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perseverance, but this does not mean that they are forbidden to seek a means to alleviate

the suffering. The Holy Qur’an states that ‘‘surely the good deeds will drive away the evil

deeds [which cause suffering]’’ (Al-Qur’an 11:114); inferentially, this implies the per-

missibility for a person’s endeavour to overcome pain (Albar 2007; Sachedina 2005). This

precept is further substantiated by other verses in the Holy Qur’an and the Sunnah that

encourage Muslims to remove harm and difficulty (Al-Qur’an 2:185, 5:6 and 94:28; al-

Bukhari 1997 (Book 2, Hadith no. 38)). In Islamic ethics, an individual’s welfare is

intimately linked with his or her family and community (Sachedina 2005). Hence, neither

autonomy nor paternalism is the determining factor in deciding a course of action in

matters relating to end-of-life decisions, but rather, a joint decision made by all parties

associated with the patient, which may require the involvement of religious authorities, if

needed (Sachedina 2005).

The Developing Legal Standards

Decision making at the end of life must necessarily take into account the courts’ standing

on such issues and the legal implications that would ensue. In order for a comprehensive

ethico-legal framework to exist where medical codes of ethics are affirmed as good

practice, the latter must be compatible with current developments of the law. In the UK,

when decisions are made on behalf of a patient, the principle of ‘‘best interests’’ has

consistently been the determinative principle in legal cases. A responsible decision by a

team of medical experts to withdraw life-sustaining treatments and withhold further

medical interventions which have been determined to be futile and would not be in the

patient’s best interests is permissible under the law and would not subject healthcare

professionals to criminal proceedings. This principle was enunciated in the landmark case

of Airedale NHS Trust v Bland (‘‘Airedale NHS Trust v. Bland’’ 1993), where the House

of Lords discussed its legal justification in relation to the principle of sanctity of life and

patient autonomy.

The case concerned one Anthony Bland, a victim of the disaster at the Hillsborough

Football Stadium who suffered irreversible damage to his cerebral cortex which rendered

him in a persistent vegetative state. He was fed artificially and mechanically with a

J Relig Health (2016) 55:119–134 129

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nasogastric tube and showed no cognitive response to his surroundings. All his natural

bodily functions had to be operated with nursing intervention, requiring 4–5 h of nursing

attention by two nurses daily. After three and a half years of remaining in this condition, a

court declaration was sought by Bland’s attending doctor to cease further treatment, which

involved extubation, i.e. withdrawal of artificial nutrition and hydration and withholding of

antibiotic treatment in case of infection. The declaration was based on a clinical assessment

by medical experts that there was absolutely no hope for recovery for Bland and thus any

medical intervention would be futile and not in the best interests of the patient. In arriving

at its judgement, the court ruled that the principle of sanctity of life was not absolute; ‘‘it

must yield to the right of self-determination’’ (per Lord Goff in Airedale NHS Trust v

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