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dragonxx

Palliative Care in Shia Islam

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Definitely health care professionals will continue to treat their patient for as long as they can. When there is no hope for a recovery, the patient is transferred to palliative care or hospice. Every patient (whether a believer in a religion or without any religion) would be treated with care and comfort. Shia Islam is not against palliative care.  

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On 6/19/2020 at 12:30 AM, Liggel said:

When to stop antibiotics

i think this is one of the toughest and scariest because it is so easy and cheap to give yet so effective... so many situations where a patient with a 3 month prognosis due to for example cancer, gets some sort of infection, and antibiotics are not given because the patient is persuaded into palliative effectively shortening their prognosis to 1-2 weeks cuz of the untreated infection... i find it hard that shia islam would support this @Hameedeh, could you please elaborate sister?

Isn't it so that perhaps our suffering is extended in this world in order to expiate our sins for a pure, painless welcoming into the next world?

Or can an old man leave a will while he is competent and say "if I catch a very bad case of corona and need a ventilator, don't even try to put me on it, let me die"?

On 6/19/2020 at 1:28 AM, starlight said:

I was a part of one End of life decision more than a decade ago that haunts me to this day. Infact I was thinking about it last night too.It goes to the point where I start asking myself if I should have refused to follow my consultant's orders? did I take away a human life? if I should fast for two months for kaffara? 

 

i am sure you thought of this, but it would have happened anyway whether you were there or not, perhaps that is some consolation. As someone working under a consultant you effectively have no choice. You could have tried saying the patient wants to get back home or made up some lie about the patient but eventually they would find out.

Honestly what spurred me to start this topic is being in a similar situation to which you are alluding to, and i myself don't completely buy the excuse i just gave =/

There are even consultants who insist their resident prescribes regular/more dilaudid in a patient with cirrhosis with a 3 month prognosis due to several diseases who happens to have no family support, the excuse being to enhance comfort although the patient wants to get back home (for those unfamiliar, the consultant is intentionally shortening +/- ending the patient's life with excess pain medication that the patient isn't asking for)

 

These days are worse than ever, as now it is starting to be expected of the trainees in the West to offer "medical assistance in dying" to patients with a very bad prognosis in addition to other options like palliative measures vs. life-prolonging treatment, etc..

Edited by dragonxx

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On 6/18/2020 at 10:32 PM, Hameedeh said:

Definitely health care professionals will continue to treat their patient for as long as they can. When there is no hope for a recovery, the patient is transferred to palliative care or hospice.

Some people think palliative care and hospice care are the same thing. Actually there is a difference. Palliative care can begin at diagnosis, and goes on during the patient's treatment. Hospice care begins after treatment of the disease is stopped because it is clear that the patient is not going to recover.

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15 hours ago, ShiaChat Mod said:

Some people think palliative care and hospice care are the same thing. Actually there is a difference. 

Sorry, I thought that too.

15 hours ago, ShiaChat Mod said:

Palliative care can begin at diagnosis, and goes on during the patient's treatment. Hospice care begins after treatment of the disease is stopped because it is clear that the patient is not going to recover.

Thank you for explaining that. 

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On 6/21/2020 at 7:18 AM, dragonxx said:

Isn't it so that perhaps our suffering is extended in this world in order to expiate our sins for a pure, painless welcoming into the next world?

Or can an old man leave a will while he is competent and say "if I catch a very bad case of corona and need a ventilator, don't even try to put me on it, let me die"?

Salam from my experience my father took care of both of my grandparents until last second of their life by himself  because he was feeling responsibility &  kindness toward them although he could put them in an adult care center also his father  sometimes was wishing death because of his illness so we must think out of box of religion as a humanitarian duty for caring elders although Islam orders us to take care of all patients even old people in any situation which also Shia Islam is highly focused on caring old parents like palliative care than other sects that we can't leave someone to die even he wishes it also during Iran-Iraq war nurses & doctors in Iranian side were trying to save everyone souls even when victims had a low chance of surviving or even was an Iraqi soldier .

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4 hours ago, Ashvazdanghe said:

he could put them in an adult care center also his father  sometimes was wishing death because of his illness so we must think out of box of religion as a humanitarian duty for caring elders although Islam orders us to take care of all patients even old people in any situation which also Shia Islam is highly focused on caring old parents like palliative care than other sects that we can't leave someone to die even he wishes it also during Iran-Iraq war nurses & doctors in Iranian side were trying to save everyone souls even when victims had a low chance of surviving or even was an Iraqi soldier .

May Allah reward your father for taking care of your parents but this is different.

