Islamic Law is comprehensive. It is a combination of moral and positive laws. Secularized European law denies moral considerations associated with ‘religion’. Its failure
to solve issues in modern medicine that required moral considerations led to the birth of the discipline of medical ethics.
Muslims did not historically develop a special discipline on medical ethics because ethical and moral issues are encompassed
within Islamic Law. Concern with moral issues in medicine increased in the recent past due to new medical technology and increase
in moral violations by medical practitioners.
As recently as the early 1970s M, Beauchamps and Childress wrote authoritatively about ethical theory and ethical principles from the European
perspective. European Ethical principles have also been enunciated in several international documents such as Declaration
of Geneva, International Code of Medical Ethics, Declaration of Tokyo, Declaration of Oslo, and Declaration of Helsinki. Muslims
did not need to publish any new declarations because principles of legal medicine are found within the Islamic Law since Islamic
incorporates moral principles directly applicable to medicine. The Europeans are now beginning to turn to the Islamic approach
because laws made in many parliaments establish ethical principles and practices once again bringing ethics and morality within
the law where they were supposed to be from the start.
There are three European approaches to ethical analysis: normative (what ought to be done) or practical (what most
people do), and non-normative (what is actually going on). Europeans have a problem dealing consistently with moral issues
after removing religion from public life over the past 5 centuries of secularism. Morality became communal consensus about
what is right and what is wrong. Thus ethics became relative and changeable with change of community values. European law
does not follow a consistent moral guideline. It does not automatically ban all what is immoral and does not automatically
permit all what is moral.
There is no one coherent European theory of ethics because historically there was unifying underlying moral background. Beauchamp and Childress listed eight
European ethical theories2 none of which can on its own explain all ethical or moral dilemmas. These theories can
be listed as the utilitarian consequence-based theory, the Kantian obligation-based theory, the rights-based theory based
on respect for human rights, the community-based theory, the relation-based theory, and the case-based theory. They also enunciated
4 basic European ethical principles: autonomy, beneficence, non malefacence, and justice. As explained below, we shall see
that Islamic theories and principles of ethics are easier to understand and are more comprehensive because of deriving from
one underlying divine moral basis.
Morality in Islam is absolute and is of divine origin. The Law is the expression and practical manifestation of morality. It automatically bans all immoral actions as haram
and automatically permits all what is moral or is not specifically defined as halal.
The Islamic approach to ethics is a mixture of the fixed absolute and the variable. The fixed and absolute sets parameters
of what is moral. Within these parameters, consensus can be reached on specific moral issues. Islam considers medical ethics
the same as ethics in other areas of life. Islamic medical ethics is restating general ethical principles using medical terminology
and with medical applications. The ethical theories and principles are derived from the basic law but the detailed applications
require further ijtihad by physicians.
Islam has a parsimonious and rigorously defined ethical theory of Islam based on the 5 purposes of the Law, maqasid
al shari’at. The five purposes are preservation of ddiin, life, progeny, intellect, and wealth. Any medical action
must fulfill one of the above purposes if it is to be considered ethical.
The basic ethical principles of Islam relevant to medical practice are derived from the 5 principles of the Law are:
intention, qasd; certainty, yaqeen; harm, dharar. The Islamic principles are wider in scope and deeper
than the European principles.
THE ISLAMIC ETHICAL THEORY (also called THE 5 PURPOSES OF MEDICINE)
Protection of ddiin, hifdh al ddiin: This essentially involves ‘ibadat
in the wide sense that every human endeavor is a form of ‘ibadat. Thus medical
treatment makes a direct contribution to ‘ibadat by protecting and promoting
good health so that the worshipper will have the energy to undertake all the responsibilities of ‘ibadat. Medical treatment to restore balanced mental health is necessary for understanding ‘aqidat and avoiding false ideas that violate ‘aqidat.
Protection of life, hifdh al nafs:The primary purpose
of medicine is to fulfill the second purpose of the shari’at, the preservation
of life, hifdh al nafs. Medicine cannot prevent or postpone death since such matters
are in the hands of Allah alone. It however tries to maintain as high a quality of life until the appointed time of death
arrives. Medicine contributes to the preservation and continuation of life by making sure that the nutritional functions are
well maintained. Medical knowledge is used in the prevention of disease that impairs human health. Disease treatment and rehabilitation
lead to better quality health.
