Advance Care Planning (ACP) (English)

Introduction

1. The Office of the Mufti received a query from the Agency for Integrated Care (AIC) on Advance Care Planning (ACP). ACP is a voluntary process of ongoing discussions about an individual’s healthcare preferences which involves the individual himself, his family or loved ones and healthcare providers.¹

Principles on fatwa on Advance Medical Directive

2. The Fatwa Committee decided in 1994 that Muslims are allowed to issue an Advanced Medical Directive (AMD), which is a legal document that a person signs in advance to inform his doctor that he does not want any extraordinary life-sustaining treatment to be used to prolong his life, in the event that he is terminally ill and becomes unconscious or incapable of exercising rational judgment.This fatwa was issued based on the Islamic legal position that terminally ill Muslims can voluntarily refuse treatments. In this fatwa, a Muslim may choose not to seek or undergo active treatment, even if the medical condition is considered life threatening. It is also permissible for Muslims to accept or refuse pain and/or symptom relief, even if such treatments may hasten – although not directly cause – death. Both should not be misinterpreted as mercy killing or euthanasia which is prohibited in Islam.

3. The basis for this ruling is a Prophetic tradition or hadith narrated by Imam Al-Bukhārī which speaks of a lady who has fallen ill and asked the Prophet Muhammad s.a.w. to pray for her recovery. To which the prophet said: “If you are patient, the reward that awaits you is heaven. Or if you wish otherwise, I shall pray to Allah for your recovery.” The woman then replied: “In that case then I would want to be patient.” This Prophetic tradition highlighted above also provides the principle that a Muslim possesses the right to decide the kind of therapy or otherwise that they would wish for themselves.

Office of the Mufti's position on permissibility of Muslims making Advance Care Planning

4. Both AMD and ACP are instruments which enable an individual to make advanced decisions on the kind of care plans, medical therapy or otherwise that they would wish for when they are no longer able to do so on their own. In this regard, the Office of the Mufti is of the view that the principles in the AMD fatwa are applicable to ACP. Muslims are therefore religiously permitted to draft their own ACP plans. It is a religious right which allows Muslims to make a dignified choice on their own care plans.

5. In making decisions for Muslim individuals who no longer have the mental capacity to perform such tasks, there are no preferences or hierarchy in Islam to whom this task is assigned. In such instances one need not follow the “waris” (Muslim inheritance law beneficiaries) hierarchy. The Office of the Mufti is of the view that in such situations, immediate family members such as spouses and children should be consulted and come to an agreement prior to any decisions. The Office of the Mufti also advises Muslims that in such instances, given their in-depth medical knowledge, the opinion of the medical professionals which serves in the best interest of the patient should be respected and upheld by the family members in the final decision.

6. As Muslims, we are encouraged by faith to plan ahead and better manage our future health and life issues. To refrain from such efforts on the basis of ‘tawakkal’ (total trust in God) is contradictory to the concept of ‘tawakkal’ itself.² Early planning and discussion/consultation among family members in developing these plans can help to avoid potential conflicts. As Muslims, we are encouraged by the religion to prevent conflicts from arising should they have the means to accomplish such.

February 2019
Office of the Mufti
Islamic Religious Council of Singapore

[1] Advance Care Planning (ACP) is a voluntary process of discussion between an individual and their care providers and their loved ones. The purpose is to clarify a person’s wishes and care preferences for future care should they become seriously ill in the future and are unable to make decisions and/or communicate their wish to others. National Medical Ethics Committee (Sep, 2010). Guide for Healthcare Professionals on the Ethical Handling of Communication in Advance Care Planning.

[2] The concept of ‘tawakkal’ requires one to put in due effort before surrendering the outcome to Allah s.w.t. In a Hadith narrated by Imām Al-Tirmizī, a companion of the Prophet Muhammad s.a.w., Anas ibn Malik r.a. reported that a man said to the Prophet: “O Messenger of Allah, should I tie my camel and trust in Allah, or should I leave her untied and trust in Allah?” The Messenger of Allah, peace and blessings be upon him, said, “Tie her and trust in Allah.” Al-Tirmizī, Jāmi’ al-Tirmizī, hadith no. 2517.