Treatment for brain death patient

Treatment for brain death patient

Brain death is when the person will never be able to breathe spontaneously or regain consciousness and permanent and total loss of brain stem function. Brain death is actually better described as Brain Stem Death. The brain stem is the lower, more primitive part of the brain which controls vital functions like breathing and your heart function. Once the brain stem dies, the rest of the body will follow suite. Artificial methods like ventilators and drugs like inotropes can keep the blood pressure up and heart beating for short time but once brain stem death occurs, it’s only a matter of time.

End-of-life issues  are religiously, emotionally, and politically charged topics. As Islam teaches, everyone will face death, and the way we and those we love die is of great individual importance. For Muslims, life is sacred because God is its origin and its destiny. Death does not happen except by God’s permission, as dictated in the Qur’an. Nevertheless, there is recognition of the fact that diseases and trauma cause death. 

In Islam, health-care providers must do everything possible to prevent premature death. But, is their aim to maintain life at any cost or merely to provide comfort so that death can come as quickly and comfortably as possible? This question evokes different and often competing ethical values, which affect the course of action taken; on the one hand, there is the obligation to save and prolong life, and, on the other, there is a call to limit life-sustaining treatment because of a lack of resources; an issue that is especially pertinent in developing countries. Who, therefore, makes the final decision between the personal values and beliefs of the people, and the more objective medical analysis made by health-care providers? Should the financial burden of life-sustaining treatment ever dictate its termination?

The role of those who provide religious guidance in these and other matters related to critically ill patients is to speak authoritatively about death and about self-imposed limits at the professional level. Medical judgments about death are based on probability; a doctor can predict the end of life with certainty, for example, only very close to the time of death. Hence, the Qur’an offers a sober reminder that there are times when human beings need to recognise their own limits and entrust nature to take its own course (Qur’an 39:42). Refusal to recognise the inevitability and naturalness of death leads to more aggressive life-saving interventions, but to withhold specific interventions at the most critical time results in deliberate avoidance of responsibility in administering the right treatment to save a patient’s life.

At several IJC meetings held in Mecca, Jeddah, and Amman, Muslim jurists of different schools ruled that once invasive treatment has been intensified to save the life of a patient, life-saving equipment cannot be turned off unless the physicians are certain about the inevitability of death. However, in the instance of brain death, which is caused by irreversible damage to the brain, including loss of spontaneous respiration, the jurists ruled that if three attending physicians attest to atotally damaged brain that results in an unresponsive coma, apnoea, and absent cephalic reflexes, and if the patient can be kept alive only by a respirator, 

then the person is biologically dead, although legal death can be attested only when the breathing stops completely afterthe turning off of life-saving equipment. 

During the past three decades people worldwide have struggled to identify the right circumstances under which life-sustaining medical treatment should be discontinued. The rapid advances in medical technology have not allowed for the concomitant development of adequate procedures and processes to regulate their introduction and use in critical-care settings. 

Religious and psychological factors play a major part in any decision that leads to termination of life. Muslim scholars have debated the issue in the context of braindeath and retrieval of organs.  Although there seems to be a consensus among legal experts from different schools of Islamic law about brain death that results from irreversible damage to the brain, the question that remains to be answered is a theological one connected with the location of the human soul at the time of death. The classical legal definition of death connects death with the traditional signs, including  complete cessation of the heartbeat. For most jurists, this factor is the sole criterion for legal (shar’i) death.

Biological data about the function of the heart and other major activities, however, connect life with the brain. In a detailed study,  Husayn Habibi, physician and ethicist, compared the scientific information with the juridical definition of death, and convincingly argued that the brain is the location of the soul, the active principle of life endowed with consciousness. This discrepancy between the religious and scientific definitions of death has generated even greater challenges for families and health-care professionals who have to make decisions about the withholding of a life-saving medical intervention, for instance, in the treatment of cardiopulmonary arrest. Cardiopulmonary arrest is thefinal common pathophysiological event in the dyingprocess; without cardiopulmonary resuscitation,involving external chest compression and some form ofartificial respiration, death is certain.

In Islamic ethics an individual’s welfare is intimately linked with his or her family and community.Accordingly, the principle of autonomy (which affords the individual liberty and capacity to make a decision without coercion or other conditions that restrict one’s options) is not invoked to determine a course of action in matters related to end-of-life decisions. Whether or not a doctor can prolong life by introducing aggressive invasive treatments without causing further harm is a joint decision made by all associated with the patient. In some instances the matter is even eferred to the religious leaders, who povide prescriptive rulings for the families’ consideration.

