What instructions should Muslims put in their Advance Healthcare Directive (sometimes known as a living will)? Consider this example.
Abid has a car crash. A serious one. Among other medical problems, he is unconscious. In a hospital bed. As the days go by, doctors start to lose hope. They do some tests and take the position that Abid is in a vegetative state. He can breathe on his own. His heart’s functioning so he does not need any machines to make that work. However, doctors believe his brain is showing that he is vegetative. They tell the family that he needs food and water, so he needs a feeding tube. However, it may be best to just stop the food and water and let him die. What do you do if Abid is in your care because of an advanced health care directive?
This is a serious issue many Muslim families grapple with in their own Estate Planning. The question always comes up: “What does Islam say.” Is there something definitive in how we do our advanced health care directives and living wills? Well here is what is happening. The proposal is to deny a sick, hungry person food and water. Could that be the most compassionate thing to do? Or could it be cruel? What if there was no way for you to know the difference?
Here is some more information for you: There is no scientific test that measures of consciousness. There is often no way of knowing if a sick person knows what is going on in the world around him or her or not. It is possible to be in a coma for 15 years and then wake again with a brain just as sharp as it was 15 years before. It is unclear what “vegetative state” actually means. There is no definition for this term or a scientific way of determining if it exists.
But if you were doing your own planning, in an Advanced Healthcare Directive for example, what might you say? Common answers are “I don’t want to be a vegetable,” or “pull the plug.” But what if there are no machines keeping Abid alive except a feeding tube? What if it’s the case that the term “vegetative state” is a largely meaningless concept?
Unfortunately, I don’t have an answer for you as to the “right” decision to make in such a situation. What I can do is suggest some guidelines:
- You need to have family or friends that you name who would have the ability to make health care decisions for you in the event they cannot make it themselves. This is an enormous issue and there is a whole lot of doubt and while there are doctors involved, the science is far from precise much of the time.
- Those loved ones you trust should then have someone with religious knowledge and experience in these matters. Of course, it is your loved ones who make the decision about your treatment, not the people they consult with.
It is doubtful to me if there is much utility in stating in a document, in advance, if you want to continue being treated or not continue being treatment under certain vague circumstances in an advance health care directive. The California Advance Health Care Directive form says for example “ I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness.” Since basic questions like what consciousness is exactly and how you can determine it is not known, the language does not necessarily help. You don’t know the nature of the healthcare decision you are making just because you cannot see the future.
The best thing you can do is give the right people respond to make decisions for you, just like you would with the rest of estate planning.
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