Q 1: Last year, I was in King Khalid Hospital serving my training year. Meanwhile, an old patient suffering from cancer that had spread in her kidney and body, entered the hospital. It is medically known that these patients cannot be treated and do not survive for long. We used to give her the needed nutrients and drugs. A few days later, she had renal failure and lost consciousness for a few days and then died. In this case, death occurs after the patient's case deteriorates gradually. The heart could cease to function at any moment, medically known as "cardiac arrest" and subsequently the patient dies. The cardiac arrest may occur at any age and has numerous reasons. If employed immediately after the cardiac arrest, cardiopulmonary resuscitation may succeed to restore breathing and heart rate and rescue the patient if Allah so wills. In King Khalid Hospital, as in other big hospitals, there is a group of qualified members to employ cardiopulmonary resuscitation; each of them carries a special calling system and can be called at anytime in case a cardiac arrest strikes any patient. The cardiopulmonary resuscitation is a procedure in which artificial respiration is made by breathing into (Part No. 25; Page No. 72) the lungs of the patient. Repeated pressing on the patient's heart may break some ribs. If this does not work, an electric shock may be given by passing electric currents to the patient, or a needle may be inserted in his chest to enter deep in his heart to inject a substance that may help restore the heart rate. These procedures are repeated until the heart functions again and respiration is restored or otherwise, the physician decides that the patient is dead. This may take half an hour or more. The case in question is that the prevailing view among physicians is that if a patient in the case mentioned above is stricken by a cardiac arrest, it will be better to let them die comfortably than to expose them to the violent cardiopulmonary resuscitation, particularly that the success of this procedure has a very low possibility; if it succeeds, it will restore the heart rate and respiration and then stop again after less than a few hours. Then the cardiopulmonary resuscitation must be made again. This may be repeated several times until the cardiopulmonary resuscitation fails and the patient dies.The physicians write in the record of such patients that the team of cardiopulmonary resuscitation is not to be called when a cardiac arrest strikes the patient. This is what the specialist wrote in the record of the patient in question. Usually what the physician writes is not considered official unless he writes it in the patient's record. At that time, I called Shaykh ibn `Uthaymin and explained the case to him. He answered that as long as the harm of the cardiopulmonary resuscitation for (Part No. 25; Page No. 73) this patient is greater than its benefit, it should not be made. The case is not specific to a certain patient or rare cases; rather, due to the spread of cancer among old people, no big hospital is free from patients having the same case. What is the ruling if the patient is not in a coma, but they have the case mentioned above and do not see, hear or perceive; they can hardly eat or speak.Q 2: Here is a current case: A sixty-year-old patient suffers from blood pressure and hemiplegia. His left kidney was surgically removed. Six months ago, he was admitted to hospital because of the presence of a ruptured pulmonary parasitic cyst. Since this might lead to death, the physician decided to perform surgery to excise it. During the surgery, a cardiac arrest struck him and he received the cardiopulmonary resuscitation and it succeeded as the heart and respiration returned to their normal rate. Nevertheless, the patient did not recover his consciousness until now. He neither hears nor perceives. He breathes and his heart works normally. A neurosurgeon decided that the forebrain cells that regulate consciousness of the patient deteriorated and died due to the cardiac arrest. As for the hindbrain that includes centers of respiration and the heart, it is still working normally. The patient is now (Part No. 25; Page No. 74) under medical care and is subjected to constant analyses and gets the required nutrients and drugs. This patient may remain like this for a long period of time. However, he is more vulnerable than any other person to serious inflammations and blood clots and other repercussions that could lead to cardiac arrest and then to death. The physician ordered the nurses not to call the team of cardiopulmonary resuscitation if the patient has a cardiac arrest.A few days ago, he got acute renal failure. We performed the necessary procedures for him by organizing liquids and drugs given to him. The kidneys function is to filter the blood of metabolic wastes, which are then excreted as urine. Therefore, if there is a kidney failure, then hemodialysis should be made, through a machine to which an artery and a vein from the patient are connected to replace the kidney function. The specialists wrote in the record of the patient that they do not recommend doing this for him if needed, meaning to let him be exposed to death, as is medically known. However, the patient's kidney returned to work normally, thanks