Technology at the end of life: “Medical futility” and the Muslim PVS patient

Abstract

Advanced life-sustaining technologies can now prolong indeterminately the lives of patients in a persistent vegetative state (PVS). However, where the assistance rendered is not expected to restore consciousness, they are considered futile from a medical perspective. English law, in such a scenario, has taken the view that it is not in the best interests of the patient to continue to receive medical intervention. This makes it lawful to discontinue all life-sustaining treatment and medical support measures including the termination of clinically assisted nutrition and hydration (CANH). The withdrawal of such apparatus, which is classified as medical treatment, is deemed as an omission rather than negligence or an act which causes death. In light of this, the law holds that doctors are merely allowing such patients to die a natural death rather than bringing about their death. The medical debate on the matter, which is underpinned by a series of intertwined medico-legal concepts which justify the English Law position, is often considered as settled. The UK Court of Protection was nevertheless recently asked to resolve a conflict between the family of a Muslim PVS patient who objected to his doctors' intention to withhold resuscitation or ventilation should there be a life-threatening event on the grounds that such measures would be futile and thereby not in the patient's best interests. The family instead insisted that all steps should be taken to preserve the patient's life until such time that God takes it away. This paper seeks to discuss how such medical futility or at least the semantic conceptual landscape (which also includes best interests, omissions and medical treatment) that determines the legal position is dealt with under Islamic Law with a view to assess its compatibility with English Law. Some of the key questions that the article will consider as part of the above will be: does Islam allow all medical interventions, including CANH to be withdrawn when these are not expected, by medics, to bring any medical benefit? Or does it instead deem their withdrawal from such patients, who may still be able to breathe naturally, as an activity which is tantamount to killing? The work concludes by emphasizing the need for more religiously and culturally sensitive discussions to take place among medical, legal and religious representatives.