Muslims believe that death comes by divine decree and marks the beginning of an eternal journey in the afterlife. Some terminally ill Muslim patients receive care in intensive care units that prolong their lives through significant medical intervention when they may instead suffer without meaningful benefit. There is limited information available about Islamic beliefs regarding end of life issues for Muslims living in non-Muslim countries. Withdrawal of futile treatment is permitted in Islamic law for terminally ill patients to allow death to take its natural course. "Do not resuscitate" orders are also permitted in certain situations according to Islamic rulings if three physicians agree treatment would be non-beneficial. However, hydration and pain management should continue until death.
The document outlines policies and procedures for Do Not Resuscitate (DNR) orders. It states that CPR will be administered to patients unless a DNR order is written by a physician. The physician must discuss the decision with the patient and family. If the patient cannot participate, the physician obtains opinions from interested parties about the patient's wishes. A DNR order is written on the patient's record and other measures are taken to communicate it to staff.
The document discusses Not For Resuscitation (NFR) orders for elderly patients. It covers the benefits of NFR status, including increased chances of dying at home and reduced family conflicts. It also discusses advance care planning, documenting preferences in writing using forms like POLST/MOLST, periodically reassessing plans, and providing supportive care for patients with NFR orders while avoiding potential harm. Palliative care can help address symptoms and provide psychosocial support without necessarily implying giving up on treatment.
Muslims believe that death comes by divine decree and marks the beginning of an eternal journey in the afterlife. Some terminally ill Muslim patients receive care in intensive care units that prolong their lives through significant medical intervention when they may instead suffer without meaningful benefit. There is limited information available about Islamic beliefs regarding end of life issues for Muslims living in non-Muslim countries. Withdrawal of futile treatment is permitted in Islamic law for terminally ill patients to allow death to take its natural course. "Do not resuscitate" orders are also permitted in certain situations according to Islamic rulings if three physicians agree treatment would be non-beneficial. However, hydration and pain management should continue until death.
- Physicians are obligated to fully communicate with patients and surrogates about diagnoses, prognoses, treatment options and risks in a timely manner to allow for informed medical decision making. However, studies show physicians often fail to discuss end of life care preferences with patients.
- Determinations of medical futility can be difficult due to uncertainties in prognosis and a lack of understanding of patient values. Physicians are encouraged to have open discussions with patients and surrogates about medical futility and end of life options.
- If a surrogate cannot understand the patient's medical situation or make decisions that reflect the patient's wishes, the physician may need to seek a new surrogate or consider the patient's best interests in
1) The document discusses several key principles in medical ethics including autonomy, beneficence, non-maleficence, and justice as they relate to informed consent and treatment decisions.
2) It examines the concepts of medical negligence, duty of care, standards of care, damages, and proximate cause in medical malpractice cases.
3) It also addresses treatments for incompetent patients, the principles of patient autonomy and medical futility in end-of-life decisions around cardiopulmonary resuscitation.
DNR in Emergency Department - The Practice and the Islamic view Rashid Abuelhassan
The document discusses end-of-life care and do-not-resuscitate (DNR) orders. It provides guidance on when DNR is appropriate according to different medical conditions and opinions of specialists. DNR policies are discussed for different countries and regions, noting they can vary significantly. The key messages are that palliative care does not automatically mean DNR; DNR only refers to chest compressions and not other interventions like airway maneuvers or fluids in some cases; and the validity and requirements of DNR orders should be confirmed according to the local hospital policies. Communication with families is also emphasized.
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Present...Irish Hospice Foundation
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Presentation at Dublin Community Network Meeting / Residential Network Meeting, November 2016)
The document outlines policies and procedures for Do Not Resuscitate (DNR) orders. It states that CPR will be administered to patients unless a DNR order is written by a physician. The physician must discuss the decision with the patient and family. If the patient cannot participate, the physician obtains opinions from interested parties about the patient's wishes. A DNR order is written on the patient's record and other measures are taken to communicate it to staff.
The document discusses Not For Resuscitation (NFR) orders for elderly patients. It covers the benefits of NFR status, including increased chances of dying at home and reduced family conflicts. It also discusses advance care planning, documenting preferences in writing using forms like POLST/MOLST, periodically reassessing plans, and providing supportive care for patients with NFR orders while avoiding potential harm. Palliative care can help address symptoms and provide psychosocial support without necessarily implying giving up on treatment.
Muslims believe that death comes by divine decree and marks the beginning of an eternal journey in the afterlife. Some terminally ill Muslim patients receive care in intensive care units that prolong their lives through significant medical intervention when they may instead suffer without meaningful benefit. There is limited information available about Islamic beliefs regarding end of life issues for Muslims living in non-Muslim countries. Withdrawal of futile treatment is permitted in Islamic law for terminally ill patients to allow death to take its natural course. "Do not resuscitate" orders are also permitted in certain situations according to Islamic rulings if three physicians agree treatment would be non-beneficial. However, hydration and pain management should continue until death.
- Physicians are obligated to fully communicate with patients and surrogates about diagnoses, prognoses, treatment options and risks in a timely manner to allow for informed medical decision making. However, studies show physicians often fail to discuss end of life care preferences with patients.
- Determinations of medical futility can be difficult due to uncertainties in prognosis and a lack of understanding of patient values. Physicians are encouraged to have open discussions with patients and surrogates about medical futility and end of life options.
- If a surrogate cannot understand the patient's medical situation or make decisions that reflect the patient's wishes, the physician may need to seek a new surrogate or consider the patient's best interests in
1) The document discusses several key principles in medical ethics including autonomy, beneficence, non-maleficence, and justice as they relate to informed consent and treatment decisions.
2) It examines the concepts of medical negligence, duty of care, standards of care, damages, and proximate cause in medical malpractice cases.
3) It also addresses treatments for incompetent patients, the principles of patient autonomy and medical futility in end-of-life decisions around cardiopulmonary resuscitation.
DNR in Emergency Department - The Practice and the Islamic view Rashid Abuelhassan
The document discusses end-of-life care and do-not-resuscitate (DNR) orders. It provides guidance on when DNR is appropriate according to different medical conditions and opinions of specialists. DNR policies are discussed for different countries and regions, noting they can vary significantly. The key messages are that palliative care does not automatically mean DNR; DNR only refers to chest compressions and not other interventions like airway maneuvers or fluids in some cases; and the validity and requirements of DNR orders should be confirmed according to the local hospital policies. Communication with families is also emphasized.
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Present...Irish Hospice Foundation
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Presentation at Dublin Community Network Meeting / Residential Network Meeting, November 2016)
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
This document discusses ethical issues surrounding cardiopulmonary resuscitation (CPR) and informed consent. It provides 4 case scenarios involving decisions around initiating or not initiating CPR. It outlines general principles governing resuscitation decisions, including patient autonomy and medical futility. Circumstances for not starting or stopping CPR for in-hospital and out-of-hospital settings are presented. The document also discusses 'Do Not Attempt Resuscitation' orders and criteria for determining medical futility of resuscitation efforts.
This document discusses the ethical issues surrounding cardiopulmonary resuscitation (CPR). It outlines key ethical principles like autonomy, beneficence, non-maleficence, justice, dignity and honesty. It discusses when CPR may be withheld or withdrawn based on these principles and medical futility. Factors like advanced directives, surrogate decision makers, signs of death, drug intoxication and hypothermia are considered for initiating or stopping CPR. The document provides guidance on ethical decision making around CPR.
Advanced directives are legal documents that specify a person's medical wishes in case they become unable to make decisions themselves. There are several types, including living wills, durable power of attorney, and health care proxies. A living will outlines preferences for life-sustaining treatments. A durable power of attorney designates someone to make medical and financial decisions. Health care proxies appoint a surrogate decision maker. The Patient Self-Determination Act protects patient rights regarding advance directives and medical decision making. However, ethical issues can arise regarding competency determinations and disagreements between patients, families and medical staff over treatment plans.
This document summarizes an advance medical directive webinar presentation. It discusses the key components of advance medical directives including durable power of attorney, living wills, and organ donation directives. It also summarizes a landmark Virginia Supreme Court case on withdrawing life-prolonging treatment from patients in a persistent vegetative state. The document provides guidance on drafting, executing, and revoking advance medical directives.
This document discusses the concepts of informed consent and refusal of treatment. It outlines that patients have the right to refuse treatment as long as it is an informed refusal. For consent or refusal to be valid, the patient must be competent and the decision must be voluntary. The nurse's role is to ensure the patient understands the risks of refusing treatment through education. If refusal is documented, the record must show the teaching provided and that the patient understood risks but still refused.
