End-of-Life Care for Anencephalic Infants: A Comparative Analysis from Islamic and Secular Perspectives

Anencephaly is a lethal congenital anomaly that raises profound ethical questions about treatment futility, moral status, and end-of-life decision-making in neonatal care. While secular bioethical frameworks dominate clinical guidance, Islamic jurisprudence remains underrepresented in comparative neonatal ethics scholarship. This study examines how classical Islamic legal reasoning addresses withholding or withdrawing life-sustaining interventions for anencephalic infants, and compares these positions with dominant secular approaches. This article employs a normative and doctrinal analysis of classical Islamic jurisprudential sources across the four major Sunni schools of law (Ḥanafī, Mālikī, Shāfiʿī, Ḥanbalī), combined with a comparative ethical evaluation of contemporary secular bioethical frameworks, particularly principlism. Classical legal texts were analyzed with particular attention to the distinction between definitive and speculative treatment efficacy, and these findings were interpreted in light of current medical knowledge on anencephaly. The analysis demonstrates that Islamic jurisprudence does not impose an absolute obligation to sustain biological life at all costs. Across all four schools, obligations to provide medical treatment are contingent upon the presence of an achievable benefit. When treatment is deemed medically futile—offering no possibility of recovery or meaningful benefit—Islamic legal reasoning permits, and in some cases supports, the withholding or withdrawal of life-sustaining interventions. This position affirms the inherent dignity of the infant while rejecting the moral necessity of prolonging dying through futile care. A comparative analysis reveals substantive convergence between Islamic and secular frameworks in practical conclusions, alongside significant divergence in normative foundations. Islamic jurisprudence offers a coherent, clinically sensitive ethical framework for end-of-life decisions in anencephaly, challenging the assumptions that religious ethics necessarily oppose non-intervention. These findings inform ethically grounded decision-making in culturally and religiously diverse clinical contexts and contribute to pluralistic bioethics by demonstrating how Islamic moral reasoning enriches, rather than merely parallels, dominant secular approaches.