Assisted dying – Islamic Perspective

by | Jan 6, 2022 | 0 comments


 

Abstract

With Assisted dying is causing the death of a terminal patient to save him/her from further pain and suffering. The Qur’an explicitly declares that taking a human life or one’s own life is categorically forbidden. All the Fatwas prohibit assisted dying and consider it a crime punishable both in this world and the hereafter. Withholding a treatment because it is futile is acceptable in Islam but withholding it to hasten the death of the patient, to avoid further suffering, is illegal and forbidden in Islam.

Case History

A  70-year-old  man  with  advanced  cancer  with  severe pain  was  not  responsive  to  morphine  and  asked  the doctor  to  kill  him  and  save  him  from  suffering.  The doctor refused, claiming that he could not commit illegal homicide. The doctor also refused to give the patient  any advice about  suicide. Upon  the  patient’s  insistence, the doctor agreed to stop hydration and nutrition to enable slow death (1)

Types of euthanasia:

Voluntary  euthanasia  is  defined  as:  “The   intentional  administration  of  lethal  drugs   in   order   to  painlessly terminate the life of a patient suffering from an  incurable condition  deemed  unbearable  by  the  patient,  at  the patient’s request.’’

Assisted  dying is  defined  as:  ‘‘intentionally assisting  a person, at this person’s request, to terminate his or her life.”

Non-voluntary    euthanasia    is    defined    as:    “The intentional administration of lethal drugs to painlessly terminate the life of a patient suffering from an  incurable condition   deemed   unbearable,   not   at   the patient’s request.” (2)Involuntary euthanasia against the will of  the patient is also called mercy killing.

Introduction

Euthanasia, assisted suicide, medical assistance in  dying, death with dignity: these and many other different terms are used around the world to capture various types of  assistance in dying. (3)

In palliative care, a hastened death is when a person who has   a   life  limiting  illness has   the   wish,   desire, or intentionally seeks to end their life prematurely. (4)

Euthanasia  is a  Greek word composed of two  syllables: eu means good or easy, Thanatos means death. Thus, the meaning   becomes   good   death   or   easy   death,   and nowadays proponents like to call it “mercy killing.”

Euthanasia   is   an   intentional   act   ‘that   is   explicitly intended to end another person’s life and that includes the following elements:  the  subject  has an incurable illness; the  agent  knows  about the person’s  condition; commits the act with the primary intention of ending the life of that person; and the act is undertaken with  empathy and compassion  and without personal  gain. Physician-assisted suicide, on the other hand, intends to provide the patient   with   adequate   knowledge   about   means  and resources,  i.e.,  lethal  drugs,  and  counseling  to commit suicide. According to Islamic  sources,  euthanasia is also defined as ‘ending an individual’s life out of compassion for that person’s suffering’ (5)

Assisted   dying   is   increasingly   advocated   in   public discourse  as a  humane response to a terminal prognosis and distress on the part of selected patients, and their care providers (6)

There appears to be momentum internationally to permit some form of assisted dying within legal processes, with the Governments in areas of Australia, Germany, Ireland, Portugal, Spain, and New Zealand being the latest to  produce legislation in support of these practices. (4)

The British Medical Association has recently dropped  its opposition to assisted dying in a narrow vote at its annual representative  meeting.  Doctors  and  medical  students voted for the union to “move to a position of neutrality on  assisted  dying,  including  physician-assisted dying”. The   BMA,   which   represents   150,000  doctors,   has opposed  legalizing  assisted  dying  since  2006. Members of  the  UK’s  biggest  doctors’  union voted  to  adopt  a neutral stance on assisted dying,  with 4% in favor, 48% opposed, and 3% abstaining.

Currently,  euthanasia  or  physician-assisted  suicides are legal in  the  Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2  14, nationally as of   June   2016).   Physician-assisted   suicide, excluding euthanasia, is legal in 5 US states and Switzerland. Public support  for  euthanasia  and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In  Western Europe, an increasing and strong public support  for euthanasia and physician-assisted suicide has been reported; in Central and  Eastern Europe, support is decreasing. In the United States, less than 20% of    physicians   report   having   received   requests for euthanasia  or physician-assisted suicide, and 5%  or  less have complied (8,9)

The number of dementia patients requesting euthanasia in the Netherlands has increased recently. (10) A survey of physicians in Canada showed that physicians who were older,  had  stronger  religious  beliefs,  were  trained in palliative care, practiced in a teaching hospital, and had not received assisted dying requests in the year preceding aid/assistance   in   dying   (MAID)   for   non-competent the survey held less favorable attitudes towards medical patients with dementia. (11)

