Contemporary Bioethics

Front matter

Mohammed Ali Al-Bar Hassan Chamsi-Pasha

Contemporary Bioethics

Islamic Perspective

Foreword

Bismi Allah Al Rahman Al Rahim

Contemporary Bioethics: Islamic Perspective, by Dr. Mohammed Ali Al-Bar and Dr. Hassan Chamsi-Pasha, is a timely contribution in the field of Islamic bioethics. The book is authored by two prominent practitioners of medicine in Saudi Arabia with an impressive knowledge of Islamic religious sciences and legal-ethical rulings on various topics of clinical significance. Rapid advancement in the innovation of medical technology has given rise to the critical need for expansion of the bioethical field to keep up with medical practice and research while relating the ethical decisions to their religious sources and reliable medical knowledge. Muslim bioethicists are struggling to keep pace with and produce answers to the questions posed by the medical establishment. The early phases of Islamic bioethics saw a number of medical professionals taking up to write on various issues in medical practice and research. Some of these early works were supplemented by Muslim legal scholars who teamed up with medical professionals to write responses to religious questions for clinical cases that required careful analysis of Islamic tradition and jurisprudence to provide dependable rulings. The present works are now being authored by some medical professionals who also have a good understanding of the religious sources that provide spiritual and moral guidance for complicated medical cases.

Contemporary Bioethics: Islamic Perspective is such an endeavor that provides the readers a theoretical framework and practical decisions made by leading Muslim jurists. Accordingly, the first half of the study presents the Islamic sources that are utilized by Muslim legal scholars in deducing appropriate rulings on various medical cases on which bioethicists around the world have offered solutions. In the second part of the book, the authors have compiled and discussed Islamic rulings in various controversial fields of modern medical practice and research. This combination of theory and practice in Islamic bioethics makes Contemporary Bioethics: Islamic Perspective an indispensable reading for those who work on bioethics from an Islamic ethical-legal point of view. In the Western world, questions range over concerns such as stem cell research, cloning, cessation of life support, and fertility vi Foreword treatments. Often contentious and filled with fervor, proponents and opponents of controversial medical advances struggle to prevail in the disagreement. The means of resolving the argument are usually achieved through official legislation. The predominant reason for government authority in resolving bioethical issues correlates with the plurality of ethnicities, religions, social values, and ideologies of most Western countries. While religion in particular motivates and influences at the individual level, in secular bioethics no religious figure has the authority to enact law. Religious authorities can unquestionably influence the law but do not promulgate or enforce laws.

Unlike in Western countries, there is no established apparatus that institutes, monitors, and regulates the field of bioethics in the Muslim world. The very reason for the lack of such an establishment stems from a fundamental flaw in the application of traditional rulings in the field of bioethics. Since the 1970s, the Muslim scholarly community has come together to establish a physician-jurist consultation group that meets under the auspices of the Supreme Islamic Juridical Council. The council meets regularly to undertake important investigations of pressing questions in the field of medical practice and research and provide reliable juridical decisions in accord with Islamic religious texts. Although the body has no power to enact laws, it certainly functions as an advisory body for Muslim governments in their healthcare policies.

In the West, the field of bioethics is largely based on utilitarianism, an ethical principle that places primacy of consequences of an action over the action itself. Utilitarianism is the major source of resolving ethical questions in the West. In light of the characteristic Western approach to bioethics, it is important to note that in Contemporary Bioethics: Islamic Perspective, Dr. Al-Bar and Dr. Chamsi-Pasha have combined medical practice and research and scrutinized these in light of Islamic religious values, laws, and ethics. It is important to underscore and evaluate the contribution made by these two medical doctors drawing from their professional knowledge of medicine and profound understanding of Islamic tradition in the cultural context of Islamic Sunni countries. In other words, their study combines the theory and practice of clinical ethics in an important part of the Arab-Muslim world. In order to address bioethical issues within Muslim society in Islamic Sunni countries, the authors focus on medical as well as cultural issues that inform Muslim attitudes toward human body in relation to family, community, religion, and science. They have attended to the sensibilities of Islamic jurisprudence and have approached Islam from both legal and ethical perspectives.

