Stopping Medical Treatment when there is no Expected Benefit
Question:
A dilemma facing many in my profession. I am a doctor, currently working in the intensive care unit with children. Although it is not a daily event, the question of withdrawing treatment in patients where further treatment is futile often arises.
In the past where technologies such as ventilators, equipments and drugs such as inotropes (keeping the heart going) were not available these issues would have not risen as these groups of patients would (Allah willing) soon die.
However, with modern technologies so far, a small albeit significant group can be sustained on the above treatment despite a futile outcome that results in the inevitable slow death.
My questions are:
1) What is the Islamic ruling on withdrawing or limitations of treatment?
2) As a corollary to the above, what is the Islamic stand to the concept of ‘living will’? (A living will is a legal document that a sound-minded adult makes to set out the circumstances under which they could wish withdrawal of treatment, in the event that they cannot make the decision at such time).
Answer:
When a patient is severely ill in a way that further treatment is futile and apparently there is no chance of survival, then in such a case, in order to ease and hasten the death there are normally two procedures taken:
a) Using of certain drugs and other methods that cause death,
B) Withdrawing treatment in order to allow the patient to die naturally,
As far as the using of certain drugs in order to hasten the death of the patient is concerned, there is no doubt that this is unlawful (haram) in Shariah.
The human body is a trust (amanah) given by the Almighty Creator to the human being which he himself does not own. As such, according to Islam, it is impermissible for an individual to tamper with even his own body that was given to him as a trust. Islam regards human life as sacred.
Allah Most High says:
“And verily we have honoured the children of Adam.” (Surah al-Isra, V.70)
It light of the above, it becomes evident that it is unlawful (haram) to use methods and means that would actively cause a person do die.
The Messenger of Allah (Allah bless him & give him peace) said:
“Whoever intentionally throws himself from a mountain and kills himself, will be in the (Hell) Fire falling down into it and abiding therein eternally forever; and whoever drinks poison and kills himself with it, he will be carrying his poison in his hand and drinking it in the (Hell) Fire wherein he will abide eternally forever; and whoever kills himself with an iron weapon, will be carrying that weapon in his hand and stabbing his abdomen with it in the (Hell) Fire wherein he will abide eternally forever.” (Sahih al-Bukhari & Sahih Muslim)
The Messenger of Allah (Allah bless him & give him peace)) also said:
“There was amongst those before you a man who had a wound. He was in (such) anguish that he took a knife and made with it a cut in his hand, and the blood did not cease to flow till he died. Allah the Almighty said: “My servant has himself forestall me; I have forbidden him Paradise.”
Therefore, in order to save oneself from undue pain and hardship, it will not be permissible to use methods that will cause death. If the medical expert did carry this out, it will be tantamount to murder. If the patient gave his consent to this, it will be regarded as suicide.
With regards to withdrawing treatment from patients in order for them to die naturally and in a dignified way, it should be remembered that according to the majority of scholars medical treatment is not something that is necessary (wajib) upon the person inflicted with a illness. It is merely something that is permissible. Some scholars went to the extent to say that it is preferable to abstain from treatment and have patience (sabr) rather than treating the illness or disease.
This understanding is based on a Hadith narrated by the Companion Sayyiduna Abd Allah ibn Abbas (Allah be pleased with him) that a girl was inflicted with the disease of epilepsy, thus she came to the Messenger of Allah (Allah bless him & give him peace) and asked him to supplicate to Allah for her. The Messenger of Allah said to her: “If you wish you may exercise patience and receive paradise in return or if you want I can ask Allah to cure you.” She said: “I would like to remain patient on this severe illness (and receive the rewards), but the only thing is that at times due to this illness, parts of by body become exposed, so please ask Allah that it does not open up. The Prophet (Allah bless him & give him peace) made Dua for her. (Recorded by Imam al-Bukhari & Imam Muslim in their respective Sahih collections)
Imam Abu Hamid al-Ghazali (Allah have mercy on him) mentions in his famous Ihya uloom al-Din that the majority of the scholars hold medical treatment to be merely something that is permissible, whilst others regard it as recommended (mustahab) and a very few number of scholars consider it to be necessary (wajib).
Generally, Medical treatment is thought to be a means that may cure a patient. It is not something that guarantees restoring of health for the person using medication, for the fact that many times despite using medication an individual is not cured.
It is stated in the Hanafi Fiqh reference book al-Fatawa al-Hindiyya:
Means used for the removing of harms are of three types.
1) Those that remove potential harm for certain (maqtu’) such as the drinking of water in order to quench thirst and eating of food in order to remove hunger.
2) Those that by exercising them, it is presumed health will be restored such as medical treatment.
3) Those that may cure (but less significant than the second situation) such as the using of amulets, etc…
As far as the first set of means are concerned, abstaining from using them is no way considered as part of reliance and trust in Allah (tawakkul), rather it is unlawful to refrain from using these means. If a person was to die due to not drinking water, he will be sinful.
The last category of means is not essential in that complete reliance in Allah is only achieved by abstaining from using them.
With regards to the middle category such as using medication, using it is not contrary to the concept of Tawakkul, and abstaining from its usage is not a sin also. It is in between the two categories.” (al-Fatawa al-Hindiyya, 5/355)
It becomes clear from the above excerpt that to abstain for medical treatment is not unlawful in Shariah, and if an individual did die due to this, he/she will not be sinful.
However, the Messenger of Allah (Allah bless him & give him peace) did himself use medication and also encouraged the Companions to resort to medication.
In a Hadith it is stated:
“O servants of Allah! Use medication, for Allah Almighty has not created any illness except that He has also produced its cure, besides one thing. The Companions asked: “What is that?” He replied: “death”. (Tirmidhi 2039, Abu Dawud 3855, Ahmad 4/278 & Ibn Majah 3436)
In light of the above, it would generally be advisable to resort to medication and use the means provided by Allah Almighty. However, in a situation where further treatment is futile and there is no apparent hope for the patient to be cured, then it would be permissible to withdraw treatment with the consent of the patient or his immediate relatives. Also, it will be permissible for the patient to make a living will that gives permission to withdraw treatment in such situations.
And Allah knows best
[Mufti] Muhammad ibn Adam
Darul Iftaa
Leicester , UK