Religious Beliefs and Bioethics: An Islamic Perspective

Transcription

1 Religious Beliefs and Bioethics: An Islamic Perspective Naser Z. Alsharif, PharmD, M.S., PhD Professor of Pharmacy Sciences Pharmacy Ethics Special Interest Group Session July 16, 2012

2 OBJECTIVES Discuss the status of Islamic Bioethics Summarize guiding principles in Sunni and Shia Bioethics Discuss implications for the Muslim patient, health care educators, Health care professionals, health care organizations and other stakeholders

3 INTRODUCTION ISLAM Muslim Beliefs/Actions Judeo-Christian-Muslim Traditions Demographics

4 MUSLIM POPULATION IN THE WORLD BILLION Accessed 6/8/2012

5 MUSLIM POPULATION IN AMERICA : 4-7 MILLION African American - 30% South Asian - 33 % Arab - 25% Africans, Iranians, Turks and others - 12% Muslims in California: over 1 million 2/3 in S. California; 1/3 in N. California

6 Islam is not monolithic CAVEAT Not all Muslims are practicing Muslims Islam shares its moral, spiritual, and cultural genome with Judaism and Christianity At the core of doing God s work on earth is to address own biases and prejudices Commonality among humans in warding harm, doing good, establishing justice, harmony with the earth

7 DISCUSS THE STATUS OF ISLAMIC BIOETHICS

8 ISLAMIC LAW/JURISPRUDENCE Sharia & Islamic Law (Figh, deep understanding) Divine guidance Drawn from the Qur an and Sunnah (primary sources) Two main areas: Guidance in worship p( (main focus), Ibadat Guidance in worldly matters (Mu amalat) Five goals: Necessity overrides prohibition Accept the lesser of the two harms if both cannot be avoided Public interest overrides the individual interest Harm has to be removed at every cost if possible Respect for autonomy, beneficence, nonmaleficence and distributive justice

9 ISLAMIC BIOETHICS Islamic Medical Ethics: refers to Islamic guidance on ethical or moral issues relating to medical and scientific fields, in particular, those dealing with human life. Al-Akhlaq Al-tibbiyah (9 th Century, Ishaq Ibn Ali AlRuhawi, wrote Adab Al-Tabib). Human life is a gift from God Protection of life Respect for the dignity of humans "if anyone slays a human being, unless it be [in punishment] for murder or spreading corruption on earth, it shall be as though he had slain all mankind; whereas, if anyone saves a life, it shall be as though he had saved the lives of all mankind."(qur an 5:32)

10 ISLAMIC BIOETHICS Two basic principles: Saving a life is obligatory while unjustified taking of a life is classified as murder Emphasis on seeking a cure Fitra: Humans can distinguish between what is morally acceptable and what is unacceptable Aql (reason) (use own conscience in deciding on a course of action based on a jurist advice) Free will: Ability of humans to discern God s will and to abide by it (have a moral responsibility to do God s work on earth)

11 ISLAMIC BIOETHICS Health and healing practices: Islam considers access to health care a fundamental right of the individual. Maintain health and prevent illness (stewardship of own health) In the case of illness, Muslims are obliged to seek medical treatment in an Islamic manner which is appropriate and permissible. ibl Muslims are asked to be moderate and balanced in all matters, including health Illness is seen as a trial/test from God or even as a cleansing ordeal/purification from sins Physician duty to strive to heal acknowledging God as the ultimate healer

12 ISLAMIC BIOETHICS Health and healing practices: Patient must be treated with respect and compassion Both the physical and spiritual dimensions of the illness experience must be taken into account Saving of life is a duty Maintaining lineage is a must Unwarranted taking of life is a grave sin Every sickness has a cure from God Visiting sick is highly encouraged Belief in the Hereafter Death is a test of faith for family and friends

13 ISLAMIC BIOETHICS Oath of the Muslim Doctor includes: to protect human life in all stages and under all circumstances, doing [one's] utmost to rescue it from death, malady, pain and anxiety. To be, all the way, an instrument of Allah s mercy, extending... medical care to near and far, virtuous and sinner and friend and enemy.