However, there is strong opposition to euthanasia in most states of America and most European countries.  McEvoy raised the question “Should doctors allow themselves to become  authorized  agents f  society  in  ending  life? To allow   some   physicians   to   perform  euthanasia would damage   the   integrity   of   the   profession.   Even   the authorized  experts  in the US penal system are  not  very good  at  administering  the  lethal  dose.  We  should  not accede to becoming the bedside analogue of this  practice(6) Bauer  argues that  Euthanasia  cannot be  restricted  to exceptional  cases,  based  on  the  idea  that  the patient’s autonomy is  to  be  valued more  highly than  their actual illness. If autonomy is of a  solute value, it could not be limited to the most serious cases of illness. (12)

Islam and Euthanasia

Life is given by God and cannot be taken away except by Him or with His permission. Taking away life should be the domain of the One who gives life. The Qur’an emphasizes that “it is the sole prerogative of Allah to bestow life and to cause death.” (13)

Preservation of life is one of the five basic purposes of the  sacred  law.  Human  beings  are  considered  to  be responsible stewards of their bodies, which are viewed as gifts from God.

The sanctity of human life is affirmed in the Qur’an. One cannot take  the  life of  another:  “Do not  take life which God has made sacred except in the course of Justice” (14).

The Holy Qur’an says: “…One  who has killed  a  person except in lieu of murder or mischief on earth; it would be as he slew the whole mankind and whoever saves the life of a human being, it is as if he has saved the life of all mankind …” (15)

One  also  cannot  take  on ’s  own  life:  “Do  not  kill yourselves,   for   verily   God   has   been   to   you  most merciful.”  (16). God says  in  the  Qur’an:  “It  is  He  who created death and life, that He may try which of you is best  indeed …” (17).   He also says: “… Nor can they control death nor life nor resurrection.” (18).

Thus, the person who intentionally ends his life will be punished on judgment day because of his disobedience to Allah,  and  for  denying   His  mercy.    he   Sunnah and teaching of  Prophet  Muhammad  (PBUH)  describes one such instance. He (PBUH) said in a Hadith: “Whoever  kills  himself  with  an iron instrument  will be carrying it forever in hell. Whoever takes poison and kills himself  will  forever  keep  sipping  that  poison  in hell. Whoever jumps off a mountain and kills himself will forever keep falling down in the depths of hell” (19).

According to Sahih Muslim, for example, in the battle of Hunain,   a   courageous   Muslim   warrior   was   fatally  wounded and killed himself because of unbearable pain due    to    his    wound.    Prophet   Muhammed    told his companions, when they praised his courage, that he is not fighting for the sake of God, but to be called brave and courageous. When he killed himself, he  proved that he is not a good Muslim and that he was fighting for fame! (20).

Lifesaving is a duty and the unjustifiable taking of life is considered a  grave sin. The  strong opposition to suicide in  the  hadith  literature formed a strong opinion among Muslims   that   neither   repentance   (if   suicide attempt failed) nor the suffering of the person can remove the sin of   suicide   or   mercy  killing   even   if   these  acts are committed with a purpose to relieve suffering and pain. Some  interpretations  of  the  Islamic  sources  even give advantage   to   murderers   as   opposed   to   people who commit suicide because the murderers, at least, may have the  opportunity to  repent for  their sin.  However, people who commit suicide are ‘labeled’ as l  sing faith in the afterlife without a chance to repent for their act. (21)

Islamic    law    clearly    prohibits    euthanasia    in    all circumstances. However, the wishes of the patient not to have  his dying prolonged artificially in  the  presence  of hopeless  prognosis  need to be  respected  and abided by. Such  wishes  may be  declared in the accepted “standing Do Not Resuscitate (DNR) orders” in certain hopeless  medical conditions (22,23).

The  physician  therefore  has  no  right  to  terminate any human life under his care. This also applies to the unborn baby since clear evidence indicates that human life starts at the time of ensoulment.

