When the Body Can No Longer Sail: Ethical Boundaries of Cardiac Surgery through a Universal and Islamic Lens

All articles of this category (opens in new window) Letter to: “End-of-Life Care” in Cardiac Surgery Thorac Cardiovasc Surg 2025; 73(08): 649-660 DOI: 10.1055/a-2686-4680 10.1055/a-2686-4680 I read with great interest the position paper “‘End-of-Life Care’ in Cardiac Surgery” by Lichtenberg et al, which thoughtfully addresses the ethical and clinical boundaries of operative treatment in patients with severe, advanced, or multimorbid cardiac disease.[ 1 ] The authors rightly emphasize that modern surgical capability does not eliminate situations in which intervention becomes disproportionate or futile, and structured end-of-life (EOL) pathways are essential. To complement their discussion, I would like to highlight an additional perspective from Islamic medical ethics, presented here in an academic and cross-cultural context. Islamic bioethics is closely aligned with internationally accepted ethical frameworks and offers four foundational principles that correspond directly to Western biomedical ethics: Beneficence (the obligation to act in the patient's best interest and provide treatments that offer real, meaningful benefit), Non-maleficence (avoiding harm, especially when an intervention is likely to cause suffering without improving survival or quality of life), Respect for Autonomy (ensuring that patients and families receive transparent information and are supported in making informed decisions consistent with their values), Justice (providing fair, equitable care and ensuring that limited medical resources are used responsibly, especially in high-risk or non-beneficial surgical scenarios). Within this framework, Islamic scholarship clearly states that treatment is not obligatory when it becomes futile or excessively burdensome, a position that fully aligns with the authors' recommendations.[ 2 ] When surgery does not improve quality of life and only prolongs the dying process or imposes disproportionate suffering, shifting to comfort-focused, dignity-preserving care is considered ethically sound.[ 3 ] [ 4 ] [ 5 ] This highlights a key point: Islamic ethics does not promote “maximum intervention at any cost,” but rather proportionate treatment that respects both the sanctity of life and the natural limits of medical therapy. For cardiac surgery teams working within increasingly multicultural environments, understanding these principles can improve communication, align expectations, and reduce ethical conflict. Ultimately, the convergence between Islamic medical ethics and contemporary EOL guidelines reinforces the authors' central message: Compassionate, ethically grounded EOL care is a shared universal responsibility.[ 3 ] [ 4 ] [ 5 ] Contributor's Statement K.A. contributed to conceptualization, formal analysis, writing–review and editing. Publication History Received: 30 December 2025 Accepted: 15 January 2026 Article published online: 28 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany