Islamic perspectives and contemporary bioethics: case of DNR (Do Not Resuscitate orders)

End-of-life decision-making is one of the most difficult situations in contemporary medicine. One of the significant medical developments in this area is cardiopulmonary resuscitation (CPR), which refers to a set of interventions that are meant to restart oxygenated blood circulation in those people who experience cardiopulmonary arrest. Any decision regarding attempting or not attempting CPR should be made in advance or immediately, using previously well-established guidelines such as the the idea of Do Not Resuscitate (DNR). While performing CPR in many cases is counted as therapeutic beneficence and consequently a moral and professional obligation, doing this intervention for dying patients whose death looks irreversible, inevitable, and imminent because of an underlying disease such as end-stage cancer is controversial. Some Islamic sources recognize the dying process (Ihtedar) as a different and distinct stage between what is called stable life (Hayat el-Mostaghar) and death. Islamic resources require for special rituals and issue specific decrees for this period. This three-phasic sequential formulation (stable life-unstable life or Ihtidar and then death and after here life, opens the ground for the reevaluation of medical professional obligations and possibly acceptance of withholding CPR for dying patients. However for non-dying patients who are counted as people at the stable life professional obligation could be different. However, Fatwas of several contemporary Muslim jurists are generally in favor of DNR orders for a Mohtadar (a person in the dying process or in final moments of life which called Ihtidar).