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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0004-GENERAL SYSTEMIC CONDITIONS

Background reading material for medicine & fiqh panel discussion held on 1st April 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA by Professor Omar Hasan Kasule Sr.

OUTLINE

14.1.1 PATHO-PHYSIOLOGICAL DISTURBANCES

A. Non-Specific Conditions Affecting Whole Body

B. Localised Conditions With Systemic Effects

C. Endocrine

D. Metabolic

E. Others

 

14.1.2 INFECTION

A. Contagious Infections And Social Obligations

B. Contagious Conditions And Religious Obligations

C. Epidemic Diseases

D. Sexually Transmitted Disease:

E. Environmental Sanitation

 

14.1.3 NEOPLASIA

A. Risk Factors/Exposures

B. Primary Prevention

C. Secondary Prevention:

D. Treatment Side Effects Vs Quality Of Life

E. Genetic Aspects Of Cancer

 

14.1.4 GENETIC and IMMUNOLOGIC

A. Pre-Nuptial Genetic Testing And Advice

B. Pre-Natal Genetic Screening

C. Marriage Of Close Relatives

D. Treatment By Genetic Engineering

E. Systematic Social Discrimination

 

14.1.5 TRAUMATIC INJURY

A. Types, Causes And Pathophysiology

B. Prevention

C. Management

Legal Liabilities For Accidental Injuries

E. Legal Liability For Work-Related Injuries 

 

14.1.1 PATHO-PHYSIOLOGICAL DISTURBANCES

A. NON-SPECIFIC CONDITIONS AFFECTING WHOLE BODY

POOR GENERAL CONDITION

General ill feeling and general weakness: Non-obligatory duties are delayed until there is physical and mental good feeling. Three obligatory physical acts of ibadat may be affected: salat, saum, hajj.

 

Salat: Concentration in salat may be difficult; this is however not a valid excuse for delaying salat. Salat is delayed only if a person is not physically able to perform the physical acts. The physically disabled is allowed to pray sitting down, yuswalli jaalisan (KS 310-311: Bukhari K8 B18, Bukhari K18 B17-20, Bukhari K19 B16, Bukhari K22 B9, Bukhari K75 B12, Muslim K4 H77-84, Muslim K6 H107-120, Muslim K6 H107-120, Abudaud K2 B68 & B174, Tirmidhi K2 B150 & B158, Nisai K10 B17 & B40, Nisai K20 B18, B19, B22; Muwatta K8 H16, H17, H21-23; Tabaqaat J2 Q2 P16, Musnad Zayd K235, 241; Ahmad. .., Tayalisi H1519, H1609, H2090). The reward of the person praying while sitting down is the same as that of the person praying standing up, ajr man salla jaalisa ka ajr man salla qaimat (KS 311: Bukhari K18 B17 & B18; Abudaud K2 B174; Tirmidhi K2 B157; Nisai K20 B20-21; Muwatta K8 H19; Ibn Majah K5 B141; Darimi K2 B108; Ahmad 2:162, 192, 201, 203, 233; Ahmad 3:136, 214, 240, 425; Ahmad 4:433, 435, 442; Ahmad 6:61, 62, 71, 220, 221, 227; Tayalisi H 2289, Hisham p. 414). If the sitting position is not possible salat is allowed while lying on the side, al salat ala al janb (KS 311 Bukhari K18 B17; Abudaud K2 B174; Tirmidhi K2 B157; Ibn Majah K5 B139; Ahmad 4:426, 433).

 

Saum: Exemptions on fasting are allowed only if there is potential physiological harm when the exemption for the sick operates, rukhsat al iftaar li al mariidh (KS 334).

 

Hajj: Hajj is a physical burden and special considerations are given to the weak for example they are allowed to move before the others to avoid being pushed, taqdiim al dha’afat (KS 183).