Withholding and withdrawal of medical therapies Jelisa1975
This document discusses the complex ethical and legal issues surrounding the withholding or withdrawal of life-sustaining medical treatments. It addresses key definitions, considerations regarding patient autonomy and provider responsibilities, relevant policies and acts, and two case studies that illustrate common dilemmas providers may face. Overall, the document stresses the importance of open communication, compassion, and ensuring the dignity and self-determination of the patient in all end-of-life medical decisions and care.
A lecture on patients' rights delivered to the staff of King Fahad Medical City in Riyadh on Monday 18/9/2017. It given an overview on patients' rights then focus on three of them: shared decision-making, privacy, and confidentiality
Review of the Saudi Guidelines for informed consent in Surgery as well as the international best practice guidelines for a better approach to Informed Consent in the Kingdom of Saudi Arabia.
1) End-of-life decisions in the ICU are an important issue due to the advent of life support technologies that can prolong the dying process artificially. However, such aggressive treatment for patients with hopeless prognoses causes physical, emotional and financial suffering.
2) Studies from India show that end-of-life discussions and limitations of life-sustaining treatments are becoming more common in Indian ICUs, though rates are still lower than in Europe and the US. Barriers include legal/administrative issues, lack of guidelines, and cultural/religious factors.
3) Key ethical principles around end-of-life care include patient autonomy, beneficence, non-maleficence, and
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
This document discusses end-of-life decision making through advance directives. It defines three types of advance directives: living wills, durable power of attorney for healthcare, and general advance directives. Living wills allow patients to specify treatment preferences if they become terminal or permanently unconscious. Durable power of attorney appoints a healthcare proxy. General advance directives provide instructions and may appoint a proxy. The document outlines requirements, limitations, and the nurse's role in educating patients and ensuring advance directives are documented and followed.
Informed Refusal: you are doing it wrong Robert Cole
This document discusses informed refusal of care in emergency medical services. It emphasizes the importance of determining a patient's capacity to refuse care through a thorough cognitive assessment. A robust refusal process involves obtaining vital signs, assessing cognition using a tool like the Folstein Mini-Mental State Examination, addressing the patient's reasons for refusing care, making multiple offers of transport, and thoroughly documenting all aspects of the assessment and refusal. Proper determination of capacity and a well-executed refusal can help mitigate legal liability if the patient later experiences an adverse outcome.
This document discusses ethical and legal decisions in critical care units. It begins by outlining the learning objectives which are to distinguish between ethical and legal standards, review ethical principles, discuss common ethical dilemmas and decisions, and discuss common legal decisions in critical care units. It then defines ethical and legal standards and principles like autonomy, beneficence, and justice. It explores common ethical dilemmas around end-of-life care including palliative care, CPR, euthanasia, withdrawing treatment, and futile care. It also examines legal considerations such as medical documentation, use of restraints, declaring brain death, and organ donation. The document provides information on these topics to help medical professionals navigate complex ethical and legal situations in
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
This document provides an overview of end of life care, including defining end of life care and palliative care, identifying the target population, and differentiating between palliative care and hospice care. It discusses factors that influence attitudes towards death, decision making at end of life, barriers to good end of life care, and nursing skills needed to provide palliative care. The goal is to help students understand end of life care and how to support older adults and their families during this process.
This document discusses several ethical dilemmas that can arise at the end of life. It describes situations involving conflicts between clinicians and families over appropriate care, as well as conflicts within clinical teams. It also addresses issues around withdrawing or withholding treatment, physician assisted suicide, palliative sedation, and ensuring comfort at end of life. The document emphasizes the importance of open communication, establishing goals of care based on patient values and preferences, and providing care aimed at both cure and comfort.
Through the Eyes of Taiwanese Palliative Care Providers: End-of-life Treatmen...inventionjournals
The growth of medical knowledge and enhanced technology has increasingly blurred the line between life and death. Resuscitation procedures and life-sustaining devices such as mechanical ventilators, defibrillators, hemodialysis, and parenteral nutrition were introduced just a few decades ago, but have brought significant changes to the treatment of EOL patients. These treatments have given physicians the ability to prolong the process of dying; yet, the decision of when and how to use them has become complicated. An understanding of these controversial life-sustaining procedures and knowledge of current legal guidelines in the American EOL treatment context is necessary when palliative care in Taiwan seems to follow the Western experience in legislation regarding life-sustaining treatment. In this article, how EOL decisions made in the United States is summarized through the eyes of Taiwanese palliative care providers.
Recommendations for end-of-life care in the intensive care uni.docxdanas19
This document provides recommendations for end-of-life care in the intensive care unit (ICU). It discusses preparing both the patient and family for withdrawal of life-sustaining treatments by clearly explaining what to expect and ensuring pain and suffering are minimized. It also emphasizes the importance of addressing the needs of families through open communication, allowing them to be present and helpful, and providing emotional support. The overarching goal is to integrate palliative care principles to ensure a dignified and comfortable death for patients in the ICU.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
This document discusses ethical issues surrounding cardiopulmonary resuscitation (CPR) and informed consent. It provides 4 case scenarios involving decisions around initiating or not initiating CPR. It outlines general principles governing resuscitation decisions, including patient autonomy and medical futility. Circumstances for not starting or stopping CPR for in-hospital and out-of-hospital settings are presented. The document also discusses 'Do Not Attempt Resuscitation' orders and criteria for determining medical futility of resuscitation efforts.
This document discusses the ethical issues surrounding cardiopulmonary resuscitation (CPR). It outlines key ethical principles like autonomy, beneficence, non-maleficence, justice, dignity and honesty. It discusses when CPR may be withheld or withdrawn based on these principles and medical futility. Factors like advanced directives, surrogate decision makers, signs of death, drug intoxication and hypothermia are considered for initiating or stopping CPR. The document provides guidance on ethical decision making around CPR.
Advanced directives are legal documents that specify a person's medical wishes in case they become unable to make decisions themselves. There are several types, including living wills, durable power of attorney, and health care proxies. A living will outlines preferences for life-sustaining treatments. A durable power of attorney designates someone to make medical and financial decisions. Health care proxies appoint a surrogate decision maker. The Patient Self-Determination Act protects patient rights regarding advance directives and medical decision making. However, ethical issues can arise regarding competency determinations and disagreements between patients, families and medical staff over treatment plans.
This document summarizes an advance medical directive webinar presentation. It discusses the key components of advance medical directives including durable power of attorney, living wills, and organ donation directives. It also summarizes a landmark Virginia Supreme Court case on withdrawing life-prolonging treatment from patients in a persistent vegetative state. The document provides guidance on drafting, executing, and revoking advance medical directives.
This document discusses the concepts of informed consent and refusal of treatment. It outlines that patients have the right to refuse treatment as long as it is an informed refusal. For consent or refusal to be valid, the patient must be competent and the decision must be voluntary. The nurse's role is to ensure the patient understands the risks of refusing treatment through education. If refusal is documented, the record must show the teaching provided and that the patient understood risks but still refused.
Withholding and withdrawal of medical therapies Jelisa1975
This document discusses the complex ethical and legal issues surrounding the withholding or withdrawal of life-sustaining medical treatments. It addresses key definitions, considerations regarding patient autonomy and provider responsibilities, relevant policies and acts, and two case studies that illustrate common dilemmas providers may face. Overall, the document stresses the importance of open communication, compassion, and ensuring the dignity and self-determination of the patient in all end-of-life medical decisions and care.
A lecture on patients' rights delivered to the staff of King Fahad Medical City in Riyadh on Monday 18/9/2017. It given an overview on patients' rights then focus on three of them: shared decision-making, privacy, and confidentiality
Review of the Saudi Guidelines for informed consent in Surgery as well as the international best practice guidelines for a better approach to Informed Consent in the Kingdom of Saudi Arabia.
1) End-of-life decisions in the ICU are an important issue due to the advent of life support technologies that can prolong the dying process artificially. However, such aggressive treatment for patients with hopeless prognoses causes physical, emotional and financial suffering.
2) Studies from India show that end-of-life discussions and limitations of life-sustaining treatments are becoming more common in Indian ICUs, though rates are still lower than in Europe and the US. Barriers include legal/administrative issues, lack of guidelines, and cultural/religious factors.
3) Key ethical principles around end-of-life care include patient autonomy, beneficence, non-maleficence, and
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
This document discusses end-of-life decision making through advance directives. It defines three types of advance directives: living wills, durable power of attorney for healthcare, and general advance directives. Living wills allow patients to specify treatment preferences if they become terminal or permanently unconscious. Durable power of attorney appoints a healthcare proxy. General advance directives provide instructions and may appoint a proxy. The document outlines requirements, limitations, and the nurse's role in educating patients and ensuring advance directives are documented and followed.
