Introduction
Death is a divine process and human intervening to His process is a breach of His law. Thus, the physician-assisted dying of a terminally ill patient or their facilitation of a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act such as sleeping pills and information about the lethal dose that the patient may commit suicide. God has chosen how long each person will live and human beings should not interfere in this. This end-of-life option is, therefore, forbidden. Hence, physicians must not take active measures to terminate a patient’s life but should take care of a patient according to medical ethics, providing appropriate comfort care and adequate pain control in a critical situation as long as the soul does exist in the body.
God creates life and causes death
Like all other aspects of our life on earth God controls our life and death. The Quran has confirmed that He has created life and causes it to death, which is found in the following verses of the Quran:
[22:5] O people, if you have any doubt about resurrection, (remember that) we created you from dust, and subsequently from a tiny drop, which turns into a hanging (embryo), then it becomes a fetus that is given life or deemed lifeless. We thus clarify things for you. We settle in the wombs whatever we will for a predetermined period. We then bring you out as infants, then you reach maturity. While some of you die young, others live to the worst age, only to find out that no more knowledge can be attained beyond a certain limit. Also, you look at a land that is dead, then as soon as we shower it with water, it vibrates with life and grows all kinds of beautiful plants.
[23:14] Then we developed the drop into a hanging (embryo), then developed the hanging (embryo) into a bite-size (fetus), then created the bite-size (fetus) into bones, then covered the bones with flesh. We thus produce a new creature. So blessed is God, the best Creator.
[23:15] Then indeed, after that surely, you will die.
[23:16] Then indeed, a Day of the Resurrection, you will be resurrected.
[3:185] Every person is tasting the death, while you are only given your reward in full on a Day of the Resurrection. So, whoever has been pulled away of the Fire and has been admitted to the Garden, then certainly, he has succeeded. And the life of the world is not but an enjoyment of the delusion.[4:78] Wherever you may be, the death will catch up with you, even if you have been in high-rise towers. If any good befalls them, they say: “This is from God,” but if any evil befalls them, they say: “This is from you!” Say: “All is from God.” So what is wrong with these people, do they not understand statement?
[56:60] We have decreed the death for you, and we are not to be stopped.
Death is mediated by the angels
The life of the Hereafter starts with the death, which is a peaceful event for those who believed in their Lord and His revelations while it is a terrible event for those who disbelieved in their Lord and His revelations. Even, two different groups of angels are given responsibility to terminate the lives of people on earth. The angels those who terminate the lives of the righteous are al-naashitaat while the angels those who terminate the lives of the unrighteous are al-naazi’aat. The angels of death (al-naashitaat) invite the believers to enter Paradise with the greeting of “Peace be upon you” (16:32) when they take their souls gently (79:2), while the believers know that they have been forgiven by their Lord and made them honorable (36:26-27). On the other hand, the angels of death (al-naazi’aat) beat the disbelievers on their faces and rear ends (8:50, 47:27) giving painful retribution (6:93) when as they snatch their souls away from them (79:1) while the disbeliever says: “My Lord, send me back (23:99) so that I may do good in what I have left behind” but there is a barrier to prevent the disbelievers from going back until the day they are resurrected (23:100). The disbeliever also says: “My Lord, if You could delay this for a short while, I would then be charitable to be with the righteous (63:10)” but there will be no delay for any soul when its term has come (63:11):
The angels, al-naashitaat terminate the lives of the righteous
[79:2] (I swear) By the angels who take (the souls of the righteous) gently.
[16:32] Those whom the angels take them in a state of righteousness say: “Peace be upon you, enter Paradise for what you have done.”
[36:26] It was told, “Enter Paradise.” He said, “Oh, I wish my people knew.
[36:27] “That my Lord has forgiven me, and made me honorable.”
The angels, al-naazi’aat terminate the lives of the unrighteous
[79:1] (I swear) By the angels who snatch (the souls of the unrighteous) forcibly.
[8:50] And if you could see when the angels take them in death of those who disbelieved, striking their faces and their backs, and (saying): “Taste the punishment of the blazing.”
[47:27] So how will it be when the angels put them to death, striking their faces and their backs?
