Use of a resuscitation device
Machine translationRead the Arabic original
Fatwa number ( 8926 )
Q 1: Last year, I was at King Khalid Hospital completing my training year. An elderly female patient was admitted to us, suffering from cancer that had spread to her liver and body. It is medically known that this type of patient cannot be cured and does not live for a long time. We were giving her the nutrients and medications she needed. After a few days, she suffered total liver failure and became unconscious for several days until she died. In this situation, death occurs after the patient’s condition deteriorates gradually, and at a certain moment the heart stops, meaning a cardiac arrest occurs, and the patient dies. Cardiac arrest can happen at any stage of life and has other known causes. There is a procedure called cardiopulmonary resuscitation (CPR); if performed on the patient immediately, it may succeed in restarting the heart and breathing, saving the patient from death, with the permission of Allah the Exalted. At King Khalid Hospital —as is usually the case in large hospitals—there is a team consisting of several qualified individuals for performing CPR. Each carries a special device that allows them to be called immediately when a patient suffers a cardiac arrest. CPR is performed by artificial breathing, blowing into the
lungs, and repeated strong pressure on the patient’s heart, which may cause some ribs to break. If this does not help, electrical pads are attached to the patient to deliver a strong electric shock, or a needle is inserted into his chest to enter the cavity of his heart to inject a substance that may help restart the heart. These actions are repeated until the heart and breathing function, or the doctor decides that the patient has died. This may continue for half an hour or more. The issue being asked about here is that the prevailing view among doctors is that if a patient in the condition described above suffers a cardiac arrest, it is better to let him die peacefully than to subject him to the violence of CPR, especially since the success rate in this case is low. Even if it succeeds, it does not go beyond restoring heart and breathing movement, which will stop again after a period that may be only a few hours, and CPR must be performed again. This may be repeated several times until CPR fails and the patient dies. Doctors usually write in the patient’s file—in this case—that the cardiopulmonary rescue team should not be called when he suffers a cardiac arrest. This is what the specialist wrote in the file of the aforementioned female patient. Usually, what a doctor says is not considered official until it is written in the patient’s file. I contacted Shaykh Ibn Uthaymeen at that time and explained this case to him. He said: “Since the harm of CPR for this patient is greater than its benefit, it should not be performed.” The issue is not about a specific patient or rare cases; rather, with the spread of cancer diseases, especially among the elderly, no large hospital is free of a number of patients in such a condition. Then, what is the ruling if the patient is not unconscious, but is in the condition described above, yet he sees, hears, and understands, and may eat and speak with difficulty? Q 2: This is a current case: a patient aged 60 years, who had high blood pressure and hemiplegia, and whose left kidney had previously been removed. About 6 months ago, he was admitted to our hospital due to a ruptured parasitic cyst in his lung. Since this could lead to death, the doctors decided to perform a surgical operation to remove this cyst. During the operation, he suffered a cardiac arrest, so CPR was performed on him, and with the permission of Allah, it succeeded, and the heart and breathing returned to their normal function. However, the patient did not recover after the operation and remained unconscious until now. He does not hear or understand, and he breathes and his heart works normally. The brain specialist has decided that due to the aforementioned cardiac arrest, damage and death occurred in the brain cells responsible for consciousness and sensation in humans, which is the upper part of the brain. The lower part of the brain, which contains the centers for breathing and the heart, is still alive and working normally in this patient. The patient
is now under medical care, undergoing continuous tests and being given the nutrients and medications he needs. This patient can remain in this condition for a long time, but he is more exposed than others to dangerous infections, blood clots, and other causes that lead to cardiac arrest and then death, with the permission of Allah. The doctors have instructed the nurses not to call the respiratory resuscitation team for him if he suffers a cardiac arrest. A few days ago, he suffered acute failure in his only kidney. We did what was necessary to regulate the fluids given to him and the medications he needs. The kidney’s function is to filter the blood, extract toxic substances from it, and excrete them as urine. Therefore, if kidney failure becomes intractable, blood dialysis must be performed. This is done using a device connected to an artery and a vein from one of the patient’s limbs, acting as a substitute for the kidney. The specialists wrote in the patient’s file that they do not see fit to perform this for him if he needs it. This means leaving him exposed to what is medically known to lead to death. However, the patient’s kidney has returned to normal function, praise be to Allah, and he did not need blood dialysis. But he is exposed to the same problem occurring again and may need blood dialysis. The doctors may not object to performing blood dialysis for him in the case of acute kidney failure—meaning temporary failure from which the patient recovers—but kidney failure may develop into
