Thank you, Imam Elturk, for answering our question this week!
Dying, End of Life and Death in Islam
By Imam Mustapha Elturk
Islamic Organization of North America (IONA)
Death is a subject people often avoid talking about much less remember. The Quran alludes to death at various places. A verse from chapter three called the Family of Imran (Aal ‘Imran) reads, “Every soul shall taste death and you will be paid in full only on the Day of Resurrection. Whoever is kept away from the Fire and admitted to the Garden will have triumphed. The present world is only an illusory pleasure” (Quran, 3:185).
What is life? Philosophers have grappled with this question for centuries. Rather than discussing their speculative thoughts, it is best to know what God Himself says about life. “Know (O people) that the life of this world is but play and amusement, adornment and mutual boasting and (competition in) multiplying of wealth and children” (Quran, 57:20). This is generally the reality of man’s perception about this worldly life, whether that person is a Muslim, a follower of another faith, an agnostic, or even an atheist.
Although death is certain and inevitable, people tend to live as if they are going to live forever. Death knows no age. Very often people die in the prime of their youth. There are times a father has to bury his own son. My own son died at the young age of 33. The term of one’s life is predetermined before birth and this knowledge rests only with God. “If God took people to task for the evil they do, He would not leave one living creature on earth, but He reprieves them until an appointed time: when their time comes they cannot delay it for a moment nor can they bring it forward” (Quran, 16:61). This mystery of life and death is not without purpose. The life of this world is a test from God. “Every soul is certain to taste death: We test you all through the bad and the good, and to Us you will all return” (Quran, 21:35).
In this worldly life, people will constantly be put to all types of tests. Believers are urged to be patient while facing trials and tribulations. “O you who believe, seek help through patience and prayer, for God is with the patient” (Quran, 2:153). “We shall certainly test you with fear and hunger, and loss of property, lives, and crops. But, give good news to those who are patient” (Quran, 2:155). When inflicted with illness, believers do not complain but resign themselves to God’s will. They remain patient in the face of adversity knowing they belong to God and to Him they will return. “Those who, when inflicted with a calamity say, ´We belong to God and to Him we will return.’ Those are the people who will have blessings and mercy from their Lord; they are the ones who are guided” (Quran, 2:156,157).
What is the reality of death? When it occurs, the spirit (ruh) leaves the body. We learn through prophetic traditions that a righteous soul comes out of the body with ease, while an evil soul, which resists leaving the body, is taken out harshly by the angel of death. The two types of souls are accordingly honored and dishonored in their respective journeys to the heavenly dimensions and back to the grave when they are questioned. “Say (O Prophet), ´The Angel of Death, who has been given charge of you, will take you back and then you will be sent back to your Lord’” (Quran, 32:11).
Some die suddenly while others may go through pain and suffering before they die. According to prophetic traditions, sickness is a source of mercy and a chance for forgiveness. In one saying Prophet Muhammad (Peace be upon him, pbuh) says, “For every misfortune, illness, anxiety, grief or hurt that afflicts a believer – even the hurt caused by the pricking of a thorn – God wipes off his sins and his sins fall away from him as leaves fall from a tree.” The Prophet (pbuh) informed us that, “If a servant of God falls sick or goes on a journey, he (continues) to be rewarded for the good deeds that he used to do when he was healthy or at home. This is God’s gift to the believer.”
Visiting the sick is not only highly encouraged, it is an obligation. This is because it gives the patient much needed care and moral support. In this regard, the Prophet (pbuh) said, “A caller from heaven calls out to the person who visits a sick person, ‘You are good and your path is good. May you enter your residence in Paradise.’” He also mentioned, “When a Muslim visits the sick in the morning, seventy thousand angels pray for him, and they continue praying for him until the evening. When one visits the sick in the evening, the angels pray for him and continue to pray for him until the next morning. Moreover, he will be rewarded with the choicest fruits of Paradise.”
Visitors should pray for the recovery and health of the sick. The Prophet (pbuh) instructed, “When you visit a sick person, give him hope for a long life. This will not avert anything, but will please the patient and give him comfort.” When the Prophet visited sick people, he used to say to them, “Do not worry! It is a means of cleansing (you) of sins, God-willing.” Unless desired by the sick person, it is preferred to shorten the visits and to make them less frequent, lest they should become burdensome for the patient.
One may supplicate for the sick person the way the Prophet (pbuh) did, “O God, The Sustainer of mankind! Remove the illness, cure the disease. You are the One who cures. There is no cure except Your cure. Grant (us) a cure that leaves no trace of illness.” One may supplicate using his or her own words in any language he or she speaks.
A patient who is going through severe pain or one whose days are numbered is prohibited to wish for death. When the Prophet Muhammad (pbuh) found his ailing uncle wishing for death, he said, “O Abbas! O uncle of God’s messenger! Do not wish for death. If you do good and live long, your good deeds will multiply. Then that is better for you. If you are not well and your death is delayed, you may seek God’s forgiveness. That is better for you. So do not wish for death.”
Visiting someone who is on his deathbed is highly desirable. The Prophet said, “When you visit someone who is ill or is dying, say good things about him (or her). Indeed, the angels say, ‘Amen’ to whatever you utter.” It is highly desired to have the patient or someone on behalf of the dying patient to do as many good deeds as possible. This allows the person to die on a state of goodness.