These sources from the Qur’an and hadith illustrate the sanctity  of  human  life,  prohibition  of  killing  a human being  with  no  justification,  and  prohibition  of   killing oneself. Thus, killing a person to ease his suffering even though   it   is   at   the   request   of   the   person   will be inconsistent with Islamic law, regardless of the different names given to the procedure, such as, active voluntary  euthanasia,  assisted  suicide,  or  mercy  killing  (24,25).  A person in such situation is expected to persevere patiently with  the  available  medical treatment  as  the  reward for such patience in the Hereafter is tremendous as  promised in Qur’an, in which Allah (swt) stated: “And those who patiently persevere will timely receive a reward without measure”  (26).  However,  pain-relief  or   withholding  or withdrawing   of   life-support,   in   which   there   is   an intention of  allowing a  person  to  die  when  there is no doubt that their  disease  is causing untreatable  suffering, are  permissible  as  long as the structures of consultation between all the parties concerned about the wellbeing of the patient are in place. (13)

The Islamic Jurisprudence Council held in Jeddah in May 1992   declared   a   strong   rejection   against   so-called euthanasia under all circumstances. And those terminally ill   patients  should  receive the appropriate  palliative medication,  utilizing  all  measures  provided  by God in this  universe,  and  one  should  not  despair  of  Allah’s mercy, and that doctor should do their best to support their  patients   morally  and  physically,  irrespective  of whether these measures are curative or not (27,28, 29)

The   Islamic   Medical   Association   of   North America assisted  suicide  in  terminally  ill  patients  by healthcare (IMANA)  is   absolutely opposed to euthanasia  and providers or patients’ relatives (30)

A  famous  fatwa  (religious  ruling)  by  the  European Council   for   Fatwa   and  Research   (2008)   states: The patient whatever his illness and however sick he (or she)  is shall not be killed because of desperation and loss of hope in recovery or to prevent the transfer of the patient’s  disease to others, and whoever commits the act of killing will be a deliberate killer. (31)

Religion and  moral  values affect  the  attitudes  of health caregivers  toward  MAID.  Muslims  believe  in  divine predestination  and  therefore  assume  that  any suffering has a purpose. As Sachedina   outlined, either they believe their  suffering atones for their past  sins  or  it  will bring reward  after the divine  test.  Many Muslims also refer to the   life   of   the   Prophet   Muhammad   who compared suffering  and  pain of the believer  to  a  tree  in  the fall where God absolves a sin with every leaf that falls off the tree. (31)

Killing is a crime whatever its name (mercy killing) and is  not  allowed in Islam and by the  law. The  perpetrator will be punished; the type of punishment may be reduced from   capital    punishment   to    imprisonment,    as  the perpetrator  did  it  upon  demand  by  the  person  himself. Even  if  the  law  exonerates  him from retribution,  he is morally wrong and will be judged by God on the final Day   of   Judgment.   The   laws   in   Islamic   and  Arab Countries   criminalize   euthanasia   an     the   physician participating   in   it   is   punished.   The   consent   of the deceased or the action on his repeated plea to end his  life reduces   the   punishment   from   capital   punishment to  imprisonment and abrogation of his medical practice  license (29).

The Saudi regulation of medical profession No 21 clearly criminalizes whoever kills or assists to kill a patient in response to the patient’s request to kill him. Similarly, the Syrian penal code No 552, criminalizes what is called mercy killing or assisting the patient to kill himself. (32). Islamic  Jurisprudence  exonerates  the  (person  who kills himself) if he was insane or suffered a serious psychiatric disease. However, the physician who kills a patient upon his  demand, will  not face  Qisas  (capital punishment) in Shafi Mazhab (Minhaj Attalibeen by Imam Nawawi). The physician may not  face  any punishment,  the  maximum being to pay the diyyah (blood fine).

In  the  Hanafi  and  the  Hanbali  mazhabs  (schools), the physician  will  be  ordered to  pay diyyah. It  is  only  the Maliki  scholars  and  some  of  the  Hanafi’s Ulema, who judge  that the killer in  cases  of  euthanasia, even  by the request  of  the competent adult  patient should face Qisas (capital punishment). The killer will face the wrath of Allah on the Day of Judgement, for which his abode will be Hell fire (32).

Conclusions

Assisted dying  or euthanasia is not  allowed even  if   the patient  insistently requests it and his  family agree  to  it. No  one  is  authorized  to  deliberately  end  life, whether one’s own or that of another human being. Saving life is encouraged,   and reducing  suffering  with  analgesia  is  however  acceptable,  even  if,  in  the process,  death  is hastened. This rule is based on the central teaching that “actions are to be judged by their intentions”. Withdrawal of  food  and  drink to  hasten death  is not  allowed and is considered murder.

References

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