Fatme is on life-sustaining Fatme is on life-sustaining treatment. The only way to treatment. The only way to

save her is through the use of save her is through the use of embryonic stem cells. To make embryonic stem cells. To make matters worse, she’s pregnant matters worse, she’s pregnant and considering an abortion. and considering an abortion. Because of her condition, her Because of her condition, her

child would be born with child would be born with hydrocephaly. Her very hydrocephaly. Her very

religious parents are against religious parents are against the abortion. the abortion.

Fatme comes to you for advice Fatme comes to you for advice on the Islamic perspective of on the Islamic perspective of

this situation!this situation!

The Islamic MedicalThe Islamic MedicalAssociation of North Association of North

AmericaAmerica(IMANA)(IMANA)

Islamic Medical Islamic Medical EthicsEthics

Definition of Definition of Islamic MedicineIslamic Medicine

The art and science of practice The art and science of practice of medicine by Muslim of medicine by Muslim physicians and other helath physicians and other helath care providers in the service of care providers in the service of humanity under Islamic humanity under Islamic guidelines as ordained by the guidelines as ordained by the divine book al-Qur’an and divine book al-Qur’an and taught by Prophet Muhammad, taught by Prophet Muhammad, peace be upon him (PBUH)peace be upon him (PBUH)

Islamic Medical Ethics: The IMANA PerspectiveIslamic Medical Ethics: The IMANA Perspective

Islam considers Islam considers access to health care access to health care as a fundamental as a fundamental right of the individualright of the individual

When faced with difficult decision-When faced with difficult decision-making options for a patient, a making options for a patient, a physician's decision should take physician's decision should take into consideration…into consideration…

*Available Knowledge*Available Knowledge

*His/Her Experience*His/Her Experience

*His/Her Peers*His/Her Peers

*Consensus of the Community*Consensus of the Community

And, of course, a final conclusion And, of course, a final conclusion should be based upon the rules should be based upon the rules

of ~of ~Islamic Laws~Islamic Laws~ mostmost of which are based upon of which are based upon the Holy Qur’an and/or saying the Holy Qur’an and/or saying

of the Holy Prophet Muhammad of the Holy Prophet Muhammad (PBUH)(PBUH)

From Islmaic Law comes From Islmaic Law comes two main principles in two main principles in

Islamic MedicineIslamic Medicine Sanctity of Human Life Sanctity of Human Life Whosoever saves a human life, saves the Whosoever saves a human life, saves the

life of the whole mankindlife of the whole mankind (5:32) (5:32) Seeking Cure Seeking Cure The Holy Prophet has said…The Holy Prophet has said…““There is no disease that God has created, There is no disease that God has created,

except that He also has created its except that He also has created its treatment.” treatment.”

““Seek treatment, for God the Exalted did Seek treatment, for God the Exalted did not create a disease for which He did not not create a disease for which He did not

create a treatment, except senility.’create a treatment, except senility.’

Furthermore, these two Furthermore, these two principles are supported by principles are supported by the 5 Goals of Islamic Lawthe 5 Goals of Islamic Law

Protection and Preservation of Protection and Preservation of LifeLife ProgenyProgeny IntellectIntellect Property Property ReligionReligion

Sanctity of Human LifeSanctity of Human Life

To what extent should the To what extent should the preservation and protection of preservation and protection of

human life be upheld?human life be upheld?

Let’s first define deathLet’s first define deathTwo conditions which render a person Two conditions which render a person

dead:dead: The physician has determined that after a The physician has determined that after a

standard examination, a person’s standard examination, a person’s cardiopulmonary function has come to a cardiopulmonary function has come to a permanent stoppermanent stop

A specialist physician has determined that A specialist physician has determined that after standard examination, the function of after standard examination, the function of the brain and the brain stem, has come to a the brain and the brain stem, has come to a permanent stop, even if some other organs permanent stop, even if some other organs may continue to show spontaneous activitymay continue to show spontaneous activity

Versus of the Qur’an which Versus of the Qur’an which Address DeathAddress Death

It is he who gives life and death and when It is he who gives life and death and when He decides upon an affair, He says to it: Be He decides upon an affair, He says to it: Be and it isand it is (40:68) (40:68)

No soul can die except by God’s permission, No soul can die except by God’s permission, the term being fixed by writing…the term being fixed by writing…(3:145)(3:145)

Every soul will have a taste of death. In the Every soul will have a taste of death. In the end, to us, shall you be brought back end, to us, shall you be brought back (29:57)(29:57)

It is He who gives life and Who takes it It is He who gives life and Who takes it away and to Him shall you be brought backaway and to Him shall you be brought back (10:56)(10:56)

Nor take life which God has made sacred-Nor take life which God has made sacred-except for a just cause. except for a just cause. (17:33)(17:33)

Obvious ConclusionsObvious Conclusions

Euthanasia and Physician Euthanasia and Physician Assisted Suicide are Assisted Suicide are prohibited in Islam. prohibited in Islam.

1. Mohamed on his death-bed is 1. Mohamed on his death-bed is breathing via a life-sustaining-breathing via a life-sustaining-ventilator. ventilator.

Would removing the ventilator which Would removing the ventilator which would cause death be considered would cause death be considered haram (Islamically impermissible)?haram (Islamically impermissible)?

2. Mohamed refuses a ventilator 2. Mohamed refuses a ventilator needed to sustain life.needed to sustain life.

What about the pain and What about the pain and suffering of the terminally suffering of the terminally ill or persistent vegetative ill or persistent vegetative

state?state?

To treat with full respect, a patient’s comfort To treat with full respect, a patient’s comfort should be maintained by pain control.should be maintained by pain control.

1. If a patient’s death is medically inevitable, 1. If a patient’s death is medically inevitable, the patient is permitted to die without the patient is permitted to die without unnecessary procedures. unnecessary procedures.

(It is Islamically permissible to remove (It is Islamically permissible to remove Mohamed from the ventilator).Mohamed from the ventilator).

2. A terminally ill patient should decide if he 2. A terminally ill patient should decide if he or she wants to continue life-sustaining or she wants to continue life-sustaining treatment. However, further or new treatment. However, further or new attempts at life support are not allowed. attempts at life support are not allowed.

(If Mohamed is on his death bed, he may (If Mohamed is on his death bed, he may reject the ventilator for this reason).reject the ventilator for this reason).

Feeding TubeFeeding Tube(Terminally Ill)(Terminally Ill)

In order to maintain comfort, In order to maintain comfort, nutrition cannot be withheld nutrition cannot be withheld because of prolonged suffering. because of prolonged suffering.

If a If a feeding tubefeeding tube is removed, it is removed, it cannot be re-inserted. A cannot be re-inserted. A patient should be allowed to patient should be allowed to die peacefully. die peacefully.

Persistent Vegetative Persistent Vegetative State (PVS)State (PVS)

Again, Islam does not encourage Again, Islam does not encourage prolonging the misery of those prolonging the misery of those persons in PVS.persons in PVS.

Thus, when nothing more can be Thus, when nothing more can be done for the PVS, it is best to allow done for the PVS, it is best to allow the patient to dies peacefully.the patient to dies peacefully.

REMEMBER: Nutrition must, REMEMBER: Nutrition must, however, be maintained until deathhowever, be maintained until death

Let’s now define lifeLet’s now define lifeMan We did create from a quintessence Man We did create from a quintessence

(of clay); Then We placed him as (a (of clay); Then We placed him as (a drop of) sperm in a place of rest, firmly drop of) sperm in a place of rest, firmly fixed; Then We made the sperm into a fixed; Then We made the sperm into a clot of congealed blood; then of that clot of congealed blood; then of that

clot We made a (fetus) lump; them we clot We made a (fetus) lump; them we made out of that lump bones and made out of that lump bones and

clothed the bones with flesh; then we clothed the bones with flesh; then we developed out of it another creature. developed out of it another creature. So blessed be God, the best to create!So blessed be God, the best to create!

(23:12-14)(23:12-14) Islam holds that biological life begins Islam holds that biological life begins

at conception while human life at conception while human life begins at ensoulment (personhood). begins at ensoulment (personhood).

When is ensoulment?When is ensoulment?

Different schools of thought Different schools of thought believe ensoulment takes believe ensoulment takes place 40 to 120 days after place 40 to 120 days after fertilization.fertilization.

From Islamic Law comes From Islamic Law comes two main principles in two main principles in

Islamic MedicineIslamic Medicine Sanctity of Human Life Sanctity of Human Life Whosoever saves a human life, saves the Whosoever saves a human life, saves the

life of the whole mankindlife of the whole mankind (5:32) (5:32) Seeking Cure Seeking Cure The Holy Prophet has said…The Holy Prophet has said…““There is no disease that God has created, There is no disease that God has created,

except that He also has created its except that He also has created its treatment.” treatment.”

““Seek treatment, for God the Exalted did Seek treatment, for God the Exalted did not create a disease for which He did not not create a disease for which He did not

create a treatment, except senility.’create a treatment, except senility.’

Seeking CareSeeking Care

The Holy Prophet (PBUH) The Holy Prophet (PBUH) clearly said “Seek treatment..” clearly said “Seek treatment..” This has some medical This has some medical implications. If an illness could implications. If an illness could be treated or cured with be treated or cured with medication, an ill person medication, an ill person should “seek treatment”should “seek treatment”

Genetic EngineeringGenetic Engineering

If gene therapy could prevent, If gene therapy could prevent, cure, or treat a disease, does cure, or treat a disease, does Islam permit gene therapy to Islam permit gene therapy to

“seek treatment”?“seek treatment”?

Yes, Yes,

Though Muslims are by no Though Muslims are by no means morally obligated, means morally obligated,

gene therapy is only gene therapy is only permitted in order to alter or permitted in order to alter or

delete diseased genes.delete diseased genes.

Embryonic Stem Cells Embryonic Stem Cells (ESC)(ESC)

Embryonic stem cells provide Embryonic stem cells provide means for ill or diseased Muslims means for ill or diseased Muslims to “seek treatment.” to “seek treatment.”

However, ESC come from the However, ESC come from the death of an embryo whose (at death of an embryo whose (at least) biological life was killed. least) biological life was killed.

Are ESC permitted in Islam?Are ESC permitted in Islam?

Yes,Yes,

Only if the embryonic stem Only if the embryonic stem cells come from cells come from spontaneousspontaneous

miscarriages or extra ova miscarriages or extra ova from in vitro fertilizationfrom in vitro fertilization

By the way,By the way, When a couple is unable to conceive When a couple is unable to conceive

a child, in vitro fertilization is a child, in vitro fertilization is Islamically permitted only between Islamically permitted only between their own sperm/ovum and at both their own sperm/ovum and at both of their consent. of their consent.

Third parties are Islamically Third parties are Islamically impermissible in the conception of a impermissible in the conception of a child. Therefore, surrogate child. Therefore, surrogate motherhood, sperm donors, etc. are motherhood, sperm donors, etc. are haram. haram.

AbortionAbortion

Islamic Law on Abortion Come Islamic Law on Abortion Come From Most of the Same From Most of the Same

Qur’anic VersusQur’anic Versus It is he who gives life and death and when It is he who gives life and death and when

He decides upon an affair, He says to it: Be He decides upon an affair, He says to it: Be and it isand it is (40:68) (40:68)

No soul can die except by God’s permission, No soul can die except by God’s permission, the term being fixed by writing…the term being fixed by writing…(3:145)(3:145)

Every soul will have a taste of death. In the Every soul will have a taste of death. In the end, to us, shall you be brought back end, to us, shall you be brought back (29:57)(29:57)

It is He who gives life and Who takes it It is He who gives life and Who takes it away and to Him shall you be brought backaway and to Him shall you be brought back (10:56)(10:56)

Nor take life which God has made sacred-Nor take life which God has made sacred-except for a just cause. except for a just cause. (17:33)(17:33)

Direct ConclusionsDirect Conclusions

Therefore, the premise of the Therefore, the premise of the conclusion is similar to euthanasia:conclusion is similar to euthanasia:

Abortion of a healthy baby from a Abortion of a healthy baby from a healthy mother is Islamically healthy mother is Islamically

prohibitedprohibited

If the fetus harms the mother, the If the fetus harms the mother, the latter is Islamically obligated to get latter is Islamically obligated to get an abortion.an abortion.

