Medical ethics

References:

1. 
   Al-Abd OM. Islamic Organization for Medical Sciences. Islamic Law Ruling on Certain Medical Questions-The Argument and Supporting Evidence, 2004. [on-line] Available from: http://www.islamset.com/ioms/Code2004/Islamic_vision2.html.
   
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    Fadel HE. Cloning: The Role of Muslim Scientists and Scholars. Editorial. J Islam Med Assn 1997;29:51-3.
    
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    Mishal AA. Cloning and Advances in Molecular Biotechnology: Islamic Shari‘ah Guidelines. In: Fadel HE, editor, FIMA Yearbook. Islamabad, Pakistan: Federation of Islamic Medical Associations and Medico Islamic Research Council; 2002. pp. 33-48.
    
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Chapter 10

Professional Ethics as a science and source of inspiration for Health professional.

Medical science is one of the fastest growing fields among all natural sciences and has witnessed some dramatic advances just in the past two to three decades. These technological and bio-medical advances have had a significant impact on the practical aspects of medical sciences weather in clinical practice or in research. Our understanding of humamanity, life and human relations has been greatly affected by Modern medicine and has aroused serious debate on medico-legal, bio-ethical and spiritual aspects of these dilemmas. Muslim medical practitioners have an obligation to practice their profession sincerely and not to abide the bindings of Islamic Medical Ethics. There is an increasing amount of literature available on the Islamic standpoint of a number of medico-ethical dilemmas but, very little on how Muslim physician can implement these concepts in a safe way, which is conducive to their daily practice, within an ethico-legal framework. And yet strictly in compliance with Islamic Shari’a. On the other hand Muslim patients are not just passive recipients of medical decisions, imposed by health professionals or organizations but have their own religious views and beliefs about how they would like to be cared for by the health profession. Muslim and Non-Muslim health professionals need to have practical awareness of the religious dilemmas one may have to face with increasing Muslim patients. Islam considers access to health care as a fundamental right of the individual. In medicine, there are sometimes difficult decision-making options for the patient’s care. Thus, a physician at times has to decide for his /her patient in light of available knowledge, his/her experience, his/her peers and consensus of the community. In addition, a Muslim physician derives his /her conclusion from rules of Islamic laws (Shari`a) and Islamic medical ethics. Without continuous research and enhancement of the knowledge of ethical dilemma of Islamic Shari’a, related to current medical knowledge and practice, it is virtually not possible for a health professional to provide ethical upright medical care to Muslim patients. The five basic ethical principles laid down in shri’a are: Protection of life, religion. Intellect, wealth and honour provide the basis of understanding of Islamic frame work of medical ethics. Sanctity of human life which derives from al-Qur’an: “Whosoever saves a human life saves the life of the whole mankind”- (Qura’n- Al Maidah 5: 32), is an important principle of Islamic Shari’a. The second impotent principle derived from the traditions of The Prophet Mohammad PBUH is the emphasis on seeking treatment:

“There is no disease that God has created, except that He also has created its treatment.(Sahih Al-Bukhari- Hadith 5354). An other important principle derived from the traditions of The Prophet Muhammad PBUH is that all disease is curable including those so called incurable one. This give an incentive to the medical professionals to perform intensive research to find out the cure for all diseases: “Seek treatment, for Allah the Exalted did not create a disease for which He did not create a treatment, except senility”. (Sunan Abi Dawuud- Hadith 3855). The duty of a Muslim doctor is not only to the protection and preservation of life, intellect, and progeny but also the protection of property and religion. Every emerging situation is being examined studied and dealt with in view of these basic principles and find out the solution of every ethical dilemma in the light of Quranic teachings and Prophetic traditions. Again A Muslim doctor need to strive continuously to come up with the solution of very merging problem in medicine in the light of Shari;a. Few guide line of Islamic medical ethics for seeking solutions to these problem can enlisted here:

1. Necessity overrides prohibition; that is, if there are certain things islamically not permissible in usual circumstances, under dire necessity they can become permissible. For example: Eating pork is not permissible according to Islamic shri’a but to save life it is allowed to consume only for that particular situation and when there is no element of transcription in intention.

