ISLAMIC CODE OF ETHICS:ISLAMIC CODE OF ETHICS:MEDICAL PRACTICEMEDICAL PRACTICE

FARHAT MOAZAM, M.D., PHDFARHAT MOAZAM, M.D., PHD

Center of Biomedical Ethics and Culture, SIUT, Center of Biomedical Ethics and Culture, SIUT, Karachi, PakistanKarachi, Pakistan

Institute of Practical Ethics, University of Virginia, USAInstitute of Practical Ethics, University of Virginia, USA

DISCUSSION POINTSDISCUSSION POINTS

Modern secular ethics versus Islamic religious-Modern secular ethics versus Islamic religious-ethical conceptsethical conceptsThe contemporary English term “ethics” versus The contemporary English term “ethics” versus the Arabic (Urdu) word “the Arabic (Urdu) word “Adab/Akhlaq”Adab/Akhlaq”Rich Islamic heritage of Virtue Ethics (Rich Islamic heritage of Virtue Ethics (al-Fada’el) al-Fada’el) and stress on the moral physician: the sourcesand stress on the moral physician: the sourcesA brief account, and some examples, of virtues A brief account, and some examples, of virtues that must be included in the body of the Islamic that must be included in the body of the Islamic Code of Medical Ethics of IOMS Code of Medical Ethics of IOMS

MODERN BIOETHICS:MODERN BIOETHICS:BASIC CHARACTERISTCSBASIC CHARACTERISTCS

Multidisciplinary discipline conceived in the Multidisciplinary discipline conceived in the 1970s to address new ethical dilemmas in 1970s to address new ethical dilemmas in medical practice and biomedical researchmedical practice and biomedical researchGrounded in secular, philosophical principles Grounded in secular, philosophical principles relying on human reasonrelying on human reasonFocus on autonomy and individual rights to Focus on autonomy and individual rights to ensure justiceensure justiceEthical theories satisfied with minimal obligations Ethical theories satisfied with minimal obligations to othersto othersAsks the question – “is this Asks the question – “is this actionaction ethical?” (“Hal ethical?” (“Hal al-’aml salih wa akhlaqi?”)al-’aml salih wa akhlaqi?”)

ISLAMIC RELIGIOUS ETHICS:ISLAMIC RELIGIOUS ETHICS: BASIC CONCEPTS BASIC CONCEPTS

Historically, Muslim moral and ethical thought Historically, Muslim moral and ethical thought rooted in Revelation and human reason (rooted in Revelation and human reason (al-’aql al-’aql wa ‘l-shari’wa ‘l-shari’))

Recognizes rights of individuals, but emphasizes Recognizes rights of individuals, but emphasizes human obligations to establish social justicehuman obligations to establish social justice

Those more privileged in life have greater Those more privileged in life have greater responsibilities towards the less fortunateresponsibilities towards the less fortunate

Asks the question – “is the acting Asks the question – “is the acting agent/physician a moral person?” agent/physician a moral person?” (“hal al-Tabib (“hal al-Tabib shakhsun salihun, shakhs du akhlaq?”)shakhsun salihun, shakhs du akhlaq?”)

ETHICS vs. ETHICS vs. AKHLAQ/ADABAKHLAQ/ADAB

Ethics for physicians is translated in Arabic (and Urdu) Ethics for physicians is translated in Arabic (and Urdu) as as Akhlaq al-TabibAkhlaq al-TabibThe historical and social construct of how Muslims The historical and social construct of how Muslims comprehend comprehend akhlaqakhlaq is much broader than the is much broader than the contemporary use of term “ethics”contemporary use of term “ethics”An understanding of An understanding of akhlaqakhlaq incorporates both the incorporates both the virtuous virtuous agentagent and his/her ethical and his/her ethical actactThe IOMS Islamic Code of Medical Ethics for physicians The IOMS Islamic Code of Medical Ethics for physicians must include, in addition to what constitutes ethical must include, in addition to what constitutes ethical actions, a list of virtues and moral traits that physicians actions, a list of virtues and moral traits that physicians must adopt and cultivatemust adopt and cultivateBy highlighting the need for virtuous physicians and By highlighting the need for virtuous physicians and researchers as well as ethical acts, IOMS can make an researchers as well as ethical acts, IOMS can make an important contribution to contemporary bioethical important contribution to contemporary bioethical discourse which peripheralizes the former discourse which peripheralizes the former

