Advance Directives and Living Wills for Muslims

I will start my talk with an actual case. JW, 74, the father of a Catholic physician, who is also an ethicist in a Catholic hospital, suffered a massive stroke that left him paralyzed with receptive and expressive aphasia. His advance directive stated that he did not want mechanical ventilation, nutrition, or hydration if he were to end up in a terminal state. He is now paralyzed and has expressive aphasia, but he is not terminal. He is somewhat conscious. His caregivers decided to insert a g-tube and start feeding. When he lapsed into a coma after 150 days, it was decided to stop the feeding and allow him to die peacefully at home under hospice care. Both his wishes were fulfilled, and all care was provided. The patient should have access to information, and his privacy and right to exercise control on self should be respected. When we are talking about rights, whose rights are they? What are the rights of man? What are the rights of the Creator? There is also the question of the ownership of the body. Do we have ownership of our bodies when we are dead or just while we are living? Can my wife after my death inherit my organs? Probably not. You may have right to donate an organ, but Islamically, do you have the right to put in your will that you should be cremated? No. Do Muslims have the right to seek Shariah rulings in end-of-life issues? Do we have a right to put Shariah rulings in our advance directives and living wills in terms of autopsy or other matters? Yes, we do. What is forbidden in life is desecration of the human body. Unnecessary mutilation of the body is not permitted while we are alive, and it is not permitted after death, unless it is required by law or a medical issue has to be solved. What is the underlying moral value? We should all be protected by the constitution and law. If you do not have a living will, and your body is still alive but in a vegetative state, your body becomes the property of the state, and the state sometimes decides what can be done. A physician who pulls the tube out on his own can be charged with murder. The Society for the Right to Die, a Boston organization, published a very nice book, The Physician and the Hopelessly Ill Patient.1 That book outlines all the different states’ laws. I will describe the Indiana law later. Informed consent is better described as the shared mutual consent that the physician participates in the informative process and patient partakes in an intelligent discussion, discussing with both the family and his care provider. Patients have the right to refuse treatment, but they have to understand the consequences of the refusal. Yes, I refuse to have my two legs amputated because of gangrene but the gangrene and infection and sepsis will proceed if I refuse to do that. I probably will die. Sometimes the problem is not with the patient, but it is with us, the physicians. We do not sit down and communicate with the patient. We instead have the nurse give the consent forms to the patient the night before or the early morning of the surgery. The patient is already drowsy and he signs it without understanding all the legal terminology. The physician needs to sit down and explain to the patient in a language that he can understand, and the patient has the right to make advance directives, and he has a right to a health-care representative. So what is an advance directive? It is documented in advance of a critical illness, disability, or incapacity, that is before it happens. The directive states his or her wants, wishes about preferences about health care, including religious and moral values. Some individuals think that if they give an advance directive they will not be treated. Some individuals think that by appointing a health-care representative they are giving up control of their health-care decisions. I have appointed my son to be my healthcare representative, and he will make all medical decisions for me. No, this is not true. You can still make these decisions as long as you are conscious. Some think it is only for elderly? No. Advance directives should also be for the young including the children who can understand. I propose that there should be a discussion on advance directives Article DOI: http://dx.doi.org/10.5915/43-3-8478 Video DOI: http://dx.doi.org/10.5915/43-3-8478V