chronic failure, meaning the patient becomes dependent on blood dialysis as long as he lives. Blood dialysis may take a few hours and usually needs to be performed two, three, or more times every week. It requires equipment and medical efforts that the doctors may see as not worth exerting for this unconscious patient, who lives—as they say—as a burden on others, and it is medically known that his condition will not improve from what it is. In general, the doctors we work with may ask us about the ruling of our religion in these matters, but they do not find an answer from us. This shows the necessity for our scholars, may Allah preserve them, to understand such medical issues, and the necessity for us, Muslim doctors, to understand the ruling of our religion in them. Q 3: In some cases, the patient suffers from severe pain that is not relieved by the medications usually given to alleviate pain, such as (Panadol or aspirin). The doctor is then forced to give the drug (morphine), which affects the brain and reduces its sensitivity, so the patient does not feel pain. It is a sedative drug and causes disturbance in the patient’s mood. Also, the patient becomes addicted if given many doses of it, to the extent that some patients begin to feign pain and complain to the doctor to obtain doses of this drug. Another drug called (pethidine) is similar to morphine in its effect on the brain, but it is weaker and is not sufficient to relieve the patient’s pain.
Chronic failure, meaning: the patient becomes unable to do without blood dialysis as long as he lives, and blood dialysis may take several hours, and it is obligatory to perform it usually two or three times or more in every week, and it requires equipment and medical efforts that doctors may see that it is not befitting to exert them for this unconscious patient, who lives—as they say—a burden on others, and it is medically known that his condition will not improve from what it is. Generally, doctors who we work with may ask us about the ruling of our religion in these matters, and they do not find an answer from us, and this shows the necessity of our scholars (may Allah preserve them) understanding such medical issues, and the necessity of us, the Muslim doctors, understanding the ruling of our religion in them. Q 3: In some cases, the patient suffers from severe pains that the medicines usually given to relieve pain, such as (Panadol, or aspirin), do not benefit him, so the doctor is forced to give the drug (morphine) which affects the brain and reduces its sensitivity, so the patient does not feel the pain, and it is a sedative drug and causes disturbance in the patient's mood, and the patient becomes addicted if given many doses of it, to the extent that some patients begin to feign pain and complain to the doctor in order to get doses of this drug. And another drug called (Pethidine) is similar to morphine in its effect on the brain, but it is weaker than it, and it is not sufficient in relieving the patient's pain.
These two medications are frequently used for patients with heart clots, both before and after surgery, to calm the patient’s nerves and alleviate his pain. Do these medications count as the intoxicants that are forbidden by the Shari'ah, and what is the ruling on using them in cases of dire necessity or pressing need? Q 4: In the previous question, I mentioned that in some cases the patient suffers from severe pain and requires treatment with morphine or pethidine to relieve the pain. In some cases of widespread lung cancer, the patient’s breathing is very weak. It is known that breathing operates according to a center in the brain called the respiratory center. The aforementioned medications have a specific effect on this center, as they depress it. If the doctor administers a small dose of this treatment such that it does not lead to the depression of the respiratory center, it may not be sufficient to relieve the pain. If the dose is increased, the likelihood of the patient’s breathing stopping increases, because his breathing is weak and on the verge of stopping due to his original illness. The patient is tormented by the severe pain he endures. According to the experience of doctors, these patients usually die—by the permission of Allah—after a period that may not exceed a few weeks. The doctors differ in their approach: some give the patient morphine and say that it is better for the patient to die comfortably, even if this medication is the cause of his death to some extent, than for him to suffer from his pain and then die. Others prohibit this. What is the preferred course of action from the perspective of the Shari'ah?