Cases for AbortionCases for Abortion If the infant will die shortly after If the infant will die shortly after

birth due to a fatal disease, an birth due to a fatal disease, an abortion is Islamically permissible. abortion is Islamically permissible.

If the baby is born with a non-fatal, If the baby is born with a non-fatal, yet sever, malformation (e.g., yet sever, malformation (e.g., severely comatose), the mother can severely comatose), the mother can only abort before 40-120 days after only abort before 40-120 days after conception. conception.

Rape victims who conceived can opt Rape victims who conceived can opt for abortion.for abortion.

Another ArgumentAnother Argument

Other schools of thought state that Other schools of thought state that aborting a fetus from a rape incident aborting a fetus from a rape incident is only committing another crime. is only committing another crime.

Four Principles in Islamic Four Principles in Islamic BioethicsBioethics Respect for the autonomy of the patientRespect for the autonomy of the patient

BeneficenceBeneficence Nonmaleficence: “first do no harm” the Nonmaleficence: “first do no harm” the

ethical principal of doing no harmethical principal of doing no harm Distributive Justice: normative Distributive Justice: normative

principles designed to guide the principles designed to guide the allocation of the benefits and burdens allocation of the benefits and burdens of economic activity (Standford of economic activity (Standford Encyclopedia of Philosophy) Encyclopedia of Philosophy)

Some rules of Islamic Some rules of Islamic BioethicsBioethics

Necessity overrides prohibition: Necessity overrides prohibition: Under severe circumstances, Under severe circumstances, Islamically prohibited items may Islamically prohibited items may become permissiblebecome permissible

Harm has to be removed at every Harm has to be removed at every cost if possiblecost if possible

Accept the lesser of two harms if Accept the lesser of two harms if both cannot be avoidedboth cannot be avoided

Public interest overrides individual Public interest overrides individual interestinterest

The consumption of pork is The consumption of pork is forbidden in Islam; pigs are forbidden in Islam; pigs are also considered impure.also considered impure.

With that said, is it Islamically With that said, is it Islamically permissible to implant a pig’s permissible to implant a pig’s heart valve in humans?heart valve in humans?

Yes, Yes, Only when the valve is life Only when the valve is life

sustaining and no other sustaining and no other substitutes are available do the substitutes are available do the

necessity of the heart valve necessity of the heart valve overrides the impurity of pigs. overrides the impurity of pigs.

Scarce Medical Scarce Medical ResourcesResources

Rules of Bioethics:Rules of Bioethics:

Public interest overrides Public interest overrides individual interest.individual interest.

Decisions should be in-part Decisions should be in-part based on the Consensus of the based on the Consensus of the CommunityCommunity

The Communitarian ViewThe Communitarian View If life-sustaining treatments If life-sustaining treatments

consume the community’s scarce consume the community’s scarce medical resources, then such medical resources, then such treatment should be stopped. treatment should be stopped.

With freely accessible medical With freely accessible medical resources, a disease should be resources, a disease should be fought rigorously when a chance of fought rigorously when a chance of survival exists. survival exists.

Fatme is on life-sustaining Fatme is on life-sustaining treatment. The only way to treatment. The only way to

save her is through the use of save her is through the use of embryonic stem cells. To make embryonic stem cells. To make matters worse, she’s pregnant matters worse, she’s pregnant and considering an abortion. and considering an abortion. Because of her condition, her Because of her condition, her

child would be born with child would be born with hydrocephaly. Her very hydrocephaly. Her very

religious parents are against religious parents are against the abortion. the abortion.

Now, what is your advice?Now, what is your advice?