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Brain Death is one of the contemporary jurisprudential issues referring to the complete and irreversible loss of all functions of the brain. Jurists (fuqaha) differ regarding the criteria for determining whether individuals with brain death are alive or dead. According to jurists such as Muhammad Fadil Lankarani and Mirza Jawad Tabrizi, customary standards ('urf) is authoritive and custom considers a brain-dead patient to be alive. Others, like Nasir Makarim Shirazi and Husayn Nuri Hamadani, leave the determination of the details of the issue to medical specialists and consider such individuals dead. Some, like Muhammad Mu'min Qummi, consider the jurist's determination authoritative and deem their being alive conditional upon the heart's activity.

Brain-dead patients have specific rulings. For example, the burial, shrouding, and ritual bathing of the dead for these individuals is not permissible as long as they have not reached complete death. There is also disagreement regarding the permissibility of organ transplantation from these patients. Some believe that if removing organs accelerates the patient's death, it is not permissible while others allow transplantation if it leads to saving the life of a Muslim. Some also argue that if the heart's activity is solely maintained by a machine, organ removal and transplantation are permissible. There are also differing views on continuing medical treatment or disconnecting medical devices.

Conceptual Analysis

Brain death is one of the contemporary issues that has entered the field of Fiqh from medical science,[1] and it means the cessation of all brain activities while the heart and other organs remain active.[2] Some have added the qualifier "irreversible and irreparable" to this definition.[3] In brain death, blood flow to the brain stops and oxygen does not reach it, which causes the brain tissues to die.[4] A brain dead patients breathing is assisted with the help of a ventilator, and they will eventually suffer cardiac arrest and die after a while.[5]

A critical distinction exists between brain death and conditions like coma or a persistent vegetative state. The brain in a coma, though impaired, retains some functional capacity and the potential for recovery. Brain death, by contrast, signifies the absolute and final loss of all brain activity and no possibility of returning to life.[6]

The Meaning of Death

Many jurists have not addressed the technical definition of death because they consider the definition of death to be clear.[7] However, some jurists have defined death as the separation of the human soul from the body.[8] Since determining the exact moment of death and detecting the separation of the soul from the body is difficult,[9] jurisprudential texts mention signs for death, such as: hollow temples, wrinkled facial skin, cessation of breathing and pulse, and the skin turning yellow.[10] Of course, from the perspective of jurists such as Sahib al-Jawahir, these signs are not definitive, and the criterion for death is knowledge and certainty of it.[11] It has been stated that whenever a person's death begins with the cessation of the heart and breathing, "natural death" has occurred, which is agreed upon by jurists, physicians, and custom. The main doubts and objections concern the stage where a person's death starts from the brain cells.[12]

In medical sources, three definitions of death are presented: cessation of the heart, complete cessation of the brain, and simultaneous cessation of the heart and brain.[13] The simultaneous cessation of the brain and heart is considered the most complete definition.[14]

Some researchers have compared brain death with jurisprudential concepts such as an "unstable life" (hayat ghayr mustaqir),[15] the fetus before the breathing of the soul into it, and the state of agony (ihtidar), considering their rulings to be the same.[16]

Is a Brain-Dead Patient Alive or Dead?

Jurists have presented various views on whether a brain-dead patient is dead or alive. Their disagreement stems from the criterion for determining death; that is, whether the standard should be customary understanding urf, medical opinion of experts, or the jurist's own ruling.[17]

