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JIMA: Volume 39, 2007 - Page 173

The word euthanasia comes from the Greekeuthanatos, derived from the words eu andthanatos, meaning good and death respec-

tively.1 Therefore, euthanasia means allowing aneasy and good death. It is also defined as mercykilling (qatl al-rama) of the hopelessly ill, injured,or incapacitated and the ending of the life, as pain-lessly as possible, of the patient who is sufferingfrom a terminal illness and extreme pain. Euthanasiathus includes the following:

Administering an overdose of barbitu-rates or another lethal injection with theaim of terminating the life of the patientwith or without the patients explicitrequest,

A decision to withhold or withdrawpotentially life-prolonging treatment so

as to hasten the patients death, and Alleviating pain with large doses of opi-

oids, allowing for a probability of causingdeath, but not explicitly intending tocause death.

Euthanasia is in essence the termination of thelife of the terminally ill at their request or in theirinterest. Euthanasia continues to pose a religious,legal, and moral problem in all cultural and religioustraditions. Before tackling the issue of euthanasia inthe light of the shar`a (Islamic moral law), it isimperative that we deliberate upon Islams attitudeto the sanctity of life.

Sanctity of LifeIslam, like other religions, upholds the sanctity

of life.

If you do stretch your hand to slay me, it isnot for me to stretch my hand to slay you forI do fear God the cherisher of the worlds.2

Euthanasia (Qatl al-rama)

Abulfadl Mohsin Ebrahim, PhD, MAProfessor of Islamic Studies

School of Religion and TheologyUniversity of KwaZulu-Natal

Durban, South Africa

Abstract: Euthanasia can be effected at the request of the terminally ill or intheir interest by medical practitioners. However, euthanasia remains a contro-versial issue because of its proponents claim that it is an act of mercy despite itsending human life. This article examines Islams stance on the sanctity of lifeand pain and suffering. It also discusses the various types of euthanasia and themotivations for euthanasia in the light of Islamic teachings.

Key words: Islam, medical ethics, euthanasia, suicide, terminally ill.

Islamic Perspective

Correspondence should be directed to

Professor Abulfadl Mohsin Ebrahim, PhD, MA18 Magdelan AvenueReservoir HillsDurban 4091South Africaemail: [email protected]

November15-07JIMA:38486-IMANA.qxd 11/15/2007 12:50 PM Page 173

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However, the Islamic penal code, based on divineinjunctions, advocates the death penalty for thosewho commit certain grave crimes. It is for the sake ofcurtailing crime and ensuring peace, security, andtranquillity that Islam prescribes preventive meas-ures and just punishments for acts that tend towards

terminating life without reasonable justification.3

The Quran permits the death penalty for willfulmurder:

O you who believe! al-Qi (just retribution)is ordained for you in respect of the mur-dered.4

The Arabic equivalent for the punishment of the

person guilty of committing murder is al-qi (justretribution). This measure ensures that if the deathsentence is to be carried out, only the one guilty ofthe crime will lose his life. However, the family of theone who has been murdered has the option to for-give the murderer or to accept compensation.5

Active EuthanasiaActive euthanasia is the deliberate act undertak-

en by the attending physician to cause the death of apatient. It could be voluntary, i.e. fulfilling thepatients wish, and it could be involuntary if itinvolves ending the patients life without his explic-it approval. This is carried out on the basis of a pater-nalistic decision to do what is best for the terminallyill. The Quran warns:

And do not take any human beings life (the life) which Allah has made sacred savewith right (justice).6

It is evident from this verse that human life issacred and, therefore, cannot be disposed of exceptfor a just cause, that is, in execution of a legal sen-tence, or in a just war, or in legitimate self-defense.7

To terminate the life of the terminally ill does not fallwithin the gambit of a just cause. Therefore, if amedical practitioner were to deliberately end the life

of a patient, he would be guilty of homicide. Life anddeath are the prerogatives of Allah as categori-cally stated in the Q uran:

Allah gives life and death, and Allah sees wellall that you do.8

One may safely infer from this verse that even ifthe physician chooses to increase a medication dose,being fully aware that this would in effect causedeath, he would then be held liable for terminatingthe life of his patient, which equates to murderunder the shari`a. While it is true that intention(niyya) of the physician is beyond the jurisdiction ofthe judge or the court of law, his intention cannot

escape the ever-watchful supervision of Allah .The Quran states the following in this regard:

[Allah] knows the treachery of the eyes andwhat the hearts conceal.9

Hence, although the physician may not be con-victed by the court of the land, he would neverthe-less be answerable to Allah for his part in termi-nating the life of the terminally ill.

