By Rev. Alejandro De Jesus
The Veterans Affairs Department expects VA chaplains to have a respectable level of knowledge of the major religious traditions, including Islam. Out of over 1.3 million active duty service men and women, a little fewer than 6,000 self-identify as Muslim. The Muslim veteran population forms an even lower percentage, but is growing steadily as younger Muslims join the military service. Chaplaincy in both military and VA hospitals, clinics and treatment centers has worked hard to respond appropriately to the spiritual needs of the Muslim population. In some localities, VA medical centers have even hired Muslim imams as chaplains.
A quick recall of what Islam means and requires is helpful before discussing organ donation and end-of-life concerns. Islam means “submission,” and a Muslim understands the life mission of every follower to submit to God (Allah) and Muhammad, the messenger of Allah. Islam is a monotheistic faith that traces its origins back to Abraham. The worldwide Muslim population is over 1.8 billion, and the U.S. is home to several million Muslims. The Qur’an is the Word of God they believe in and rely on, while the Hadith refers to the collection of stories and sayings of the Prophet Muhammad. However, there are also other writings of prophets or followers of Muhammad contained in the Sunnah and the Seerah.
The Islamic tradition has evolved through time, and while there are admittedly many diverse views on numerous issues, there is also consistency on the basic tenets. Faith in God and his prophet Muhammad, praying five times a day, almsgiving, the Ramadan fast, and pilgrimage to Mecca form the five pillars of Islam.
Based on this main creed and on other Islamic laws, the Sharia is believed to benefit all humans. Its major goals are the protection and preservation of life, intellect, progeny, property and religion. The fundamental medical ethic that flows from this is the First Principle of the Qur’an: “Whosoever saves a human life, saves the life of all mankind.” Most Islam believers uphold principles where necessity overrides prohibition; that harm must be removed at every cost, if possible; accepting the lesser of two harms if both cannot be avoided; and upholding public interest over individual interest.
The Islamic Medical Association of North America notes that suicide and active euthanasia are prohibited, especially in the face of terminal illness. When death is inevitable, as determined by a team of medical providers, unnecessary procedures are not expected to be utilized. And while medical treatments can still continue, withdrawing mechanical support is morally acceptable.
As noted, Islamic communities around the world do not have a common global leadership. There are, however, regional groups of theologians, medical practitioners, leading intellectuals, etc., who contribute by their discussion and recommendations on issues such as end of life and organ donation.
The general perception is that Islam forbids organ donation on the grounds that the human body must be protected and preserved with integrity. However, respected regional councils such as Islamic Fiqh Council in Saudi Arabia and the Islamic Medical Association of North America have declared that organ donation is allowed under the following conditions: (1) donation must be specifically indicated by the donor in a will or document (2) for the purpose of saving life (3) with no financial incentive and no cost to the donor’s family and (4) cannot involve a donation of reproductive organs. Furthermore, contrary to popular belief, Muslims can donate to non-Muslims.
The Sindh Institute of Urology and Transplantation estimates that over 50,000 patients die each year of end-stage organ failure in Pakistan, who otherwise could have been saved through organ donation. Some patients refuse it, even if it will save them, due to a misconception of what they understand as the will of God as expressed in their religious practices.
It is painful enough for patients and their loved ones to suffer from the illnesses they are afflicted with. However, a much deeper pain is involved when one’s spirit is torn between what faith tells them (or what they perceive faith to be telling them), and what they need to do in order to be cured from the illness and healed at the core. Chaplains can assist in helping their patients make an informed decision over their goals of care and medical options.
Alejandro De Jesus, PhD, BCC, is certified in the NACC, NCVACC, and NAVAC and has specialty certification in hospice and palliative care and in mental health.