“How fortunate you are that you died while you were not afflicted with illness”,  said the Prophet addressing the person whose funeral rites he was reading. Such an assessment of death without illness, coming from the founder of Islam, indicates the importance attached to a healthy life in Muslim culture. Good health is God’s blessing for which a Muslim, whenever asked, “How are you [How is your health?]?” responds, “All praise is due to God!” This positive appraisal of good health suggests that illness is an evil that should be eliminated at any cost, and no doubt illness is seen as an affliction that is to be cured. In fact, our search for a cure for every disease is founded on the unusual confidence generated by the divine promise that God has not created a disease without also creating its cure. 

Hence, the purpose of medicine is to search for a cure through the application of human knowledge and scientific endeavour, and to provide the necessary care to those afflicted with diseases. The primary obligation of a Muslim doctor is to provide care and alleviate pain. Decisions about ending the life of terminally ill patients at their request are beyond a doctor’s moral and legal obligations: “it is not given to any soul to die, save by the leave of God, at an appointed time.” (Qur’an 3:145) “By the leave of God” in this instance means the destiny that is fixed by God for every individual. Moreover, “God gives life, and He makes to die” (Qur’an 3:156). Hence, “A person dies when it is written” (Qur’an 3:185, 29:57, 39:42). 

However, persons are generally compelled to end their life when in severe discomfort, and when all advanced medical treatments have not restored the hope of a return to good health. How is pain, therefore, viewed by Islam? And to what point is life worth preserving?

Treatment for brain death patient is euthanasia. Euthanasia  is mercy killing, the deliberate ending of a person's life to reduce their suffering. The intentional killing by act or omission of a dependent human being for his or her alleged benefit. The key word here is "intentional". If death is not intended, it is not an act of euthanasia. 

Also known as assisted suicide, physician-assisted suicide (dying) , doctor-assisted dying (suicide), and more loosely termed mercy killing, basically means to take a deliberate action with the express intention of ending a life to relieve intractable (persistent, unstoppable) suffering. Some interpret euthanasia as the practice of ending a life in a painless manner. Many disagree with this interpretation, because it needs to include a reference to intractable suffering. 

By Action, do it intentionally causing a person's death by performing an action such as by giving a lethal injection. By Omission, do it intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water. 

Assisted suicide, It is someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. Physician Assisted Suicide, It is when it is a doctor who helps another person to kill themselves. 

There are two main classifications of euthanasia. First, voluntary euthanasia. It is when the person who is killed has requested to be killed. It has been legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon (USA) and Washington (USA). Second, non-voluntary euthanasia. It is when the person who is killed made no request and gave no consent. 

There are two procedural classifications of euthanasia. First, passive euthanasia. This is when life-sustaining treatments are withheld. The definition of passive euthanasia is often not clear cut. For example, if a doctor prescribes increasing doses of opioid analgesia (strong painkilling medications) which may eventually be toxic for the patient, some may argue whether passive euthanasia is taking place - in most cases, the doctor's measure is seen as a passive one. Many claim that the term is wrong, because euthanasia has not taken place, because there is no intention to take life. Second, active euthanasia. This is lethal substances or forces are used to end the patient's life. Active euthanasia includes life-ending actions conducted by the patient or somebody else.

There is no euthanasia unless the death is intentionally caused by what was done or not done. Thus, some medical actions that are often labelled "passive euthanasia" are no form of euthanasia, since the intention to take life is lacking. There are not euthanasia if not commencing treatment that would not provide a benefit to the patient, withdrawing treatment that has been shown to be ineffective, too burdensome or is unwanted and he giving of high doses of pain-killers that may endanger life, when they have been shown to be necessary.

Ethics of death and dying, The debate on the need to withhold or withdraw ‘futile’ life-prolonging treatments and the idea of ‘death with dignity’ was started by intensive care physicians (not ethicists or lawyers) in the mid-1970s . At present, almost half of all deaths in intensive care follow a decision to withhold or withdraw treatment . There is no moral or legal distinction between withholding or withdrawing. As discussed above, person who is brain dead is dead — disconnecting the ventilator will not cause him or her to die. Patients in a vegetative state are not dead, but when their situation becomes hopeless it can be judged unethical to continue their life-sustaining treatment. Unlike patients with brain death, patients in a vegetative state do not usually require ventilatory or cardiac support, needing only artificial hydration and nutrition. The internationally reported case of Terri Schiavo centred first on opposing opinions between her husband and parents about whether she would wish to continue living in such a severely disabled state, and also on the lack of family consensus regarding her diagnosis of vegetative state. This case illustrated how hard it is for lay persons (and inexperienced physicians and policy makers) to accept the medically established ethical framework that justifies letting patients in an irremediable vegetative state die. Misinformation stemming from highprofile cases such as Schiavo’s may increase societal confusion and consternation about end-of-life decision-making.

Reasons Proposed for Euthanasia  are first, unbearable pain. It probably the major argument in favor of euthanasia is that the person involved is in great pain. Today, advances are constantly being made in the treatment of pain and, as they advance, the case for euthanasia/assisted-suicide is proportionally weakened. 