Informed Refusal: you are doing it wrong Robert Cole
This document discusses informed refusal of care in emergency medical services. It emphasizes the importance of determining a patient's capacity to refuse care through a thorough cognitive assessment. A robust refusal process involves obtaining vital signs, assessing cognition using a tool like the Folstein Mini-Mental State Examination, addressing the patient's reasons for refusing care, making multiple offers of transport, and thoroughly documenting all aspects of the assessment and refusal. Proper determination of capacity and a well-executed refusal can help mitigate legal liability if the patient later experiences an adverse outcome.
This document discusses ethical and legal decisions in critical care units. It begins by outlining the learning objectives which are to distinguish between ethical and legal standards, review ethical principles, discuss common ethical dilemmas and decisions, and discuss common legal decisions in critical care units. It then defines ethical and legal standards and principles like autonomy, beneficence, and justice. It explores common ethical dilemmas around end-of-life care including palliative care, CPR, euthanasia, withdrawing treatment, and futile care. It also examines legal considerations such as medical documentation, use of restraints, declaring brain death, and organ donation. The document provides information on these topics to help medical professionals navigate complex ethical and legal situations in
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
This document provides an overview of end of life care, including defining end of life care and palliative care, identifying the target population, and differentiating between palliative care and hospice care. It discusses factors that influence attitudes towards death, decision making at end of life, barriers to good end of life care, and nursing skills needed to provide palliative care. The goal is to help students understand end of life care and how to support older adults and their families during this process.
This document discusses several ethical dilemmas that can arise at the end of life. It describes situations involving conflicts between clinicians and families over appropriate care, as well as conflicts within clinical teams. It also addresses issues around withdrawing or withholding treatment, physician assisted suicide, palliative sedation, and ensuring comfort at end of life. The document emphasizes the importance of open communication, establishing goals of care based on patient values and preferences, and providing care aimed at both cure and comfort.
Through the Eyes of Taiwanese Palliative Care Providers: End-of-life Treatmen...inventionjournals
The growth of medical knowledge and enhanced technology has increasingly blurred the line between life and death. Resuscitation procedures and life-sustaining devices such as mechanical ventilators, defibrillators, hemodialysis, and parenteral nutrition were introduced just a few decades ago, but have brought significant changes to the treatment of EOL patients. These treatments have given physicians the ability to prolong the process of dying; yet, the decision of when and how to use them has become complicated. An understanding of these controversial life-sustaining procedures and knowledge of current legal guidelines in the American EOL treatment context is necessary when palliative care in Taiwan seems to follow the Western experience in legislation regarding life-sustaining treatment. In this article, how EOL decisions made in the United States is summarized through the eyes of Taiwanese palliative care providers.
Recommendations for end-of-life care in the intensive care uni.docxdanas19
This document provides recommendations for end-of-life care in the intensive care unit (ICU). It discusses preparing both the patient and family for withdrawal of life-sustaining treatments by clearly explaining what to expect and ensuring pain and suffering are minimized. It also emphasizes the importance of addressing the needs of families through open communication, allowing them to be present and helpful, and providing emotional support. The overarching goal is to integrate palliative care principles to ensure a dignified and comfortable death for patients in the ICU.
The document discusses several ethical issues in intensive care, including goals of care, withdrawing vs withholding treatment, medical futility, and do-not-resuscitate orders. It notes that ICU physicians have a responsibility to use medical skills to avoid non-beneficial treatment while allowing natural death. Withdrawing life-sustaining treatment that is not reversing illness is distinguished from active euthanasia.
This document discusses euthanasia, or mercy killing. It defines euthanasia as facilitating the death of an incurable patient at their own request. It notes that euthanasia can involve patients in a permanent vegetative state or those with a terminal illness not relying on life support. There are two types - passive euthanasia by withdrawing life support, and active euthanasia using a fatal injection. Conditions that may lead to euthanasia include being brain dead or having an irreversible terminal condition with no hope of recovery. While it may relieve pain and low quality of life, some argue euthanasia devalues human life and could be used for health care cost containment. Muslim scholars generally
ETHICAL ISSUE IN PALLIATIVE CARE GMCH.pptxanjalatchi
The document discusses several key ethical issues in palliative care:
- Communication with patients and families is important to guide treatment based on benefits, risks, and patient values and wishes.
- Pain management with opioids does not shorten lives when used for symptom control.
- As death approaches, all care must be reviewed to avoid futile interventions and ensure patient comfort.
- Advance care planning is important so patient values and preferences can guide care if they lose decision-making capacity.
- Ethical principles of beneficence, non-maleficence, autonomy, and justice must be considered in clinical decision making.
Despite remarkable advancement of modern medicine in last century, people are still not satisfied with current health care.
There is world wide consensus that holistic approach is lacking in contemporary medical models as well as in medical curriculum.
Moreover, modern medicine is still based on biological vision of disease as advocated by bio-medical model.
The bio-psychosocial-spiritual model which offers more humanistic and holistic approach is not implemented yet globally.
Therefore keeping in view its broader and holistic vision it is important to incorporate contents in medical curriculum regarding all dimensions of human illness including spirituality.
This talk covers ethical dilemmas in Neurology/Neurosurgery clinical practice, and the practical ways of dealing with those ethical dilemmas. There are guidelines available for these dilemmas. Following them would help in our clinical practice.
The legal authority to make decisions about withdrawing life-sustaining treatment depends on the patient's competence and wishes. For incompetent patients, legally authorized decision-makers include substitute decision-makers like family or an advance directive. In Australia, decisions must consider the patient's best interests based on values, goals, and medical recommendations. In complex cases, courts may provide guidance. Withdrawing treatment requires consent from competent patients or substitute decision-makers considering the patient's wishes and best interests.
- Advance directives are legal documents that allow patients to specify their end-of-life medical care wishes in advance in case they become unable to communicate their decisions.
- They can be used to refuse life-sustaining treatment or appoint a healthcare agent to make decisions on their behalf if they lose decision-making capacity.
- Having advance directives gives families and medical professionals peace of mind by making a patient's end-of-life wishes clear from the start.
Addressing Myths and Misconceptions About Heart Transplants.pdfparmilshah
If there's one medical procedure that continues to stir curiosity and misunderstanding, it's heart transplantation. This life-saving procedure has made remarkable strides in the medical field, yet it remains shrouded in myths and misconceptions. In this article, we'll dive deep into debunking these myths, providing you with accurate insights into heart transplants, from the procedure itself to recovery and long-term outcomes. Let's separate fact from fiction and gain a clearer understanding of this remarkable medical advancement.
The document discusses advance care planning and end-of-life care for people of color. It explains what advance care planning and advance directives are, including types of advance directives like medical power of attorney, living wills, do not resuscitate orders, and medical orders for scope of treatment. The document also distinguishes palliative care from hospice care and provides important links and tools for advance care planning.
Death and Dying Slides for Medico Legal Subjectduraiw124
The document discusses several ethical considerations surrounding death and dying, including different definitions of death, autonomy of patients, beneficence and non-maleficence of healthcare providers, quality of life concerns, cultural and religious factors, and views on practices like euthanasia and physician-assisted suicide. It also addresses issues like palliative care, resource allocation, advance directives, prolongation of life, and the right to die with dignity.
PELATIHAN PERAWATAN PALIATIF PADA STROKE - 16 maret 2020papahku123
This document discusses palliative care and end-of-life care for stroke patients. It outlines the seven principles of palliative care programs which focus on informed patient and family involvement, support for caregivers, a palliative approach to care, access to specialist palliative care, coordinated and integrated treatment, quality care from skilled staff, and community support. It also discusses assessing patient needs, managing symptoms, communication with patients and families, and the goals of palliative care for stroke which are to manage symptoms, provide counseling and support, and improve quality of life.
Published April 2017
Part of hospital test scenarios, escalation to ethics committee
Patients with a terminal illness who communicate their wish to die to a nurse shall receive appropriate care that is in line with institutional procedures, local laws, and their personal preferences. A nurse should be able to rely on the support of the institution he or she works for in terms of training, clear line of responsibility for such decisions, and unambiguously communicated expectations defined in organizational procedures. Assisted suicide is legal in Switzerland and several other European countries, in several states in the U.S., and in Canada. The mental capacity of the patient has to be considered in addition to locally applicable laws. Medical Power of Attorney is helpful if the patient previously described his or her wishes regarding end-of-life decisions and became incapacitated in the meantime. Financial toxicity, in addition to dubious effectiveness, contributes to the reluctance of some patients to undergo aggressive and invasive therapies. German physician Albert Moll in his book Medical Ethics (1902), argues that aggressive care in incurably ill patients is unethical. Healthcare staff, including nurses, can conscientiously object to assisting with suicide.
