Use Of Ventilator

[chitown]

I want to discuss something from my very recent personal experience. Earlier this year my father went on a visit to Pakistan. While there, he suffered from a stroke and fell terribly ill. Due to further complications like a very severe lung infection, cardiac arrest (he was resuscitated) and then subsequently a heart attack. While in Pakistan one of my aunts was taking care of him; I got there on the fourth day after his stroke.

 

When I got there, I found out that he was on a ventilator (which my aunt didn't tell me while I was in US). She had given the consent for the use of the ventilator. He was heavily sedated and could not move or talk. Even when he was not much sedated, he could barely communicate, it was usually just a nod or a faint blink of an eye.

 

The day I got there I was told by a very dear friend of my father (who is also a doctor) that I should prepare myself for any news. This pretty much told me that my dad was not going to make it. The doctors in the hospital said there was a chance of improvement, but they also said they will NEVR SAY NO until the very end. This was a private (and a very expensive) hospital (one could easily see their commercial interest in everything they did).

 

His condition deteriorated every day and the infection got out of control. Four days after I got there two of my aunts flew in as well and right away said we should remove the ventilator. At the time I said no, because I was told by a (shia) doctor a day before, that it is not allowed to take the ventilator off. (My father was a Sunni and so are his sisters). So I thought I should confirm this and talked to two maulanas (shia as well, as I follow the shia faith).

 

One of them was very clear that taking a machine off that can cease one's breathing is equivalent of being involved in his murder.

 

Another was of the view that if the doctors say that the patient is not going to make it then, you can take the ventilator off. But as I mentioned earlier, the doctors at the hospital said they are never going to say no.

 

We got in touch with one of our distant relatives who worked at the hospital. He went through the whole case and said to me that I needed to take his ventilator off and end his agony. Which I did; this happened 17 days after his stroke. He was then breathing on his own for another 26 hours and passed away.

 

Its been two months now and I am still very disturbed by all that happened. After he passed away the same people who had asked me to take the ventilator off said to me that I had killed my own father.

I feel guilty and not a single day has gone by where I haven't thought about all this.

 

I would like people to share any and all information they have on this issue of use of machines like a ventilator that can artificially support a person, when he/she cannot live/breathe on their own. And why is it that there is a strong verdict on it being equivalent of removal of such devices as committing or being part of a murder. Also, how is it that one aalim says its murder and the other says it is OK to remove it if the doctor says it. What I don't get is; how can it be a huge sin if you listen to one aalim, and OK if you listen to another. How are you supposed to decide? After all they are all opinions right?

 

Since these machines are so commonly used, I wish there was more awareness about his issue (which in all honestly I did not know much about until all this happened), and also wish the aalims talked more about it.

 

Thank you.

[taha8]

Hi, I just sent you an email at your address, let me know if you'd like to discuss further!

[Guest Guest]

My dad had a brain haemorhage and subsequently had a heart attack too but after CPR he returned and was put on ventilator doctors had given hope on his survival and we were informed to take him home on ventilation or were advised to remove ventilation we had to take a decision we were confused and we were just trying to find a heal for his ailment rather than asking moulana about what to do. Even though we had family members visiting him from the Molana family no one advised us that removing ventilation is not allowed in Islam later we had done it everyone said we killed him. A family in distress can only think of saving someone life or saving them from giving more pain at this situation whether we go to Moulana or not our generation kids should be educated on it else in that moment no one would be in a situation of thinking about how to go ahead. If you have a family member who stands up and guides you towards the right then you are blessed.

[Aale Mohammad]

I am a doctor and work in ICU. This ventilator issue is a huge problem and I have had countless discussions on this topic. It is an extremely complicated and difficult situation to be in and scholars do say that removing the ventilator is equivalent to murder. There is therefore a tremendous debate on this issue and many doctors have, over the last 2 decades discussed this matter with scholars but unfortunately there is no solution yet. This is an issue which has haunted Shia doctors esp. ICU doctors as well as families of patients for years.

Some important points to be considered are what constitutes as "death" in Islam? How does Islamic law define death because there is discrepancy in what scholars consider as death vs. what is death medically. Brain death is not considered death by the scholars as long as the heart is beating even if by artificial means. Some individuals can be brain dead but their hearts may go on beating for even months. If they are on ventilator, then switching it off would imply that the doctor is a murderer. Many times the family simply cannot afford to pay for the ventilator for even a few days, but scholars even then strongly believe that no matter what, even if the family has to sell everything they own and end up on the street, the ventilator must still continue. If the family refuses to pay for the ventilator, and the hospital switches it off because they cannot afford to bear the expenses themselves, then who is the murderer? 

What if a hospital has only a limited number of ventilators and one of them is being used on a brain dead individual who has been on the ventilator for many weeks with no signs of recovery. If another patient comes in who needs a vent and there is hope that the vent. will save his life, isn't it sad that the patient who could be saved would die as the vent is being used by a patient who is already medically dead. 

The one thing that scholars do allow is that a patient or his family can give orders for DNR/DNV - do not resuscitate, do not ventilate. Allowing the patient to die without putting him on the ventilator in the first place is permissible, but removing the patient from vent is not allowed, unless the heart stops. In other words, de-escalation of treatment is forbidden. 

Many doctors remove the vent. by saying that we should not prolong the misery of the patient. This is a wrong concept because every second of life is a very big blessing of Allah, even if it may appear as miserable to the person himself or to the doctors. A doctor or his relatives may feel that the patient is in misery, but the disease may be a great reward from Allah on that person because the disease may be nullifying many of the person's sins. Termination of life prior to the time Allah has decided for the patient would mean we have robbed that person of precious days of his life, even if he appears brain dead to us. 

Perhaps in the future, Shia scholars and marjas will come up with practical solutions to this extremely, critical matter. Anyone of us can face such situation in life and should be prepared before-hand. 

May Allah protect us all. 

[chitown]

@Ale Mohmmed about what  you mentioned "In other words, de-escalation of treatment is forbidden".

 

During the ordeal that I went through, in the midst of all the confusion, one Aalim in the US (who is the follower of Ayatollah Makarem) advised that the vent should not be taken off, instead we should scale back the medication each day until there was no medicine given to him. This would eventually have the same result!! 

 

There clearly needs to be a more clear and uniform guidance on this.