Islam, Euthanasia and Western Christianity: Drawing on Western Christian thinking to develop an expanded Western Sunni Muslim perspective on euthanasia. Submitted by Rishad Raffi Motlani to the University of Exeter as a thesis for the degree of Doctor of Philosophy in Theology In August 2011 The thesis is available for Library use on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. I certify that all the material in this thesis which is not my own work has been indentified and that no material has previously been submitted and approved for the award of a degree by this or any other University. Signature:................................................................ 1 All praises and glory be to God for giving me this opportunity, and the strength and fortitude to complete this work. This thesis is respectfully dedicated to: Syed Lateefullah Hussaini, my late grandfather Munawar Sultana and Abdul Razzak, my parents And The rest of my family Without their continuous guidance, priceless wisdom and invaluable support, I would not have reached this stage in life. I also express my profound gratitude and utmost appreciation to: Dr. Mark R. Wynn Dr. Ian R. Netton And Dr. Michael Hauskeller Without their supervision, expertise, encouragement and friendship, this work would not have been completed. 2 Thesis Abstract In this thesis, I will examine various methods of argument used for and against euthanasia by Christian, Islamic and secular ethicists. Overall, this is intended to examine the role of faith-specific or tradition-specific assumptions and sources in shaping the stance on euthanasia that is taken by certain Western Christian thinkers and scholars in Islamic Medical Ethics. Following an initial overview of some of the central concerns of the thesis in the introduction (Chapter I), I will look at a range of select Western Christian perspectives (Chapter II) and certain Western and Eastern Islamic perspectives (Chapter III) on euthanasia. In these chapters, I will investigate how various sources are used by particular Western Christian and Islamic scholars to formulate their perspective for or against euthanasia. In Chapter IV, I will compare the approaches of these Western Christian and Islamic ethicists to determine points of overlap and distinction. Based on this comparison, it may be contended that the Western Christian literature on euthanasia is in some respects more developed than the Islamic literature. Chapter V will take account of some of the types of argument that are found in the Christian literature but for which there is at present no fully developed counterpart in Sunni Islamic literature. For example, the notion of respecting the elderly, as it specifically relates to opposing euthanasia, is discussed in the Western Christian ethics literature reviewed, but is not considered at least in Islamic Medical Ethics sources examined in this thesis. On this basis, Chapter V will offer an expanded Western Sunni Islamic perspective on euthanasia, which engages with strategies of argument drawn from the Western Christian literature, so providing a contribution to the literature in the developing discipline of Islamic medical ethics. The conclusion to the study will identify the possibilities and nature of dialogue on this issue between faiths, and between monotheistic and other ethical perspectives. So a secondary objective is to examine the possibility of convergence of thought among Christians and Muslims not just on medical ethical issues, but on a range of further issues from a Western point-of-view. In this way, the thesis also aims to make a broader contribution to interfaith dialogue as well as the study of method in ethics directed toward a Western audience. 3 Table of Contents Chapter I: Terms, Issues and Positions in the Euthanasia Debate...............page 5 Chapter II: Selected Christian Perspectives on Euthanasia.........................page 22 Chapter III: Selected Islamic Perspectives on Euthanasia...........................page 78 Chapter IV: Western Christian and Islamic Viewpoints: A Comparative Discussion ..................................................................................................................page 117 Chapter V: An Extended Western Sunni Islamic Account of Euthanasia......page 151 Conclusion.................................................................................................page 218 Bibliography...............................................................................................page 225 4 Chapter I: Terms, Issues and Positions in the Euthanasia Debate The fundamental purpose of this thesis is to develop an expanded Western Sunni Islamic account of euthanasia by bringing the established