Islamic Center of Southern California

The Arguments of Islamic Law Rulings on Recent Medical Issues

Topic Thirteen

Ruling on (1) Extending Aid When the Heart Is Dead but Not the Brain and (2) Removing Life-Supporting Equiment When Brain Death Is Confirmed

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Definition

It has been stated that the end of a human being can take one of three forms. They are:

1. when both the brain and all major organs die, and it is unanimously agreed that such a person is dead;

2. when the brain stem dies, but not all the major organs, such as the heart, and this is a case on which the majority of physicians and some jurists believe to be that of a dead person, subject to the rulings that apply to the dead; and

3. when the heart or any other major organ dies, but the brain continues to function.

These forms raise the question of the rulings on the two cases mentioned above, in the title, which are discussed here:

The First Issue: Extending Aid When the Heart Is Dead but Not the Brain

The Medical Point of View

Participating physicians are unanimous in maintaining that the cessation of the heart and respiration, but not the brain and brain stem, is not a decisive indication that death has occurred. Aid can be extended to the person concerned by using a substitute pump to circulate the blood through the circulatory system, by massaging the heart, or by using electric shocks with artificial respiration. In some cases, the heart resumes its function, involuntary respiration resumes as well, and the person regains consciousness.

In most cases, however, what happens is that the heart stops, cessation of respiration immediately follows, and then the other organs die, with the brain going first, within few minutes. If it proves possible to give aid to the heart just as it stops, and it responds, the patient's life may be saved.

As stated by Dr. Mukhtar Al-Mahdi, a chairman of a department of neurosurgery, every physician who is available at the moment when the heart stops should attempt this type of aid as much as possible. If he fails to do so, he would be guilty of one form of treatment negligence.

The Legal Position Chosen by the IOMS and Its Argument

In its second seminar, Human Life: Its Inception and End, in 1985 and ninth, The Medical Definition of Death, in 1996, the IOMS accepted the opinion agreed upon by participating physicians and scholars, which is to regard the stopping of the heart as a medical case that can be treated.

The recommendations of the second seminar stipulate that "any vital organ or function, such as the heart or respiration, may temporarily stop, but as long as the brain stem is alive, that organ or function can be revived."

The IOMS cited the recommendation of the Human Life seminar on that point in the recommendations of the ninth seminar, held in December 1996.

The Ruling of the Islamic Jurisprudence (fiqh) Academy

The Islamic Jurisprudence (fiqh) Academy, in a meeting held in Amman in October 1996, maintained that it is permissible to remove artificial respirators in the case of a patient whose heart is dead and whose respiration has stopped, even if his brain is not dead yet. Resolution No. (5) D 3/07/6 of the Academy stipulates that,

In Islamic Law, a person is regarded as dead, and all the legal consequences of death become operative, if one of the following symptoms is detected:

1. if his heart and respiratory system stop completely and physicians decide that this cessation is irrevocable, or

2. if all functions of his brain cease completely.

When this is the case, the artificial life-supporting equipment attached to the patient may be removed, even if some organs, such as the heart, continue to function automatically by virtue of the attached equipment.

The Second Issue: Removing Life-Supporting Equipment in the Case of a Patient with a Dead Brain

The Medical Point of View

When the brain is no longer capable to live, it is irreparable, nor can it be replaced immediately or even within a short time. Therefore, as things stand at present, the final death of the brain leads to the death of its owner.

This is something that is established and commonly accepted in international medical circles. In no way can a person with a dead brain come back to life at present or in the near or even remote future, provided that correct technical criteria are observed in the diagnosis. This means that the life-supporting equipment can no longer benefit the patient, although it might be able to keep major functions, such as the heart's, going on for as long as two weeks, or a little longer.

The Legal Position Chosen by the IOMS and Its Argument

In both its second (Human Life) and ninth (The Medical Definition of Death) seminars, the IOMS endorsed the statement that it is permissible, but not obligatory, to remove life-supporting equipment when a patient's brain is actually dead, taking into consideration that the IOMS recognizes brain death as actual death. The recommendations of the second seminar say, "It is agreed that if brain stem death is confirmed through the report of a specialized medical committee, it is lawful to turn off artificial life-supporting equipment." The IOMS reaffirmed this recommendation in the statement (recommendations) of the seminar on the Medical Definition of Death in December 1996.

The Ruling of the Islamic Jurisprudence (fiqh) Academy

The Islamic Jurisprudence (fiqh) Academy, in a meeting held in Amman in October 1996, endorsed the position that it is lawful to remove life-sustaining equipment. Resolution No. (5) says on this subject, "In this case, it is proper to remove any life-sustaining system used for such a person, even if some organs, such as the heart, continue to operate mechanically due to the systems attached." Islamic Center of Southern California