and blessingsbe upon him [pbuh], conveyed by the angel Gabriel, in the verywords of God. It is the final arbitrator and there is no other appeal.

∎ The second source is a composite of the teachings of the ProphetMohammad pbuh not explicitly found in the Qur'an known as theSunnah and functions as an exegesis of the Qur'an.

∎ The third source is scholarly consensus which is the unanimityupon a single legal ruling of those qualified and existing at oneparticular period after the demise of the Prophet pbuh. Whilstsuch consensus is basically a rational proof it constitutes an au-thoritative part of sacred law and is binding.

∎ The fourth source is analogical reasoning which is the transcrip-tion of an original ruling of the previous three sources into a sub-sidiary ruling based on a causative factor which is commonbetween the two.

2. Sanctity of life

Preservation of life is one of the five basic purposes of sacred law[1]. Each moment of life is precious and must be valued and preserved.Human beings are considered to be responsible stewards of their bod-ies, which are viewed as gifts from God. The sanctity of human life isaffirmed in the Qur'an. One cannot take the life of another:

uncil of Britain, PO Box 57330,5.

sevier Ireland Ltd.

“Do not take life which God has made sacred except in the course ofJustice”

[Qur'an, 6:151]

Similarly:

“…One who has killed a person except in lieu of murder or mis-chief on earth; it would be as he slew the whole mankind…”

[Qur'an, 5:32]

One cannot also take one's own life:

“Do not kill yourselves, for verily God has been to you most mer-ciful.”

[Qur'an, 4:29]

Taking away life should be the domain of the One Who gives life.True, there is pain and suffering at the terminal end of an illness,but Muslims believe there is immeasurable reward from God forthose who patiently persevere in suffering.

“Those who patiently persevere will truly receive a reward with-out measure.”

[Qur'an, 39:10]

“And bear with patient constancy whatever befalls you, for this isfirmness (of purpose) in (the conduct of) affairs.”

[Qur'an, 31:17]

84 M.M.Z. Butt / Early Human Development 88 (2012) 83–85

3. Sickness, ill health and death

All things good and bad, including health and sickness, originatefrom God. He favours health but also allows suffering as a means ofexpiation or that one may draw close to Him.

“The Bedouin Arabs came to the Prophet pbuh and said: ‘O Mes-senger of God, should we not treat ourselves?’ He replied, ‘Yes,youmust treat yourselves: for verily, God has not created a diseasewithout providing a cure for it, except for one disease.’ They askedhim: ‘Which one is that?’ He replied, ‘Old age’.”

[Tirmidhi] [2]

The lexical meaning of Islam is submission which is quite rigor-ously tested when parents and relatives are faced with the decisionto withdraw life sustaining treatment for their newborn. Althoughthere are exceptions, Muslims will generally view sickness and illhealth as a test from God, the Creator; often just simply acceptingthe situation in which they find themselves. This is not only consid-ered to be a virtuous trait but an essential requirement of one'sfaith. Muslims will also find comfort in the knowledge that their suf-fering is not in vain but a means of expiation and a source of closenessto God. The Prophet pbuh said:

“Never is a Muslim stricken with sickness, distress, anxiety, grief,pain, sorrow or even the prick of a thorn, except that throughthese God expiates some of his sins.”

[Bukhari] [3]

The Prophet pbuh is reported to have also said:

“When God has ordained for his servant a rank he cannot achieveon account of his deed, God puts him to suffering in his body orhis belongings or through his children. Then he observes patienceover that until it raises him to the rank God has ordained for him.”

[Abu Dawud] [4]

Muslims believe that death is the departure of the soul from thebody by divine decree. Death marks the transition from one state ofexistence to the next and the beginning of the journey in the life here-after which is perpetual and infinite.

“It is He Who gives life and death; and when he decides upon anaffair, He says to it, “Be”, and it is.”

[Qur'an, 40:68]

One of the basic tenets of Islam is that death cannot be hastened ordelayed from its appointed time by even a single second. The Qur'anreminds Muslims:

“It is not given to any soul to die, save by the leave of God, at anappointed time.”

[Qur'an, 3:145]

But what exactly is the soul and how is this departure deter-mined? The Prophet pbuh was asked regarding the soul:

“And they ask you concerning the soul. Say: The soul is of the com-mand of my Lord and of knowledge it is only a little that is com-municated to you.”

[Qur'an, 17:85]

The exact nature of the soul is not known. We can guess andhypothesise, but that is all it will be — conjecture. There is also no ab-solute sign to indicate at exactly what point this departure occurs. Is-lamic jurisprudential texts contain mainly only human interpretationsof the point of this departure which in turn are based on available med-ical knowledge at the time.

According to the current medical opinion accepted by many Mus-lim jurists today, an individual is considered dead in one of the fol-lowing two situations:

1.When there is complete irreversible cessation of the respiratoryand cardiovascular systems.2.When there is complete irreversible cessation of the functions ofthe brain including the brain stem [5].

