Modern Issues On Islamic Medical Ethics in Light of COVID-19 – A Conversation with Dr. Aasim Padella
We may be experiencing one of the biggest tragedies of our generation at this moment. There are many questions and uncertainties when it comes to modern issues we face regarding medical practices due to COVID-19.
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Cena mala su de la vida Ali, he was a happy woman, what am I bad? So Tuesday's as you know, we have our regular q&a sessions. And today, I wanted to do something different today in light of what is happening, you know, with the Coronavirus, with all of these issues taking place, I want to actually get involved directly with some of the medical issues that we're facing, and raise public awareness about some of the issues that I believe all of us within the Muslim community should be aware of. Now, if you remember a few months ago, I think it was I gave a longer lecture. And you can find it on the q&a section of our websites, where I mentioned the various positions that our classical
scholars had about to the issue of tidel. We or availing oneself to medicine and the necessity or lack thereof, is it Why is it obligatory for the Muslim to avail oneself to each and every medical procedure? Or is it something that is recommended? Or is it better to do nothing and I had a very long lecture at that stage. And I don't want to go over all of that again. But just to rehash very quickly, what I explained in that lecture and the evidence was there in that lecture, you'll find them online. What I explained Is that pretty much unanimous position of all of our classical and and you know, traditional scholars, is that the general concept of availing oneself to medicine taking
medication, generally speaking, it is between Mr. hab and MOBA, it is something that is permissible, and an occasion you have the option to basically opt out of it. And this is the position that all of the four schools of law, basically held that the henna fees said that there's no sin on somebody who chooses to abandon treatment, the Sharpies have been hydrated, hate me or wrongly, they said that, you know, usually the default is that it is most to have to take medicine, but it is not wise to do so. And the Maliki is pretty much have the same position. In fact, Mr. humble, he was the only scholar who basically generally felt that you know what, when a person is sick, then if they want to
take medicine, they can, but if they don't do anything, and they simply, you know, leave it up to Allah subhanho wa Taala that might actually be even more rewarding. This is the generic position of all of the four schools. However, there are certain scenarios very, very rarely, where some of our scholars said it is obligatory, to avail oneself to medicinal practices and shareholders and even taymiyah he summarizes this very concisely as his his his typical methodology in volume 18, page 12 of is much more fatawa. He says that the correct position regarding meditating medicine and medicinal procedures is that sometimes it is held on and sometimes it is mcru, sometimes it is MOBA.
And sometimes it is Mr. hub, and very occasionally it will be obligatory, it is going to be wajib, to avail oneself to a doctor or to medicinal procedures. And that is when it is pretty much certain that if he were not to undertake this medicine or procedure, if he were not to do what the doctors told him to do, then he would die as a result. And therefore this would be a type of suicide. And the most common example that our scholars give is that of a person with blood gushing out because of a wound, obviously, he didn't cause that wound, obviously, you know, suppose you know, there was a an incident at the house or somebody attacked or he fell or whatever happened, and an animal
attacked and there was blood gushing out, and there's somebody that can tie the wound up, or maybe he himself is able to basically tie the wound up on his own. And he says, No, I'm not going to take advantage of medicine. And I'm not going to let somebody tie the wound up in this type of very narrow scenario, the majority of our scholars and especially the modern field councils, they have said that in this scenario, when there is very minimal effort, that is that is involved, and the outcome is fairly certain that if he were not to do this procedure, he would die and to do this procedure is life saving. In such a scenario, it is essentially obligatory to avail oneself to the
medicinal procedures that the people of one's timer or culture are familiar with. Again, the point is that it should be fairly certain that life will be saved. And that also that it is a fairly simple procedures not involving an immense amount of effort or invasive procedure or something that's going to cost a few million dollars or something that is not reasonable for the average person to do. If it is reasonable, and it is something that is not that difficult and it is something that is certainly
To save one's life, then in sha Allah in this case, the position that most of our field councils have is that it is obligatory to undertake and to then avail oneself to whatever knowledge that we have of science and medicine. Now that is hypothetical, we're now getting to the issue of Coronavirus and of COVID-19. And this is presenting a number of unique situations and scenarios. And already in our own community here in Dallas and across America and across the world. Our Muslim community has already began begun to feel the pinch of this this reality number of, you know, our own extended You know, Friends and family members, they are suffering from the virus and some of
them have passed away We ask Allah subhana wa tada to count their death as Shahada We ask Allah subhana wa Taala to bless the families would suffer. And we also want to, in particular, to through today's topic and lecture, raise public awareness to those of us that are perhaps not fully understanding the ramifications, the repercussions of what might potentially happen. And today's lecture frankly, it was not easy for me to to prepare emotionally. Because it's somewhat of a morbid topic. It's somewhat of a topic that we don't like to talk about. But times and situations are different than normal. And it is imperative that awkward conversations take place now, before they
get even more awkward. And because of this, I decided to bring in a person who might consider a friend of mine, we have a very special guest that's going to be joining us. And this guest Alhamdulillah his introduction his resume is several times longer than my own. And it is something that I have to condense but I'm very honored to have him on our show today. Dr. Austin Padilla. He is an associate professor of medicine. He is the director of the initiative of Islamic medicine and program on medicine and religion. He's in the McLean Center for Clinical medical medical ethics. He is the Associate faculty in the Divinity School and University of Chicago. Dr. Austin is a clinician
and a researcher with a scholarly full Chi that is at the intersection of healthcare, bioethics and religion. He's a doctor and a scholar, an academic his scholarship aims at improving health and health care through better accommodating religious values in health care delivery, using Muslim Americans and Islam as a model. He studies how religion impacts patient health behaviors and healthcare experiences. How religion informs the professional identities and workplace experiences of doctors and how religion furnishes bio ethical guidance to patients, providers, policymakers and religious leaders. Dr. Padilla holds an MD from the Weill Cornell Medical College. He has a
bachelor's degree in Biomedical Engineering and classical Arabic from the University of Rochester, and he has also studied Islamic theology and law in Islamic seminaries and in academic settings. Dr. Padilla has authored over 100 peer reviewed articles Marshall that's about a COLA and book chapters, and he serves as an as an editor for a number of famous journals, including the Encyclopedia of Islamic bioethics, the American Journal of bioethics and other journals. Dr. Padilla's work has been featured in The New York Times the USA Today, the Chicago Tribune, The Washington Post, the NPR, BBC, CNN, and it goes on and on. Most importantly, in my opinion, Dr. Padilla and hamdulillah is a
good friend of mine Hamza. And I've had the pleasure of working with him as a part of our fifth Council of North America where we regularly invite him to come to our seminars in our conferences, when we have issues of a medical nature, Dr. Padilla Assalamualaikum
masala, hello, what's up with this mask? What's going on? I think COVID is in the air everywhere. So I want to protect myself, I encourage our viewership to also protect themselves. So I'm one person who follows the law of the land. And our brother has told us to wear your masks, although they're not watching upon him. So.
