Bismillah wal haldulillah was salaatu was salaamu alaa Rasool illah SAW

Whenever Allah’s Messenger (ﷺ) paid a visit to a patient, or a patient was brought to him, he used to invoke Allah, saying, “Take away the disease, O the Lord of the people! Cure him as You are the One Who cures. There is no cure but Yours, a cure that leaves no disease.”

عن عائشة رضي الله عنها أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم كَانَ إِذَا أَتَى مَرِيضًا ـ أَوْ أُتِيَ بِهِ ـ قَالَ ‏ “‏ أَذْهِبِ الْبَاسَ رَبَّ النَّاسِ، اشْفِ وَأَنْتَ الشَّافِي لاَ شِفَاءَ إِلاَّ شِفَاؤُكَ، شِفَاءً لاَ يُغَادِرُ سَقَمًا

The importance of learning medicine and its natural connection to biomedical ethics

The fountain of wisdom, our teacher and prophet SAW emulated the perfect example of a worshipper. Through his inclusive sunnah, he also left examples of him engaging with the same worldly acts we do today, such as engaging in business[1], serving his family[2], visiting the sick of his community[3] and also treating them[4].

There’s no question that the pursuit of medicine is considered of the noblest worldly sciences, given several ayaat and ahadith indicating its importance.

Imam Dhahabi (d. 748h) once said, “Medical treatment is a sunnah because the Prophet SAW himself treated others and ordered that it should be done”[5].

Just as the pursuits of the Islamic sciences including aqeedah, fiqh and preservation of Qur’an continue after the prophet SAW’s death for the eventual purpose of preserving the deen, medicine is a worldly pursuit of knowledge that the prophet SAW encouraged[6] for the eventual purpose of preserving life. Even Imam Shafi’ee considered knowledge of medicine most important after seeking knowledge of the religion.

Ibn Abi Hatim reported: Al-Shafi’i, may Allah have mercy on him, said, “Verily, knowledge is only two types: knowledge of the religion and knowledge of the world. The knowledge of religion is to achieve juristic understanding (fiqh) and the knowledge of the world is medicine. Do not settle in a land in which there is no scholar to inform you about your religion, nor a doctor to inform you about your body.”[7]

Since the time of the prophet SAW, increased knowledge of pathophysiology and immunology have significantly changed our understanding of medicine, providing a more evidence-based perspective to medicine that is now practiced around the world in the form of allopathy. On the other hand, ethical principles to aid in clinical decision-making have been part of the physician’s toolkit for millennia.

The Hippocratic oath brings up themes of the limits of medicine, the search for benefits, bedside humanism and the connections of teaching and practice[8], common themes that influence how we all practice today. Additionally, the most commonly taught bioethics framework, the principle-based theory of Beauchamp and Childress, encourages decision making through autonomy, beneficence, non-maleficence and justice[9].

While there is a need for a uniting framework that has universal appeal, bioethical frameworks are dependent on context. In the case of Tom Beauchamp, he was a member of the US Commission and involved in writing the Belmont Report in 1979, which was focused more on guidelines for biomedical research than clinical decision-making[10]. While this doesn’t discount their contribution to the field of bioethics, it is important to consider this context.

The complexities of decision-making by physicians have always gone beyond pathophysiology and the corpus of Islamic knowledge also has much to contribute in this regard.

What is Islamic medicine?

Islamic medicine generally refers to the practice of medicine in the form or manner indicated by the prophet SAW through the Qur’an and Sunnah. However, a clearer definition is needed to encourage further research and investigation.

A classification to clarify its various types was previously described by Dr. Rafaqat Rashid[11]:

1. Medical treatment or prevention: This refers to prophetic advice on treating with a particular therapy, including honey[12], drinking water during infection[13], or staying away from cautery.

2. Normative positions on treatment — This refers to prophetic advice on what is permitted or not. As a general principle, anything that is considered to be haram including products of pork or alcohol should only be used in extenuating circumstances and where there is clear benefit in its use[14].

3. Spiritual nature of treatment — This refers to the spiritual nature of pain, disease and cure, including the fact that cure is ultimately from Allah, and the promise that pain removes sins[15].

While these topics are broadly present, a modern curriculum for teaching Islamic medicine includes topics such as Islamic bioethics, Islamic medical science, as well as the codes of conduct of a physician (ibid).

