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Islam and Medical Practice: Any Conflict?

Maryam Bello-ImamPharmacy Department, UCH, Ibadan.

Preamble

Islam as a religion means submission. Therefore, a Muslim is onewho submits to the will of Allah. As a slave of Allah, a Muslim obeysAllah with all humility and avoids following his/her own whims andcaprices. This is what Islam requires of us. Should any of our desiresclash with the tenets of Islam, then we are to forgo our selfishdesires and opt for the Islamic duty required of us. Thus, Allah says:I created not the jinn and mankind except that they should

worship Me (Quran 51:56).

As personnel in the medical field, how do we avoid situations inwhich medical practices seem to clash with our Islamic tenets?Some Muslims even hold the belief that it is wrong to enter into themedical profession because they consider aspects of medicalpractice to be contrary to Islamic jurisdiction. To this class of people,modern medical practice is a kind of innovation (bidah) that isantithetical to Islam since some of the medical procedures of todaywere unknown at the time of Prophet Muhammad (S.A.W.), andhence could not have been performed nor endorsed by him.

This stand of some Muslim brethren should not however, bemindlessly waived aside. First, we must realise that it is theunconditional duty of every Muslim to keep to Allahscommandments as elucidated in the Quran and the Sunnah ofProphet Muhammad (S.A.W.). This requirement of a believer isclearly stated in the following verse of the Quran: It is not for abeliever, man or woman, when Allah and His Messengerhave decreed a matter that they should have any option intheir decision. And whoever disobeys Allah and His

Messenger, he has indeed strayed into a plain error (Quran33:36).

Therefore, when issues relating to medical ethics are brought up, agood Muslim must take steps to know the position of Islam on thematter. Contemporary medical issues that have been subject toethical considerations in recent times include euthanasia (alsoknown as mercy killing), abortion, organ transplantation,surrogacy, AIDS, cloning and the use of ritually unclean and haram(Islamically forbidden) materials or substances for medicine. Whatdoes Islam require or demand of us with regard to these issues?

Various learned scholars of Islam, some of them, with background in

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medical practice, have carefully viewed these ethical questions andproffered answers based on Islamic jurisprudence. This writerreviews these various issues for the benefit of fellow brethren infaith.

Euthanasia

This is also known variously as mercy killing, assisted suicide, theright to die or duty to die. It may be described as the process ofputting an end to a patients life (usually of a critically ill orterminally ill patient) by the physician or healthcare provider, withthe consent of the patient or patients relative/guardian, with thegoal of ending the patients suffering in illness. Viewed from anIslamic perspective, this practice is strictly forbidden. The sanctityof human life is firmly emphasised in Islam and taking anothers lifeor ones own life without just causeis a major sin against Allah. Inthe following verses of the Quran, we will appreciate the greatvalue placed by Islam on human life.

O you who believe! Eat not up your property among yourselvesunjustly except it be a trade amongst you by mutual consent.Anddo not kill yourselves (nor kill one another). Surely, Allah is MostMerciful to you.(Quran 4: 29).

Because of that We ordained for the Children of Israel that if

anyone killed a person not in retaliation of murder, or (and)to spread mischief in the land, it would be as if he killed allmankind and if anyone saved a life, it would be as if hesaved the life of all mankind.And indeed, there came to themOur Messengers with clear proofs, evidences and signs, even thenafter that, many of them continued to exceed the limits (e.g. bydoing oppression unjustly and exceeding beyond the limits set byAllah by committing the major sins) in the land.(Quran 5:32).

Say: Come, I will recite what your Lord has prohibited you from:Join not anything in worship with Him; be good and dutiful to your

parents; kill not your children because of poverty We providesustenance for them; come not near to Al-Fawahish (shameful sins,illegal sexual intercourse, etc.) whether committed openly orsecretly, and kill not anyone whom Allah has forbidden,except for just cause (according to Islamic law). This He hascommanded you that you may understand.(Quran 6: 151).