 

Travel: Travelling is both a physical and a mental stress. It leads to fatigue and exhaustion. The prophet described it as a type of punishment. An exemption is given to shorten salat (KS 278-279: Bukhari K18 B1, B5, B11; Bukhari K64 B52; Muslim K6 H5-H16; Abudaud K4 B1, B2; Tirmidhi K4 B39; Nisai K5 B12, B20; Nisai K15 B1-B3; Nisai K22 B50, B51, B62; Ibn Majah K5 B73; Ibn Majah K7 B12; Darimi K2 B179, B180; Darimi K4 B16; Muwatta K9 H7, H8, H10-18; Tabaqat J2 Q1 p103; Ahmad 1;30, 215, 226, 237, 241, 243… Tayalisi…. ). The person may however choose to fast or may choose to take the exemption (KS 330).

 

FEVER:

Salat: High fever may be reason for delaying salat because of generalized weakness

 

Saum: Fasting with high fever aggravates dehydration

 

Hajj:

 

BODY WEIGHT

Fasting: Nafilat fasting is highly recommended for the obese and in cases of rapid gain of weight. It is discouraged for the under-weight. IN cases of extreme malnutrition, cachexia, obligatory fasting may have to be delayed.

 

Salat: The Obese cannot perform the physical acts of salat comfortably

 

Jihad: the very obese and the cachectic may not be able to undertake jihad

 

Sexual activity: extreme forms of obesity interfere with sexual function

 

FATIGUE & EXHAUSTION

Salat: Situations of extreme fatigue may necessitate delay of salat.

 

Saum: may also have to be made up if it will aggravate the health situation.

 

Hajj: physical cats like tawaaf may have to be rescheduled. However effort must be made to be in Arafat on the appointed day because being in Arafat is a pillar of hajj.

 

Chronic fatigue syndrome: is a state of permanent lack of energy. Its exact cause is unknown.

 

TEMPERATURE

Salat: Salat is delayed on a hot day until the temperature cools down to what is reasonable, ta ajiil al salat li shiddat al bard (KS 315). Salat on cold nights was described in books of hadith, al salat fi al layl al baridat (KS 317). On cold days tayamum may have to be done even if water is available.

 

Saum: Permission is given to cool oneself in Ramadhan, rukhsat al tabarrud fi Ramadhan (KS 333). Exemption may have to be taken to break the fast on extremely hot days because of the danger of dehydration. Fasting in winter was described in books of hadith, al saum fi al shitaa (KS 326). Saum on cold days also has its physiological effects. The cold results into loss of more heat that requiring metabolising more food to maintain body temperature. There is dehydration in extreme cold because of the dry air.

 

Hajj: Heat stroke in hajj. Tawaaf and standing in Arafat.

Cold: wudhu and ghusl on a cold day, salat on a cold day

 

ALTITUDE

Salat: Salat on high mountains may be difficult because the rarefied atmosphere has low oxygen concentration. Salat in weightless space?

 

Saum: Saum at high altitudes? Saum in space?

 

B. LOCALISED CONDITIONS WITH SYSTEMIC EFFECTS

PAIN: HEADACHE, BACKACHE

Salat: Salat in severe headache such as migraine. Salat with back-pain: acute or chronic. Skin conditions leading to itching all the time that disturbs salat. Anginal attacks during salat. Salat and arthritic pain.

 

Saum: need for constant medication due to chronic pain

 

Hajj: Tawaaf and sa’ay

 

COLD INJURY

Salat: Wudhu in the extreme cold may aggravate peripheral vascular disease. The floor may be too cold to stand during prayer. It is allowed to pray wearing sandals or khuff (KS 312: Bukhari K8 B24-25, Bukhari K77 B37, Muslim K5 H60, Abudaud K2 B88 & B89; Tirmidhi K2 B176; Nisai K9 B23 & B24; Ibn Majah K5 B66; Darimi K2 B103; Ahmad … Tayalisi H39, H1109, H1357, H2123, H2154, and H2595).

 

Saum: In extreme cold the loss of heat must be compensated by increased food intake. A fasting person may not have enough food intake to generate sufficient heat for maintaining body temperature.

