The default Islamic ruling on seeking medical treatment is that it is permissible, as per the proofs outlined above from the Qur’an and Sunnah. Furthermore, seeking medical treatment for disease is conducive to the preservation of life, which is one of the main objectives of Islamic law. However, the circumstances of illness, which vary by patient, necessitate particular rulings.
As per the Islamic Fiqh Assembly of the OIC, the cases in which seeking medical treatment is obligatory include:cases in which refraining from medical treatment will lead to significant harm to the patient and/or one of his/her organs, as determined by the physician in consultation with the patient. In the case of an emergency situation that meets this criterion, the consent of the patient or his/her proxy is not needed for treatment. Consent is necessary in non-emergent cases;
cases in which refraining from medical treatment will lead to long-term handicap;
cases in which the patient’s disease may be transmitted to others and result in significant harm to them and/or to society, as determined by the physician.
It is recommended to seek medical treatment if refraining from it will lead to weakening of the body, even without the outcomes mentioned above.
It is permissible to seek medical treatment, but not viewed as better than refraining, if none of the above conditions are met.
It is disliked to seek medical treatment if the mode of treatment may cause complications that are deemed more harmful than the illness itself, as determined by the physician in consultation with the patient with the patient’s best interests taken into account. 
Artificial Nutrition & Hydration
The initiation of artificial nutrition and/or hydration is viewed as a form of medical treatment by Muslim jurists, as they are medical procedures done with the hope of extending life and preserving bodily strength. The physician must weigh the risks and benefits of these interventions in each particular patient—does the net gain from artificial feeding in a patient with little hope of regaining function outweigh the potential losses from its possible complications? For instance, in the case of enteral feeding, delivery of nutrients by way of the GI tract has been shown to maintain physical and immune-mediated barriers and decrease a patient’s risk of sepsis. However, it may also expose a patient to new metabolic, mechanical, and infectious complications. In such a situation, the patient’s personal goals from treatment and prognosis must be considered. Enterally feeding a patient with a good prognosis, but who cannot take in food by mouth, is permissible and at times recommended or obligatory in order to avoid the harm of starvation, which may be more likely and detrimental than the potential complications of tube feeding. Alternatively, in a patient with a grim prognosis and/or an incurable disease, the decision for enteral feeding depends on the patient’s goals. However, the benefits of artificial nutrition in end-of-life care rarely raise its initiation to the status of recommended or obligatory. It is permissible and at times disliked to initiate tube feeding in such patients, as the potential harms of the intervention often outweigh the possible benefits.
Withholding vs. Withdrawing
Life-sustaining measures, such as artificial nutrition and hydration, are considered differently once they have been initiated. Continuing with the example of tube feeding, a difference in opinion exists on whether delivery of nutrients via enteral access constitutes treatment or simple feeding of the patient. The distribution of nutrients through a tube that is already in place is not perceived as an invasive procedure, as the route has already been made and is considered an alternative to the mouth. Hence, continuing to deliver nutrients enterally is perceived as simply feeding the patient by some experts. However, the fact remains that the contents of enteral nutrition are not ordinary food, but are rather fashioned in a laboratory and optimized on a per-patient basis. This causes some scholars to equate the persistence of enteral nutrition with medical treatment. When it is considered treatment, it is permissible to withdraw artificial nutrition from a patient with little hope of recovery or who is in the terminal stage of his/her disease. However, when it is considered simply feeding, it is prohibited to withdraw enteral nutrition, as this is viewed as starving the patient. Hence, withdrawing an intervention is more problematic than the decision to initiate it, which highlights the importance of discussions with the patient and/or proxy/surrogate regarding prognosis before performing such procedures.
Regardless of the incurable or debilitating nature of a disease, it is never Islamically appropriate to take one’s own life or to take a patient’s life in hopes of saving him/her from suffering. This stems largely from the fact that preservation of life is one of the primary goals of Islamic law and that Muslims believe in a fixed life term that is pre-ordained by God. As humans, including physicians, do not know with certainty the natural progression of any given patient’s disease, it is impossible to Islamically justify assisted suicide as a method of easing his/her suffering. Rather, we are encouraged to search for treatment, as in the aforementioned statement of Prophet Muhammad
ﷺ: “Treat sickness, for God has not created any disease except that He has also created its cure.” Suicide is prohibited in the Qur’anic verse: “And do not kill yourselves [or one another]. Indeed, God is to you ever Merciful.”
Palliative care offers an alternative to suicide or euthanasia in the face of a disease with a grim prognosis, painful course, and intolerable medication side effects. It involves methods to minimize discomfort without artificially prolonging or truncating the course of an illness. Interventions to tackle pain, respiratory distress, and depression are integral to proper management of illness at the end of life.