VIRTUES FOR PHYSICIANS:VIRTUES FOR PHYSICIANS:MUSLIM SOURCESMUSLIM SOURCES

““The physician is an instrument of God’s mercy on The physician is an instrument of God’s mercy on earth.” Ibn Ali al-Ruhawi (d. late 9earth.” Ibn Ali al-Ruhawi (d. late 9thth century) century)

From From ethical concepts in theethical concepts in the names of Allah:names of Allah: al-Rahimal-Rahim (compassionate), (compassionate), al-Rahmanal-Rahman (gracious), (gracious), al-Ghafural-Ghafur (forgiving), (forgiving), al-Haqal-Haq (truth, justice) (truth, justice)

FromFrom the Qur’an and Hadith: the Qur’an and Hadith: Cultivate Cultivate al-birral-birr (piety, (piety, godliness), godliness), ahsanaahsana (the ideal), (the ideal), hilmhilm (gentleness, (gentleness, patience, moral reasonableness), patience, moral reasonableness), ‘adl wa qist‘adl wa qist (justice, (justice, equity), equity), tawazantawazan (balance). Avoid (balance). Avoid kibrkibr (pride), (pride), bakhilabakhila (avarice), (avarice), istaghnaistaghna (unbound confidence in self), (unbound confidence in self), baghabagha (injustice, intoxication with worldly power)(injustice, intoxication with worldly power)

VIRTUES FOR PHYSICIANS:VIRTUES FOR PHYSICIANS:MUSLIM SOURCES (CONT.)MUSLIM SOURCES (CONT.)

From From Muslim Muslim ulemaulema and and fuqahafuqaha:: The The usul al-akhlaqusul al-akhlaq of of Imam Abu Hamid al-Ghazali – Imam Abu Hamid al-Ghazali – hikmahikma (wisdom), (wisdom), shuja’ashuja’a (courage), (courage), ‘iffa‘iffa (temperance), and (temperance), and ‘adl‘adl (justice) (justice)From From Muslim physicians:Muslim physicians: Kitab al-Tibb al-RuhaniKitab al-Tibb al-Ruhani of Abu of Abu Bakr al Razi – the exemplary physician “must cultivate Bakr al Razi – the exemplary physician “must cultivate good moral character, good health, and be cultured in good moral character, good health, and be cultured in manners.” Must “listen more, talk less.”manners.” Must “listen more, talk less.”Adab al-TabibAdab al-Tabib by Al-Ruhawi – “train by employing good by Al-Ruhawi – “train by employing good morals and actions with sympathy, mercy, gentleness, morals and actions with sympathy, mercy, gentleness, chastity, courage, generosity, justice. Do not aim for an chastity, courage, generosity, justice. Do not aim for an excess of worldly riches.” The physician with “exemplary excess of worldly riches.” The physician with “exemplary adabadab is one who truly fears God.” is one who truly fears God.”

WHY STRESS MORAL CHARACTER WHY STRESS MORAL CHARACTER OF PHYSICIAN?OF PHYSICIAN?

Physicians and patients are spiritually equal in Physicians and patients are spiritually equal in the eyes of Allah as His creaturesthe eyes of Allah as His creaturesRelationship between physicians and patients by Relationship between physicians and patients by nature is an unequal one; the patient is not nature is an unequal one; the patient is not autonomous in illness. Physicians possess autonomous in illness. Physicians possess knowledge and skills which patients do not, but knowledge and skills which patients do not, but need for recovery and survival need for recovery and survival Rules and guidelines alone are insufficient Rules and guidelines alone are insufficient safeguards against abuse of patients in the safeguards against abuse of patients in the hands of unethical practitioners. E.g. the hands of unethical practitioners. E.g. the informed consent for therapy or researchinformed consent for therapy or research

FINAL WORDSFINAL WORDS

“ “The believers whose faith is most perfectThe believers whose faith is most perfect

are those who have the best character.”are those who have the best character.”

((Akmalu al-momineen imanan ahsanuhumAkmalu al-momineen imanan ahsanuhum

khuluqankhuluqan) )

Hadith of the Prophet (SAW) Hadith of the Prophet (SAW)

(from Imam Ibn Hanbal)(from Imam Ibn Hanbal)