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Expert opinion presented to the 16th Session of the Fiqh Academy of India held at Jamia Islamia darul Uloom Muhazzabpur Azamghar near Varanasi India on 01st April 2007 by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine at the Institute of Medicine University of Brunei Darussalam and Visiting Professor of Epidemiology University of Malaya
STATEMENT OF THE QUESTION
In the name of Allah-the most merciful, the most compassionate.
Euthanasia is one of the issues that have cropped up due to dominance of the western culture. Such issues were considered to be part of the western society; however, globalization has pushed them knocking the doors of India as well as other eastern countries. It is in this background the Islamic Fiqh Academy (India) has chosen this issue for discussion. Hazart Qazi Mujahidul Islam Qasmi (Rahmatullah Aley) had circulated a brief note raising various issues pertaining to euthanasia among Fiqh scholars. The note had dealt with the issue comprehensively. We are reproducing below the same note as questionnaire on the issue:
Euthanasia means the act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection or by the suspension of extraordinary medical treatment. Euthanasia (from Greek: eu, "good", thanatos, death) is the practice of terminating the life of a person or an animal because they are perceived as living an intolerable life, in a painless or minimally painful way either by lethal injection, drug overdose, or by the withdrawal of life support.
There are two kinds of Euthanasia: active Euthanasia and passive Euthanasia. Active Euthanasia… refers to the doctors taking certain positive actions that actively cause death. For example, a cancer patient in immensely painful state or a patient who is in prolonged coma and, in the opinion of the doctors, there is no hope for his survival, in such a situation the patient is administered some pain-killer medicine in large quantities which causes death of the individual. Similarly a person suffering from meningitis or has suffered such a severe head injury that the person has gone in coma and, in the opinion of doctors, there is no possibility of his recovery, or who is being kept alive through some artificial means or instruments i.e. life support system and if such a support is removed the person would die. In such a situation, allowing the person to die by removing the life support system is also known as active euthanasia.
Passive Euthanasia means that no act is done to take life of the patient. Rather, the patient is deprived of the treatment and care needed to keep him alive. For example a cancer patient or a patient, who is suffering from meningitis, head injury or spinal injury causing paralysis, having no hope of survival, is denied medical treatment so that death is hastened. Likewise, medical care is denied to a child having congenital defects when he contracts any disease like pneumonia or any other disease, to hasten his death. Similarly, a view is getting acceptance in the western world that the elderly persons who contract some dangerous diseases requiring huge expenditure, may be allowed to die in order to save resources.
Therefore, the stated object of euthanasia is to relieve the patient of the pain he/she is suffering from and his/her relatives of the financial burden which they have to incur in order to keep the person alive.
In the light of above, following important question arise for consideration:
- Whether Islam permits any such acts which allow a patient to die in order to save him from severe pain in any of the situation mentioned above?
- Whether Islam allows denial of medical treatment to a patient in order to let him to die?
RESPONSE TO THE QUESTION
Summary of the response:
I agree with the definition of euthanasia above and its classification as active and passive. Islamic Law does not distinguish between active and passive euthanasia because the intention and the consequence are the same in both. The Islamic position on euthanasia (active and passive) is clear prohibition, haram. In practice the difference between euthanasia as withdrawing life support, medical treatment, nutrition, as well as hydration to cause death that relieves the from pain and withdrawing life support, nutrition, hydration as well as medical treatment that have no further net benefit in a terminally-ill patient is based on the underlying intention since the actions taken in both cases are exactly the same.
Justification of the response:
Euthanasia violates the purpose of preserving life, hifdh al nafs (physicians treat and do not kill) and the purpose of preserving diin, hifdh al ddiin (life and death are in the hands of Allah). Active and passive euthanasia are the same because they have the same intention since actions are judged by their intentions, al umuur bi maqasidiha. Physicians and family members can be motivated by self-interest to decide for euthanasia. Euthanasia causes injury which is prohibited, la dharara wa la dhiraar. The pain of terminal illness is a lesser evil that causing death, ikhtiyaar ahwan al sharrain. Euthanasia violates public interest by cheapening life and therefore encouraging genocide; public interest takes precedence over personal interest, al maslahat al aamat muqaddamat ala al maslahat alkhhaasat. Pain in terminal illness is not a necessity that legalizes murder that is according to the principle al dharuraat tubiihu al mahdhuraat. A necessity is defined in law as what threatens any of the 5 purposes of the Law (ddiin, nafs, nasl, aql, & maal). Euthanasia cannot be accepted as a necessity since it destroys and does not preserve 2 of the purposes of the law: diin and nafs. Euthanasia violates the principle of custom, qa’idat al aadat, because the customary role of the physician is to heal and not to kill.
The physician who advises, assists, or carries out a euthanasia operation at the instructions of the patient in full knowledge of the underlying intention is committing a crime. An action is haram whether done by the person or is done by another on his/her behalf, ma haruma fi'iluhu haruma talabuhu. The physician carries is the final actor, al fi'ilu yudhhafu ila al fa'ili al akhiir. Refusal of treatment by a patient is euthanasia if the intention is causing death.
In conclusion, there is no legal basis for euthanasia. Physicians have no right to interfere with ajal that was fixed by Allah. Disease will take its natural course until death. Physicians for each individual patient do not know this course. It is therefore necessary that they concentrate on the quality of the remaining life until the ajal reaches its appointed time.
Allah knows best