2. Evils and factors of harm have to be removed at all cost taking all possible measures.

3. If avoidance of evil or harm is not avoidable than accept one of the two of lessor evils or harm.

4. Interest of the society and public overrides the individual’s interest. The individual concern but however must be taken in to account whenever it is possible without jeopardizing the public introits at larger scale.

Basic principles of 1) Autonomy of the patient, 2) Beneficence, 3) Nonmaleficence, and 4) Distributive Justice are also upholds in Islamic Medical ethics. In my humble view these principles are not only in accordance to Islamic Shri’a but Shari’a greatly emphasizes on these principles. Thus, when making decision about patient care, a Muslim physician is bound to make decision in the best interest of the patient, whether Muslim or non-Muslim. Further, that decision should not only be based on his/her own knowledge and experience, but as a Muslim, he/she has to consider the Islamic teaching in regards to the situation, but without imposing his/her religious views on the patient.

A Muslim physician knows that his/her life time is fixed on this earth, and he/she also knows that he/she is here on "probation" therefore, he/she does not strive too much importance to grab more wealth, power, rank, position, children etc. If, through a reversal in fortunes, he loses these, be is not overwhelmed with sorrow. He/she is not demoralized by worldly losses and never surrenders to despair. He is always full of hope, brings hopes for the others and knows that hardship might be a test of his faith. He, therefore, puts his trust in Allah's unlimited and endless mercy, and accepts whatever befalls him, without any grievance. He never doubts that things, no matter how bad at the time, would work out for him in the end. A Muslims’ faith in Allah's never-ending mercy remains firm in the entire situation to come. He remains confident hopeful and forward looking in every thick or thin. His relation with Quarnic revelation remains more and more firm and he always remembers the saying of Allah: “That you may not grieve over what is lost to you, nor you exult because of that which he has given you, and Allah loves not any self conceived boaster.” (Qura’n- Alhadid: 57:23). A Muslim physician exerts his maximum efforts to provide maximum relief to the humanity because he knows from the quranic revelations:
"...We ordained for the Children of Israel that if any one slew a person - unless it is for murder or for spreading mischief in the land - it would be as if he slew the whole people.  And if anyone saved a life, it would be as if he saved the life of the whole people...." (Qur'an 5:32).

It is not possible for a Muslim doctor to remain ignorant or even unconcerned over the most effective, less traumatic and evidently proven better means of treatment. It will be un ethical to provide inferior quality or an obsolete treatment to his patients and knowingly that scientific evidences do not support the treatment which he is providing to his patients. At the same time he continuously works hard to find solution of new issues in medicine through exploring and finding answer to all unanswered questions in the light of fundamental tenets of the Islamic Shariah. The close collaboration between the scholars of jurisprudence and the scientific and medical fraternity are basic prerequisites to keep abreast of the plethora of bio-technical advancing, creating fresh ethical questions to be answered. Living in multicultural and muti-religeous societies, Islamic medical ethics remained as source of inspiration for doctors due to its “middle of the road” approach moderating between the extremes of conservatism and liberalism. Islamic medical ethics provides a forum for the genuine and responsible quest for new knowledge and has provided a legal framework for responsible societal governance of human genetic and reproductive technologies and banned all forms of free market eugenics. It provoke continuous research as said in Quran: “Surely in the creation of the heavens and the earth and the alteration of the night and day, there are signs for men of understanding. Those who remember Allah while standing, sitting, and lying on their sides, and mediate (do research) on the creation of heaven and the earth (then say) Our Rabb1 You have not created this in vain, Glory to you! Save us from the punishment of fire. (Qura’n: Ale- Imran3: 190-191. It is the duty of Muslim doctor to acquire more and more knowledge and expertise and breakthroughs in new research frontiers in his field of interest. At the same time he should remain very optimistic and aware about his responsibilities, being member of the last Ummah: "We have made you a moderate Ummah (nation), so that you may testify against mankind, and that your own Rasool may testify against you". (Qur;an- 2: 143)

