Chest 10 23
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The document discusses end-of-life care from an Islamic perspective in three main points: 1. Islam emphasizes doing no harm to oneself or others, and removing harm, but not by committing greater harm. A lesser harm may be tolerated to prevent a greater harm. 2. Necessities allow the use of otherwise forbidden things. 3. Withdrawing life support is allowed in Islam if continued treatment will not provide benefit to the patient. Palliative care including nutrition, hydration and antibiotics is encouraged. Organ donation may be permitted.
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Chest 10 23
- 1. End of Life care in the ICU Islamic View Islam Ibrahim, MD, FACP, FCCP. Associate professor, University of California San Diego. imibrahim@ucsd.edu
- 12. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 23. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 30. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 33. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 35. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 49. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 52. 1- Doing no harm to oneself or others.
- 53. 2- harm should be removed but not by committing greater harm.
- 54. 3- a lesser harm is tolerated if it is necessary to mitigate a greater harm
- 55. 4 - necessities allow the use of forbidden things
- 72. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 76. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 77. opening statement religious symbols. spiritual leaders To do and not to do. Withdrawing care DNR, CPR, turning off life support. Palliative extubation, DO NOT INTUBATE. Nutrition, hydration. Antibiotics. Lines, tubes, other devices. Organ donation
- 85. • [4] Kamali MH. Maqasid al-Shariah Made Simple. Kuala Lumpur, Malaysia: International Institute of Advanced Islamic Studies; 2008:3-7. • [5] Kamali MH. Qawa’id al-Fiqh: The Legal Maxims of Islamic Law. High Wycombe, England: The Association of Muslim Lawyers; 2006:3-4. • [11] Islamic Fiqh Assembly of the Organization of the Islamic Conference (OIC). Decision Number: 67(7/5). Jeddah, Kingdom of Saudi Arabia: May 9th-14th, 1992. • [12] Islamic Fiqh Assembly of the Muslim World League. Decision Number: 10(2). Makkah, Kingdom of Saudi Arabia: Oct 17th-21st, 1987. • [16] Al-Haj, Hatem. The Impact of Medical Advancements on Religious Edicts and Judgeship. [dissertation, Arabic]. Tripoli, Lebanon: al-Jinan University; 2008. p.103. • [18] American Academy of Neurology Guidelines for Brain Death Determination. University of Miami Health System: Miller School of Medicine. Available: http://surgery.med.miami.edu/laora/clinical-operations/brain- death-diagnosis. Accessed August 22, 2017. • [19] Islamic Fiqh Assembly of the Muslim World League. Decision Number: 10/2. Makkah, Kingdom of Saudi Arabia: Oct 17th-21st, 1987.
Editor's Notes
- decisions pertaining to life and death matters are greatly influenced by the person’s set of beliefs and values
- culture and religion. Influence the manner in which palliative care is delivered
- Medical team understanding of patients’ faith and culture is essential for the delivery of high-quality, patient-centered care.
- cultural competency, is now an integral part of the (ACGME) accreditation of medical schools and training programs,
- A 2017 study showed that spiritual well-being and a sense of “meaning in life” were associated with lower levels of depression and anxiety and higher levels of function among palliative patients at the end of life
- While Many other factors. influence the end of life decision-making process. religion remains one of the major determinants
- This is true in the Islamic faith However, Islam embraces nearly 1.6 billion followers,
- Muslims are geographically and culturally diverse, with a variety of schools of jurisprudence; To deal with such diversity is a big task that is beyond this presentation.
- What is perhaps more useful, is to take Islam’s basic teachings which are likely to influence most Muslims regardless of their particular cultures.
- I will be following this outline. I will try to address each one of these 10 points
- But first, allow me to introduce you to some of the General Muslim Beliefs and values, which could help your communication with your Muslim patients, and their families. and to avoid certain remarks that could be misunderstood,, or compromise the trust between you and your patient.
- 1-The cornerstone of Islam is the belief in God, the creator of the universe, God of Abraham In Arabic God’s name is Allah
- God is the creator and owner of everything all that is in the heavens and the earth are for human benefit,
- to help humans fulfill their trusteeship roles while on earth.
