Empowering and Nurturing Muslims in End-of-Life Care through Mutual Enrichment of Islamic Ethics and Secular Healthcare
Hirra Rafi, MS, Duquesne University, Pittsburgh, PA
Integrating the diverse perspectives of Islamic end-of-life ethics into secular healthcare not only empowers Muslim patients to make ethically aligned decisions but also fosters mutual enrichment between Islamic and secular ethics, enhancing holistic care for Muslim patients. This paper is structured in three sections: first, it explores the diversity of sources in Islamic bioethics; second, it examines how these varied sources shape Islamic perspectives on end-of-life decisions; and finally, it discusses the relevance of Islamic bioethics in patient care within secular healthcare contexts.
Islamic bioethics is informed by a diversity of sources through an intersection between Islamic law (fiqh) and Islamic ethics. Through primary sources such as the Quran, Sunnah, Ijma (consensus), Qiyas (analogical reasoning), and Aql (independent reasoning), distinct approaches emerge within Sunni and Shia traditions in the interpretation and application of these sources. Sunni Islam often emphasises Qiyas for addressing new ethical issues, while Shia Islam prioritises Aql as a method of independent reasoning. The diverse interpretations of the sources have also given rise to different approaches—such as the traditionalists, rationalists, and principalism—highlighting the complexity within Islamic bioethics. Both sects and the following varied approaches uphold the foundational importance of the Quran and Sunnah. However, their diverse interpretations and differing use of consensus, reasoning, and analogical deduction lead to diverse normative outcomes. Recognising these varied sources is essential for a holistic understanding of Islamic medical ethics.
Reflecting on all the diversity in and use of foundational sources can help us understand how Islamic perspectives on end-of-life decisions are shaped. Some scholars who have developed a principle-based approach within Shiite jurisprudence, draw upon universal Islamic ethical norms. Their framework brings forth principles like “No harm, no harassment” which are rooted in Quran. This principle also aligns with non-maleficence in Western bioethics but goes further by examining the intent behind actions. Under such a principle, decision to cease treatment must be directed toward minimising suffering rather than hastening death. Some authors interpret Islamic ethics to allow for passive assistance in two specific contexts: administering pain-relief treatments that might unintentionally shorten life and withdrawing futile life-sustaining measures. These decisions are viewed as morally sound when guided by consultation (shura) among healthcare providers and family, aiming to serve justice and prevent harm, without attributing death to the act of treatment cessation but rather to the underlying illness. In contrast, other authors draw from the Sunnah of the Imams in Shiite jurisprudence and urge us to be very cautious about the concept of brain death. Their perspective discourages equating brain death with actual death. They hold that once life support is initiated, it should continue, reflecting trust in God’s will. However, they allow terminal patients to decline aggressive, non-beneficial treatments like ventilators, while continuing basic sustenance, such as hydration and feeding. The major difference lies in the permissibility of removing life support: the principlist approach in Shia Islam would allow withdrawal under certain conditions, while other interpretations, based on the Sunnah in Shia Islam, would not and emphasise the continuation of life support once initiated. Importantly, under both perspectives of Shia Islam as well as Sunni Islam taking life with the intent to do so remains strictly forbidden. However, there is a lack of literature on detailed comparison of Sunni and Shiite rulings on end-of-life care, and thus this needs further exploration.
Secular healthcare organisations must first acknowledge the religious roots in secular ethical thought. They must also remember the significant contributions of Muslims in the field of medicine and bioethics and keep them involved in the ever-evolving world of medical ethics. Early advancements in Western hospital structures, medical ethics, and comprehensive studies on diseases were inspired by the Muslim world. Works like “The Conduct of a Physician” laid foundational medical ethics and influenced Western medicine for centuries. Islamic contributions declined over time due to various historical challenges. Muslim bioethics since the 1990s has gained renewed recognition in global forums with increasing engagement from Western bioethicists. Understanding Muslim end-of-life ethics is a requirement to enhance patient care in a multicultural world with many Muslim patients. Healthcare providers should be educated on general Muslim needs but also recognise that each Muslim patient is unique, with diverse interpretations and uses of Islamic resources. Understanding Islamic end-of-life ethics can enrich and strengthen secular healthcare organizations, and the exchange can be mutual. Islamic medical ethics can develop into a more structured and comprehensive field by integrating valuable insights and terminology from secular ethics, particularly in end-of-life care, that align with its foundational sources.