Disorders of Consciousness (DOC)
Acute, traumatic medical events in previously healthy individuals are frequently encountered in medicine. In a state between brain death and normal life, the difficult decision of how to proceed in a patient’s care must be made. This decision is largely placed on the patient’s proxy or surrogate in consultation with the treating physician. The question arises of whether there is, from an Islamic law standpoint, a choice to withdraw life-sustaining interventions that would allow a patient to go on living indefinitely, but in a state in stark contrast to his/her normal life. The qualities that define a normal human life have been put forth by scholars and may be used to guide this decision. Jurists define life as the combination of input and output—input may be quantified as a patient’s awareness of his/her self/environment and reception of ideas. Output is a person’s own will, which may be manifested by purposeful action or communication. If both of these components are not present, then the person is not considered to be living a normal human life. There is no division in classical Islam of life into normal human and vegetative/artificial. Hence, a life devoid of either input or output is equated by Muslim jurists to the life of an embryo before it has been given its soul. Rulings of killing do not apply to such a state because it is not a normal human life to begin with. Disorders of consciousness are separated into three levels: coma, vegetative state (VS), and minimally conscious state (MCS). Patients in coma and VS have no measureable awareness of self/environment and no purposeful behavior. The differentiation between the two lies in the presence of sleep/wake cycles in VS and their absence in coma. Coma generally lasts 2-4 weeks and progresses to recovery, transitions to VS, or death. VS is deemed “persistent” when it lasts for 1 month or longer. VS is deemed “permanent” when it extends past 3 months after a nontraumatic brain injury and for 12 months after a traumatic brain injury. MCS is characterized by evidence of self and/or environmental awareness as well as reproducible purposeful behaviors. It is important to note that patterns of emergence from disorders of consciousness vary widely across patients and that prognosis is very difficult to characterize in the acute phase of an injury.
Coma and VS show little evidence of normal, sustainable human life as they are devoid of input and output. Hence, if a patient’s coma or VS is deemed irreversible (such as a permanent VS), based on the judgment of three specialty-trained physicians, it is considered permissible by most jurists to withdraw this patient’s life-sustaining measures. An MCS is considered a normal, sustainable human life, and this condition is treated as a general medical illness when considering withdrawing life-sustaining measures. An MCS in itself is not considered a condition with a grim prognosis. However, medical conditions that a patient may have in association with the MCS (e.g., a severe antibiotic-resistant infection) may lower the patient’s potential for overall recovery and make life-sustaining measures futile. Again, this must be concluded by three qualified physicians, at which point life-sustaining measures may be withdrawn. In cases in which withdrawal of life-sustaining measures is permissible, it is not obligatory to do so. The decision to continue or withdraw life-sustaining measures in these cases should be based on the surrogate/proxy’s perception of the patient’s wishes. It is critical in DOC that the physician properly educates the patient’s surrogate or proxy on the likelihood of emergence and subsequent prognosis based on the available evidence.
A question that frequently arises in discussions around medical interventions in the context of Islamic jurisprudence is the validity of brain death as a declaration of death. The American Academy of Neurology guidelines for brain death determination include two separate neurologic exams performed by trained physicians in the absence of reversible causes of cognitive depression (e.g., hypotension, hypothermia, electrolyte abnormalities, intoxicants). The evaluation necessitates an absolute lack of responsiveness, including to painful stimuli, an absence of brainstem reflexes, and an absence of respiratory drive. Ancillary tests, including an electroencephalogram (EEG), cerebral angiography, transcranial doppler ultrasonography, and cerebral scintigraphy may be used to confirm brain death. In its statement regarding the permissibility of withdrawing life-sustaining measures in a person deemed brain-dead, the Islamic Fiqh Assembly of the Muslim World League decided in 1987:
It is permissible to turn off the life support systems of a patient whose brain has completely stopped functioning on condition that a committee of three specialized expert doctors decides that the cessation is final and irrecoverable. Such permissibility is valid even if the heart and respiratory systems are still functioning mechanically due to the life support systems. However, the legal judgment of death is not declared until it is assured that the heart and respirations have fully stopped after turning off all the life support systems.
This declaration does not equate brain death with death, but rather states that death can only be declared upon the cessation of vasomotor and respiratory functions, regardless of whether those are being artificially sustained. Furthermore, it raises a stipulation that is generally not ascertained during the routine brain death evaluation: that a brain-dead patient’s whole brain has stopped functioning. The standard brain death exam that physicians perform typically evaluates specifically for brain stem function, which is considered representative of the viability of the rest of the brain. The special testing mentioned above, such as EEG to ascertain the presence of meaningful brain function and vascular studies of the brain to evaluate for adequate blood flow that is compatible with life, would provide more information on the condition of the whole brain than the brain death exam alone, and may be requested by the Muslim patient’s family.
An advance directive is drafted while a person is of sound mind and states his/her wishes about health care should he/she be afflicted with a critical illness or incapacity. As long as it conforms to the guidelines detailed above, it is recommended for a Muslim to have an advance directive, as it typically eases decision-making for the patient’s family during a time of difficulty. One component of advance directives is the “Do Not Resuscitate” (DNR) order, which communicates whether the patient wishes to have cardiopulmonary resuscitation (CPR) performed in the event that his/her heart stops beating. CPR is considered a form of medical treatment. A patient whose body has weakened at baseline and whose illness has a grim prognosis likely does not require resuscitation in the event of cessation of vasomotor function, from an Islamic perspective. In such a situation, the potential harms and limited benefits of CPR may downgrade its initiation to “disliked.” Similar to the initiation of artificial nutrition and hydration, the potential benefits of resuscitation are minimal in this scenario. A 2009 study showed that only 18% of adults aged 65 and older survived to hospital discharge following in-hospital CPR. A 2012 study found that only 2-5% of adults who underwent CPR in the field had good functional outcomes
—defined as no, minimal, or moderate neurological disability
—one month after the event. Hence, CPR is associated with its own morbidity and its outcomes vary as a function of the patient’s previous condition. CPR for a young, previously healthy patient is generally encouraged due to its higher likelihood for positive outcomes.