Ever since first heart Transplant was carried out,in 1967 the question of recognition of brain death surfaced with urgency not only in the scientific and clinical circles but also amongst the lawyers, states, clergy and society in general. Since then Brain death has been recognized as the death of an individual and medically criteria have been established and accepted all over the world. My writing here is specifically for the Muslim Families and Muslim physicians
Islamic position is that brain death is accepted as death in Shariah, the Ulama signing a document in mid-september 1986 in Amman Jordan. The statement is similar to official position of Islamic Medical asssociation of North America published in their Journal (Vol.29; 1997, Page99)
It reads:
"A person will be considered dead when one or both conditions given below are met
1.A physician has determined after standard examination that a person's cardiopulmonary function has come to a permanent stop.
2. A specialist physician has determined after standard examination that the function of brain including the brainstem has come to a permanent stop even if some organs of the body continue to show some activity (by artificial means)."
Muslims living in the West are likely to be confronted with a situation (God forbid) where brain death will be diagnosed on one of their loved one and they will have to accept it as most hospitals in most states will enforce discontinuing the use of artificial means of maintaining life. It therefore behoves on all of us to understand this from Islamic standpoint. The Qur'an states "It is Allah that takes the souls at death and those that die not (He Takes) during their sleep. Those on whom He has passed the decree of death He keeps back (from returning to life) but the rest He sends (to their bodies) for a term appointed....." (Sura 39, Verse 42)
And also, "Nor can a soul die except by Allah's leave; the term being fixed as by writing........." Sura 3, verse 145.
Islamically therefore we can say that every living person must die and there is a time fixed, known to Allah and that the soul separates from the body permanently, at the time of death. Physicians do not know exactly where the soul resides in the body. Physicians make the diagnosis of death traditionally when they find heart and lungs have stopped functioning. When lungs and heart functioning is carried out with artificial menas that is the time when 'brain death' is considered for diagnosing death. In this situation the heart may be functioning with important medications being given and lungs may be functioning because the automatic machines are pumping the lungs and the kidneys may be forming urine etc. these functions can be maintained with machines for prolonged periods, from many hours to many days or weeks. The physicians make a decision of starting and maintaining these life-sustaining equipments function depending upon the cause and disease of the person that resulted in that state. This 'death' is called 'Irreversible coma" in clinical terms and is very different from other comas or coma-like conditions. Only the physicians know these types of comas. It is stated without hesitation that no patient has ever recovered from irreversible coma diagnosed with accuracy. Those cited examples in the media were NOT CORRECTLY DIAGNOSED who recovered. Also the question of Persistent Vegetative State is very different and should not be confused with irreversible coma.
It must be stated then clearly that physicians decide to continue because they have hope of tiding over this suspended function requiring automatic machines to sustain 'life'. That hope is dependent upon the condition which may or may not be treatable and may or may not be reversible. For example:
If there has been brain injury (Trauma or loss of oxygen supply to brain for a critical time for whatever reason) which does not result in brain death the physicians will maintain the machines until the brain recovers or dies.
Coming back to Islamic understanding of body-soul connection, all the functions of the body including the brain function are present with the connection of the body and soul and all functions of the body stop when soul has left he body permanently. So how do we tell the soul has departed-- by the functions of the body. Now all the functions of the body depend on continuous supply of aerated blood which depends on adequate function of heart and lungs If the heart and lung functions are artificially maintained, we would be forced to depend on brain function ( to diagnose death) as it is the brain that runs all the functions of the body including the heart and lungs even though heart and lungs have some limited ability to function for a few seconds to minutes without brain connection. That is not because we feel that the soul resides in the brain but soul commands the function of all organs including the brain, and the brain commands on all the rest of the organs.
It is thus we as Muslims come to understand the process of death. The Ulama had their sharia supported methods of coming to that statement of Brain Death the details of which are not known to me but I came to know the results of their meeting/s that were held in 1976 or so) I as a physician and as a neurologist accept the Brain Death as the death of a person.
I have tried to simplify as much as I could but I would be very happy to answer any questions by anybody physicians or non-physicians. I have been involved in very emotionally draining situations for some families on such occasions and would like to advise the Muslim physicians to understand and be able to answer the doubts and question of families under such situations, May Allah keep us from such situations by His Grace. I humbly suggest that neither the physicians should make statements to the families concerned without knowledge nor the family members should take the statements of non -physicians during their difficult time.
Also the physician should make clear statements so that the family does not get confusion or doubts.
