Islamic Bioethics: The Interplay of Islam and the West

Contemporary Islamic bioethics is generally characterized by a friendly relationship with biomedical technology which is usually seen as one of the good fruits of Western modernity. Muslim religious scholars usually hailed this technology and further acknowledged and endorsed, within specific limits, its public benefits in the fields of medical treatment and healthcare. However, contributions of Muslim religious scholars on the religio-ethical challenges posed by the outbreak of AIDS as a fearful epidemic since the 1980s, showed another vision of these scholars towards Western modernity and its possible ethical dangers from an Islamic perspective.

This paper examines one of the milestones of the religio-ethical discussions on AIDS in the Muslim world. On the 3rd of December 1993, the Islamic Organization for Medical Sciences (IOMS) held a conference entitled “An Islamic vision for the social problems of AIDS” where more than one hundred Muslim religious scholars and biomedical scientists participated. One of the key issues heavily dealt with was the concept of the “virus of Western modernity”, a phrase formulated by some participants in this conference. Here, the participants debated on the “ugly” or “good” face of Western modernity concerning AIDS. On one hand, some voices stressed that rampant promiscuity promoted by Western modernity should be seen as the main culpable for the outbreak of AIDS. On the other hand, other voices expressed their admiration for the human rights dimension, which characterizes the approach of Western countries towards people infected with AIDS. The other key issue which busied the minds of participants had the tincture of a “science and religion” debate. In order to provide an Islamic “recipe” for the social problems encountered by people infected with AIDS, Muslim religious scholars were in need of medical information about different aspects and possible dangers of this disease. Some participants complained that information provided by biomedical scientists was insufficient and sometimes even sounds contradictory. Alternatively, some biomedical scientists criticized some religious scholars for basing their conclusions on unauthentic information, from a medical perspective.

In their bid to formulate an overall Islamic vision on or “recipe” for the social problems of AIDS, the participants elaborated further on different religio-ethical questions. Some contributions discussed the ontological aspects of AIDS from an Islamic theological perspective. Other contributions approached the social problems of AIDS through the lens of higher objectives of Sharia (maqasid al-Sharia). Furthermore, most contributions focused on specific social problems encountered by people infected with AIDS within family or within society at large. Some central questions in this respect read: Does Islam justify drafting a law requiring a to-be-married couple to receive a certificate before contracting marriage, which shows that they are not infected with AIDS? Is abortion permitted for a pregnant woman infected with AIDS? Does the woman have the right to terminate marriage if her husband got infected with AIDS or vice versa? What is the criminal liability of AIDS patients who deliberately infect other people? Should people infected with AIDS be isolated from specific social interactions especially in schools and workplaces?

في هذا البحث دراسة عن صحة الإنسان في الأديان المختلفة موضحين نقاط التشابه و الاختلاف في مواقف الأديان من الإنسان و صحته ، و قد لاحظنا اتفاق الديانات التوحيدية حول عدد كبير من القضايا المرتبطة بالأخلاق الحيوية. فالقرابة الدينية التي تجمع الديانات التوحيدية وحّدت رؤيتها تجاه الحياة الإنسانية ، و قيمة الإنسان في هذه الحياة ، و ضرورة الحفاظ عليها ، و تقديم حلول لمشاكل الإنسان الصحية التي لا تتعارض مع وجهة النظر الدينية في طبيعة الإنسان و علاقته بالخلق و الخالق، كما يجب أن لا تتعارض أيضا مع الأخلاقيات التي طورتها الأديان التوحيدية باعتبارها أخلاقيات مرتبطة بالدين و غير منفصلة عنه.

وقد اختلفت مواقف الديانات الشرقية من طبيعة الإنسان و طبيعة الحياة الإنسانية حول موضوع الصحة الإنسانية بين الاهتمام بمظاهر الزهد و التقشف الى حد الرغبة في إماتة الجسد الإنساني و من الناحية الاخرى الاهتمام بالصحة الإنسانية إلى حد اعتبارها موضوعا أساسيا للدين و اعتبار تحقيق صحة الإنسان و إطالة عمره على الأرض غاية النظام الديني النهائية. و قد نشأت حول هذين الموقفين أخلاقيات و قيم متناقضة بين النظر الى الفقر على أنه القيمة العليا أو إعتبار الصحة و إطالة العمر هما ذوي القيمة العليا.

