Care of the Terminally Ill: Religious Perspectives. Discussion.

C Ca ar re e o of f t th he e T Te er rm mi in na al ll ly y I Il ll l: : R Re el li ig gi io ou us s P Pe er rs sp pe ec ct ti iv ve es s.. D Di is sc cu us ss si io on n.. A Aa as si im m P Pa ad de el la a, , M MD D: : Thank you so much for your presentation. I think it highlights the problem many of us in this room face whether we are physicians, Muslim chaplains , imams, or scholars. Dr. Shanawani and I wrote about the problem of us being labeled the " Islamic bioethics experts " because we are part of a minority community. You highlighted that the roles of a chaplain are different than those of the imam. As a community we need to delineate the core compe-tencies of these different professionals. We need to disseminate this knowledge, as Muslim chaplaincies are gaining popularity. You mentioned a case where a Shia Muslim refused to allow the withdrawal of life support from his dying cousin. I am from Michigan, where there are many Shia Muslims. I have worked at a hospital there, interviewing physicians, staff, and patients about this issue. Many of the Shia families in this community did not want to withdraw care. During discussions, the family members would say, " We cannot allow removal of the ventilator; you are going to make us kill him. " The families are going think we are killing their loved one or we are hastening his death. Because of this, the hospital and its physicians came up with the idea to assume the role of limited paternalism. The policy is that when a person is near the end of life and physicians think there is no benefit to continue efforts, they would withdraw care without asking the family. Some people might find this difficult to accept based on the principle of autonomy and negating the role of the family. Physicians justify this because there is a greater burden in having the family discussion of deciding who is the proxy. They would ask the patient or the family: " Do you trust me as your physician? Do you want me to do what is best for the patient? If I do …