Brain Death – An Islamic Perspective
Prof. Ibrahim B. Syed
Islamic Research Foundation International, Inc.
Terri Schiavo, a white female of Roman Catholic faith was born on 3rd December 1963 in Philadelphia, PA. She married Michael on 10-11-84.
Terri Schiavo entered a vegetative state in 1990 after adopting an "iced tea diet" (related to her bulimia), resulting in a disastrous potassium deficiency that caused her heart to stop. She suffered cardiac arrest on 25 February 1990 early morning and heart beat was revived after some delay. By the time her heart was revived she suffered irreversible brain damage. (WHEN THE HEART STOPPED, THE BRAIN DID NOT GET THE BLOOD SUPPLY WHICH NOURISHES THE BRAIN WITH GLUCOSE, OXYGEN AND MINERALS. There is a popular belief that the brain "dies" after 4 to 6 minutes without oxygen. In some cases it may take 10 to 16 minutes. Within four minutes of the blood supply to the brain ceasing, the central nervous system is irreversibly damaged.). She lived in different stages of unconsciousness and long considered in a ‘persistent vegetative state’ (PVP), in a Pinellas Park, Florida hospice. Severe brain damage which does not involve the brain stem may result in a persistent vegetative state. These patients breathe spontaneously, open and close their eyes, swallow and make facial grimaces. However, they show no behavioral evidence of awareness. In this persistent vegetative state she remained the last fifteen years of her life. Neurological tests indicated that her cerebral cortex was principally liquid. The electroencephalogram (EEG) of someone who is brain dead shows no electrical activity, and an injection of mild radioactive isotopes into the brain reveals the absolute absence of blood flow. Death is now accepted as meaning brain stem death or brain death. The brain stem is a small area of the brain which controls respiration (breathing). If this area is dead the person will never be able to breathe spontaneously or regain consciousness.
She died shortly after 9 AM (EST) on March 31, 2005, nearly two weeks after the feeding tube was removed from her. Treatment in an Intensive Care Unit costs $2000 per day whereas in Hospice its costs about $500/- per day. WHO WILL PAY?
Both Schiavo's doctors and her court-appointed doctors expressed the opinion that there existed no hope of rehabilitation. Her husband, Michael Schiavo, stated that it was his wife's wish that she not be kept alive through unnatural, mechanical means. Michael Schiavo wanted life support (her feeding tube) removed, after which Terri would slowly die of malnutrition and dehydration.
Politicians inserted themselves into the fray. The case was the catalyst for Florida's controversial "Terri's Law", which gave Gov. Jeb Bush the authority to have Schiavo's feeding tube re-inserted when a court ruled that her husband could have it removed. It was a tremendously sad family situation, undoubtedly painful for everyone involved (except, of course, the vegetable Terri Schiavo).
In the legal battle, many court rulings and appeals took place (all the way to the US Supreme Court-6 times). There was involvement of Florida State Governor (Jeb Bush), the State and US legislature and the bills passed to save Terri Schiavo.
The U.S. Congress quickly passed legislation allowing federal courts to intervene, and President George W. Bush flew back to Washington to sign the bill into law. It should be noticed that this is the same George W. Bush who, as Governor of Texas, signed into state law the power of hospitals to remove a patient (in identical situations as Terri's) from life support -- a critical factor being the family's ability to pay the hospital bills -- even if such removal was against the family's objections.
House Majority Leader Tom DeLay lied for national newscasts that Schiavo "talks and she laughs, and she expresses happiness and discomfort... It won’t take a miracle to help Terri Schiavo; it will only take the medical care and therapy that all patients deserve." But in 1988, DeLay had concurred in his own family's decision to withhold care for his comatose father. (1)According to Schiavo's husband, "It is an invasion of the American people when you make a family matter public.
In a Muslim country, in a situation like this, the family of the patient would treat the patient at home and feed her thro' her mouth. The patient would expire in 15 days.
In June 2005, the Autopsy Report of Terri Schiavo indicated that her brain weighed half the normal size. Her brain was in a vegetative state with irreparable damage and that she was blind. Her husband did not abuse her.
In USA, Terri Schiavo lived for 15 years with modern medical technology and with a tube inserted to feed her nutritious food. This is a testimony to the will and the technology to perform medical miracles -- the right-to-life resolve making demands of the technological sophistication. Was the life of Terri Schiavo prolonged or her death delayed? WHAT IS THE QUALITY OF LIFE OF A VEGETATIVE STATE PATIENT IN COMA? A patient in coma is absolutely unaware of what is happening. In the US, there are thousands (30-40,000 according to some reports) in similar PVP, with hardly any fuss, but Schiavo’s case is now mired in a raging right-to-die debate, more precisely, the-right-to-die ‘in dignity’. The right-to-die in dignity does not necessarily mean euthanasia, mercy killing, assisted suicide, or deliberate ending of life of a person suffering from an incurable disease or a state that’s near impossible (given the medical resources available) to revert to normal life.
euthanasia is illegal, but the reality seems more sympathetic. In
Belgium, euthanasia has been legal since 2002. Same is the case in the
Netherlands, where physician-assisted suicide is also legal. In these
two countries alone, there are on the average 2,500 cases a year.