14 Jurists ISLAMIC JURISPRUDENCE Alim (ulama) A muslim Scholar Fagih: Deals with theoretical Islamic law (figh) Qdai (Judge): Practicing or implementing the law Mufti: gives legal responses (fatwa) to people s questions Qualifications: interpret the sources of the law, know the Qur an and the hadith and how to interpret these two sources, thorough knowledge of Arabic language and its grammar, logic, history, history of the law and the schools of law and their difference and legal precedents, other disciplines as needed.

15 ISLAMIC JURISPRUDENCE Jurists Process Understand the issue, consult with area specialists, gather primary evidence and opinions (Quran, Sunnah, Figh literature, academic dissertations, Figh Councils Recommendations). If nothing found, returns to basic concepts of justice, benevolence, equity, basic legal maxims, values of Sharia If nothing, repeat the process (Ijtihad) If not certainty, I do not Know.

16 ISLAMIC JURISPRUDENCE What is the moral responsibility for the jurist? Not to oppose the law of the land, decide scale of obligation in a non-muslim land Weigh public interest (Al-Maslaha Al-Amah, Mustahab) Not to do sin Aggressive translation of the text, prophet example Appreciate methodologies from every field Understand d prerequisite it for the case at hand Necessity: go extra mile to do research to find a solution (Ijtihad)

17 ISLAMIC JURISPRUDENCE Source of authority: Absolute authority is to God Local ulema (Scholars), muftis National Committees of Medical Ethics/Bioethics Islamic Organization for Medical Sciences ( Islamic Medical Association of North America (IMANA) Figh Councils Islamic Figh Academy

18 SUMMARIZE GUIDING PRINCIPLES IN SUNNI AND SHIA JURISPRUDENCE BIOETHICS

19 ISLAMIC BIOETHICS Islamic Legal Decision (Hukm, ruling) Jurist s response to a question from an individual or a group is called fatwa (legal l opinion) i Conduct Ijtihad (careful process of individual reasoning) to address issues not in the primary sources Issue fatwas: Obligatory (wajib/fard) e.g. pillars of Islam Encouraged (Recommended) (mustahabb): e.g. umrah, peace greeting, giving charity Permitted, neutral (mubah) e.g. driving a car Discouraged (makruh) e.g. wasting resources Forbidden (haram) e.g. murder

20 ISLAMIC JURISPRUDENCE Ijtihad in Sunni Islam: (U sul Al-figh) Qiyas (analogy): use logic and reasoning to apply a known law to a new situation not covered in the original law (e.g. Islam forbid drinking wine, by analogy whiskey, beer, opium because it intoxicates). Ijma (consensus): jurist who are known to each other agree on the judgment Maslaha (public welfare): Istihsan: if no answer from making an analogy from a known case, decide in favor of public interest in a matter that is not otherwise prohibited Urf (Customary practice): preserve what is familiar to people in a certain place based on established tradition.

21 SUNNI JURISPRUDNECE No clergy/priesthood No central authority that hands out final judgments Source of authority is the recognized knowledge of the jurist

22 ISLAMIC JURISPRUDENCE (U sul Al-figh) Ijtihad in Shia s Islam aql (reason) It is an independent source of Islamic law urf (custom) Community practice (custom) is a supplementary tool in the process of inferring the Islamic law In general, its bioethical rulings do not differ fundamentally from the Sunni positions

23 ISLAMIC JURISPRUDENCE (U sul Al-figh) Principles and methods of Ijtihad: Istihab, meaning continuity: It means that a situation or thing known to exist, continues to exist until its opposite is proven. Ibahah: Anything is permitted if it is not expressly prohibited Bayina: The plaintiff or accuser bears the burden of proof.

