A doctor killed a patient by mistake due to negligence, so what is his obligation?

The questioner : My brother Abu Ahmad asked me today whether the profession of anesthesia is a dangerous profession, or whether anesthesia is one of the medical professions in which the doctor sees more difficulties and problems than in others. I told him that I recently completed fasting two consecutive months for killing a person by medical error, not intentionally, of course. Then my brother Abu Ahmad said:Abu Layla : I wish you had asked our Shaykh, Abu Abd al-Rahman, about whether this fasting that was upon you was in its proper place. I told him, "I already asked a brother of ours, Abd al-Rahman Abd al-Khaliq, in Kuwait, and I explained the story to him as it happened. He asked me to fast two consecutive months, and the matter was settled." Now, my brother Abu Ahmad has asked me to ask you for a ruling on the same case and to recount to you some of what happened to me, so that we can be sure of the ruling.

The Shaykh : First of all, is there anything regarding the two months?

The questioner : There is nothing other than fasting two consecutive months.

The Shaykh : Is there no blood money?

The questioner : There is no blood money.

The Shaykh : Because it was an accident?
The Doctor: Because no one demanded it.

The Shaykh : No one demanded it because you did not admit that you killed him by mistake, or because they did not know?
The Doctor: They did not know; it did not become apparent to them that I killed him by mistake.

The Shaykh : The important thing is, did it become apparent to you that you killed him by mistake?
The Doctor: Yes.

The Shaykh : In that case, it is not permissible to separate the two matters. Either you do not fast because you did not kill him by mistake, or you fast and pay the blood money because you killed him by mistake. We do not have a half-measure in the Shari'ah. In any case, let us understand the story now; perhaps your fasting was voluntary.
The Doctor: Regarding the blood money, it appears that there is no possibility, because the brother—may Allah have mercy on him—was a Pakistani alone, and we do not know where he is in his country.

The Shaykh : This is a second ruling: you have settled your case.
The Doctor: Then, if there is a payment of blood money, the Kuwaiti Ministry of Health will cover it.

The Shaykh : I understand, my brother. Did you pay the blood money?
The Doctor: I do not know.

The Shaykh : Because now the Ministry of Health has written a report stating that this was an accidental killing, so you bear the blood money and we bear the fasting? Of course, no.
The Doctor: Yes, it was not written.

The Shaykh : That is it.
The Doctor: It is my strong opinion that nothing of this kind was written.

The Shaykh : And that is the case. Well, what happened to you?
The Doctor: The story in brief is that the patient was in a critical condition, and they asked me to perform a procedure to complete an examination on this patient. This procedure can only be done with general anesthesia, total sedation. I knew the patient from a week prior; I greeted him and saw him. He was in a bad condition, then it became worse, and then he became in a very bad condition. [Here the doctor, may Allah forgive and have mercy on him, is crying.] So I told them, "Yes, I will anesthetize him, if Allah wills, so that you can perform the necessary tests and procedures to save him." A conversation took place between two doctors in English; I understood from their words, from a distance, that they had done something for this patient. Of course, I do not mention names and details because it may not be necessary for you.

The Shaykh : Well, there is no need.

The questioner : The Doctor: So I assumed that they had done it. The patient was in front of me, and I imagined—what I imagined was that there was a tube, for example, in the nostril reaching the stomach, to empty the stomach of fluids, pus, and harmful things. I saw it as if the tube was present. So I began the anesthesia, and large amounts of dirty fluids came out of the patient's stomach, such that the mouth and throat filled with these fluids. I could no longer see the airway or the entry of air into the lungs until I removed these fluids. This takes time, two, three, or four minutes. So the patient remained for four minutes or a little more without oxygen, without air. His heart stopped. Then we did what was necessary to restart his heartbeats, but we knew the patient was finished because he was originally very bad. This serious situation occurred, and we knew the patient was finished. I told the surgeon, "Perhaps this tube that was reaching the stomach was blocked, which is why these fluids accumulated." He said, "My brother, there is no tube; it was not there in the first place." I said, "By Allah, it seemed to me that I was seeing it. I was sure that I saw this tube, and it was supposed to be there before starting the anesthesia." He said, "No, but we forgot to put it in. By 'we,' I mean the head of the surgery department, who is responsible for this patient, and all the members of the department; they all forgot to put in this tube."

The Shaykh : And you were with them?
The Doctor: And I was with them.

The Shaykh : Why?
The Doctor: I forgot because I imagined that he had it and that he had this tube.

The Shaykh : How did you imagine that?
The Doctor: It just seemed that way to me.

The Shaykh : How did it seem that way to you? The matter is physical, not theoretical.
The Doctor: Yes, it seemed that way to me even after the procedure was finished. As I said, I told the brother surgeon, "Perhaps this was blocked." He said to me, "This was not there in the first place to be blocked." I said to him, "By Allah, I did not notice, and it seemed to me that I was seeing it present, and it was supposed to be there to empty the stomach so that we would not fall into this problem." He said, "He was originally, meaning, dead or..."

The Shaykh : In the status of a dead person.
The Doctor: In the status of a dead person. I said to him, "Yes, but your surgical procedure was to save him; otherwise, there would have been no necessity to anesthetize him and do what was necessary, since we had despaired of him. You did not see this tube and did not put it in, and I did not either. He died after two or three days. So I thought that I..."

The Shaykh : How after two or three days? Was it not after you did the procedure for him?
The Doctor: Yes, we restarted his heart, and it returned to its beats, but irregularly. So we placed the patient under machines that help sustain his life until the heart finally relaxes and the medical work ends. I thought that I was a partner with them in this negligence, and that it was upon me to put in this tube, empty what was in his stomach, and then perform the anesthesia according to the rules. This was missed by me. I said to the brothers, "Did we not make a mistake in this matter?" They said, "Yes." The surgeons said, "Yes, we made a mistake; we did not put in this tube." I said, "Subhan Allah, four or five people make a mistake and it does not occur to them?" They said, "Yes, this is what happened." I also said, "And I forgot, and it appears that I am a partner with you in killing him." They said that they would justify the situation by saying that this patient was finished, so they were performing their work as a voluntary act, not as an obligation. So, in this brief summary, I informed Abd al-Rahman Abd al-Khaliq. Is there anything upon me? He said, "If you feel that you made a mistake and you are responsible because you are the specialist, then it is upon you to fast two consecutive months." I did not ask him about the blood money. I performed the fasting of two consecutive months.
Abu Layla : May I ask him his question, Shaykh?

The Shaykh: Go ahead.
Abu Layla : Placing the tube is within your specialty.
The Doctor: Yes, it is the core of my specialty, and also the specialty of the others, but...