Let us see the context of this important contribution in comparison to other recently published works on Islamic bioethics. In the past decade the literature on Islamic bioethics has come to its own. Several monographs written by both secular and confessional students of religious ethics, medical anthropology as well as historians of medicine, and medical law have appeared in English and other major European languages. In particular, ethnographic studies working on specific Muslim societies have enriched our understanding of the way ethical dilemmas at critical moments of patients’ illness have been handled by healthcare providers, in consultation with close family members and communal religious leaders. More

Foreword Vii pertinently, some medical anthropologists have acted as sensitive conveyers of this culture of pain, suffering, and relief to those living in the affluent Western societies where the entire worldview is founded on the human ability to defeat the evil of illnesses through costly medical intervention. In contrast, in many parts of the Muslim world where unspeakable poverty levels have denied any medical care to suffering patients and financial relief to their families, these ethnographers have worked as advocates of mercy and compassion. After all, bioethics has to engage in negotiating proper recognition of human suffering. Human affliction goes beyond the technicalities of who can afford to pay for expensive treatment or which state has better policies to alleviate everyday suffering in the healthcare institutions. In the developing world, in most cases, healthcare institutions are professionally geared toward maintaining a culture of treatment for those who can afford it.

In the midst of this growing literature one can feel the void of authoritative religious-moral guidance on various topics that arise in the departments of critical care in hospitals regarding the bioethical aspects of the problematized clinical cases that require satisfactory resolution for the wellbeing of the patient as well as his/her family. In the recent anthropological study, Sherine Hamdy’s sustained fieldwork in Egypt entitled: Our Bodies Belong to God explores the ethics of organ transplant. The author demonstrates the confusion that exists in the area of authoritative religious-ethical opinions that could provide critical guidance to both public health officials as well as healthcare providers to resolve some of the urgent moral dilemmas that face patients and their families. In fact, Hamdy takes the reader through the maze of ethical minefields confronting Egyptian doctors, torn between their own religious-cultural sensibilities and the professional obligations to do everything possible to relieve their patients from long-term affliction caused by hard to cure diseases. However, to address bioethics within Egypt, Hamdy narrows the expansive field of Islamic ethics by focusing narrowly on organ transplantation, particularly kidney and cornea, as a method of assessing Egyptian attitudes toward the human body in relation to religion and society. Hamdy’s fieldwork in the area of transplant is highlighted by the fact that she had to consult the written literature produced by Egyptian religious scholars to understand the ethical-legal implications of organ transplant based on organ donation or organ acquisition through the legal or illegal thriving black market managed by every possible agent engaged in money-making schemes.

Compared to this and other similar studies on Muslim bioethics, the present volume, Contemporary Bioethics: Islamic Perspective, advances a meticulously documented necessity of engaging bioethics as a discipline. The authors combine Islamic textual analysis with juridical methodology to engage dominant secular bioethics in Muslim healthcare institutions. Contemporary Bioethics integrates Islamic textual resources with medical information in order to provide careful analyses of the political, economic, and cultural terrains that are necessary for bioethicists to effectively promote social justice. In many Arab countries, national media attention is directed at the views of Islamic legal scholars, whose answers to religious questions on various issues in bioethics are part of the larger political project. This political project has to direct ethical queries to medical and Islamic viii Foreword authorities who are challenged to solve problems of allocation and managing of meager resources to address social inequalities in corruption-ridden governance. Islamic revivalism since the 1970s has prompted medical practitioners and educated people in the Arab world to actively engage in learning about Islamic views independently, bypassing the religious scholars connected with the state bureaucracy whose views are distrusted as being politically motivated. In a country where ethics is still dominated by legal rulings (fatawa) of Islamic jurisprudence and where bioethics still awaits definition within healthcare institutions that could determine the outcome of morally problematic procedures, the contribution made by Contemporary Bioethics is both timely and critical for medical professionals and the larger educated public that is thirsty of biomedical information at the level of everyday resolutions of moral dilemmas touching life and death decisions in Muslim societies. Naturally, culture plays a leading role in seeking realistic solutions. The authors of Contemporary Bioethics have admirably interwoven medicine and religion to provide a sense of legalistic-ethical discourse on subjects dealing with biomedical issues. What is understood in Muslim societies as right or wrong still abides with legally formulated technical terms such as halal (permissible) and haram (forbidden). It is to Dr. Al-Bar and Dr. Chamsi-Pasha’s credit that they have been able to translate for their readers the medical culture in Sunni Islamic countries in a comprehensible language that can benefit any educated reader of the subject.