24 ISLAMIC JURISPRUDENCE Major Schools of Sunni Thought (Mathaheb) Following the death of the prophet and his original companions, there was a need to develop systemic methods and processes to reach judgment and disseminate knowledge to others: Hanafi (Abu Hanifa), C.E.) Maliki (Malik ibn Ana) C.E. Shafi ( Mihammad Idris al-shafi) C.E. Hanbali (Ahmed ibn Hanbal) C.E.

25 ISLAMIC JURISPRUDENCE Major schools of Shia thoughts Zaydi ibn Ali (5 th Imam) (Zaydis) Ismail ibn Jafar (Ismaeli) Twelvers (Ali, Al-Mahdi) 13 th century: Eiz Al-Deen Abed Al-Salam ( The Sultan of Ulama) Islamic Government (Wilayat Al-Fagih)

26 ISLAMIC JURISPRUDENCE What is Islamic in secular science? A beneficial knowledge: Oh God! we ask you a beneficial knowledge. Mission in Islam as humans is to transform myself and the world Reform the world to the better Change: God will not change something unless we change ourselves Make an effort: resist what is bad/reform myself Educate yourself, God is the main educator (Al-Raab) Adaptational reform, knowledge of the context Figh is important but should be not protected Scholars of text and scholars of discipline need to come together

27 DISCUSS IMPLICATIONS FOR THE MUSLIM PATIENT, HEALTH CARE PROFESSIONALS, HEALTH CARE ORGANIZATIONS AND OTHER STAKEHOLDERS

28 STAKEHOLDERS-Patients Need for Islamic literacy/awareness Need for literacy in Islamic Jurisprudence Culture vs. religion Need for literacy of the American healthcare system and insurance Will, directive, case manager

29 STAKEHOLDERS-Educators Need basic understanding of Islam Need basic understanding in Islamic Jurisprudence and Islamic Biothics Need basic culture competency knowledge as it pertains to the Muslim patient

30 STAKEHOLDERS-HCP Need for culture competency Spiritual history Diversity among Muslims Halal menu Direction of Mecca, water for ablutions, quiet area for prayer Privacy, respect modesty Interpreter Cleanliness other

31 STAKEHOLDERS-HCP Build a trusting relationship with patients/family Context should be the patient/family rather than the numbers, x-rays, NMR Muslim HCP: Risks: insufficient knowledge Own agenda Benefits: Emotional attachment t Belief in the principles Ability to provide context Seek information about Islamic bioethics

32 STAKEHOLDERS-Health Organizations Hospital ethics committee Role: quality, transparency, accountability Process: team members, communication Infrastructure Availability of a Muslim chaplain Availability of Muslim jurist consultants t Interpreter New York Hospital: Rises like a prayer for healing

33 STAKEHOLDERS-Health Organizations Role of the Muslim chaplain Not to clone Christian or overseas chaplains Standards to train Presence for support Islamic principles when it comes to compassionate care Patient advocate Honoring patient preference/autonomy

34 ISLAMIC PERSPECTIVE ON A NUMBER OF CONTEMPORARY MEDICAL ISSUES Disclaimer: The following is a summary of common Islamic perspectives on current bioethical issues. They are not meant to be fatwas or advocating for rulings on specific issues.

35 MEDICAL ISSUES ISSUE Artificial Support For a prolonged time Assisted Suicide id and euthanasia Death ISLAMIC PERSPECTIVE Not encouraged Patient in a vegetative state is considered a living person and have all the rights of a living person Not permitted When soul left the body Exact moment cannot be known with certainty Diagnosed by physical signs

36 MEDICAL ISSUES ISSUE Brain Death Autopsies Cremation Living will, advance directive, case manager ISLAMIC PERSPECTIVE Most Muslim countries accept a brain death criteria: Function of the brain including the brain stem has come to permanent stop. Permitted under certain circumstances Strictly yprohibited Recommended

37 MEDICAL ISSUES ISSUE ISLAMIC PERSPECTIVE Organ Allowed after consultation with Transplant patient or guardians. Need and benefit defined, consent from donor, no financial incentive to donor or relatives, no harm, no sale of organs, cadaver donation is permitted. Organ O Permissible ibl if there is a will or if Donation the family permits it.