Protection of progeny, hifdh al nasl: Medicine contributes
to the fulfillment of this function by making sure that children are cared for well so that they grow into healthy adults
who can bear children. Treatment of infertility ensures successful child bearing. The care for the pregnant woman, perinatal
medicine, and pediatric medicine all ensure that children are born and grow healthy. Intra-partum care, infant and child care
ensure survival of healthy children.
Protection of the mind, hifdh al ‘aql: Medical
treatment plays a very important role in protection of the mind. Treatment of physical illnesses removes stress that affects
the mental state. Treatment of neuroses and psychoses restores intellectual and emotional functions. Medical treatment of
alcohol and drug abuse prevents deterioration of the intellect.
Protection of wealth, hifdh al mal: The wealth of any
community depends on the productive activities of its healthy citizens. Medicine contributes to wealth generation by prevention
of disease, promotion of health, and treatment of any diseases and their sequelae. Communities with general poor health are
less productive than a healthy vibrant community.
THE ISLAMIC ETHICAL PRINCIPLES
The principle of intention, qa’idat
al qasd: This principle comprises several sub principles. The sub principle
that each action is judged by the intention behind it calls upon the physician to consult his inner conscience and make sure
that his actions, seen or not seen, are based on good intentions. The sub principle that what matters is the intention and
not the letter of the law rejects the wrong use of data to justify wrong or immoral actions. The sub principle that means
are judged with the same criteria as the intentions implies that no useful medical purpose should be achieved by using immoral
The principle of certainty, qaidat al yaqeen: Medical diagnosis does cannot reach the legal
standard of yaqeen. Treatment decisions are best on a balance of probabilities.
Each diagnosis is treated as a working diagnosis that is changed and refined as new information emerges. This provides for
stability and a situation of quasi-certainty without which practical procedures will be taken reluctantly and inefficiently.
Existing assertions should continue in force until there is compelling evidence to change them. All medical procedures are
considered permissible unless there is evidence to prove their prohibition.
The principle of injury, qaidat
al dharar: Medical intervention is justified on the basic principle that
injury, if it occurs, should be relieved. An injury should not be relieved by a medical procedure that leads to an injury
of the same magnitude as a side effect. In a situation in which the proposed medical intervention has side effects, we follow
the principle that prevention of harm has priority over pursuit of benefit of equal worth. If the benefit has far more importance
and worth than the harm, then the pursuit of the benefit has priority. Physicians sometimes are confronted with medical interventions
that are double edged; they have both prohibited and permitted effects. The guidance of the Law is that the prohibited has
priority of recognition over the permitted if the two occur together and a choice has to be made. If confronted with 2 medical
situations both of which are harmful and there is no way but to choose one of them, the lesser harm is committed. A lesser
harm is committed in order to prevent a bigger harm. In the same way medical interventions that in the public interest have
priority over consideration of the individual interest. The individual may have to sustain harm in order to protect public
interest. In the course of combating communicable diseases, the state cannot infringe the rights of the public unless there
is a public benefit to be achieved. In many situations, the line between benefit and injury is so fine that salat al istikharat is needed to reach a solution since no empirical methods can be used.
Principle of hardship, qaidat al mashaqqat: Medical interventions
that would otherwise be prohibited actions are permitted under the principle of hardship if there is a necessity. Necessity
legalizes the prohibited. In the medical setting a hardship is defined as any condition that will seriously impair physical
and mental health if not relieved promptly. Hardship mitigates easing of the shari’at
rules and obligations. Committing the otherwise prohibited action should not extend beyond the limits needed to preserve the
Purpose of the Law that is the basis for the legalization. Necessity however does not permanently abrogate the patient’s
rights that must be restored or recompensed in due course; necessity only legalizes temporary violation of rights. The temporary
legalization of prohibited medical action ends with the end of the necessity that justified it in the first place. This can
be stated in al alternative way if the obstacle ends, enforcement of the prohibited resumes. It is illegal to get out of a
difficulty by delegating to someone else to undertake a harmful act.
The principle of custom or precedent, qaidat al urf: The standard of medical care is defined by custom. The basic principle is that custom or precedent has legal force.
What is considered customary is what is uniform, widespread, and predominant and not rare. The customary must also be old
and not a recent phenomenon to give chance for a medical consensus to be formed.