If an elderly patient is in the last stages of uncurable cancer, who has also developed bed sores and has to be fed with the help of a tube,is not well oriented mentally and hence unable to communicate with family now develops a respiratory infection. Would giving him antibiotics for respiratory infection be equivalent to prolonging his miserable life by a few days?

Because it's obvious he is not going to recover from his illness and its associated complications,are the financial costs of putting him on ventilator worth it?

Because he is not going to recover so should we utilize the ventilatory support for another patient instead who has a better chances of recovery and let him die in peace(Being on ventilators is uncomfortable, to say the least)

Or a preterm baby born with a severe birth defect e,g anencephalic( a large part of the skull and brain is missing, babies are often blind, deaf and are unable to feel things by touch who do not survive beyond a few weeks at most.) Should such babies be resuscitated, offered life support? Keeping in mind the longer the baby lives higher will be financial and emotional toll on the parents. 

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Whilst I understand that withdrawing care is subject to many variables including ethical, financial, quality of life etc, I should note that according to Sayed Sistani, one cannot withdraw care as long as there is a heartbeat.

السؤال: متى يجوز رفع اجهزة الانعاش الصناعي ؟ هل يجوز رفعها اذا حصل تزاحم في الحالات المرضية وقرر الاطباء ان يرفعوا الاجهزة عن المريض ميئوس من شفاءه لانعاش مريضٍ آخرٍ ؟ وما حكم استمرار الطبيب بوضع أجهزة الانعاش رغم ثبوت موت دماغه ؟

الجواب: يُحكم بحياة المريض ما دام قلبه نابضاً، وعليه لا يجوز رفع الجهاز عنه إذا كان يؤدّي إلى توقف قلبه وإن كان لإيصاله بمريضٍ آخر، والله العالم.
 
 
"Question: When is it permissible to withdraw mechanical resuscitation? Is it permissible to withdraw it when there is pressure (in numbers) on healthcare providers and doctors decide to withdraw it from a patient with a hopeless recovery prospect to resuscitate a different patient? What's the ruling on a doctor continuing the use of resuscitation machines despite confirming the patient is brain dead?
Answer: A patient is considered alive as long as his heart is beating, and therefore it is impermissible to withdraw the machine from him if it results in his heart stopping, even if it was for the purpose of using the machine on a different patient. "
    

May Allah help and guide the doctors and families going through such difficult tests. 

Edited by Moalfas

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If a person is at home, he/she won't be on life support. It is when they are transferred to a medical setting (hospital, rehab, hospice) that life support might be started. What is life support? Usually a ventilator to keep the patient breathing: 

Quote

One end of a tube goes into the windpipe through the nose or mouth. The other end attaches to the electric pump. 

Before life support starts, patients can make the decision to refuse life support:

  • You decline it outright.
  • You left written instructions saying you don't want it.
  • Your medical power of attorney or closest family member, with the right to make decisions for you, turns it down on your behalf.

https://www.webmd.com/palliative-care/what-is-life-support#1

Edited by ShiaChat Mod
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18 hours ago, starlight said:

not well oriented mentally and hence unable to communicate with family

Salam both of my grandparents had this issue in final days of their life  anyway out of religious  duty my father continued caring them because  of his love for them untill  their last breath anyway in any case Allah determined  our lifetime so we must do our best for caring anyone  until they reach to end of time of their life on earth that in any case that you mentioned we can't  let elders die because they just waste time & space and about child the parents will receive their reward in other aspect of their worldly life but the greater reward will be in judgment  day.

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33 minutes ago, Ashvazdanghe said:

you mentioned we can't  let elders die because they just waste time & space and about child the parents

Sometimes doctors don't make the rules.

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Everything  is not rules & rules are vary in each country anyway I think we talk here about moralism .

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On 6/23/2020 at 8:48 AM, Moalfas said:

Whilst I understand that withdrawing care is subject to many variables including ethical, financial, quality of life etc, I should note that according to Sayed Sistani, one cannot withdraw care as long as there is a heartbeat.

السؤال: متى يجوز رفع اجهزة الانعاش الصناعي ؟ هل يجوز رفعها اذا حصل تزاحم في الحالات المرضية وقرر الاطباء ان يرفعوا الاجهزة عن المريض ميئوس من شفاءه لانعاش مريضٍ آخرٍ ؟ وما حكم استمرار الطبيب بوضع أجهزة الانعاش رغم ثبوت موت دماغه ؟

الجواب: يُحكم بحياة المريض ما دام قلبه نابضاً، وعليه لا يجوز رفع الجهاز عنه إذا كان يؤدّي إلى توقف قلبه وإن كان لإيصاله بمريضٍ آخر، والله العالم.
 