So you've just come from the the hospital today. And I know that you're at the forefront of dealing with patients that are suffering from COVID-19. Just so that again, we're aware, what are some of the most common patient complaints that you're seeing? And you know, what are some of the the the worrisome issues that we should be aware of? Do you have any generic information and also personal stories from your from your daily routine and practice? Sure, so So, Chef iass. It's a pleasure to be here. Mila Swann bless you and the audience and keep you safe. I work in the emergency department. So it's a place where I don't want to see friends or any of you there. And the ER you
know, our most of our patients come and they're worried about having COVID so let me give you three story scenarios. You have people who are what I call worried Well, they heard someone had COVID in the building. They're concerned
So you come in to try to get checked for COVID Oh, they might not have any symptoms, right. And we know that some people might not have any symptoms but have COVID. But that's one population. The second population is that people will have symptoms of what might be COVID-19. They have, you know, fevers, chills, flu like symptoms, and there they come in to get it get specific testing for COVID. There's a third sort of population that has some other issue, but are doing very poorly. This is the one that concerns me the most people who might have symptoms of a pneumonia, are having difficulty breathing, who are having kidney failure. And this is all because of their body's reaction to this
disease. That's the most important one we have to care for. And the one that troubles us most in the ER, that they're really having difficulty breathing, and their body is shutting down because of this overwhelming response from having COVID in their system.
So vital. So from a medical standpoint, we've been hearing a lot about this need for social distancing for lockdowns. How is that going to play out like we are all of us who have having the same question. And we're hearing different politicians, and different medical experts give us different analyses and future scenarios. And again, only Allah knows the future. But you are an actual expert, you're on the for field, you're at the forefront of this, you are engaged daily, this is your area of expertise, help us understand what is exactly going on. And what is the end game for COVID-19?
Yeah, well, as you said, last month knows, I think, from the health data. So I do health research. As I mentioned, we can only think of two ways out of this scenario, right. So we've talked about the likely scenario, and the hope for expect or expected scenario. So likely scenario is that people will get infected with the disease, and they'll have so many infections in society, most people doing okay, that you'll develop immunity, that it won't be transferred from people, right. So this idea is that at some point, there'll be enough people have gotten the disease have recovered, that they will not have a chance of getting it again, and spread will go down. That's why you heard about
flattening the curve, right, we want to have sort of modulated infections so that it's not overtaking the healthcare system. So that's our expected sort of scenario, which would mean for months, we'll have intermittent COVID flares. Or, alternatively, the most exciting scenario would be that we get a vaccine. And if you get a vaccine, you can deliver it to everybody, then just like the flu, this will be a seasonal thing for some people. But you'll have a vaccine that will make disease less severe upon most people. And therefore you will not have these people are dying, right. So those are the sort of two scenarios more expected. One is that we'll have COVID. For months, it will
peter out. But they'll still be present. And the most exciting one will be if you get a vaccine, neither of those are going to happen within the next sort of month, or next two months. These are sort of six to eight months projections. So that's the end game from the healthcare system standpoint. So realistically, and again, we're not going to hold you to word and we're just alone knows the future. Realistically, you do not see this lifting in two, three months.
I don't see us not dealing with COVID in the ER or in the ICU as a routine matter in the next two, three months. Now, we will still have even with social distancing, they'll be pockets of flares, people will have disease, for example, nursing homes, and we'll have to gear up and take care of patients with COVID-19. So no, I don't see it going away. I think your viewership and all of us are worried about the the idea, can we return to normal life like not go and wear masks, you know, be able to have congregations together. And that Allah knows right? If you have significant fears of disease, that might not ever be the case in the next two, three months. However, if Allah wills, you
know, with Ramadan coming, perhaps our duels will be accepted. And then we can sort of saying, Oh, we can return to normalcy after that, but alone, he knows what will happen. You don't sort of foresee it, it's not an expected outcome right away. Okay. And again, realistically, given our parameters, given our human knowledge, suppose theoretically, a vaccine were to be discovered within a week, again, realistically, so that our viewers understand what does that mean for us? In our houses? How long would it take for the discovery of a vaccine at Stanford or at MIT? Until it actually gets to, you know, our local, you know, wall, you know, Walgreens or something? Correct. So
that's, that's, that's, what six months right? So population based vaccinations are not easy to deploy, even if they're effective. Just like we had difficulty getting PP right. or difficulty getting medications to get every Walgreens Walmart, every hospital to have enough vaccine for 300 plus million people, right? Or at least 250 million people is uneasy enterprise. The United States is not set up for that, by the way, maybe smaller countries, but us to get in every corner, every rural community, we don't have that ability, it will take months. So again, the quick fix that many of us hope for your daughters might be accepted, but it's not the most probable likelihood from a
medical standpoint. Yeah. So this is what I
I've been saying for quite a while, that's not something that I like to say. But it does appear like we're in this for the long haul. And knowing what to expect is really half the battle, just preparing yourself psychologically, and emotionally and then figuring out what to do financially. And logistically, this is all a part of our religion, you know, our Prophet system has told us the Quran tells us to do a thorough comb, you know, take your precautions, you know, don't just be foolish. And this is something that we learned from our shediac as well. So again, this is something that we wanted to hear from you that, Realistically speaking, there does not seem to be barring some
miracle. And obviously, we do believe in miracles, we ask Allah for a miracle. But barring that type of divine intervention, it might realistically take six to eight months at a bare minimum. And even in that point of time, there might actually be even after that point in time flares that might come back and forth. And we might just have to do this every once in a while. Right, right. So we're talking about just realistically even say, in three months, we come some normalcy, but things will never be the same. For example, the idea of us having massive events and concerts and Majumdar Wu Jamaat conventions with 1000s of people that might need to be controlled, right? Because one person,
two people being infected in that whole gathering could then cause a flare, or people traveling in the way that they travel all the time, those normal things that we're used to unless we get a cure, and that's the pilot problem, right? There might be a vaccine, but there is no known cure for COVID-19, right? Unless we get a cure that we can deploy, we're gonna have to practice our lives in a different way post this COVID-19 era subpanel it's literally like a game changer. Everything might change in all that we're doing. SubhanAllah it's very eye opening. So again, you know, Dr. Awesome, again, you are an expert, you are dealing with COVID on a daily basis. And Hamdulillah, you are a
practicing Muslim, I can testify to this as well, you've gone through a madrasa system a little bit as well. And again, I'm not saying this for any reason, except because the next question I'm going to ask you is a very sensitive one to some viewers. You're actually memorizing the Quran and have it memorized more than half the Quran. So your deen your dunya hamdulillah shala very role model for many of us here. Can you please elaborate from your technical expertise background as a practicing Muslim? What do you say to those Muslims that believe that COVID-19 is some type of conspiracy theory that some governments you know, some unnamed governments, we're not going to mention any
names, but are sinisterly just you know, putting this into the population? or What is all this 5g technology linked to this? Can you please give us your expert medical opinion as a practicing and Sharla card fearing Muslim? Not somebody who was working for any you know, so please Bismillah. What do you say to that? Yeah, a shift. I mean, I think that the question is for the US to be somewhere out answer it. I mean, I think, you know, we are people who have to go by the, quote unquote, natural law of how things happen right here. And so there is seems to be a logical link between animal transfer of diseases and like this Coronavirus is to humans, we've had the same thing
happened with the flu, the swine flu. And so there is a model upon which this logical connection makes sense from animals to people. Right. And we've been talking about this for decades. Now. There is no reason to believe at this point, that that's not the case. Right? That there's some conspiracy theory for us to, you know, eliminate the disabled or something like this or for a warfare from China to the ICC, whatever else it might be. I think that that we have to follow the law in this sense, right, what's happening and not believe in exotic theories. And from my perspective, when we do that, I want to hear what you think when we do that and allow for conspiracy theories about
whatever else to affect the way we act. We have this psychology of not taking ownership of what we can do, right, we sort of disempower ourselves. So as a scientist, as a clinician, I have not read anything that suggests that there's some nefarious thing happening here. But I do you know that this age people sort of spread a lot of untruths, about 5g.
