Islam means the submission or surrender of one’s will to the only one and true Allah (God) worthy of worship, and anyone who does so is termed a “Muslim.”1 The two main sources for Islamic law, Shari’ a, are the Qur’ an and Sunnah. Shari’ a is a complete detailed code of conduct, based on the rules and regulations that were revealed to the Prophet Muhammad. The Qur’ an is the sacred book of Islam and the highest and most authentic authority in Islam. It is the word of Allah revealed to the Prophet Muhammad, via the angel Gabriel, written in Arabic, and is the essential guide for all aspects of a Muslim’s life. The Sunnah is a collection of deeds, words, and traditions of the Prophet Muhammad and his followers, checked for their authenticity and passed down over time.2,3
Jurists and scholars in Islam agree that the aim of Islamic Shari’ a is to safeguard the five sublime objectives of life, namely: faith, body, offspring, property, and mind. The scholars of Islam express these five objectives in terms of the five essentials, by which they mean what is fundamental and without which life may not be possible. When any of these fundamentals is undermined, life will be compromised and may become chaotic and humanity will suffer. The loss incurred will be either short-term in this life or long-term in the hereafter.4
For Muslims, Islam is not only a religion but a complete way of life with values that advocate peace, mercy, and forgiveness. For Islam, a Muslim can be defined as a person who accepts the Islamic way of life and complies with the will of Allah without question. All Muslims have to fulfill five essential religious duties that include declaring that there is no other God but Allah, and that the Prophet Mohammed is his messenger; praying five times a day: at dawn, midday, late afternoon, after sunset, and late evening; fasting during the month of Ramadan, (with some flexibility or exemptions for sick and elderly people, pregnant women if they cannot tolerate it, and young children); giving money to charity (Zakat) amounting to 2.5% of an individual’s annual income and savings; and going on a pilgrimage to Mecca (Hajj), at least once in a lifetime if one can afford it.5 Based on the Qur’an, Hadith (sayings), and Qiyass (analogy), Islamic jurists classify human actions into one of five categories on a spectrum: obligatory (Wajib), recommended (Mustahab), permitted (Masmoush), disapproved but not forbidden (Mak-rouh), and absolutely forbidden (Haram).6
Although the Qur’an is not a book about medicine or health sciences, it contains information that leads to guidelines in health and diseases. The traditions of the Prophet Muhammad in matters of health and personal hygiene are also a guide for his followers; a vital component of human life is being healthy, which enables us to undergo our daily life while carrying out our responsibility and duties in the community. According to the Qur’an:7
God has bestowed on humans his blessings, both hidden and apparent. Of these blessings the greatest is that of health, which the prophet regarded as one of the two graces, the importance of which was not appreciated by many people. Divine law in matters of blessings does not change: because God will never change the grace which he hath bestowed on a people until they change what is in their own souls. (8:53)
This verse stresses that God has enjoined humankind to worship and thank him in accordance with the precepts enshrined in his Shari’a. This message targets the individual and the community of Muslims to promote their spiritual and material aspects and to achieve their well-being in this world and the hereafter.
Some common and essential Islamic terms need to be clarified for health care providers who do not know Arabic and who do not have an Islamic background.8
Hadith: Saying(s) or action(s) ascribed to the Prophet Mohammad or act(s) approved by the Prophet.
Fatwa: Formal religious rulings that are produced by Muslim Scholars.
Fiqh: Islamic jurisprudence, that is, knowledge of practical Islamic rulings deduced from detailed statements and religious texts. Literally, it is the understanding and acquisition of knowledge.
Schools of Fiqh: The schools of Islamic thought or jurisprudence. The four most important were founded by Malik, Abu Hanifa, Al-Shafie, and Ibn Hanbal.
Haram: Prohibited, banned, illegal, and impermissible, from a religious standpoint, generally applied to actions or things considered sinful to Muslims.