Allah has already decreed death for mankind, thus He says:Everyone shall taste death.And only on the Day of Resurrectionshall you be paid your wages in full. And whoever is removed away

from the Fire and admitted to Paradise, he indeed is successful. Thelife of this world is only the enjoyment of deception (a deceiving

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thing). (Quran 3:185). In the same vein, Allah reminds us:However, death will only come according to Allahs plan. Therefore,as far as Islam is concerned, no human being has the right or powerto predict that anyones time on earth is up; neither is anyoneempowered to end the life of someone at will under the pretext of

reducing pain or suffering in illness.

As Muslims, we should be patient in the course of any illness even ifit is life-threatening. In the face of such suffering and while seekingmedical attention, we should intensify our prayers to Allah and seekHis help in enabling us go through our trial with ease. Such is thenature of true faith in a believer. When we hold on to our faith insuch times of adversity, we earn the reward both for our suffering(leading to forgiveness of sins) and our patience (which reward is ofgreat magnitude which Allah alone knows). In the following versesof the Quran, the virtues of keeping our duty to Allah and beingpatient even in the face of trials are emphatically advocated:

O my son! (Prophet Luqman advising his son) Aqim-is-salat(perform As-salat), enjoin (on people) Al-Maruf (Islamic monotheismand all that is good), forbid (people) from Al-Munkar (i.e. disbelief inthe Oneness of Allah, polytheism of all kinds and all that is evil andbad), and bear with patience whatever befall you. Verily, theseare some of the important commandments ordered by Allah with noexception. (Quran 31:17).

Say: O my slaves who believe (in the Oneness of Allah Islamicmonotheism), be afraid of your Lord (Allah) and keep yourduty to Him. Good is (the reward) for those who do good inthis world, and Allahs earth is spacious (so if you cannot worshipAllah at a place, then go to another)! Only those who are patientshall receive their reward in full without reckoning.(Quran39:10).

Therefore, in Islam, there is a reward for pain and suffering. Thegoal of doctors who treat the patient in pain should be to reducesuch pain using all lawful means (Islamically lawful) available to

them. The physicians are ordered to help save lives, alleviate andreduce suffering in obedience to the Quran: and anyone whosaved a life, it would be as if he saved the life of allmankindHowever, it is not encouraged for Muslim physicians toartificially prolong misery in a vegetative state (that is, using the lifesupport to keep the patient artificially alive when he/she is as goodas dead without the support).

There is therefore, no place in Islam for euthanasia in the medicalmanagement of patients, irrespective of the name, title or tag such

practice is given - mercy killing, suicide, assisted suicide, the rightto die or duty to die. No one, not even the doctor is allowed to

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determine a patients lifespan. The sick Muslim should patientlyendure the pain and expect the rewards from Allah. One should notsay or do anything that could invalidate his/her faith. Praying andremembering that it is all a trial form Allah can greatly help inbearing the pain and suffering of illness. There will be blessing and

great reward in this world and in the Hereafter for those who beartheir pain with patience.

According to some learned ones in this field, in a situation where anumber of medical experts determine that a patient is in a terminalcondition and there is no hope for his/her recovery, then it may bepermissible for them to stop medication or switch off the life supportmachine, since this does not translate to euthanasia. As regardsthis, Allah knows best, as He only knows when the end is near.Organ Transplant

Organ transplantation is the medical process of obtaining an organform a human or animal donor (dead or alive) to treat an exitingillness or deformity in a patient. The goal is to transfer viable organsfrom those who are not in dire need of them to those who requirethem as a way of saving their lives or reducing their pain orsuffering. Examples include transplantation of the kidney, bonemarrow, liver, cornea (of the eye), pancreas and heart. Theincidence of organ transplantation is limited to the cost andavailability of organs.

