Withdrawing treatment, and when a person is dead

When a person is dead. The International Islamic Fiqh Academy, Resolution 17 (5/3), 3rd session, Amman, October 1986, resolves that “a person is considered deceased, and all Shariah rulings pertaining to death become effective, if he or she shows one of the following two signs: (1) complete cardio-respiratory arrest and confirmation by physicians that such an arrest is irreversible; (2) cessation of all brain activity and confirmation by physicians that such cessation is irreversible and that the brain has entered a state of” — the Academy’s own English page breaks off there, and the Arabic original completes it with “and his brain has begun to disintegrate”. It then adds: “In these circumstances, the person may be weaned from the life-support equipment, even though some of the organs in his or her body, such as the heart, continue to function artificially.” The Muslim World League’s Islamic Fiqh Council, Resolution 49 (2/10), 10th session, Makkah, October 1987, expressly citing the Amman resolution, is more cautious about the second half: the equipment may be removed once all brain function has irreversibly ceased and a committee of three specialist physicians so determines — “but he is not judged dead in law unless breathing and heartbeat stop completely after the equipment is removed”. So the two bodies agree on withdrawal and differ on when the legal moment of death falls. The North American statement. AMJA’s 19th Imams’ Conference (2023) permits withdrawing life-sustaining treatment “with the consent of the patient or their guardians ... if the doctors see that the therapeutic procedures are futile in achieving recovery or maintaining a dignified life, and that they only serve to prolong the suffering of the patients and their families”; permits a DNR direction in a terminal illness; treats artificial nutrition and hydration as forms of treatment that may likewise be withheld when futile; recommends the testimony of three experts before a condition is judged incurable; and holds that advance directives, living wills and medical powers of attorney “are in harmony with Islamic law, and their use is permissible and legitimate” — which is the sentence a Canadian Muslim planning ahead actually needs. Its earlier fatwa 2193 allows a DNR direction where the patient is in a vegetative condition and not otherwise. This is not euthanasia, and a body says so. Dar al-Ifta al-Misriyya was asked, in terms, what the difference is. Its fatwa 635 answers that removing devices that keep a hopeless patient alive with no improvement is lawful if the physicians so advise — but that devices serving another purpose, such as easing breathing, may not be removed — and then: “this differs from what is called euthanasia, in which the patient asks the doctor to end his life, or the doctor decides it himself because of the patient’s disability or the severity of his pain. That is categorically forbidden, because the patient’s life there is ongoing and not dependent on the machines ... ending it is taking a soul God has forbidden to be taken.” The same body, in 2025, called euthanasia “among the gravest of the major sins”, however requested. AMJA states the prohibition alongside the permission but does not spell the distinction out, which is why the words above are Dar al-Ifta’s. What is still open. The Fiqh Academy’s Resolution 67 (5/7) of 1992 discusses hopeless cases but its own recommendations leave the decisive question unanswered — “who decides to discontinue treatment in such cases, is it a panel of doctors, or an ethics committee, or the doctors with the patient’s relatives?” — and we found no later Academy resolution closing it. AMJA fills the gap for North America by sending an unresolved dispute to “a neutral third party like the hospital’s ethics committee or the judiciary”.