Health Concerns for the BELIEVERS
|ETHICAL DECISION MAKING IN PATIENT CARE: AN ISLAMIC PERSPECTIVE|
|Written by Dr. Shahid Athar|
Islam, the meaning of which is peace and submission to the will of God, is not merely a way of worship but a way of life from womb to the tomb. We believe we have been created as humans and placed on this planet as a test from God, how we conduct ourselves .
things, Who has created Life and death that He may try you, which of you
is best in conduct; and He is the Mighty, the Forgiving" (67:1-2).
In the absence of any ordained clergy in Islam, the role of decision making can be taken by the leader of a mosque, a religious scholar, a practicing Muslim physician or an elder in the family or community. However, he or she must consult the Quran, the Word of God, and the Sunnah, the sayings of the Prophet Muhammad (PBUH) before giving his or her opinion, and should not place his or her opinion above the opinion of God and the Prophet. "And it becomes not a believing man or a believing woman, when Allah and His messenger have decided an affair (for them), that they should (after that) claim any say in their affair,- and who so is rebellious to Allah and His messenger, he verily goes astray in error manifest" (33:36).
The guiding verse in Quran regarding the sanctity of life is, "If anyone killed a person, unless in lieu of murder or spreading mischief on earth, it would be as if he killed all of mankind. And if anyone saved a life, it would be as if he saved the lives of all mankind" (5:32).
Muslim patients understand that illness, suffering and dying are part of life and a test from God.
Death is nothing but part of a joumey and transformation from one life form to another and component of their faith.
With calamity: 'To God
We belong, and to Him
Is our retum' (2:156).
They seek God's help with patience and prayer.
With patient perseverance
And prayer: for God is with those
Who patiently persevere (2:153).
The major roles of the ethicist in the patient care area are: a) Understanding the concerns of the patient and his family and transmitting them to physicians and others involved in the decision making process; b) interpreting the scripture as it applied to the specific concerns of the patient; c) consoling and comforting the patient and his family so that they can accept the present situation as a will of God and pray for a better life in the hereafter; and d) taking care of the needs of family (spiritual, emotional or even financial) after the death of the loved one.
The important principles used by Islamic ethicists are the preservation of faith, sanctity of life, alleviation of suffering, enjoining what is good and permitted, and forbidding what is wrong and prohibited, respecting patients' autonomy and couples' marriage, while achieving medical justice without harm and always being honest and truthful in giving information. He or she must consult the patient, the family, the physician and preferably another Islamic scholar, before giving a final opinion.
MEDICAL FUTILITY / ISLAMIC PERSPECTIVE
CASE PRESENTATION: BABY K
Baby K was born anencephalic (absence of all brain except for rudimentary brain tissue) in October, 1992. The baby breathes, sucks, swallows and coughs. The baby cannot see, hear, feel or think. The baby's mother, out of a firm Christian faith that all life should be "protected," insists that everything should be done for her baby, including mechanical and artificial ventilation. The Muslim physicians were asked the question as to whether or not mechanical ventilation in this situation was permissible, prohibited or uncertain.
Before discussing this case itself, there are several questions that come to mind about this particular issue.
As far as Baby K itself is concerned, the chances of this child's survival without mechanical ventilation are very small. The cost of maintaining him or her on long-term ventilation, either in the hospital or in a home situation, is extremely high, and it places tremendous pressure on parents in caring for such a child without improving any quality of life. However, their emotional attachment, as well as their faith perspective, should be taken into account and respected.
Let me explain some of the principles of biomedical ethics:
We conducted a survey of Muslim physicians about Baby K (Chart A). Twenty-nine of them, or twenty-four percent, thought it was permissible to institute mechanical ventilation for Baby K. However, seventy- nine of them, or sixty-five percent did not feel that way. At the same time, fourteen or eleven percent were not sure.
The true role of physicians is to alleviate suffering and give comfort to the patient and the relatives, improving the quality of life, the terms of which have been fixed. The physician should not perform heroic measures in the care of a hopelessly ill patient. Technically, a patient in a vegetative state can be kept alive for months and years, like Karen Quinlan's case, eventually to die anyway. It may also be very painful for the relatives to see one of their loved ones being in a vegetative state for such a period of time and cost to the family of such care can be over $100,000. Nor at the same time, should physicians hasten the process of death by pulling the plug or withdrawing nutritional support.
Therefore, the decision in such cases cannot be an individual decision by either the family or the physician but should be a decision of all those concemed or who are involved in the care of the individual patient. The team should include not only the physician and relatives but also a Muslim clergy for the interpretation of the Shariah.
CHART ASurvey of Muslim Physicians about Baby K's Mechanical Ventilation