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Author Topic: Question regarding end of life care  (Read 1367 times)

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Offline larazahabi

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Question regarding end of life care
« on: Wednesday 08 November 2006, 22:11 »
Assalamu 3alaykum
I am a medical doctor pursuing a master's degree in bioethics. I would like to know what is the Islamic rules regarding the following issues:
1. if a patient is terminally ill and in a vegetative state (brain dead, brain stem active (can breathe and beating heart, but his brain has no function at all) with no hope (scientifically of cure) is it allowed to withdraw life support/sustaining measures (like feeding tubes, hydration intravenous lines) knowing that the patient will die as a consequence?
2. If a patient is brain dead and is on a respirator machine (cannot breathe by him/herself and is in coma), is it allowed to stop the respirator and other life-sustaining measures?
Thank you
L.

Offline samsparky

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Re: Question regarding end of life care
« Reply #1 on: Thursday 09 November 2006, 02:30 »
wa 3alaikom assalaam wa RaHmatullaah

A big welcome to the forum. :)

For your questions, you said the patients were brain dead. That is classified as clinically dead and so that's it for that person. They are gone even if you try to keep them on a respirator.

If however they were not brain dead then you would not take them off life support.

May Allaah bless you for asking.

Offline larazahabi

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Re: Question regarding end of life care
« Reply #2 on: Thursday 09 November 2006, 04:44 »
Thank you for your reply.
The issue might be simpler when also the brain stem is dead - however in the second case, the brain stem is intact, that is the patient can go into sleep-wake cycles, seems awake, might have some involuntary actions including grimaces and smiling from time to time - but the upper brain activity is nill (flat electroencephalogra m). In other words the patient is not aware of anything, has no consciousness of the surroundings or him/herself and there's no hope scientifically as the brain space becomes filled with liquid instead of brain material. These patients usually can breathe and their heart beats (as the brainstem that coordinates these activites is intact), but cannot eat or do any other thing.
Some people think that there's time when these patients should be left alone, to die naturally (feeding tubes is an inartificial way of inserting food through naso-gastric tubes, or tubes that are inserted surgically from the stomach). The question here, the "treatment" of feeding is futile in this case - has no benefit to the patient, who is most probably not feeling or knowing anything.
A lot of people believe that these techniques were not present, and people used to die naturally in their homes (in this case they might die because of dehydration and malnutrition) as they cannot eat by mouth. The issue is not as simple as you made ;) and it might need some more debate.
Baraka Allah feekom
L.
« Last Edit: Thursday 09 November 2006, 04:48 by amazing moon »

Offline larazahabi

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Re: Question regarding end of life care
« Reply #3 on: Thursday 09 November 2006, 15:37 »
Another philosophical question also comes up, what do u consider as life support? what are the things that u can forego and things that u must keep, or are all things similar?
I would appreciate it if a scholar would be asked into these delicate issues (I have a trust in all of you, but sometimes difficult things need a lot of knowledge), and I would appreciate it if you can provide me with evidence/proofs, as I am writing papers on these topics, and to be honest, I don't know which opinion i should take, as I am being convinced with some scientific perspectives, but i know that eventually i should argue into whatever our religion dictates.
Thank you for your help, and I hope i'll be getting more answers soon (sorry for the rush, but papers are due :)
L.

Offline samsparky

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Re: Question regarding end of life care
« Reply #4 on: Friday 10 November 2006, 01:08 »
Thank you for your reply.
The issue might be simpler when also the brain stem is dead - however in the second case, the brain stem is intact, that is the patient can go into sleep-wake cycles, seems awake, might have some involuntary actions including grimaces and smiling from time to time - but the upper brain activity is nill (flat electroencephalogra m). In other words the patient is not aware of anything, has no consciousness of the surroundings or him/herself and there's no hope scientifically as the brain space becomes filled with liquid instead of brain material. These patients usually can breathe and their heart beats (as the brainstem that coordinates these activites is intact), but cannot eat or do any other thing.
Some people think that there's time when these patients should be left alone, to die naturally (feeding tubes is an inartificial way of inserting food through naso-gastric tubes, or tubes that are inserted surgically from the stomach). The question here, the "treatment" of feeding is futile in this case - has no benefit to the patient, who is most probably not feeling or knowing anything.
A lot of people believe that these techniques were not present, and people used to die naturally in their homes (in this case they might die because of dehydration and malnutrition) as they cannot eat by mouth. The issue is not as simple as you made ;) and it might need some more debate.
Baraka Allah feekom
L.

You are very welcome.

If the person is considered as still alive then you do not stop feeding them and leave them to die, eventhough such ways of nutrition were not present in the past.

I guess the question is whether that person is considered alive or dead. The presence of the actions - eventhough involuntary - seems to compicate the issue and I do not have enough knowledge about this to say whether he is alive or dead.

You can ask fatwa@darulfatwa.org.au Islamic High Council of Australia. Please also ask them of the questions about the life support :)

May Allaah bless you.
« Last Edit: Friday 10 November 2006, 01:11 by samsparky »

Offline Hadi

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Re: Question regarding end of life care
« Reply #5 on: Sunday 12 November 2006, 04:06 »
Sis, your question is answered in the Arabic forum,


http://safeena.org/f/index.php/topic,29022.new.html

Offline larazahabi

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Re: Question regarding end of life care
« Reply #6 on: Sunday 12 November 2006, 08:19 »
Baraka allah bikom,
Untill when? do u keep those feeding tubes indefinitely? when do u consider that the patient will not get better and we are not benefitting him? since usually at the beginning, even if you don't have to ut those tubes or machines, you do it in the hope of recovery, but when the recovery has no  more hope, do u keep them? Does that mean you can keep a patient on respirators for 50 years (when their heart stopped beating and they can't breathe, but their brain still has some activity)?
I guess the question is this, when do u consider the patient still alive or dead? is it the heart beat, the respiration or the brain function?
Looking forward for the reply
????? ?????? ? ????? 

Offline samsparky

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Re: Question regarding end of life care
« Reply #7 on: Sunday 12 November 2006, 13:38 »
It's the brain sis.

Offline larazahabi

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Re: Question regarding end of life care
« Reply #8 on: Sunday 12 November 2006, 13:45 »
which part of the brain? is it the part that is related to thinking and feeling and consciousness and awareness or also the part that coordinates reflexes like heart beat, respiration and sleep-wake cycles?

Offline samsparky

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Re: Question regarding end of life care
« Reply #9 on: Sunday 12 November 2006, 13:46 »
That I don't know sis.

 



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