Yes, through 5g.
So the nefariousness is in the rumor spreading via 5g
5g So again, I need to say this because I cannot believe how prevalent this theory is in so many Muslims, sub communities like is there any actual pseudo evidence even like semi you know, backed up evidence that 5g is somehow linked to COVID-19? Not that I've seen so i don't i don't try to scour the internet for everything but I have not seen and I'll tell you from a practical standpoint as a physician, how for your viewership unless you as a you know, a chef
It doesn't matter. It's here now we have to take care of ourselves, right? So why are we worrying about where it came from Allah spawn, tada gathercole Shea, right? He's made it happen for whatever reason, we have to take action, it's time for us to take ownership of what we can do to combat this disease and make our loved ones secure from it. Excellent. So two very important points. Firstly, there's not a shred of scientific credible evidence that COVID is either some type of government conspiracy or coming from 5g. All of this is just rumor mongering. And secondly, even if you wanted to believe that it's not going to change your day to day practical routine of how you're going to
combat COVID-19, you're still going to have to do this social distancing, and be careful and whatnot. It doesn't change any of that. And the again, you asked me my position on this, and I had mentioned a few days ago that, you know, there's a psychology of conspiracy theories that people who believe in conspiracy theories, they actually are typically disenfranchised, and they empower themselves via conspiracy theories. So they feel a sense of, like lost, they don't have ownership of the narrative. But when they believe in a conspiracy theory, it gives them a false sense of power that I am shaping this narrative, I know what's going on. And that false sense of power is
potentially lethal or fatal is potentially dangerous, because they have convinced themselves of an illusion. And in that illusion, they it's like the people who think the world isn't gonna come to an end in a particular day, and they wait and wait and wait. And they that day comes in goes, nothing happens, they've just wasted all of that time. Well, in this case, the conspiracy theory is potentially very problematic, because they might not take necessary precautions, and they or their loved ones might actually get harmed in this. So again, we are trying our best to keep on saying that there is no shred of evidence, please stop forwarding these WhatsApp messages or you know,
people who are saying this or whatnot are there there are people who already have very dubious backgrounds as it is look up into their psychology and into their backgrounds. They're the ones spreading these 5g and whatnot conspiracy theories. It's not something that is credible, every rational person is seeing the world is hurting. No one entity is benefiting all countries are hurting in their own manner. So anyway, this is something we're telling our people so that inshallah tada they understand this is a test from a lot of xojo. And you know, if there's anything that needs to be blamed from a spiritual level, it is our collective sins and I've given hold vision lectures
about this, stop blaming some third entity Subhanallah I have to say this, the Quran and Sunnah is very clear on this point, that these collective calamities come because of collective lawfulness, collective arrogance, collective fascia, that is the real problem, not 5g, and not some other, you know, for for term territory. But anyway, so that's the issue.
Yeah, I mean, I mean, okay, now before we get to some of the the physical issues that we're going to be discussing back and forth, and by the way, one of the reasons I wanted to do no doctor asked him to come is to again demonstrate that these types of issues, which involve aspects of the modern world and aspects of Islamic ethics, they cannot and should not be decided by only one area of speciality. So Dr. osem is a doctor, he is a medical doctor, he's a professor, he's a researcher in medicine, and his expertise is medicine. And the fifth council their expertise are, they don't know medicine, as well, as Dr. Awesome does. And Dr. Awesome, hasn't studied. Fifth, as much as the field
councils have done, the two need to come together, which is what the fifth council North America does with Dr. osem, in particular, and other doctors as well, these types of issues. You cannot just go to the Mufti and share and ignore what the doctor says. And also neither should you go to a doctor who doesn't know Islamic ethics when it involves areas. Obviously, there are areas that don't involve Islamic ethics. I mean, just a simple procedure. But there are areas of life and death of withdrawing support, which is we're going to get to now these areas, right? Are you allowed to withdraw medical, you know, life support, life saving support? Are you allowed to, you know, refuse
the intubation let's say these are questions that intersect law, ethics, and morality and medicine, and to answer these types of questions. Generally speaking, it is very difficult to find one person who has mastered all of these fields, you might there are rare people Hamdulillah, Allah has blessed them to be experts in all of these fields. And by the way, even those experts, they typically defer to other councils that have more people. So that's one of the reasons I wanted to have a conversation with an expert you know, in medicine, and I'm not an expert in film, but I'm a student of knowledge of film so the two of us can converse. And before we get to our conversation, a legal
disclaimer This is just a general discourse for public awareness. This is not meant for specific advice for any particular
Killer person in a specific situation and scenario, please, if any of you or your loved ones and is in a specific situation, do not derive a verdict based upon our conversation on the air, this is just for general information sake, so that you are have more awareness. If and May Allah protect all of us if and when the time comes when you need to actually make a decision. Feel free to listen to this lecture. But the actual decision cannot be made based upon this generic lecture, the actual decision will be made with the doctor who's in charge of that particular person and with your share for them or that you were in touch with that can then assess that situation. And scenario. Don't
assume you agree with that disclaimer or any other disclaimer, I'll just say one thing about this idea of intersectional expertise, I think we also need to have a notion that we have to be critical of both fields, right? These are bodies of knowledge. So the people who can take a critical standpoint not automatically accept every bit of knowledge from the medical scientific world, there's many different sciences and fall. Similarly, you know, our traditional martial arts fast, some people have theological expertise, some people have legal expertise. So we need to be critical on both sides. So we get closer to the real thing, right? We're all making use that in different
ways, or you're making yours to hide your fit counselors, but we're trying to get to an answer that's acceptable with this tradition, not the answer, right. I think sometimes we get caught up in this notion that there's only one truth and everybody else is false. And I would what dissuade us, we're all doing our best effort, bringing things together.
Excellent point, and that is that even within film, there's a spectrum of opinion, generally speaking, and even within medicine, there's a spectrum of opinion. And so it should not be ever understood that if one faculty says something, or one doctor says something, that is the end all be all. Excellent point. Jay, before we get to the actual conversation, some medical terminologies
that we should be aware of. So can you explain to our viewers, especially when it comes to COVID-19, what are the main medicinal interventions that they should be aware of such as intubation, and such as being put on a ventilator and anything else that comes to mind? Just explain for us lay people so at least as I mentioned, the most worrisome patient to me is a patient who comes into the emergency department is having difficulty breathing. So I had a case of this is a 48 year old woman who came in the other night who had asthma and she was having difficulty breathing. We could not distinguish with asthma or was a COVID-19 Jetta fever. She had some flu like symptoms. We found that in
COVID-19, so when you have someone's having difficulty breathing, for example, right, and or has you they're thinking about how do I solve that problem? Now, in the era of COVID-19, I think your your viewership to know many people I've asked around the world, they use inhalers, they get sort of, you know,
ventilate, not ventilated. I'm sorry to get nebulizer treatments, and the air of COVID-19 we can't give nebulizer treatments, because it gets everywhere in the air. So if you have COVID-19 in your respiratory tract, and you put that on you, it's gonna get all over the ER. So we're limited in what we can do. Meaning I can give you some medicine through an IV, I can give you oxygen through the nasal cannula. But I can't give you that particular medicine that makes your lungs expand through through the the mask. So what am I left with. And this is the most important thing I'm left with trying to intubate someone, which means putting a tube down their throat, if they're having
difficulty breathing, and taking over their lungs, respirator or ventilator, same thing, I'm going to be breathing for them, I'll be giving them medication to make them not conscious, right, because having a tube down your throat is not not something people like, but I'll sedate you, I'll intubate you, and then I'll have take over your lung control so that I can have a machine and breathe for you. And that is the most concerning thing, I think for this whole COVID-19 because we know that COVID-19 specifically breaks down our has a difficulty with the lungs tissue, right, and it causes the lungs not to be able to oxygenate the body. So that's the most troublesome aspect of COVID-19.