4. Is medical treatment mandatory?

Mainstream classical jurisprudential discourse regards medical treat-ment to be simply permissible or at most preferable and is founded onthe premise that such interventions give rise, at best, to presumption ofa cure, and whilst a cure remains only a presumption one cannot bemandated to pursue medical treatment. By implication, and indeed asmentioned by some jurists, where a cure is known to result medicaltreatment can be deemed mandatory. Some jurists have expoundedthe concept of causality which may be summarised as follows:

Removal of harm is effected by one of the following three types ofcause:

1. Definitive. i.e., harm is removed as a rule and without fail. E.g. con-sumption of food and water to remove hunger and thirst respec-tively. It is mandatory to adopt such means when there is athreat to life or limb and abstention is not a form of reliance. Con-sequently, if one abstains from food or drink, and in doing so diesof hunger or thirst, one will be sinful. Similarly, by analogy, forthose ailments where a cure is achieved as a rule and non-treatment will lead to significant harm or certain death, treatmentis mandatory within ones means. Seeking medical treatment isalso not contrary to reliance on God's will. Rather, abstentionamounts to non-reliance.

2. Presumptive. i.e., removal of harm is often achieved. However,there are many instances when the desired result is not realised.E.g. venesection or cupping, taking a purgative agent and relievinghumoral imbalances such as ‘hot’ with ‘cold and vice versa. Pursuitof a presumptive cause is not inconsistent with reliance, nor is ab-stention prohibited. Rather abstention is better for some people incertain circumstances. Medical treatments have generally beendeemed to fall within this category. However, some have opinedthat if one finds through experience that a presumptive cause ef-fects a particular cure then in his case that cause becomes defini-tive [6].

3. Speculative. i.e., removal of harm is not a realistic expectation. E.g.cauterisation and incantation. Abstention is a condition of reliance.

5. Withdrawal of life sustaining treatment

In light of the above it is possible to conclude whether Islamic eth-ical and legal opinion allows the withdrawal of life sustaining treat-ment from a newborn in the following scenarios:

1. The newborn ceases to breath and there is also no heart beat de-spite the life support systems. I.e., there is complete irreversiblecessation of the respiratory and cardiovascular systems. There isno question here that the life sustaining treatment can be with-drawn as the newborn has now deceased. On the contrary, nonwithdrawal is an unnecessary waste of resources.

85M.M.Z. Butt / Early Human Development 88 (2012) 83–85

2. The newborn continues to breath and the heart continues to beatdue to the life support systems. However, there is complete irre-versible cessation of the functions of the brain including thebrain stem. Here also, the life sustaining treatment can be with-drawn as this is a reliable indicator of the departure of the soulfrom the body and that the newborn has deceased.

3. The newborn continues to breath and the heart continues to beatdue to the life support systems. However, the brain stem is aliveeven if other vital organs or other parts of the brain are irreversiblydamaged. In this instance, the newborn is considered to be alive.With reference to the discussion ‘Is medical treatment mandato-ry?’ we can conclude:a. It is mandatory to administer vital food and fluids to sustain the

interest of life as long as the newborn is alive provided this doesnot inadvertently result in harm.

b. Similarly, if following treatment a cure is achieved as a rule andnon treatment will without doubt lead to significant harm orcertain death, treatment is mandatory and the life sustainingtreatment cannot be withdrawn.

c. If a cure is probable following treatment, treatment should beattempted as this was the established practice of the Prophet

pbuh. However, treatment in this instance is not mandatory. Ifthe physicians, parents and relatives conclude through mutualand informed decision-making that maintaining life sustainingtreatment is not in the best interest of the newborn it may bewithdrawn.

d. If cure is not a realistic expectation, although it is permissible toattempt at treatment it is more superior to exercise reliance onthe will of God and not to attempt at treatment.

e. If attempting at a cure is futile, then maintaining life sustainingtreatment is an unnecessary waste of resources.

References

[1] Al-Shatibi I. Al-Muwafaqat, 2. Khobar: Dar Ibn Affan; 1997. p. 20.[2] Al-Tirmidhi M. Sunan al-Tirmidhi, 3. Beirut: Dar al-Kotob al-Ilmiyah; 2000. p. 132.[3] Al-Bukhari M. Sahih al-Bukhari. Karachi: Qadimi Kutub Khana; 2:843.[4] Al-Sajistani S. Sunan Abu Dawud. Multan: Maktabah Imdadiyyah; 2:84.[5] Resolution No. 17 (5-3). Resolutions and Recommendations of the Council of the

Islamic Fiqh Academy Jeddah. Jeddah: Islamic Research and Training Institute,Islamic Development Bank; 2000. p. 30.

[6] Badruddin Mahmood. Jami al-Fusooleyn, Karachi: Islami Kutub Khana; 190-191.