Basically, violating the human body, whether living or dead isagainst the rulings of Islam. It would follow that incising the body ofa living donor or a cadaver and obtaining the organ to be donatedwould be impermissible, had it not been for the invocation oftwo judicial rules that readily solve the impasse:

1. Necessities overrule prohibition2. Choice of the lesser of the two evils if both cannot be

avoided.

Since saving life is a necessity that carries more weight than

preserving the integrity of the body of the donor or cadaver andsome injury of the body of the donor is less evil compared withleaving the patient to die, the procedure of organ donation andtransplantation is sanctioned (approved) in Islam. However, certainconditions must be met before this. One, the procedure should notpose danger on the donor as far as can be medically ascertained.Secondly, rules offree consent devoid of all kinds of pressureshould be observed as the donor (or next of kin of the deceaseddonor) should indicate willingness to allow the procedure (withoutpressure from any quarter).

Certain ethical questions should also be considered:

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1. What are the rights of the living donor?2. What are the rights of the dead body?3. What are the rights of the recipient?4. To prolong a life, does the recipient have a right to take

away organs from the dead?

5. Is the sale of organs justified?6. Is taking of animal organs justified?7. Is accepting organs from an aborted foetus justified?8. Is cost of transplantation worth the benefit derived from it?

(Cost of heart transplantation alone: about $70,000, notincluding long term expenses).

Surrogacy and assisted reproduction

Surrogacy is a form of assisted reproduction. It is the practice ofassigning another woman to carry a pregnancy on behalf of thebiological mother (owner of the ovum) because the latter is unableto do so due to some abnormalities in her system. In the case of themale, a surrogate may donate sperm where the husband isdeficient. Technology has got to the level in which an egg (ovum)can be fertilized outside the uterus to produce test-tube babies.Sperm may also be injected into the uterus from the husband or asurrogate donor. In other cases, the ovum of a woman is fertilized

with the sperm of her husband and injected into the uterus ofanother woman for incubation.

Surrogacy is forbidden in Islam. This is because the marriagecontract accommodates only two persons in wedlock: the husbandand wife. Therefore, assisted reproduction which involves bringing ina stranger into the wedlock violates the marriage contract. Assistedreproduction is allowed in Islam only when it involves thecooperation of the husband and wife alone in their wedlock.

The practice of surrogacy will lead to a conflict of lineage. The

Quran states that ones kinship comes through either bloodrelationship or marriage: And it is He who created man from water,and has appointed for him kindred by blood and kindred bymarriage (Quran 25:54). Allah also says; None can be theirmothers except those who gave them birth (Quran 52:2).Who will then be the true mother of the child the one whoproduced the ovum or the one who does not even own the ovum butyet carries the child in her womb and thereafter delivers it? Hence,surrogate motherhood is not acceptable on the grounds of:

1. Who is the mother (or father, in the case of male spermdonor)?

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2. The question of lineage.3. Violation of the marriage contract.

It is important to note here that a woman may not save the spermof her dead husband to have his baby after his death. All methods of

assisted reproduction are allowed between husband and wife onlyduring the intact span of their marriage. Allah knows best.

Abortion of pregnancy originating from rape

Abortion is the act of killing an unborn baby because it is unwantedby the mother or in some cases, with the intention of saving the lifeof a mother at risk were the pregnancy be allowed to continue. Intreating this issue, we should go back to the Quranic ayah: killnot your children because of poverty (Quran 6:151); And killnot your children for fear of poverty. We shall provide for them aswell as for you. Surely, the killing of them is a great sin (Quran17:31).

Allah says of believing women:

O Prophet! When believing women come to you to give you Baiah(pledge), that they will not associate anything in worship with Allah,that they will not steal, that they will not commit illegal sexualintercourse, thatthey will not kill their children, that they willnot utter slander, intentionally forging falsehood (i.e. by making

illegal children belonging to their husbands), and that they will notdisobey you in Marf Islamic monotheism and all that which Islamordains), then accept their Baiah (pledge), and ask Allah to forgivethem. Verily, Allah is Oft-Forgiving, Most-Merciful (Quran 60:12).

