Question Summary:
My grandfather had a severe heart attack a month ago. He underwent triple bypass surgery and after he became a little bit better. However, recently his health has started to deteriorate. …

Question Detail:

My grandfather had a severe heart attack a month ago. He underwent triple bypass surgery and after he became a little bit better. However, recently his health has started to deteriorate.  He is on a respirator so he is not really breathing on his own.  The machines are basically breathing for him most of the time.  When he does breath on his own, he takes deep breaths that seem painful for him. He has been in the hospital, sedated and under anesthesia most of the time, for about a month. Today I just found out that he has gangereen in his toes so they may need to amputate his hands and feet. My dad who is also a physician is not ready to let him pass on. I feel so bad seeing my grandfather in so much pain and suffering. I don't know how my family and I should handle this situation, Islamically. If you can give some advice to us, that would help. Is it Islamically acceptable to end my grandfather's suffering by removing the machines, and letting him pass on.

Answer :

 
In the name of Allah, Most Gracious, Most Merciful

Assalaamu `alaykum waRahmatullahi Wabarakatuh
 
Before issuing a verdict with regards to your query, hereunder are previous answers on the different types of euthanasia and their rulings according to Shari’ah (Prepared by Ml. Ashhad bin Said-Student of Iftaa and Student of Medicine):

1)
The various types of euthanasia

Euthanasia comes in a number of different means:

1. Direct or deliberate euthanasia:
Active euthanasia, an act of commission, is taking some action that leads to death like a fatal injection. Passive euthanasia, an act of omission, is letting a person die by taking no action to maintain life.

This is done through giving the patient a lethal dose of curare or barbiturates or other derivatives of cyanide with the intention of killing. This has three cases:

a. The voluntary case, when the process is carried out at the pressing request of the patient who desires to die while he is fully conscious, or according to an already written testament.

b. The involuntary case, which is the case of a sane unconscious adult patient. The action to end his life is taken on the decision of the physician who thinks that killing him is for his or her own good, or according to the decision of the patient’s guardian or relatives who think that killing is in his or her best interests.

c. In the involuntary case where the patient is incapable of reasoning, whether a child or insane, the action is taken according to a decision made by the treating physician.
The prohibition of direct active euthanasia, the prohibition of suicide and assisting in bringing it about, for according to the Shari`ah killing a patient suffering from a terminal illness is not permissible for the physician, the patient’s family, or the patient himself. The patient, whatever his illness, and however sick he (or she) is, shall not be killed because of desperation and loss of hope in recovery or to prevent the transfer of the patient’s disease to others, and whoever commits the act of killing will be a deliberate killer. The Qur’an confirms without a shadow of a doubt that homicide is absolutely forbidden, as Allah Almighty says:
(And take not life, which Allah has made sacred, except by way of justice and law.)
(Al-An`am 6: 151)
We ordained for the Children of Israel that if anyone killed a person not in retaliation of murder or for spreading mischief in the land—it would be as if he killed all mankind.)
(Al-Ma`idah 5: 32)
 2. Assisted suicide:

In this case the patient ends his (or her) life by himself according to instructions given to him by another person that provides him with the information and devices that help him to die.
It is unlawful for the patient to kill himself (or herself) and it is unlawful for somebody else to kill him (or her) even if he is given leave to kill him. The former case will be suicide and the latter will be aggression against the other by killing him, for his permission does not render the unlawful act lawful. The patient does not posses his own soul to permit somebody else to take it. The Prophetic hadith is known regarding the prohibition of suicide in general. The person who commits suicide will be tortured in the Hellfire in the same way he (or she) killed himself. If he believes that suicide is lawful, he will be a disbeliever and will abide in the Hellfire forever; otherwise, he will be severely punished.

3. Indirect euthanasia:

This is done through giving the patient doses of tranquilizers or sedatives to abate the severe pain. With time the doctor will have to increase the doses to control the pain. It is a procedure preferred by therapists, but large doses may lead to difficulties in breathing and dysfunction of the cardiac muscle, which will result in death that was intended though anticipated beforehand.
It is impermissible to kill the patient for fear that his (or her) disease may transfer through contagious infection, even if he is terminally sick (such as one suffering from AIDS). It is not permissible to kill him to prevent the spread of the disease, for there are many other means to do so, such as quarantine. On the contrary, the patient must be protected as a human being and be provided with the required food and medicine till his or her life comes to its natural end.