وقد رأينا في هذا البحث أن من خلال دراسة الصورة الدينية لصحة الإنسان بشكل مقارن بالنظر الى ما طورته الديانات الشرقية من أفكار حول صحة الإنسان ومقارنتها بمنظور الديانات التوحيدية ، و النظر أيضا في إمكانية تشكيل موقفا دينيا موحّد من الصحة الإنسانية و تكوين قاعدة نظرية مشتركة للأخلاقيات الحيوية في أديان العالم استنادا الى وحدة الموقف من الأخلاق الحيوية، ستدعم الدعوة إلى تأسيس هيئة دولية عالمية للأخلاقيات الحيوية تتكون من علماء يمثلون الأديان المختلفة وفريق آخر من علماء الواقع المتخصصين في العلوم الطبية والبيولوجية ليعملوا معا على حل مشكلات الإنسان الصحية على أسس دينية و أخلاقية و علمية تحمي الإنسان وتحافظ عليه. وستضمن هذه الهيئة الاستدامة للبيئة المشتركة و الحفاظ عليها على أسس التي تضمن سلامتها و استمراريتها كبيئة صحية صالحة للحياة الإنسانية و الحيوانية و النباتية. إن وحدة الموقف الديني من الحياة و الأخلاق تجعل الأخلاقيات الحيوية نتاجا طبيعيا لهذا الموقف وتجعل اتحاد و تعاون علماء الدين والواقع أمرا منطقيا ومعقولا. و يشتمل البحث على العناصر التالية: •صحة الإنسان في الديانات التوحيدية. •صحة الإنسان في الديانات الشرقية. •صحة الإنسان بين الحضارة الإسلامية و الغربية. •أهم نقاط الاختلاف و الالتقاء. •الصحة الإنسانية كموضوع لحوار الأديان و حوار الحضارات. •الأخلاقيات الحيوية : نحو أساس إنساني مشترك. •خاتمة : نحو تأسيس هيئة عالمية للأخلاقيات الحيوية.

As scientific progress in the realm of assisted reproduction and biotechnology continues to race ahead, the next revolutionary breakthrough on the horizon is the prospect of womb transplantation. Fertility doctors around the world are researching how to attain the first human pregnancy following a womb transplant. The world’s first human womb transplant was first attempted in Saudi Arabia in 2000 with some success . On the 9th of August 2011, the world’s second human womb transplant was performed in Turkey and thus far it has been considered to be a success, since the new uterus has been inside the recipient for more than 120 days without any complications. We await to see whether it can successfully carry a foetus to term.

The purpose of womb transplantation is to restore fertility to patients with an abnormal, damaged, or absent uterus. In the UK alone, it is estimated that approximately 15,000 women per year who seek the help of fertility specialists are found to be incapable of becoming pregnant because of uterine factor infertility. Even though these women may have functioning ovaries, the lack of a functioning womb means they have no chance of gestating their own child to term. The only other option for such woman to achieve genetic motherhood is via surrogacy. For Muslim women, surrogacy is regarded as prohibited in Islam and thus not an option. The possibility of womb transplantation would provide a welcome means by which these women could experience gestational and genetic motherhood. However, this advance raises a host of legal and bioethical questions that have thus far been relatively neglected in legal and Islamic and Western bio-ethical discourse. Should this “non-life-saving transplant” be permissible? Is it akin to the transplantation of any other major organ or does it raise separate and unique ethical questions? This presentation outlines the research currently underway into this advance and considers the legal, bio-ethical and regulatory ramifications this advance could raise.

Contemporary western bioethics is based on two predominant philosophical theories and their off shoots, viz

1-Utilitarianism:(utilis=useful) is an ethical theory holding that the proper course of action is the one that maximizes the overall happiness, first expounded by Jeremy Bentham (1748-1832) and expanded by his disciple John Stuart Mill (1806-1873) with many offshoots e.g. rule utilitarianism, act utilitarianism. The consequences of each act are more important than its motives. In fact, consequentialism depends on the consequences of the act, and if it brings benefit to the majority then it is a moral act, even if it infringes the rights of some, or even may cause harm to some, provided that the harm is not intended and that the benefit involved is much larger.

2-Deontology (deon=duty) is a moral philosophy which implies doing what we ought to do, whatever may be the consequences. Lying is never a virtue even if it is done to save an innocent man. This philosophy was expounded by Immanuel Kant (1724-1804), but there are many additions or deletions by modern Kantian Philosophers.

The Islamic perspective combines both theories with a completely different background. The Muslim attitude to morality and ethics is not limited to our life in this world but extends to the hereafter. Any act should aim to the appeasement of Allah (God), and hence should not in any way contradict a clear Islamic rule laid down in the Quran or the Sunna (sayings and acts of the prophet Mohammed).

The motive of each act is of paramount importance. The Prophet Mohammed (PBUH) said: “All actions will be judged by the intention (motive) of the person doing it. A person who migrates to Medina (1st Islamic city state) from Mecca (idol worshippers city), to marry a specific women or to get worldly gain, is not a Muhajir (a person who leaves his home, city or family for the sake of God). His intention rules over him.