[6:93] And who is more wicked than one who invents lies about God, or says: “It has been inspired to me,” while anything was not inspired to him; or who says: “I will bring down the same as what God has sent down.” And if you could only see the wicked at the moment of death when the angels have their arms opened: “Bring yourselves out, today you will be given the humiliating punishment for what you used to say about God without the truth, and you used to be arrogant towards His revelations.”
[23:99] Until when the death came to one of them (transgressors), he said: “My Lord, send me back.
[23:100] That I may do as righteous in what I have left behind.” No, it is but a word he speaks, and there is a barrier before them until the day they are resurrected.
[63:10] And you shall give from what we have provided you before the death comes to you, then he says, “My Lord, if You could delay me for a short while, then I would be charitable and be among the righteous.”
[63:11] But God never delays for any soul when its term has come. And God is Cognizant of what you do.
Soul is immortal
In killing, our concern is the physical body not the soul as human being is mortal but not its soul as God designed our body from dust (30:20) and blew into it from His spirit (32:9, 38:72), and Jesus’ death may serve as an example for us to confirm it as his soulless body was tortured and crucified (3:55, 4:157). When death overtakes us, we get into other dimension leaving our body on the earth. Thus, the dust returns to the earth as it was and the soul returns unto God who gave it (2:156, 84:6):
[30:20] And of His signs is that He created you from dust, then you are humans by reproducing.
[38:72] “Once I design him, and blow into him from My spirit , you shall fall prostrate before him.”
[32:9] Then He shaped him and blew into him from His spirit. And He gave you the hearing, the vision, and the understanding; rarely are you thankful.
[3:55] God said: “O Jesus, indeed Me taking yours and raising yours to Me, and purifying yoursfrom those who have disbelieved, and making those who have followed you superior to those who have disbelieved until a day of the Resurrection. Then to Me is your return when I will judge between youin what you had been differing in it.”
[4:157] And it is their saying: “Indeed, we have killed the Messiah, Jesus,son of Mary, a messenger of God!” And they have not killed him, nor have they crucified him, but it has been made so to them. And indeed, those who have differed in it are surely, in doubt about it. For them there is no knowledge of it except following the conjecture; and they have not killed him is a certainty.
[2:156] Those who, when the adversity has afflicted them, they say: “Indeed, we belong to God and indeed, to Him we are returning.”
[84:6] O human being, indeed, you are working toward your Lord hard so is His meeting.
Killing is a gross sin
Killing is one of those what God has prohibited in the Quran being a crime. Thus, killing any person or killing oneself is a gross sin while killing others or killing themselves is permitted in the cause of God to eliminate aggression and oppression as aggression and oppression are worse than killing as reflected in the following verses of the Quran:
[4:29] O you who have believed, you are not to consume your money between yourselves unjustly, except that there is a business from a mutual consent among you. And you are not to kill yourselves. Indeed, God has had mercy towards you.
[5:32]Owing to that we have decreed for the Children of Israel that whoever has killed a person without being a killer, or spreading corruption in the land; then as if he has killed all the human being, while whoever has saved it, then as if he has saved all the human being. And certainly, our messengers came to them with the clear proofs, Yet even after that, many of them are committing excesses in the land.
[6:151] Say: “You shall come, I will recite what has prohibited your Lord for you that you should not associate anything with Him, and should be good with the parents; and you should not kill your children for fear of poverty, we provide for you and for them; and you should not go near the immodesties, what has noticed of them or what has concealed; and you should not kill the soul, which God has forbidden except of the justice. That, He has enjoined you that you may think.”
[17:31] And you are not to kill your children (unborn) for fear of poverty; we provide for them and for you. Indeed, their killing is a gross sin.
[17:33] And you are not to kill the life, which God has forbidden, except in the course of justice. And whoever has been killed unjustly, then we have given authority for his heir, while he should not exceed in the killing. Indeed, he has been helped.
[2:191] And you may kill them wherever you find them, and drive them out from where they drove you out. Oppression is worse than killing. Do not fight them at the Sacred Masjid, unless they fight you in it. But if they fight you, then you may kill them. Such is the requital for the disbelievers.
Medical ethics
Physicians are expected to uphold the ethical norms of their profession in following conscience:
(a) Thoughtfully consider whether and how significantly an action (or declining to act) will undermine the physician’s personal integrity, create emotional or moral distress for the physician, or compromise the physician’s ability to provide care for the individual and other patients.
