Medical Ethics from an Islamic Perspective - Part 2


By Shaykh Mohammed Roziur Rahman (posted May 2017)


Organ transplantation and blood donation 


Muslim scholars understand that certain organs may fail in the human body while the rest of the body may still be functional. Currently medical experts hold the view, with scientific proof, that if a certain diseased organ is replaced with a healthy organ and it is accepted by the body, then the body can continue to function rather than die due to the one diseased organ. Islam instructs all Muslims to save life. So on this basis, transplantation in general, both giving and receiving organs, is allowed for the purpose of saving life. This has to be done using the following guidelines:

1. The medical need has to be defined.

2. The possible benefit to the patient has to be defined.

3. Consent from the donor as well as the recipient must be obtained.

4. There should be no sale of organs by any party.

5. There should be no financial incentive to the donor or his relatives for giving his organs, but a voluntary gift may be permitted. Likewise, there should be no cost to the family of the donor for removing the organ.

6. Any permanent harm to the donor must be avoided.

7. Transplants of sex organs (testicles or ovaries) which would violate the sanctity of marriage are forbidden.

8. Cadaver donation is permitted but only if specifically mentioned in that person's will. Blood transfusion is permissible. Giving blood to or receiving blood from people of other faiths is permissible.


Assisted reproductive technologies and surrogacy


Infertility is recognised as an issue and the desire for a cure by an infertile couple is natural. However, in Islam, for an action to be permissible, all means of achieving that action are to be pure. We believe in the sanctity of marriage and the importance of preserving lineage. The Qur'an says: “And God has made for you mates (and companions) of your own nature, and made for you, out of them, sons and daughters and grandchildren, and provided for you sustenance of the best, will they then believe in vain things, and be ungrateful for God's favours?” The Qur'an also says: “It is He who has created man from water: then has He established relationships of lineage and marriage: for thy Lord has power (over all things).”

Based on these Qur'anic guidelines, Muslim scholars hold the following views and positions:

1. All forms of assisted reproductive technologies are permissible between husband and wife during the span of their marriage using the husband's sperm and the wife's ovaries and uterus. No third party involvement is allowed. Muslims believe in the sanctity of marriage and that the death of the husband terminates the marriage contract on earth, thus frozen sperm from a deceased husband cannot be used to impregnate his widow.

2. Sperm, ovaries and embryo donation are not permitted.

3. Additional embryos produced by IVF between husband and wife can be discarded or given for genetic research, if not to be used by the same couple for a future attempt.

4. Surrogacy involving a third person is not permissible, as Muslims believe that it exceeds the boundaries of the marriage contract and lineage.

5. Use of fertility drugs is permissible.

6. An infertile couple, if they cannot find a permissible cure, can care for an orphan or someone else's child as their own within current legal and Islamic rules of adoption.


Contraception and sterilisation


For married couples, contraception for several reasons, including the health of the mother, social or economic reasons, is permitted, provided that it is practiced by mutual agreement of the husband and wife and that the method used is reversible and not harmful. Withdrawal, prophylactics, birth control pills and other hormonal methods are allowed. Contraceptive methods which can lead to abortion are not allowed.

Sterilisation, whether by vasectomy or tubal ligation, as a national policy for family planning or population control is unlawful and should not be allowed. On an individual level it is permissible provided that both husband and wife want it and:

1. There is a significant medical contraindication to the pregnancy; for example, if there is a significant risk to the wife's health if she conceives.

2. Other methods of birth control have failed or are causing significant side effects.

3. A genetic disease of the husband or wife or both poses a high risk of being transmitted to the foetus.

4. It is done for family planning, i.e. some scholars permit it when the husband and wife are satisfied with the number of children they have.


Termination of pregnancy


Abortion is the wilful termination of pregnancy by artificial means - such as drugs, chemicals, mechanical or surgical procedures - before the age of viability (23 menstrual weeks, calculated from the first day of the last menstrual period) for any reason. Chemical or mechanical means to prevent the formation of the zygote (fertilised ovum, which marks the beginning of human life) is not considered abortion. Muslims believe that life begins at conception and unless interrupted by disease or artificial means, the fertilised ovum will continue to grow and become a viable mature human being. However, some scholars differentiate between biological life, which starts at conception, and human life, which starts after ensoulment.