As far as Islam is concerned, abortion of a viable foetus is infanticide(killing of children) except when the aim is to save the life of themother. Even in this situation, every attempt should be made tosave both lives.

The foetus is alive as a cell from the very beginning with sleeping

starting at 4 weeks and movements at 4 months. According toHadith, at 120 days (about 4 months), the angel visits the foetusand blows the spirit into it; which coincides with the babys firstmovements. Medically, the viability of the foetus has improved withthe development of neonatology. For example, an infant as small as4oz at 3mths (after birth) can survive.

Islam considers that the baby should be the responsibility of societyif the mother cannot support it. Coverage, care and sympathy areamong the mothers rights. Abortion is therefore forbidden even in

the case of rape. What is the use of committing one crime (abortion)because of another (rape)? A Muslim physician should refuse to

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perform abortion if approached by a patient to do so. He/she mustalways stand by the principles of Islamic faith while practicingmedicine.

Treatment of AIDS patients and others

Acquired immune deficiency syndrome (AIDS) is a medical disorderwhich has defied medical cure so far. It is acquired by infection withHuman Immunodeficiency Virus (HIV). It is only subject tomanagement with a variety of antiviral drugs. It may take severalyears after contacting HIV before one develops AIDS, which is thestate in which the disease becomes manifest. People with HIV/AIDSare prone to discrimination because it is basically a sexuallytransmitted disease acquired through irresponsible sexualbehaviour, although contaminated blood from shared medicalinstruments and equipment (mainly sharps) may contribute.

Islam requires prevention of the disease and its occurrence; andtreating it like other diseases after its occurrence. As a rule, Muslimphysicians, pharmacists, nurses and other health workers have noright to discriminate between patients, no matter the cause of theirafflictions, even if personally inflicted. Therefore smokers,alcoholics, over-eaters or AIDS patients should all be given therequired treatment when they report at the hospital. While medicalethics requires that patients should not be castigated on account oftheir lifestyle, the physician and other health professionals are in aunique position to advise patients to change their lifestyle for the

good of their health; however while treating patients withtransmissible diseases, health workers should take necessaryprecautions to protect themselves from any harm.

Treating members of the opposite sex

It is lawful for a medical member of one sex to look at the awra(private parts as defined in Islam) of a member of the opposite sexfor purposes of medical examination, treatment and education.Exposition should however be limited to what the need callsfor. It is highly commendable for female Muslims to go into various

specialties in the medicine. Female patients usually prefer to beattended to by female medical workers and vice versa (males formales).

Use of cadavers in medical studies

The use of cadavers in aspects of medical training like Anatomy isapproved by virtue of necessity (Dhaoorah). However, there are alsoplastic modules and computer programmes that can also be used.

Foetal sex selection

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The scholars are of the opinion that foetal sex selection is unlawfulwhen it is practiced at a national level; however, if it is done onindividual basis, the scholars allow it.

Milk banks

Islam prohibits marriage of persons with milk relationship, that istwo people who were breastfed by the same woman are not allowedto get married even though they may not be legal blood relations.However, some scholars, for example Zhahiriyyah school permitmilk banks because they differentiate between actual sucking ofbreast milk from the milk mother and milk donated from milk bankswhich does not involve direct sucking. Allah knows best.

Blood transfusion and Insulin from pork

In Islam, blood is considered impure. However, in the case ofnecessity to save lives, blood transfusion is considered lawful bymajority of the scholars. The use of insulin derived from pork(another haram material) is permitted for diabetic patients whoneed it, also on the grounds of necessity.