(b) Before entering into a patient-physician relationship, make clear any specific interventions or services the physician cannot in good conscience provide because they are contrary to the physician’s deeply held personal beliefs, focusing on interventions or services a patient might otherwise reasonably expect the practice to offer.
(c) Take care that their actions do not discriminate against or unduly burden individual patients or populations of patients and do not adversely affect patient or public trust.
(d) Be mindful of the burden their actions may place on fellow professionals.
(e) Uphold standards of informed consent and inform the patient about all relevant options for treatment, including options to which the physician morally objects.
(f) In general, physicians should refer a patient to another physician or institution to provide treatment the physician declines to offer. When a deeply held, well-considered personal belief leads a physician also to decline to refer, the physician should offer impartial guidance to patients about how to inform themselves regarding access to desired services.
Physician-assisted dying causes societal risks
It is understandable, though tragic, that some patients in extreme duress—such as those suffering from a terminal, painful, debilitating illness—may come to decide that death is preferable to life. However, permitting physicians to engage in assisted suicide would ultimately cause more harm than good. It is incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life:
(a) Should not abandon a patient once it is determined that cure is impossible.
(b) Must respect patient autonomy.
(c) Must provide good communication and emotional support.
(d) Must provide appropriate comfort care and adequate pain control.
Conclusion
Ethically and spiritually physician assisted dying is not permitted while physician would provide appropriate comfort care at the end of life refraining from assisting or encouraging the terminally ill patient to end the life. While it would not be wrong if the life support is taken away from the soulless body and the advancement in medical science provides an opportunity with physician to confirm whether the body is soulless or the soul does exist in it. Even God knows that human being cannot kill the soul, has forbidden to kill the physical body having soul is a means of saving human life to reward us distinguishing between good and evil behavior being the purpose of human being on the earth. Thus, the true believers who trust on their Lord would not break divine law when the adversity befalls them, or when they are in to end the life situation being patient expecting better reward with their Lord.
Peaceful Friday, salaam and God bless.
Tafazzal (3/27/2020).
Death is a divine process and human intervening to His process is a breach of His law. Thus, the physician-assisted dying of a terminally ill patient or their facilitation of a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act such as sleeping pills and information about the lethal dose that the patient may commit suicide. God has chosen how long each person will live and human beings should not interfere in this. This end-of-life option is, therefore, forbidden. Hence, physicians must not take active measures to terminate a patient’s life but should take care of a patient according to medical ethics, providing appropriate comfort care and adequate pain control in a critical situation as long as the soul does exist in the body.
God creates life and causes death
Like all other aspects of our life on earth God controls our life and death. The Quran has confirmed that He has created life and causes it to death, which is found in the following verses of the Quran:
[22:5] O people, if you have any doubt about resurrection, (remember that) we created you from dust, and subsequently from a tiny drop, which turns into a hanging (embryo), then it becomes a fetus that is given life or deemed lifeless. We thus clarify things for you. We settle in the wombs whatever we will for a predetermined period. We then bring you out as infants, then you reach maturity. While some of you die young, others live to the worst age, only to find out that no more knowledge can be attained beyond a certain limit. Also, you look at a land that is dead, then as soon as we shower it with water, it vibrates with life and grows all kinds of beautiful plants.
[23:14] Then we developed the drop into a hanging (embryo), then developed the hanging (embryo) into a bite-size (fetus), then created the bite-size (fetus) into bones, then covered the bones with flesh. We thus produce a new creature. So blessed is God, the best Creator.
[23:15] Then indeed, after that surely, you will die.
[23:16] Then indeed, a Day of the Resurrection, you will be resurrected.
[3:185] Every person is tasting the death, while you are only given your reward in full on a Day of the Resurrection. So, whoever has been pulled away of the Fire and has been admitted to the Garden, then certainly, he has succeeded. And the life of the world is not but an enjoyment of the delusion.[4:78] Wherever you may be, the death will catch up with you, even if you have been in high-rise towers. If any good befalls them, they say: “This is from God,” but if any evil befalls them, they say: “This is from you!” Say: “All is from God.” So what is wrong with these people, do they not understand statement?