January 2014/Rabi I, 1435 Abdulaziz Sachedina Professor and Endowed IIT Chair

in Islamic Studies

George Mason University, USA

Acknowledgments

We have to forward our deepest thanks to the Chair of Medical Ethics, headed by Prof. Adnan Albar, who supported this work and took charge of publishing it under the Chair of Medical Ethics, King Abdulaziz University, which is supported by a generous grant from Sheikh Mohammed Hussein AlAmoudy, who supported many chairs in Saudi universities.

Our thanks and gratitude to Prof. Abdulaziz Sachedina, Professor and Endowed INT Chair in Islamic Studies George Mason University, for his elegant Foreword.

Our deepest thanks and gratitude to sister Ms. Cumiya Johnson, the Office Manager of CEO Dr. Walid Ahmad Fitaihi of the International Medical Center for typing the whole manuscript despite scribbling and poor handwriting.

We extend our thanks to Dr. Shihab Ghanem and his son Dr. Wadhah Shihab Ghanem for reading the first three chapters diligently and commenting on them and to Dr. Abdullah Srour Aljoudi for reading through the book and giving his important comments.

Mohammed Ali Al-Bar Hassan Chamsi-Pasha

Part I Introductory Chapters

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Part II The Four Principles of Biomedical Ethics with an Islamic Perspective

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Contents XV

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Chapter 1 Introduction aall Grea) All aa

The present study undertakes to examine biomedical issues as they have emerged in the last three decades. In the Muslim world, as in any part of the globe, advancements in biomedical technology has meant a number of new issues in the medical treatment and procedures that impinge upon Islamic values as taught by the Qur’an and the Sunna (the Tradition of Prophet Muhammad). Our investigations in bioethical issues require Muslim ethicists to examine a number of judicial decisions made by Muslim scholars in response to the growing number of cases in the clinical settings as well as national health policies adopted by various Muslim governments in the last two decades. The field of bioethics is new even in the Western countries where its principles and rules are being worked out in a standard approach to secularly mediated resolutions of morally problematic issues regarding, for instance, embryonic inviolability or end of life decisions in connection with terminally ill patients.

For several centuries, the world, and particularly Europe, has benefited from the great contributions made by Muslim physicians in the field of medicine. These contributions were not only based on technical skills but also on the role of eminent Muslim physicians in establishing medical ethics. Many prominent physicians of the Islamic civilization involved themselves with professional ethics; among them were al-Ruhawi, and al-Razi (Rhazes). Both wrote the earliest and most thorough books on medical ethics over a 1000 years ago [1].

In this study we hope to bring these and other ethical issues on which Islamic scholars have provided religious-moral guidance by investigating the foundational sources of Islam like the Qur’an and the Sunna.

Ethics in this Study

It is important to begin our study by elucidating some key concepts with which we will be concerned in this research. The most important term that we need to formulate in view of its central role in Islamic legal-ethical decision-making is ethics. Although the term ethics is clearly a heritage of all humanity experiencing

© The Author(s) 2015 3 M.A. Al-Bar and H. Chamsi-Pasha, Contemporary Bioethics, DOI 10.1007/978-3-319-18428-9_1 moral dilemmas in their everyday relations with other persons, in this study we have taken ethics to mean that inquiry which examines the rightness and the wrongness in human conduct. Human conduct is informed by moral principles which determine the outcome of particular acts or activities. Furthermore, according to Beauchamp and Childress, ethics is a “generic term for various ways of understanding and examining moral life [2].” In this latter usage, then, it is appropriate to speak about normative and non-normative ethics, depending upon the sources of this understanding. Normative ethics based on the source of these norms, attempts to understand which general moral norms should we accept and why. In contrast, ethical theories attempt to identify and justify these norms revealing justificatory reasoning that provide resolution to moral dilemmas. However, ethics is concerned with examining human conduct and, therefore, it seeks to find ways of predicting practical aspects of human activity by investigating moral problems, practices and policies in professions, situations, and public policy. In other words, ethics is concerned with applications and in this sense bioethics is a branch of applied ethics concerned with resolving problems in the area of living sciences, including research and practice in the field of medicine.