The two scholars Al-Bukhari and Muslim relate on the authority of Abdullah ibn Mas'ud that God's Messenger (PBUH) said: “The creation of each one of you is brought in the belly of his mother for forty days, then for a similar period he is a germ cell, then for another forty days he is an embryonic lump, then an angel is sent to him and ordered to write down four words. He is told: ‘write down his career, his livelihood, his life duration and whether he is to be miserable or happy’, and the angel breathes spirit into him.” The time of ensoulment, based on this Hadith, is 40 days after fertilisation according to some scholars, while others consider it to be at 120 days after fertilisation.

The Islamic position on abortion can be classified as follows:

1. Elective abortion of a viable foetus in a healthy mother is prohibited.

2. Abortion is permitted if continuation of pregnancy may cause the pregnant woman to die or cause serious deterioration of her health, both medical and mental, if done before 120 days after fertilisation, i.e. 19 menstrual weeks.

3. Foetal congenital malformations in which abortion can be sought and is permitted are lethal malformations not compatible with extra uterine life such as bilateral renal aplasia, Trisomy 13, 18, etc. However, even in these situations it is preferable to do it before the 120th day after fertilisation or 19 weeks of gestation, calculated from the first day of the last menstrual period.

4. In the case of non-lethal malformations such as severe hydrocephaly, cervical meningomyelocele, chromosomal aneuploidies and unbalanced translocations, abortion may be permissible before the 120th day of conception after consulting Islamic scholars and medical experts in the field.

5. Pregnancy occurring because of rape, war crimes and incest may be a cause to seek abortion. In all cases in which abortion is sought, the recommendation should be made by a team of Islamic scholars and medical experts in the field.

Prohibition of infanticide is mentioned in several Qur'anic verses. One of these verses is:

“Kill not your children for fear of want: We shall provide sustenance for them as well as for you. Verily the killing of them is a great sin.”


Genetic engineering and human cloning


Genetic research and engineering to alter or delete diseased genes is allowed and genetic research using stem cells from products of miscarriages or surplus ova after IVF procedures is permissible. However, to conceive in order to abort the foetus and harvest and use its stem cells is not permissible. Muslim scholars believe that each individual is born with unique qualities and genetic makeup. Islamically, a child should be born through marriage between husband and wife and the lineage of the child should be maintained. Therefore, human reproductive cloning is not permitted in Islam.


Care for HIV/AIDS infected patients


The HIV infection is known to be acquired through heterosexual and homosexual acts, as well as intravenous drug use, and blood transfusion. While Islam does not agree with homosexual lifestyles, promiscuity, or drug abuse, Islam is not opposed to the care of HIV patients. In fact, it instructs Muslim physicians to care for HIV patients with the same degree of compassion as they would for other patients. Muslim scholars believe that none should be discriminated against, whether carer or patient, on the basis of their lifestyle. Muslims do advise healthcare providers to take precautions for themselves while taking care of HIV patients.


Examination of patients of the opposite sex


Muslim scholars encourage but do not mandate same sex healthcare provision. Examination of a patient of the opposite sex is allowed in the presence of a third person of the same sex as the patient. In case of a minor, one of the parents’ presence is desirable. Only necessary examination should be undertaken. Pelvic examination must be done using gloves. Medical or nursing students may be allowed to observe during examination of a female patient, but only with her prior consent and in the presence of a female nurse or relative.


Drug research


Biomedical research involving double blind trials, controls and the use of placebos in drug research is allowed, but the patient must be informed and consent must be taken. Worsening of a disease during drug research, either due to placebo or an ineffective dosage of a drug, must be carefully monitored and the trial should be ended if necessary for the safety of the patient.


Shaykh Mohammed Roziur Rahman