[56:60] We have decreed the death for you, and we are not to be stopped.
Death is mediated by the angels
The life of the Hereafter starts with the death, which is a peaceful event for those who believed in their Lord and His revelations while it is a terrible event for those who disbelieved in their Lord and His revelations. Even, two different groups of angels are given responsibility to terminate the lives of people on earth. The angels those who terminate the lives of the righteous are al-naashitaat while the angels those who terminate the lives of the unrighteous are al-naazi’aat. The angels of death (al-naashitaat) invite the believers to enter Paradise with the greeting of “Peace be upon you” (16:32) when they take their souls gently (79:2), while the believers know that they have been forgiven by their Lord and made them honorable (36:26-27). On the other hand, the angels of death (al-naazi’aat) beat the disbelievers on their faces and rear ends (8:50, 47:27) giving painful retribution (6:93) when as they snatch their souls away from them (79:1) while the disbeliever says: “My Lord, send me back (23:99) so that I may do good in what I have left behind” but there is a barrier to prevent the disbelievers from going back until the day they are resurrected (23:100). The disbeliever also says: “My Lord, if You could delay this for a short while, I would then be charitable to be with the righteous (63:10)” but there will be no delay for any soul when its term has come (63:11):
The angels, al-naashitaat terminate the lives of the righteous
[79:2] (I swear) By the angels who take (the souls of the righteous) gently.
[16:32] Those whom the angels take them in a state of righteousness say: “Peace be upon you, enter Paradise for what you have done.”
[36:26] It was told, “Enter Paradise.” He said, “Oh, I wish my people knew.
[36:27] “That my Lord has forgiven me, and made me honorable.”
The angels, al-naazi’aat terminate the lives of the unrighteous
[79:1] (I swear) By the angels who snatch (the souls of the unrighteous) forcibly.
[8:50] And if you could see when the angels take them in death of those who disbelieved, striking their faces and their backs, and (saying): “Taste the punishment of the blazing.”
[47:27] So how will it be when the angels put them to death, striking their faces and their backs?
[6:93] And who is more wicked than one who invents lies about God, or says: “It has been inspired to me,” while anything was not inspired to him; or who says: “I will bring down the same as what God has sent down.” And if you could only see the wicked at the moment of death when the angels have their arms opened: “Bring yourselves out, today you will be given the humiliating punishment for what you used to say about God without the truth, and you used to be arrogant towards His revelations.”
[23:99] Until when the death came to one of them (transgressors), he said: “My Lord, send me back.
[23:100] That I may do as righteous in what I have left behind.” No, it is but a word he speaks, and there is a barrier before them until the day they are resurrected.
[63:10] And you shall give from what we have provided you before the death comes to you, then he says, “My Lord, if You could delay me for a short while, then I would be charitable and be among the righteous.”
[63:11] But God never delays for any soul when its term has come. And God is Cognizant of what you do.
Soul is immortal
In killing, our concern is the physical body not the soul as human being is mortal but not its soul as God designed our body from dust (30:20) and blew into it from His spirit (32:9, 38:72), and Jesus’ death may serve as an example for us to confirm it as his soulless body was tortured and crucified (3:55, 4:157). When death overtakes us, we get into other dimension leaving our body on the earth. Thus, the dust returns to the earth as it was and the soul returns unto God who gave it (2:156, 84:6):
[30:20] And of His signs is that He created you from dust, then you are humans by reproducing.
[38:72] “Once I design him, and blow into him from My spirit , you shall fall prostrate before him.”
[32:9] Then He shaped him and blew into him from His spirit. And He gave you the hearing, the vision, and the understanding; rarely are you thankful.
[3:55] God said: “O Jesus, indeed Me taking yours and raising yours to Me, and purifying yoursfrom those who have disbelieved, and making those who have followed you superior to those who have disbelieved until a day of the Resurrection. Then to Me is your return when I will judge between youin what you had been differing in it.”
[4:157] And it is their saying: “Indeed, we have killed the Messiah, Jesus,son of Mary, a messenger of God!” And they have not killed him, nor have they crucified him, but it has been made so to them. And indeed, those who have differed in it are surely, in doubt about it. For them there is no knowledge of it except following the conjecture; and they have not killed him is a certainty.