- 2- Everything we posses is a gift, and a trust from God
- Including the human body, and health that should be enhanced, and protected.
- #3-humans do not “own” their life, health, or wealth in an absolute sense. A Muslim does not accept such argument as “It is my body. I do with it what I want,
- #4- When one’s destined time of death comes, it comes, neither earlier nor later. It is better to avoid phrases like prolonging or shortening life
- #5- Muslims strongly believe in an eternal life after death
- 6- And view life here on earth as a short transition by a traveler who sets out on a long journey [to eternal life].
- Examples of things you can say to address the Muslim patient or family that would help you connect with them emotionally and intellectually
- Only God has the healing power to cure illness.
- The medical personnel is the vessel through which God Almighty exerts his healing power
- Prayers are an essential part to help achieve cure from illness. And ease the suffering
- While the medical team is committed to providing the best care available, God will ultimately decide the outcome. This is a good and a comforting statement when dealing with complications, or expect a bad outcome
- Illness can be a test for your patience and endurance, a believer is generously rewarded for enduring that test.
- Illness is not all evil. It can bring a person closer to God, It can Help transform a. person’s life into a better one. and makes a person more appreciative of the gifts of health , life, and prosperity.
- Examples of religious symbols and their meaning.
- These are simple prayers , yet have very powerful effect on patient’s and family’s. They can be downloaded from the Internet, Printed, and placed in a visible area This is a prayer quoted in the Quran by Prophet Abraham And when I am sick, it is he who cures me
- And this is a prayer by prophet MOHAMED Oh, lord of the people, remove this pain and cure it, you are the one who CURES, and no one else can. Grant such cure that leaves no sickness
- Best way to contact spiritual leaders,
- and to seek guidance, and support in dealing with patients with terminal illness and their families is by Calling the local mosque, or Muslim community center and ask to speak to the Imam
- To do and not to do.
- Little things can go a long way And improve the relationship with your muslim patients and families
- Assisting your patient in performing his/ or her religious duties. If all possible, facing the direction of Mecca during prayers. If not possible, the patient is allowed to pray in any direction. As Quran states, Whichever direction you face you find God.
- Abulotion, Helping the patient with washing before prayers. If not possible, a wet towel can be used.
- When water is not available, or cannot be used, for any reason Dust box can be used instead for the purification purpose. They are Commercially available in hospitals, in many countries. If none is available, The patient can be assured that his prayer is still valid.
- Quran Audio is available, and can provide a great comfort Muslims believe in the healing power of the Quran
- This African surgeon was recognized by the United Nations for reciting the Bible” and Quran to his patients.
- I travel frequently to Saudi Arabia, and work in the ICU at this hospital, IMC, and interact with families, and deal with end-of-life issues
- A common request that I usually get from families, is to allow administering honey with water, or tube feeding. The healing effect of honey is quoted in the Quran in this verse . So do not be surprised when you get such request
- KSA They usually also ask the permission to administer the ZAMZAM water through the feeding tubes. It Comes in sealed bottles. In most cases, I have no problem allowing this.
- not to do. Muslim patients are very sensitive to body exposure. particularly females. Entering the room without first asking permission will not give time for patients, or family members to cover
- Especially women who wear head scarve When there is infection control issues, then a surgical bonnet may serve the patient well.
- Hospital gowns are not always adequately covering. This can cause unnecessary anxiety to the patient and the family.
- not to do.
- I will address these issues together, as they are closely related Withdrawing care turning off life support. DNR, Palliative extubation, DO NOT INTUBATE.
- I will be making references to consensus rulings, of scholars known as fatwa issued by, The fiqh Council of North America. The Muslim world league. The organization of the Islamic conference.
- Goals of all rules is the Preservation of Faith Human life Intellect Posterity Wealth
- 1 doing no harm to oneself or others, 2 harm should be removed but not by committing greater harm. 3 “a lesser harm is tolerated if it is necessary to mitigate a greater harm
- 1 doing no harm to oneself or others, 2 harm should be removed but not by committing greater harm. 3 “a lesser harm is tolerated if it is necessary to mitigate a greater harm
- 1 doing no harm to oneself or others, 2 harm should be removed but not by committing greater harm. 3 “a lesser harm is tolerated if it is necessary to mitigate a greater harm
- 4 - necessities allow the use of forbidden things This is useful when discussing porcine medical products, or alcohol-containing medications, when there is no alternative.