Islam considers health as one of the greatest blessings that has been given to human beings by God after faith itself. The prophet says: “There are two blessings which many people do not appreciate: health and leisure.”9 He also says: “No blessing other than faith is better than well-being.”10
One of the most important texts from which the Fiqh of health may be deduced is the verse in the Qur’an: “And he enforced the balance. That you exceed not the bounds: but observe the balance strictly: and fall not short thereof. ” (55:7–9)
This comprehensive verse emphasizes the balance that God established in the universe, with its different forces and influences, including humankind; it draws our attention to God’s balance that applies to everything, making it clear that any disturbance of the balance, whether by increase or decrease, may lead to terrible consequences. God says: “Mankind! Your transgression will rebound on your own selves.”(10:23)
Ali Ibn Abbas (died approx. 994 CE), a Persian physician and psyhologist, in his book, Kamil As-Sina’ah, concludes that health means that the body is in a state of equilibrium. The state of equilibrium was further explained by Ibn Sina (known in the west as Avicenna) in 1093 CE as dynamic: The state of equilibrium that a human being enjoys has a certain range with an upper and a lower limit, meaning that it is like a balance that moves between two extreme limits.11
In order to maintain the state of equilibrium, protect it against imbalance, and restore it to its proper position, a human being must have a “health potential.” This is referred to in the Hadith by the Prophet as saying: “And store up enough health to draw on during your illness.”12 “Health potential” in Islam takes different forms: proper nutrition, good immunity, physical fitness, as well as mental and personal security and stability, which enable a person to deal and cope well with the stressors; therefore the concept of health in Islam is not restricted to curative aspects, but implies aspects of restoration, preservation, and maintenance of health.13
The importance of the concept of health restoration is evident in a number of Hadiths that have come down to us from the Prophet Muhammad, prescribing certain medicines for certain diseases. The Prophet emphasized the importance of seeking medical care. In an authentic (trusted) Hadith he says: “God has not created a disease without creating a cure for it”14 raising the hopes of patients and making it clear that all diseases may be cured.15
The Prophet also placed the whole issue of the treatment of diseases in its proper context, as he made it clear that supplication (a humble prayerful request), medication, and methods of prevention are also parts of God’s will. It is evident that Islam leaves no room for fatalism, even though it may be mistaken for reliance on God. The Prophet also opposed so-called “faith healing” but approved medical practice that relies on study and experimentation, seeking to relate causes to effects.16
The preservation of health as a blessing can only be achieved through taking good care of one’s health and taking every measure to maintain and enhance it. Based on this principle, Muslims are required to comply with physician recommendations regarding the preservation of good health. Both the Qur’an and Sunnah include teachings that clarify important health issues for Muslims, ranging from health maintenance to caring for each organ of the body.
The body, offspring, and mind cannot be completely safeguarded without maintaining good health, viewed as a top priority by the Prophet, and to maintain good health requires the provision of developmental needs such as good food, drink, clothing, shelter, marriage, transport, security, education, and income. He instructs Muslims to pray to God for forgiveness and sound well-being, “No blessing other than faith is better than well-being.”17 The Prophet says: “Wealth is appropriate to a God-fearing person, but good health is better for the God-fearing than wealth.”18 He further says: “He of you who finds himself enjoying good health, is secure in his community and has daily sustenance, as if he had the whole world at his fingertips.”19
Therefore, it is no wonder that the Qur’an and the traditions of the Prophet include many statements to protect and promote health to preserve the properly balanced position in which persons are created. If we study these statements carefully and apply them properly, as we are required to do, we will find at our disposal a large volume on the Fiqh of health. This is based on the fact that the Shari’a is embodied in clear statements, whereas the Fiqh is the result of careful study of such statements and implementing them.
Good health is something for which we are accountable to God. The Prophet says: “The first thing every servant of God will have to account for on the Day of Judgment is that he will be asked by God: Have I not given you a healthy constitution and have I not quenched your thirst with cold water?”20 The Prophet also says: “No one will be allowed to move from his position on the Day of Judgment until he has been asked how he spent his life: how he used his knowledge: how he learnt and spent his money: and in what pursuits he used his health.”21 It is part of the duty of all Muslims, therefore, to safeguard this blessing and not to allow any chance to overcome it through ill usage, otherwise they will be severely punished according to God’s immutable laws. The Qur’an states: “Anyone who tampers with God’s grace after it has been bestowed on him will find God to be stern in punishment” (2:211) and “God would not alter any grace he has bestowed on a folk unless they alter what they themselves have.”(8:53)
It is well known that Islam attempts to solve problems within their proper context and not in isolation. This Islamic approach to social problems integrates health within the concept of social development. For example, the health of the community cannot be improved unless there is a marked improvement in income, education, nutrition, housing, clothing, as well as the improvement in the supply and distribution of clean water, sanitation, proper disposal of rubbish, and other important human needs. This Islamic approach to health care is based on the essential features of Islamic society, discussed later.
Islam considers the individual within the context of human rights and human security. The Islamic Shari’a aims at obtaining benefits for individuals and societies while protecting them from harm. For this reason the rules of Shari’a explain the rights of human beings, whether as a fetus, child, young or old person, and male or female. Islam emphasizes that the existence of any right implies the existence of a duty; hence it is the duty of individuals, societies, and states to protect these rights from harm caused by others. A verse in the Qur’an says: “who quickens a human being, it shall be as if he has quickened all mankind.” (5:32) This “quickening” in Islam is not only physical; it is also mental and social. All members of a Muslim society (including non-Muslims) are considered brothers in Islam and in humanity, and this brotherhood implies many duties. A brother, to use the words of the Prophet, “cares for his brother and protects him” and “he does not fail or forsake him.”22 In Islam, the individual is entitled to respect as a human being, irrespective of race or religion.