And the most worrisome treatment is this one that I have to intubate You mean, put a tube down your throat and put you on a ventilator meaning take over your lung function for you to get you through the event. Again, as I said, there's no cure. So I'm hoping over time, that your body itself generates an immune response to the disease and you get better while you're on the ventilator. That is the hope. Right? And that's I think that these two are intellectual conversations, because that procedure is one that is not Yeah, as you mentioned the beginning right? It might be for some people who are very skilled, easy to do. But it always carries a chance that we might not be able to
intubate, you might have some, you know, body physiology that we difficult or some large neck or something. Or and here's the more important thing for our viewership and just did appoint we know from data from China data from Italy, data from Spain, data from the United States, that half the individuals more than half who have to have that ventilator on
When they for COVID-19, will not get off the ventilator, meaning they will die on the ventilator.
Right? So if you have COVID-19 disease that requires you to have a ventilator, meaning I have to take over your lung function, there is a higher likelihood, right? As far as we know that you will never be able to return to normal lung functioning. And that makes it very difficult for us to have conversation. Those are the choices we face every day. There. Let me ask you, so 40%, roughly can get off the intubation. If they do get off as of yet have they got back to normal? Or is it still depends on the person's own risk factors, right. So that people, as you look at the CDC guidelines, or others, they say, people who have lung function disorders in the beginning like asthma, or have
interstitial lung disease or have COPD, it's very hard for them to return to normalcy, right? You might have to put in a, you know, a hole in their neck and have a ventilator every now and then. Right. So so we don't have good outcome data. But those individuals are highest risk and the elderly, my, but it's not 40%. So some data points. For example, in New York here, 73% 73% of people die, before they get a chance to get cured from the disease or meaning their body tours themselves of the disease on a ventilator. These are hiring statistics. We haven't Wait, I want to make sure we understood this. You're saying in New York City, more than seven out of 10 people that got to that
stage of intubation, we're not able to sign Allah Subhana Allah Wow. Subhana Allah that's harrowing, along with Stan, may Allah protect us. So now this leads us to now the the the main reason why you're on here today to have this conversation. So is it therefore in your so let's talk about from a medical perspective, then let's get the Islamic stuff here. This issue of suppose somebody comes to you in this state that they're having difficulty breathing? Right. As a doctor, what fac, what factors are you looking at to assess? Are they hopefully going to be in the 30 40%? That will make it through or not? based upon that? Why am I asking you the question, less than get to after you're,
you're explaining to me the medical stuff, let's get to the fifth aspect of what they should know about intubation being Muslim, or whatever to you in some of those areas so that we can have a conversation, let me say, medically, as you asked me about, you know, what?
What are the the, the the concerns that we'll have? Right, so so I've mentioned to the statistics here about intubation. I mentioned to the outcomes, right. And what we do in the hospital is we have 100, it allows given us the ability to analyze a lot of data, we have data from other diseases like COVID-19, SARS, for example, MERS, right. And we have other diseases that cause this breakdown of
the brain.
So from that, we can prognosticate what predicts people not doing not getting off the ventilator, and what predicts people dying on the ventilator? Right. And so we have some credible evidence that tells us certain people won't do well, I mentioned to you those who have disease, people, elderly people have concomitant problems, right. So someone's got pneumonia, lung failure, you have kidney failure, as well. We know a lot of our population has diabetes, and they have kidney disease, right? We have to get, you know, dialysis, all of those particularly bad. That's right, meaning that they will not get off the ventilator or they will die on the ventilator. And this is what we use medical
sort of clinical benefit. So the idea is who will benefit from this intervention? Those people who don't have those risk factors, and we can calculate with a reasonable surety? What is their 30? Day mortality? How many what percentage of this person how likely is they'll die in 30 days? Or how likely is it that this treatment will extend their life although we believe last month who knows when we're going to die, but we can calculate with some certainty or shortness? how life beneficial this will be life saving this, sir. Okay, so let me know. I mean, obviously, we're going to go back and forth here. And you're also aware of this, these issues because you have presented the council
you've written papers about Islamic bioethics, as you are aware as well. Generally speaking, our scholars have not considered such such medicinal interventions as being obligatory unless it is something unless it is something that he has a lowball oven there is a preponderance of evidence that a relatively trivial and cost effective procedure will save one's life. If there are mitigating factors of them is excessive, you know,
invasion of one's body of them is an exorbitant cost because locally for long enough senate levels are, and of them is a minimal chance of recovery. In any of these situations and scenarios, the vast majority of our scholars, the four methods have actually vacillated between it being mobile and maybe even makuu. Like, why would you want to increase somebody, you know, difficulty at that stage. And I think this is one of the and again, you've written papers of this. But I think as Muslims, we have a different attitude than people outside of faith to life and death, in reverse of this culture that are outside our faith, their main goal is just to extend life, no matter what the cost. And for
us, we have as a less as what are called the kurama, Benny Adam, we have honored the children of Adam, there's something called the kurama of the children of Adam, and there's something called a dignified death. So we don't want our loved ones to live in a vegetable state, necessarily, that's not something that the Shetty is looking to do, to increase them, you know, on a ventilator where they have no cognitive faculties where they're not able to pray and, and, and, you know, worship Allah Subhana, WA, tada, they're unconscious, and knocked out. And they're there just for the sake of being there. And that is why and again, you know, this, you know, as well, that all of the fuqaha
councils, all of the fifth councils across the globe, have opined that, in such cases were a vegetative state has been achieved, and there is very little chance to obviously, the one in a million miracles always happens. But the shediac is not based on the 1 million million miracle dish, it is based on what is called the preponderance or the hub. And that is why the mergermarket Islami over the oyc in his verdict in 1986, and the image filter under arrabiata of 1987, and the escape out of Saudi Arabia and the quality Council, the trading Council and to have all of the listed councils here, pretty much all of them, they have opined that when a person is on this vegetative
state, it is not necessary to a even give this person the the the medicine or intervention or be to even sustain it and one can actually withdraw, one can actually get Take, take care of this person in a manner that they can withdraw the breathing apparatus, the ventilator, and they can allow this person to basically pass on and let nature take its course. And this would not be considered causing the death because causing the death has been tamed me and others they mentioned this is by depriving the person of the air that they can breed themselves to suffocate somebody, this is causing them to die, or to not give them food and water to withdraw a ventilator system that they're using when
they're in a vegetative state, the council's across the globe, including here in America Amgen the council, they have all ruled that if the doctors opine that there is very little chance of survival or even that the survival be in a vegetative state that it is permissible to withdraw. Now, I know you've written papers about this as well. So you want to comment on this and give us some of your expertise as well. So I think,
correct me if I'm wrong, but I think that in this context of COVID-19, I would differentiate two different types of patients and two different scenarios here. Now, caveat, I think is the vegetative aspect that we're talking about 11 papers on that, you know, and I have some things about brain death. And we've talked about this, you and I together, I don't think it applies here. So let's take a scenario shared with you about a patient right, so I have a patient who's having breathing difficulties. And my choice is to intubate her put on a ventilator, right. And I said to you that the statistics there show that there's less likelihood of recurrent getting off the ventilator than
on if she has certain features. So the question here, as you said, is okay, well, now I'm obliged. Is it logical for me to continue this treatment? So the question then becomes about, well, you know, is there benefit, right, so you mentioned that the metamorphic talked about life saving nature here, right. So is this and is it life saving? Certainly are a lot of us have done wise, right.