Islamic jurists formulated the principle of public interest, maslaha. However, maslaha does not only imply the interest of the majority, but it has to be in line with the Islamic teachings. For example it can be argued breweries can employ thousands, provide income for many people and taxes will be levied to the benefit of the government, which will be spent on matters of public interest. Nevertheless, this maslaha is revoked and nullified, as Islam categorically forbids brewing, manufacturing, selling or imbibing of alcohol. The catastrophes that it brings about weigh heavier than its benefits.

The deontologist approach is accepted in Islamic teachings, yet the intent should be to please God and act fairly to others. The Islamic teachings are however not as categorical as the Kantian dogma, in which, lying is a vice and should not be committed even if it is done to save a human innocent life. According to Islamic teachings, virtues should be held high and practiced, unless real harm is going to befall an innocent person which could be avoided by a slight violation of the virtues. This paper discusses the different aspects of public interest (maslaha), the paradigms of telling the truth, and other virtues.

The achievements of the organ transplantation program in Saudi Arabia during the year 2011 reflected the progressive success in the number of organ donations and transplantations, but with escalating numbers of end stage organ failure patients awaiting transplantation. The organ failure census during 2011 showed more than 12,500 patients are on dialysis in 178 hospitals in the Kingdom of Saudi Arabia (KSA), and about 22.3% are on the active waiting list for transplantation, with another 20% being evaluated for inclusion in it. The KSA has an active deceased transplant program under the supervision of the Saudi Center for Organ Transplantation (SCOT). Clear policies have been laid down to facilitate diagnosis of death by brain function criteri, and the management of potential deceased donors. At the end of the year 2011, a total of 8820 possible deceased cases have been reported to SCOT, of which 710 were reported from 97 intensive care units around the Kingdom during that year. In the last five years, an average of 615 cases per year were reported. More energetic measures are still required to increase the number of reports of possible deceased cases, as well as obtaining consents. Only this will help bridge the gap between supply and demand of organs for more than 3000 patients in the active waiting list for organ transplantation. Inside the Kingdom by the end of 2011, renal transplantation have been performed from a total of 4830 living donors and 2349 deceased donors, of which 489 were transplanted in 16 active renal transplant centers. Also, liver transplations were performed from a total of 439 living donors and 620 deceased donors, in which 130 of them were transplanted in 4 active liver transplant centers. Whole heart transplantations have been performed from a total of 205 deceased donors; 540 were used as sources for heart valves, and 18 whole hearts were transplanted in one active heart transplant center, during that year. In addition, during that year, 19 lung transplant operations and two harvested pancreases were successfully transplanted. The consent for corneal donation was obtained from 43 eligible deceased organ donors, a result of 37 % of total consented cases. Finally, bone transplantations have been active since 2009. Although we still have to work harder to achieve the self-sufficiency of organ donation and transplantation, we believe we have made major strides towards this goal in the KSA, especially in the last year.

Through ethnography of Islamic legal debates over assisted reproduction in Lebanon, this paper reaffirms the need to place discussions of ‘Islamic bioethics’ within particular intellectual, social and political contexts. ‘Islamic bioethics’, as most commonly employed in academic discourse at least, serves as a term of art for Islamic legal (fiqhi) discussions of biomedical ethical issues. Such discussions in the first place are, in the context of the Shi‘i debates focused on here, responses to particular cases and queries on the part of comprehensive religious authorities (maraji‘ al-taqlid). Relative expertise in responding to such ‘contemporary’ issues is, amongst other things, a source of prestige and advancement in the highly politicised and competitive field of Shi‘i religious authority in Lebanon.

Incorporating such Islamic legal discourse into medical institutional or state legal regulation has proved problematic in this area in Lebanon. Such incorporation has occurred in other medical ethical areas in Lebanon and elsewhere. There is, then, a varied institutional and political topography that needs to be considered in any investigation of a putative instance of ‘Islamic bioethics’. The paper thus concludes with some critical comments with regards to the category, ‘Islamic bioethics’ itself. ‘Bioethics’ is a specialised discourse distinctive to late modern societies, as manifested in a variety of institutions with particular genealogies. If ‘Islamic bioethics’ is to refer to anything at all, it must refer not to instances of casuistic Islamic legal discourse but to emergent constellations of interrelation between Islamic legal, medical and state legal institutions.

Clinical ethics consultation is defined as a service provided by an individual or a group to help patients, families and healthcare providers, to address uncertainty or conflict regarding value-laden issues that emerge in healthcare. Currently, in many Western societies, healthcare providers and patient populations increasingly come from diverse religious and cultural backgrounds. In this situation, the practitioner and patient or even the clinical ethicist do not share a common moral perspective or the same set of values regarding health, disease, life and death. Culture and religion, give identity and shape people’s moral reasoning and responses; for example, while in Western societies, bioethics relies on human reason to find out what is right or wrong, in many other societies people turn to traditional or religious values to understand what constitutes moral conduct.