 

HEAT INJURY

Salat: The floor may be too hot to stand on in prayer. It is allowed to pray in sandals. It is allowed to pray wearing sandals or khuff (KS 312: Bukhari K8 B24-25, Bukhari K77 B37, Muslim K5 H60, Abudaud K2 B88 & B89; Tirmidhi K2 B176; Nisai K9 B23 & B24; Ibn Majah K5 B66; Darimi K2 B103; Ahmad … Tayalisi H39, H1109, H1357, H2123, H2154, and H2595).

 

LIGHT INJURY

Salat: praying in the open exposes the person to ultra-violet rays that have harmful effects. It is recommended to pray inside a house or to use a shelter.

Hajj: Photodermatitis in hajj

 

C. ENDOCRINE

DIABETES MELLITUS:

Salat: Eye complications leading to blindness and inability to go for congregational salat. Foot complications and ulceration and standing or sitting in salat.

 

Fasting: There is a difference between insulin dependent and non-insulin dependent diabetes. Insulin-dependent diabetics have to reduce their insulin dose because of reduced food intake during the day. In some cases this is not possible and they have to be exempted from fasting. Diabetic control is more difficult in pregnant women making fasting doubly hazardous.

 

ADDISON’S DISEASE

 

CONN'S DISEASE:

Primary hyperaldosteronism

 

CUSHING SYNDROME:

Excessive cortisol

 

PITUITARY

 

THYROID: hyperthyroidism

 

PATHYROID: hyperparathyroidism

 

PANCREAS: insulinoma secreting insulin & gastrinomas secreting gastrin which raises stomach HCL

 

PHEOCHROMOCYTOMA

 

D. METABOLIC

 

E. OTHERS

Chronic physical disability/handicap

 

14.1.2 INFECTION

A. CONTAGIOUS INFECTIONS AND SOCIAL OBLIGATIONS

Duties of brotherhood: In cases of contagious disease with possibility of cross-infection, some duties of brotherhood may have to be modified. For example a sick person may not visit others and others may not visit him.

 

Family life: The need to isolate a patient with infectious disease may interfere with normal family interaction and fulfillment of duties but is a medical necessity. Discovery of a chronic infectious disease after marriage, man tazawwaja imra at wa biha judhaam (KS 550).

 

Discrimination: AIDS, leprosy, and STD may be grounds for illegal social isolation and discrimination. Kindness is required but precautions must be taken to avoid spreading infection.

 

B. CONTAGIOUS CONDITIONS AND RELIGIOUS OBLIGATIONS

Hajj: The congregation of millions of people in a small place has all the ingredients for a major epidemic. People coming from different parts of the world may be highly susceptible to certain diseases because they have no immunity. It may therefore be necessary to exclude infectious persons from performing the rites of hajj for protecting public health.

 

Salat al jama: Infectious persons should not attend congregational prayers in the mosque. It is offensive for them to attend salat al nafilat like salat an eid and salat al taraweeh.

 

C. EPIDEMIC DISEASES

Restriction of freedom of movement & quarantine: The prophet taught that when plague afflicts a place, people should not leave and those outside should not enter it to control the epidemic. Omar Ibn al Khattab did not enter Syria when he was told that it had an epidemic of plague.

 

Obligatory mass immunization: If the state sees that mass immunization is needed to control an epidemic it may order all citizens to be immunized.

 

Forced treatment or prophylaxis:

 

Destruction of property eg animals to prevent disease spread

 

Forced movement: People may have to be moved from an area of endemic or epidemic disease transmission

 

D. SEXUALLY TRANSMITTED DISEASE:

Pre-marital screening: In areas with endemic infectious diseases, premarital screening may be made obligatory to protect the infants.

 

Refusal of conjugal rights: A wife could refuse co-habitation with the husband if there is valid fear of catching infectious disease. This cannot be grounds for a case of nushuuz in the courts.

 

Discovery of STD and zina: Incidental finding of STD in an unmarried person is not grounds for conviction for zina because of uncertainty, shakk.

 

Discovery of STD and divorce: Discovery of STD can similarly not be legal grounds for seeking divorce or khulu’u on the basis of adultery.