In its essence, and by virtue of its rules and regulations, Islam provides the individual, especially children and elderly people, with a protective environment. A highly authentic Hadith by the Prophet indicates that: “Your body has a (human) right.”23 This means that human rights were recognized by Islam 14 centuries before the international Universal Declaration of Human Rights. On the care and protection of children, the Prophet says: “Allah will (on the Day of Reckoning) question each person in a position of responsibility about what he or she was responsible for in this life.”24 Likewise, Islam values the care of aged people. According to the second Caliph, Omar Ibn Al-Khattab (589–644 CE) “it is unfair to exploit the youth of a human being and then to forsake him when he becomes old.”25
Although Islam clearly distinguishes between the individual as a separate entity and as a member of the community, these two realities are nevertheless deeply interrelated. This explains why community actions have a spiritual value for the individual, and vice versa. Two traditions of the Prophet seem to be quite relevant in this respect:(a) “The faithful in their mutual love and compassion are like the body; if one member complains of an ailment all other members will rally in response,”26 and (b) “The faithful to one another are like the blocks in a whole building; they fortify one another.”27 God describes the Faithful in the Qur’an saying: “They give priority over themselves even though they are needy.” (9:59)
The preservation of any individual’s life should embrace the utmost regard to his and her dignity, feelings, tenderness, and the privacy of sentiments and body parts. Patients are therefore entitled to full attention, care, and a feeling of security while with their physician. The physician’s privilege of being exempt from some general rules is only coupled with more responsibility and duty, which they should carry out in conscientiousness and excellence in obeying God, and worship God as if they see him.
God warns against corruption of the earth and pollution of the environment in several places in the Qur’an. This is also evident in God’s directives, such as: “Eat and drink of the sustenance God has provided and do not corrupt the earth with evil” (2:60) and “Do not corrupt the earth.” (7:85) Other Islamic directives on keeping the environment healthy concern water sources and roads. There is a complementary order to keep the environment clean and pollution free, as reflected in the Prophet’s Hadith: “the removal of harmful objects from the road counts as an act of benefaction.”28
Islam urges people to learn, making learning an obligation for all Muslims (men and women) while emphasizing truth and knowledge. The Prophet says: “Seeking knowledge is obligatory for every Muslim, male or female.”29 He also says: “Whosoever has three daughters or three sisters, whom he teaches and brings up until Allah provides them with the means of independence, will definitely be rewarded with an admission to heaven.”30
Truth is defined as what benefits humankind in this present life and in the life to come. God says: “what has been sent down to you by your Lord is the truth” (13:1) and “those who are endowed with knowledge believe that has been revealed to you by your Lord is the truth.” (34:6) Knowledge is part of the knowledge of God “who taught man what man never knew” (96:5), which reveals God’s signs in his creation: “And in yourselves do you not see?” (51:21)
The Qur’an also states that: “It is only those who have knowledge among his slaves who fear Allah. Verily, Allah is all-mighty, oft-forgiving,” (35:28) and “my Lord, increase me in knowledge.” (20:114) We also find rich evidence of the same idea in the tradition of the Prophet. He says: “When the son of Adam dies, his work ceases, except for three: [leaving behind] continuous charity; [leaving behind] knowledge that is of benefit [to humankind], or [leaving behind] a righteous child who would make invocation on his behalf.”31 Therefore, knowledge of health is part of the knowledge of God “who taught man what man never knew” (96:5) and the study of medicine entails the revealing of God’s signs in his creation.
The Qur’an recommends the prayer: “O my Lord, advance me in the knowledge” (20:114) and the Prophet Muhammad decrees that: “the pursuit of knowledge is a mandate on every Muslim man and woman.”32 There is no censorship on scientific research in Islam, be it academic, to reveal the signs of God in his creation, or applied, aiming at the solution of a particular problem. Islam is a religion that is open to scientific progress: God encourages people to find solutions to their problems, and God will help them.
The views on community in Islam are founded on the pillars of solidarity, cooperation, self-sufficiency, and perfection or ihsan. Solidarity is based on the view that a society comes into existence when every individual becomes a person, without losing the identity of individuals within the community. Solidarity establishes a bond of unity among members of the society as emphasized in the Qur’an: “He it is who has made you strong with his help, and rallied the believers round you, making their hearts united. Had you spent all the riches on earth you could not have so united their hearts, but God has united them together. He is indeed almighty and wise.” (8:63)
The Prophet highlights the meaning of the concept of “society of believers” by saying: “In their mutual love, compassion and sympathy for one another, believers are like one body: when one part of it suffers a complaint, all other parts join in, sharing in the sleeplessness and fever.”33 The second Caliph, Omar Ibn Al-Khattab decreed that if a man living in a locality died of hunger, being unable to sustain himself, then the community should pay ransom money (fidiah), as if they had killed him. This explains the social responsibility of individuals and societies to protect their members, especially the disadvantaged.