I gave you statistics, it is not certain. Right. Therefore, we're not talking about withdrawing, we're just talking about not going on the ventilate in the first place. Right? If you have certain characteristics, and the doctors, as you said, are saying that I have little chance for you to benefit from this treatment, meaning extend your life is less than 50%. Right? Well, then we have a choice that it's not. It's not life saving, in my view. And I think that's what you're saying. That's not the vegetative point is the point where you don't even have to start the idea of giving you medication, or having the complications where they're not conscious. You don't even have to put
the tube down your throat. Right, if you know, you're not less than 50% benefit. So the idea is clinical benefit, right. I think sometimes people forget what that means. They talk about futility and all these other terms, but just say
The prognosis is a you will not get out the ventilator. It's not life saving, therefore there is no obligation to continue. The other scenario and I want to know, once against what you said, is about withholding, and withdrawing. So you put the ventilator on. Now, do we have to keep it on? Right? As you mentioned, the cost of a powder mine calm on your right. So I believe as a physician, right, and with a little bit of literacy in Islamic tradition, that every time I'm patient, the ICU, you know, they're not able to interact with me as they normally would, sometimes, because you have to give them medication to be on the ventilator. They're not conscious for the prayers, right? They don't
have the are not they have to be in there, you know, to give for allow them to urinate nurse comes in, has to clean their back, right? This isn't undignified in my view, existence, that that all that existences right. And I think that we have to recognize that those are threatening from the column of the body, if that is odd existences, so I wouldn't use the term vegetative that means something specifically mentally, I'm just saying at that state that the hematoma and the Chroma individual might be at risk here. And if there is no known benefit, that I can, we can list in my view, I think and
Islami and other councils and MFIs have said you can withdraw. Right? So there's a distinction in withholding and withdrawing. If you know, there's no benefit, but the idea of benefits there. The last thing I'll say this idea about
recovery, right, and harms and benefits. So in my understanding, and I want you to comment on this, is that oftentimes we don't think about the end goal, you were mentioning this right? What is the end goal of a person state? What do we want to achieve? By giving them medical treatment? Right? Not just how likely is but what is it? And you just said that Islam doesn't call upon them to live in an undignified manner? Can you kind of give me a sense what that really means to you as a family? Right? What what, because there are some people who at baseline, right have mental disabilities, right? There are some people who get really concerned about utilitarian reasoning. And in secular
ethics, when they talk about these people don't have qualities of life, right? So I want you to kind notice that for us, because there might be people we take care of, don't Well, some might say, are not dignified individuals because of their incapacity. And I don't believe that tradition says that either. So can you help us think about that? So that's okay. So you mentioned three things.
Obviously, I welcome this is your expertise. So you said that I shouldn't use the term vegetative. How about comatose? Is that more accurate? Well, so comatose again, I have so let me let me comatose is a creation of the mental capacity of individuals, right? When I, you do a surgery, you're comatose, right? You're not feeling things? Correct. You can say that's a vegetative, but it's not vegetative. But that's a temporary state. When I have to intubate someone, I have to give them medication. So they don't feel the pain of being intubated. They're in a in a quasi comatose state. But these are all mental. These are sort of popular understandings of medical terms. And when we
want to use medical terms, vegetative state means an individual who does not have alertness, or awareness becomes permanent or persistent after six months, right? a comatose individual, there's different traditions of alertness. And we have many different categories of common. So I don't want us to confuse a lay understanding of a coma is what it looks like to us with the medical. And if I tell you the best outcome is that this individual will not be able to eat, drink, open their eyes, those are things you can understand. And we can notice a coma, right? There's a different diagnosis for that. So I don't want us to use terms that confused people oftentimes, let me in here, I
oftentimes I find when I get consulted by some family, that they don't understand what the doctor is saying. And then they say, oh, they're saying the vegetative or they're saying coma, or they're saying this. But actually, that's not what they're saying. But that's how they can conceive of it, right. That's how they picture. And we have different medical therapies, people in different ways. So I wouldn't want to use those that are quasi, I never hear this. Again, this is the whole point of us coming together and having this conversation, this is not my expertise. And you're educating us about the gradations of comatose and the vegetative state has a technical meaning. So from our
perspective, you said you there are three things that are very, very important. The first of them, the patient comes, and they have yet to be intubated. And you they can weigh the pros and the cons. Now, what do you advise as a Muslim physician, that Muslims have their in their wills in their will see as what do you advise Muslim patients of yours who are worried they might, you know, Allah protect all of us, but it presented, you're going to get this COVID virus? What is the conversation that they should be taking place? And what are the factors that they need to take into account? So we're going to or all three scenarios one by one, the first of them before they're intubated?
They're all normal and healthy. They're putting these conversations now. Yeah. So I think that that families and now have to have a car
About what they desire to be their end goal, right? So I want to be able to interact with my family that might be a quality of mine, right? Or I want to be able to do the Salah, or to be conscious enough to Vica. And if that's the goal, you can ask the physicians. If we intubate How likely is that they will reach that goal, right. And when you have a family conversation, you've told people, that's the goal I want to move towards. And if there's not a dominant likelihood, I'll get there, then I don't want that treatment, whether it's an ventilator, whether it's antibiotics, whether it is whatever it is surgery, but I think families need to say, here's the state I would like to live
in. And for me, and I advise us to leave right the aisle even one is the far right might have the ability to move us from Jonathan to Jenna. So if I can have that one, so far, I want to live life. But if I cannot have to sit David Ornette will be in a state where I will have no awareness. Now I can use a clinical term persistent vegetative state, I would not consider that to be a life that I would like to be living until the quality, you know, if I had that for now. So that's the conversation about withholding. Excellent to be precise, though, that is your personal preference of what you would want a dignified life to be. And again, to be Islamic, others might have a different
level of preference. Right? Right. Right. Oh, guess was asking you right, excellent. From an Islamic perspective, before the intubation is done, if there is no certainty that they will be saved, then it is not obligatory on them to undergo that procedure, according to the vast majority of scholars, and should they opt out, and they feel that it is undignified from from their own perspective, to be intubated for typically, by the way, how long is intubation for the COVID patient is of some average can be a rough average, we don't have independent, we don't have good data. So why right now they're talking about, you know, in 72 hours or 96 hours, we'll know if this person will get better. So
that's initial trial period, right. And then sometimes people might be two weeks on it, but that's the best try for 72 or 96 hours. And if they're not getting better than the competition becomes withdrawing, which we'll talk about in a second.
So we don't have four days is the initial default, you're just going to get in three to four days. Right? Right, then after that, you'll get a preliminary assessment of how realistic it is going to be whether they're actually going to kind of come out or not, I suppose, theoretically, somebody who's already elderly, and they, you know, they, they already have other complications, and they feel you know, what, I just don't want to go through that procedure. islamically my point now, the fifth councils across the globe, and this is the standard position of all of them that they have, in fact, let me say, I don't know of any scholar that would disagree, that given that type of scenario,
it is not obligatory on this person to opt in to intubation, hence, the conversation that this person might want to have, it's up to them, that they should tell their loved ones, their children or their, you know, their spouses, whatever, that if it gets to that level, and they're going to intubate me, then, as long as they're, you know, they're uncertain about what the outcome is going to be, I don't want to opt into intubation.