A fair bit of the following discussion shall focus on Islamic bioethics. According to Aasim Padela, Islamic bioethics can be defined as “a discourse that uses the Islamic tradition to address moral questions and ethical issues arising out of the biomedical sciences and applied health practice”[16] This definition will become more important as we discuss issues of abortion and euthanasia.

Are Muslims obligated to use the medicine from the time of the Prophet SAW?

Several ahadith point towards the use of Nigella sativa (black seed), honey and the Qur’an itself.

The prophet SAW said, “There is healing in black seed for all diseases except death”[17].

In the case of the specific hadith above, there is no definitive description of cure mentioned.

Generally, however, this is a topic that has been discussed in some detail, especially in Ibn al Qayyim’s Zaad al Ma’ad (Now translated and published under the title Medicine of the Prophet)[18].

As a brief summary, Dr. Rafaqat Rashid describes the three separate opinions in this regard:

1. All forms of therapy mentioned in prophetic tradition are the best forms of therapy and the most effective.

a. This would include black seed and honey with hopes that it may have some healing for all diseases as they are sacred.

2. Therapies mentioned in prophetic tradition were the most effective forms of therapy during the time of the Prophet SAW and revelation.

a. This includes the notion that the prophet SAW used therapies like cautery, even though he disliked it, as there is some extrinsic value to its use in the form of barakah, but no sacredness in and of itself. As a result, better treatments should be used today if available. Dr. Rashid opines toward this view.

3. The Prophet SAW is promoting therapy as a principle, not the actual therapy itself.

a. This includes the notion that none of the specific treatments provided by the prophet SAW need to be used today, as there is no sacredness nor is there barakah

Can bioethics be Islamic?

For the sake of this article, we will cover the most well-known model of principle-based bioethics from Beauchamp and Childress (1979). This theory was touted for its appeal towards various societies and religions (with differing importance of each principle) and is taught by several medical schools. However, it is clear that given differing sociopolitical views, certain principles may be given more priority than others.

As a basic example, most countries do not allow the sale of kidneys to prevent misuse and abuse of living unrelated donors. However, India is one of few countries that allows the sale of kidneys. On the one hand, the hope is that less resources are used for dialysis in a country where resources are limited. On the other hand, illegal racketeering continues to be a great concern, in addition to data showing that donors mainly used funds to pay off existing debts[19].(Goyal, Mehta, Schneiderman, & Sehgal, 2002) Non-maleficence is prevalent, but prioritized less than the beneficence that comes from receiving a transplant and the recipient avoiding a poorer quality of life due to dialysis dependence.

With a more Islamic example, medical assistance in dying is considered a form of active euthanasia, which is categorically prohibited in Islam. While many in North America would praise the autonomy provided to patients in choosing this route, Muslims would prefer palliation through comfort measures, even if death becomes more imminent as a result (citation missing).

Decisions never occur in a vacuum. As a result, bioethical principles based on Islamic belief will continue to be important for Muslim patients and providers. So, while bioethics remains a broad field, decisions may or may not be in keeping with Islamic values, which separates Islamic bioethics from bioethics in general.

Is Islamic bioethics only for Muslims?

What every physician hopes to make use of is a holistic approach to curing the patient. No patient is the same, and clinical cure depends heavily on non-medical factors, including the social determinants of health.

Islamic bioethics may offer a further avenue to help patients understand their pain and disease, and also encourage consistent character development on the physician’s part. For patients feeling depressed along with their sickness, conveying hope is part of the sunnah. For patients that have treatments fail one after the other, setting realistic expectations regarding medications limits are important to convey.

When addressing issues such as the use of medicinal marijuana, or the importance of the COVID vaccine, collaborations between Muslim community leaders (scholars, imams) and the physician are important in understanding the Islamic perspective on specific treatment and also educating the general public.

Is it possible to have differences of opinion in Islamic bioethics?

Valid differences of opinion on treatment have existed in every Islamic science, even within the finer details of aqeedah. In fact, even the importance of medical treatment is differed upon, depending on the clinical scenario.

A quick summary of the Islamic view on medical treatment (in general) has been written elsewhere[20]. It’s clear that differences of opinion do exist, with some schools of thought conveying that medical treatment is permissible (such as the Hanafi school), while some individual scholars (such as Ibn Taymiyyah) suggest that treatment is obligated on a Muslim if it has a high degree of success and the treatment is life-saving (Ghaly, 2009).

This underscores the example that difference of opinion may very well exist in the realm of Islamic bioethics.

How can we contribute as Muslim physicians?