Given the fact that in many cases clinical ethics consultations are needed when there is a disagreement on a value-laden decision making, the question is how should a clinical bioethicist advise, and help patients, families and healthcare providers in decision making in a diverse, cultural and religious setting? In other words, when a clinical ethicist is bound to her/his own cultural and religious inclination(s), how can s/he ensure that professional approaches in resolving the conflict between physician and patient are unbiased? For example, how can a Muslim ethics consultant provide consultation about abortion for an 18 weeks pregnant woman, or providing clinical ethics advice to a homosexual patient?

By providing some examples such as the concept of individual autonomy, the importance of religious principles, the model of decision making in Islamic and non-Islamic context(s), this paper presents some of the challenging issues in which a Muslim clinical ethicist may face, while providing clinical ethics consultation in a non-Muslim society.

يقوم هذا البحث على فكرة إعمار الأرض بيد الإنسان، وأنه المسئول عن وضع البرامج والمناهج وتطويرها حتى الأخلاقيات بما يتفق والطبيعة الإعمارية بحيث لا يضار الإنسان بعلمه، ولا يحرم الإنسان من نتاج بحثه. أما الدين فهو شرع الله للإنسان يهديه إلى معرفة ما يعجز عن الوصول إليه إلا عن طريق الوحي من أمور الغيب والتكاليف العبادية، ويثبّته على الحق الذي أراه الله عند طريق الاجتهاد، ويبارك له خطوه في كل ابتكار يعود بالنفع على الإنسان مادياً ومعنوياً. وإذا كانت التقنيات الطبية والحيوية قد بلغت تقدماً مذهلاً يكاد يكشف أسرار الإنسان في مستقبله الصحي التي كانت تعد قبل دراسة الجينوم غيباً، فإن الحاجة الإنسانية إلى ضبط تلك المعرفة والتحكم في توظيفها صار ضرورة أخلاقية لإنقاذ مستقل الإنسان من نفسه، وبقناعة ذاتية دون سلطة قانون يكون عرضة للاحتيال. لذلك كان من الواجب على ذوي الشأن وأهل الاختصاص من جميع النخب الطبية والبحثية والدينية والفكرية أن تتعاون على تفعيل الدعوة على "الأخلاقيات الحيوية" التي نادى بها أول من نادى "جيمس واطسن" سنة 1971 م، واستجابت لها المنظمات الدولية والجامعات العلمية والمراكز البحثية. وكأني برسول الله  يباركها، لما أخرجه البيهقي عن طلحة بن عبد الله بن عوف، أن النبي  قال: "لقد شهدت في دار عبد الله بن جُدعان حلفاً ما أحب أن لي به حمر النعم، ولو أُدعى به في الإسلام لأجبت". قال الطبري في تهذيب الآثار : وهذا هو حلف الفضول الذي شهده الرسول  قبل أن يبعث نبياً، وهو الحلف الذي تعاقده بنو هاشم وبنو عبد المطلب وبنو أسد بن عبد العزى وبنو زهرة وبنو تيم بن مرة، على أن لا يدعوا بمكة مظلمة إلا ردوها. إن من أهم الأخلاقيات الحيوية : ما قدمه إريك لاندر بمناسبة البصمة الوراثية، وهو القبول العام لأهل الاختصاص، والموضوعية، والوقوف على طبيعة عدة التقنية والحذر من التكنولوجيا المتطورة.، وإن منها : ما اقترحه مشروع القانون المصري لضوابط أخلاقيات البحوث الطبية والإكلينيكية، تحت الاعتماد : التنسيق بين المبادئ الأخلاقية الدولية، وتقييم المخاطر بأقصى دقة، والاعتماد في الموافقة البحثية على الاستنارة دون إكراه أو إغراء، وعلى احترام كرامة الإنسان منذ بداية تكوينه وسرية بياناته، وأن تكون الجهة البحثية على درجة عالية من التجهيز وتوفر الخبرات، وأن يتم التأمين على المبحوثين لتوفير الرعاية الطبية أثناء الدراسة أو بعدها. ويجب وفقاً لقواعد العقل وأصول الدين أن تعطى الوسائل حكم المقاصد، فالغاية لا تبرر الوسيلة، ويقدم درء المفاسد على جلب المصالح إلا عند اختلاطهما وتعارضهما فيؤخذ بأهون المفسدتين وأعظم المصلحتين. أخرج مسلم عن جابر بن عبد الله، قال: لدغت رجلاً منا عقرب، ونحن جلوس مع رسول الله ، قال الرجل: يا رسول الله. أرقى؟ قال: "من استطاع منكم أن ينفع أخاه فليفعل". وقال تعالى: وافعلوا الخير لعلكم تفلحون (الحج :77).