In the event that a terminally ill patient requeststhe attending physician to terminate his life as aresult of his excruciating pain and suffering, such arequest would be termed voluntary euthanasia orassisted suicide. The Quran explicitly censures suchan action and categorically states:

Do not kill yourselves: for verily Allah is toyou Most Merciful.10

Suicide, self-inflicted or assisted, is a crimeaccording to the shari`ah and hence constitutes a sinin the sight of Allah . The following hadith dis-closes the fate of a person who terminates hislife:


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There was a man before you who was wound-ed. The pain became unbearable and so hetook a knife and cut his hand. Blood began toooze out profusely leading to his death.Almighty Allah said: `My servant hurried tobring death upon himself and so I madeParadise unlawful for him.11

From this hadith we gather that while voluntaryeuthanasia may end the terminally ill patients pain

and suffering in this world, his problem would befurther compounded in the hereafter by beingexcluded from inheriting a place in Paradise.

The Concept of Pain and SufferingAccording to the Islamic philosophy of life, there

is a transcendental dimension to pain and suffering.The Quran tells us that those who claim to believe inAllah will not be left alone after proclamationof their belief (mn):

Do people reckon that they will be left (inease) after saying We believe, and (that)they will not be tried with affliction?12

The Quran further asserts that the believers willbe put to the test in various ways:

Be sure that We shall test you with somethingof fear and hunger, some loss in goods or livesor the fruits of your toil, but give glad tidingsto those who patiently persevere.13

Thus, we find that Muslims in general view afflic-tion with a disease, fatal or otherwise, as a test oftheir faith and true resignation to their Creator. Infact, such tribulation contributes in their favor inthat it helps to expiate their sins. This is evidentfrom the following hadith:

When a Muslim is tried with a disease in his

body it is said to the angel: Write for him thegood actions which he used to do. If He(Allah) cures him, He (Allah) absolves him (ofall sins); and if He (Allah) takes his life (as aresult of this disease), He (Allah) forgives himand shows mercy upon him.14

There is, therefore, no justification for endingthe life of a person so as to relieve suffering. TheQuran says:

Allah does not tax any soul beyond thatwhich it can bear.15

Muslims believe in the hereafter, the real andeverlasting life, and it is this belief that enables themto bear their pain and suffering with what the Qurantermsabr(perseverance).

Passive Euthanasia

Passive euthanasia is an omission on the part ofthe attending physician to resuscitate the terminallyill, which results in the death of the patient. In thiscontext, the physician would be absolved of liabilityin causing the death of the patient on the basis of theIslamic legal principle of l arar wa l irr(no harmand no reciprocating harm). This principle justifiesone to allow death to take its natural course.


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Moreover, while the physician is obligated to pro-vide medical care at all times, treatment may be dis-continued if in his opinion, as a member of ahl al-khi-bra (experts in the field of medicine), there is little orno hope of the patients recovery. The same argu-ment would justify the nonutilization of nasogastric

tubal feeding if recourse to such form of artificialfeeding would, according to medical experts, notbenefit the patient. Likewise, it would be permissiblefor the attending physician to switch off the life-sup-port equipment, once his patient has been diagnosedas brainstem dead and medical experts have con-firmed that cessation of the patients brain activity isirreversible.16

Motivations for EuthanasiaAdvocates of euthanasia justify their stance on

the basis of the following:

Economic factors, Considerations of hospital space, beds,

staff, and therapeutic equipment thatcould otherwise be used by otherpatients; and

Death with dignity.

Let us now examine each one of these motiva-tions so as to ascertain their validity in the light ofIslamic teachings.

Economic FactorsAs a student in America, I noticed that people

were afraid of becoming ill in view of the high cost ofmedical care. It always baffled me as to how thisgreat nation that in the recent past reached themoon was unable on earth to solve the problem ofreducing the extremely high cost of medical care.The situation in South Africa is not very different.People tend to become sicker when they learn of thehigh cost of medicine and medical care. Economicfactors are of no consideration in Islams censuring

of euthanasia. In a Muslim state, it is the responsibil-ity of the executive head, whether caliph or king,president or prime minister, to secure funds frombayt al-ml (the public treasury) in order to assist theneedy in meeting their medical expenses or otherneeds. Islam has left a rich legacy in this regard, andMuslim rulers are known to have taken personalinterest in alleviating the suffering of the sick. For

example, in the Mansuri hospital in Cairo, built bythe Mamluk ruler, al-Manr Sayf al-Dn Qalawn in1284, everyone was treated without financial cost tothe patient.17

Considerations of Hospital Space, Beds, Staff and

Therapeutic DevicesThe argument for justifying euthanasia in theseinstances is centered upon the logic of preferencegiven to one individual over another on the basis ofthe quality of life. This proposition would seem plau-sible if it were related to a terminally ill patient incomparison with another younger patient who had abetter prognosis. However, for a Muslim, the prob-lem becomes acute when faced with the issue of opt-ing for one life at the expense of another. This is sobecause the Quran emphatically states that deathcomes about by Allahs will:

And no human being can die save by Allahsleave, at a term preordained.18

Thus, there is no guarantee that a patient who isnot suffering from a fatal disease will outlive onewho is terminally ill. Both are equally importantmembers of the human race. The solution is certain-ly not to get rid of one (the terminally ill patient) inorder to accommodate the other. The answer to thisproblem perhaps is to allocate more funds in orderto increase hospital space so that more beds may bemade available, more staff may be employed, andmore therapeutic devices may be procured.

