Wednesday, May 05, 2010

Euthanasia and Islam - Part 2

This is a guest post by Nidhal Guessoum (see his earlier posts here). Nidhal is an astrophysicist and Professor of Physics at American University of Sharjah.

As I mentioned in Part 1, the movie You don’t know Jack pushed me to rethink the question of euthanasia within myself, and I recalled the discussions I had had many years ago on the subject with Islamically knowledgeable people, so I went and did some quick search for Islamic positions on “mercy killing”.

I expected to find some diversity of opinion, or at least a few voices looking at the question from various angles; I was surprised to find virtual unanimity among Muslim scholars against euthanasia. More than that, I was quite astonished at the weakness of some of their arguments.

First, Muslim scholars insist that suicide is strongly abhorred and outlawed in Islam, that its punishment is eternal hell, and that one who commits it will be denied proper funeral service. (One finds no discussion on the possible reasons for a suicide; it is all rejected across the board.)

Secondly, the scholars stress the fact that human life is not only sacred in Islam, it is God’s “property” and prerogative, and no one is allowed to “interfere” with His will and authority over when it should end, the precise moment of death (“ajal”) being known to God exclusively. (I will leave aside the issue of God’s omnipotence and omniscience, to what extent excludes any human will, power, or knowledge, and how a mere human could “interfere” with God’s “property” or authority over something. I will, however, point out the contradiction with some of the Qur’anic verses that the opponents of euthanasia themselves often cite: 3:145 “No soul can ever die except by Allah's leave and at a term appointed” and 16:61 “and when their term [for dying] cometh they cannot put (it) off an hour nor advance (it)”. In other words, whatever you do regarding the ending of a given life, that’s what God will have programmed…)

Thirdly, one finds repeated talk about “endurance” (accepting and swallowing one’s pain), which is highly rewarded in the life after. And surprisingly, there is quite a bit of discussion about the extent to which the treatment of a sickness is (or is not) obligatory and in which cases, and one learns that most religious scholars consider treatment to be generally non-obligatory! (We’ll see later why this point is made and how important it turns out in the argumentation.)

More to the point, a hadith (statement by Prophet Muhammad) is cited, according to which “[in ancient times], there was a man who got a wound, and growing impatient (with the pain) he took a knife and cut his hand with it, and the blood did not stop till he died. Allah said, 'My servant hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' "

And that is why one finds Muslim scholars (ranging from Ayatollah Khamanei to Saudi Arabia’s late grand mufti Bin Baz) quite unanimously rejecting any consideration for euthanasia and attempting to find justifications for that rigid position. Al-Qaradawi (probably the top Islamic jurist of today), who usually tries to present “reasonable” or “balanced” views, rejects “mercy killing” and allows only for “stopping medication” if it “happens to be of no use”, when the sickness “gets out of hand”… Quite surprisingly, Al-Qaradawi adds that “the physician can practice this for the sake of the patient’s comfort and the relief of his family”!

I was also pleasantly surprised to find that an Islamic Code of Medical Ethics had been produced in 1981 in the First International Conference on Islamic Medicine held in Kuwait, and in it euthanasia was addressed quite squarely. Among the relevant pronouncements, however, one finds: “The claim of killing for painful hopeless illness is also refuted, for there is no human pain that cannot be largely conquered by medication or by suitable neurosurgery...”; “A physician should not take an active part in terminating the life of a patient, even if it is at his or her guardian’s request, and even if the reason is severe deformity; a hopeless, incurable disease; or severe, unbearable pain that cannot be alleviated by the usual pain killers. The physician should urge his patient to endure and remind him of the reward of those who tolerate their suffering.

