Mercy Killing (Euthanasia) between Religion and Medicine

The students of the Faculty of Medicine conducted a dialogue via the internet with His Eminence, the Religious Sayyed Muhammad Hussein Fadlullah. This dialogue centered on the religious stance towards the issue of mercy killing.

The issue of medical care at the end of one's life is a controversial one. The religious opinions occupy an important position when such issues are considered. Although many medical students, believe in the necessity of separating religion from medicine, many other doctors, nurses, and patients believe that religion has an essential role in making decisions related to medical care, especially the ones related to the cases of ending one's life.

Today, we converse with His Eminence, Sayyed Muhammad Hussien Fadlullah, who is well-informed and distinguished in both religion and science at the same time. His Eminence is not a new comer when it comes to medicine. He has many known published opinions about the issues of religion and medicine such as mercy killing, abortion, cloning, in-vitro fertilization… etc.

Q: We welcome His Eminence, Sayyed Muhammad Hussein Fadlullah in our campus. What is the religious stance towards mercy killing?

R: The issue of mercy killing is usually dealt when the patient asks his doctors to put an end to his pains. Faced by such a preposition, we ought to ask: Does the person own his body, in a way that he has the absolute right to do with it whatever he wants, such as piercing his eyes or cutting his hand? Regardless of the religious question, we ask whether one's own life is a personal or an existentialist universal issue?

We consider that the person's own life is one of the secrets of his existence and that he does not own his existence, because there is no duality between the person and his existence, as is the case between the owner and what he owns. The person's role is to use both his body and his life and to mess up with them. In the light of this, we say that this person possesses neither his soul nor his life. Therefore, the issue of mercy killing is one of the issues that the person does not have the right to ask for nor do doctors have the right to do, even if they are asked to, because the person is asking to end something he does not possess. If the doctor does, then he becomes a killer exactly like any other killer.

If man possesses his soul, in the religious sense of the word, then it would be possible to say that man is free to commit suicide based on the idea that if man possesses something, the he is free either to keep it or get rid of it. Accordingly, if a person suffers from psychological problems –some people may not suffer from physical pains as a result of an incurable disease, but as a result of some psychological pains which lead them to despair – does he have the right, in this case, to ask his doctor to end his life by means of mercy killing? We refuse this, since there is no religious or human basis for such a thing. Allah blessed man with life and He is the only one Who possesses this life on the ground that He gives life and takes it. This is not only the religious idea, but it is also the existential one.

Nevertheless, there is only one case to which I issued a Fatwa allowing the ending of "life". It is only in the case of brain death, that I do not prohibit the removal of the devices that stimulate the heart; at the same time I do not deem it necessary to install them, since just as these devices do not give life to the person, their removal does not kill life either, but it kills the artificial cell that can be called "vegetal life". Therefore, I issued a Fatwa saying that we do not object on the removal of the devices, thus ending the life of this cell. Similarly, religiously speaking, we must not install them when we are asked to; since the medical supposition confirms that the brain death represents the final death of the person's biological life.

In any case, the patient does not have the right to ask his doctors for mercy killing, under the pretext that they have to provide him with a calm death, even if they suppose that there is no hope in his recovery.

In the light of what I have mentioned, no authority, whether religious, medical, or political has the right to order mercy killing because mercy killing is not religiously (juristically) justified.

Let us suppose, and we are allowed to suppose, because there is also what is called science fiction, let us suppose that the moment this patient asks for mercy killing medicine discovers a treatment to his disease. So why should we shut the doors before the medical discovers that would take place at any moment? Life is a gift from God. Accordingly, we do not have the right to do with it whatever pleases us, under any physical or psychological influence.

Q: In the state of brain death, who has the right to decide whether to remove the devices or not; the husband or the wife?

R: It is possible that the person who follows up the patient's case has the right to decide. But this is only when we know that the patient is in the state of brain death and that the only life existing is that of the cell. For example – with our total respect to the human being – when the snake's head is cut, its tail keeps on moving, or when we want to implant an eye or a heart in the body of another person, we keep the cell of these organs alive, although the body is totally dead. In this case, if there is no person to take such a decision, the doctors can simply do it.

Q: Your Eminence, in the case of a patient who has no hope for recovery, does he have the right to stop the treatment and stop eating or drinking water leaving himself for a quiet death?

R: If he were, to live even for one more week, then he does not have the right to end his life before that.

Q: Commenting on this idea can the person, for example, state in his will not to be revived after his heart or his breathing stops?

R: Since the will is applied only after one's death, such a will is meaningless. No one has the right to take a decision in putting an end to his life.