In contrast to normative ethics, non-normative ethics which takes human experience, culture, and history as important sources of moral decision-making takes the form of descriptive ethics which studies how people reason and act. Thus, for instance, anthropologists, sociologists, psychologists and historians study the norms and attitudes of societies towards moral issues in different societies and epochs and the factors that are used to justify their actions in different professions and in matters connected with larger public. The other branch of non-normative ethics is meta-ethics. Meta-ethics involves the analysis of conceptual language and methods of reasoning in ethics. It addresses the meaning of right and wrong, virtue and vice, the good and the bad, and so forth in the larger global context. In short, it addresses the ethical epistemology and forms of justificatory reasoning.

In this study, we use ethics and morality interchangeably to refer to norms about right or wrong in human conduct that are so widely shared in a certain society. These norms differ, at least in details, from one society to another, and from one era to another in the same society. However, many principles, rules and virtues remain constant across different cultures and different times. For instance, almost all persons know that lying, stealing and killing an innocent person is immoral; and veracity, fidelity and saving a human life is a great virtue and a highly commended moral act. Our interest in this book is to discuss the sources of common principles of morality and ethics to show that commonalty unites all human beings in understanding the difference between moral and immoral. This is the scope of our first chapter, where we explain and elaborate:

1. Intuitive nature (al-fitr’ a): This is a fundamental Qur’anic idea, which speaks about the basic nature of all human beings by which human beings can discern certain things to be morally right (honesty, truth telling, doing good, benevolence, etc.) and certain things to be wrong (lying, cheating, stealing, killing an innocent person or being unjust).

Ethics in this Study 5

2. Reason (intellect, mind, al-‘agl): God endowed humanity with the ability to use

reason to differentiate between right and wrong, and to discern the proper course of action. Those who refuse to use their minds and follow their egotistic desires, and blind themselves with self-importance follow their instincts and hedonistic desires and deviate from the true path, becoming unable to minimally distinguish right from wrong. To be sure, even if they know the truth of the matter, they are inclined to follow their carnal desires and lust for material ends and tramp over whatever remains of their conscience.

The Qur’an extols humanity to strive to control egotistic and hedonistic desires, and it deplores those who are arrogant, mischievous and having insatiated desire for wealth and power, which they use to crush the poor and weak. Muslim theologian, Abu Hamid al-Ghazali, has admonished people correctly when he says: “If you cannot reach the level of Angels, then do not fall into the level of beasts, scorpions and snakes [3].” We will have more opportunity to cite the Qur’an and the Sunna, in addition to theological and philosophical heritage of Islam, when we undertake to elaborate this point further.

3. Revelation (wahy, Tanzil): Muslims believe that all communities had received Allah’s (God’s) guidance through revelation given to the Prophets and Messengers of God. In Islam, Adam is not only first human being; he is also the first Prophet who delivered God’s message of monotheism to his descendants.

It is important to state from the outset that Muslims do not believe in original sin. Adam committed an act of disobedience by eating from the fruit of the tree which God had ordered him not to eat. According to the Qur’an, he and his wife, Eve, repented and God accepted their repentance and they became pure. God bestowed on Adam and Eve and their children His Grace and Blessing “We honored the progeny of Adam, provided them with transport on land and sea; given them for sustenance things good and pure; and conferred on them special favors above a great part of Our creation” (Qur’an/17:70). Furthermore, Muslims believe that God sent to every nation and people, prophets and messengers to guide them to worship one God and follow the path of righteousness. In other words, Muslims believe in all these prophets and that they brought the same religion in its essence, and worshipped only one God. This belief is the source of unity among human beings under the unity of God’s religion, which is essentially the same. However the followers of these religions distort God’s religion and bring back polytheism in different forms and shapes, by changing the pristine clear messages of the prophets altering the good teachings with adulterated misconceptions both in theology and morality. It is significant to note that, as the youngest of the monotheistic traditions, Islam addresses the whole humanity and respects all the prophets from Adam to the last Prophet Muhammad and considers all nations to have witnessed God’s uncompromising unity confirmed in all the messages and teaching of God’s true envoys on earth. Belief in God’s unity (Tawhid) is the basis not only for Muslim theology; but it is also the basis of morality and ethics in Islam. We will return to this subject in greater detail in the first two chapters: “The Sources of Common Principles of Morality and Ethics” and “The Origins of Islamic Morality and

Ethics.” There we shall explain how Islamic theology and Islamic religious law— the Shari’ah are integral and based on morality and ethics.

