Wednesday, February 03, 2010

Chronic Pain, Suicide, Physician-Assisted Suicide, Family-Assisted Suicide ...

Yusuf Smith left me this comment and I wanted to address some of what is in it in a separate post:

"As-Salaamu 'alaikum,

Have you been following the Lynn Gilderdale story here in the UK? It was about a woman who committed suicide (with her mother's help) after suffering for 17 years with ME (no, not MS). She'd been ill since she was 14 and had been bed-bound for almost all of that time. The mother was accused of attempted murder but was acquitted last week, and there has been a lot of public sympathy (although some criticism as well).

Has it received much coverage in the USA? I posted two long entries about it as, although I know nobody who has that illness, I found it affected me quite deeply, particularly reading the published extracts from her blog (which was mostly private).

Do you have any opinion on this? I know there have been some with MS who are quite vocal in support of euthanasia, particularly here in the UK; is this quite widespread or is it a few people given disproportionate coverage?"

Wa Alaikum As Salaam Dear Brother Yusuf and Everyone:

To my knowledge, this case hasn't received a lot of coverage in the US. Of course, we have had similar cases here, and there are Americans who believe that people should be able to die with "dignity" when, where, and how they choose.

You may be familiar with Dr. Jack Kevorkian, also known as the notorious "Dr. Death."

In the US, they are referred to as "right-to-die activists" and in the case of Dr. Kevorkian, "physician-assisted suicide." I'm not sure or aware of the position of the MS community.

Some people feel that the medical profession should help terminally ill patients and their families so there will not be tragic and sad cases such as the one you wrote about.

As for me personally, and my position, my life is guided in all matters by Islam, Alhamdulillah. Islam does not permit a person to wish for death, nor does Islam permit the ill person to kill himself. Further, Islam doesn't permit anyone else to do it either, including the Muslim patient's physician.

It is Allah swt Who gives life and causes death.

However, there are cases where it is Islamically permissible for a physician to remove the life-support system of a Muslim, after the physician is absolutely sure that the person is "dead." Dr. Muhammad al-Jibaly explains the details very nicely in his book, Sickness: Regulations & Exhortations, 2nd Edition. I recommend every Muslim to have this excellent book on his bookshelf, may Allah swt reward Sheikh Jibaly/Ameen.

That being said ...

I can definitely understand how a person, including a Muslim, would reach the point in his illness, whether it be a brief illness or chronic one, wherein the person would want to end his life and his suffering.

I have numerous health problems which affect my back and legs, particularly my left leg. The problems are complicated by overall MS and Arthritis. I have severe varicosity, Schamberg's disease, a back injury, peripheral neuropathy, and Restless Leg Syndrome. I also have a Baker's cyst behind my left knee which does not want to leave me (they say they dissolve by themselves, Allahu Alim). MS causes me to have severe balance issues, pain, and mental confusion. At times it affects my eyesight. I have slight tremors that make fine motor skills a nightmare. Arthritis causes severe pain and stiffness. I live with these illnesses as well as a lifelong heart valve problem and asthma one day at a time.

But there have been times where I have been severely depressed. Chronic health problems and pain can cause depression. Because I am a retired counselor, I am able to recognize when I am becoming depressed, and I do things to snap myself out of it. It is important to mention that this depression is not the same as chemical imbalance depression seen in some psychiatric disorders. However, if the human brain lives with depression or anxiety long enough, the brain will become changed because the brain tends to be an adaptogenic body part in certain cases. The challenge is not to let depression progress to the point of no return where someone may have feelings of suicide, and where the person cannot recognize that he is depressed.

Back to my left leg ...

The other day I saw a program on National Geographic called Taboo. In the particular episode I saw, they highlighted a problem that some people have which is a kind of body dysmorphic illness, but in this case, the person has issues with a limb or limbs. The one guy profiled felt since childhood that his right leg was not a part of his body. He had strong negative feelings about his right leg to the point it negatively affected all the major areas of his life. He was a very unhappy camper. Since most physicians and psychiatrists are not willing to recommend amputation for this condition on what they perceive to be ethical and moral grounds, many sufferers do something to injure the limb to the point where IT HAS TO BE AMPUTATED. Some people have gone as far as to shoot themselves in the leg or attempt to chop their own leg off, etc. Can you imagine?

(Funny how physicians have no ethical or moral problems amputating a man's penis because he feels like he is a woman. Anyhow, I digress ...)

