Medical futility: a major ethical issue in end of life care: an outlook from medical and Islamic legal rulings

Aims / Background: The ethical issues surrounding end of life care are recent subjects of heated discussions. While issues like brain death has been thoroughly deliberated and well responded by Islamic authorities; some remain far from certainty and requires further exploration. This study aimed to identify various clinical situations with ethical implications related to selected major issues in end of life care followed by in-depth analysis on the medical aspects and Islamic legal rulings. Methodology: A qualitative study was conducted involving the followings: 1. Literature review gathering relevant materials performed using various search engines and databases. 2. Content analysis on the collected materials performed to identify various clinical situations related to end of life care. Major issues were subsequently shortlisted. 3. In-depth interviews of medical experts and religious scholars conducted to gather views and understanding on the major issues. Their responses recorded, transcribed and analysed using Nvivo 11. 4. Series of roundtable discussions attended by medical professionals and Islamic Studies academicians conducted to establish research framework, questionnaire formulations and elaborate the findings. Results: We found that one of the major issues in end of life care is the determination of death based on the diagnosis of brain death and medical futility. In contrast to brain death, there is neither clinical guidelines nor official Islamic legal rulings for the diagnosis of medical futility. Although the concept of medical futility for discontinuation of care for the terminally ill has been introduced in the 1980s, no consensus on accepted diagnostic criteria are available to date. From Islamic legal perspectives, the diagnosis of death based on the establishment of medical futility is ‘permissible’ as it conforms to the principles of qawaid al fiqhiyyah and maqasid al shari’ah. Conclusion: Medical futility is one of the major ethical issues in end of life care. It warrant in depth analysis from both medical and Islamic viewpoints.