14.1.1 PATHO-PHYSIOLOGICAL DISTURBANCES
A. Non-Specific Conditions Affecting Whole Body
B. Localised Conditions With Systemic Effects
A. Contagious Infections And Social Obligations
B. Contagious Conditions And Religious Obligations
C. Epidemic Diseases
D. Sexually Transmitted Disease:
E. Environmental Sanitation
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
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
Salat: High fever may be reason for delaying salat because of generalized weakness
Saum: Fasting with high fever aggravates dehydration
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.
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
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
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.
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
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.
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.
PANCREAS: insulinoma secreting insulin & gastrinomas secreting gastrin which raises stomach HCL
Chronic physical disability/handicap
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
A. RISK FACTORS/EXPOSURES
Carcinoma of the breast: Late age at first pregnancy is associated with a higher risk. Breast feeding is
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
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
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.
LEGISLATION: engineering, alcohol and drugs
EDUCATION: human behavior
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
Impotence in paraplegia
Employment of the disabled
Food with disability
Drink with disability
LEGAL LIABILITIES FOR ACCIDENTAL INJURIES
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
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
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
Wudhu and ghusl with wounds
Physical disability/handicap and salat
Impotence in paraplegia: issues of marriage and divorce
Employment of the physically handicappedPhysical handicap in leadership