Brain Death; Dead or not Dead – That is the Question
Brain death puts forth a challenge to epistemological, metaphysical, ethico-legal, and theological understandings of death. Potentially, it also has many practical implications in Islamic law. The burial, funeral, inheritance, organ transplantation, euthanasia, and the required waiting period of a widow before remarriage (iddah) are all connected to death, and therefore can be connected to brain death.
Medically brain death implies the permanent absence of cerebral and brainstem functions. It does not include the colloquial understanding which includes those inflicted with severe brain damage or those in vegetative states. This can be diagnosed when neurologic examinations establish the absence of brain function. This examination must conclude that the patient exhibits no cerebral or brainstem function in the following findings: coma, absent brain-originating motor response, absent pupillary light reflex, absent corneal reflexes, absent oculovestibular reflexes, absent jaw jerk, absent gag, suckling, and rooting reflex, absent cough with tracheal suctioning, absent sucking or rooting reflexes, and absent apnea.
The technology to diagnosing brain death has not always been reliable. Before the available technology which can establish the absence of neurological activity in the brain existed, patients were misdiagnosed. Today, there are many developing countries who do not benefit from this technology and due to the lack of technology, brain dead patients are misdiagnosed. Furthermore, there are theories which state that the medical industry is intentionally diagnosing certain patients with brain death in order to harvest their organs. Technology solves many of these problems, but recognisably, not all of them.
The Quran states: “Every soul shall taste death.” (Quran, 21:36) Religiously, death occurs when the soul departs from the body. If one acts righteously and adheres to his religious obligations his soul will be removed gently from his body, but if one fails to do so his soul will be violently removed. Hence, if one considers brain death to be actual death he is insisting that the soul of a brain dead patient has been removed from his body.
Islamic scholars have issued various opinions regarding brain death. The following will mention some of them. Firstly, there are two main Sunni councils who specialise in bioethics - Organization of Islamic Conferences’ Islamic Fiqh Academy (OIC-IFA) and Islamic Organization of Medical Sciences (IOMS). These bodies have had extensive conferences on the issue of brain death. The conclusions taken from their research and conferences are as follows:
OIC-IFA set two legal standards for the declaration of death: 1) when all vital functions of the brain cease irreversibly and the brain has started to degenerate as witnessed by specialist physicians, 2) when the heart and respiration stop completely and irreversibly as witnessed by physicians. Thus, brain death exists.
IOMS states that if a person has reached, with certainty, the state of brain-stem death, then such a person has departed from his life and some of the rulings concerning death are applicable to him. Hence, disconnecting the person from artificial life support apparatus may be carried out.
Shia jurists have also discussed this issue in their jurisprudential works. Ayatollah Hadavi Tehrani has asked questions to the offices of numerous maraja’ (religious authorities) regarding donating the organs of a brain dead patient. Due to his diligence, close relationships to the offices, and piety one can be confident that the answers he published are credible.
He states that Sayyid Khamenei is of the opinion that if brain death is untreatable medically, irreversible, and causes brain functioning to cease and all forms of intellect, feeling, and movement to be lost, then some of his organs can be harvested, with specific conditions. One of the conditions is that the organs removed would not expedite death. Hence, the vital organs of a person inflicted with brain damage cannot be harvested.
He states that Ayatollah Makarem Shirazi is of the opinion that if brain death is certain than the person suffering from it would be considered dead. Therefore, harvesting the organs would not be a problem in order to save a Muslim’s life. Describing Ayatollah Makarem Shirazi’s opinion, it can be understood from the term “certain” that a physician who is both an expert in the field and trustworthy must diagnose the patient after exhausting all of the necessary tests. Otherwise, one would not be able to accept his diagnosis.
Ayatollah Hadavi Tehrani also states that Sayyid Sistani is of the opinion that it is impermissible to remove the organs that would cause serious harm to a living, adult, and sane person. This would hold true for all Shia jurists. He then adds that Sayyid Sistani prohibits severing body parts from a dead Muslim. This is also accepted by all jurists, with various exceptions mentioned in the books of jurisprudence. Sayyid Sistani then adds that brain death is not considered death as long as his heart and lungs are working, even with the help of medical machinery. Thus, it would be impermissible to harvest his organs. The following answer to a question about the beating heart of a brain dead patient found on Sayyid Sistani’s website gives further clarification: “The criterion in applying the term “dead” in so far as the application of religious laws goes is the common perception of people, in the sense that they would call him “dead”. And this is not proven in the situation mentioned in the question.”
Hence, there is a major difference between the maraja’ on this issue. Ayatollah Makarem Shirazi seems to accept the medical definition of brain death as being death, whereas Ayatollah Sistani and Sayyid Ali Khamenei do not accept this as long as the heart and lungs are working, even with the help of medical machinery. And Allah knows best.
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