Islamic bioethics is informed by a diversity of sources through an intersection between Islamic law (fiqh) and Islamic ethics. Through primary sources such as the Quran, Sunnah, Ijma (consensus), Qiyas (analogical reasoning), and Aql (independent reasoning), distinct approaches emerge within Sunni and Shia traditions in the interpretation and application of these sources. Sunni Islam often emphasises Qiyas for addressing new ethical issues, while Shia Islam prioritises Aql as a method of independent reasoning. The diverse interpretations of the sources have also given rise to different approaches—such as the traditionalists, rationalists, and principalism—highlighting the complexity within Islamic bioethics. Both sects and the following varied approaches uphold the foundational importance of the Quran and Sunnah. However, their diverse interpretations and differing use of consensus, reasoning, and analogical deduction lead to diverse normative outcomes. Recognising these varied sources is essential for a holistic understanding of Islamic medical ethics.
Reflecting on all the diversity in and use of foundational sources can help us understand how Islamic perspectives on end-of-life decisions are shaped. Some scholars who have developed a principle-based approach within Shiite jurisprudence, draw upon universal Islamic ethical norms. Their framework brings forth principles like “No harm, no harassment” which are rooted in Quran. This principle also aligns with non-maleficence in Western bioethics but goes further by examining the intent behind actions. Under such a principle, decision to cease treatment must be directed toward minimising suffering rather than hastening death. Some authors interpret Islamic ethics to allow for passive assistance in two specific contexts: administering pain-relief treatments that might unintentionally shorten life and withdrawing futile life-sustaining measures. These decisions are viewed as morally sound when guided by consultation (shura) among healthcare providers and family, aiming to serve justice and prevent harm, without attributing death to the act of treatment cessation but rather to the underlying illness. In contrast, other authors draw from the Sunnah of the Imams in Shiite jurisprudence and urge us to be very cautious about the concept of brain death. Their perspective discourages equating brain death with actual death. They hold that once life support is initiated, it should continue, reflecting trust in God’s will. However, they allow terminal patients to decline aggressive, non-beneficial treatments like ventilators, while continuing basic sustenance, such as hydration and feeding. The major difference lies in the permissibility of removing life support: the principlist approach in Shia Islam would allow withdrawal under certain conditions, while other interpretations, based on the Sunnah in Shia Islam, would not and emphasise the continuation of life support once initiated. Importantly, under both perspectives of Shia Islam as well as Sunni Islam taking life with the intent to do so remains strictly forbidden. However, there is a lack of literature on detailed comparison of Sunni and Shiite rulings on end-of-life care, and thus this needs further exploration.
Secular healthcare organisations must first acknowledge the religious roots in secular ethical thought. They must also remember the significant contributions of Muslims in the field of medicine and bioethics and keep them involved in the ever-evolving world of medical ethics. Early advancements in Western hospital structures, medical ethics, and comprehensive studies on diseases were inspired by the Muslim world. Works like “The Conduct of a Physician” laid foundational medical ethics and influenced Western medicine for centuries. Islamic contributions declined over time due to various historical challenges. Muslim bioethics since the 1990s has gained renewed recognition in global forums with increasing engagement from Western bioethicists. Understanding Muslim end-of-life ethics is a requirement to enhance patient care in a multicultural world with many Muslim patients. Healthcare providers should be educated on general Muslim needs but also recognise that each Muslim patient is unique, with diverse interpretations and uses of Islamic resources. Understanding Islamic end-of-life ethics can enrich and strengthen secular healthcare organizations, and the exchange can be mutual. Islamic medical ethics can develop into a more structured and comprehensive field by integrating valuable insights and terminology from secular ethics, particularly in end-of-life care, that align with its foundational sources.