  1. From the perspective of authorities (maraji') such as Muhammad Fadil Lankarani[18] and Mirza Jawad Tabrizi,[19] the determination of custom is valid. According to Ayatollah Fadil, since custom considers a brain-dead patient to be alive and all the rulings of a living person apply to such patients.[20]
  2. Some jurists, such as Nasir Makarim Shirazi[21] and Husayn Nuri Hamadani,[22] leave the diagnosis of the details to medical specialists. Accordingly, Ayatollah Nuri considers brain death to be the complete death of the person, because in his view, human death occurs when the brain stops functioning.[23] Ayatollah Makarim, based on the statements of physicians, does not consider a patient with brain death to be alive; however, at the same time, he believes the person is not considered completely dead either. Therefore, some rulings of the dead apply to such a person, and some rulings of the living.[24]
  3. Muhammad Mu'min Qummi leaves the detection of vital signs of the brain to medical specialists; however, he believes that defining the concept of life and death is a customary issue, and to detect it, one should refer to a jurist aware of the language of custom.[25] He and some others maintain that if there is cardiac activity without the help of a machine, such a person is considered alive; otherwise, they are ruled as dead.[26] Accordingly, the criterion for life is the activity of the heart by itself (not with the help of a machine).[27]

Jurisprudential Rulings

It has been stated that the general rule regarding illnesses such as brain death is that their religious rulings depend on the subject of the ruling (mawdu' al-hukm). Specifically, the subject and criterion of some rulings are absolute and complete death, which is not realized with brain death, such as burial and shrouding. Conversely, the subject and criterion for some other rulings are animal life possessing consciousness, such as representation (wakala). In this case, such rulings include brain-dead patients.[28]

Some of the specific rulings for patients with brain death are as follows:

  • Burial and Shrouding: It is said that burying, shrouding, and ritual bathing of a brain-dead person is not permissible until they reach complete death. This is because most jurists maintain that as long as someone's death is not certain, their burial and shrouding are not allowed, and in cases of uncertainty, one must wait until certainty is reached.[29]
  • Organ Transplantation: There is a difference of opinion regarding organ transplantation from brain-dead patients. According to jurists such as Sayyid Ali Khamenei[30] and Fadil Lankarani,[31] if using the organs of brain-dead patients accelerates their death, it is not permissible. However, if organ retrieval is done with the person's prior permission or if saving the life of a Muslim is dependent on that organ, it is permissible.[32] Makarim Shirazi has only made the removal and transplantation of organs from brain-dead patients conditional on saving the lives of Muslims.[33] Muhammad Mu'min believes that if the heart's activity is dependent on a machine, organ removal and transplantation is permissible.[34] The justification for the permissibility of organ removal and transplantation is based on the Rule of Necessity (qa'idat al-idtirar) and the Rule of Obligation (qa'idat al-ilzam).[35] There is disagreement over whether the patient's permission or the consent of the family is a condition for organ transplantation.[36] According to the laws for using the organs of brain-dead patients, it is conditional upon a will or the consent of their guardians.[37]
  • Treatment of the Patient: There are divided views regarding continuation of treatment and the disconnecting of medical devices for a brain-dead patient. A large number of jurists have ruled against the permissibility of killing a brain-dead patient while some believe that disconnecting medical devices is not prohibited.[38] A group of jurists such as Mirza Jawad Tabrizi,[39] Makarim Shirazi,[40] and Nuri Hamadani[41] have ruled that continuing treatment is not obligatory. Ayatollah Fadil Lankarani however, considered continuing treatment obligatory and did not allow disconnecting it.[42] According to Mirza Jawad Tabrizi, if disconnecting the device accelerates the death of the brain-dead patient, it is not permissible.[43]
  • Blood Money: If a person with brain death is considered alive, killing them is not permissible. Killing them would entail full blood money (diya), and this blood money belongs to the heirs.[44] Some jurists believe that if the patient has given permission for their own death, the right to retaliation and blood money is waived;[45] however, there are differences of opinion as some jurists believe that permission for killing does not waive the right to retaliation because a person has no right or authority over their own destruction.[46]
  • Matrimonial Status: According to some jurists, a brain-dead patient does not have the right to marry or divorce, and his wife does not observe the waiting period for death;[47] that is, the marital ruling remains. However, since the expenses for treating such diseases are beyond the normal limit, paying them as spousal maintenance (nafaqa) is not obligatory for the husband.[48]
  • Inheritance: It has been stated that the properties of individuals with brain death cannot be distributed among their heirs.[49]

