From the Department of Critical Care (Dr Rady), Mayo Clinic Hospital; and the Department of Physical Medicine and Rehabilitation (Dr Verheijde), Mayo Clinic.
CORRESPONDENCE TO: Mohamed Y. Rady, BChir, MB (Cantab), MD (Cantab), Department of Critical Care, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054; e-mail: Rady.Mohamed@mayo.edu
FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
Brain death remains controversial in Islam. In a literature review in a recent issue of CHEST (October 2014), Miller et al1 indicated that the majority of Muslim scholars and organizations have acknowledged brain death as true death. We wish to clarify pertinent points regarding acceptability of brain death as a criterion of death within the moral code of Islam.
The historical introduction of two alternative (brain or circulatory) criteria of death was a medical necessity to fulfill the need for procurement of transplantable organs at the end of life.2,3 Heart-beating organ procurement is performed on brain-dead donors.3 However, worldwide practice of end-of-life organ donation and transplantation requires public acceptance of brain death as an authenticated criterion of death. We have outlined elsewhere contemporary scientific evidence that refutes equating brain death with biologic death.3 A death criterion that is not scientifically validated can harm donors and families at the end of life and transgresses the moral code of Islam.4
The Quran and the Sunnah are the primary sources for the Islamic moral code, and both characterize death as a singular irreversible event.4 Furthermore, the Quran differentiates between the dying process and the final outcome of death.4 The dying process occurs over time and results in death when spontaneous disintegration of the body begins.4 In brain death, persistent somatic integration and homeostasis prevent disintegration of the body.3,5 Therefore, brain death as true death in Islam conflicts with the Quran.4 It is also not surprising that the scientific validity of the concept of brain death has been challenged in Western societies for the past 4 decades.5 Applying medically erroneous criterion of death would certainly violate the religious values of observant Muslim patients and families.3
Miller et al1 cited fatwas (legal opinions) that were issued by a number of worldwide authoritative Islamic professional and religious organizations endorsing brain death as true death. They concluded that the majority of the Islamic communities accept brain death. Fatwas in Islam that clash with the Quran, however, are considered annulled irrespective of the authoritative power of the issuing bodies. Through reinterpretation of religious scriptures and reeducation of faith leaders, the field of “Islamic bioethics” has reemerged to overcome religious barriers to acceptance of brain death in Muslim communities.4 We have cautioned elsewhere that embracing controversial end-of-life practices that violate the moral code can have profound sociocultural consequences.2,4 Islamic moral code upholds truthfulness and transparency about brain death and the inviolability of life.
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