Cooperation is based on the concept of the “brotherhood of believers,” as written in the Qur’an: “Believers are indeed brothers.” (49:10) This is clearly explained by the Prophet who says: “None of you attains to the status of faith until he wishes for his brother whatever good he wishes for himself.”34 Islam does not allow any of its followers to take a passive or indifferent attitude toward social responsibility.
Self-sufficiency requires that the Muslim community should be in a state of progress and development, and to give practical effect to the description first expressed in the Bible and related in the Qur’an. The Muslim community is described “as the seed which puts forth its shoot and strengthens it, so that it rises stout and firm upon its stalk, delighting the farmers.” (48:29) This means that every member of the Muslim community is like a shoot or a branch of a tree, not representing a burden to it, but on the contrary, fulfilling its duty of strengthening it. The underlying principle in all this is that Islamic society places a duty on every individual to support the community and its members until it has reached the stage of self-sufficiency. A Muslim, as the Prophet says, is one who “works with his own hands to benefit himself and to give others in benefaction.”35
Islam provides safeguards for keeping Islamic society healthy through charity and setting things to right, as stated in the Qur’an: “no good comes, as a rule, out of secret confabulations save for those who are devoted to enjoining sadaqa, or maa’rouf, or setting matters to rights between people.” (4:114) Sadaqa means “charity” as stated by the Prophet: “Every individual must give with every rising sun sadaqa for his own soul.”36 Sadaqa, right behavior, is a strong indication of individual commitment and belonging to the society. The Prophet further stresses perfection or ihsan as the fourth concept for safeguarding Islamic society when saying “God has decreed that whatever human beings do should be done with perfection.”37
The family in Islam is viewed as the building block of society. Marriage is the foundation of Islamic society that provides stability and security. The Shari’a, as in the Qur’an and the traditions of the Prophet, enjoins a man who seeks to set up a family to focus his attention primarily on looking for a woman who is virtuous and of sound conduct. The Prophet stresses that choosing a wife who is of virtuous conduct and high morality is a great accomplishment for men as he says: “Acquire the woman who is religiously observant and you will succeed.”38 As for the woman’s choices for a husband, the Prophet says: “When you are approached for marriage by a man whose religiosity and manners are acceptable to you, then do accept his proposal and marry him.”39 This reflects the equity between women and men in relation to women’s rights in choosing their spouse.
Value systems drawn from religious, philosophical, ideological, and other cultural systems are the main sources of health ethics also in Islam, with the main professional health ethical principles being respect, justice, and beneficence.40
Respect for human dignity means that a human being should be treated as a person or individual who has rights to claim and duties to perform; this entails independent decision making and continuous protection of such independence, as well as taking full responsibility and accountability for all one’s actions. Individuals have the right of independent decision making, which is clearly spelled out in the following verses of the Qur’an: “Do whatever you may wish” (41: 40); “You are not the one to impose on them” (88:22); and “You are not the one to compel them” (50:45). The right to take full responsibility and accountability is stated in the following verses: “Each individual is accountable for his deeds” (52:21) and “Every soul is responsible for its deeds.” (74:38)
These important Islamic principles fit within the main principles of dealing with patients; they imply recognition of the patient’s fundamental right as a person or individual, entitled to rights and committed to duties. Persons have the right to know the details related to their health problems, receive proper treatment, safeguard their confidentiality with respect to their medical condition and treatment protocols, and to obtain adequate care.
The principles of justice and beneficence are also among those strongly stressed by Islam. They are mentioned together in the Qur’an: “God commands justice and beneficence” (16:90) and are highly regarded in contemporary medical ethics. Justice means equity in meeting patients’ needs and in delivering quality care. This is reflected in maintaining, as much as possible, equality in the distribution of health care resources and the provision of preventive and curative opportunities without discrimination for sex, race, belief, political affiliation, social, or other considerations.