I just want to know, of course, that's
in the ER, right? I won't necessarily know you have COVID-19 or not, right? I might have to send the test, it might take a few hours to come back. So I don't want people to leave, you're thinking, Okay, well, all intubations have this, you know, high risk mortality, and that everybody should just say, I don't want admission, you could have an asthma flare. And you can be a young person. And I can tell you with a surety that, you know, a 150 percent of the fine after one days, two days or three days. But if you have COVID-19 positive, then those statistics drop. So I think for families, we should have a general conversation what my goal is, but if I get COVID, I need to know that the
likelihood is that I might not get off. And I need to tell you that. And I did think about that before I get intubated. And so those that's that's the nuance here, right? It might be that they have asthma, I don't want them to generalize from obese stage perfect. So if the result is COVID-19, and then intubation, then these statistics are Okay, so then this conversation needs to take place when everybody's healthy, everybody's fine. And everybody should have this conversation, because a lot who item you know what's going to happen we were already seeing across the globe, young men and women who didn't even know they had any symptoms, any underlying symptoms are being put on
incubators, simply because you know, you don't know what's going to happen at that stage. So these are conversations everybody should have J. Now let's move to the second one. And that is the issue of withdrawing. And again, this goes back to the point of what is in your opinion, your personal opinion, a dignified level of living now, the Shetty I by the way doesn't have a very specific line here. And in fact, no don't go into too much you know, discussion here but as you're aware as well. This is a gray area, even within the fifth councils about what is the final
line between life and death in between what not however, generically speaking, generically speaking,
most Roma would say, a dignified living would be that in which you are aware of your surroundings and are able to therefore do some type of rebirth or decline, even if it is mental, that's the bare minimum level. Now, a lot of people would not want to just be aware mentally, and not do anything physically, like basically, their brains are functioning but not their bodies, they would to them that would not be a dignified, a lot of other people would not even want to have anything less certain than this. And again, I gave this example, a few months ago, and I talked about the issue of not opting in for medical treatment. One of my teachers that I've that impacted me the most on a
personal level, the great Adam Schiff, heaven Earth, I mean, I'll let him know that he was diagnosed with stomach cancer. And in the year 2000, he came to America for treatment. And they told him that, you know, his prognosis was not that much, you know, maybe a few extra months if he does radiation therapy. And if he were to duration to radiation therapy, they told him that, you know, you're going to lose all your hair, you're going to become sickly, you're going to become weak, you're going to be vomiting this and that. And, you know, it might if Allah wills, it might give you a few extra months or maybe even a year. And he was like, I don't want to just suck. Thanks. But no thanks. And
he went back. And he did not undergo a single radiation. Because he did not he felt that
that's what
really is your half that you should be aware of. And you should
be before that time, that
he was mentally fully alert, and he could understand what's going on. But what would happen if you're not mentally alert? What would happen if your family your children have to make this decision? And this is really one of the main reasons why I wanted to have this conversation with you, Dr. Ross. And because I've had this question posed to me in the last two weeks by five or six people in my own extended, you know, direct circle, and 4050 people indirect circle, and you've had this question as well. And it is so difficult, dear Muslims, you do not want your children or your parents or your spouse to make this decision? Because it's already difficult enough to see you in
that state. Give them some relief and mercy and make this decision for them before you get to that state. Right, right.
Yeah, so I'll actually give you medical data to back that up, right, and the Islamic point. So we know that families who have to make decisions to withdraw life support upon their families have symptoms of anxiety, like PTSD, upon right, you're actually causing them harm, you know, physicians, right, who have to withdraw life support, struggle emotionally with that, it's much easier to withhold at the beginning than now I see this body and three days, four days later, after I am the one, I am the proximate cause of withdrawing that, too, and they will die within minutes. So you're actually by not making a decision, I would argue you're causing harm to both your family and the
physicians who have to do that. And we allowed them to not do that, as you know, so we should not leave this to them. I've had many families who struggle with this specific issue, and you know, as well, so I urge people to have these conversations when they're full and capable. So inshallah you don't cause harm to others. So this is such a difficult thing PTSD, you know, you all know what that means. You are causing emotional shock and trauma to your loved ones. If you are not taking reasonable precautions by pre empting. what might be happening to you, and I'm sorry to guilt trip you. But you know, Dr. osem, and me, we are the ones that have to talk to the loved ones because
I've had to even three days ago, I had to talk to somebody that broke my heart like he's literally, you know, literally about to just break down emotionally. Why? Because he has to make the decision whether to pull the plug or not, you know, have the medical support. And I'm telling him, Look, the doctors have told you there's no hope, but he cannot help but feel guilty. He cannot help but be traumatized that I caused my father's death. And I told him No, you haven't. It's not your fault. You are not doing anything wrong. But these are words, it hurts him. It hurts me It hurts Dr. awesome to have to do it. All of us are suffering. And that's why I'm urging every one of you
especially those who are at high risk and you know who you are, or speak to your doctors to please have these conversations and you know what, if you don't want to have conversations, at least put it in your will and let everybody know where your will is right? Say in case of emergency open envelope right? You don't have to talk to them. If it's that awkward, but put it in writing. You don't have it notarized or whatever is the legal mechanism. Go to your lawyer and make sure people know that your will is over there in case of a murder.
Just open that envelope and document so that it saves the family, the trauma. And again, as the shift, I've had to be dragged into this and it's so emotional, the doctor has to be dragged into this. It's not my position to get in between fighting siblings, right? It's not my position to have to, to. And it's so awkward, because they're already emotionally traumatized. They're already raw. They see their mother, their father on the ventilator. And then the chef comes in, and they're having a fight between the chef and themselves. And then, you know, Dr. osem comes in, and if he has to do it, one of them's going to be angry at him. The other ones grudgingly saying, Yes, Subhanallah
it's such a difficult scenario. And they're gonna go ahead here. So let me tell you the other issue in COVID-19. So that's generally speaking, right? And my urging to our audience is that you actually not just want to put it somewhere you want to have a conversation, I'll tell you why. Because right now, you know, in the hospital, there's a no, no visitor policy. Oh, yeah, that's right. Right. You're not gonna have family around you to make that decision. There will be no one with you. You're lucky if you have someone to make through our say, Shahada, right. And and I've been called a hospital Can someone make dua for this person who you know, it's Muslim, but there's no one around.
