Brain Death: Difference between revisions

According to jurists who regard a brain-dead patient as legally alive, none of the rulings specific to the deceased apply to such individuals.<ref>Qāʾinī, *al-Mabsūṭ Masāʾil Ṭibbīyah*, vol. 2, p. 714.</ref> Those jurists who entrust the determination of life or death in cases of brain death to expert custom maintain that if, in the judgment of specialists, the designation of death applies to a brain-dead patient, the rulings of the deceased are to be observed; otherwise, the rulings applicable to living persons remain in force.<ref>Montazerī, *Medical Rulings*, pp. 76, 120–121.</ref> Nāṣer Makārem Shīrāzī, one of the contemporary Shiʿi *marājiʿ al-taqlīd*, adopts a differentiated approach in this regard. He holds that certain rulings of the deceased, such as the termination of agency and the cessation of the capacity to engage in transactions, marriage, and divorce, apply to a brain-dead patient. At the same time, some rulings of living persons remain applicable, including the non-division of the patient’s property among heirs and the non-obligation of the wife to observe the waiting period (*ʿiddah*) of death. By contrast, rulings exclusive to the deceased, such as the obligation of ritual washing upon touching the dead, the duties of funeral preparation, the funeral prayer, and burial, do not apply until cardiac activity has ceased and the body has become cold.<ref>ʿAlīān Nezhādī, *Medical Rulings*, pp. 113–115.</ref> On this basis, a number of specific rulings concerning brain-dead patients may be outlined.

The majority of jurists maintain that as long as death has not been established with certainty, the performance of ritual washing, funeral prayer, shrouding, and burial is impermissible. In cases of doubt, one must wait until certainty of death is attained.<ref>Qāsemī, *Encyclopedia of Medical Jurisprudence*, vol. 3, p. 346.</ref> Accordingly, jurists who do not consider a brain-dead patient to be definitively dead cannot rule in favor of shrouding and burial.

Disagreement regarding organ transplantation from brain-dead patients follows directly from differing assessments of whether such patients are alive or dead. Nāṣer Makārem Shīrāzī holds that, given the medical determination of death in brain-dead patients, the removal of organs for the purpose of saving the lives of Muslims is permissible.<ref>ʿAlīān Nezhādī, *Medical Rulings*, pp. 114–115.</ref> Some scholars, such as [[Muhammad Mumin|Muḥammad Muʾmin]], maintain that if cardiac activity is sustained solely by mechanical devices rather than occurring spontaneously, the removal and transplantation of organs is permissible.<ref>Muʾmin, “Organ Transplantation”, p. 44; Qāʾinī, *al-Mabsūṭ Masāʾil Ṭibbīyah*, vol. 1, p. 140.</ref> In contrast, other jurists argue that if the use of a brain-dead patient’s organs accelerates the patient’s death, such action is impermissible.<ref>Khāmeneʾī, *Ajwibat al-Istiftāʾāt*, p. 287; Khodādādī, *Rulings for Physicians and Patients*, p. 151.</ref> However, if it does not hasten death and is carried out with the patient’s prior consent, or if saving the life of a respected person depends upon organ transplantation, it is deemed unobjectionable.<ref>Khāmeneʾī, *Ajwibat al-Istiftāʾāt*, p. 287.</ref> [[Mohammad Mohammadi Ghaeni]] bases the permissibility of organ transplantation from a brain-dead patient on the rule of necessity and further adds that if the patient belongs to a religion that permits organ transplantation in such cases, permissibility may also be established through the rule of obligation.<ref>Qāʾinī, *al-Mabsūṭ Masāʾil Ṭibbīyah*, vol. 1, pp. 140–142.</ref>

With respect to continuing medical treatment and disconnecting life-support devices, such as respiratory equipment, two principal views have been advanced. Many jurists regard the killing of a brain-dead patient as impermissible, whereas others consider the disconnection of life-support devices to be not prohibited in itself.<ref>Qāsemī, *Encyclopedia of Medical Jurisprudence*, vol. 3, pp. 334–335.</ref> Jurists who consider a brain-dead patient to be alive deem continued treatment obligatory and disconnection impermissible.<ref>Khodādādī, *Rulings for Physicians and Patients*, p. 150.</ref> Nāṣer Makārem Shīrāzī explicitly rules that the continuation of treatment is not obligatory.<ref>ʿAlīān Nezhādī, *Medical Rulings*, pp. 114, 117.</ref> From the perspective of [[Husayn Ali Montazeri|Ḥusayn‑ʿAlī Montazerī]], if there exists a possibility of recovery, discontinuing treatment and disconnecting supportive devices is impermissible. However, if a more urgent case exists and the device in question is uniquely required for that case, priority must be given to the more important obligation. This ruling is grounded in the jurisprudential principle of resolving conflicts between competing duties by giving precedence to the more significant one.<ref>Montazerī, *Medical Rulings*, p. 121.</ref>

If a brain-dead patient is considered legally alive, killing such a person is impermissible and entails full *dīyah* (blood money). In the event of the patient’s killing, the *dīyah* is due to the heirs.<ref>Khodādādī, *Rulings for Physicians and Patients*, p. 150.</ref> Some jurists hold that if the patient has consented to his own killing, the right to retaliation and *dīyah* is thereby waived. Others reject this view, arguing that a human being possesses no authority over his own destruction and that consent does not negate the right to retaliation.<ref>Qāsemī, *Encyclopedia of Medical Jurisprudence*, vol. 3, pp. 336–339.</ref> A number of jurists regard the payment of *dīyah* as an obligatory precaution and maintain that the amount should be expended on charitable purposes on behalf of the deceased.<ref>Montazerī, *Medical Rulings*, p. 120.</ref> Some also hold that in cases involving the severing of an organ, precaution requires the payment of *dīyah*, which is the responsibility of the person who performed the act.<ref>ʿAlīān Nezhādī, *Medical Rulings*, p. 115.</ref>

Rulings pertaining to marriage, such as the obligation of maintenance, depend on whether the marital bond is considered to persist after brain death. According to some jurists, the legal status of marriage remains intact in cases of brain death; however, because the costs of medical treatment in such cases exceed customary limits, they are not regarded as part of obligatory maintenance and are therefore not binding upon the spouse.<ref>Qāsemī, *Encyclopedia of Medical Jurisprudence*, vol. 3, p. 349.</ref> Nāṣer Makārem Shīrāzī further maintains that until a brain-dead patient reaches complete and certain death, the wife is not permitted to observe the waiting period (*ʿiddah*) of death.<ref>ʿAlīān Nezhādī, *Medical Rulings*, pp. 113–114.</ref>