Commentary from Egypt

In Egypt, in deciding for an incompetent patient, or even for themselves, most members of families appeal to their attendant physicians to decide. They think that their physicians better understand the governing laws and the Islamic Sharia rules for their case, since Islam is the religion of the majority and Islamic Sharia in most cases affects and shapes the ethical and legal responses to the ethical challenges of medicine. When people doubt the Islamic verdict of a certain case, they consult a religious scholar. Even when they know that there are alternative means of cure from which they can choose, most of them leave it to the physician to make the decision. This situation can be explained as follows.

Egypt is a country that is plagued by poverty and illiteracy, where there is a correlation between the two. According to the state-run statistics of the Central Agency for Public Mobilisation and Statistics (CAPMAS), a considerable number of people are still poor and illiterate. The poverty rate has reached an average of 25.5 per cent for the year 2010–2011 compared to 21.6 per cent in 2008–2009. Poverty remains predominant in rural areas compared to urban areas, and in Upper Egypt more than in Lower Egypt, with 69 per cent of its total population below the poverty line (Ahram Online, November 2012). According to a new study conducted by CAMPAS, the percentage of illiteracy among poor families in 2008–2009 has increased to 41 per cent as opposed to 24 per cent in non-poor families. Additionally, 11 per cent of members of non-poor families have university degrees, but only 2 per cent of members of poor families have university qualifications (Ahram Online, September 2011).

This has helped paternalism in the domain of medicine to prevail in Egypt for a long time, though informed consent is stipulated by law in most medical interventions (UNESCO Cairo Office 2011), and explaining the medical situation to the patient and/or his family is among the important duties of physicians, as stipulated in many codes of ethics (Code of Ethics, Alexandria Medical Research Institute). However, in Egypt, most people still leave it to the attendant physician to decide, and physicians decide according to the regulating laws that in most cases follow the Islamic Sharia.

The Islamic Regulation of the Case

This case comes under the topic “end of life”. Before I explain the Islamic opinion regarding this case or, more generally, regarding end-of-life issues, it is important to note, as an important background, that in Islam, all forms of life are precious and have intrinsic value. This is simply because life is created by God. Among all forms of life in the world, human life is the most precious. In the Qur’an, which is for Muslims the agreed-upon first source of jurisprudence, Allah says, “We have indeed honored the children of Adam … and exalted them high above the greater part of Our creation” (Qur’an 17: 70). Such a privileged status is conferred on humans because humans are God’s vicegerents on earth. And since they are so, Allah has endowed them with reason and free will and they are therefore held responsible for what they do (Shomali 2008: 3; Daar and Al-Khitami 2001: 60). Thus, all human life issues should be decided based on such a concept of sanctity of life.

Since Muslims believe that human life is endowed by Allah, and that it is He who should decide its beginning and end, there is a consensus among Islamic religious scholars that active euthanasia is haram (religiously sinful). Any action that intends to end life is sinful. Consequently, any action, whether by the patient him/herself or by the help of a physician, to end the patient’s life is sinful. As for passive euthanasia in the sense that medical treatment is thought to be useless, most religious scholars agree that the attendant physicians are not obliged to cure a patient when there is none.

Applying such opinion on our case, we can say that since there is little hope that the patient will regain...