Cloning

The term cloning essentially means a copy or duplicate. Biologically,

it refers to the process of producing genetically identical individualsamong living organisms (such as plants, insects and animals) byasexual means. In biotechnology, cloning refers to the processesused to create copies of DNA fragments (as in molecular cloning),cells (as in cell cloning) and organisms (organism cloning). Clonescan occur naturally and unnaturally. Natural clones occur throughthe asexual reproduction of some species, especially plants; or inidentical twins which develop from a single fertilized egg.

The subject of ethical and theological debate however is deliberatecloning by unnatural means. This can be done by the process of

nuclear transfer which involves extracting the genetic material froma donor cell (that is the cell of the organism to be cloned) andputting it into an egg with its own genetic material removed. Thegenetic material is the nucleus of a cell containing the fused maleand female sex characteristics. The resulting embryo is then allowedto develop by transferring to a surrogate mother until it comes toterm. The end result is an exact but time-delayed replica of thecloned (donor) organism. Cloning has already been done in manyplants and animals including mammals. The one that attractedworldwide attention was the cloning of a sheep named Dolly in

1996. However, many individuals, religious bodies and countrieshave expressed apprehension over the possibility of cloning human

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beings, while some others do not see any harm in such occurrence.There is as yet no documented case of human clones being allowedto survive beyond a few days in the embryo stage.

Two types of human cloning have been defined: therapeutic cloning

and reproductive cloning. Therapeutic cloning basically involvescloning organs or tissues to prevent and treat diseases whilereproductive cloning is the process of cloning for reproductivepurposes (producing new life). The point raised by some cloningantagonists is that the scientists involved are playing God by takingover His work as the Creator of life. Muslim scholars from variousschools of thought have been cautious in passing judgments oncloning, first because it is still an emerging concept and second toavoid closing doors to aspects that may be considered beneficial.Many of the scholars prohibit cloning in any form whether applied toanimals or humans. Others permit cloning of plants and animalsalone to improve food production. Some other scholars commentthat cloning, including human cloning may have some usefulpurposes as in treating diseases; hence they permit therapeuticcloning alone provided that certain guidelines are followed (cloningonly useful organs, not whole beings). Most scholars prohibitreproductive cloning because of the ethical, social and moralquestions it raises.

In the Quran Allah describes the process of human creation thus:

And indeed We created man out of an extract of clay. ThereafterWe made him as a Nutfah (mixed drops of male and female sexualdischarge) in a safe lodging (womb). Then We made the Nutfah intoa clot (a piece of thick congealed blood), then We made the clot intoa little lump of flesh, then We made out of flesh bones, then Weclothed the bones with flesh and then We brought it forth asanother creation. So blessed is Allah, the best of creators (Quran23:12-14).

Muslim scholars are almost unanimous in agreement that cloningdoes not in any way give man the prerogative of the Creator (Allah).

They concur that cloning is a cause and only Allah by His will is ableto produce the effect of a new creation. Just as sowing a seed in aground is a cause but Allah produces the effect of growth by His will. The Islamic argument against cloning, particularly reproductivehuman cloning is that it goes against the plan of Allah. The act ofcloning is a form of interference with the work of Allah. Allahintended mankind to procreate by normal sexual reproductiveprocess involving a husband and wife; hence He laid down variousrules on marriage, intercourse and rearing of children in the society.Hence, if mankind decides by his own will to interfere with Allahs

laws of procreation it could only lead to harming of the human race.The moral issues raised include the production of innocent bastards

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and incestuous offspring. For instance if the host is a surrogatemother, the child will be born as a bastard (out of wedlock) and ifthe original mother is used and decides to clone her son, brother orfather, an incestuous child is born! Hence, the issue of relationshipsis affected. Cloning also contradicts Allahs plan of creation in pairs.

In addition, Allah created the universe on the basis of diversity whilecloning is based on duplicity. Such duplicity would lead to confusionand other social problems if human cloning is permitted.

Therefore, by way of conclusion the best is to avoid cloning where ithas no valid use and Allah knows best.

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