Inevitably, people will eventually have to expire. Man takes nothing with him in his grave. We learn through a prophetic saying, “When a man dies, his deeds come to an end except for three things: perpetual charity (Sadaqah Jariyah); knowledge which is beneficial; or a virtuous descendant who prays for him (the deceased).” Such admonitions remind us that we should hasten in doing good deeds before our time is up and our book of deeds close forever.
Being the most certain reality, a conscious believer prepares himself here in this world for the eternal and perpetual blissful life of the hereafter. The Prophet Muhammad (pbuh) in one of his sayings said, “Clever is the one who controls his passions and prepares for life after death.”
End of Life Situations
In medical and health institutions, end of life care refers to health care of patients who are on their last breaths or terminally ill with no cure available to them such as cancer or brain-dead patients. Once it is determined that the patient’s disease can no longer be controlled and is medically incurable the health care team will make sure the patient is comfortable and receiving the proper treatment and medication to control pain and other symptoms. Some patients may be treated in hospitals while others may be treated at hospice or home.
The patient and family members should discuss their end of life concerns with the health care team. The health care team will assist and address to the best of their abilities the patient and his/her family’s medical, psychological and spiritual concerns through experts in each field.
The often asked question that usually arises from patients and family members is, “How long is he or she going to live?” Doctors usually give their educated guesses based on knowledge and experience. Some doctors refrain from answering for fear of instilling false hope. However, no one really knows how long a person is going to live. At times doctors are surprised at how much a patient’s belief in some higher being affects the patient’s duration of life. Only God knows when a person is going to expire.
By law, doctors and health care teams are not allowed to make decisions on behalf of the patient or his/her family. They will answer every question the patient or the family of the patient may have including but not limited to medical, technical, economic as well as bioethics in order for the patient and his/her family to make the right decision. Ultimately, it is the patient and his/her family who make decisions regarding end of life treatment or the removal of life support equipment. This practice of intentionally ending life in order to relieve pain and suffering is called euthanasia.
It must be understood that, as long as the heart is beating and the brain is functioning any decision taken to end one’s life due to pain, suffering or other reasons is against Islamic principles and considered suicide; an act forbidden in Islam. Muslims believe that all human life is sacred and only God determines its life span. “Do not take life, which God made sacred except in the course of justice” (Quran, 17:33). Only God decides how long each of us will live. “When their time comes, they cannot delay it for a single hour nor can they prolong it by a single hour” (Quran, 16:61).
End of Life Decisions
One of the most commonly asked questions is, “What must one do if the patient is in a coma and/or is brain-dead (i.e. vegetative-state), while his/her heart is still beating?”
There is a difference of opinion among Muslim scholars regarding what determines death. Is brain-dead a criterion for death? Secular institutions may conclude that it is. Doctors may pronounce a person who is brain-dead as dead even though his/her heart is still beating. This is contrary to the common belief that one is pronounced dead when the heart stops or the lungs cease to function.
The following excerpt from an online article published on BBC entitled, End of Life and DNR (Do Not Resuscitate)Order, may help you and those involved in deciding on end of life situations,
“… the Islamic Code of Medical Ethics states, “it is futile to diligently keep the patient in a vegetative state by heroic means… It is the process of life that the doctor aims to maintain and not the process of dying.” This means doctors can stop trying to prolong life in cases where there is no hope of a cure.
According to the Islamic Medical Association of America (IMANA) “When death becomes inevitable, as determined by physicians taking care of terminally ill patients, the patient should be allowed to die without unnecessary procedures.”
IMANA say that turning off life support for patients deemed to be in a persistent vegetative state is permissible. This is because they consider all mechanical life support procedures as temporary measures.
While turning off a life-support is allowed, hastening death with the use of certain pain-killing drugs is not allowed as this would equate to euthanasia.”
According to many scholars of Islam and schools of thought, it is pointless to keep the patient in a vegetative state by whatever means available. At this stage, the patient is unable to make a decision on his/her own and therefore the family of the patient will have to decide on his/her behalf.
The family is urged to contact and consult with Islamic bioethics experts before making decisions. Such professionals may include but not limited to, Muslim physicians and professional organizations, Muslim Jurists, Imams, Muslim chaplains, or perhaps Muslim lawyers when necessary.
One thing that must be kept in mind is, according to Muslim Jurists, “life-saving equipment cannot be turned off unless the physicians are certain about the inevitability of death.”
In the case of brain death, “the jurists ruled that if three attending physicians attest to a totally damaged brain that results in an unresponsive coma, apnoea, and absent cephalic reflexes, and if the patient can be kept alive only by a respirator, then the person is biologically dead, although legal death can be attested only when the breathing stops completely after the turning off of life-saving equipment.”
The human life is a divine trust and cannot be terminated at one’s own will. It is possible through consultation with health care providers, attending physicians and Muslim jurists, among others to judiciously make an end of life decision. Health care providers must do everything they can to preserve life and avoid premature death. In some cases, the removal of life-sustaining equipment or treatment is seen as allowing death to take its natural course. Death does not happen without the express permission of God. Everyone will have to face death. It is the supreme true reality.
 End-of-life: the Islamic view, Abdulaziz Sachedina