 

Legal liability: Can a spouse be legally liable for medical complications due to STD transmitted

 

E. ENVIRONMENTAL SANITATION

Personal hygiene:

Food hygiene:

Excreta disposal:

Waste disposal:

 

14.1.3 NEOPLASIA

A. RISK FACTORS/EXPOSURES

Carcinoma of the breast: Late age at first pregnancy is associated with a higher risk. Breast feeding is protective.

 

Basal cell carcinoma of the skin: unprotected sun exposure

 

Squamous cell carcinoma: chronic irritation

 

Melanoma: sun exposure.

 

Carcinoma of the cervix: Risk related to genital hygiene

 

B. PRIMARY PREVENTION

Legislation on tobacco and its products: Physicians argue that the evidence that tobacco causes cancer is now beyond the level of ghalabat al dhann and is yaqeen. Many jurists are reluctant to issue a fatwa that tobacco is haraam and they go as far as declaring it makruuh. On the basis of established disease causation, there is legal liability on tobacco companies for people who are afflicted by tobacco-related disease.

 

Legislation on food: Scientific evidence shows that diet is involved in many human diseases but the evidence does not reach the level of yaqeen. High fat and low lipid diets are associated with high risk of ischemic heart disease and cancer. Individual diets at home can not be regulated by law but institutional diets must be regulated. Parents can be held liable for malnutrition in their children due to negligence.

 

Legislation on environmental causes: Sources of pollution in the environment can be controlled by Law

 

Hygiene and cervical cancer: Poor hygiene is thought to be the main risk factor in cervical carcinoma. This makes it obligatory on the state to supply clean water to the citizens.

 

Regulation of menarche and menopause: breast and ovarian cancer are related to hormonal exposures related to the female menstrual cycle.

 

C. SECONDARY PREVENTION:

Obligatory early screening of those at high risk

Surgical treatment of screen-detected disease

 

D. TREATMENT SIDE EFFECTS VS QUALITY OF LIFE

Decision to treat advanced disease

Balance of benefit and harm

Radical mastectomy and sexual attraction

Effect of prognosis on validity of business contracts

Gene therapy

Gene engineering

The human genome project

 

GENETIC ASPECTS OF CANCER

 

14.1.4 GENETIC and IMMUNOLOGIC

A. PRE-NUPTIAL GENETIC TESTING AND ADVICE

Results of genetic testing as a basis for refusing marriage

Results of genetic testing as a basis for refusing pregnancy

 

B. PRE-NATAL GENETIC SCREENING

Amniocentesis for sex selection

Amniocentesis for disease detection: pros and cons

 

C. MARRIAGE OF CLOSE RELATIVES

Balance of disease risk due to consanguinity and social advantages of marrying within the family

 

D. TREATMENT BY GENETIC ENGINEERING

Permissibility of change of fitra

Gene therapy

Gene engineering

The human genome project

 

E. SYSTEMATIC SOCIAL DESCRIMINATION

Discrimination based on gene profile for disease

False scientific basis for racial discrimination

 

14.1.5 TRAUMATIC INJURY

A. TYPES, CAUSES and PATHOPHYSIOLOGY

Causes: blunt injury (90% of cases), penetrating injury, burns (thermal, chemical, electrical), bites (animal and human). Road Traffic accidents are an increasing cause of injury.

 

Pathophysiologic response to injury: metabolic, adult RDS, shock, coagulopathy, multi-organ dysfunction syndrome, neuropathophysiology, spinal injuries, fractures, peripheral nerve injury, fat emboli, wound healing (primary and secondary. Inflammatory phase, proliferation phase, maturation phase); burns. Infectious complications.

 

Trauma to the skin: lacerations, abrasions, open wounds, and contusions.