Assisted suicide has not been illegal or a crime in Switzerland for
nearly 60 years.
While the Catholic church remains opposed to euthanasia, many countries in Europe overwhelmingly support (about 80% according to some polls) the idea of euthanasia and assisted suicide. Other religions have different opinions. For instance, the Jewish law and tradition regard human life as sacred, and forbid doing anything that might shorten life. Active euthanasia is regarded as murder, without any exception, and it makes no difference if the terminally ill wants to die. Saving someone from pain is, according to the Jewish tradition, not a reason to kill them; nor is it lawful to kill oneself to save oneself from pain. However it does not require doctors to extend the state of dying.
Muslims are also against euthanasia and suicide: The Qur'an says, “Do not take life, which Allah made sacred, other than in the course of justice.” (Qur’an, Surah, Al-Isra' 17.33).:
“Do not take life, which Allah made sacred, other than in the course of justice.” (Qur’an, Surah, Al-Isra', 17.33).
5:32. On that account: We ordained for the Children of Israel that if any one slew a person - unless it be for murder or for spreading mischief in the land - it would be as if he slew the whole people: and if any one saved a life, it would be as if h e saved the life of the whole people. Then although there came to them Our apostles with clear signs, yet, even after that, many of them continued to commit excesses in the land.
The Qur'an says, “If anyone kills a person - unless it be for murder or spreading mischief in the land - it would be as if he killed the whole people.” (Qur’an 5.32); “When their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour.” (Qur’an 16.61);
“And no person can ever die except by Allah’s leave and at an appointed term.” (Qur’an 3:145);
“Take not life which Allah made sacred other than in the course of justice” (Qur’an 6:151 and 17:33).
“Do not kill (or destroy) yourselves, for verily Allah has been to you most Merciful” (Qur’an 4:29).
To warn against suicide Prophet Mohammad said," Whoever kills himself with an iron instrument will be carrying it forever in hell. Whoever takes poison and kills himself will forever keep sipping that poison in hell. Whoever jumps off a mountain and kills himself will forever keep falling down in the depths of hell.”
Islamic Code of Medical Ethics endorsed by the First International
Conference on Islamic Medicine (Islamic Organization of Medical
Sciences, Kuwait, 1981, p.65) includes: “Mercy killing, like suicide,
finds no support except in the atheistic way of thinking that believes
that our life on this earth is followed by void. 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
39: 10. Says: "O ye my servants who believe! Fear your Lord, good is (the reward) for those who do good in this world. Spacious is Allah's earth! those who patiently persevere will truly receive a reward without measure!"
“And bear in patience whatever (ill) maybe fall you: this, behold, is something to set one’s heart upon” (Qur’an, Surah, Luqman, 31:17).
31:17. "O my son! establish regular prayer, enjoin what is just, and forbid what is wrong: and bear with patient constancy whatever betide thee; for this is firmness (of purpose) in (the conduct of) affairs.
Mohammad taught “When the believer is afflicted with pain, even that of
a prick of a thorn or more, God forgives his sins, and his wrongdoings
are discarded as a tree sheds off its leaves.”
The introduction of
newer technology in medicine in areas of life support in terminal
patients, abortion, organ transplantation, biotechnical parenting, and
care of AIDS patients has posed Muslim physicians and patients some new
questions of ethics. Islamic medical ethics are based on the principles
of the sanctity of human life and safeguarding its values, taking the
lesser of the two evils.
Medical Ethics: An Islamic Perspective
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.
The objectives of Islamic Shariah (Laws) is for the protection of individual life, religion, mind, property and family. In difficult cases, the rules are:
a) take the lesser of the two evils,
b) necessity overrides the prohibition.
The following Questions and answers took
place at ISNA Convention of 1997(2)
If a number of medical experts determine that a patient is in a terminal condition, and there is no hope for his/her recovery and all medications have become useless, then it permissible for them, through a collective decision, to stop the medication.
Question (3). What is the definition of
"death" when do you say it is OK to turn the machine off when the
patient is dead? Is brain death and brain stem death the same thing?
Question 4. If a person is in a vegetative
state on artificial life support but he/she is not brain dead but
his/her survival chances are minimal, are physicians' allowed to turn
off the machine at this point?
If a Living Will and Durable Power of Attorney for Health Care is not made out in life, then at the time of serious decision making if the patient is not competent, the legal system in the United States gives that power to the spouse.
" Medical Ethics Questions From the Audience
During the Medical Ethics Symposium at ISNA Convention, 1997
and answers by Dr. Hassan Hathout
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