Fatme is on life-sustaining treatment. The only way to save her is through the use of embryonic stem cells. To make matters worse, she’s pregnant and considering an abortion. Because of her condition, her child would be born with hydrocephaly. Her very religious parents are against the abortion. Fatme comes to you for advice on the Islamic perspective of this situation!

The Islamic Medical Association of North America (IMANA) Islamic Medical Ethics

Definition of Islamic Medicine The art and science of practice of medicine by Muslim physicians and other helath care providers in the service of humanity under Islamic guidelines as ordained by the divine book al-Qur’an and taught by Prophet Muhammad, peace be upon him (PBUH) Islamic Medical Ethics: The IMANA Perspective

Islam considers access to health care as a fundamental right of the individual Islam considers access to health care as a fundamental right of the individual

When faced with difficult decision- making options for a patient, a physician's decision should take into consideration… *Available Knowledge *His/Her Experience *His/Her Peers *Consensus of the Community

And, of course, a final conclusion should be based upon the rules of ~Islamic Laws~ most of which are based upon the Holy Qur’an and/or saying of the Holy Prophet Muhammad (PBUH)

From Islmaic Law comes two main principles in Islamic Medicine Sanctity of Human Life Sanctity of Human Life Whosoever saves a human life, saves the life of the whole mankind (5:32) Seeking Cure Seeking Cure The Holy Prophet has said… “There is no disease that God has created, except that He also has created its treatment.” “Seek treatment, for God the Exalted did not create a disease for which He did not create a treatment, except senility.’

Furthermore, these two principles are supported by the 5 Goals of Islamic Law Protection and Preservation of Life Life Progeny Progeny Intellect Intellect Property Property Religion Religion

Sanctity of Human Life To what extent should the preservation and protection of human life be upheld?

Let’s first define death Two conditions which render a person dead: The physician has determined that after a standard examination, a person’s cardiopulmonary function has come to a permanent stop The physician has determined that after a standard examination, a person’s cardiopulmonary function has come to a permanent stop A specialist physician has determined that after standard examination, the function of the brain and the brain stem, has come to a permanent stop, even if some other organs may continue to show spontaneous activity A specialist physician has determined that after standard examination, the function of the brain and the brain stem, has come to a permanent stop, even if some other organs may continue to show spontaneous activity

Versus of the Qur’an which Address Death It is he who gives life and death and when He decides upon an affair, He says to it: Be and it is (40:68) It is he who gives life and death and when He decides upon an affair, He says to it: Be and it is (40:68) No soul can die except by God’s permission, the term being fixed by writing…(3:145) No soul can die except by God’s permission, the term being fixed by writing…(3:145) Every soul will have a taste of death. In the end, to us, shall you be brought back (29:57) Every soul will have a taste of death. In the end, to us, shall you be brought back (29:57) It is He who gives life and Who takes it away and to Him shall you be brought back (10:56) It is He who gives life and Who takes it away and to Him shall you be brought back (10:56) Nor take life which God has made sacred-except for a just cause. (17:33) Nor take life which God has made sacred-except for a just cause. (17:33)

Obvious Conclusions Euthanasia and Physician Assisted Suicide are prohibited in Islam.

1. Mohamed on his death-bed is breathing via a life-sustaining-ventilator. Would removing the ventilator which would cause death be considered haram (Islamically impermissible)? 2. Mohamed refuses a ventilator needed to sustain life. What about the pain and suffering of the terminally ill or persistent vegetative state?

To treat with full respect, a patient’s comfort should be maintained by pain control. 1. If a patient’s death is medically inevitable, the patient is permitted to die without unnecessary procedures. (It is Islamically permissible to remove Mohamed from the ventilator). 2. A terminally ill patient should decide if he or she wants to continue life-sustaining treatment. However, further or new attempts at life support are not allowed. (If Mohamed is on his death bed, he may reject the ventilator for this reason).

Feeding Tube (Terminally Ill) In order to maintain comfort, nutrition cannot be withheld because of prolonged suffering. In order to maintain comfort, nutrition cannot be withheld because of prolonged suffering. If a feeding tube is removed, it cannot be re-inserted. A patient should be allowed to die peacefully. If a feeding tube is removed, it cannot be re-inserted. A patient should be allowed to die peacefully.

Persistent Vegetative State (PVS) Again, Islam does not encourage prolonging the misery of those persons in PVS. Again, Islam does not encourage prolonging the misery of those persons in PVS. Thus, when nothing more can be done for the PVS, it is best to allow the patient to dies peacefully. Thus, when nothing more can be done for the PVS, it is best to allow the patient to dies peacefully. REMEMBER: Nutrition must, however, be maintained until death REMEMBER: Nutrition must, however, be maintained until death

Let’s now define life Man We did create from a quintessence (of clay); Then We placed him as (a drop of) sperm in a place of rest, firmly fixed; Then We made the sperm into a clot of congealed blood; then of that clot We made a (fetus) lump; them we made out of that lump bones and clothed the bones with flesh; then we developed out of it another creature. So blessed be God, the best to create! (23:12-14) Islam holds that biological life begins at conception while human life begins at ensoulment (personhood). Islam holds that biological life begins at conception while human life begins at ensoulment (personhood).

When is ensoulment? Different schools of thought believe ensoulment takes place 40 to 120 days after fertilization.

