JEDDAH, 11 November 2004 — Although there has been some debate on euthanasia or mercy killing in the Muslim world in recent years, it is too early to tell whether or not a consensus has emerged.
One reason for this is that the world of Islam lacks any single and easily identifiable source of religious opinion. Although many people regard themselves as professional religious experts and earn a living as such, there is no recognized clergy within an organized and hierarchized structure in Islam.
This system has obvious points of strength. It allows for a maximum of debate and the widest possible variety of opinion from all parts of society.
But it also has the chief weakness of making it virtually impossible to achieve consensus on many major issues.
Broadly speaking, three views could be identified.
The first belongs to those who could be described as agnostics. Many Muslims, including some scholars, admit that they do not know enough about the subject to form a solid opinion. This is a new subject, involving medical, ethical, political and cultural aspects that cannot be easily mastered. It cannot be dealt with through a standard “yajuz” (permitted) or “layajuz” (forbidden) discernment.
The second view belongs to those, including some prominent ulema, who reject euthanasia as a sinful act that should be forbidden. The argument is that since it is God who decides when a man should die it would be wrong for anyone to try and speed things up in the name of mercy-killing.
Supporters of this view also reject the claim made, mostly by Western liberal thinkers, that human beings, having control over their own bodies must have the right to decide when to terminate their lives. If we assume that whatever happens is decreed by Divine Will, then the prolongation of life through medical and scientific means must also be regarded as willed by God. If God did not want us to prolong a patient’s life, He would not allowed us to learn how to build a life-support machine.
Since mercy killing is supposed to involve the consent of the patient concerned, it amounts to a form of suicide. And suicide is strictly forbidden in Islam, being regarded as one of the few unforgivable sins.
Most Christian churches as well as Jewish schools share that position.
Some Muslim, Christian and Jewish scholars, however, turn the above arguments upside down.
They argue that if Divine Will decrees the time, place and mode of a man’s death, then euthanasia, too, could have been so willed by God in some circumstances. God, they argue, does not want his creations to be subjected to unendurable suffering when it is plain that they cannot, in exchange, enjoy the full blessings of life, be productive and useful to the community.
Beyond the religious debate, the ethical dimensions of mercy killing are bound to be debated for years. The question is whether it is morally permissible for a third party, such as a physician, to end the life of a terminally ill patient who is in intense pain.
The euthanasia controversy is part of a larger issue concerning the right to die. Staunch defenders of personal liberty argue that all of us are morally entitled to end our lives when we see fit. Thus, according to these people, suicide is in principle morally permissible.
Four Ways of Death
For health care workers, the issue of the right to die is most prominent when a patient in their care is terminally ill, is in intense pain, and voluntarily chooses to end his life to escape prolonged suffering. In these cases, there are several theoretical options open to the health care worker.
First, the worker can ignore the patient’s request and care can continue as usual. Second, the worker can discontinue providing life-sustaining treatment to the patient, and thus allow him to die more quickly. This option is called passive euthanasia since it brings on death through nonintervention. Third, the health care worker can provide the patient with the means of taking his own life, such as a lethal dose of a drug. This practice is called assisted suicide, since it is the patient, and not technically the health care worker, who administers the drug. Finally, the health care worker can take active measures to end the patient’s life, such as by directly administering a lethal dose of a drug. This practice is called active euthanasia since the health care worker’s action is the direct cause of the patient’s death.
Active euthanasia is the most controversial of the four options and is currently illegal in many Western countries. They are theoretically possible in most Muslim countries because there are no laws specifically banning them.
Two additional concepts are relevant to the discussion of euthanasia. First, voluntary euthanasia refers to mercy killing that takes place with the explicit and voluntary consent of the patient, either verbally or in a written document such as a living will. Second, nonvoluntary euthanasia refers to the mercy killing of a patient who is unconscious, comatose, or otherwise unable to explicitly make his intentions known. In these cases it is often family members who make the request. It is important not to confuse nonvoluntary mercy killing with involuntary mercy killing. The latter would be done against the wishes of the patient and would clearly count as murder.
Like the moral issues surrounding suicide, the problem of euthanasia has a long history of philosophical discussion.
On the whole, ancient Greek thinkers seem to have favored euthanasia, even though they opposed suicide. An exception is Hippocrates (460-370 BC), the ancient Greek physician, who, in his famous oath, sworn by every graduating doctor of medicine, states that “I will not prescribe a deadly drug to please someone, nor give advice that may cause his death.”
In medieval times, Christian, Jewish, and Muslim philosophers opposed active euthanasia, although the Christian church has always accepted passive euthanasia.
During the Renaissance, English humanist Thomas More (1478-1535) defended Euthanasia in book Utopia (1516). More describes in idealistic terms the function of hospitals. Hospital workers watch after patients with tender care and do everything in their power to cure ills. However, when a patient has a torturous and incurable illness, the patient has the option to die, either through starvation or opium.
In New Atlantis (1627), British philosopher Francis Bacon (1561-1626) writes that physicians are “not only to restore the health, but to mitigate pain and dolors; and not only when such mitigation may conduce to recovery, but when it may serve to make a fair and easy passage.”
In “Active and Passive Euthanasia: An Impertinent Distinction?” (1977), Thomas Sullivan argues that no intentional mercy killing (active or passive) is morally permissible. However, extraordinary means of prolonging life may be discontinued even though the patient’s death may be foreseen.