to Allah. He did not need hemodialysis, but he is vulnerable to the same problem and may need hemodialysis and hence the physicians may not object to do it for him in case of suffering from acute renal failure, i.e., the temporary failure from which the patient can recover. However, renal failure may develop to (Part No. 25; Page No. 75) chronic renal failure, meaning that the patient may not be able to do without hemodialysis as long as he is alive. Hemodialysis may take some hours and should take place twice or three times weekly. It requires medical apparatus and efforts that the physicians do not consider necessary for this unconscious patient who lives, according to them, as a load over others. It is known medically that his case will not get better.Generally, the physicians may ask us about the ruling of the Shari`ah in such matters, but get no answer. This necessitates that our religious scholars be acquainted with such medical matters and that we, Muslim physicians, be acquainted with the respective religious ruling.Q 3: In some cases, the patient suffers from severe pains that painkillers cannot relieve them, including Panadol or Aspirin, in which case the physician is obliged to give him Morphine that lessens the brain's consciousness, so that the patient no longer feels pain. This drug is an anesthetic and causes disturbance of the patient's mood. Moreover, the patient may become addicted to it if doses are given frequently, to the extent that some patients pretend to feel pain and complain to the physician to get extra doses of the drug.There is another drug called Pethidin that has the same effect that Morphine has on brain, but it is less powerful and is not sufficient to relieve the patient's pain. (Part No. 25; Page No. 76) These two drugs are widely used in cases of myocardial infarction, before and after performing operations to relieve the patient's pains; are such drugs considered Haram (prohibited)? What is the ruling on using them when necessary?Q 4: I mentioned in the previous question that in some cases the patient suffers from severe pains and needs morphine or Pethidin to relieve pain. In some cases of lung cancer, the patient's respiration becomes very weak. It is known that respiration is regulated by a center in the brain called respiration center. The said drugs affect this center and deactivate it. Nevertheless, if the physician prescribes a small amount of this drug that does not deactivate the respiration center, the patient's pain might not be relieved. If he increases the dose, the stopping of the patient's respiration becomes more likely, for it is already weak due to his illness. The patient suffers from agonizing pains. According to physicians, such patients usually die, by Allah's Will, after no longer than a few weeks. The physicians differ; some give the patient Morphine arguing that even if this drug will cause his death, it is better to let him die comfortably than to let him suffer from agonizing pains and then die. Others object to this. What is better according to the Shari`ah? (Part No. 25; Page No. 77) In conclusion, here are the questions we need to get answers for: 1. What is the ruling on giving cardiopulmonary resuscitation after cardiac arrest in the case of the patient mentioned in the first and second questions?2. What is the ruling of not making hemodialysis for the patient in question two when he needs it on having acute or chronic renal failure?3. What is the ruling on using Pethidin or Morphine which are intoxicant drugs, when needed or necessary as mentioned in the third question?4. What is the ruling on using the drugs mentioned in the case of question four?Moreover, we do not feel easy when physicians prescribe some drug for the patient which we fear to be Haram (prohibited). We cannot object to them without a Shar`y (Islamic legal) ruling. Praise be to Allah Who bestowed on us scholars to teach us our religious affairs. May Allah reward you well! All praise and thanks are due to Allah, the Lord of the 'Alamîn (mankind, jinn and all that exists). May peace and blessings be upon our Prophet Muhammad, his family, and Companions.

A: First, in the first case, the cardiopulmonary resuscitation team should be called to employ it to rescue the patient if there is hope that he may recover from the cardiac arrest. (Part No. 25; Page No. 78) However, if the cardiac arrest ends when employing the cardiopulmonary resuscitation and returns when finishing it, it should not be made, for it is clear that the patient is dead. Second, the ruling of the first case applies to the second case. Besides, if the case of the patient in the second case requires giving hemodialysis to save him from the medical point of view, then it should be made, for adopting causes to get their effects is Islamically acceptable. Third, if there are no other permissible drugs that can be used to relieve pain except for those two types, it will be permissible to make use of both of them when necessary, unless a severer or equal harm results from using them such as being addicted to them. Fourth, it is not permissible to administer this for him in order to relieve him by accelerating his death. May Allah grant us success. May peace and blessings be upon our Prophet Muhammad, his family, and Companions.