Death with DignityThe concept of death with dignity is what gave

birth to the hospice movement in England.According to the Hopsice Foundation of America,hospice is a special concept of care designed to pro-vide comfort and support to patients and their fami-lies when a life-limiting illness no longer responds tocure-oriented treatments, with a special emphasison controlling a patients pain and discomfort.19

According to proponents of euthansia, such as


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Dr. Christiaan Barnard, the pioneer of heart trans-plant surgery, suffering causes a patient to becomedepersonalized. In fact, his brother, Dr. MariusBarnard, the founder of critical care insurance, andhe vowed to help each other in the event that eitherfinds himself in circumstances that they thought

would justify euthanasia. This could be done eitherwith the administration of a fatal overdose if the suf-ferer was incapable of helping himself, or by leavingwithin reach enough tablets so that the sufferercould take his own life.20 Islams position is that thesuffering that one undergoes as a result of any dis-ease does not rob one of ones dignity, but ratherbenefits one spiritually, as can be deduced from thefollowing hadith:

Àbd Allah ibn Mas`d reported: I visitedthe P rophet while he was having highfever. I said, You have a high fever. Is itbecause you will have a double reward? Hesaid, Yes. No Muslim is afflicted with anyharm but that Allah will remove his sins forhim as the leaves of a tree fall down.21

At the same time, Islam allows pain control.22

According to Anas ibn Mlik, the Prophet ga vehis followers the following advice:

None of you should wish for death because ofa calamity befalling him; but if he has to wishfor death he should say: O Allah! Keep me

alive as long as life is better for me and let medie if death is better for me.23

A Muslim should therefore place his trust(tawakkul) at all times in Allah , and despair mustnot be allowed to set in during adverse times.

While accepting the eventuality of dea th one ma ynot lose hope of Allahs mercy :

Do not lose not heart nor grieve for you mustgain mastery if you are true in faith.24

References1. Illustrated Stedmans Medical Dictionary. 24thed. Baltimore: Williams & Wilkins; 1982.2. The Glorious Quran Chapter 5, Verse 28.3. Muhammad Qutb. Islam the MisunderstoodReligion. Stuttgart: Ernst Klett Publishers; 1971.4. The Glorious Quran Chapter 2, Verse 178.5. Àbd al-Ramn al-Juzayr. Kitb al-Fiqh àl al-madhhib al-arbaà. Beirut: Dr al-Dhikr; n.d.6. The Glorious Quran Chapter 17, Verse 33.7. Muhammad Asad. The Message of the Quran.Chicago: Kazi Publications; 1980.8. The Glorious Quran Chapter 3, Verse 156.9. The Glorius Quran Chapter 40, Verse 19.10. The Glorius Quran Chapter 4, Verse 29.11. a al-Bukhr. Kitb al-anbiy. Bb m dhuki-ra àn ban 'Isr'l. Available online athttp://www.muhaddith.org. Hadith no. 3276.12. The Glorius Quran Chapter 29, Verse 2.13. The Glorius Quran Chapter 2, Verse 155.14. Musnad al-Imm Amad. Musnad Anas bin Mlik.Available on-line at http://www.muhaddith.org.15. The Glorious Quran Chapter 2, Verse 286.

16. Resolution No. 5 of the Third Session of theCouncil of the Islamic Fiqh Academy (1407 AH/1986)in Organisation of the Islamic Conferences IslamicFiqh Academy: Resolutions and Recommendations(1406-1409 AH/1985-1989), p. 30.17. Rahman F. Health and medicine in the Islamictradition. New York: The Crossroad PublishingCompany; 1989.


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18. The Glorious Quran Chapter 3, Verse 145.19. Hospicefoundation.org [homepage on theInternet]. Washington, DC: Hospice Foundation ofAmerica; c2007 [cited 2007 Sep 4]. Available from:http://www.hospicefoundation.org/hospiceInfo/.20. Barnard C. Good life good death: a doctors case

for euthanasia and suicide. Cape Town: HowardTimmins (Pty) Ltd.; 1980.21. a al-Bukhr. Kitb al-mar. Bb shidda al-mara. Available on-line at http://www.muhad-dith.org. Hadith no. 5323.

22. Imana.org [homepage on the Internet.] Lombard,IL: Islamic Medical Association of North America;c2002-6 [updated 2005 May 15; cited 2007 Sep 4].Available from:http://www.imana.org/mc/page.do?sitePageId=5699&orgId=imana.

23. a al-Bukhr. Kitb al-mar. Bb nahytamann al-mar al-mawt. Available on-line athttp://www.muhaddith.org. Hadith no. 5347.24. The Glorious Quran Chapter 3, Verse 139.

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