Extending Life Support When No Recovery is Expected

Answered by Shaykh Faraz Rabbani

Question: What would be the Islamic position on terminating life support when someone enters into a ‘”vegetative state?” Can Muslims state, in their will, their desire not to be kept alive by machines?

Answer: In the Name of Allah, Most Merciful.

Walaikum assalam wa rahmatullah,

It is permitted to stop medication, because it is established from the Sunna of the Messenger of Allah (peace and blessings be upon him) that it is a recommended sunna, but not obligatory, to undertake medical treatment. This is the position of the overwhelming majority of Islamic scholarship.

The issue remains whether it is permitted to stop feeding, because it is not generally permitted to stop eating and drinking, whether directly or through a guardian or caretaker’s decision.

In cases where a patient is in a ‘vegetative’ state, such that no human function is likely to return to them even in the future according to expert medical opinion, this feeding is considered akin to medication and the decision to continue it or cease it returns to the individual or their guardian or caretaker.

Some of the Fiqh of This Case

In general, the ruling of medical treatment itself is that it is a sunna, for the Messenger of Allah (peace and blessings be upon him) told us, “Allah has created a cure for every disease He has created.” [Related by Bukhari and Muslim] It is not obligatory, however, because of the many narrations from the first generations in which they chose to forgo available medical treatment that was likely to benefit. This is related from some of the leading Companions (Allah be pleased with them all), including Ibn Mas`ud and Abu al-Darda’, and the righteous Caliph Umar Ibn Abd al-Aziz [Ibn al-Hajj, al-Madkhal, 4.115-116].

This is the position of the Hanafi school, and also of the majority of Islamic scholarship [Ibn Abidin, Radd al-Muhtar; Nawawi, al-Majmu`; Ibn Qudama, al-Mughni]. Iraqi said in Tarh al-Tathrib that it is the position of the vast majority of the early Muslims (salaf) and the generality of the later Muslims (khalaf) [Iraqi, Tarh al-Tathrib, 8.181].

Some scholars, however, considered leaving medical treatment better because they deemed it closer to reliance on Allah–this is a strong position in the Hanbali school, though some notable Hanbali ulema such as Abu Ya`la and Ibn al-Jawzi disagreed [Buhuti, Kashshaf al-Qina`, 2.76]. Other scholars held that when the treatment is of reasonably sure healing or cure, then it is either a very strong sunna or even obligatory to pursue such treatment.

Living Will To Leave Treatment

It is permitted to make a living will in which one expresses the desire not to be kept alive by machines or through medication. However, it would not be permitted to request that one not be given food or drink in situations when there is medical hope of recovery.

Euthanasia

Active euthanasia, in which means are taken to end the life of the patient, is prohibited and a major sin, because of the words of Allah Most High,

“Say: Come, I will recite unto you that which your Lord has made a sacred duty for you: That you ascribe no thing as partner unto Him and that you do good to parents, and that you slay not your children because of penury – We provide for you and for them – and that you draw not nigh to lewd things whether open or concealed. And that you slay not the life which Allah has made sacred, save in the course of justice. This He has command you, in order that you may discern.” [Qur’an, 6.151]

Suicide Is Not An Option

Likewise, suicide is also prohibited and a major sin, even in situations of grave physical or emotional hardship, because of numerous texts of the Qur’an (like the above verse) and the Sunna.

Imam Ibn Hajar al-Haytami (909-974 AH) wrote in his al-Zawajir `an Iqtiraf al-Kaba’ir, which lists and explains the major sins (kaba’ir),

“The 314th Major Sin: Killing oneself. Allah Most High said, ‘Do not kill yourselves. Verily, Allah is ever Merciful unto you. Whoever does that through aggression and wrongdoing, We shall cast them into Fire, and that is ever easy for Allah’ [Qur’an, 4: 29-30].” [Haytami, al-Zawajir `an Iqtiraf al-Kaba’ir]

May Allah give life to our hearts, minds, and souls, through true love for Him and His Beloved Messenger, our master Muhammad (Allah bless him & give him peace).

Wassalam,
Faraz Rabbani