- Forbidden Disliked discouraged Permissible Ok to do or not to do Liked Encouraged recommended a Must do
- seeking medical treatment for disease is conducive to the preservation of life, which is one of the main objectives of Islamic law
- It is the duty of the patient to seek medical care if the disease process Can cause significant harm to the body. long-term handicap. Or can be transmitted to others.
- Consent is required It is no different from our modern current practice, So I would not spend a lot of time talking about it. And it is obviously not required for emergent intervention
- The patient is Discouraged to seek medical treatment if The Treatment is deemed more harmful than the illness itself, as determined by the physician in consultation with the patient
- Withdrwal of care following brain injury, or dysfunction Jurists define life as the combination of input and output— input a patient’s awareness of his/her self/environment and reception of ideas. Output purposeful action or communication.
- If both of these functions are not present, then the person is not considered to be living a normal human life. equated by Muslim jurists to the life of an embryo
- In a case of brain death, however, It is permissible to turn off the life support systems of a patient whose brain has completely stopped functioning When three specialized expert doctors decides that the cessation is final and irrecoverable. even if the heart and respiratory systems are still functioning on life support systems.
- The same rule applies to cases of coma or permanent VS it is permissible by most jurists to withdraw this patient’s life-sustaining measures. based on the judgment of three specialty-trained physicians,
- minimally conscious state (MCS). When the patient shows signs of Brain input or output MCS is considered a sustainable human life, and is treated as a general medical illness
- CPR is considered a form of medical treatment.
- A patient whose illness has a grim prognosis the potential harms and limited benefits of CPR may downgrade its initiation to “disliked.”
- What do Islamic traditions say about prolonging the suffering of loved ones? Although suffering has redemptive value relief of suffering, is a duty of Muslim patients and physicians. “No harm shall be inflicted or reciprocated in Islam
- However, Euthanasia never Islamically permissible Based on Qur’anic verse: “And do not kill yourselves [or one another].
- Palliative care offers an alternative to euthanasia in the face of a disease with a grim prognosis, and a painful course, With the focus on reducing pain and suffering.
- Nutrition, hydration, and administering antibiotics
- it is prohibited to withdraw enteral nutrition, from a patient with a good prognosis as this is viewed as starving the patient
- However, in a patient with a grim prognosis and/or an incurable disease, it is permissible to withdraw artificial nutrition Physicians need to weigh Benefits, vs risks, and consider the patient’s wishes
- Q ? should the terminally ill patient be treated for infections such as pneumonia? if its treatment makes the patient more comfortable, The answer is yes If physicians decide that treatment is likely to enhance the patient’s pain and suffering. The answer is no.
- Maintaining Lines, tubes, and other devices. It is determined based on the relative benefits, versus harm, Based on the physicians judgment, and patient’s wishes.
- Organ donation in Islam
- There is a Consensus among Muslim jurists that Organ donation is allowed, and is considered an act of charity Based on the saying of the prophet, “Whoever helps another will be granted help from Allah in the Hereafter”
- Live donor It is permissible and encouraged, to donate an organ that renews itself automatically, such as blood and skin.
- It is acceptable to donate a kidney, partial liver or pancreas unless it carries harm to the donor or the recipient
- It is forbidden to transplant an organ on which life depends,
- There is a consensus on the prohibition of donating organs related to fertility and progeny.
- Cadaveric organ donation is permissible, When permission was given by the deceased before his death, or by his heirs after his death, or by the authorities if the identity of the deceased is unknown
- it is not permissible to subject human organs to sale under any circumstances.
- Here are some references for your review.
- In the end, I conclude with A. prayer to ease the suffering of our patients, and to provide us physicians with the strength and compassion to help our patients, and families in the most vulnerable moments of their lives.