End of Life Care presentation for Nursing.pptxHimadri Samanta
This document discusses end of life care and palliative care. It defines end of life care as care for patients with terminal illnesses in their final hours or days as well as those with progressive, incurable conditions. Palliative care focuses on relieving symptoms rather than curing disease. Common symptoms experienced by terminally ill patients are discussed such as pain, fatigue, dyspnea, and depression. Advance care planning and goals of palliative care are outlined which emphasize enhancing quality of life and honoring patient values and wishes.
The document discusses various topics related to end-of-life issues and medical ethics. It defines different types of death, such as brain death, and explores cultural and religious perspectives on life and death. It examines principles of end-of-life care, including autonomy, beneficence, and nonmaleficence. The document also discusses issues like euthanasia, distinguishing between voluntary, non-voluntary, and involuntary euthanasia. It provides arguments for and against euthanasia and looks at the history and global status of euthanasia policies.
Randy M. Rosenberg is a clinical assistant professor of neurology at Temple University School of Medicine. The document discusses several topics related to bioethics including:
- Moral principles and ethics are not the same as feelings, religion, laws, or cultural norms. Ethics considers what is good/bad and right/wrong based on a value system.
- Key principles of physicians include saving life, keeping patients comfortable, respecting patient choices, treating all patients equally, providing competent care, and maintaining skills/knowledge.
- Autonomy, beneficence, non-maleficence, and justice are central elements of bioethics.
- Determining death can involve obligations, ideals
The document discusses palliative care, which aims to improve quality of life for patients facing life-threatening illness. It defines palliative care according to the WHO as preventing and relieving suffering through early assessment and treatment of pain and other problems. Palliative care is applicable early on and provides relief from symptoms, affirms life, and offers support for patients and their families coping with illness and bereavement. Common symptoms in advanced cancer patients and effective palliative care approaches are described.
This document discusses some of the key ethical issues surrounding cardiopulmonary resuscitation (CPR). It outlines the goals of resuscitation as restoring health, preserving life, relieving suffering, and respecting individual decision rights. Resuscitation decisions are guided by science, individual patient preferences, surrogate preferences, local policies, and legal requirements. When providing CPR, healthcare professionals should consider ethical principles like respect for autonomy, non-maleficence, beneficence, futility, and justice. They must play a role in resuscitation decision making and uphold patients' medical preferences.
The document discusses ethics of end-of-life care. It begins by defining end-of-life care and palliative care. It then outlines the four guiding ethical principles of clinical integrity, beneficence, autonomy, and justice/non-maleficence. The document discusses some key ethical dilemmas at the end of life including advance directives, surrogate decision makers, and refusal of treatment. It also discusses controversial issues like euthanasia and physician-assisted suicide.
This document provides guidelines for managing diabetes during Ramadan fasting. It was created by the International Diabetes Federation and Diabetes and Ramadan International Alliance. The guidelines cover epidemiology of diabetes and Ramadan fasting, physiology changes during fasting, risk stratification for fasting, diabetes education, and medication adjustments. The goal is to enhance healthcare provider knowledge to safely support patients with diabetes who choose to fast during Ramadan.
This review article summarizes the 2011 evidence-based practice guideline published by the American Society of Hematology for the diagnosis and treatment of immune thrombocytopenia (ITP). The guideline was created using a rigorous evidence-based approach and provides treatment recommendations using the GRADE system where evidence exists. It identifies a lack of evidence in several key areas of ITP therapy, such as comparative studies of front-line therapies and management of bleeding. The guideline covers diagnosis and treatment of ITP in both children and adults, including recommendations for initial treatment, management of non-responders, treatment of specific secondary forms of ITP, and treatment during pregnancy.
Two types of acute diarrhoeal emergencies are cholera, which causes acute watery diarrhoea, and Shigella dysentery, which causes acute bloody diarrhoea. Both are transmitted through contaminated water, food, hands, and vomit or stool of sick individuals. The first steps in managing a diarrhoeal outbreak are determining if there are an unusual number of similar cases, identifying whether patients have cholera or Shigella by their symptoms, and being prepared for a potential increase in cases.
The document provides guidelines for diabetic eye care developed by the International Council of Ophthalmology (ICO). It aims to improve eye care quality worldwide by addressing screening and management of diabetic retinopathy for different resource settings. The guidelines describe classifying and screening for diabetic retinopathy, detailed eye exams, treating retinopathy and macular edema, and managing special circumstances. It includes tables outlining follow-up schedules and treatment recommendations based on retinopathy severity and resource level.
This document discusses special considerations for managing chronic myeloid leukemia (CML) during pregnancy and in the pediatric population. For pregnancy:
- Tyrosine kinase inhibitors (TKIs) used to treat CML are teratogenic and known to cause fetal toxicities. TKI therapy during pregnancy has been associated with higher rates of miscarriage and fetal abnormalities.
- If a patient wants to conceive, discontinuing TKI therapy may be considered if a deep molecular response has been maintained for at least 2 years. Close monitoring would be needed if CML recurs during pregnancy.
- For pediatric CML management, no evidence-based recommendations exist since CML is relatively rare in children. Specialized care at a cancer center is
This document discusses several minor blood group systems beyond ABO and Rh, including I/i, Lewis, P, MN, and SsU. It provides details on the antigens and antibodies in each system, including frequencies, clinical significance, and serological characteristics. The key points are:
- Over 500 antigens beyond ABO have been identified on red blood cells.
- The I/i, Lewis, P, MN, and SsU systems involve antigens that are inherited based on allelic genes and their interactions.
- Antibodies in these systems are usually naturally occurring and clinically insignificant, though some like anti-S, anti-s, and anti-U can cause hemolytic disease of the new
This document provides a focused update to the 2013 ACCF/AHA guidelines for the management of heart failure. It was developed by a writing group comprised of experts from the ACC, AHA, HFSA, and other organizations. The update provides new recommendations on the use of biomarkers for diagnosis and prognosis of heart failure as well as for treatment of stages A through D. It also includes new recommendations on treating anemia, hypertension, and sleep disordered breathing in heart failure patients. The update was reviewed and approved by several committees and is intended to provide guidance for clinicians on best practices in heart failure management.
These guidelines provide recommendations for managing dyslipidemia and preventing cardiovascular disease. They were developed by a writing committee and task force of experts based on reviews of current literature. The guidelines note that medical decisions should be made using clinical judgment and local resources, as rapid changes in the field may lead to periodic revisions. The document aims to assist healthcare professionals while not replacing their independent judgment.
This document provides an overview of the process and methods used to develop recommendations for the testing, management, and treatment of hepatitis C virus (HCV) infection. A panel of HCV experts from various medical fields develops the guidance using an evidence-based approach. Recommendations are rated based on the strength of evidence. The guidance is intended to be a living document that is regularly updated as new treatments and information become available. Strict processes are in place to manage conflicts of interest among panel members.
This document provides information on drugs that are contraindicated (Pregnancy Category X) for use during pregnancy. It lists the generic and brand names of drugs across several therapeutic categories including cardiovascular, dermatological, gastrointestinal, infections/infestations, musculoskeletal, neoplasms, nutrition, OB/GYN, pain/pyrexia, respiratory, and urogenital systems. For some drugs, it specifies the trimester or stage of pregnancy during which they should be avoided. The document also explains the pregnancy categories (A, B, C, D, X) used to qualify contraindications and precautions for drug use during pregnancy.
This document reviews recent guidelines for treating painful diabetic neuropathy (DPN) and compares their recommendations. It finds that the main drug classes recommended as first-line treatment are anticonvulsants like pregabalin and gabapentin, antidepressants like tricyclic antidepressants and duloxetine, and opioids. Pregabalin and duloxetine are the only drugs approved to treat neuropathic pain in diabetes. The guidelines differ in their methodologies, with some based more quantitatively on clinical trial evidence while others incorporate additional factors. Patient characteristics may also influence which treatment is most appropriate.
This document provides guidance from NICE on the assessment and treatment of acute stroke. It outlines recommendations for promptly admitting patients to specialist stroke units, performing brain imaging, providing thrombolysis or mechanical clot retrieval if appropriate, administering antiplatelets or anticoagulants, managing blood pressure and blood sugar, assessing swallowing function and providing nutrition, and carrying out carotid imaging and endarterectomy if indicated. The pathway is designed to optimize stroke care from initial presentation through the acute and subacute phases of recovery.
1) A randomized clinical trial of 576 adults with acute sore throat found that a single dose of oral dexamethasone did not increase the proportion of patients with complete resolution of symptoms at 24 hours compared to placebo.
2) However, at 48 hours significantly more patients in the dexamethasone group experienced complete resolution of symptoms than those in the placebo group.
3) The study found no other significant differences between the dexamethasone and placebo groups in secondary outcomes such as duration of symptoms, health care use, time off work, or medication use.