 
"Question: When is it permissible to withdraw mechanical resuscitation? Is it permissible to withdraw it when there is pressure (in numbers) on healthcare providers and doctors decide to withdraw it from a patient with a hopeless recovery prospect to resuscitate a different patient? What's the ruling on a doctor continuing the use of resuscitation machines despite confirming the patient is brain dead?
Answer: A patient is considered alive as long as his heart is beating, and therefore it is impermissible to withdraw the machine from him if it results in his heart stopping, even if it was for the purpose of using the machine on a different patient. "
    

May Allah help and guide the doctors and families going through such difficult tests. 

Ok impermissible to withdraw the machine, but what about starting the patient on the machine in a hopeless situation like some examples highlighted above?

 

Also Sayed Mohammed al Hakeem has a bit of a different ruling:

Question : If a patient is diagnosed as brain dead and expert medical opinion says that he is not going to get out of his coma, is it permissible to switch off the ventilator machine that he is using?
Furthermore, if the treatment which is being offered to the patient is not helping him medically and he is considered incurable, is it allowed to stop his treatment and medications?

Answer : If the machines and the instruments are keeping the heart beating and the blood circulating, then it is permissible to disconnect them. If they are helping the heart in such a way that it would continue to beat when the machines are disconnected – although with difficulties and weakness – then it is not permissible to disconnect the machines.
It is not obligatory to continue treating the patient in the first case and it is obligatory in the second case.

http://www.alhakeem.com/en/questions/681

 

But again this obviously doesn't address many issues, such as the one's that @starlight raised which happens to occur by the 1000s every day.

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2 minutes ago, dragonxx said:

Q: "Furthermore, if the treatment which is being offered to the patient is not helping him medically and he is considered incurable, is it allowed to stop his treatment and medications?"

A: "it is obligatory in the second case."

also this answer does not make sense.

the questioner is saying the treatment is not medically helping yet the answer is to treat anyway...

So a patient with progressive cancer despite chemotherapy should continue to get chemotherapy only to potentially die faster from another cause?

Or should we still give pills to an 90 year old man on death's door for whatever conditions he has although we know it won't medically improve the patient's life or prolong it?

This is a huge deficiency in guidance that our marjaas need to address. Do literally everything you possibly can for every patient is not sufficient guidance in a world with limited resources, and in a world where muslims families live under unislamic laws and muslim workers must work by unislamic policies. This needs to be addressed... and if it has been in a book or website somewhere please someone enlighten me.

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@dragonxx

I agree that the general rulings set out above would not necessarily cover the vast range of variables that are faced in such dire situations. What I would suggest is to have a group of professionals in the medical field suggest and agree to a set of say 10 more specific questions that would cover the majority of scenarios faced including the specifics about adhering to patient care policies set out in their respective non-Islamic jurisdictions. These set of questions can then be put forward to our main Maraji' and will hopefully further guide professionals and families alike in such circumstances.

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20 hours ago, Moalfas said:

@dragonxx

I agree that the general rulings set out above would not necessarily cover the vast range of variables that are faced in such dire situations. What I would suggest is to have a group of professionals in the medical field suggest and agree to a set of say 10 more specific questions that would cover the majority of scenarios faced including the specifics about adhering to patient care policies set out in their respective non-Islamic jurisdictions. These set of questions can then be put forward to our main Maraji' and will hopefully further guide professionals and families alike in such circumstances.

good idea, i wonder if they will address even those though. and unfortunately while that would be a nice start if it were answered, there 100s more similar questions that would be unique in their own way and deserves a specific answer 

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On 6/30/2020 at 9:18 PM, dragonxx said:

good idea, i wonder if they will address even those though. and unfortunately while that would be a nice start if it were answered, there 100s more similar questions that would be unique in their own way and deserves a specific answer 

Jurists through their offices are always receiving and answering literally hundreds of questions on a daily basis; and the more complicated/case specific questions that aren't covered by their general rulings can always be put forward for specific and detailed rulings by the Faqeeh/Jurist himself. I don't see why they wouldn't answer important medical decision making questions if presented to them.

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On 7/3/2020 at 4:56 AM, Moalfas said:

Jurists through their offices are always receiving and answering literally hundreds of questions on a daily basis; and the more complicated/case specific questions that aren't covered by their general rulings can always be put forward for specific and detailed rulings by the Faqeeh/Jurist himself. I don't see why they wouldn't answer important medical decision making questions if presented to them.

i don't see why either, but it is reality right now, which seems to imply that the concept of palliative care may be frowned upon...

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