See Also

Notes

  1. ↑ Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, p. 77.
  2. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, p. 149.
  3. ↑ See for example: Muntaẓirī, Aḥkām-i pizishkī, p. 119; ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, p. 114.
  4. ↑ See: Gūdarzī & Kiyānī, Pizishkī-yi qānūnī, 1392 Sh, pp. 42-43.
  5. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, p. 149.
  6. ↑ See: Gūdarzī & Kiyānī, Pizishkī-yi qānūnī, 1392 Sh, p. 83; Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, pp. 56-57.
  7. ↑ Āqābābāʾī, Paywand-i aʿḍā az bīmārān-i fawt shudih wa marg-i maghzī, 1385 Sh, p. 21.
  8. ↑ Khūʾī, al-Mawsūʿat al-Imām al-Khūʾī, 1418 AH, vol. 2, p. 464; Mishkīnī, Muṣṭalaḥāt al-fiqh, 1392 Sh, p. 552; Muḥsinī, al-Fiqh wa al-masāʾil al-ṭibbiyya, 1384 Sh, vol. 1, p. 129; Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, pp. 148-149.
  9. ↑ Āqābābāʾī, Paywand-i aʿḍā az bīmārān-i fawt shudih wa marg-i maghzī, 1385 Sh, p. 23; Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, pp. 38-40.
  10. ↑ See: Najafī, Jawāhir al-kalām, vol. 4, pp. 24-25; Muḥsinī, al-Fiqh wa al-masāʾil al-ṭibbiyya, 1384 Sh, vol. 2, p. 196.
  11. ↑ Najafī, Jawāhir al-kalām, vol. 4, p. 25; Muḥsinī, al-Fiqh wa al-masāʾil al-ṭibbiyya, 1384 Sh, vol. 2, p. 196.
  12. ↑ Āqābābāʾī, Paywand-i aʿḍā az bīmārān-i fawt shudih wa marg-i maghzī, 1385 Sh, p. 69.
  13. ↑ Naẓarī Tawakkulī, "Muqāyisih-yi tatbīqī-yi marg wa zindagī...", pp. 81-84.
  14. ↑ Naẓarī Tawakkulī, "Muqāyisih-yi tatbīqī-yi marg wa zindagī...", pp. 83-84; Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, p. 42.
  15. ↑ Unstable life refers to the life of a person on the verge of death who lacks perception and voluntary movement. (Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, p. 58)
  16. ↑ See: Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, pp. 58-61.
  17. ↑ See: Sutūdiih, Marg-i maghzī; pardāzish-i fiqhī-ḥuqūqī, p. 78.
  18. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, pp. 149-150.
  19. ↑ Khūʾī & Tabrīzī, Aḥkām-i jāmiʿ-i masāʾil-i pizishkī, 1390 Sh, p. 279.
  20. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, pp. 149-150.
  21. ↑ Makārim Shīrāzī, Dāyirat al-maʿārif-i fiqh-i muqāran, 1427 AH, p. 44.
  22. ↑ Nūrī Hamadānī, Hizār wa yak masʾalih-yi fiqhī, 1388 Sh, vol. 1, pp. 253-254.
  23. ↑ Nūrī Hamadānī, Hizār wa yak masʾalih-yi fiqhī, 1388 Sh, vol. 1, pp. 253-254.
  24. ↑ ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, pp. 113-114.
  25. ↑ Muʾmin, "Paywand-i aʿḍā", p. 45.
  26. ↑ Muʾmin, "Paywand-i aʿḍā", p. 44; Qāʾinī, al-Mabsūṭ fī al-masāʾil al-ṭibbiyya, 1430 AH, vol. 1, pp. 135, 136, & 139.
  27. ↑ Muʾmin, "Paywand-i aʿḍā", p. 44.
  28. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, p. 351.
  29. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, p. 346.
  30. ↑ Khāmanih-ī, Ajwibat al-istiftāʾāt, 1424 AH, p. 287.
  31. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, p. 151.
  32. ↑ Khāmanih-ī, Ajwibat al-istiftāʾāt, 1424 AH, p. 287.
  33. ↑ ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, pp. 114-115.
  34. ↑ Muʾmin, "Paywand-i aʿḍā", p. 44; Qāʾinī, al-Mabsūṭ fī al-masāʾil al-ṭibbiyya, 1430 AH, vol. 1, p. 140.
  35. ↑ Qāʾinī, al-Mabsūṭ fī al-masāʾil al-ṭibbiyya, 1430 AH, vol. 1, pp. 140-142.
  36. ↑ See: ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, p. 115; Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, p. 345.
  37. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, p. 343.
  38. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, pp. 334-335.
  39. ↑ Khūʾī & Tabrīzī, Aḥkām-i jāmiʿ-i masāʾil-i pizishkī, 1390 Sh, p. 279.
  40. ↑ ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, pp. 114 & 117.
  41. ↑ Nūrī Hamadānī, Hizār wa yak masʾalih-yi fiqhī, 1388 Sh, vol. 1, pp. 253-254.
  42. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, p. 150.
  43. ↑ Khūʾī & Tabrīzī, Aḥkām-i jāmiʿ-i masāʾil-i pizishkī, 1390 Sh, p. 285.
  44. ↑ Khudādādī, Aḥkām-i pizishkān wa bīmārān, 1385 Sh, p. 150.
  45. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, pp. 336-338.
  46. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, p. 339.
  47. ↑ ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, p. 113.
  48. ↑ Qāsimī, Dānishnāmih-yi fiqh-i pizishkī, 1395 Sh, vol. 3, p. 349.
  49. ↑ ʿAlyān-nizhādī, Aḥkām-i pizishkī, 1387 Sh, p. 113.