The Prophet (Sallallaaahu ‘alayki wassalam) is reported to have said, “Allah created no disease but created something to cure it.” (Reported by Al-Bukhari and Muslim)

In another hadith narrated in Tirmidhi:

“O Allah’s Servants! Seek treatment, for Allah does not create a disease but creates a treatment for it.”
The hadith in Muwatta Imaam Ahmad: “Allah created no disease but created something to cure it. Some may know it and some may not.” So these Prophetic hadiths give us hope of discovering cures for what we term today as ‘incurable’ diseases.

Indeed, we have witnessed the discovery of cures for what people considered at one time incurable diseases. Therefore, it is impermissible to kill the carrier of the disease because it is incurable, nor on the pretext of protecting the healthy people from it.
 

4. Passive euthanasia

This is achieved by refusing to treat the patient or interrupting the treatment necessary for his survival, including the removal of the apparatus of artificial breathing from the patient in the resuscitating room when it is confirmed that his (or her) brain is dead and there is no hope of restoring his consciousness.
As for facilitating death by withdrawing artificial resuscitating apparatus from the patient who is clinically regarded as “dead” or “practically dead” because of the damage to the brainstem or brain, with which human beings live and feel; if the action of the physician is merely stopping the treatment instruments, it will be no more than giving up the treatment, in which case his action is legal and permissible, bearing in mind that these instruments can preserve the apparent life of the patient - represented by breathing an For more Queries don’t hesitate to write back. May Allah Increase all of us in Knowledge and piety.
Ml. Mohammad Ashhad Bin Said,
Student Darul Iftaa
2)
 
Active euthanasia, an act of commission, i.e. taking some action that leads to death like a fatal injection. Passive euthanasia, an act of omission, i.e. letting a person dies by taking no action to maintain life. Passive euthanasia can be withholding or withdrawing water, food, drugs, medical or surgical procedures, resuscitation like CPR, and life support such as the respirator. The patient is then left to die from the underlying disease. Sometimes a distinction is made between normal nutrition and hydration on one hand and medical nutritional support involving intravenous and naso-gastric feeding on the other hand. Euthanasia can be by the patient or by the health care giver. Euthanasia can be voluntary when the patient takes the decision, non-voluntary when the decision is made by another person for an unconscious patient and involuntary when the decision is made contrary to the patient's wish.
Islam considers human life sacred. Life is to be protected and promoted as much as possible. It is neither permissible in Islam to kill another human being, nor even to kill one's own self (suicide). Killing is allowed only in a declared just war situation when the enemy comes to attack, then killing of the enemy is allowed for self-defense. The court of law may pass a death sentence against a person as a punishment for some crimes such as premeditated murder or other serious crimes. However, there is no provision in Islam for killing a person to reduce his pain or suffering from sickness.

It is the duty of the doctors, patient's relatives and the state to take care of the sick and to do their best to reduce the pain and suffering of the sick, but they are not allowed under any circumstances to kill the sick person.

If, however, a number of medical experts determine that a patient is in a terminal condition and there is no hope for his/her recovery, then it could be permissible for them to stop the medication; in other words passive euthanasia will be permissible.
If the patient is on life support, it may be permissible, with due consultation and care, to decide to switch off the life support machine and let the nature take its own time. Under no condition it is permissible to induce death to a patient.
Ml. Mohammad Ashhad Bin Said,
Student Darul Iftaa
 
Verdict: In light of the abovementioned, if it is determined by medical experts that your grandfather is terminally ill and there is absolutely no hope for his recovery and/or survival, then it will only be permissible to resort to passive euthanasia, i.e. to stop the medication or remove the machines and let nature take its own time.
وفي الكيسانيات في الجراحات المخوفة والقروح العظيمة والحصاة الواقعة في المثانة ونحوها إن قيل قد ينجو وقد يموت أو ينجو ولا يموت يعالج وإن قيل لا ينجو أصلا لا يداوى بل يترك كذا في الظهيرية .
(Al-Fatawa al-Hindiyyah, 5/360, Rashidiyyah)
If however, after consultation with medical experts, it is determined that there is a possibility for recovery, then it will not be permissible to abstain from such treatment which is vital for the survival of the person. It will be the duty of the doctors and the family of the sick person to ensure that they do everything possible to ease his pain and assist him in every way possible.
We ask Allah Ta’ala to make it easy for your grandfather and your family.
 
And Allah knows best
Wassalamu Alaikum
Ml. Asif Umar,
Student Darul Iftaa
Checked and Approved by:
Mufti Ebrahim Desai
Darul Iftaa, Madrassah In'aamiyyah