[2:156] Those who, when the adversity has afflicted them, they say: “Indeed, we belong to God and indeed, to Him we are returning.”
[84:6] O human being, indeed, you are working toward your Lord hard so is His meeting.
Killing is a gross sin
Killing is one of those what God has prohibited in the Quran being a crime. Thus, killing any person or killing oneself is a gross sin while killing others or killing themselves is permitted in the cause of God to eliminate aggression and oppression as aggression and oppression are worse than killing as reflected in the following verses of the Quran:
[4:29] O you who have believed, you are not to consume your money between yourselves unjustly, except that there is a business from a mutual consent among you. And you are not to kill yourselves. Indeed, God has had mercy towards you.
[5:32]Owing to that we have decreed for the Children of Israel that whoever has killed a person without being a killer, or spreading corruption in the land; then as if he has killed all the human being, while whoever has saved it, then as if he has saved all the human being. And certainly, our messengers came to them with the clear proofs, Yet even after that, many of them are committing excesses in the land.
[6:151] Say: “You shall come, I will recite what has prohibited your Lord for you that you should not associate anything with Him, and should be good with the parents; and you should not kill your children for fear of poverty, we provide for you and for them; and you should not go near the immodesties, what has noticed of them or what has concealed; and you should not kill the soul, which God has forbidden except of the justice. That, He has enjoined you that you may think.”
[17:31] And you are not to kill your children (unborn) for fear of poverty; we provide for them and for you. Indeed, their killing is a gross sin.
[17:33] And you are not to kill the life, which God has forbidden, except in the course of justice. And whoever has been killed unjustly, then we have given authority for his heir, while he should not exceed in the killing. Indeed, he has been helped.
[2:191] And you may kill them wherever you find them, and drive them out from where they drove you out. Oppression is worse than killing. Do not fight them at the Sacred Masjid, unless they fight you in it. But if they fight you, then you may kill them. Such is the requital for the disbelievers.
Medical ethics
Physicians are expected to uphold the ethical norms of their profession in following conscience:
(a) Thoughtfully consider whether and how significantly an action (or declining to act) will undermine the physician’s personal integrity, create emotional or moral distress for the physician, or compromise the physician’s ability to provide care for the individual and other patients.
(b) Before entering into a patient-physician relationship, make clear any specific interventions or services the physician cannot in good conscience provide because they are contrary to the physician’s deeply held personal beliefs, focusing on interventions or services a patient might otherwise reasonably expect the practice to offer.
(c) Take care that their actions do not discriminate against or unduly burden individual patients or populations of patients and do not adversely affect patient or public trust.
(d) Be mindful of the burden their actions may place on fellow professionals.
(e) Uphold standards of informed consent and inform the patient about all relevant options for treatment, including options to which the physician morally objects.
(f) In general, physicians should refer a patient to another physician or institution to provide treatment the physician declines to offer. When a deeply held, well-considered personal belief leads a physician also to decline to refer, the physician should offer impartial guidance to patients about how to inform themselves regarding access to desired services.
Physician-assisted dying causes societal risks
It is understandable, though tragic, that some patients in extreme duress—such as those suffering from a terminal, painful, debilitating illness—may come to decide that death is preferable to life. However, permitting physicians to engage in assisted suicide would ultimately cause more harm than good. It is incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life:
(a) Should not abandon a patient once it is determined that cure is impossible.
(b) Must respect patient autonomy.
(c) Must provide good communication and emotional support.
(d) Must provide appropriate comfort care and adequate pain control.
Conclusion
Ethically and spiritually physician assisted dying is not permitted while physician would provide appropriate comfort care at the end of life refraining from assisting or encouraging the terminally ill patient to end the life. While it would not be wrong if the life support is taken away from the soulless body and the advancement in medical science provides an opportunity with physician to confirm whether the body is soulless or the soul does exist in it. Even God knows that human being cannot kill the soul, has forbidden to kill the physical body having soul is a means of saving human life to reward us distinguishing between good and evil behavior being the purpose of human being on the earth. Thus, the true believers who trust on their Lord would not break divine law when the adversity befalls them, or when they are in to end the life situation being patient expecting better reward with their Lord.
Peaceful Friday, salaam and God bless.
Tafazzal (3/27/2020).