Euthanasia

Euthanasia refers to ending the life of a person out of compassion due to an incurable and painful illness. It is usually carried out either by administering a lethal, painless substance or by withholding necessary and essential care. The former is known as active euthanasia, while the latter is called passive euthanasia. In some cases, medications are made available to the patient so that they may end their own life by taking them; this is referred to as indirect euthanasia. Euthanasia is considered a contemporary issue in Islamic jurisprudence (al-masa'il al-mustahdatha).

Jurists consider active euthanasia to be haram (forbidden). They state that if it is performed without the patient’s permission, the patient's guardian (wali) has the right to Qisas (retaliation) or Diya (blood money). However, regarding cases in which the patient has given permission, there is a difference of opinion among jurists: some hold that the guardian retains the right to qisās or diyya, while others maintain that this right does not apply.

There is also a difference of opinion regarding passive euthanasia. Some jurists issue rulings declaring it haram, while others argue that if a person has an incurable disease and continues to suffer, medical treatment is not obligatory.

Jurists regard indirect euthanasia, defined as the patient’s own consumption of lethal medication, as Suicide, and rule it to be forbidden.

Concept and Status

Euthanasia means killing an individual who is afflicted with an incurable and painful disease. This act is done out of compassion using a painless method, by using a lethal substance or abandoning necessary care. Euthanasia is performed in three forms: active, passive, and indirect. If death is caused by medication, it is called active euthanasia. If treatment and medication are merely withheld so the patient dies, it is called passive euthanasia. In indirect euthanasia, medications are placed within the patient's reach so they can personally end their life by consuming them.

In classical Shi'a jurisprudential works (during the time of al-Shaykh al-Tusi and before), the prohibition of killing someone who has consented to their own death was discussed; however, the specific rulings of euthanasia were not discussed. Accordingly, this issue is considered one of the Masa'il al-mustahdatha (new issues) in jurisprudence. The jurisprudential discussion on euthanasia is distinct from the subject of Brain death; thus, a jurist may consider it permissible to disconnect devices from a brain-dead patient or a patient in a coma with no hope of recovery. Yet, the same jurist may consider passive euthanasia—meaning the abandonment of treatment out of compassion—to be haram.

Injunctive Ruling

The views of Shi'a jurists regarding the practical ruling (al-hukm al-taklifi) of euthanasia, whether it is haram or halal, are as follows:

• Active Euthanasia: According to inquiries (istifta'at) from contemporary Shi'a jurists, active euthanasia is considered murder and is haram. According to the opinion of jurists, the patient's permission and consent to perform euthanasia do not affect a change in the practical ruling, i.e., the ruling of prohibition.
• Passive Euthanasia: Some jurists, such as Lutf Allah Safi Gulpayigani and Husayn Ali Montaziri, consider it haram to refrain from treating an incurable patient who suffers from their disease. In contrast to this opinion, the fatwa of jurists such as Mirza Jawad Tabrizi, al-Sayyid Abu l-Qasim al-Khoei, and Sayyid Ali Husayni Khamenei is that continuing treatment in these conditions is not obligatory.
• Indirect Euthanasia: According to the fatwa of Shi'a jurists, indirect euthanasia or the consumption of medication by the patient themself to end their life is considered Suicide and is haram.

Declaratory Ruling

The declaratory ruling (al-hukm al-wad'i) in euthanasia concerns the liability or non-liability for Qisas (retaliation) or Diya (blood money) that may fall upon the person performing it. The fatwas of jurists in this regard are as follows:

Active Euthanasia

If a physician or another person intentionally kills an incurable patient suffering from their disease without their permission, they are considered to have committed intentional murder, even if they do so out of compassion and pity. This act establishes the right of qisas or diya for the victim's guardian (wali). However, assuming the patient consents to their own death and permits it, there is a difference of opinion among jurists:

• No Right to Qisas and Diya: According to the opinion of jurists such as Sayyid 'Abd al-A'la Sabziwari, Imam Khomeini, and Sayyid Muhammad Sadiq Ruhani, since the victim permitted their own killing, they have nullified the right to Qisas and Diya.
• Right to Qisas and Diya Exists: Jurists such as al-Sayyid Abu l-Qasim al-Khoei, Mirza Jawad Tabrizi, and Ja'far Subhani believe that even with the victim's consent and permission for their own killing, the right to qisas and diya is not waived; because a human being does not have permission to destroy themself.

Passive Euthanasia

According to the fatwa of jurists, whoever sees a human being in a state of perishing and does not save them despite having the power to do so, although they have committed a sin, diya or qisas is not incumbent upon them. Accordingly, if a physician does not treat a patient and the patient dies due to the abandonment of treatment, the physician has sinned; however, they are not liable, and the deceased's heir does not have the right to qisas or diya.