Second, right to commit suicide. It probably the second most common point pro-euthanasia people bring up is this so-called "right." But what we are talking about is not giving a right to the person who is killed, but to the person who does the killing. In other words, euthanasia is not about the right to die. It's about the right to kill. Euthanasia is not about giving rights to the person who dies but, instead, is about changing the law and public policy so that doctors, relatives, and others can directly and intentionally end another person's life. People do have the power to commit suicide. Suicide and attempted suicide are not criminalized. Suicide is a tragic, individual act. Euthanasia is not about a private act. It's about letting one person facilitate the death of another. That is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us. Nearly all pain can be eliminated and - in those rare cases where it can't be eliminated - it can still be reduced significantly if proper treatment is provided. It is a national and international scandal that so many people do not get adequate pain control. But killing is not the answer to that scandal. The solution is to mandate better education of health care professionals on these crucial issues, to expand access to health care, and to inform patients about their rights as consumers. Everyone - whether it be a person with a life-threatening illness or a chronic condition - has the right to pain relief. With modern advances in pain control, no patient should ever be in excruciating pain. However, most doctors have never had a course in pain management so they're unaware of what to do. If a patient who is under a doctor's care is in excruciating pain, there's definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will kill the patient. There are board certified specialists in pain management who will not only help alleviate physical pain but are skilled in providing necessary support to deal with emotional suffering and depression that often accompanies physical pain.

Third, people should not be forced to stay alive. Neither the law nor medical ethics requires that "everything be done" to keep a person alive. Insistence, against the patient's wishes, that death be postponed by every means available is contrary to law and practice. It would also be cruel and inhumane.There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That's where hospice, including in-home hospice care, can be of such help.That is the time when all efforts should be placed on making the patient's remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patient's loved ones.

Fourth, people should not be forced to stay alive. Neither the law nor medical ethics requires that "everything be done" to keep a person alive. Insistence, against the patient's wishes, that death be postponed by every means available is contrary to law and practice. It would also be cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That's where hospice, including in-home hospice care, can be of such help. That is the time when all efforts should be placed on making the patient's remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patient's loved ones.

Arguments for and against voluntary euthanasia  are first, choice which is freedom of choice is the cornerstone of free market systems and liberal democracies. The patient should be given the option to make their own choice. Second, quality of life, only the patient is really aware of what it is like to experience intractable (persistent, unstoppable) suffering; even with pain relievers. Those who have not experienced it cannot fully appreciate what effect it has on quality of life. Apart from physical pain, overcoming the emotional pain of losing independence is an additional factor that only the patient comprehends fully. 

Third, dignity. Every individual should be given the ability to die with dignity. Fourth, witnesses which is people who witness the slow death of others are especially convinced that the law should be altered so that assisted death be allowed. Fifth, drain on resources - in virtually every country there is never enough hospital space. Channelling the resources of highly-skilled staff, equipment, hospital beds and medications towards life-saving treatments makes more sense; especially when these resources are currently spent on terminal patients with intractable suffering who wish to die. Sixth, public opinion - in nearly all countries a significantly higher proportion of people are for euthanasia than against it. In a democracy legislation should reflect the will of the people. Seventh, humane . It is more humane to allow a person with intractable suffering to be allowed to choose to end that suffering. Eighth, loved ones - it helps shorten the grief and suffering of the patient's loved ones. Ninth, we already do it - if a loved pet has intractable suffering we put it down. It is seen as an act of kindness. Why should this kindness be denied to humans?. Tenth, prolongation of dying - if the dying process is unpleasant, the patient should have the right to reduce this unpleasantness. In medicine, the prolongation of living may sometimes turn into the prolongation of dying. Put simply - why should be patient be forced to experience a slow death?. Eleventh, Muslims are also against euthanasia and suicide: The Qur'an says, “Do not take life, which Allah made sacred, other than in the course of justice.” (Qur’an, Surah, Al-Isra' 17.33) 

As a conclusion, in Islam, the killing of a terminally ill person, whether through voluntary active euthanasia or physician assisted suicide, is judged an act of disobedience against God. However, pain-relief treatment or withholding or withdrawing of life-support treatment, in which there is an intention of allowing a person to die when there is no doubt that their disease is causing untreatable suffering, are permissible as long as the structures of consultation between all the parties concerned about the wellbeing of the patient are in place. 

To warn against suicide Prophet Mohammad said," Whoever kills himself with an iron instrument will be carrying it forever in hell. Whoever takes poison and kills himself will forever keep sipping that poison in hell. Whoever jumps off a mountain and kills himself will forever keep falling down in the depths of hell.” Muslim Physicians are not encouraged to artificially prolong the misery in a vegetative state, however, they are ordained to help alleviate suffering. On pain, suffering and endurance, Islam has special consideration: “Those who patiently persevere will truly receive a reward without measure” (Al-Qur’an Surah, Zumar, 39:10).