Beneficence involves the fulfillment of one’s duty toward one’s brothers and sisters in humanity, particularly those who are weak or helpless, as indicated in the following verse: “And why should you fight for God’s sake in the cause of the deprived men, women and children?” (4:75) This verse presents beneficence as a noble Islamic value that is closely related to the duty of nurses and health care providers who should acquaint their patients with their rights and enhance their health and well-being. In addition, beneficence also entails perfection, as far as possible, both in performance and in kindness, as stated by the Prophet: “God has decreed perfection on everything.”41
However, the prohibition of causing harm is stated in the following two verses in the Qur’an: “My Lord has forbidden all atrocities, whether overt or disguised, and harm (ithm)” and “abandon all harm (ithm), whether committed openly or in secret.” (6:120) The Prophet also warns against selfharm or harming others, as stated in the Hadith: “there shall be no infliction of harm on oneself or others”42 and “Cursed be everyone who causes harm to a believer or scammed [cheated] him.”43
The principles of respect, justice, and beneficence and other related values are the main pillars of biomedical ethics in Islam. Currently, religious scholars in Islam are considering emerging global health issues and their relevance to and application in Islam.44
The flexibility of Islamic law is not accidental: it is an essential part of the Qur’an, where it reveals that Islam is for all people at all times. Consequently, its jurisprudence must be capable of responding to widely diverse needs and problems. Islam was revealed gradually. This fact illustrates the divine recognition of the human difficulty in adjusting to sudden change. Hence, flexibility and evolution are inherent characteristics of this religion. Based on this, Islamic juridical tradition seeks to address and accommodate the demands of justice and public good for every ethical dilemma. Thus legal doctrines and rules, in addition to analogical reasoning based on theoretical cases, enable a Muslim jurist to resolve ethical dilemmas about issues concerning, for example, life and death and reproductive issues. The fatwa can explore and reveal the insights of a jurist who has been able to analyze and connect cases to an appropriate situation of linguistic and rational principles and rules that are able to provide keys to a more valid conclusion for a case under consideration.45
This section presents the Islamic views on some of the debated issues such as life and death and reproductive health issues, including abortion, contraceptives, reproductive assisted technology, and female circumcision. These issues are discussed within the philosophical foundation and principles of Islam with less emphasis on the technical aspects of their nature.
Morality in Islam is expressed in the intentions of the person who is performing the action, therefore morality is determined by intentions, and actions are considered moral if intentions are good and genuine. Muslims believe in life after death and that they will be judged by their actions on the Day of Judgment. They also believe that life in heaven is everlasting and is the main reward for their good deeds; this explains the intimate connection between morality and the fact that God is the creator and law-giver, whose precepts humans should abide by.46
Life and death are in Allah’s hands, and human beings should not “play God.” Life and death are considered as the two main guiding principles in Islam, supported by the following verses from the Qur’an: “Blessed be he in whose hands is the Dominion, and he has Power over all things. He who created death and life that he may test which of you are best in deed, and he is Exalted in Might, Oft-Forgiving” (67:1–2) and “No soul can die except by Allah’s permission.” (3:185) God is the creator of humankind who gives and ends life as indicated in these verses: “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 who created them for the first time, for he is versed in every kind of creation.’ ” (36:77–79) Hence, human life is regarded as precious and sacred in Islam and taking a life is considered a major sin, including intrauterine life of the embryo and fetus, which should not be willfully taken unless indicated by Islamic jurisprudence that should not be compromised by the medical profession. The Qur’an says: “Whoever kills a human soul for other than slaughter or corruption on earth, it shall be as if he killed all mankind.” (5:32)
Muslims believe that in life sickness and suffering are God’s ways to test their faith; they are seen as a form of purification or recompense for wrong deeds and a time to make peace with Allah. The Islamic stance on the issue of life and death is clear to health care providers and it guides their practice. For example, Muslims believe and realize that:
Spiritual and physical needs should be accommodated in the care of terminally ill people who should be treated with sympathy, care, and compassion.
“Mercy killing” in Islam is prohibited and is not considered one of the legitimate indications for killing (because life is in God’s hands).
Islam allows resuscitation; a space should be left for the will of Allah, which should be allowed to prevail in case the person does not wish to be resuscitated.
