When is a person deemed to have died?
Question

                When determining that a person has died, is what matters death of the brain or of the heart?
Praise be to Allah.
		Firstly: 

	The brain is composed of three parts: 

	·The cerebrum, which is the 
	centre of thought, memory and sensations 

	·The cerebellum, the function 
	of which is to help in maintaining the body's sense of balance 

	·The brainstem, which is the 
	main control centre for breathing, the heart and the blood circulation. 

	If the cerebrum or cerebellum dies, which 
	are parts of the brain, the patient is able to live an abnormal life, which 
	is called a vegetative state. 

	But if the brainstem dies, this is what 
	leads to the end of human life according to doctors. If any of the other 
	major faculties or functions – such as the heart or breathing – stops 
	temporarily, it may be saved and treated, and many patients have been saved, 
	so long as the brainstem is still alive. 

	But if the brainstem dies, there is no 
	hope of saving it; rather the patient’s life has ended, even if other 
	systems in the body continue to move and function. 

	See: Majallat Majma‘ al-Fiqh al-Islami 
	(issue 2, vol. 2, p. 440) 

	Based on that, a number of fiqhi issues 
	arise, one of which is: is a person deemed to have died if only the cerebrum 
	dies, or must there also be heart death? 

	Is it permissible to remove life support 
	from one whose brain has died, even if his heart is still functioning? 

	With regard to removing life support from 
	someone whom the doctors have ruled is brain dead, most of the contemporary 
	fuqaha’ are of the view that this is permissible, because that equipment 
	should not continue to be used when there is no hope of recovery. Similar 
	statements have been issued by fiqh councils. 

	Please see the answer to question no.
	115104 

	Secondly: 

	With regard to the ruling on his death 
	from a shar‘i point of view, contemporary scholars differed concerning death 
	of the brainstem and whether it is regarded as the end of human life. There 
	are two views:

	The first view 
	regards brain death, without heart death, as real death, and they do not 
	stipulate that the heart should stop beating in order for the individual to 
	be deemed as having died. 

	This is what was stated by the Islamic 
	Fiqh Council belonging to the Organisation of the Islamic Conference during 
	its meeting held in Amman in 1986 CE. See: Majallat Majma‘ al-Fiqh al-Islami 
	(issue 3, vol. 2.809) 

	It says in their statement: 

	From a shar‘i point of view, the 
	individual is deemed to have died, at which point all the rulings connected 
	to death come into effect, when one of the following two signs develops: 

	1.
	His heartbeat and breathing cease completely, and the 
	doctors have determined that this cessation cannot be reversed.

	2.
	All brain function ceases completely and expert 
	specialist doctors have determined that this cessation cannot be reversed, 
	and the brain has begun to disintegrate.

	End quote from Qaraaraat wa Tawseeyaat 
	Majma‘ al-Fiqh al-Islami (p. 12) 

	They quoted as evidence for that the fact 
	that if the newborn infant does not cry, he is not regarded as being alive, 
	even if he breathes, urinates or moves. Involuntary movements that occur as 
	a result of brain reflexes are not regarded as a sign of life. This also 
	applies to one whose brain has died; he comes under the same ruling as a 
	newborn infant who does not cry. 

	But this view may be subject to further 
	discussion, because the cases of newborn infants vary. Moreover, there is 
	doubt as to whether the newborn infant is alive or not, which is different 
	from the case under discussion here, because in principle the (adult) 
	patient is still alive, and that does not change unless there is certain 
	proof to the contrary. 

	The second view is that brain death of the 
	individual – without heart death – is not regarded as death; rather the 
	heart must also stop beating in order for it to be deemed that the 
	individual has died. 

	This is what was established by the Fiqh 
	Council belonging to the Muslim World League in its tenth session, held in 
	Makkah al-Mukarramah in 1408 AH. 

	It says in their statement: 

	With regard to the patient who is 
	connected to life-support, that life-support may be removed if all brain 
	functions have ceased completely and a committee of three specialist experts 
	has determined that this cessation of function is irreversible, even if the 
	heartbeat and breathing are still being artificially maintained with the aid 
	of the life-support equipment. 

	But he cannot be deemed to have died from 
	a shar‘i point of view unless the breathing and heartbeat cease completely 
	after the life-support equipment is removed. 

	End quote from Qaraaraat al-Majma  al-Fiqhi 
	al-Islaami li’r-Raabitah (p. 49) 

	They quoted as evidence for that the story 
	of the people of the Cave, and the verses in which Allah, may He be exalted, 
	says (interpretation of the meaning:

	“Therefore 
	We covered up their (sense of) hearing (causing them, to go in deep sleep) 
	in the Cave for a number of years.

	Then We raised them up (from their 
	sleep), that We might test which of the two parties was best at calculating 
	the time period that they had tarried”

	[al-Kahf 18:11-12]

	“And 
	you would have thought them awake, while they were asleep. And We turned 
	them on their right and on their left sides”

	[al-Kahf 18:18]. 