  All doctors in general and a Muslim doctor in particular have to lead a very careful life because during his life time he often faces difficult decisions.  Sometimes these decisions are a matter of life and death.  Should I donate a kidney so that another may live?  Should I turn off life support for my brain-dead child?  Should I mercifully end the suffering of my terminally ill, elderly mother?  If I am pregnant with quintuplets, should I abort one or more so that the others have a better chance of survival?  If I face infertility, how far should I go in treatment so that I might, Allah-willing, have a child?  As medical knowledge and modalities of treatment expand and advance continuously, more and more ethical questions come up. A Muslim doctor seeks guidance on such matters from Qura’n and Sunnah of the Prophet and also seeks advice of Muslim scholars about the gray areas in these matters. He is assured by his Lord that he will be successful and his Lord observes every act: “ Who who has better Deen ( the way of life ) than the one who is Muslim ( submit himself entirely) to Allah, does good to others and follow the faith of Ibraheem . the upright one, whom Allah chose to be his friend, To Allah belongs all that is in the heaven and in the earth, Allah encompasses everything.” (Qur’an- 4: 125-126).

Qur’an also provides the basic guideline to address any emerging issue and how a Muslim can find the righteous solution of problems.

Qur’an Provide basic guidelines for that: “Whenever you have mutual conflict on any matter you must follow Qura’n and traditions of the Prophet PBUH
More over it is not in human capacity to find the correct solution of his problem mere by theological or philosophical basis. has to depend on divine guidance. Quran provide these guide lines so that following these guidelines one must find the solution of his problems.

"Does not man see that it is We who created him from sperm. Yet behold! He stands as an open adversary! And he makes comparisons for Us, and forgets his own creation. He says who can give life to (dry) bones and decomposed ones? Say, 'He will give them life That created them for the first time, for He is versed in every kind of creation.'"

(Qur’an 36: 77-79)

Health professionals keep them very busy throughout their professional carrier and a little time is spend on the issue of ethics and learning correct ethical concept. In the result of that very basic ethical issues remains unsolved during the last many years. The process of research in this field is governed by the market forces. Most of the ethical issues discussed and being examined by the scientists is because of the obvious ethical concerns of the society or professionals. Nearly two decay ago there was hardly any department of medical ethics in the medical institutions though ethical committees were existing in most prestigious teaching institutions mostly dealing with day to day and research ethics. New dimensions in medical practice, obligations of health professionals and public awareness about their rights compelled the health institutions to come up with ethical committees and departments. It is more required than any time before to conduct regular research and come up with the recent recommendations, well before an ethical dilemma erupts in the result of creation of new knowledge in different specialties of medical sciences. For Muslim professionals basic guidelines are available to dissect any ethical issue in the light of Qur’an and Sunnah (Traditions) of the Prophets PBUH. Doing research for Muslim health professionals is mandatory rather than optional, as described at several verses of Qur’an and Hadiths of the Prophet PBUH. Qur’an and Sunnah provide the basic guide lines, to conduct research and come up with recommendations in the best interest of humanity. Muslims strongly believe in the fact that all those divine guidelines are in the best interests of humanity. The prophet Mohammad PBUH has translated all those conceptual guidelines in to practical, his companions and following generations successfully demonstrated the superiority of the divine principles over all other existing one. The most basic concept described in Qur’an is: "And whatever the Messenger gives you, take it, and whatever he forbids you, leave it. And fear Allah: truly Allah is severe in punishment”. Qur’an 59:7

References:

1. The Holy Quran: Translated by Mohaqmmad Farooq Azam Malik,  Published by The Institue of Islamic Knowledge Houstn, Texas, USA

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