Yes, the will can be applied if the patient has donated some of his organs after his death. This is legal and allowed, and I issued a Fatwa deeming it permissible. However, if he is still alive and asks those around him to stop nurturing and treating him, even if it is for a short period of time, such a decision is worthless, since he does not own his life.

Q: Your Eminence, once again, we would like to follow up on the same question. If the patient is alive and says that if he enters in a state of coma he does not want anybody to insert a tube in his mouth or make him live via machines, does he have the right to take such a decision, of course we are talking here about a coma and not about brain death?

R: If there is no brain death and there is a chance for him to stay alive, even through the use of certain medications or machines, then he does not have the right to take such a decision.

Q: If the patient suffers from an incurable disease and is in need for a long time treatment that will not cure him, does he have the right to put an end to his treatment and go home, because neither he nor his family can afford the high cost of the treatment?

R: We must keep on treating him for as long as we can. If the patient's financial situation does not allow him to continue his treatment, then it becomes a societal responsibility. From the religious perspective, all people must contribute in saving the life a human being if they can, even if the patient's case requires one or two years of treatment. The general responsibility of the society, including the doctors and the government, is to save those whose lives are endangered and are unable to afford the expenses of their treatment. Saving a human being is indeed, a human duty and, thus a social one.

Q: The patient's incurable disease might be so costly that the hospital cannot afford due to the limited capabilities that are available in the hospitals. Therefore, this money that is used for a treatment of a hopeless case can be used for the treatment of tens of other patients. Is there any legislative stance towards this issue?

R: We must cure him in as much as we can, "Allah does not impose upon any soul a duty but to the extent of its ability." (2:286). If the other ten patients need to be saved and there is a chance for saving the patient with the incurable disease as well, we have to try. But if the hospital can not tend to both, then it is the responsibility of every person (outside the hospital) to try to save him. Accordingly, we ask the hospitals never to refuse or abstain from accepting any critical patient even if he does not have the money to cover the expenses. In fact, it is illegal and anti-religious to abstain from helping him. It is obligatory to help this person and try to save him.

Q: If the patient suffers from a severe pain, because of cancer, for example, and the doctors said for example that will not live more than six months, and at the same time, there is a medicine that might alleviate his pain, but this medicine might shorten his living days. Is it allowed to give him this medicine?

R: We have to try as much as we can. If we are able to keep him alive by giving him the medicine that his body can endure, then we have to do it. However, if the patient's pains are so severe that he cannot endure, and this medicine can alleviate them, then we have to ease his pains, and it is up to God to decide when to end the human life.

Q: Your Eminence, how can a religious person issue Fatwas in such significant issues, especially that such things require much knowledge in the medical field. Is not it better to separate religion from medicine?

R: There are two aspects in medicine. The first is the scientific aspect, while the second is the human one, which impels that the graduate from the school of medicine should take an oath to be faithful to the human being when treating patients and alleviating their pains. Therefore, I believe that the field of science, whether it is medicine or something else, should conform to the human values. We believe, for example, that medicine is found to serve human beings, so we should not turn it to act against man and his benefit, at the same time. According to that, we have to understand the religious approach towards any issue and keep in mind that there are several religious points of view concerning any single issue. Thus, we might find a certain authority deeming something permissible while the same thing might be prohibited by another. And we might find two different religious perspectives concerning the same issue. One side might deem it lawful, while the other might prohibit it. Therefore, for every issue, we have to compare between the religious axioms and the medical considerations. I simply do not think that religion differs from medicine, because we have learned that knowledge is of two kinds: The knowledge of religion and the knowledge of the bodies.

Q: If a doctor is asked by the family or by another doctor not to keep patient alive by means of machines, but the doctor is not convinced with that what is the religious stance in this case?

R: This doctor must do what he believes in, if he is convinced that keeping the patient alive is beneficial. He must not apply the negative instructions, especially that both the family and the doctors do not have the authority to take such a decision. Nobody has the authority over the patient either from the legislative side or from the general humanity.   

Q: Sometimes, the patient might need a surgical operation that might be very dangerous, but the family or the patient refuses it. Should the doctor, in this case, insist or should he listen to the family?

R: If the danger of this operation on the patient is 90%, and the patient refuses to be exposed to this danger, then the doctor should not perform it.

Q: Sometimes, the patient's family asks us to give the patient untruthful hopes, especially for the hopeless cases. Religiously speaking, should we be truthful?

R: We have to take into consideration the patient's health and psychological conditions. If truth is dangerous for him, we should not tell him. But if telling him the truth makes him more open on the future, then it is acceptable to tell him. This depends on the health and the psychological conditions of the patient.

Q: Is not it better to tell the truth to the patient so that he might be given a chance, either to repent to God or to write his will?

R: Telling the truth is the norm, unless it exposes his life to a direct danger.