This document provides guidelines for managing diabetes during Ramadan fasting. It was created by the International Diabetes Federation and Diabetes and Ramadan International Alliance. The guidelines cover epidemiology of diabetes during Ramadan, physiology of fasting and how it impacts diabetes, risk stratification of patients, education recommendations, and medication adjustments for various diabetes medications and high-risk patient groups, such as those with type 1 diabetes. The goal is to enhance healthcare professionals' knowledge to best support patients during Ramadan fasting.
May-Hegglin anomaly is part of a spectrum of disorders called MYH9-related disease. Mutations in the MYH9 gene cause macrothrombocytopenia (low platelet count with large platelets) and basophilic inclusions in white blood cells. A diagnosis can be facilitated by platelet electron microscopy and MYH9 gene sequencing. While each disorder in the spectrum has some unique characteristics, they are all characterized by macrothrombocytopenia and are now considered manifestations of MYH9-related disease.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Chamsi‑Pasha and Albar: Do not resuscitate, brain death, and organ transplantation islamic perspective
36 Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
about Islamic beliefs and laws regarding ethical issues in
patients at the end of life.
DO NOT RESUSCITATE
Cardiopulmonaryresuscitation (CPR)isroutinelyperformed
on any hospitalized patient suffering cardiac or respiratory
arrest. Advanced invasive procedures and treatments that
may sustain life may not confer any predictable benefit
and may cause further suffering to the patient and his/her
family.[3]
The frequent performance of CPR on terminally ill patients
raised concerns that these resuscitations were often utilized
inappropriately. This leads to the emergence of “do not
resuscitate” (DNR) policy identifying patients who will
not benefit from CPR. DNR is a medical order to provide
no resuscitation to patients, for whom resuscitation is not
warranted.
Concerns were also raised that many patients were kept alive
with futile medical therapy. This leads to further worries
about the financial and emotional burdens inflicted on
the patients and their families. These invasive measures
may sustain life for a while but ultimately may not confer
any genuine benefits to the patient.[3]
The futility of the
end‑of‑life treatment can be difficult to define due to several
factors such as chances of success, effect on the quality of
life, and emotional and financial costs.[4]
The American
Thoracic Society states that treatment should be considered
futile if it is highly unlikely that it will result in “meaningful
survival” for the patient.
Futile treatment may be requested by relatives. This is a
subject of great debate even among Muslim scholars. Many
scholars do not advocate treatment if it merely prolongs the
final stages of life. Delaying death with futile or hopeless
treatmentisunacceptablebymanyIslamicscholars.Miracles
can rarely occur, and Islamic jurists do not make their rules
and fatwas upon such very rare occurrence.[5]
Futile treatments must be carefully observed in light of
patients’ outcome and resource utilization in end‑stage
patients. Treatment can be withheld in patients with a
terminal illness such as widespread metastatic cancer.
However, reversible illnesses (e.g., pneumonia) should
normally be treated.[1]
The Permanent Committee for Islamic Research and Issuing
Fatwa in Saudi Arabia issued Fatwa (decree) No. 12086
on 28/3/1409 (1989) based on questions raised using
resuscitative measures:
• If a person arrives at the hospital is already dead, there
is no need to use any resuscitative measures in such a
case
• If the medical file of the patient is already stamped “Do
not resuscitate,” according to the patient’s or his/her
proxy’swillandthepatientisunsuitableforresuscitation,
as agreed by three competent specialized physicians,
then there is no need to do any resuscitative measures
• If three physicians have decided that it is inappropriate
to resuscitate a patient who is suffering from a serious
irremediable disease and that his/her death is almost
certain, there is no need to use resuscitative measures
• If the patient is mentally or physically incapacitated
and is also suffering from stroke or late‑stage cancer
or having the severe cardiopulmonary disease and
already had several cardiac arrests, and the decision
not to resuscitate has been reached by three competent
specialist physicians, then it is permissible not to
resuscitate
• If the patient had irremediable brain damage after a
cardiac arrest and the condition is authenticated by three
competent specialist physicians, then there is no need
for the resuscitative measures as they will be useless
• If resuscitative measures are deemed useless and
inappropriate for a certain patient in the opinion of
three competent specialist physicians, then there is no
need for resuscitative measures to be carried out. The
opinion of the patient or his/her relatives should not
be considered, both in withholding and withdrawing
resuscitative measures and machines, as it is a medical
decision and it is not in their capacity to reach such
a decision.[6]
However, the whole situation should be
explained to the family and the Fatwa given to them.
Usually, Muslim patients and their relatives abide by
the Fatwa, as it was issued by highly respected Ulama
(Muslim Scholars).
Hydration and feeding should continue until the end of
life. If the patient is competent enough, DNR should be
discussed with him/her. He/she should be ensured of being
given all necessary care and medication to alleviate pain
and distressing symptoms. If the patient is not competent
enough, DNR should be discussed with the family members,
especiallythe most appreciative and comprehendingperson.
It should be clarified to the patient or his/her guardian
that this does not mean abandoning the treatment in the
meantime, it does not deprive the patient of receiving
suitable health care, and it respects his/her dignity at all
times.[7]
TheIslamicMedicalAssociationofNorthAmerica (IMANA)
believes that when death becomes inevitable as determined
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3. Chamsi‑Pasha and Albar: Do not resuscitate, brain death, and organ transplantation islamic perspective
37Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
by physicians taking care of terminally ill patients, the
patient should “be permitted to die naturally with only the
provision of appropriate nutrition and hydration” and any
medications and procedures that are necessary to provide
comfort and alleviate pain. IMANA does not believe in
prolonging misery on mechanical life support in a patient
in a vegetative state, when a team of physicians, including
critical care specialists, has determined that no further
attempt should be made to sustain artificial support. Even
in this state, the patient should be treated with full respect,
comfort measures, and pain control. No attempt should
be made to enhance the dying process in patients on life
support.[8]
Physicians’religiositymayaffecttheirapproachtoend‑of‑life
care beliefs. Saeed et al. studied the religious aspects of
end‑of‑life care among 461 Muslim physicians in the US and
other countries. Only 66.8% of the respondents believed that
DNR is allowed in Islam.[9]
The need for education of the
public is an essential part of DNR practice. Poor explanation
to the family has often led to family dissatisfaction in many
cases.
BRAIN DEATH
Medical background
The complexity of defining death is in part due to the
confluence of spiritual, medical, legal, ethical, and other
factors.[10]
Death is defined by almost all cultures and
religions as the departure of the soul out of the body.[11]
Human death involves the irreversible loss of the capacity
for consciousness, combined with the irreversible loss of
the capacity to breathe.[12]
After discovering the circulation, death has been defined
as the irreversible cessation of cardiac and respiratory
activity.
Although it is more than 40 years since the concept of brain
death was first introduced to clinical practice, many of the
controversies surrounding the issue have not settled yet.
These include relationship between brain death and death
of the whole person, criteria for determination of brain
death, and inseparable links between brain death and organ
donation.[13]
The development of organ transplantation and the need to
determine death before organ retrieval led to the publication
of the widely accepted standard for the confirmation of
brain death by an Ad Hoc Committee of the Harvard
Medical School in 1968.[13]
Although this link might give the
impression that brain death was a construct designed only
to facilitate donation, this is incorrect. More importantly,
the confirmation of brain death facilitates the withdrawal
of therapies that can no longer conceivably benefit a patient
who has died.
In 1980, the Uniform Determination of Death Act (UDDA)
defined “brain death” and that definition was approved by
the National Conference of Commissioners on Uniform
State Laws (1981). According to the UDDA, death is:
• Irreversible cessation of circulatory and respiratory
functions
• Irreversible cessation of all functions of the entire brain,
including the brainstem.
Unlike whole‑brain death, the diagnosis of brainstem death,
such as that used in the UK, does not require confirmation
that all brain functions have ceased.[14]
The determination of brainstem death requires the
confirmation of the “irreversible loss of the capacity for
consciousness combined with irreversible loss of the
capacity to breathe” and is based on the fact that the key
components of consciousness and respiratory control, the
reticular activating system and nuclei for cardiorespiratory
regulation, are located in the brainstem.[15]
Initially, it was argued that brain death equates to the death
of the individual, because after brain death, the body ceases
to be a whole integrated organism and will rapidly become
a disintegrating collection of organs that permanently lost
the capacity to work as a coordinated whole.[16]
However,
it is now clear that brain‑dead patients can show levels of
somatic integration that may persist for some time.[17]
The US President’s Council on Bioethics proposed a new
unifying concept of death in 2008. The Council reiterated
its support for a whole brain formulation and rejected the
reliance on brainstem death, arguing that the inner state
of a person with residual cortical activity in the complete
absence of brainstem activity is unknown.
