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Advance Care Planning

Advances in modern medicine with life-support equipment have created new ethical challenges. In which cases would “doing everything possible” help a patient recover, and in which cases would it simply prolong one’s suffering, or possibly worsen it? With a vast range of treatment options available, it has become clear that a patient’s wishes must be considered, which includes respecting a patient’s value system and beliefs.

An ‘Advance care plan’ is a plan made beforehand that informs doctors of a patient’s treatment preferences, in case they are too sick to communicate them at the time.1For helpful resources, one may visit http://www.advancecareplanning.ca/ 

What does Islam say about life and death?

Islam teaches that life has a purpose – to come closer to the One God by worshipping Him alone, doing good deeds and taking care of God’s creation.2Qur’an 51:56, 90:12-17  The life of this world is a test and suffering is in reality an opportunity for moral and spiritual growth.3Qur’an 2:155-6  Death is not the end of one’s existence, but rather the inevitable return to the Almighty Creator.4Qur’an 29:57  Remembering one’s death enables reflection on what’s really important in life.5Qur’an 67:2   In the last moments of life, Muslims recite the testimony of faith,6Authentically reported in Sunan Abi Dawud, Hadith 3116 and look forward to meeting God.7Authentically reported in Sahih Muslim, Hadith 2684 

 

What Islamic values guide choices about treatment?

Islam encourages medical therapy to cure disease and alleviate suffering. Saving a single life is as blessed as saving all humanity, as the Qur’an states.8Qur’an 5:32  The Prophet Muhammad (P) said, “Seek medical treatment, for verily God has not made any disease except that He has also made for it a cure, with the exception of one: aging.” 9Authentically reported in Sunan al-Tirmidhi Book 28, Hadith 2172 The Islamic command to seek curative therapy demonstrates patient responsibility, as the human body is a trust from God.10The Prophet said, “Your body has a right over you.” Authentically reported in Sahih al-Bukhari 5199. In addition to patient responsibility, there is also patient autonomy ,11This refers to a patient’s right to make decisions about their own treatment as the Prophet Muhammad forbade forcing medication upon any person who refuses it.12Authentically reported in Sahih al-Bukhari 5709

Islam also provides practical guidelines for cases where medical options are unlikely to bring benefit. When there is excessive risk of harm and low likelihood of a positive outcome,13The chance of survival after CPR for frail elderly patients or chronically ill patients can be very poor for instance (cf. You, J et al CMAJ 2014, 186 (6) ) such therapeutic options are Islamically unadvisable as the Qur’an indicates.14Qur’an 2:195. (Cf. resolution 67 of the Islamic Fiqh Academy of the OIC, 1992) The Prophet Muhammad (P) forbade all types of harm, which in medicine is called the principle of non-maleficence .15Refer to Hadith 32 in the Forty Hadith of Imam Nawawi, cited from Sunan Ibn Majah and Sunan al-Daraqutni This is very important for deciding when to initiate or withdraw life-support equipment. When a dying person has no hope for a meaningful recovery, the goal of care should be to minimize suffering and increase comfort.16In addition, any reversible components of a patient’s illness should be treated.  For those afflicted with much suffering, the Prophet provided the prayer, “O God, keep me alive as long as life is better for me, and allow me to die if death is better for me.”17Authentically reported in Sahih al-Bukhari 5671 

What is the definition of death?

When is a patient considered deceased? In Islamic theology, death is defined as the departure of the soul.18Qur’an 39:42 In the medical community, the need for a precise definition of death arose to facilitate decisions surrounding removal of life-support and procuring organs for transplantation. Since 1968, “brain death” has been widely accepted as the medical definition for death.19Wijdicks EF. Neurology. 2003 Oct 14;61(7):970-6.  This was upheld by the Islamic Fiqh Academy in Jeddah, SA in 1988 among other international bodies. Withdrawal of life support equipment occurs at this point, and is also considered in the terminally ill when continued therapy becomes futile. With prior consent, organ transplantation may be performed after death.20Res. 26, Islamic Fiqh Academy of the Organisation of Islamic Cooperation, 1988

Why should you have an Advance Care Plan?

When a patient is brought to hospital, they may be asked what kinds of treatment they would want in the event of critical illness. These are important conversations to have with one’s family before hand so that one’s wishes are clearly known and to prevent a person from being subjected to aggressive forms of resuscitation against their wishes.

Questions to consider:

– What kinds of medical procedures would I want or not want? If I am severely ill, would I want doctors to do whatever is possible to keep me going on machines, or would I just want medications only, or just comfort measures?

– Who will make medical decisions on my behalf if I am unable at the time?

– When I am dying, what special sources of comfort would I like?

– What needs to be taken care of when I am dying?

 

In conclusion, all individuals need to carefully consider the level of medical care they wish to receive during severe illness. These wishes should be discussed, documented and respected.

References   [ + ]

1. For helpful resources, one may visit http://www.advancecareplanning.ca/
2. Qur’an 51:56, 90:12-17 
3. Qur’an 2:155-6 
4. Qur’an 29:57
5. Qur’an 67:2
6. Authentically reported in Sunan Abi Dawud, Hadith 3116
7. Authentically reported in Sahih Muslim, Hadith 2684 
8. Qur’an 5:32 
9. Authentically reported in Sunan al-Tirmidhi Book 28, Hadith 2172
10. The Prophet said, “Your body has a right over you.” Authentically reported in Sahih al-Bukhari 5199.
11. This refers to a patient’s right to make decisions about their own treatment
12. Authentically reported in Sahih al-Bukhari 5709
13. The chance of survival after CPR for frail elderly patients or chronically ill patients can be very poor for instance (cf. You, J et al CMAJ 2014, 186 (6) )
14. Qur’an 2:195. (Cf. resolution 67 of the Islamic Fiqh Academy of the OIC, 1992)
15. Refer to Hadith 32 in the Forty Hadith of Imam Nawawi, cited from Sunan Ibn Majah and Sunan al-Daraqutni
16. In addition, any reversible components of a patient’s illness should be treated. 
17. Authentically reported in Sahih al-Bukhari 5671
18. Qur’an 39:42
19. Wijdicks EF. Neurology. 2003 Oct 14;61(7):970-6. 
20. Res. 26, Islamic Fiqh Academy of the Organisation of Islamic Cooperation, 1988
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