Islamic literature on euthanasia into stronger dialogue with the Western moral philosophical literature on euthanasia and also the literature in Western Christian ethics on euthanasia. By adopting this comparative perspective, the thesis aims to bring some central themes in the Islamic literature on euthanasia into clearer focus by reading them through the lenses provided by the Western philosophical and Western Christian literature. The study also aims to extend the Islamic literature on euthanasia by, for example, considering whether strategies similar to those employed in the Western Christian and philosophical literature can also be developed in Islamic terms. For example, the ideal of respect of the body is used in the Western Christian ethics literature to make a case against euthanasia, and in this thesis we shall consider whether a similar case can be constructed in Islamic terms. Such an approach can help to strengthen the interfaith and intra-faith dialogue on medical ethical and other issues, as well as the dialogue between monotheistic and secular traditions at least from a Western perspective (or for Western audiences). The purpose of Chapter I is to set the scene for the later chapters by presenting an initial overview of some of the central concerns of the thesis. This overview will cover: 1) terms and definitions of euthanasia, 2) focal issues in the debate and 3) the range of ethical positions in the debate. Euthanasia derives from a Greek term meaning ‘easy or gentle death,’ and is generally defined by religious and secular scholars as the intentional hastening of an individual’s death mainly in terminal medical cases, or cases of serious, chronic pain which cannot be relieved by conventional means.1 However, although John Finnis presents a similar account of the meaning of euthanasia, he also contends that ‘the term euthanasia has no generally accepted and philosophically warranted core of meaning.’2 There are two major forms of euthanasia with related subtypes. The first major form is called active euthanasia, sometimes termed ‘mercy killing,’ which involves an agent like a health-care professional who provides and administers a lethal dose of some substance by means of pills, gas or injection to terminate the 1 Albert Jonsen, Mark Siegler, William J. Winsdale, Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, fifth edition, (New York: McGraw Hill, 2002), p. 137; Thomas Wood, A Dictionary of Christian Ethics, edited by John Macquarrie, Euthanasia (SCM Press, 1967), p. 119; Helga Kuhse, A Companion to Ethics (Blackwell Reference, 1993), p. 294; Jonathan Glover, Causing Death and Saving Lives (London: Penguin Books, 1977), p. 182. 2 John Finnis, ‘A Philosophical Case Against Euthanasia,’ in Euthanasia Examined: Ethical, Clinical and Legal Perspectives, Edited by John Keown (Cambridge: Cambridge University Press, 1995), p. 23. 5 patient’s life.3 Physician-assisted suicide (PAS) may be considered a form of active euthanasia which similarly involves an agent providing lethal means, but here the patient administers it themselves by ingestion, inhalation or injection.4 Currently, the Netherlands permits both active euthanasia and PAS whereas Switzerland (e.g. Dignitas clinic) and the American state of Oregon, for example, only allow PAS.5 Some relevant subtypes of active euthanasia may also be considered by reference to different accounts of the patient’s ‘will’ in such cases. For example, voluntary active euthanasia (VAE) also known as ‘aid-in-dying’ generally must involve a competent patient’s consent to euthanasia, in most cases both verbal and written.6 However, for Mary Warnock and Elisabeth Macdonald, the standard conception of ‘voluntary’ does not adequately underscore what they more forcefully describe as the ‘passionate wish to die.’7 They claim that this passion which is present in those who want to die indicates not only consent, but also an emphatic ‘begging to die.’ 8 Therefore, they recommend that ‘voluntary’ should be substituted with ‘asked for,’ ‘requested’ or ‘chosen.’9 Like other proponents of euthanasia, Warnock and Macdonald emphasize upholding patient autonomy and independence. A second subtype involves a non-voluntary form of euthanasia (NVE) in which the patient is unable to give consent or communicate their request due to incompetence or mental incapacitation (e.g. a severely deformed newborn, or one suffering from dementia, a persistent vegetative state (PVS) or brain death).10 In these cases, some scholars argue NVE may be justified on the basis of a professional paternalistic judgment that the patient would not want to continue (suffering) in their present condition.11 However, other scholars believe euthanasia