Catálogo de publicaciones - libros

The present study undertakes to examine biomedical issues as they have emerged in the last three decades. In the Muslim world, as in any part of the globe, advancements in biomedical technology has meant a number of new issues in the medical treatment and procedures that impinge upon Islamic values as taught by the Qur’an and the Sunna (the Tradition of Prophet Muhammad (PBUH)). Our investigations in bioethical issues require Muslim ethicists to examine a number of judicial decisions made by Muslim scholars in response to the growing number of cases in the clinical settings as well as national health policies adopted by various Muslim governments in the last two decades.

All nations have common principles in morality and ethics. The source of these moral and ethical attitudes can be traced back to three main sources: (a) Intuitive Reasoning (al-fitra) or the basic innate constitution of all human beings; (b) Faculty of Reason (al-‘Aql): The ability to reason and derive a decision by using one’s mind. It is logical to derive that people of wisdom acquire morality. Muslim philosophers like Ibn Tufail believe that any normal human being can recognize God, with his divinely endowed nature and his reason; (c) Divine Revelation (al-wahy, Tanzil): Muslims believe that God guides humanity by sending a number of prophets and apostles, who are the bearers of the revelation.

Islam differs from many other religions in providing a complete code of life. It encompasses the secular with the spiritual, the mundane with the celestial. Man is the vicegerent of God on earth “Behold thy Lord said to the Angels: I will create a vicegerent (khalifa) on earth” (Q. 2:30). The satanic claim to superiority is the source of arrogance. Islam considers it the worst sin since through arrogance all other sins are committed. Freeing humanity from the original sin, empowering human beings, and giving them full responsibility of their actions is the message of the Qur’an: “Every soul will be held responsible for what it had done” (Q. 74:38)—is the essence of morality and ethics in Islam.

Although moral values are universal, their application varies in different cultures. To Aristotle moral values are the result of habitual adherence to them. They become second nature. Galen combined the innate nature and temperaments. Al-Mawardi divided the origin of morality into two main branches: (a) The innate ones, (b) The voluntary character, which emanates from the training and using our faculties. Muslim philosophers tried to combine Aristotle and Galen; Miskawaih defined morality as being innate, controlled by instincts and humors, but definitely can be changed by training, cultivation, and culture. The motive and intention play an important role in the formation of moral character. In Islam, Prophet Muhammad (PBUH) taught that acts will be judged in accordance with the intention. If the motive is good and the act is good, the person will be rewarded by God; however, if the act is good and the motive is bad, the person will be punished for it.

Professional virtues and codes of conduct were historically associated with the philosophy and ethos of each community. The old Egyptians, Chinese, Indians, Persians, Babylonians, etc., had a mode of conduct for the medical profession, requirement for the priest physicians, and laws regulating the profession. The Hippocratic Oath extolled the following principles: Beneficence, Nonmaleficence and Confidentiality. From 1970, the Hippocratic tradition started to collapse. The rights of the patient became more important. These included fidelity, autonomy, and veracity. Islamic teachings differ from the paternalistic approach of the Hippocratic Oath. The Qur’an is replete with such verses, which orders freedom of faith and human personal responsibility. In Islam the consent of the person or his guardian is imperative. Seeking remedy may be obligatory (mandatory) in certain life saving situations or may be preferred or encouraged (Mandoob) in other situations. It may be facultative or optional and may be Makrooh, i.e., not preferred and in some situations and with certain types of treatment may be Haram, i.e., not allowed. There were many codes especially for medical research since the appearance of the Nuremberg code (1946) to the present time.

Autonomy is a Greek word, autos: self, nomos: govern, rule, i.e., self-rule or self-government. In order to have autonomy two conditions are essential: Free will and Capacity of intentional action by an adult competent individual. The details of consent will be discussed fully, and when it is allowed to omit the need for consent. The role of the family and close friends should be respected in places where they have different philosophies and cultures that differ greatly from Western liberal, individualistic patterns. Even in the West, with different minorities, e.g., Chinese, Indians, Pakistanis, etc., the role of the family should be respected, as the patients themselves agree to this role, and health providers have to understand that there are different cultures that do not give priority to autonomy, as it is understood in the West.

Nonmaleficence is an important obligation in morality and medical ethics (doing no harm). It is associated with the maxim “primum non nocere,” above all do no harm. In Islamic teachings Prophet Muhammad (PBUH) said, “Doing harm and reciprocating harm is not allowed”  “La Dharar wa la Dhirar.” In Islamic jurisprudence axioms: “Avoiding harm takes precedence over bringing good. Al Izz ibn Abdul Salam (d 660H/1262 CE) said “The aim of medicine is to preserve health, restore it when it is lost; remove ailment or reduce its effect. To reach that goal it may be essential to accept the lesser harm, in order to ward off a greater harm, or lose a certain benefit to procure a greater one.” Doing harm and reciprocating harm is not allowed. Harm should be warded and avoided as much as possible. The prohibited things would be allowed if there is necessity. Using medicine made of porcine material or containing alcohol or poisonous snakes is allowed if there is no alternative medicament. Similarly, autopsy and dissection of human bodies, organ donation from living or dead persons would be allowed if there is no harm and there is valid consent.

Beneficence connotes acts of mercy, kindness, and charity. It includes all forms of action intended to benefit or promote the good of other persons. Preventing harm and removing harm (or evil) are both considered a type of beneficence. The Qur’an and the Tradition are full of passages and sayings of the Prophet enjoining good and refraining from doing harm. Those who strive to purify themselves, abstaining from harming others (humans, animals, or environment), performing good and enjoining others and the whole community to do the right things and abstain from evil acts, are the true believers and those will succeed in the Day of Judgment. Nonmaleficence and Beneficence are the cornerstones of morality and ethics throughout history in different nations and cultures. Both the Old and the New Testament enjoined doing good (beneficence) and avoiding harm (Nonmaleficence) The good Samaritan is an example of beneficence.

It is a disgrace to find many millions worldwide dying from malnutrition, famines, diarrhea, malaria, and tuberculosis. Health services should be distributed in a fair way between rural areas and cities; and between tertiary hospitals and primary healthcare. Disease prevention, health education, and health promotion deserve their fair share. It is not only the number of physicians or nurses or beds that will improve the health standard of the nation. It needs equity in distribution of health resources and an efficient system of delivery. USA spends on health per capita double or triple of all the 28 industrialized countries; nevertheless, it is behind all these countries in certain health criteria put by WHO, such as infant mortality rate, and 5-year-old mortality rate. There are about 50 million citizens with no health insurance, or partial on and off insurance, in the USA until the beginning of the twenty-first century. The health system should move from only curative medicine to preventative medicine and health promotion.

Abortion is the termination of a pregnancy before the infant can survive outside the uterus. Abortion is still used in many countries as a means of family planning. The moral, religious, and legal aspects of abortion are subject to intense debate in many parts of the world. More than 60 % of all induced abortions in the USA, Canada, and Europe are carried out on young unmarried girls under the age of 20. In Islam, abortion is allowed if continuation of pregnancy would endanger the life or health of the expectant mother; or if there is proven serious congenital anomaly in the embryo or fetus. Abortion on demand, as carried out in many countries, with liberal abortion laws, will never be condoned by Shari’ah (Islamic Law).