But I found myself oddly relating to the man in the program. I thought of my own left leg. I found myself agreeing with the man. There have been times I have felt like I didn't want my left leg. Oh how nice it would be to have it gone sometimes!

What good is my left leg? After all, it is barely useful or functional. About the only use it has is for balance - and that is even SOMETIMES. I can't even make salaat on all of my limbs. Sitting back in jalsah is nearly impossible.

What use is my left leg?

It is the cause of constant excruciating pain, stiffness, burning, stinging, swelling ...

Of what use is it?

Well, all I can come up with is the each body part of mine will speak for or against me on the Last Day.

Will my left leg explain to my Lord that I was patient and tender with it? Will it tell my Lord about the times I cursed it out, lol, or wished ill of it?

So I try to remind myself that Allah swt tests me through this body and especially my left leg.

So my opinion Brother Yusuf? I would encourage a person to be patient in illness or any other hardship or trial.

I would recommend that the ill person become familiar with the signs of depression, and have a plan for dealing with it. I would also recommend that the person see a qualified pain management person. I myself go to a pain management doctor. All the medical and psychological strategies for pain we use manages to take the edge off, even though it doesn't remove the pain entirely.

I would remind the Muslim that "with every hardship comes ease" even if it's in another area, not necessarily the health area.

I would remind the person that every pain expiates sin. It also evevates the Muslim in ranks, and purifies his heart.

The Sahabah (ra) were well aware of the benefits and rewards of illness, so much that some of them wished for illness. The Prophet (saw) had to warn them against asking for illness!

So I would in the end implore Allah swt to allow me to care for myself the best I can so I do not emotionally progress to the point where I may think or suicide, or cause my body to be a trial for my family and friends.

But at the end of the day, although I don't agree, I can undersand how a person could be in so much pain that they would wish for death.

I'm just glad that I'm Muslim, Alhamdulillah, and as in all major areas of my life, I have Qur'an and Sunnah in my life for guidance in all of my affairs.


Yusuf Smith said...

As-Salaamu 'alaikum,

Thanks for replying in this way. It is natural that Islam would influence the thinking of any Muslim, even someone with a severe or progressive disability. I felt so much pain for Lynn G, wondering what could have been done to alleviate her condition, if she couldn't have been gradually exposed to light or sat up more, etc., rather than just letting her lie in bed for seventeen years (it's common for disabled people to develop hypotension, which causes them to pass out when sat up). The family had developed an intense distrust of doctors because of everything from misguided treatment to outright abuse, including sexual abuse, early on in her illness. It is painful to think that she went through so much suffering and ended it all herself, having been of such help to others yet eventually giving up hope for herself. Of course, it is too late to change anything now.

Normally, I'm very harsh on the matter of assisted suicide, particularly the lobby in the UK which doesn't even reserve it for terminal illnesses, but approved of it when a young man with a spinal cord injury at C6, caused by rugby, went "the Swiss route" in late 2008. When I later made the acquaintance of Kim Robbins, who has a similar injury from transverse myelitis, the contrast between her attitude (explained in this post, written at my request) and his was startling and sometimes distressing. He didn't need to die any more than she did; people indulged his death wish because they didn't place any value on patience in extreme circumstances. This is the case with a lot of people in this country, particularly the more liberal elements; the whole idea of the "stiff upper lip" as well as the concept of human life as sacred are both seen as old-fashioned and, in the latter case, tyrannical dogma.

A while ago the lady who writes another blog I read, entitled The Site that Breathes, asked readers how they would deal with the situation of being told that, in a few months time, they would be a vent-dependent quadriplegic. (The author already is, from a car accident in 2002, when she was 16.) The post is here and my response is second in the comments, but the key point was, "personally I'd rather be alive than dead, but to people who don't believe in an afterlife, it's difficult to persuade them of that". And this is a big problem: a lot of people either don't believe in an afterlife or have some kind of wishful view of it (as is evident from some of the tribute postings on some of Lynn G's old friends' blogs and Facebook pages). It's sad but not too distressing to hear of some arrogant old atheist taking this course of action and worsening his situation; it's more so when the person who presents that possibility is someone young and fragile.

Anyway, I am grateful to you for bringing an Islamic perspective from someone who's "there"; coming from me, it would be dismissed by many people as just some guy spouting religious dogma. I feel a lot of compassion for the Gilderdales and am glad the mother was not sent to jail, but it doesn't mean I approve and I'd like to think I wouldn't do the same, insha Allah. (I am more fearful of how I would deal with imprisonment than with disability, personally.)

