A Maqāṣid al-Syarī'ah Perspective on Withholding and Withdrawing Life-Sustaining Treatment for Vegetative Patients in the Intensive Care Unit (ICU)

Advances in life-sustaining treatment in intensive care units (ICUs) have improved biological survival among patients with severe neurological injuries. However, decisions regarding mechanical ventilation in patients with persistent vegetative state (PVS) or unresponsive wakefulness syndrome (UWS) present complex clinical, ethical, and Islamic legal challenges. This study aims to synthesize scientific evidence and Islamic bioethical perspectives on withholding and withdrawing mechanical ventilation in vegetative ICU patients based on Maqasid Al-Syariah principles. A systematic literature review (SLR) was conducted using the PRISMA 2020 guidelines and the Population, Exposure, Outcome (PEO) framework. Literature published between 2021 and 2026 was searched through PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and Garuda, supplemented by relevant regulatory and Islamic legal documents. The final synthesis included 13 sources comprising eight scientific studies and five foundational legal or regulatory references. The synthesis indicates that withholding or withdrawing mechanical ventilation may be permissible (mubah) when treatment is medically futile and neurological impairment is considered irreversible. Such decisions align with the five objectives of Maqasid Al-Syariah, emphasizing human dignity, clinical judgment, resource justice, spiritual considerations, and family well-being. Nevertheless, appropriate palliative care, hygiene, and clinically suitable nutrition and hydration must be maintained. Withholding or withdrawing futile mechanical ventilation can be ethically distinguished from euthanasia when supported by comprehensive clinical assessment, appropriate ethical considerations, and continued compassionate care.