From Islamic Law comes two main principles in Islamic Medicine Sanctity of Human Life Sanctity of Human Life Whosoever saves a human life, saves the life of the whole mankind (5:32) Seeking Cure Seeking Cure The Holy Prophet has said… “There is no disease that God has created, except that He also has created its treatment.” “Seek treatment, for God the Exalted did not create a disease for which He did not create a treatment, except senility.’

Seeking Care The Holy Prophet (PBUH) clearly said “Seek treatment..” This has some medical implications. If an illness could be treated or cured with medication, an ill person should “seek treatment”

Genetic Engineering If gene therapy could prevent, cure, or treat a disease, does Islam permit gene therapy to “seek treatment”?

Yes, Though Muslims are by no means morally obligated, gene therapy is only permitted in order to alter or delete diseased genes.

Embryonic Stem Cells (ESC) Embryonic stem cells provide means for ill or diseased Muslims to “seek treatment.” However, ESC come from the death of an embryo whose (at least) biological life was killed. Are ESC permitted in Islam?

Yes, Only if the embryonic stem cells come from spontaneous miscarriages or extra ova from in vitro fertilization

By the way, When a couple is unable to conceive a child, in vitro fertilization is Islamically permitted only between their own sperm/ovum and at both of their consent. When a couple is unable to conceive a child, in vitro fertilization is Islamically permitted only between their own sperm/ovum and at both of their consent. Third parties are Islamically impermissible in the conception of a child. Therefore, surrogate motherhood, sperm donors, etc. are haram. Third parties are Islamically impermissible in the conception of a child. Therefore, surrogate motherhood, sperm donors, etc. are haram.

Abortion

Islamic Law on Abortion Come From Most of the Same Qur’anic Versus It is he who gives life and death and when He decides upon an affair, He says to it: Be and it is (40:68) It is he who gives life and death and when He decides upon an affair, He says to it: Be and it is (40:68) No soul can die except by God’s permission, the term being fixed by writing…(3:145) No soul can die except by God’s permission, the term being fixed by writing…(3:145) Every soul will have a taste of death. In the end, to us, shall you be brought back (29:57) Every soul will have a taste of death. In the end, to us, shall you be brought back (29:57) It is He who gives life and Who takes it away and to Him shall you be brought back (10:56) It is He who gives life and Who takes it away and to Him shall you be brought back (10:56) Nor take life which God has made sacred-except for a just cause. (17:33) Nor take life which God has made sacred-except for a just cause. (17:33)

Direct Conclusions Therefore, the premise of the conclusion is similar to euthanasia: Therefore, the premise of the conclusion is similar to euthanasia: Abortion of a healthy baby from a healthy mother is Islamically prohibited If the fetus harms the mother, the latter is Islamically obligated to get an abortion.

Cases for Abortion If the infant will die shortly after birth due to a fatal disease, an abortion is Islamically permissible. If the infant will die shortly after birth due to a fatal disease, an abortion is Islamically permissible. If the baby is born with a non-fatal, yet sever, malformation (e.g., severely comatose), the mother can only abort before days after conception. If the baby is born with a non-fatal, yet sever, malformation (e.g., severely comatose), the mother can only abort before days after conception. Rape victims who conceived can opt for abortion. Rape victims who conceived can opt for abortion.

Another Argument Other schools of thought state that aborting a fetus from a rape incident is only committing another crime. Other schools of thought state that aborting a fetus from a rape incident is only committing another crime.

Four Principles in Islamic Bioethics Respect for the autonomy of the patient Respect for the autonomy of the patient Beneficence Beneficence Nonmaleficence: “first do no harm” the ethical principal of doing no harm Nonmaleficence: “first do no harm” the ethical principal of doing no harm Distributive Justice: normative principles designed to guide the allocation of the benefits and burdens of economic activity (Standford Encyclopedia of Philosophy) Distributive Justice: normative principles designed to guide the allocation of the benefits and burdens of economic activity (Standford Encyclopedia of Philosophy)

Some rules of Islamic Bioethics Necessity overrides prohibition: Under severe circumstances, Islamically prohibited items may become permissible Necessity overrides prohibition: Under severe circumstances, Islamically prohibited items may become permissible Harm has to be removed at every cost if possible Harm has to be removed at every cost if possible Accept the lesser of two harms if both cannot be avoided Accept the lesser of two harms if both cannot be avoided Public interest overrides individual interest Public interest overrides individual interest

The consumption of pork is forbidden in Islam; pigs are also considered impure. With that said, is it Islamically permissible to implant a pig’s heart valve in humans?

Yes, Only when the valve is life sustaining and no other substitutes are available do the necessity of the heart valve overrides the impurity of pigs.

Scarce Medical Resources Rules of Bioethics: Rules of Bioethics: Public interest overrides individual interest. Decisions should be in-part based on the Consensus of the Community Decisions should be in-part based on the Consensus of the Community

The Communitarian View If life-sustaining treatments consume the community’s scarce medical resources, then such treatment should be stopped. If life-sustaining treatments consume the community’s scarce medical resources, then such treatment should be stopped. With freely accessible medical resources, a disease should be fought rigorously when a chance of survival exists. With freely accessible medical resources, a disease should be fought rigorously when a chance of survival exists.

Fatme is on life-sustaining treatment. The only way to save her is through the use of embryonic stem cells. To make matters worse, she’s pregnant and considering an abortion. Because of her condition, her child would be born with hydrocephaly. Her very religious parents are against the abortion. Now, what is your advice?