Finally, in an interesting recent article published in an Iranian journal of medicine, Aramesh and Shadi (2007) present the orthodox views of Islamic scholars (Shiite and Sunni), but at the very end try to show some “flexibility” by pointing to two instances where “passive assistance in allowing a terminally ill patient to die” would be permissible under Islamic law: (a) “administering analgesic agents that might shorten the patient’s life, with the purpose of relieving the physical pain or mental distress”; (b) “withdrawing futile treatment on the basis of informed consent (of the immediate family members who act on the professional advice of the physicians in charge of the case), allowing death to take its natural course.”

The second “instance” is the same as what Al-Qaradawi mentions; the first, however, is an interesting one: basically, it says that if we are giving a patient some analgesic (e.g. morphine) with a dose that we know could result in death, then that is OK because we were trying to reduce the pain, not induce death…

What do we make of these views and arguments? While I still see some value in some of the arguments that can be brought to bear on the issue (sacredness of life, importance of not rushing to end a life just because it’s painful or distressing, difficulty in determining who qualifies for the life-ending action and when, etc.), I find many of the above arguments rather weak and forced. Many Muslim scholars, even when discussing this topic, start by stressing that “Islam is a religion of mercy” but then ignore this aspect of the issue altogether. No careful examination of the various cases and situations is made (at least not in the references I read). And I have difficulty with the logic of “you can stop the treatment, knowing it will result in death”, and “you can disconnect life-support systems if the brain is dead or the person has no chance of recovering” but you cannot inject the patient with anything that will induce death even if s/he is mentally and physically unable to function. Of course, I understand that this reasoning is built upon the earlier premises of: (a) we can’t decide to end a life, because that’s prerogative; (b) we can let a person die (on his/her own) if it seems that it is God’s will (terminal illness); (c) treatment is not obligatory…

Our modern life, with its science and other societal developments, has brought new perspectives on issues that need careful, critical, and open-minded reexamination. Rigid standpoints will not do, for there will always come situations that will render them absurd, or at least unreasonable. This does not mean one should just accept any new philosophy or position that is advocated by various voices or groups, but careful, honest, and positive thinking will always do us good.


Rational Vs Irrational said...

Interesting take....

But for a moment consider the fact that we have ourselves increased the chances of sustained debility by fighting the natural phenomena of death -longevity of life by various [italic]unnecessary [/italic] medical approaches, by eating unhealthy food (excessive indulgence) and so called shams of high tech lifestyle.

On one hand doctors/scientists are fighting religious ideologies for saving life through various biotech breakthrough products (grafting of bones, skin )and on the other hand having arguments on putting people to sleep.

Who decides who would die - You? Ah! sorry its patients wish. But who decides what is threshold of pain/time of suffering. For some a prick is equal to car crash injury ...because people accept or not we do have interindividual variability on all levels (I guerss thats why we are individuals).

And with regards to suicide, I aint sure what mental state of self pity people end up with and sadly have take such extreme steps.But isnt is that we as a society are responsible for those people because we have made those blurred standards of life/lifestyle/intellect and pressurize individuals to stand up to those fake standards of living. I am doing a little study on depression and not surprising - patients who have social pressures (you dont have figure, looks height, weight, intellect???), lack of support from family, child molestation, previously raped individuals are in more numbers on the suicidal ideation list than not. Isnt moral deprivation of society (which I guess majorly is rooted with lack of religiosity ) playing a major role here.

Nidhal Guessoum said...

Hi; thanks for the comment.

Sure, society is responsible to some extent (in various ways), in many cases the individual is too, but sometimes it's nobody's fault (if you get multiple sclerosis, you know that nobody did anything wrong)...

But perhaps the point where we agree is that the issue is not solely the purview of the patient. Society must help, at least by supporting the difficulties faced by the patient, and not just show him/her euthanasia as the only alternative left.

As I said in my piece, we all need to look at the issue (in general) and the cases (one by one) with more compassion and open-mindedness, less dogmatism. Until now, I think, the debate has been too polarized by the "accept/reject euthanasia" on philosophical/religious grounds...

Anonymous said...

Thank you, definetely a topic that could need some more in depth research.