Despite the overall consensus on the concept of brain
death, there are differences in its diagnosis. The majority
of countries have followed the lead of the US and the UK
in specifying that the clinical diagnosis of brain death is
sufficient for the determination of death in adults.[15]
Confirmatory tests are optional in most countries (required
in Saudi Arabia and some other countries) and include
electroencephalography (EEG) of 30 min duration which
should be silent or absence of blood flow to the brain
proved by Doppler or cerebral angiograms or computed
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4. Chamsi‑Pasha and Albar: Do not resuscitate, brain death, and organ transplantation islamic perspective
38 Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
tomography (CT) angiography or magnetic resonance
imaging (MRI) angiography.
These are usually reserved for circumstances where
some doubt exists about the clinical diagnosis of brain
death (e.g., after infusion of long‑acting sedative drugs such
as thiopental) or because the patient might be too unstable
to undergo an apnea test.[15]
The High Committee on brain
death in Saudi Arabia insists on performing an EEG before
establishing the diagnosis of brain death. Other ancillary
tests are optional.
We think that confirming the absence of intracerebral
brain flow, for example, by transcranial Doppler, is feasible,
inexpensive and will reduce the resistance against accepting
brain death as a true death.[11]
Islamic view of brain death
The Islamic faith values any means to save a human life
and condemns the termination of a human life without
just cause: “And kill not anyone whom God has forbidden,
except for a just cause (according to Islamic law).”[18]
Muslim
scholars who advocate organ donation commonly cite the
verse: “If anyone killed a person—not in retaliation of
murder, or (and) to spread mischief in the land—it would be
as if he killed all mankind, and if anyone saved a life, it would
be as if he saved the life of all mankind”[19]
and emphasizing
the latter, i.e., the saving of a human life equals the saving
of whole humankind.[20]
The Quran mentioned Jacob, “peace be upon him (PBUH)”
whenhewasapproachingdeath:“Orwereyouwitnesseswhen
death approached Ya’qub (Jacob)?” When he said unto his
sons, “What will you worship after me?” They said, “We shall
worshipyourIlah (God‑Allah),theIlah (God)ofyourfathers,
Ibrahim (Abraham), Isma’il (Ishmael), Ishaque (Isaac), One
Ilah (God), and to Him we submit (in Islam).”[21]
It is also mentioned in the Quran that sleep is similar in a
way to death. Body is a home for the soul. The soul departs
at sleep and returns when it is time to get up. People move
from one state, with its governing laws, to a different state,
with completely different laws each day without knowing
or thinking about it. God says, “It is Allah Who takes away
the souls at the time of their death, and those that die not
during their sleep. He keeps those (souls) for which He has
ordained death and sends the rest for a term appointed.
Verily, in this are signs for a people who think deeply.”[22]
Furthermore, the newborn will not be considered alive by
jurist even if he/she breathe or pass urine, but only when
he/she raises his/her voice and cries. It was narrated from
Jabir bin “Abdullah that the Messenger of Allah PBUH) said,
No child inherits until he cries.”[23]
It is noteworthy that the jurists consider a person who
is seriously wounded and left with only the “slaughtered
movements,” a dead person, despite the continuation of
heart beating and breathing.[24]
Several questions are raised about brain death: Is brain death
equal to cardiopulmonary (traditional) death or is brain
death just an intermediate state between life and death?
Which formulation, whole‑brain or brainstem death, is
consonantwithIslamicbioethics?Finally,whataretheclinical
responsibilities of physicians to patients in these states?[25]
The Islamic consensus on brain death is lacking. Some
equate brain death with cardiopulmonary arrest, both
being death proper in Islamic law. Others hold brain death
to be an in‑between state between life and death, where life
support needs not be continued, while some have rejected
the concept in toto.[25]
The idea that brain death represents true death in Islam
remains a subject of debate.[26]
Brain death has been
acknowledged as representing true death by many Muslim
scholars and medical organizations, including the Islamic
Fiqh Academies (IFAs) of the Organization of the Islamic
Countries (OICs), the Islamic Medical Association of
North America, and other Islamic medical organizations,
and considered as legal rulings by multiple Islamic
nations. However, consensus in the Muslim world is not
unanimous, and an appreciable minority accepts death by
cardiopulmonary criteria only.[26]
At the Third International Conference of Islamic Jurists
(October 11–16, 1986) in Amman, Jordan, the IFA of
the OICs on resuscitation apparatus (October 1986)
incorporated the concept of brain death into the legal
definition of death in Islam:
A person is pronounced legally dead, and consequently,
all dispositions of the Islamic law in case of death apply if
one of the two following conditions has been established:
(1) There is total cessation of cardiac and respiratory
functions, and doctors have ruled that such cessation is
irreversible; (2) there is total cessation of all brain functions,
and experienced specialized competent doctors have ruled
that such cessation is irreversible, and the brain has started
to disintegrate.[27,28]
Under these circumstances, it is justified
to disconnect life‑supporting systems even though some
organs continue to function automatically (e.g., the heart)
under the effect of the supporting devices.
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5. Chamsi‑Pasha and Albar: Do not resuscitate, brain death, and organ transplantation islamic perspective
39Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
The Islamic Fiqh Majma (Council) of the Muslim World
League (MWL; Kingdom of Saudi Arabia) issued its ruling
in 1987. However, the MWL made some distinctions and
decisions that are not found in the IFA‑OIC’s decision.[29]
Notably, the MWL stated that brain death criterion could
only be applied if three competent specialist physicians
agree that brain death has occurred and is irreversible. In
such case, the life support could be stopped despite the fact
that the heart is still pumping and respiration is still going
on by the machine.
Furthermore, any legal consequences linked to the
determination of death can come into effect only after
circulation and respiration have finally stopped. In other
words, cardiac death and brain death are clearly not equated.
The determination of death remains important not only
for burial rights of the deceased and conformity with
Sharīah but also for critically important reasons, including
inheritance, marriage law, and criminal law.[29]
Many Muslim countries adopted the death definition of the
IFA‑OIC. In 2003, the IMANA Ethics Committee developed
aprimertitled,“Medical Ethics:TheIMANAPerspective.”[28]
The statement reiterates the accepted criteria for the
diagnosis of death and the issue of diagnostic uncertainty
is implied in more detail.[10]
Despite the IFA‑OIC, MWL decisions (Qararat) recognizing
brain death criteria, these decisions are nonbinding
resolutions. Although these decisions represent majority
opinions, concerns have limited the widespread acceptance
of this concept.[30,31]
Furthermore, contemporary Muslim
scholarshaveconflictingnotionsregardingtheirreversibility
of patients maintained on resuscitation devices. Some claim
that absolute death cannot become manifest without cardiac
death.[28,30]
The Islamic Organization for Medical Sciences (IOMS)
revisited the issue in 1996 after they sent three members
to participate in an international bioethics conference.
These members reported back to the IOMS, this time with
some eminent Islamic scholars attending the meeting. The
meeting was called for because an Egyptian professor of
Anesthesia (Dr. Safwat H. Lutfi) campaigned against brain
death both in the medical circles and media (newspaper,
television, and public meetings) in Egypt and stirred
antagonism against the physicians who wanted to take
organs from poor people and give them to wealthy persons
for money! The issue was then discussed by Al‑Azhar and
the parliament which was about to accept brain death.
However, he succeeded in stopping this approval.[11]
In 2010,
the Egyptian Parliament approved organ transplantation
from a patient whose brain and heart completely ceased
functioning.
Controversies in brain death
Thirteen countries (16 legal decisions) in the Near‑ and
Middle‑East and South Asia were surveyed regarding brain
death. Twelve had legislation in support of the use of brain
death criteria.[10]
Even within medical circles, the notion that brain death
represents complete death has been met with some
resistance.[30,32]
The Muslim opponents of brain death
concept criticize it in several points.
They claim that the 2010 update of the American Academy
of Neurology guidelines for determining brain death fails
to meet the three essential requirements stated in the
Islamic definition of death: (1) Total cessation of all brain
functions, (2) irreversibility of cessation, and (3) onset of
disintegration of the brain.[20]
The opponents argue that organ procurement is performed
in the operating room with no general anesthesia because
donors are presumed dead.[33]
In fact, most surgeons require
general anesthesia to procure organs from brain‑dead
individuals to avoid spinal reflexes.