In conclusion, I summarize the matters whose rulings need to be known as follows: 1. What is the ruling on performing cardiopulmonary resuscitation when a heart attack occurs, in a case like the patient mentioned in the first and second questions? 2. What is the ruling on not performing blood dialysis for the patient mentioned in the second question if he needs it in the event of acute or chronic kidney failure? 3. What is the ruling on using (pethidine) or (morphine), which are medications with an intoxicating effect, in cases of dire necessity or pressing need, as mentioned in the third question? 4. What is the ruling on using the aforementioned medications in a case like the one mentioned in the fourth question? We find ourselves in a difficult position when the specialists decide on a course of action for the patient that we fear is religiously forbidden, and we have no power to stop them, nor do we have a religious ruling to convince them with. Praise be to Allah, who has provided us from among our scholars those who teach us the matters of our religion and convey to us the ruling of Allah in them. May Allah reward you with good for us, and praise be to Allah, Lord of the worlds, and may Allah send prayers and blessings upon our Prophet Muhammad, and upon his family and all his Companions.
A: First : In the first case: the resuscitation team is called to save the patient by using the cardiopulmonary resuscitation device if it is medically expected that he will be cured of the heart attack by using it.
However, if the attack subsides when the resuscitation device is used and returns when it is removed, it is not to be used; because it has become clear that the patient has died. Second : In the second case: what was mentioned in the first case is performed for him, in addition to what the patient’s condition in the second case requires, namely the use of dialysis for him if its performance is what saves him in the view of medicine, and taking the means in the cosmic Sunnah of Allah. Third : If no other permissible substances are known to be used to relieve the patient’s pain other than these two substances, it is permissible to use either of them to relieve the pain in cases of dire necessity, provided that using them does not result in greater or equal harm, such as becoming addicted to their use. Fourth : It is not permissible to give it to him in order to seek his comfort in order to hasten his death. And success is from Allah, and may Allah send prayers and blessings upon our Prophet Muhammad, and upon his family and his Companions.
Q 1: Last year, I was at King Khalid Hospital completing my training year. An elderly female patient was admitted to us, suffering from cancer that had spread to her liver and body. It is medically known that this type of patient cannot be cured and does not live for a long time. We were giving her the nutrients and medications she needed. After a few days, she suffered total liver failure and became unconscious for several days until she died. In this situation, death occurs after the patient’s condition deteriorates gradually, and at a certain moment the heart stops, meaning a cardiac arrest occurs, and the patient dies. Cardiac arrest can happen at any stage of life and has other known causes. There is a procedure called cardiopulmonary resuscitation (CPR); if performed on the patient immediately, it may succeed in restarting the heart and breathing, saving the patient from death, with the permission of Allah the Exalted. At King Khalid Hospital —as is usually the case in large hospitals—there is a team consisting of several qualified individuals for performing CPR. Each carries a special device that allows them to be called immediately when a patient suffers a cardiac arrest. CPR is performed by artificial breathing, blowing into the
lungs, and repeated strong pressure on the patient’s heart, which may cause some ribs to break. If this does not help, electrical pads are attached to the patient to deliver a strong electric shock, or a needle is inserted into his chest to enter the cavity of his heart to inject a substance that may help restart the heart. These actions are repeated until the heart and breathing function, or the doctor decides that the patient has died. This may continue for half an hour or more. The issue being asked about here is that the prevailing view among doctors is that if a patient in the condition described above suffers a cardiac arrest, it is better to let him die peacefully than to subject him to the violence of CPR, especially since the success rate in this case is low. Even if it succeeds, it does not go beyond restoring heart and breathing movement, which will stop again after a period that may be only a few hours, and CPR must be performed again. This may be repeated several times until CPR fails and the patient dies. Doctors usually write in the patient’s file—in