Many American Muslims oppose physician-assisted suicide, rely on family to make their end of life decisions and lack spiritual support in major medical centers, says Dr. Aasim Padela, an emergency physician and director of the University of Chicago’s Initiative on Islam and Medicine.

Padela spoke with Life Matters Media about Muslim beliefs regarding so-called “Death with Dignity” legislation, burial and terminal illness.

Advocates of “Death with Dignity” legislation hope to legalize the practice in Illinois in the coming years. Do you believe most Muslims would oppose it?

I think from the standpoint of suicide being impermissible in Islam, one who helps someone commit suicide is being party to that wrongful action. I think the term “Death with Dignity” has been in some ways used to advance an objective which may not be dignity at all, but rather just a sense of trying to have control over one’s life and death. It assumes that someone is fully knowledgeable of their state-of-being at all times.

Islamic theologians and ethicists would say that a physician helping a patient to end their life willfully is being party to sin.

Suicide usurps the role of God in a certain way, but also neglects the fact that there is a metaphysical reality. There are things that we don’t have full knowledge of, and discounting the fact that there may be some benefit in the afterlife is problematic for a religious person. It’s a very similar line of logic to Roman Catholicism.

Would stopping artificial nutrition also be considered “sinful”?

There are many similarities in all the Abrahamic faiths, and feeding is considered apart from medical treatment. Feeding is considered a human responsibility.

Now in medicine, you have a specialist community of physicians helping someone by medical procedures to have an alternate way of eating – feeding tubes. But oftentimes it’s not the medical personnel who are feeding the patient, it might be a family member who is administering the feeding formula through the G-tube. So, it is not considered a medical procedure in Islamic law. But stopping feeding as a way to facilitate death by starvation is problematic.

However, if someone chooses not to eat, are you forced to feed them? That’s not the case, either. There are aspects of feeding that physicians facilitate, and that can draw a distinction that’s not so clear between medical treatment and human responsibility. But force feeding is problematic. You can offer them food and facilitate it for them, but not force it.

Why are Muslims typically buried in a simple shroud and grave?

There are prescribed rulings from the traditions of the Prophet about how to bury someone. You are buried in a simple shroud and put into the grave. The grave can’t be solid or covered, meaning that there should not be ornate mausoleums. The idea is that you return to the ground in a simple form. You don’t want to make the grave a site of worship.

Burial is a communal obligation, and it reflects your end. All the things you accumulate in your life, you don’t take them with you. The decay of the body is going to happen to you.

Another reason people are buried in shrouds is because they are considered the same. No matter what status you had in life, death is a certainty. For example, many Muslims are buried in the same garb they wore when they went on the hajj. It’s a sense of equality.

There are many Catholic and Protestant medical centers in the U.S. Is it difficult for Muslims to find spiritual support in them?

Just as any minority community, Muslims face challenges. If you are a minority, it’s hard to find people from the minority group to take care of you, and spiritual care is the same. There aren’t many schools that produce Muslim chaplains, but the field is growing and defining its parameters. There are not certifying bodies, so there are few people that can be hired by hospitals.

Spiritual support is also a new idea, stemming from Protestant roots during the last 50 or 60 years. For a structure that has a new idea of chaplaincy to then open the gamut to other forms of ministry is challenging.

In the hospital setting, there are very few resources for Muslims. Some patients seek expertise from local imams or ask for recommendations from the chaplaincy office.

Do you believe there are similarities between the Abrahamic faiths concerning end of life care?

I think that there are a lot of commonalities between the Abrahamic traditions in how they think about the sanctity and dignity of the body. The human life does not end here, there is a metaphysical reality.

Like Judaism, Islam has a very deep legal reasoning, which often has a lot of weight behind what you can and can’t do. But like Christianity, there is also a spiritual or theological component to the moral reasoning.

In Islam, things can be permissible by the law, but not the most wholly right thing to do. In regards to “Death with Dignity,” people say “how can you not give people dignity?” We give people dignity, but within the bounds of law. There is a symbiotic relationship between philosophy or moral theology and the legal structure. You have to account for both when you make end of life decisions.

There is no cookie-cutter response, and there are a lot of controversies in Islam, because end of life care is an emerging area.