Others have rejected the diagnosis of brain death over
potential conflicts of interest with the issue of organ
donation.[34,35]
For example, Egypt experienced an intense
ethical reaction against deceased donor transplantation
and the notion of brain death, following the procurement
of organs from executed prisoners under controversial
conditions.[34]
Similar outrage regarding organ donation
and its linkage to declaration (or not) of death has fueled
debate, following the allegedly government‑sponsored
forced organ removal from Muslim political demonstrators
in China.[35]
Padela et al.[28]
have pointed out the serious gaps in
contemporary medical understanding and clinical diagnosis
of brain death and its endorsement as human death in the
Islamic faith. These gaps pertained to (1) the retention of
residual brain functions, (2) the recovery of some previously
ceased brain functions, (3) the absence of whole brain
degeneration and necrosis, and (4) the uncertainty of
medical tests and bedside examination in determining this
condition with reasonable accuracy.[28]
Rady and Verheijde[36]
argue that the residual functions
of the central nervous system, homeostasis, and somatic
integration of the whole body persist in brain death. They[36]
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6. Chamsi‑Pasha and Albar: Do not resuscitate, brain death, and organ transplantation islamic perspective
40 Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
claim that death is biologically defined in the Quran by
disintegration as emphasized in several Quranic verses:
“And he puts forth for us a parable, and forgets his own
creation. He says: “Who will give life to these bones after
they are rotten and have become dust?”[37]
“When we are
dead and have become dust and bones, shall we (then) verily
be resurrected?[38]
This definition is incorrect since there is a prolonged period
elapsing between the moment of death; i.e., departure of
soul from the body, and the disintegration of a corpse into
dust and bones and nobody would wait until the bones of
the dead become dust!
The American evidence‑based guideline update published
in 2010 stated that “in adults, there are no published reports
of recovery of neurologic function after a diagnosis of brain
death using the criteria reviewed in the 1995 American
Academy of Neurology practice parameter.” All “recovered”
adult cases reported in the literature and those in the
media are suspected due to the presence of confounders,
no detailed description of testing, or no mention of the
apnea test.[17,39]
Dr. Martin Smith from Queen Square, London, confirms
that “The criteria for the determination of brain death are
robust.”[12]
He also states that the recent reports describing
the apparent “reversibility” of brain death have been refuted
because of failure to adhere to such standard guidelines.[40]
In summary, although guidelines are available in many
countries to standardize national processes for the diagnosis
of brain death, the current variation and inconsistency
in practice make it imperative that an international
consensus is developed. This should clarify the criteria
for the determination of brain death and provide specific
instructions about the clinical examination necessary and
the conduct of the apnea test. It should also stipulate the
role and type of confirmatory investigations and detail the
requiredlevelofdocumentation.Aninternationalconsensus
on the determination of brain death is desirable, essential,
and long overdue.[12]
Following the established guidelines scrupulously can
maintain the foundation of a transplantation system that
saves thousands of lives a year.[41]
A confirmatory test is
mandatory to establish the absence of blood flow to the
brain by cerebral angiography or CT angiogram or MRI
angiogram or Doppler. If strict adherence to the principle
of “total cessation of cerebral functions is the criteria” is the
rule, in many patients, the diagnosis of brain death cannot
be made.[42]
Finally, Islamic juridical deliberations around brain death
largely took place 30 years ago in response to medical
developments and ethical controversies in the Western
world. The IOMS studied the subject in December 1996 and
ended with a publication of a large volume on this issue in
2000 and agreeing to the concept of brain death. However,
the debates within Muslim bioethics need updating and
deepening concerning the early rulings on brain death.[11,25]
ORGAN DONATION
Organ donation is the donation of biological tissue or an
organ of the human body, from a living or dead person
to a living recipient in need of transplantation. Organ
transplantation has become one of the most effective ways
to save lives and improve the quality of life for patients
with end‑stage organ failure in developing and developed
countries.[43]
Nowadays, many diseased organs are being replaced by
healthy organs from living donors, cadavers, and from
an animal source. Successful bone marrow, kidney, liver,
cornea, pancreas, heart, and nerve cell transplantations
have been taken place. The incidence is limited only by cost
and availability of the organs. The discovery of effective
immunosuppressivedrugsinthelate1970swasanimportant
step toward increasing the success rate of organ transplants
and thus paved the way for organ transplantation to become
a medical routine affair in the 21st
century.[44]
The increasing incidence of vital organ failure and the
inadequate supply of organs, especially from cadavers,
have created a wide gap between organ supply and organ
demand, which has resulted in very long waiting time to
receive an organ as well as an increasing number of deaths
while waiting.[43]
These events have raised many ethical,
moral, and societal issues regarding supply, methods of
organ allocation, and use of living donors including minors.
It has also led to the practice of organ sale by entrepreneurs
for financial gains in some parts of the world through the
exploitation of the poor, for the benefit of the wealthy.
Despitethefactthattransplantationprogramsaredependent
on brain‑dead patients as a supply of organs, these two
questions should be separated. Accepting the concept of
brain death is one thing, and allowing organs to be procured
from a dead loved one is a different question, with additional
difficulties and concerns for the family.[42]
Islamic rules on organ transplantation
Muslimjuristssanctionedtransplantationofteethandbones,
which had been practiced by Muslim surgeons for over a
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7. Chamsi‑Pasha and Albar: Do not resuscitate, brain death, and organ transplantation islamic perspective
41Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
thousand years. Imam Nawawi (631‑671H/AD1233‑1272)
fully discussed the subject of bone and teeth transplantation
in his voluminous reference textbook Al Majmu.[45]
Al Imam
Al‑Shirbini commented on the same subject in his book
Mughni Al Muhtaj.[46]
The bone to be implanted could be
from the same person (autograft) or the corpse of another
person (allograft) or an animal (xenograft). The latter could
be from a slaughtered (Halal) animal or a Najas, i.e., a dead
(Carcass)orofporcineorigin,bothofwhichwillnotbeallowed
unless there is any other alternative and is deemed necessary.
However, Zakariya al‑Qazwini, a grand Qadhi (judge) in
Iraq (600‑682H/1203‑1283AD), noticed that porcine bone
grafts function more efficiently than other xenografts and
reported this fact in his book “Wonders of Creatures.”[47]
Ibn Sina (Avicenna 607‑687H/1210‑1288AD) (the greatest
Muslim physician) in his voluminous textbook “Canon”
regarded bone transplantation as a hazardous operation
that he would never attempt to perform!
The human being should always maintain his/her dignity
even in disease and misfortune. The human body, living or
dead, should be venerated likewise. Mutilation of humans or
animalsisnotallowed.[48]
However,performingpostmortems
or donating organs from a cadaver is not tantamount to the
mutilation of the corpse or an act of disrespect.[49]
The
harm done, if any, by removing an organ from a corpse
should be weighed against the benefit obtained and the
new life given to the recipient. The principle of saving
human life takes precedence over whatever assumed harm
would befall the corpse.[50]
Nevertheless, Sheikh Shaarawi,
a renowned commentator on the Holy Qur’an, but not a
Mufti (Jurisconsult), rejected all types of organ donation.
In the case of a living donor, the principle of doing no
harm is invoked. The donation of an organ whose loss
would usually cause no harm or a minimal increased risk
to the health or life of the donor is acceptable if the benefit
to the recipient is much greater than the harm. It invokes
the principle of accepting the lesser harm when faced with
two evils. The harm done by the disease, which can kill a
human life, is not to be compared with the harm incurred
by donation.[51]
Organ transplantation can save many human lives and
improve the quality of life for many others. Islam encourages
a search for a cure and invokes Muslims not to despair, for
there is certainly a cure for every ailment, although we may
not know it at present. The donation of organs is an act of
charity,benevolence,altruism,andloveforhumankind.God
loves those who love fellow humans and try to mitigate the
agony and sorrow of others and relieve their misfortunes.
Any action carried out with good intentions and which aims
at helping others is respected and encouraged, provided no
harm is inflicted. The human body is the property of God;
however, man/woman is entrusted with the body as well as
other things. He/she should use it in the way prescribed by
God as revealed by his/her messengers. Any misuse will be
judged by God on the day of judgment, and transgressors
will be punished.[11]
Donation of organs should not be considered as acts of
transgression against the body. Human organs are not a
commodity, and they should be donated freely in response
to an altruistic feeling of brotherhood and love for one’s
fellow beings. Encouraging donation by the government is
allowed by Islamic jurists and is practiced in Saudi Arabia,
Gulf Countries, and Iran.
Islamic jurists’ fatwas (juridical resolutions) regarding
organ transplantation
The majority of the Muslim scholars and jurists belonging
to various schools of Islamic law invoked the principle of
priority of saving human life and hence gave it precedence
over any other argument. Sheikh Hassan Mamoun (the
Grand Mufti of Egypt) sanctioned corneal transplants
from cadavers of unidentified persons and from those who
agree to donate upon their death (Fatwa No. 1084 dated
April 14, 1959). His successor, Sheikh Hureidi, extended
the fatwa to other organs in 1966 (Fatwa No. 993). In
1973, the Grand Mufti, Sheikh Khater, issued a fatwa
allowing harvesting of skin from an unidentified corpse.