References

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  • ʿAlyān-nizhādī, Abū l-Qāsim. Aḥkām-i pizishkī mutābiq bā fatāwā-yi Āyatullāh al-ʿUẓmā Makārim Shīrāzī. Qom, Madrasat al-Imām ʿAlī b. Abī Ṭālib (a), 1387 Sh.
  • Gūdarzī, Farāmarz and Mihrzād Kiyānī. Pizishkī-yi qānūnī barāyi dānishjūyān-i rishtih-yi ḥuqūq. Tehran, SAMT, 1392 Sh.
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  • Khūʾī, Sayyid Abū l-Qāsim and Jawād Tabrīzī. Aḥkām-i jāmiʿ-i masāʾil-i pizishkī. Qom, Dār al-Ṣiddīqa al-Shahīda (s), 1390 Sh.
  • Khūʾī, Sayyid Abū l-Qāsim al-. al-Mawsūʿat al-Imām al-Khūʾī. Qom, Muʾassasat Iḥyāʾ Āthār al-Imām al-Khūʾī, 1418 AH.
  • Makārim Shīrāzī, Nāṣir. Dāyirat al-maʿārif-i fiqh-i muqāran. Qom, Madrasat al-Imām ʿAlī b. Abī Ṭālib (a), 1427 AH.
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  • Naẓarī Tawakkulī, Saʿīd. "Muqāyisih-yi tatbīqī-yi marg wa zindagī dar mutūn-i dīnī-pizishkī". In: Masāʾil-i mustaḥdathih-yi pizishkī. Qom, Bustān-i Kitāb, 1386 Sh.
  • Nūrī Hamadānī, Husayn. Hizār wa yak masʾalih-yi fiqhī (majmūʿih-yi istiftāʾāt). Qom, Mahdī Mawʿūd (a), 1388 Sh.
  • Qāʾinī, Muḥammad. al-Mabsūṭ fī al-masāʾil al-ṭibbiyya. Qom, A'imma Athar Jurisprudential Center, 1430 AH.
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