Karen Armstrong in her book, A History of God explicates this point about the relationship between ethics and belief in one God. According to her, “the assertion of unity of God (Tawhid, monotheism) is not only a denial that deities were worthy of worship. To say that God is one is not just a mere numerical definition; it is a call to make that unity the driving factor of one’s life and society” [4]. In another place she observes: “In practical terms, Islam meant that Muslims had a duty to create a just, equitable society where the poor and vulnerable are treated decently. The early moral message of the Qur’an is simple: It is wrong to stockpile wealth and build a private fortune, and it is good to share the wealth of society fairly by giving a regular portion of one’s wealth to the poor’ (Holy Qur’an Surah 92/18, Surah 9/103, Surah 63/9, Surah 102/1) [5].

Some Important Concepts Related to Islamic Legal-Ethical Tradition in this Study

The Shari’a: (lit. “a way or well-trodden path to a source of water”) refers to the normative religious law of Islam with the Qur’an and the Sunna (The Tradition of Prophet Muhammad including his sayings, acts and approvals) as its sources. The norms of the Shari’a are immutable, since they have supernatural source in God’s revelation for humankind. Islamic jurisprudence (al-fiqh) engages in understanding (lit. sense of the word fiqh) of these revealed texts and formulating rules and rulings to cover all human activity in the area of human-God relations (‘iba da t) and human-human relationships (mu’a malat). In Islamic rulings acts are classified as obligatory, recommended, permissible, reprehensible, and forbidden.

1. Obligatory Acts: The research in and understanding of the revealed texts makes it possible to declare certain acts as required (fardh, wajib) and certain other acts as recommended or even forbidden. The rule of thumb is that where there is a clear command in the Qur’an or the Sunna (for instance performing the five daily prayers) then performance of that action becomes obligatory. Obligatory acts include paying the annual alms (zakat) to the poor, fasting during the month of Ramadan between dawn and dusk for a month; performance of the annual pilgrimage—the Hajj, once in a lifetime, if he/she has got the means to perform it.

2. Recommended Acts: These are the acts that are performed as supererogatory acts (mustahab, mandub). It includes all those acts that are good to perform, but they are not required. For instance, it is recommended to fast on Mondays and Thursday every week. Likewise, on certain important days of the Muslim calendar, it is highly recommended to perform extra prayers and fasting. Those who perform these acts are rewarded for their piety by God. But if they cannot, for any reason, perform them, they do not become blameworthy.

Some Important Concepts Related to Islamic ... 7

Permissible Acts: These acts are neutral and permissible (mubah) in the sense that whether one performs them or not, it does not matter since they constitute neither blame nor recrimination. It includes all daily life activities. Everything is allowed unless there is a clear text prohibiting it. This is also equivalent to the legal presumption of innocence until the proof of guilt is established. Things are presumed allowed in the absence of prohibition.

. Reprehensible Acts: These acts, although better to avoid (makrooh), do not constitute blame or sin. It simply requires a person to think before performing it since there is no clear order of avoiding it. Certainly, being reprehensible, if avoided then God would reward the person for abstaining from it, but will not punish the person who did it.

. Forbidden Acts: These are forbidden explicitly in the Qur’an or the Sunna

(haram). If a person performs such an act, then he/she will be punished either in this world or in the hereafter, unless he/she repents. Repentance is direct between God and human, and He (God) accepts repentance at any time except at the time of death when it is too late.

Islamic jurisprudence (al-figh) consists of two sets of inquiry: one set of inquiry deals with case studies (furu’), and the other relates the cases to the legal principles and precedents derived from the foundational sources of Islamic tradition (Usoo’ 1). These include:

(a) The Qur’an: Muslims believe that the Qur’an contains the revelation that the

Prophet Muhammad received directly from God. Accordingly, it is regarded as the most authentic source of religious and moral directives that can be extrapolated to formulate judicial decisions touching all practical matters in everyday life of the community.