Muslims believe that individuals with brain-stem death should not be kept alive artificially.47
It is important here to clarify the two main principles that provide a frame-work for much of the discussion and rulings on reproductive issues in Islam: first is the preservation of posterity and second is the ensoulment and the sacred nature of human life. A detailed examination of these foundational principles provides a comprehensive background for delving into an examination of specific reproductive issues.48 The preservation of one’s lineage through marriage, family formation, and procreation is of the utmost importance in Islam. The Qur’an states: “Wealth and progeny are the allurements of this world.” (18:46) The importance of progeny within the context of Islam is twofold: first, it is critical to understand the effect of some modern reproductive technologies on blood relationships, and second, an emphasis on lineage helps one to understand the root of the need for many reproductive technologies based on the significant hardship of infertility.49
Abortion is not permitted in Islam because human life is highly valued, even in cases of rape or incest, as Muslims believe that the child has the right to live. The Qur’an does not explicitly refer to abortion but offers guidance on related matters. In some cases, abortion is allowed when the pregnancy threatens the mother’s life. In that case, Islam recommends abortion before the fetus is 120 days old, leaving only two options: to let either the mother or the fetus survive, but not both. Scholars argue that such a case can only be determined by a specialist who is a trusted and committed Muslim doctor.50 This is supported by the Qur’an: “Kill not your children on a plea of want. We will provide sustenance for you and for them. Come not near shameful deeds whether open or secret. Take not life which God has made sacred except by way of justice and law. Thus he commands you that you may learn wisdom.” (6:151)
Contraception and family planning are allowed and there has not been a direct explicit opposition to contraception in the Qur’an. Muslim couples are encouraged to have children, who are referred to as their “wealth.” Muslims believe that every baby comes with his or her own provision. Muslims are infl uenced by the Prophet Mohammed’s call to “get married and multiply,” and believe that procreation is one of the most important objectives of marriage.51
Within Islamic legal interpretation, the use of some forms of birth control is allowed. Birth control is not forbidden, but some interpretation considers tubal ligation and other nonreversible techniques as unlawful.52,53 Although the use of reversible contraception is not forbidden in Islam, it is regarded as undesirable, and its use must have medical reasons and must not cause harm to the user.54 The consent of the marital partner is essential for the use of any contraceptive method, including withdrawal, because the husband’s or wife’s one-sided decision may jeopardize the rights and interests of the other partner, including the right to full sexual enjoyment.55
Even though ensoulment is at 120 days of conception, many Muslim authorities prohibit the use of postcoital methods of contraception, such as the intrauterine device because these could result in the abortion of a fertilized egg. For Muslim scholars, the rhythm method and coitus interruptus are acceptable forms of contraception provided they are performed with the consent of the wife.56 The coil and emergency contraception (the morning-after pill) are considered unsuitable, as they effect abortion. Instead, barrier methods are advocated, as they do not interfere with the body’s natural function.
One of the debated reproductive issues that arises and creates a gap between religion and science is assisted reproductive technology (ART), which relies on the use of technology to assist infertile couples to conceive a much longed-for child.57 ART is essential if it involves the preservation of procreation and treatment of infertility in one partner of the married couple.
Although Islam views infertility as a “serious disease” and “a threat for families,” adoption is not acceptable as a solution to the problem of infertility; therefore fertility treatment is acceptable, allowed and encouraged, and attempts at curing infertility are not only permissible but even believed to be a duty.58 Based on this, the prevention and treatment of infertility is encouraged and becomes a medical priority because it will ensure an uninterrupted process of procreation. Islam encourages the affected man or woman to seek medical treatment.59
The guiding principles of ART in Islam involve using it with a married couple only; it must be conducted within the context of a valid marriage, performed by a competent medical team in order to reduce the chances of failure, and to decrease risks of multiple pregnancies. Freezing of the remaining fertilized ova is permissible as long as they are only used in subsequent cycles for the same couple, and the couple is still married.60–62 The Qur’an states: “Then has he established relationships of lineage and marriage…. ” (13:38) The use of donor sperm, eggs, or embryos will result in the biological father or mother being different from the “married couple.” According to Islamic law, this is similar to adultery in confusion of the lineage.
ARTs have created religious bioethical problems and dilemmas and Islam has presented a middle of the road solution, moderating between the two extreme views. Allah says: “Thus we have appointed you a middle nation, that you may be witness against mankind, and that the messenger may be witness against you.” (2:143) The advances, availability, and the wide status of ART may create conflict between different options, not only for clients and their families but also for health care providers. Therefore, Muslim couples’ decision regarding ART options is influenced by many factors, including the socioeconomic context, knowledge of the moral, ethical and legal status of ART, and sex preference of the baby. To facilitate ethical decisions, a thorough assessment of these factors is needed. Counseling services that integrate Islamic principles on ART are essential to eliminate ambiguities and ensure credibility of health care providers, as well their practices. The need of individual fatwa, rather than general counseling statements, which integrates the individual needs and beliefs, may seem to be more effective. This approach necessitates the development of specific protocols, guidelines, and counseling materials that are designed by Muslim scholars and qualified health care providers. These materials need to be aligned with Islamic principles and based on the philosophical views of Islam on life and death, and the belief that procreation is the objective of marriage, to facilitate the couples’ informed choices within their diverse contexts, especially if they live in non-Muslim countries where the official legal stance on reproduction varies. Therefore, health care providers need to observe the principles of respect for human dignity, security of human genetics, and inviolability of the person whenever a new reproductive technology is being introduced.
