Prof.  Musa Mohd Nordin
Consultant Pediatrician, Malaysia
Chairman, Advisory Board of the Federation of Islamic Medical Associations (FIMA)

The cardinal purposes of  the  Muslim’s  individual,  community  and  global life  experiences  have  been  comprehensively  defined  by  the  maqasid  al- shari`ah,  the  highest  objectives  of  Islamic  jurisprudence.  The wellbeing and welfare of the community is protected by the preservation of the five essentials (daruriyyat) in human life, namely faith and morality (din), life (nafs), intellect (‘aql), progeny (nasl) and wealth (mal) [1].

In the hierarchy of the maqasid al-shari`ah, the sanctity of human life is prioritised, second only to the preservation of din. Life is a divine gift and trust from Allah  (ﷻ)  and  its  protection  and  continuation  is  of  utmost urgency and importance. “And if anyone  saved  one  life,  it  would  be  as  if  he  had  saved  mankind entirely”[2].

Allah, the Life Giver (al-Muhyi) is also the Life Taker (al-Mumit).
“He gives life and causes death (yuhyi wa yumit), and to Him you will be returned” [3].

The following prayer taught by the Prophet (ﷺ) reiterates the fact that only Allah (ﷻ) decides and determines the timing of life and death: “O Lord! Please let me live if that is for my good and please let me die if that is better for me”[4].

Death marks the departure from the continuum of temporal life here on earth and a journeying  towards  eternal  life  in  the  hereafter.  We are exhorted to invest our life righteously so as to enjoy the fruits in the life hereafter.  We are regularly reminded  to  prepare  for  the  afterlife  and central to this exhortation is the constant preparedness for death

Life and death issues become even more pronounced and complicated with end of life care and the myriad of clinical choices available. Advances in medicine and surgery have revolutionized the care of patients with cancer, cardiac disease and others with major organ failures. There have been improvements in the morbidity and mortality rates of the critical and terminal patients, however with variable and questionable betterment of their quality of life.  The power of the science of healing has somewhat overwhelmed the art of healing and has unwittingly unleashed new sets of clinical, ethical, legal, cultural and  religious  issues  which  now  challenge our objectives and ethics of end of life care.

Physicians, patients and their families are faced with extremely perplexing and painful dilemmas which include among others:

  • How much more should we allow our loved ones to suffer?
  • Should we explore all treatment options even though the prognosis is poor?
  • Should we allow the respirator, and other life support modalities, to be disconnected upon the advice of the attending clinicians?
  • Should we consent to Do Not Resuscitate orders (DNR)?
  • How much longer can we afford the care of our loved ones in the ICU?

The Federation of Islamic Medical Associations (FIMA) first formally addressed these difficult yet important end of life care issues in our 2002 and 2005-06 Year Books [5,6]. With the plethora of life-saving interventions, sophistications of  therapeutics  and  intensive  care modalities, we felt that it was pertinent to re-examine a wider range of these end of life issues, from the perspectives of maqasid al-shari`ah, as the third part of the Encyclopedia of Islamic Medical Ethics [7].

We have comprehensively addressed and updated the scientific and medical developments of end of life care, as well as analysed the psychosocial, ethical, legal and Islamic perspectives.

I have summarized the practical and key messages from these excellent reviews of major issues related to end of life care which are relevant to the daily practice of physicians who care for the critically ill or terminal patient :