 

Trauma to the chest: flail chest due to fracture of ribs, open pneumothorax, tension pneumothorax (due to air leakage into the pleural cavity), hemothorax, cardiac tamponade, aortic rupture

 

Trauma to the abdomen: hemoperitoneum, penetrating wounds, blunt trauma

 

Trauma to the extremeties:

 

Trauma to CNS: coma, spinal injuries

 

Burn injury: Burns can be thermal, chemical, or electric. Primary degree involves only the epidermis. Secondary degree involves the dermis. Third degree involves all the skin and subcutaneous fat. Consequences of burns: hypovolemia and infection. Management of burn injury involves: resuscitation, nutrition, infection control, and care of the wound.

 

B. PREVENTION

LEGISLATION: engineering, alcohol and drugs

 

EDUCATION: human behavior

 

C. MANAGEMENT

IBADAT

Wounds and wudhu. A patient with injury could have another one pour water for him (KS 581). Wudhu of a person with profuse bleeding, wudhu man ghalabahu al ddam min jurhi aw zi’aaf (KS 568). If there is a wound that prevents use of water, you can rub with wet fingers on the bandage. Wiping on leather socks, al mash ala al khufayn (KS 581). Wiping on socks, al mash ala al jabair (KS 581).

 

Wounds and ghusl: If a person with major impurity, janabat, fears harm from use of water he can make tayammum (KS 146, KS 415). Tayammumm in place of ghusl for the sick, al tayammum badal al ghusl fi haalat al maradh (KS 412, KS 413)

Burns and salat

Disability and salat

Disability and jihad

 

MUNAKAHAAT

Impotence in paraplegia

 

MU’AMALAAT

Employment of the disabled

 

AADAAT

Food with disability

Drink with disability

 

LEGAL LIABILITIES FOR ACCIDENTAL INJURIES

 

DISCUSSION

 

NON-SPECIFIC CONDITIONS AFFECTING THE WHOLE BODY

Salat with general feeling of ill-health

Exemptions of salat and fasting on a non-exhausting and comfortable journey

Fasting with high fever causing dehydration

Fasting ramadhan for the under-weight or malnourished person

Fasting nafilat for the under weight

Salat for the extremely obese

Sexual function for the obese

Salat in situations of fatigue but with physical ability to pray on exertion

Salat and the chronic fatigue syndrome

Salat on an extremely hot day

Wudhu and salat on a very cold day

Saum in extreme heat

Saum in extreme cold

Salat at high altitudes with low oxygen

Fasting for a diabetic on oral  hypoglycemics

Fasting for a diabetic dependent on insulin

 

INFECTIONS/CONTAGION

Visiting a person with a contagious disease

Isolation of persons with contagious disease

Discovery of a contagious disease in a spouse after marriage

Discrimination of people with contagious diseases like HIV, leprosy etc

Excluding persons with contagious disease from congregational salat

Excluding people with contagious disease from hajj

Sharia basis for imposing a quarantine in times of an epidemic

Sharia basis for measures to contain an epidemic such as mass immunization, forced treatment or prophylaxis, destruction of property, and forced movement of people

Sharia basis for obligatory pre-marital screening for infectious disease

Refusal of conjugal rights for fear of sexually transmitted disease

Diagnosis of sexually transmitted disease as a basis for zina conviction

Sexually transmitted disease in a spouse as a basis for divorce or khul'u

Legal liability of a spouse for medical complications of sexually transmitted disease

 

NEOPLASIA

Ruling tobacco use as haram because of definitive evidence of cancer causation

Rulings on institutional diets based on scientific evidence of disease causation

Rulings on home diets based on scientific evidence of disease causation

Ruling on obligatory screening for cancer

Effect of disease prognosis on validity of commercial contracts

 

GENETICS & IMMUNOLOGY

Pre-nuptial genetic testing and counseling

Genetic testing and counseling for married couples and decisions on child bearing

Pre-natal genetic screening

Marriage of close relatives

Gene therapy and gene engineering

The Human genome project

 

TRAUMATIC INJURY

Wudhu and ghusl with wounds

Physical disability/handicap and salat

Impotence in paraplegia: issues of marriage and divorce

Employment of the physically handicapped

Physical handicap in leadership

ęCopyright Professor Omar Hasan Kasule, Sr April 2000