JEDDAH: The end-of-life debate goes on in Saudi Arabia with members of the religious and medical community addressing tough questions about when to remove life support systems of patients in hospital. The debate was renewed recently after a patient in Asir awoke from an eight-year coma.
Dr. Osama Lutfi, a heart specialist, spoke to a local daily recently about the often-painful subject.
“(Comatose) patients can recover,” he said. “Medicine is developing day after day. And even if the patient is brain-dead, we can still use the organs to save the lives of others if the family agrees.”
Dr. Lutfi raises an important distinction often confused in the public discourse. Patients defined as comatose register brain activity and can recover, while patients defined as “brain dead” have no brain activity. The medical community defines brain dead patients as having no chance of recovery, but the public can often have a difficult time understanding the differences in brain dead and comatose.
Dr. Zahrour Al-Sharif says that the decision to turn off life support should come only after brain death is diagnosed and the family agrees to turn off life support.
“After we make the examinations and ensure there is no hope (for recovery), and after we come to an agreement with the family, we remove the plugs,” said the doctor.
Further complicating end-of-life issue is the debate over euthanasia: The act of prematurely ending the life of unconscious terminal patients. Ending the life of a conscious terminal patient (at the patient’s request) is called “physician-assisted suicide,” which is illegal in most countries.
Dr. Al-Sharif said that in the case of patients who are diagnosed with terminal conditions, the situation is easier because the patient can make clear what his or her family should do once he or she is unconscious and on life support.
“In these cases we inform patients of their conditions so if they want to write wills or want to pay back loans. In some other cases, we need to make critical operations to patients and we explain to them their conditions,” said Dr. Al-Sharif. But in the case of terminal patients who are no longer conscious, it is up to the next-of-kin to decide when if ever doctors should turn of life support. And for some this proves to be a moral hazard.
“I don’t want to commit the sin of killing him, we are hopping his condition will get better,” said Fawziya Faiz, the wife of a man with severe brain damage who lies in a hospital on life support.
Saudi resident Ali Al-Zahrani told a local daily newspaper that he believes that euthanasia (the act of ending a life of a patient in the final stages of a terminal disease) is acceptable if it “prevents patients from suffering more pain.”
Lawyer Mohammad Falata said that many countries allow euthanasia of unconscious terminal patients with the permission of the next-of-kin. But in Saudi Arabia this could be considered murder, which is a capital crime for which doctors can be put to death.
“Being a Muslim country with Shariah regulations it is forbidden to kill a person. The doctor does not know what will happen in the future and it is only Allah who knows it all,” said Falata.
Mohammad Al-Nujaimi, the head of civil studies at King Fahad University of Petroleum and Minerals and a member of Fiqh Academy, said that Islamic scholars have been discussing this issue for a long time and agreed that turning off life support of terminal patients and ending their lives prematurely is forbidden in Islam. Physician-assisted suicide is also illegal in Saudi Arabia, as it is in most of the world.
However, in case where the patient is brain dead, scholars have not yet agreed yet and are still studying these cases,
“If the patient is suffering from a severe illness he would be receiving rewards from Allah on all his pains, and he can always recover,” Al-Nujaimi.
Regarding the use of a person’s organs after he or she dies: Religious scholars agree that the consensual, posthumous removal of organs to save the lives of others is permitted and moral. However, families of people who have given permission to have their organs removed after death have blocked doctors from abiding by the wishes of the deceased.
