Medical Ethics from an Islamic Perspective - Part 1
By Shaykh Ridha ur Rahman (posted January 2017)
The basis of healthcare and medicine in Islam
Islam considers access to healthcare a fundamental right of the individual. In medicine there are sometimes difficult decisions to be made regarding a patient's care and a physician at times has to decide based on available knowledge, his or her experience, advice from his or her peers, and the consensus of the medical community. In addition, a Muslim derives his or her conclusions from the rules of Islamic law (Shari`ah) and Islamic medical ethics.
The first main principle of Islamic medicine is the emphasis on the sanctity of human life, which derives from the Holy Qur'an, which states: “Whosoever saves a human life, saves the life of the whole mankind”. The second main principle is the emphasis on seeking a cure. This derives from a saying of the Prophet Muhammad (PBUH): “There is no disease that God has created, except that He also has created its treatment”. The Prophet Muhammad (PBUH), in another narration, is also reported to have said: “Seek treatment, for God the Exalted did not create a disease for which He did not create a treatment, except senility”. This is further emphasised by the fact that goals of the Islamic Shari`ah include the protection and preservation of life, intellect and progeny, as well as the protection of property and religion.
Some of the rules of Islamic medical ethics include the following:
1) Necessity overrides prohibition; that is, if there are certain items which are Islamically prohibited, under dire necessity they can become permissible.
2) Harm has to be removed at every cost if possible.
3) Accept the lesser of the two harms if both cannot be avoided.
4) Public interest overrides individual interest.
Islamic medical ethics also uphold the four basic principles of biomedical ethics. These are:
1) Respect for the autonomy of the patient
4) Distributive Justice
General care of the Muslim patient
All patients, irrespective of their faith, should be treated with human dignity and respect. It is suggested that all healthcare providers familiarise themselves with the basic teachings of Islam and Islamic moral values. It is easier for a healthcare provider to deal with a patient if he or she understands the faith, values and culture of his or her patient. Below are some of the specific guidelines for healthcare providers, especially those not of the Muslim faith, for caring for their Muslim patients:
1) Muslim patients should be identified if possible as Muslim (or with the religion of Islam) in their registration information so as to prevent any mistakes happening unintentionally in terms of violating dietary rules or privacy etc.
2) Care providers should respect their modesty and privacy. Muslim patients, particularly women, may need a special gown to cover the whole body in order to avoid unnecessary exposure during physical examination. Some examinations may be carried out over the gown.
3) Provide Muslim patients Islamically slaughtered (Halal) meat. Muslim patients should not be served any pork, pork products or alcohol in their meals. A Muslim patient’s family may be allowed to bring food from home, as long as it meets the patient's dietary requirements.
4) Make it easy for Muslim patients to perform Islamic prayers if they can.
5) Inform them of their rights as a patient and encourage them to make an Islamic living will.
6) Take time to explain test procedures and treatment. Some more recent Muslim immigrants may have a language problem. Muslim women can give consent for any treatment or procedure.
7) Allow their Imam (religious teacher) to visit them and pray for them. Clerics of other faith traditions can pray for or with Muslim patients with their permission, using non-denominational words like ‘God’.
8) Autopsy is permitted if medically indicated or required by law.
9) Organ donation is permitted with some guidelines and is encouraged.
10) Always examine a female patient in the presence of another female (chaperon) or a female relative (except in emergencies). In particular during labour and delivery, if the patient's obstetrician is unavailable and upon her request, provide a female healthcare provider, if feasible. Her husband is encouraged to be present during the delivery.
11) After the death of a Muslim patient in a healthcare facility, allow the family and Imam to arrange for preparation of the dead body for burial under Islamic guidelines. A corpse should be given the same respect and privacy as he or she received while alive. Muslim relatives and friends of the dead are encouraged to stay in the room where the dead body is kept to recite the Holy Qur'an. Muslim corpses are not embalmed or cremated.
Definition of human Life
Muslims believe that God is the creator of life and life is a gift from Him. Muslims believe that all life is sacred and must be protected. The respect for life in Islam is common for all humans, irrespective of gender, age, race, colour, faith, ethnic origin or financial status.
Muslim scholars hold the position that biological life begins at conception while human life begins when ensoulment takes place. A verse from the Qur'an reads: “Man We did create from a quintessence (of clay); then We placed him as (a drop of) sperm in a place of rest, firmly fixed; then We made the sperm into a clot of congealed blood; then of that clot We made a (foetus) lump; then we made out of that lump bones and clothed the bones with flesh; then We developed out of it another creature. So blessed be God, the best to create!” Ensoulment is believed to occur at 40 or 120 days after fertilisation, according to different schools of thought. The right of the human foetus in Islam is similar to the rights of a mature human being, including the right to life, the right to inheritance, the right to compensation when injured by wilful acts and the right to penalise assailants. Muslim scholars also extend the principles of medical ethics to the patient in a vegetative state. Until death has been declared, the patient in a vegetative state is considered a living person and has all the rights of a living person.
Definition of death
The definition of the end of human life from an Islamic point of view is that when cardiopulmonary function ends, as diagnosed by a physician or a team of physicians, that is considered to be death. The concept of brain death occurs when artificial means to maintain cardiopulmonary function are employed. In such situations, cortical and brain stem death can be established by specialists using appropriate investigations. It is the attending physician who should be responsible for making the diagnosis of death.
Thus, a person is considered dead when the conditions given below are met:
1) The physician has determined, after a standard examination, that a person's cardiopulmonary function has come to a permanent end.
2) A specialist physician (or team of physicians) has determined, after standard examination, that the function of the brain, including the brain stem, has come to a permanent end, even if some other organs may continue to show spontaneous activity.
Mechanical life support of terminally ill patients or those in a persistent vegetative state and euthanasia
The following verses of the Qur'an are some of the verses which address issues of life and death:
1) “It is He who gives life and death and when He decides upon an affair, He says to it ‘Be’ and it is.”
2) “No soul can die except by God’s permission, the term being fixed by writing.”
3) “Every soul will have a taste of death. In the end, to Us shall you be brought back.”
4) “It is He who gives life and who takes it away and to Him shall you be brought back.”
5) “Nor take life which God has made sacred except for a just cause.”
Muslim scholars do not believe in prolonging the misery of dying patients who are terminally ill or in a persistent vegetative state (PVS). PVS is defined as a sub-acute or chronic condition which usually follows severe brain injury and is characterised by a normal sleep/wake pattern and a total lack of cognitive function with preserved blood pressure and respiratory control that persists for more than two months.
When death becomes inevitable, as determined by a team of physicians, including critical care physicians, the patient should be allowed to die without unnecessary procedures. While all ongoing medical treatments can be continued, no further or new attempts should be made to sustain artificial life support. If the patient is on mechanical support, this can be withdrawn.
The patient should be treated with full respect, comfort measures and pain control. No attempt should be made to withhold nutrition and hydration. In such cases, if and when the feeding tube has been withdrawn, it may not be reinserted. The patient should be allowed to die peacefully and comfortably. However, no attempt should be made to enhance the dying process in patients on life support.
Islam is absolutely opposed to euthanasia and assisted suicide in terminally ill patients by healthcare providers or by patient's relatives. Suicide and euthanasia are prohibited in Islam.
Shaykh Ridha ur Rahman
Coming soon: Medical Ethics from an Islamic Perspective Part 2
By Roszeen Afsar (poster June 2015)
By Abdurrahman Smith (posted November 2014)
By Roszeen Afsar (posted March 2014)
By Shaykh Ridha ur Rahman (posted January 2014)
By Shaykh Ridha ur Rahman (posted November 2013)