And I'm telling you that this is not something you want your daughter, your son, your wife to write, they can't even see you. And they don't know what to do. And at times, doctors, what if we get to this, may Allah protect us this situation? Where we're rationing the sources, the doctor will just do it and not tell you? Right? So I'm telling this is the time we've always avoid death, right? But the truth is, absolutely can happen a lot that we have to think about this, not just stress, because these might be the moments you can repair your relationships with people. And you can say, you know, we had a conversation, right? And my husband and my wife and my daughter are emotionally prepared
for this trauma that might not even be in their hands. Okay, in that case, scrapped my previous advice of putting it into will, you should do that in regular situations and scenarios. You're absolutely right, because of Hannah law, obviously, in most states in America, you know, visitors are being allowed inside the hospital. And this is already the case in Europe and across so many countries in the world, no visitors and what this means as we're all aware, you know, may Allah protect us, but they're passing away without a single loved one to hold their hands. Without even at times the family being able to pray janazah at the gravesite in some places and land. So the
situation is indeed to that level of grimness that we have to preempt that difficult situation. And so do not just write it down, have those conversations with your family members and understand that they're aware of your feelings and desires so that they don't because again, I'm speaking to as the chef and doctor, also speaker, as the doctor, I am telling you from more than two dozen cases, not just over COVID I mean, overall, where the family members start bickering amongst themselves, and brothers and sisters are yelling and screaming that you and I literally had this case once not over COVID-19, where one of the siblings was yelling at the others that had me You are murdering my
father. That's literally what he's saying. How do you think they're gonna feel and I'm going to feel and it's not murder from an Islamic standpoint, it's not all the majority affiliate across the globe have said that this is not a dignified state of living for him to just remain, you know, in this, whatever you want to call it comatose. I mean, he's not. There's no tech leaf, he's just lying there. And there's no hope of leaving that state. You're simply withdrawing, you know, medical support. This is not in the Islamic sense at all considered murder, it would be murder with Ebola with Ebola if you inflicted a pain or a gunshot or something of this nature, but to withdraw life
support in that situation. And scenario, as I said, there is no scholarly body that I've even aware of no fapy that I'm even aware of that has said that there's any crime on you. Rather, I know of a number of scholars who have said it is most the hub to withdraw, because that person you are prolonging the pain there in many of my teachers, including shifts and played the one of the greatest life he said in this scenario, you are actually inflicting suffering and pain for no reason. And it is better and more dignified to simply let any less clutter, take its course by withdrawing, you know that that that support. So rather than having that difficult scenario down the
line, we're asking you to preempt it and having this conversation. So to summarize this point before, before we move to our last one,
the issue of the pros and cons the issue of what is the minimal level of trauma, there is no kurama means dignity. There is no hard and fast rule. And people might have different interpretations. Like I said, my shift every night they mean his level of caramba was that I can walk on my own and pray on my own. I don't want to be on the bed and and not be able to do such and lose my hair and be with with their dog. That was his notion of God.
have a very high level. And you know what he has that right? He has everybody has the right to have a higher level. And for some people, they'd be like, No, you know, as long as I'm still mentally conscious, I'm happy with that. So you know, you have that option to decide what is that level, think about it, you know, ask your loved ones and whatnot, once you've made up your mind, then have these awkward conversations about whether even intubation should be on the table, given the pros and cons of your particular situation only, you know, with consultation with your doctor, the pros and cons, have that conversation, then have the other conversation that's opposed, the doctors say, you
know, there's a good chance you'll make it. Then after two, three days, they change their prognosis, and now you're intubated. And now they have to take it off, rather than have your family worry about it, again, pre emptive and save them that suffering and have that conversation, you know, with them. So before we move on to our final point, which is, you know, the issue of the ethics of trying to use the same ventilator multiple times. And if you want to add to these issues, let me add, and you can correct me, but we oftentimes want to see that Rasulullah saw some did similar things, you want to act in this manner. Right. And you and I both know, and Bahati and the other collections rose wa
sallam near the end of his life. You know, a family member tried to give him medication, and he turned his mouth away on his on his deathbed, exactly turned away. And then He then said to them, will you taste it right? And because he was in my now Austin Padilla interpretation, he was not wanting that, right. And people were trying to force that upon him, and was also something new his death, he had already said repeatedly, that in terms of the wealthy, he knew where he wanted to go. And I think for families, we have to recognize this is not against the Sunnah at all, this might be actually living this on my saying, actually decide that this is not beneficial, I do not want it.
Exactly. Excellent point. So again, there and like I said, I am not aware of any scholarly difference of opinion, there is pretty much unanimous consensus that the person has the right to make this decision. And he should make it or she should make it in these circumstances that the loved ones do not make it. So once again, one of the main takeaways before we move on to the final issue very briefly, is that we are encouraging every single adult male or female, and frankly, not just those that are in the high risk, obviously, especially those in the high risk, but not just those that are in the in the high risk. We are encouraging every single person to think about these
issues of whether they want to be intubated or not. If it is COVID-19. And if they are intubated, then what is the next procedure of withdrawing or not? What are the pros and cons, think about these issues, speak with your doctor, and then speak with your family before they have to make that decision for you. So now we get to the final issue that I have been asked a number of times in the last week. And to be honest, there's no clear cut answer per se, but I'm just going to bring it up. And then we're gonna have a conversation here. And that is the issue of rationing medical devices. And again, so panela It is such a morbid, filthy question. It is a question that I was researching
three, four days ago, because somebody called me up for this and I'm not going to give a fatwa on my own on this regard. We are talking within councils. And we're asking doctors like Dr. Awesome, and others. These are cutting edge issues that, frankly, it's just depressing to even research and think about. And the question is as follows that, as you're all the way across the world ventilators are on short supply, and you have more patience than machines. Are you allowed to pick and choose based upon based upon what factors are you allowed to pick and choose? And can you withdraw? You know, somebody who's on the machine, because their chances are less and then give it to somebody whose
chances are more and essentially caused that person's indirect death for the potential of saving another's life? Not because again, because see here, if their family or if the person says take me off, no problem. But suppose nobody says anything. And now the decision is the doctors or the medical facilities, On what basis are they going to make this decision? And you know, Dr. Awesome is consulting with a number of councils am just released a photo, the American Muslim jurists Association, which is somewhat generic, the fifth Council of North America, which I'm on, we're also discussing this issue right now, and other councils are also discussing this and you know, there is
no clear cut the guideline because it's such a difficult situation and scenario, and I just want to quote you some basic things over here that
we do have some precedents in terms of generic fit rulings, the question comes how do you take those generic Maxim's not rulings, the fifth Maxim's and then specifically apply them? So for example, Zarqa Sheehan and the famous scholar who sold fifth in his admin thought he mentioned that there is a rule when we have we
We have a number of people competing for the same hack, and no one of them deserves it more than the other. That is up because she says that you cannot choose any one of them, except for a legitimate reason you cannot just choose except based upon legit legitimate reasons. The first of them he goes that they were first in line a subak. Right. So one of the basic principles that we have is that generally speaking, it is first come first serve, and that the person who comes earlier versus the one who comes the next day will have something of a precedence. Another reason, Mr. Massoud he says in his famous book of Maxim's, he says, is that out of them, I've said that Mr. Dunn, Rory Alvarado,
Huma Baran built a copy of FEMA, if there are two evils that are necessarily going to happen, you choose that you you do the lesser of the two so that you avoid the greater of the two. So if you're going to have two people that you know are going to die, and one of them's death is going to cause a greater harm than the other one's death, then you are going to choose the one that is going to cause lesser harm. Based upon this, a number of councils have said and I agree with this, that, that not all life is exactly inherently equal. Yes, generally speaking, all life is equal, generally speaking, but certain people, they play a function in society, for example, doctors, for example,
nurses, for example, people that are at the forefront. And so and again, in all jokes aside, in this pandemic, we need doctors, and if there's a doctor who needs the machine, and then there's just an average person, saving the life of the doctor potentially is saving many dozens of other lives. Likewise, if there is, I'm not gonna say any politician, no, if there is a politician that is logistically involved with pandemics or with helping society, or if there's any person whose death would actually cause a harm greater than just one person's death, then Islamic and Islamic will sort of help understand why we call it would actually allow us to prioritize, because it's not a matter
of his one person's life, it's a matter of this person is linked with other people. And so these are things that we can find in in Islamic field. Also, we have, we have other situations and scenarios as well. And of them is that if all people are totally equal, the shade er allows a lottery system, and this is something well known now. And I want to be very clear here, all that I've just said, is just to make you understand how problematic it is, I do not expect any doctor to take my generic rulings and then apply them wait for the fifth counsels to release more specific fatawa. And there are fatawa that are coming that are somewhat fine tuned, detail difference. Don't worry about it, do
whatever is in the best interest of the greater community, and do not allow yourself to be bogged down in the details of consciousness because there is no right answer. There is no clear cut answer in this regard. And it is easy to make cases for all different scenarios. I mean, again, to problematize another issue young versus old, some don't say some would say that, oh, a 15 year olds life is more precious than a 60 year olds life. And you know, maybe at some level, that's true, but not in every single case. In scenario, it is possible that that 60 year old person is going to go on and do something amazing with his or her life. Whereas the 15 year old, my Dinah natural car exit in
the next year, you don't know the future. And so some field councils might say, take that age as a factor. And you know what, they'd have a point to do that. And some field councils would say, let's ignore age altogether. Some field councils will say, and I know one of my mentors is talking about this as well, that, you know, we also have to look at a person who's a breadwinner is not the same as a person who's not. So the death of somebody who's earning money is going to be a problematic issue for more people, right. And this gets to the very problematic issue of person taking care of a larger family versus a smaller family. And SubhanAllah. Let's not even go into those issues. The
reason why I brought this conversation, not only just to have it with Dr. Awesome, is to impress upon you the grim, somewhat morbid reality of what COVID-19 is causing us to think about, but again, I spoken quite a lot doctor asked him your thoughts about this issue. So actually, I think I agree with the idea that you're saying and I think that I'll just underscore that these are areas where there is really tweet news to hide in the context that we're dealing with. And I want to say two points here. So so just so we understand hamdulillah the bottom a lot right now in the United States, at least there's never been an action of rationing for this COVID-19 even in New York, to
have not had to do that. Right. we're forecasting in advance of a scenario and you all should make the other doesn't come
To pass because we haven't yet had to run out of ventilators right? Which is why interject That is why we are flattening the curve. That's correct. That's always social distancing. That is exactly the reason. So you don't have to get to this disaster resource allocation ethics, Italy, Spain have done this Italy and Spain on that progression. That's correct. Okay. So the second thing I'll say is that there's a debate within our medical community around two things. So the first factor, I think none of us disagree in the medical community and in the Islamic community, about the clinical benefit, right. We know some people might not benefit now. They're right, the ventilator. And so
therefore, we are encouraging people to have conversations and not go on the ventilator to stop people from coming on. And we know they might not get off. So clinical benefit calculations are used. And I think there's no hope that we know who will benefit most potentially. And we allow that the area we've gone to is I have some disquietude as a physician, and not just me ethicist in our world and an assignment scholars. When we start prioritizing, I'll tell you why. Because this first come first serve thing I understand, right, and I decode the text, but it privileges those who live closer to hospitals, right. So in suburbia who lives at that hospital, right? That there's
intersectionality of identity, it privileges people and can be discriminatory against people who live far away in the rural areas, right? Or if you start privileging people who are more valuable What about the person the die? Right? She think about shirahama detox, right? Or someone else that wasn't had so much to do, but now he's
had a stroke, Well, okay, let him pass, maybe, or maybe that someone else passed those sorts of things. They disturbed the heart, right? We think about that. So So for me, as a physician, I'm telling you, and also someone who reads is literally the same thing. I think those sorts of choices reeks sometimes of injustices that we have to worry about. So let's talk I'll take the New York State where they're worrying about this, they've said clearly, we're not going to make any decisions based on age criteria only. Right? We're not going to make any decisions based on just social worth of individuals only. Rather, we want to start with clinical benefit. And then we can think about
other things. So I want us to recognize that it's not all consequentialism about who's worth more, because that is a slippery slope to some decisions that we will make for people who are marginalized, and I don't think we should go there. And that's why you have to do the social distancing. You have to wear those masks, you have to have the conversation, I don't want to ever go on the ventilator so that we don't get to the wild wild west of choosing who lives or dies, right? Because we think someone's more valuable. And only Allah knows, right? Only Allah knows who is most valuable to right, whose do is being accepted. Right, and what harms will come in the future? We
don't know. And don't put us in that situation. Excellent point. So again, to reiterate all that I said, I'm just giving you various Maxim's that some fulfilled councils across the globe are using, and I've read three of them. And each one of them has slight differences. They're not unanimous, because it's a very, very cutting edge gray area. I mean, in the history of Islam, this type of situation never happened, where it is literally one machine, and maybe two, three or four people, and you have to decide on the spot, how are you going to do that? And so you have different, you know, positions coming out. And you know, whichever one that the doctor follows at that time, as
long as it was done for some issue of greater good inshallah they are forgiven because there is no right. I mean, if you're going to choose one they're going to, so there is no right answer over here. And that's why, again, and again, for three weeks, I've been saying this brothers and sisters, the reason why we are being so strict about this social distancing, and this isolation and shutting down the massage it is because we don't want anyone to have to make that decision. We don't want anyone to be there where we don't have enough machines to take care of our loved ones who might just, you know, might not like it might not be COVID-19, it might be an asthma issue. And the doctor
says, look, we need a machine. But we don't have one right now. Why? Because people weren't practicing social isolation because people are acting recklessly. And now all the machines are being used, and perhaps your loved one who was essentially guaranteed that it wasn't COVID-19 into something else. Now, they don't have that position because society acted recklessly. It's really that's the whole point of us changing all of our lifestyles, so that all of us benefit potentially if something goes wrong. So I think we've gone over the time as well. But honestly, Dr. Austin was a pleasure talking with you going back and forth. And again, I want to reiterate, this is just a
conversation to raise public awareness. The main takeaway is to talk to your loved ones about before intubation is done, and after it is done, about whether you want it to be done before it is done. And once it is done once if you if you decide to opt in, that's only if you decide to opt in, under what circumstances do you feel that you would want to opt out have that conversation before it actually happens so that it saves everyone, especially your loved ones that very, very difficult
Difficult emotional conversation which is not something you ever want to see I have been in rooms where this has happened Dr. Austin has been in rooms when he's actually had to do the the thing it's part of law you just don't want to be there you don't want to be there save your loved ones that difficulty that's really the main takeaway as for specific factoids about your situation and scenario neither doc Dawson was giving you medical advice nor I was giving you a specific thought was so it was just a generic conversation doctor awesome any last words before we conclude our coffee comes up? Okay. Hope inshallah tada we can get use conversations and I you know, I fully
agree that we have to think about this and be responsible, you know, for our families, and this is something we should think about now, Mel also make it easy for all of you. And keep us all your eyes and you don't know what to all we accepted. So I really expect the viewers to make time for all of us in this time. Mel lift this, this trial this Bella from us. I mean, I mean Giacomo hair doctor awesome for taking out of your time he was working on the car all day long. He literally just got home and change out of his scrubs and texted me that I'm ready. So we just got started now. So hello, I cannot even imagine how you're balancing everything that you're doing. May Allah bless you
and all of the medical workers and doctors and nurses that are on the front line. Truly, this is a time where the medical profession in its entirety has shown what they're really made of they really earned the respect of the entire globe and you are the heroes of this timeframe that is going on We ask Allah that Allah protects you and all of the medical fields and the people working in the medical fields and that you gent you are able to through your expertise and allows you to do your job and protect us and all of this so we better pay attention to your advice as well and all of this hamdulillah we have really had a very stimulating conversation. You know, brothers and sisters if
you want to continue this conversation I know Dr. Awesome is really busy, but maybe in a few weeks, we can have another q&a and another round of medical questions and whatnot. So leave your feedback and comments and
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