The Grand Mufti Gad Al Haq sanctioned donation of
organs from the living provided no harm was done and
provided it was donated freely in good faith and for the
love of God and the human fraternity. He also sanctioned
cadaveric donors provided there was a will, testament, or
the consent of the relatives of the deceased. In the case of
unidentified corpses, an order from the magistrate should
be obtained before harvesting organs (Fatwa No. 1323 dated
December 3, 1979).[27]
The Saudi Grand Ulama sanctioned corneal transplant in
1978 (Decree No. 66 H1398/1978). In Algiers, the Supreme
Islamic Council sanctioned organ transplantation in 1972,
while in Malaysia, the International Islamic Conference
sanctioned organ transplantation in April 1969.
The Saudi Grand Ulama Fatwa No. 99, 1982, addressed the
subject of autografts, which was unanimously sanctioned. It
also sanctioned (by a majority) the donation of organs both
by the living and by the dead, who made a will or testament,
or by the consent of the relatives (who constitute the Islamic
next of kin).The Kuwaiti Fatwa of the Ministry of Charitable
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42 Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
EndowmentsNo. 132/79,1979sanctionedliveandcadaveric
organ donation. The Kuwaiti law No. 7, 1983 reiterated the
previous Fatwa and pointed out that living donors should
be over the age of 21 years to give their consent.[27]
The subject of the brain death was not addressed in any of
these fatwas. It was discussed for the first time in the Second
International Conference of Islamic Jurists held in Jeddah in
1985. No decree was passed at that time until further studies
and consultations were obtained. In the Third International
Conference of Islamic Jurists (Amman 1986), the historic
resolution (No. 5) was passed with a majority of votes, which
equated brain death to cardiac and respiratory death.[52]
Death in the true Islamic teaching is the departure of the
soul, but as this cannot be identified, the signs of death are
accepted. This decree paved the way for an extension of
organ transplantation projects, which were limited to living
donors. Campaigns for organ donation from brain‑dead
persons were launched in Saudi Arabia, Kuwait, and many
Arab and Muslim countries.
The unfortunate high incidence of road accidents in the
Gulf area provides many cases of brain death. It is a pity to
waste such candidate cadavers without trying to save the
life of many others who need their organs.
The Islamic Fiqh Council of Islamic World League held in
Makkah Al Mukarramah (December 1987), which passed
Decree No. 2 (10th
session), did not equate cardiac death
with brain death. Although it did not recognize brain
death as death, it did sanction all the previous fatwas on
organ transplantation. This decree received little publicity
in the media, and cardiac and kidney transplants from
brain‑dead individuals continued without any hindrance
from the jurists.
The most detailed fatwa on organ transplantation was that
of the Fourth International Conference of Islamic Jurists
held in Jeddah in February 1988 (Resolution No. 1). It
endorsed all previous fatwas on organ transplantation,
clearly rejected any trading or trafficking of organs, and
stressed the principle of altruism.[53]
Later,theIslamicjuristsstartedtodiscussnewsubjectsrelated
toorgantransplantation,namely,transplantationofthenerve
tissueasamethodfortreatingParkinsonismorotherailments;
transplantation from anencephalic; transplantation of tissues
fromembryosabortedspontaneously,medically,orelectively;
and leftover preembryos in vitro fertilization projects.
The Sixth International Conference of Islamic Jurists, held in
Jeddah in March 1990, addressed all these issues fully.[54]
It
sanctioned transplantation of nerve tissues to treat ailments
such as Parkinsonism if this method of treatment proved
superior to other well‑established methods of treatment.
The source of the nerve tissues could be:
• The suprarenal medulla of the patient himself (autograft)
• The nerve tissues from an animal embryo (xenograft)
• Cultured human nerve cells obtained from spontaneous
abortion or medically indicated abortions.
However, the conference deplored the performance of
abortion for the sake of procuring organs. It reiterated
the Islamic views against elective abortion, which is only
allowed to save the life or health of the expectant mother.
If, however, the fetus is not viable, organs can be procured if
the parents donate and only when the fetus is declared dead.
The aborted fetus is not a commodity and commercialism
is not allowed.[54]
Anencephalics cannot be used as organ donors until
declared brain or cardiac dead. The fully informed consent
of the parents should be obtained in every case. Of note, a
few cases of kidney transplantations from anencephalic were
performed, where kidneys were transplanted to children
with end‑stage renal failure. The jurists also discussed
transplantation of genital organs. They did not allow the
transplantation of gonads as they carry all the genetic
inheritance from the donor. However, they sanctioned the
transplantation of the other internal sex organs.[54]
In 2003, the Islamic Fiqh Council of Islamic World League,
Makkah Al Mukarramah, in its 17th
session passed a Fatwa
No. 3, which allowed using leftover preembryos for stem cell
research and treatment of serious ailments.[55]
Organ donation among Muslims in Europe
In his article, “Religio‑ethical discussions on organ donation
among Muslims in Europe,” Dr. Ghaly sheds light on the
discussions among Muslim religious scholars on organ
donation particularly related to Muslims living in Europe.
The article examinesthree main religiousguidelines (fatwas)
issued, respectively, by the UK Muslim Law (Shari’ah)
Council in 1995 in the UK, the European Council for Fatwa
and Research (ECFR) in 2000 in Ireland, and the Moroccan
religious scholar Mustafa Ben Hamza during a conference
on “Islam and Organ Donation” held in March 2006 in
the Netherlands. The three fatwas examined in this article
shared one main purport; organ donation is in principle
permitted in Islam.[56]
The fatwa issued by the ECFR in 2000 stated that if the
deceased did not make up his/her mind before death
about organ donation, then the deceased’s family has the
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43Avicenna Journal of Medicine / Volume 7 / Issue 2 / April‑June 2017
right to decide. The ECFR went even further by giving the
same right to “the authority concerned with the Muslims’
interests in non‑Muslim countries” if the deceased’s family
was missing.
ThesecondfatwawasissuedbytheUKMuslimLaw (Shari’ah)
Council in 1995. Different to the ECFR fatwa, this fatwa was
much less dependent on the religio‑ethical discourse in the
Muslim world. The UK fatwa also dedicated much more
space to the concept of brain death and argued that this
death criterion is accepted from the Islamic perspective. The
fatwa also clearly stated that Muslims might carry donor
cards. Like the ECFR fatwa, the UK fatwa expressed no
objection to the idea that the deceased’s family can decide
if the deceased did not have a donor card nor expressed
his/her wish before death. Finally, the fatwa stressed that
organ donation should be done freely without reward and
that trading in organs is prohibited.[56]
The third fatwa was issued by a Moroccan scholar,
Mustapha Ben Hamza, during a conference on “Islam and
organ donation” held in 2006 in the Netherlands. This
fatwa approved for a Muslim to donate his/her organs
to a non‑Muslim. A similar fatwa was issued by Mufti of
Singapore Sheikh Bin Sumait in the early 1990s.
Contemporary English Sunni e‑fatwas on organ
donation
Van den Branden and Broeckaert analyzed seventy
English Sunni e‑fatwas and subjected them to an in‑depth
text analysis to reveal the key concepts in the Islamic
ethical framework regarding organ donation and blood
transfusion.[57]
They found all seventy fatwas allow for organ donation and
blood transfusion. Autotransplantation is no problem at all
if done for medical reasons. Allotransplantation, both from
a living and a dead donor, appears to be possible though
only in quite restricted ways. Xenotransplantation is less
often mentioned but can be allowed in case of necessity.
Transplantation, in general, is seen as an ongoing form of
charity.
They state that their findings are very much in line with the
international literature on the subject. They also found that
debates on the definition of the moment of death are hardly
mentioned in the English Sunni.[57]
Given the worldwide
shortage of organs for donation, the importance of these
English Sunni e‑fatwas must not be underestimated.[58]
To change the views of religious people about accepting
the diagnosis of brain death and donating organs, there
must be an education process which involves religious
and spiritual leaders from the local community. Hafzalah
et al.[59]
described the effect of an educational intervention
of the attitudes of Muslim Americans regarding organ
donation.
CONCLUSION
Islam considers disease as a natural phenomenon and a
type of tribulation that expiates sin. Unfortunately, many
elder patients with chronic illness spend their last few
weeks or months in hospitals. Life support is not required
if it prolongs the agony and suffering associated with final
stages of a terminal illness. Islamic law permits withdrawal
of futile treatment on the basis of a clear medical decision
by at least three physicians.
Although the IFA‑OIC resolution and IMANA perspective
are widely cited within the medical community as an
acceptance of brain death within Islamic law, there are still
some uncertainties about the concept of brain death among
some Muslim scholars.
Organ transplantation has been accepted as a modality
of treatment that improves the patient’s suffering from
end‑stage organ failure. Islam has given permission for
organ and tissue transplantation to save human lives or
vital organs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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