	The evidence here is the fact that Allah, 
	may He be glorified, says “Then 
	We raised them up” that 
	is, We woke them up. These verses clearly indicate that mere loss of 
	sensation and consciousness on its own is not regarded as sufficient 
	evidence to rule that the individual is dead, as is indicated by this 
	verse. 

	Because certainty cannot be removed by 
	uncertainty or doubts, and in this controversial case, the issue that we are 
	certain of is that the patient is still alive, as he was originally, and 
	because his heart is still beating and there is some doubt as to whether he 
	has died, because his brain is dead – then in this case we must still regard 
	that of which we are certain as being valid. 

	Originally the patient was alive, so we 
	stick to this original principle until we are certain that that is no longer 
	the case. 

	The real meaning of death according to the 
	fuqaha’ is the departure of the soul from the body, and the reality of its 
	departure is the separation of the soul from all parts of the body, so that 
	no part or faculty any longer has any life in it. 

	Shaykh Bakr Abu Zayd said: it is not 
	appropriate to announce a person’s death just because his heart stopped 
	beating, because there is still some uncertainty. Similarly, it is not 
	appropriate to announce his death on the basis of brain death when the heart 
	is still beating and he is still breathing with mechanical aid. 

	Similarly cessation of the heartbeat does 
	not mark real death; rather it is one of its signs, because it is very 
	possible for the heart to stop and then come back to life by means of 
	resuscitation or without taking any measures. 

	By the same token it may also be said that 
	brain death is a sign of death, but it is not complete death, because there 
	have been many cases and instances in which the doctors stated that brain 
	death had occurred, then the patient came back to life. Therefore reference 
	should be made to what has been stated by the scholars and fuqaha’ about the 
	reality of death, which is the departure of the soul from the body. al-Ghazali 
	made an important statement defining that when he described death as “all 
	parts of the body becoming devoid of the soul”, i.e., when there is no 
	longer any part of the body that is engaged with the soul. And Allah knows 
	best. 

	End quote from Fiqh an-Nawaazil 
	(1/232) 

	Perhaps what is more likely to be correct 
	– and Allah knows best – is the view that a person cannot be deemed to have 
	died unless we are certain of that because the heartbeat and breathing have 
	stopped completely. Even though cessation of the patient’s brain function is 
	one of the strong indicators of his death, there are shar‘i issues that are 
	connected to the confirmation of his death, such as the division of his 
	estate, remarriage of his wife if she so wishes, and so on. Therefore it is 
	not permissible to deem him to be dead except on the basis of certainty. 

	So he cannot be deemed to have died 
	because of cessation of breathing or heartbeat, or the death of the 
	brainstem when there are any other signs, visible or invisible, that could 
	be indicative of there being some life left in him. 

	As it is the case that death is the 
	departure of the soul from the body, this cannot be determined by tangible 
	means, because the soul is not tangible. But there are signs of its 
	departure from the body at death on the basis of which the fuqaha’ 
	determined that the one in whom those signs appear has died. These signs 
	include the following: the heart stops working, breathing ceases, the limbs 
	and sinews go limp, all movement in the body ceases, the colour of the body 
	changes, the eyes stare fixedly, the eye does not flinch when it is touched, 
	some sinking occurs at the temples, the nose tilts, the lips open and the 
	facial skin slackens. These signs do not appear in comatose patients who may 
	be described as being clinically dead. 

	There is still life in their bodies, in 
	the sense that some of their bodily systems are still functioning, such as 
	the heart, kidneys and so on. 

	This view was favoured by most of the 
	contemporary fuqaha’ and scholars, including Shaykh Bakr Abu Zayd, Shaykh 
	‘Abdullah al-Bassaam (may Allah have mercy on him) and Shaykh Muhammad al-Mukhtaar 
	ash-Shinqeeti in his essay Ahkaam al-Jiraahah at-Tibbiyyah.

	See: Fiqh an-Nawaazil by Shaykh 
	Bakr Abu Zayd (1/232); Ahkaam al-Jiraahah at-Tibbiyyah by Shaykh 
	Muhammad al-Mukhtaar ash-Shinqeeti, p. 325; Majallat al-Majma‘ al-Fiqh 
	al-Islami li Munazzamat al-Mu’tamar al-Islami (issue 3, vol. 2, p. 545) 

	Based on that: 

	1.
	It is not correct to base on this diagnosis (brain death) 
	any of the rulings having to do with death from a shar‘i point of view

	2.
	It does not make it permissible to remove the patient’s 
	vital organs – according to those who think that it is permissible to do 
	that in the case of the dead, as opposed to the living.

	For more information, please see:

	Al-Mawsoo‘ah at-Tibbiyyah al-Fiqhiyyah 
	wa’n-Nawaazil al-Mu‘aasirah 
	(2/36-61)

	Al-Masaa’il at-Tibbiyyah al-Mustajiddah 
	(2/11) by Dr Muhammad ibn ‘Abd al-Jawaad an-Natshah 

	And Allah knows best.