As Muslim physicians, it is important for us to actively engage in the field of bioethics and public health.

As a modern example, the Oxford AstraZeneca COVID vaccine (non-mRNA) initially planned to have porcine ingredients to keep the medium healthy. In the presence of alternatives such as the Pfizer and Moderna vaccine that had no porcine ingredients, being vaccinated with the AstraZeneca may have proved to be difficult for Muslims, Jews, Hindus, vegans and vegetarians across the world. After much deliberation, the company has decided to remove this ingredient, effectively removing any dilemma in receiving this vaccine. Advocacy efforts like these are only possible through engagement with leaders in our national and international communities.

Additionally, engaging with our own Muslim communities is important. We must educate them regarding medical assistance in dying (with the clarification that this treatment is never forced on any individual), and also clarify any doubts or paranoia associated with the COVID vaccine.

Finally, the prophet SAW told us, “Allah has not revealed a disease, except that he revealed its treatment”, thereby encouraging us to constantly be searching and educating ourselves regarding medical treatment. It is through his sunnah that we will have success.

And Allah knows best.

Dr. Obaidullah Khan is a second-year resident in family medicine at Western University in London, Ontario. He hopes to work as a generalist, keeping his skills in the ER, inpatient medicine, and family medicine.

Many thanks to Dr. Rafaqat Rashid, Dr. Raza Naqvi and Dr. Mona Saleh for their input towards the article.

Bibliography

Reiser, S. J. (2003). What modern-physicians can learn from hippocrates. Cancer, 98(8), 1555–1558. https://doi.org/10.1002/cncr.11565

Ghaly, M. (2009). Islam and Disability: Perspectives in Theology and Jurisprudence. Taylor & Francis.

Padela, A. I., & Qureshi, O. (2017). Islamic perspectives on clinical intervention near the end-of-life: We can but must we? Medicine, Health Care and Philosophy, 20(4), 545–559. https://doi.org/10.1007/s11019-016-9729-y

Aasim, P. (2019). Engaging the Field of Academic Bioethics. YouTube. Retrieved 26 March 2021, from https://www.youtube.com/watch?v=CvufauMe7zI&t=2658s.

Ghaly, M. (2016). Islamic Perspectives on the Principles of Biomedical Ethics.

Rafaqat, R. (2019). Introduction to Principles of Islamic Medicine. YouTube. Retrieved 26 March 2021, from https://www.youtube.com/watch?v=86aJlZ9JNQI&t=1177s.

Goyal, M., Mehta, R. L., Schneiderman, L. J., & Sehgal, A. R. (2002). Economic and health consequences of selling a kidney in India. Journal of the American Medical Association, 288(13), 1589–1593. https://doi.org/10.1001/jama.288.13.1589

Beauchamp, T. L. (1979). Principles of biomedical ethics / Tom L. Beauchamp, James F. Childress. (J. F. Childress, Ed.). New York: Oxford University Press.

Chamsi-Pasha, H., & Albar, M. A. (2017). Ethical Dilemmas at the End of Life: Islamic Perspective. Journal of Religion and Health, 56(2), 400–410. https://doi.org/10.1007/s10943-016-0181-3

[1] https://sunnah.com/muslim/22/144

[2] https://sunnah.com/bukhari/10/70

[3] https://sunnah.com/bukhari/75/11

[4] https://sunnah.com/ibnmajah/31/59

[5] Tibb an Nabawi, Imam Dhahabi. As for the particular ruling regarding seeking medicine, this will be discussed in more detail later.

[6] https://sunnah.com/bukhari/76/1, https://sunnah.com/abudawud/29/20

[7] Adab as Shafi’i wa munaqibuh (Ar Razi) 1/244

[8] Reiser, 2003

[9] Beauchamp, 1979

[10] Ghaly, 2016

[11] Dr. Rafaqat Rashid — https://www.youtube.com/watch?v=86aJlZ9JNQI&t=1177s

[12] https://sunnah.com/bukhari/76/22

[13] https://sunnah.com/bukhari/76/38

[14] https://sunnah.com/abudawud/29/20

[15] https://sunnah.com/bukhari/75/2

[16] Dr. Aasim Padela — https://www.youtube.com/watch?v=CvufauMe7zI&t=2658s

[17] https://sunnah.com/bukhari/76/11

[18] Zaad Al Ma’ad (Ibn al Qayyim)

[19] Goyal, 2002

[20] Padela, 2016