Please visit my Urdu blog at http://saugoreebsc.blogspot.com/ and my Hindi blog at http://wahajuana.blogspot.com/
Islamic position is that brain death is accepted as death in Shariah, the Ulama signing a document in mid-september 1986 in Amman Jordan. The statement is similar to official position of Islamic Medical asssociation of North America published in their Journal (Vol.29; 1997, Page99)
It reads:
"A person will be considered dead when one or both conditions given below are met
1.A physician has determined after standard examination that a person's cardiopulmonary function has come to a permanent stop.
2. A specialist physician has determined after standard examination that the function of brain including the brainstem has come to a permanent stop even if some organs of the body continue to show some activity (by artificial means)."
Muslims living in the West are likely to be confronted with a situation (God forbid) where brain death will be diagnosed on one of their loved one and they will have to accept it as most hospitals in most states will enforce discontinuing the use of artificial means of maintaining life. It therefore behoves on all of us to understand this from Islamic standpoint. The Qur'an states "It is Allah that takes the souls at death and those that die not (He Takes) during their sleep. Those on whom He has passed the decree of death He keeps back (from returning to life) but the rest He sends (to their bodies) for a term appointed....." (Sura 39, Verse 42)
And also, "Nor can a soul die except by Allah's leave; the term being fixed as by writing........." Sura 3, verse 145.
Islamically therefore we can say that every living person must die and there is a time fixed, known to Allah and that the soul separates from the body permanently, at the time of death. Physicians do not know exactly where the soul resides in the body. Physicians make the diagnosis of death traditionally when they find heart and lungs have stopped functioning. When lungs and heart functioning is carried out with artificial menas that is the time when 'brain death' is considered for diagnosing death. In this situation the heart may be functioning with important medications being given and lungs may be functioning because the automatic machines are pumping the lungs and the kidneys may be forming urine etc. these functions can be maintained with machines for prolonged periods, from many hours to many days or weeks. The physicians make a decision of starting and maintaining these life-sustaining equipments function depending upon the cause and disease of the person that resulted in that state. This 'death' is called 'Irreversible coma" in clinical terms and is very different from other comas or coma-like conditions. Only the physicians know these types of comas. It is stated without hesitation that no patient has ever recovered from irreversible coma diagnosed with accuracy. Those cited examples in the media were NOT CORRECTLY DIAGNOSED who recovered. Also the question of Persistent Vegetative State is very different and should not be confused with irreversible coma.
It must be stated then clearly that physicians decide to continue because they have hope of tiding over this suspended function requiring automatic machines to sustain 'life'. That hope is dependent upon the condition which may or may not be treatable and may or may not be reversible. For example:
If there has been brain injury (Trauma or loss of oxygen supply to brain for a critical time for whatever reason) which does not result in brain death the physicians will maintain the machines until the brain recovers or dies.
Coming back to Islamic understanding of body-soul connection, all the functions of the body including the brain function are present with the connection of the body and soul and all functions of the body stop when soul has left he body permanently. So how do we tell the soul has departed-- by the functions of the body. Now all the functions of the body depend on continuous supply of aerated blood which depends on adequate function of heart and lungs If the heart and lung functions are artificially maintained, we would be forced to depend on brain function ( to diagnose death) as it is the brain that runs all the functions of the body including the heart and lungs even though heart and lungs have some limited ability to function for a few seconds to minutes without brain connection. That is not because we feel that the soul resides in the brain but soul commands the function of all organs including the brain, and the brain commands on all the rest of the organs.
It is thus we as Muslims come to understand the process of death. The Ulama had their sharia supported methods of coming to that statement of Brain Death the details of which are not known to me but I came to know the results of their meeting/s that were held in 1976 or so) I as a physician and as a neurologist accept the Brain Death as the death of a person.
I have tried to simplify as much as I could but I would be very happy to answer any questions by anybody physicians or non-physicians. I have been involved in very emotionally draining situations for some families on such occasions and would like to advise the Muslim physicians to understand and be able to answer the doubts and question of families under such situations, May Allah keep us from such situations by His Grace. I humbly suggest that neither the physicians should make statements to the families concerned without knowledge nor the family members should take the statements of non -physicians during their difficult time.
Also the physician should make clear statements so that the family does not get confusion or doubts.
Please visit my Urdu blog at http://saugoreebsc.blogspot.com/ and my Hindi blog at http://wahajuana.blogspot.com/
5 comments:
Very interesting. Important post. I kept a copy and saved it. Thank you....
It is not an actual "Brain Death" question.
What's your position on "withdrawal of care" in vegetative state or permanent machine dependence though brain function is still intact but with any meaningful function...
Uncle - I need your proper name and designation you like to use if I send it to Pakistani/Muslim friends in mail. Please email me....This is an important write up to distribute among us....
I 'll email you IA
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