38 MEDICAL ISSUES ISSUE Abortion Rape Severe/lethal congenital anomalies and malformations ISLAMIC PERSPECTIVE Not allowed except to save the mother if her life in danger Full human life begins only after ensoulment of the fetus (120 days/40 days) Some jurist allowed abortion before ensoulment Some jurist accept before ensoulment In non-lethal l (e.g. Down Syndrome), it may be permissible before 120 days after consulting with scholars/medical experts

39 ISSUE In vitro fertilization MEDICAL ISSUES ISLAMIC PERSPECTIVE Acceptable by freezing the mother s ova : Sperm is from the husband Still married at the time fertilization Father still alive Additional embryos can be discarded or given for genetic research. Infertility drugs Permissible Surrogacy Not accepted Contraception Sex organs Permitted if not harmful, are reversible and do not cause abortion. No donation of sperm, ova or embryo.

40 MEDICAL ISSUES ISSUE ISLAMIC PERSPECTIVE Blood transfusion Allowed after proper screening Homosexuality Opposes but does not prohibit Muslim physicians from caring for AIDS patients. Gene therapy/ Accepted but not cloning. Genetic Stem cells from miscarriages or engineering to cure surplus ova after IVP is disease permissible.

41 TIPS Identify one s own preconceptions, and misconceptions and to try to dispel them. Seek a better understanding and knowledge of Islam, Muslim-Americans, Islamic jurisprudence and Islamic biomedical ethics. Recognize individuality of each patient. Talking to the patient and asking about their culture and spirituality is critical for better understanding is important Courtesy and personal value are highly respected values in Muslim culture, so "small talk" with the patient t prior to the initiation of personal questions or ones that may be perceives as personally intrusive is recommended

42 TIPS Allow patients to read the Qur an and help them if needs be to perform the prayers Inform patients of their rights and encourage a living will Allow their religious leader to visit and to follow Islamic guidelines in case of death. Provide same sex health care person if possible Provide practical health tips based on food restrictions in general, during Ramadan and when prescribing medications

43 SUMMARY Islam is not monolithic There is diversity of views in bioethical matters due to the various schools of thoughts/ jurisprudence; different sects within Islam; differences in cultural backgrounds; and difference in religious observance. Educators and healthcare professionals need to gain a basic understanding of Islam, Islamic jurisprudence and perspectives on medical issues. Culture u competency e cy is a must

44 RESOURCES Karen Armstrong. Islam: A short History. Random House Inc Kamali, Mohammad Hashim. Principles of Islamic Jurisprudence. Cambridge, UK: The Islamic Texts Society, revised ed., Abou El Fadl, Khaled. Speaking in God's Name: Islamic Law, Authority and Women. Oxford, England: One world, Abou El Fadl, Khaled. Rebellion and Violence in Islamic Law. Cambridge, UK: Cambridge University Press, Khadduri, Majid, trans. The Islamic Law of Nations: Shaybânî's Siyar. Baltimore, MD: Johns Hopkins University Press, 2002.

45 RESOURCES Ramadan, Tariq. Radical Reform: Islamic Ethics and Liberation. Oxford University Press Sachedina, Abdulaziz. Islamic Biomedical Ethics: Principles and Applications. Oxford University Press Ramadan, Tariq. Islam, the West and the Challenges of Modernity. The Islamic Foundation Alsharif, Naser Z et al. Health and Healing Practices for the Alsharif, Naser Z et al. Health and Healing Practices for the Muslim Community in Omaha, Nebraska. J Religion & Society, 2011.