this case—that the cardiopulmonary rescue team should not be called when he suffers a cardiac arrest. This is what the specialist wrote in the file of the aforementioned female patient. Usually, what a doctor says is not considered official until it is written in the patient’s file. I contacted Shaykh Ibn Uthaymeen at that time and explained this case to him. He said: “Since the harm of CPR for this patient is greater than its benefit, it should not be performed.” The issue is not about a specific patient or rare cases; rather, with the spread of cancer diseases, especially among the elderly, no large hospital is free of a number of patients in such a condition. Then, what is the ruling if the patient is not unconscious, but is in the condition described above, yet he sees, hears, and understands, and may eat and speak with difficulty? Q 2: This is a current case: a patient aged 60 years, who had high blood pressure and hemiplegia, and whose left kidney had previously been removed. About 6 months ago, he was admitted to our hospital due to a ruptured parasitic cyst in his lung. Since this could lead to death, the doctors decided to perform a surgical operation to remove this cyst. During the operation, he suffered a cardiac arrest, so CPR was performed on him, and with the permission of Allah, it succeeded, and the heart and breathing returned to their normal function. However, the patient did not recover after the operation and remained unconscious until now. He does not hear or understand, and he breathes and his heart works normally. The brain specialist has decided that due to the aforementioned cardiac arrest, damage and death occurred in the brain cells responsible for consciousness and sensation in humans, which is the upper part of the brain. The lower part of the brain, which contains the centers for breathing and the heart, is still alive and working normally in this patient. The patient
is now under medical care, undergoing continuous tests and being given the nutrients and medications he needs. This patient can remain in this condition for a long time, but he is more exposed than others to dangerous infections, blood clots, and other causes that lead to cardiac arrest and then death, with the permission of Allah. The doctors have instructed the nurses not to call the respiratory resuscitation team for him if he suffers a cardiac arrest. A few days ago, he suffered acute failure in his only kidney. We did what was necessary to regulate the fluids given to him and the medications he needs. The kidney’s function is to filter the blood, extract toxic substances from it, and excrete them as urine. Therefore, if kidney failure becomes intractable, blood dialysis must be performed. This is done using a device connected to an artery and a vein from one of the patient’s limbs, acting as a substitute for the kidney. The specialists wrote in the patient’s file that they do not see fit to perform this for him if he needs it. This means leaving him exposed to what is medically known to lead to death. However, the patient’s kidney has returned to normal function, praise be to Allah, and he did not need blood dialysis. But he is exposed to the same problem occurring again and may need blood dialysis. The doctors may not object to performing blood dialysis for him in the case of acute kidney failure—meaning temporary failure from which the patient recovers—but kidney failure may develop into
chronic failure, meaning the patient becomes dependent on blood dialysis as long as he lives. Blood dialysis may take a few hours and usually needs to be performed two, three, or more times every week. It requires equipment and medical efforts that the doctors may see as not worth exerting for this unconscious patient, who lives—as they say—as a burden on others, and it is medically known that his condition will not improve from what it is. In general, the doctors we work with may ask us about the ruling of our religion in these matters, but they do not find an answer from us. This shows the necessity for our scholars, may Allah preserve them, to understand such medical issues, and the necessity for us, Muslim doctors, to understand the ruling of our religion in them. Q 3: In some cases, the patient suffers from severe pain that is not relieved by the medications usually given to alleviate pain, such as (Panadol or aspirin). The doctor is then forced to give the drug (morphine), which affects the brain and reduces its sensitivity, so the patient does not feel pain. It is a sedative drug and causes disturbance in the patient’s mood. Also, the patient becomes addicted if given many doses of it, to the extent that some patients begin to feign pain and complain to the doctor to obtain doses of this drug. Another drug called (pethidine) is similar to morphine in its effect on the brain, but it is weaker and is not sufficient to relieve the patient’s pain.