Yusuf Smith said...

As-Salaamu 'alaikum,

Also, I have heard of Jack Kevorkian, but nobody like him exists over here.

Our politics is rather different as well. Being a smaller country, our regions have much less autonomy than with US states. An assisted dying law can get passed in Oregon but would have a whole lot of difficulty in Kansas.

It's significant that the Daily Mail, a very middle-class, right-wing paper, printed pages of highly sympathetic coverage about the Gilderdales last week. To them, it was a perfect "human interest" story involving a respectable, white, middle-class, southern English family. They would normally oppose legalising such behaviour but they know they can't get people out to actively oppose them, or abortion, or any similar life issue. There just isn't the heat over them here that there is in the USA.

AlabasterMuslim said...

Salaamu Alaikum sister,
I saw the show you are speaking of (about the man who hated his own leg) yesterday and today. I cannot understand how someone could hate a piece of their own body for no reason. But I try to not make judgment because I believe something like that is related to a psychological problem.
Alhamdullilah, its good to hear that you try to be patient. And you really made me think about your leg. You never know, on the day of judgment your leg might speak for you, saying it has caused you pain and you tried to deal with the pain patiently, inshallah. Maybe your leg is what will put you in jennah, inshallah. At the same time, I hope your pain does lessen!
As for suicide - assisted or not- I am very against. I have first hand experience with family members committing suicide and it is a very sad and selfish mistake to make.

Anonymous said...

thankyou for your advise about depresion.

Anonymous said...

As salamalaikum Sister,

I have just stumbled across your blog and I am having a great reading it. I would like to congratulate you on an AWESOME blog.... I am just catching up on all the posts ...

Keep up the Great Work Inshallah!!!


Safiyyah said...

Salaams AlabasterMuslim: Yes, did you see how the man stuck his leg in that dry ice or whatever it was to freeze it off! Ya Rab ... I couldn't believe it! And you are so correct about the effects of suicide on those left behind. We had one at our prison, a very young Muslim girl. It was powerful to see almost 2,000 women in grief and pain.

Anonymous 1 - your welcome. Muslims often struggle with depression because the pious critics make the depressed people think that the only problem is weak deen :(

Anonymous 1 - thanks! keep coming back!

Unknown said...

Dear sister, assalaamu alaikum. jazakAllahkhair to both you and brother yusuf smith. this is a very interesting discussion. even more interesting and beneficial was your response to it. it was indeed very nice. may Allah continue to increase you and us in the understanding of the religion. aameen.

i just wanted to post some selected statements of ibn al qayyim and sufyaan ath thawree, which i picked up from the website called muslimmatters and was posted there by sister Amatullah. i believe these are very pertinent to this discussion and to the topic of having patience in general. i hope we can all benefit from them:

Imam ibn al Qayyim rahimahullah:

The divine decree related to the believer is always a bounty, even if it is in the form of withholding (something that is desired), and it is a blessing, even if it appears to be a trial, and an affliction that has befallen him is in reality a cure, even though it appears to be a disease!

Unfortunately, due to the ignorance of the worshipper, and his transgressions, he does not consider anything to be a gift or a blessing or a cure unless he can enjoy it immediately, and it is in accordance with his nature. If he were only given a little bit of understanding, then he would have counted being withheld from as a blessing, and the sickness as a mercy, and he would relish the trouble that befalls him more than he relishes his ease, and he would enjoy poverty more than he enjoys richness, and he would be more thankful when he is blessed with little than when he is blessed with a lot.
Madarij al-Salikeen 2/215-216

Sufyan ath Thawri rahimahullah:

Verily, when Allah withholds, He actually gives, because He did not withhold on account of miserliness or stinginess, but rather He looked at the benefit of the servant.
So the fact that He withheld is actually His choice for the servant and His excellent decision.”
Madarij as-Salikeen 2/215

Safiyyah said...

As Salaamu Alaikum Dear Shariq:

JAK for posting daleel.

I was watching a DVD lately about death being a "reliever." Imam S. Wahaj, in 1995, gave a Friday khutbah and then prayed the Janaza prayer of his daughter. In his khutbah, he was reminding the people that EVERYTHING is from Allah swt and is for the believer. Therefore, the believer is happy with whatever befalls him, whether it be "good" or "bad." Because the believer knows that Allah swt would not give him ANYTHING that was not a benefit to him in one way or another. This is why the believer is encouraged to be patient when illness, death or something like that happens. There is always "some" good.

JAK for stopping by.