Circumcision in Islam is obligatory for males and there is no single verse in the Qur’an that relates explicitly or implicitly to female circumcision. Female circumcision or female genital mutilation (or cutting) is a forceful procedure that involves removal of a part of a girl’s genitalia at an early stage in life and is one of the most harmful practices for a female child. The position taken by a great number of scholars in the absence of any Hadith that may be authentically attributed to the Prophet is that female circumcision is neither required, obligated, nor a sunnah in the sense of Islamic tradition. Despite this fact, it is practiced in some Muslim countries such as Egypt and Sudan where misconceptions and false beliefs prevail that female circumcision removes redundant organs. Female circumcision causes medical complications, including pain, hemorrhage, urine retention, dryness of the vagina, pain during intercourse, difficulty delivering children, and vaginal and anal fistulas. Female circumcision violates women’s rights in an Islamic perspective. Because marriage is considered a sacred relationship in Islam, women have every right to psychological, moral, and emotional considerations, and their right to be sexually fulfilled must be respected on an equal footing with the right of the man.63,64
The Islamic Code of Medical Ethics was developed by WHO as a guiding tool to maintain all health care professionals’ behavior within the boundaries of Islamic teachings. It is also considered as a code of conduct for medical and nursing students in their professional life to acquaint them with what to do and what to avoid when facing pressures, temptations, or uncertainties.
This Islamic Code of Medical Ethics defines therapeusis, or the medical profession, as a noble profession, honored by God, who made it the miracle of Jesus, son of Mary. Al-Ghazali (1058–1111 CE) considered the profession of medicine as fardh kifaya, meaning a duty incumbent upon on society that some citizens carry out on behalf of all. As medicine is about preserving health and well-being of individuals, this means that the profession of medicine in Islam is a religious necessity for society. It is a unique profession and should never yield to social pressures motivated by enmity or personal, political, or military feuds.65
The medical profession has the right and owes the duty of effective participation in the formulation and issuing of religious verdicts concerning the lawfulness or otherwise of unprecedented outcomes of current and future advances in biological sciences. These verdicts should be reached between Muslim specialists together with Muslim specialists in jurisprudence and biosciences. Onesided opinions have always resulted in a lack of comprehension of the technical or legal aspects of those verdicts. The guiding rule in unprecedented matters falling under no text or law is the Islamic dictum: “Wherever welfare is found, there exists the statute of God.”66 Therefore, physicians must have a broad knowledge of jurisprudence, worship, and essentials of fiqh. This knowledge will enable them to counsel patients seeking guidance about health issues with a bearing on Islamic rituals of worship such as views pertaining to pregnancy and prayer, fasting, pilgrimage, family planning, and so forth.
Hence, medical practice becomes an act of worship and charity in addition to being a lifelong career. The medical profession operates along the single track of God’s mercy, never hostile and never punitive, never taking justice but mercy as its goal, in whatever situations and circumstances.67 It follows that the roles and responsibilities of physicians in Islam are well delineated: they are seen as catalysts through whom God, the Creator, works to preserve life and health. Physicians are merely instruments of God in alleviating people’s suffering, therefore they should be grateful and forever seeking God’s help, with an attitude of modesty, free from arrogance and pride and never falling into boasting or hinting at self-glorification through speech, writing, or direct or subtle advertisement.68 In addition, their responsibilities are focused on their commitment to update their knowledge and strive to keep abreast of scientific progress and innovation. They must also know that the pursuit of knowledge has a double indication in Islam: apart from the applied therapeutic aspect, this pursuit of knowledge is in itself worship. The following verses from the Qur’an highlight this: “My Lord, advance me in knowledge” (20–114) and “Among his worshippers the learned fear him most” (35:28) and “God will raise up the ranks of those of you who believed and those who have been given knowledge.” (58:11)
Medical education, despite being a specialty, is a tiny part in a whole mesh of knowledge founded on belief in God; God’s oneness and absolute ability, and that he alone is the creator and giver of life, knowledge, death, this world and the hereafter. Yet, medical education has to be protected and purified from every positive activity toward atheism or infidelity.69
It is clear that physicians efficiently used the underpinning philosophical views of Islam to shape the medical profession and further advance it to a theoretical framework for their practice. They are strongly involved in the juristic Islamic system by being educated about the sources of conflict and ethical dilemmas arising from advances in biosciences, participate in formulating appropriate Fatwa, and integrate these within the ethical components of the medical education and practice systems.
Unlike the medical profession, Muslim nurses did not utilize the exist ing knowledge and frameworks of health in Islam to develop the nursing profession. The failure of Muslim nurses to shape the practice, education, and the regulatory system within the Islamic views can be attributed to many factors, among them the fact that Muslim nurses were women who were struggling for social status, professional identity, and societal approval and recognition. Muslim nurses have been using western practice, education, and ethical models rather than integrating the holistic views of Islam.