Chronic failure, meaning: the patient becomes unable to do without blood dialysis as long as he lives, and blood dialysis may take several hours, and it is obligatory to perform it usually two or three times or more in every week, and it requires equipment and medical efforts that doctors may see that it is not befitting to exert them for this unconscious patient, who lives—as they say—a burden on others, and it is medically known that his condition will not improve from what it is. Generally, doctors who we work with may ask us about the ruling of our religion in these matters, and they do not find an answer from us, and this shows the necessity of our scholars (may Allah preserve them) understanding such medical issues, and the necessity of us, the Muslim doctors, understanding the ruling of our religion in them. Q 3: In some cases, the patient suffers from severe pains that the medicines usually given to relieve pain, such as (Panadol, or aspirin), do not benefit him, so the doctor is forced to give the drug (morphine) which affects the brain and reduces its sensitivity, so the patient does not feel the pain, and it is a sedative drug and causes disturbance in the patient's mood, and the patient becomes addicted if given many doses of it, to the extent that some patients begin to feign pain and complain to the doctor in order to get doses of this drug. And another drug called (Pethidine) is similar to morphine in its effect on the brain, but it is weaker than it, and it is not sufficient in relieving the patient's pain.
These two medications are frequently used for patients with heart clots, both before and after surgery, to calm the patient’s nerves and alleviate his pain. Do these medications count as the intoxicants that are forbidden by the Shari'ah, and what is the ruling on using them in cases of dire necessity or pressing need? Q 4: In the previous question, I mentioned that in some cases the patient suffers from severe pain and requires treatment with morphine or pethidine to relieve the pain. In some cases of widespread lung cancer, the patient’s breathing is very weak. It is known that breathing operates according to a center in the brain called the respiratory center. The aforementioned medications have a specific effect on this center, as they depress it. If the doctor administers a small dose of this treatment such that it does not lead to the depression of the respiratory center, it may not be sufficient to relieve the pain. If the dose is increased, the likelihood of the patient’s breathing stopping increases, because his breathing is weak and on the verge of stopping due to his original illness. The patient is tormented by the severe pain he endures. According to the experience of doctors, these patients usually die—by the permission of Allah—after a period that may not exceed a few weeks. The doctors differ in their approach: some give the patient morphine and say that it is better for the patient to die comfortably, even if this medication is the cause of his death to some extent, than for him to suffer from his pain and then die. Others prohibit this. What is the preferred course of action from the perspective of the Shari'ah?
In conclusion, I summarize the matters whose rulings need to be known as follows: 1. What is the ruling on performing cardiopulmonary resuscitation when a heart attack occurs, in a case like the patient mentioned in the first and second questions? 2. What is the ruling on not performing blood dialysis for the patient mentioned in the second question if he needs it in the event of acute or chronic kidney failure? 3. What is the ruling on using (pethidine) or (morphine), which are medications with an intoxicating effect, in cases of dire necessity or pressing need, as mentioned in the third question? 4. What is the ruling on using the aforementioned medications in a case like the one mentioned in the fourth question? We find ourselves in a difficult position when the specialists decide on a course of action for the patient that we fear is religiously forbidden, and we have no power to stop them, nor do we have a religious ruling to convince them with. Praise be to Allah, who has provided us from among our scholars those who teach us the matters of our religion and convey to us the ruling of Allah in them. May Allah reward you with good for us, and praise be to Allah, Lord of the worlds, and may Allah send prayers and blessings upon our Prophet Muhammad, and upon his family and all his Companions.
A: First : In the first case: the resuscitation team is called to save the patient by using the cardiopulmonary resuscitation device if it is medically expected that he will be cured of the heart attack by using it.
However, if the attack subsides when the resuscitation device is used and returns when it is removed, it is not to be used; because it has become clear that the patient has died. Second : In the second case: what was mentioned in the first case is performed for him, in addition to what the patient’s condition in the second case requires, namely the use of dialysis for him if its performance is what saves him in the view of medicine, and taking the means in the cosmic Sunnah of Allah. Third : If no other permissible substances are known to be used to relieve the patient’s pain other than these two substances, it is permissible to use either of them to relieve the pain in cases of dire necessity, provided that using them does not result in greater or equal harm, such as becoming addicted to their use. Fourth : It is not permissible to give it to him in order to seek his comfort in order to hasten his death. And success is from Allah, and may Allah send prayers and blessings upon our Prophet Muhammad, and upon his family and his Companions.
Source
www.alifta.gov.sa
The Arabic text is copied verbatim from the original source, without any edits.