The Islamic Ruling on Brain Death and Life Support

This is a very brief summary regarding the Islamic Regulations
regarding Brain Death and Life Support. I put it together in a rush,
so my apologies for any misspellings and awkwardness.
The source Dr. Bakr Abu Zaid's (1) Fiqh an-Nawazil(2) (Vol. 1, pp.
215-236, Article No. 4, printed by Maktabah ar-Rushd, Riyad, 1407).
I hope you will find it useful to your question.
May Allah show us mercy and forgiveness at the time of our dying. Ameen.
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Dr. Bakr Abu Zaid describes his article as aninvestigation into "the
status of the ill while under life support and the indications of
death between [the viewpoint of] medicine and fiqh." (p. 215)
He proceeds then to divide his article into fivesections:
1. A discussion of life support (pp. 217-218)
2. The medical definition of death and its indications (pp. 219-221)
3. The fiqh definition of death and its indications (pp. 222-225)
4. The various states of the ill under life support (pp. 229-230)
5. The fiqh resolution of this issue (pp. 231-236)
In the first section on "a discussion of life support," Dr. Bakr Abu
Zaid provides a list of Arabic medical terms used for life support and
proceeds to summarize what is meant by "life support."
In the second section on"the medical definition of death and its
indications," Dr. Bakr AbuZaid discusses four issues:
(1) the history background of the concept of brain death;
(2) the basic anatomy of the brain;
(3) the concept of brain death; and
(4) the indications of brain death. In his discussion he brings out
two important points which have bearing on the fiqh ruling: (a) the
difference of opinion in the medical field regarding if
death occurs with the death of the brain stem; (b) the
inconclusiveness of the indications used by doctors to determine brain
death.
In the third section on"the fiqh definition of death and its
indications," Dr. Bakr AbuZaid shows that the scholars are in
agreement that death is defined as the separationof the soul from the
body. Moreover, this definition was extracted by them from the
lengthyhadith reported by al-Bara' ibn Azib and collected by Ahmad and
others regarding the nature of the death of the believer and the
unbeliever, the questioning in the grave,and the subsequent pleasure
or torment faced by the deceased in his grave. He also quotes
al-Ghazzali (Ihya' 'Ulum ad-Din, Vol. 4, p. 493) who further clarifies
that death occurs only with the total separation of the soul from the
body. (This will have bearing on the fiqh ruling). He summarizes with
the following
two points:
(1) the reality of death according to the sharia isthe separation of
the soulfrom the body;
(2) the reality of the separation of the soul from the body is such
that the soul remains in no part of the body, and hence no part of the
body contains any life.
With regards to the indications of death according to fiqh, he begins
with the hadith which states that when the soul leaves the body the
eyes follow. (Muslim).He also lists eight indications of death which
he gathered from a number of classical fiqhworks. He then quotes
an-Nawawi (Rawdatat-Talibin, Vol. 2, p. 97) who adds this important
note regarding the indicationsof death, namely, that when there is any
doubt regarding death, it is to be
assumed that the person is still alive until death is proven conclusively.
In the fourth section on"the various states of the ill under life
support," Dr.Bakr lists three possibilities for a person in intensive
care under life support.
(1) The individual begins to breath on his own andhis heart returns
beating normally, and here life support is removed as the person is no
longer indanger.
(2) The heart no longer beats nor is there any breathing even under
lifesupport. Here life supportis remove is without doubt dead.
(3) The person is brain dead however his heart still beats and there
is breathing while he is under life support. Here doctors normally
conclude death (due to brain death) and remove the person from life
support.
In the fifth and final section regarding, "the fiqh resolution of this
issue," Dr. Bakr concludeswith the following.
(a) As for cases 1 and 2 (see above), this is not any issue for
investigation as both life (case 1) and death (case 2) are certain.
The only issue that needs to be investigated is case 3, namely there
is brain death but their is a heart beat and breathing under life
support.
(b) This third case raises three fiqh questions:
1. What is the ruling for removing someone from life support?
2. What is the ruling regarding organ removal(like a heart) for a
transplant into another person?
3. Do the sharia regulations regarding death (like inheritance) take effect?
He summarizes that the answer is pretexted uponthe question if brain
death is a conclusive signof death according to thesharia definition
of death(i.e., does brain death indicate that the soul has completely
left the body?)
He answers:
(1) Brain death as being a definition for death is an issue of
difference in the medical field.
(2) The indications to show brain death are notalways conclusive.
Thus the sharia principle is that "certainty is not removed by doubt,"
negates this being used as a conclusive sign for death.
Moreover, it has been seen in repeated cases where people have still
lived after the removal oflife support.
He also adds that among the five aims of the sharia is the
preservationof life and as a result the sharia rulings seek to
continue and rescue life and that the general principle is that life
is assumed until conclusive proven otherwise.
Thus brain death cannot be seen according to the sharia to be
equivalent tothe separation of the soulfrom the body.
However, he goes on to add the following important point that this
does not mean that braindeath is not an indicationof death; just like
the heart stopping is an indication of death, but not necessarily
death itself.
For this reason, the scholars, like an-Nawawi quoted previously, said
that the sharia refrains from ruling a judgment of death, if there is
any doubt, even though the indications of death might be present.
Based on this, he answersthe three fiqh questions (see above):
As for the removal of life support in this situation where their is an
indication of death (brain death), but an indication of life (heart
beating and breathing with the aid of life support); either the doctor
will feel that with the removal of life support, the patient
mostlikely die, most likely
live or both possibilities being equal.
If the doctor who has no ulterior motive feels that the with the
removal of life support the patient will most likely die; then it IS
PERMISSIBLE to remove life support as in this case the removal of life
support does not mean preventing treatment from an individual who
there is hope in his cure. Indeed, LIFE SUPPORT SHOULD be removed as
it only prolongs his pain as his soul is being removed.
Even with this, as the same time death is NOT tobe ruled by the mere
lifting of life support until it is certain that the soul has departed
the body. And hence the sharia regulations like inheritance do not
take effect. And similarly organ removal is not permissible (if we are
to say that it is permissible even with death being certain).
This division of sharia rulings, where some takeeffect and others held
back until certainty occurs has many examples in the sharia.
However, if the doctor has no ulterior motives,is of the opinion that
the person will still live with the removal of life support or there
is a 50/50 chance for life. It becomes impermissible to life life
support, until itis felt death in all likelihood will occur or death
does occur or the patient is no longer in need of life support.
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(1) Dr. Bakr Abu Zaid is the former Deputy Minister of Justice in the
Kingdom of Saudi Arabia and at present a member of the Council of
Leading Scholars and President ofthe Muslim World League's Body of
Scholarswhich investigate contemporary fiqh issues.
(2) Fiqh an-Nawazil refersto Sharia Rulings (Fiqh) of New Issues
(an-Nawazil, pl. of an-Nazilah or something sent down)

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