Euthanasia and Physician-Assisted Suicide
Testimony of the Islamic Medical Association
Submitted to The Institute of Medicine Committee on Care at the End of
Reproduced with permission.
Shahid Athar M.D., F.A.C.E.*
IN THE NAME OF ALLAH, THE MOST BENEFICENT,
THE MOST MERCIFUL
The IMA endorses the stand
that there is no place for euthanasia in medical
management, under whatever name or form (e.g., mercy
killing, suicide, assisted suicide, the right to
die, the duty to die, etc.).
The sanctity of human life is ordained in the Quran.
"Do not take life which God has made sacred except
in the course of Justice" (6:151), and "anyone who
has killed a fellow human except in lieu of murder
or mischief on earth, it would be as he slew the
whole mankind" (5:32).
About suicide, Quran is very clear: "Do not kill
yourselves as God has been to you very merciful"
(4:29). Taking away the life should be the domain of
the One who lives life. True, there is Pain and
suffering at the terminal end of an illness, but we
believe there is reward from God for those who
patiently persevere in suffering (Quran 39:10 and
While Muslim Physicians are not encouraged to
artificially prolong the misery in a vegetative
state, they are ordained to help alleviate
suffering. Quran says, "Anyone who has saved a life,
it is as if he has saved the life of whole mankind"
(5:32). Prophet Muhammad (PBUH) emphasized this by
saying, " O Muslims, seek cure, since God has not
created any illness without creating a cure."
There is no doubt that the financial cost of
maintaining the incurably ill is a factor. However,
the question is when the human machine has outlived
the productive span and its maintenance becomes a
financial burden on society, should it be discarded
abruptly or allowed to die naturally, gradually and
peacefully? Islamically, when individual means
cannot cover the needed care, it becomes a
collective responsibility of the society. To meet
this objective, the society has to reshuffle its
values and priorities and divert funds from those
spent on alcoholism, drug abuse, teenage pregnancy,
and other such "pursuits of happiness" to providing
health care for those who are hopelessly ill and
allowing them to live with quality and die in
The IMA endorses the stand that there is no place
for euthanasia in medical management, under whatever
name or form (e.g., mercy killing, suicide, assisted
suicide, the right to die, the duty to die, etc.).
Nor does it believe in the concept of a willful and
free consent in this area. The mere existence of
euthanasia as a legal and legitimate option is
already pressure enough on the patient, who would
correctly or incorrectly, read in the eyes of
his/her family the silent appeal to go.
Although the Committee makes no explicit mention
of euthanasia, the implications are too obvious to
At the same time, the IMA holds the view that
when the treatment becomes futile, it ceases to be
mandatory. This would reflect on the administration
or continuation of medical treatment (including the
respirator). Adequate public debate (and education)
should precede and proceed to necessary legal
Under such conditions, however, the basic human
rights of hydration, nutrition, nursing and pain
relief cannot be withheld. These may be carried out
at home or in an institution as the case warrants.
Palliative care units or institutions would answer
such need, but we are not certain whether this
justifies the branching off of a full-blown medical
specialty for palliative care.
It is realized that the demarcation line between
futile and infutile medical treatment is often
blurred. Proximity to death cannot define futility
of treatment, since near-dead patients may often be
successfully treated and revived. The gray area
between futile and promising treatment should be
narrowed as much as possible, and the subjective
element in it should be minimized. An independent
second opinion might be of help. However, this area
open to research. Perhaps the relation of outcomes
to a battery of clinical parameters, or combinations
thereof, might help the establishment of a "futility
index" with reasonable precision, that would further
guide the current clinical assessment
The IMA follows the current policy about DNR (do
not resuscitate), where treatment is deemed futile.
Brain death, including the brain stem, is an
acceptable definition of death, with all the
consequences pertaining to cessation of animation or
the procurement of vital organs for transplantation.
Because the emphasis in such patients is not on
treating the primary disease but on ameliorating the
quality of life, research is recommended towards
controlling the accompanying symptoms like pain,
weakness, excretory dysfunction, ulceration, etc.
Gadgets and aids can make a big difference.
Affective and psychological care is important,
and both both care givers and family (guidelines or
brief courses) should be trained for it. Perhaps
music therapy should be further looked into as a
significant addition to the management.
The spiritual dimension should be recruited to
help the patient. This is not the function of clergy
only, but health professionals should have adequate
training in handling patients and guiding families.
Care of the terminally ill should not belong in
"rush" medicine or hurried physicians.
Care givers should have an insight into the
various religious, cultural and ethnic backgrounds
pertaining to terminal illness and death. A book may
be collated indicating indicating culture-specific
Since we live in a time when one's home is no
more suitable to be born in or to die in, reliance
has become heavy on institutional care. In most
cases there is no one at home to look after the
patient. This is one of the drawbacks of the
industrialized society, which tremendously pushes up
the cost of the care. Encouragement of volunteerism
and perhaps providing incentives might cover part of
this gap and is good for the moral health of society
Of course, the issue of care for the terminally
ill, as a component of health care in general, is
closely combined with the modern trends in
restructuring health care. It is regrettable to see
that the business aspects of health care are
expanding at the expense of the service (humane)
side of health care. A radical review is needed, but
we seem to be drifting away from it. It takes a
society which is more human oriented than dollar
Some of the most critical topics for research
include defining and identifying end-of-life issues
and educating physicians and the public about these
issues. The third-party provider also needs to
understand that the sanctity of life is more
comprehensive than a mere cost factor.
IMA makes the following suggestions:
- Development of assessment tools and uniform
end-of-life issues guidelines by appropriate
- Specific and appropriate tests to arrive at
the agreed-upon diagnosis and prognosis.
- Define areas in which to improve care and
sustain the quality of life not at the cost of
termination of life (i.e., improved home health
- Avoid developing such specialties which can
easily be overused or misused rather educating
- Make advance directives a part of all
hospital and office medical records of a patient
The role of the Committee is to receive and
respect input from all participating organizations
and try to incorporate their views into national
guidelines for end-of-life issues in the best
interest of the American society.
Respectfully submitted by:
Medical Ethics Committee,
Islamic Medical Association of North America
- Shahid Athar, M.D., F.A.C.E., Chair (Indiana)
- Hassan Hathout, M.D., Ph.D., Member (California)
- Wahaj D. Ahmad, M.D., Member (North Carolina)
- Farooq M. Khan, M.D., M.A.C.P., Member (New York)
- Hussain F. Nagamia, M.D., Member (Florida)
Islamic Medical Association of North America
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