Necessary interventions: Muslim views on pain and symptom control in English Sunni e-fatwas

Ethical Perspectives 17 (4):626-651 (2010)
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While many western countries now have large Muslim communities, relatively little scholarly attention is given to the attitudes of Muslims regarding end-of-life issues. Meanwhile, we receive strong and significant signals from physicians and pastoral care teams on the difficulty of discussing pain treatment with Muslim patients. With this study of Islamic views on pain control and palliative sedation in English Sunni e-fatwas we wish to make a contribution from the field of religious studies to a better understanding of how Muslim patients balance their personal needs for pain treatment with the Islamic normative background. Using Broeckaert’s conceptual framework on treatment decisions in advanced disease, we conducted an in-depth analysis of English Sunni e-fatwas on pain control and palliative sedation. The e-fatwas were selected using Bunt’s typology of Cyber Islamic Environments and Tyan’s definition of a fatwa. We found that references to the use of sedative medication to reduce the consciousness of the patient for pain treatment were very scarce in the texts we analysed. Although the idea of patiently enduring pain is present in the e-fatwas, it does not dominate the discussion, since the alleviation of pain is equally encouraged. When the pain medication used is addictive, alters the patient’s state of consciousness or contains alcohol making it problematic from an Islamic normative point of view, the use of this type of medication can be permitted on the basis of a principle in Islamic jurisprudence: necessity permits breaking the law. The possible danger of death after the administration of high doses of pain medicine is countered based on the intention of the treating physician: he or she aims to alleviate the pain and not kill the patient. The study of English Sunni e-fatwas on pain and symptom control indicates the absence of an insurmountable ethical problem connected to the use of heavy pain medication



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