When can Muslims withdraw or withhold life support? A narrative review of Islamic juridical rulings

Afshan Mohiuddin,Mehrunisha Suleman,Shoaib Rasheed,Aasim I Padela

doi:10.1080/11287462.2020.1736243

Afshan Mohiuddin, Mehrunisha Suleman + Show 2 more

Open Access

https://doi.org/10.1080/11287462.2020.1736243

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Abstract

ABSTRACT When it is ethically justifiable to stop medical treatment? For many Muslim patients, families, and clinicians this ethical question remains a challenging one as Islamic ethico-legal guidance on such matters remains scattered and difficult to interpret. In light of this gap, we conducted a systematic literature review to aggregate rulings from Islamic jurists and juridical councils on whether, and when, it is permitted to withdraw and/or withhold life-sustaining care. A total of 16 fatwās were found, 8 of which were single-author rulings, and 8 represented the collective view of a juridical council. The fatwās are similar in that nearly all judge that Islamic law, provided certain conditions are met, permits abstaining from life-sustaining treatment. Notably, the justifying conditions appear to rely on physician assessment of the clinical prognosis. The fatwās differ when it comes to what conditions justify withdrawing or withholding life- sustaining care. Our analyses suggest that while notions of futility greatly impact the bioethical discourse regarding with holding and/or withdrawal of treatment, the conceptualization of futility lacks nuance. Therefore, clinicians, Islamic jurists, and bioethicists need to come together in order to unify a conception of medical futility and relate it to the ethics of withholding and/or withdrawal of treatment.

Highlights

Every culture has its own understanding of the events near the end-of-life, and the appropriate rites and rituals to perform at that time
The first stage of the search was the review of Islamic bioethics manuscripts/texts and conference proceedings that were available to the authors to uncover cited juridical rulings on the topic
Few studies have analysed religious resources commenting on the ethics of such decisions from an Islamic perspective

Summary

Introduction

Every culture has its own understanding of the events near the end-of-life, and the appropriate rites and rituals to perform at that time. For Muslims, beliefs, practices and rites nearing the end-of-life centre on this phase being a transition period that precedes an everlasting afterlife (Sheikh, 1998). These understandings influence the significance attached to the liminal state between life and death, and the ethical duties and obligations that ensue. In this way, Muslim patients, families, and physicians carry their beliefs and values into the. Clinical encounter and may seek to negotiate healthcare pathways that align with their religious values, and at the same time, cohere with the conventions, professional standards, and expectations of clinical care. When negotiating clinical care goals at the endof-life, and when making decisions about withholding and withdrawing of life-sustaining care, clinicians, patients and families may look to the ethical guidelines sourced within their faith tradition (Padela & Mohiuddin, 2015)

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