Religious teachings and reflections on advance directive--religious values and legal dilemmas in bioethics: an Islamic perspective.

INTRODUCTION In this presentation, the following Islamic concepts will be briefly outlined--the sanctity of life, the concept and definition of death, end-of-life issues, and the resulting issues of advance directives, pain control and comfort care. Some relevant case studies from the author's personal experience that highlight these dilemmas will also be explored. I. THE PURPOSE OF LIFE Islam means submission/peace--submission to the will of one God (Allah) and His will, and peace defined as inner peace with oneself, one's Creator, and His creations. (1) The key elements are true belief and righteous deeds. (2) We were created to serve (worship) God (Allah). He entrusted us with our lives, physical beings, wealth, families, communities, environment, and our earth. (3) Our responsibility is to care for and maintain that trust. (4) Muslims (followers of Islam) believe that life on this earth is only a transition period that precedes the more eternal permanent life in the Hereafter. (5) Muslims are encouraged to constantly prepare themselves, by deeds and action, for the Hereafter. The Prophet Muhammad is reported to have said, "Work for this life as if we are living forever, and work for the later life as if you are dying tomorrow." (6) II. THE SANCTITY OF LIFE Life is a girl from the Creator, and we are expected to take care of this gift to the best of our abilities. From Qur'an (7) 5:32 And if any one saved one life It would be as if he saved the life of the whole people III. THE CONCEPT OF DEATH IN ISLAM The following passages express the concept of death in Islam: Qur'an 3:185 Every soul shall have a taste of death: And only on the Day of Judgment shall you be paid your full recompense. Only he who is saved far from the Fire and admitted to the Garden will have attained the object (of Life): For the life of this world is but goods and chattels of deception. Qur'an 3:145 Nor can a soul die except by Allah's leave, the term being fixed as by writing. If any do desire a reward in this life, We shall give it to him; And if any do desire a reward in the Hereafter, We shall give it to him. And swiftly shall We reward those that (serve us with) gratitude. Qur'an 39:42 It is Allah that takes the souls (of men) at death; And those that die not (He takes) during their sleep: Those on whom He has passed the decree of death, He keeps back (from returning to life), But the rest He sends (to their bodies) for a term appointed. Verily in this are Signs for those who reflect. A. Definition of Death The following passages help define death in Islam: Qur'an 45:26 Say: "It is Allah Who gives you life, then gives you death; Then He will gather you together for the Day of Judgment about which there is no doubt": But most men do not understand. Qur'an 23:100 "In order that I may work righteousness in the things I neglected"--" By no means! It is but a word he says"-- Before them is a Partition till the Day they are raised up. Footnote 2940 Barzakh: a partition, a bar or barrier; the place of state in which people will be after death and before Judgment. Cf. 25:53 and 55:20. Behind them is the barrier of death, and in front of them is the Barzakh, partition, a quiescent state until the judgment comes. While the inevitability of death is made fairly clear in the above verses, the exact definition of death remains vague. When does one die? When the heart stops beating? When breathing stops? When the brain stops functioning? In Qur'an 39:42, Allah states that He takes away the souls upon the death of a person. Where does the soul reside, and how do health providers or lawyers determine that at the bedside? …