  • Global life expectancy in 2015 was 71.4 years, ranging from 60.0 years in the WHO African  Region  to  76.8  years  in  the  WHO European  Region.  Global average life expectancy increased by  5 years  between  2000  and  2015.  A thorough and contemporary understanding of the effects of aging on the various systems in the human body is a basic essential towards framing a holistic program for end of life care and its unique challenges. Apart from addressing their physical, cognitive and  psychological  needs,  we  must  not neglect  their  continuing  roles  in  society  and  benefit  from  their talents, experience and wisdom.
  • Like all other   specialties   of medicine   and   surgery, a Muslim physician’s approach  to  the  specific  issues  related  to  end  of  life management must be understood within the context of disease and its treatment in the Islamic paradigm.
  • “There is no disease that Allah has created, except that He also has created its remedy” [8]. This narration and several other Prophetic traditions emphasize the Islamic tradition for research into cures for ailments, thus urging believers to be at  the  forefront  of  medical research and the treatment and elimination of diseases.
  • If the medical intervention is shown to be effective and safe  and strongly correlated with a cure or recovery, Muslim  scholars have opined that it is mandatory (wajib) to undertake the treatment.
  • Otherwise, the default rule for  all  forms  of  treatment  is  optional (ikhtiyari) and not mandatory (wajib) according to the four schools of thought in Islam (madhhab). A few scholars hold the opinion that seeking treatment is supererogatory  (sunnah).  Very few scholars opine that it is obligatory (wajib) [9,10]
  • If the specialist physician counsels  his  patient  and/or  family  that the  chances  of  a  cure  or  recovery  is  virtually  nil,  then  there  is clearly no religious rationale for ruling that it is wajib or sunnah to offer or to continue with the said treatment modality.
  • Therefore, not beginning or  discontinuing  the  treatment  modality (e.g. intubation, ventilation etc) is nothing more than choosing not to operationalise the ikhtiyari ruling. Thus, the physician cannot be penalised according  to  the  laws  (ahkam),  nor  should  he/she  feel any guilt when choosing not to execute an action which is ikhtiyari.
  • Since the  preservation  of  life  is  a  priority  of  the  maqasid  al-shari`ah, we should always endeavor our very best to preserve and maintain life.
  • When we recognize that a cure  or  recovery  is  not  a  realistic expectation, or the treatment options are an exercise in futility, or the treatment entails extreme measures, we may opt to withdraw or  withhold  such  treatment  modalities  and  should  counsel  the patient or family accordingly.
  • We should ensure our patients continue  to  enjoy  appropriate medical  and  nursing  care,  maintaining  their  fluid  and  nutritional requirements and provide optimal pain relief.
  • We should encourage hospice care  of  the  terminally  ill  as  it  is consistent with the teachings of Islam. The palliative care advocates a holistic approach, caring for the physical, psychological, social and spiritual wellbeing.
  • We should check with the patient or the immediate relatives about any advanced medical directives that stipulate the patient’s choice of medical care or interventions, should clinical circumstances (e.g. coma or dementia) render him incapable of decision making when the need arises.
  • Apart from healing  the  physical  aspects,  we  should  manifest  our empathy  by  comforting  our  patients  and  encouraging  them  to beseech healing, patience, perseverance, and mercy from Allah (ﷻ).
  • The definition and  diagnosis  of  death,  has  significant  importance and many implications from the medical, legal, ethical and Islamic perspectives.
  • Euthanasia is   categorically   prohibited  (haram)  in   Islam,   even though  it  is  increasingly  advocated  and  legal  in  a  few  western countries.
  • Encourage the practise of Talqin to ensure that our patients’ critical and end of life moments  are  righteous  with  the  remembrance  of Allah (ﷻ)



  1. Al-Shatibi (790/1388), al-Muwafaqat fial-Shari`ah, 1975; 2: 8–11, p 10.
  2. The Glorious Qur’an, Chapter 5, verse32
  3. The Glorious Qur’an, Chapter 10, Verse56
  4. An-Nasa’i 3/54,  55,  Ahmad  4/364.  See  also  Al-Albani,  Sahih  An- Nasa’i 1/281.
  5. Contemporary bio-medical  issues  in  the  light  of  Islam.  FIMA    Year Book 2002. Second Edition 2003, 97-114
  6. Geriatrics and  end  of  life  issues.  Biomedical,  ethical  and  Islamic horizons. FIMA Year Book 2005-06. Dec 2006, 1-127
  7. Medical care at end of life. Encyclopaedia of Islamic medical ethics (III). FIMA Year Book 2016.
  8. Sahih al- Bukhari 7/582
  9. Dr Yusuf al-Qaradawi, Fatwa al-Muathirah, Malay Edition, Dec 1995, Volume7 & 8, p 361.
  10. Dr Yusuf  al-QaradawiFatwa    al-Muathirah,  Malay  Edition,  Dec1995,    Volume7 & 8, p 363.