Muslim nurses did not examine, utilize, and conceptualize the Islamic traditions on the views of care and caring practices; caring in Islam is the manifestation of love for God and the Prophet Muhammad. The caring concept is refl ected in various traditions and means more than the act of empathy. It is viewed within the concept of a society of brothers and sisters, based on solidarity, cooperation, self-sufficiency, and perfection or ihsan. These views refl ect that caring requires nurses to be responsible for, sensitive to, and concerned with people in need, especially the weak, the suffering, and those outcast from society.70 In addition to what physicians do in relation to preserving health and the well-being of individuals and communities, nurses have an extended role in caring for human responses and provide a unique service to society that meets the requirements of fardh kifaya. Muslim nurses need to educate themselves within the views and traditions of caring in Islam and the Islamic juristic system, and create partnerships with Muslim scholars to participate effectively in the formulation of and issuing of religious verdicts concerning the health of populations and pay their duties to the Muslim society.
Although the fiqh of Islam does not explicitly define nursing and nurses within the perspective of Islam, there are many lessons that can be learned from the Prophet traditions in acknowledging women’s role in times of peace and of battles. Therapeusis was practiced by the “Lady-Healers” who joined the Prophet’s army in battle, caring for the casualties and dressing their wounds. Rufaidah Bint Sa’ad was among those “Lady-Healers” who lived at the time of the Prophet Muhammad and was the first professional nurse and founder of the nursing profession in Islam. Her practice was influenced by her father, who was a physician, from whom she learnt the care while working as his assistant. She then trained a group of women companions as nurses and established her own field hospital tent, caring for the injured referred by the Prophet Mohammad and became very famous during the main Islamic battles. The Prophet assigned a share of the booty to Rufaidah and the other nurses, and Rufaidah’s share was equivalent to that of a soldier who had actually fought in battle. This was the first unique recognition of women in Islam refl ecting gender equity while working side by side with men that could have been a golden opportunity for Muslim nurses to develop the nursing profession.
Rufaidah’s history illustrates all the attributes expected of a good nurse: she was kind and empathic, a capable leader and organizer, mobilizing resources and involving others to produce good work. She had clinical skills that she shared with other nurses whom she trained and worked with. She extended the nursing scope of practice beyond caring for sick people to caring for people in the community to solve the social problems that affected their health and well-being. In that sense, one could say she was a public health nurse and a social worker. She is an inspiration for the nursing profession in the Muslim world for her distinguished role in war and peace. During peace time, she set up her tent outside the Prophet’s mosque in Medina where she cared for the sick and was involved in social work at the community level. With her kind personality, she cared for the poor, orphans, and handicapped people. Islamic history acknowledges her role in mentoring other nurses in Islam.71
It is evident that Islam has placed great value on ethics as a core concept in medical practice. Islam laid the foundation of the meaning of health and ethics within the five religious duties that form the theoretical principles and references for health care organizations, health care providers, patients, and Muslim communities. Islam is considered a fl exible progressive religion in responding to new biomedical challenges and provides a framework of values and ethics derived from religion. Ethical practice is the responsibility of all nurses, and developing a framework of nursing ethics within an Islamic perspective can play an important role in understanding the meaning and practical applications of ethics for nurses caring for Muslim patients all over the world.
Within the context of Islamic ethical principles, it is important that registered nurses recognize and understand that their ethical decision-making is not done in isolation, and occurs within a context of Islamic care that can bring a unique perspective to the decisions that need to be made with Muslim individuals and their families. Muslim nurses need to realize that there is no way to strengthen their profession and improve care without integrating the Islamic ethical principles in their own practice. Failure to develop and implement theoretical frameworks to guide decision making and ethical practice impair any initiative to ensure morally responsible nursing practice. This requires that nurses be informed and examine emerging religious values to revise or develop an Islamic nursing regulatory system, including laws, bylaws, codes of ethics, and standards of care to be aware of, and being responsive to ethical dilemmas that are part of their daily life. Nursing is part of the health care system and nurses have a religious moral duty to participate in issues of health policy and to contribute to religious verdicts regarding health, illness, health care, policy, and ethics.
Teaching ethics must become an essential requirement in clinical practice. Nurses must actively take part in clarifying ethical dilemmas and become scholars in utilizing Islamic essentials and ethical guiding principles to shape their practice and expand the field of fiqh of health to serve their profession. This will empower them in leading their societies to a healthier future in working side by side with other health care providers. Nurses have a critical role in generating evidence through research, in order to refine and strengthen ethical guiding principles to be responsive to the Islamic social context of health care that is continuously dominated by science and technology, similar to that of western societies, with a preference for factual and testable data and lesser attention to religious influences and human relationships. This requires stronger cooperation among all nurses from different countries and different religions to build synergies through an integrated approach in identifying the concepts of health, ethics, and nursing from various religious perspectives. This is a new paradigm shift that requires commitment and leadership of nurses to move to a higher level of investment in nursing. Scholar nurses are at the heart of these efforts and need to take this opportunity to contribute to the ethics of care as an integral part of education, socialization, and the practice of professional nursing.
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66. Ibid.
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71. Ibid.