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Islamic
Medical Ethics




                 1
Islam is the Youngest
                        2nd Largest Religion
                       Every 5th person worldwide




Judaism    Hinduism   Buddhism   Christianity   Islam




 2000 BC    1000 BC    563 BC      33 AD        610 AD       2008
                                                         2
Spiritual
         Religion     Care

         Muslim
         Patient

Values                Beliefs
                                3
Islamic Law and Rules
The Holy Book               Quran
(Hadith), words or
actions of the prophet
                            Sunnah

(Ijma) of the Clerics      Consensus

(Ijtihad) personal study    Wisdom
                                    4
Values:                Regulates:
Honor parents          Marriage
Be kind to neighbors   Divorce
Protect the weak       Inheritance
Give to the poor       Business

          The Qur’an
       Forbids:        Condemns:
       Gambling        Murder
       Pork            Stealing
       Alcohol         Lying
       Prostitution    Adultery
                                     5
Oneness of God
                        All can, no body or sex


 Life after Death                            Angels of God
 Sorting to Hill or Paradise                 From light to serve God


                Internal
                          Prophets of God
                 Beliefs From Adam to Mohammed
Day of Judgment
    Rise of humanity

                                        Books of God
         Divine Decree                  Of Abraham, David,
            Fate set in advance        Moses, Jesus, Mohammed
                                                                6
Health, Religion & Ethics

 Contraception    Brain Death

 Fertility        Organ Donation

 Cloning          Euthanasia

 Medications      Death

 Resuscitation    Life after Death

                                       7
The Sharia Law System
   Category    Arabic        Do it          Not do it
Obligatory      Fard
                Wajeb        Reward        Punishment
(Prescribed)
Recommended    Mustahab
               Mandub        Reward       No Punishment
(Desirable)
Permitted       Mubah
                Halal      No Reward      No Punishment
(Allowed)
Discouraged    Makruh
               Manboth    No Punishment      Reward
(Disliked)
Forbidden      Haraam
               Mahd’ur     Punishment      No Reward
(Prohibited)                                          8
Forbidde
      Enforcing of not
        n
          Doing
                         Maslow
     Discourage
          d
 Urging of not Doing
                          Way
   Permitted
 Choice of Doing

Recommended
Urging of Doing

 Obligatory
Enforcing of Doing
                              9
5 Pillars
                                                       5 Pillars
Obligatory
                                                                  1-9
                                                                   1-9



                                               Testimony
                                               Testimony
    Pilgrimage
    Pilgrimage                                  of Faith
       Hajj                                      of Faith
       Hajj                                     Shahadah
                                                Shahadah

              External
  Charity     Beliefs                               Prayer
  Charity            (Ibada)                        Prayer
   Zakat
   Zakat                                             Salat
                                                     Salat


                  Fasting
                  Fasting
                      Sawm
                      Sawm

              © Copyright 1995 Prentice Hall                 10
Recommended

 Blood and organ donation. (giving and receiving).
 Circumcision of male infants (7th day). Controversy
  of female circumcision.
 Breast feeding (two years).
 Human skin bank: lawful for medical grafting and
  unlawful for cosmetics and misleading others.


                                                 11
Permitted
 Autopsy: if for medically or by law indicated.
 Reconstructive Surgery (post mastectomy).
 Do Not Resuscitate order: when the treatment
  becomes futile.
 Withdrawal or withheld therapy is permitted in
  brain death.
 Genetic Engineering: to alter or cure diseased genes.
 Abortion: pregnancy that risk the mother’s health,
  physically or mentally.
                                                   12
Permitted
 Contraception: Islam approves all methods of
  contraception between husband and wife which are
  not harmful, are reversible and are not causing
  abortion.
 Artificial insemination: when using the husband’s
  sperm and the wife’s ovaries and uterus.
 Death of one of the spouse terminates the marriage
  contract on earth, thus frozen sperm from husband
  can not be used.
                                                 13
Discourage

 Forced feeding the sick.
 Smoking
 Divorce
 Elective abortion before age 120 days
  (some sects before 40 days).

                                    14
Forbidden
 Surgical contraception: (Sterilization: Vasectomy &
  tubal ligation). Permitted for mentally sick or when
  another pregnancy risks mother’s life.
 Sperm or ova donation.
 Fetal Sex Determination.
 Elective abortion in a healthy mother 120 days after
  fertilization.
 Human milk bank.
 Human cloning (permitted for tissues and organs).
                                                15
Forbidden
 Surrogacy Uterus: Surrogacy involving a third person
  is not permissible. (even if the woman involved is
  another wife of the husband).
 Sex: Oral sex, homosexual and gay/lesbian relation,
  prostitution and sex outside marriage.
 Cosmetic surgery: Changing the creation of Allah.
 Food: not Halal meat, of pork or dead animal/bird.
 Drink: alcohol.
 Others: interest, theft, gambling and drugs.
                                                  16
Forbidden
 Active Euthanasia: voluntary, non-voluntary and
  Involuntary are not permissible under any
  circumstances.
 Passive euthanasia: treatment is not obligatory when
  there is no hope of survival (brain death). Patient
  should be provided with food, drink, nursing, and
  relief from pain until death.
 Suicide: include assisted suicide and physician’s
  assisted suicide.
 Murder. "take not life which Allah has made sacred" Qur’an 6:151.17
Principles of Medical Ethics

 Necessity overrides prohibition (insulin from
  pork, medications with alcohol).
 Remove harm at every cost if possible (quit
  smoking, risk factors, disease therapy).
 Accept the lesser of two harms if both cannot be
  avoided (abortion in risk to the pregnant woman).
 Public interest overrides individual interest
  (blood and organ donation).
                                                  18
Female Modesty
 Dress: Provide a long-sleeved gown or allow to wear
  her own cloths.
 Examination: exposure of the patient’s body parts
  should be limited to the minimum necessary.
 Sex: sensitivity when asking a single, widow or a
  divorced about sexual habits.
 Respect privacy and do not touch while talking.
 Should not be placed in mixed rooms.
 Avoid eye contact and shaking hands to prevent
  unnecessary embarrassment.                    19
Cancer
 Result of Divine Will or a spiritual trial (not a
  product of a carcinogen or risk behavior).
 Cancer is often referred to as “that disease” followed
  by “God keep it away”.
 Cancer kept confidential, fear that it may affect their
  daughters marriage.
 Pain: analgesic to prevent suffering include morphine
  is allowed and recommended. Suffering delete sins.
                                                      20
Palliative Care
 When death is inevitable, Islam directs that the
  patient be allowed to die without heroic measures.
 Muslims disapprove of any medical care that may
  hasten the death of a patient.
 Muslims prefer to die at home if possible with the
  family providing comprehensive physical and
  spiritual support.
 Death is not prepared for with prior funeral
  arrangements and viewed as an interference in God’s
  will.                                          21
Death
 Death definition: when spirit leave’s the body.
 Death is Inevitable: “ Every soul shall have a taste of death: In   the end
   to Us shall you be brought back."   Qur’an 29:57


 The dying person: should sit up or lie with their face
  towards Mecca. Ideally one should die with the
  Declaration of Faith on the lips (Shahada).
 When death occur: eyes should be closed; all
  connected tubes removed; all limbs flexed and the
  body straightened.                              22
After Death
 Washing and burying the body as soon as possible
  (same day). On the right side, facing Mecca.
 Respect for the body and prayers over the dead.
 Recitation of the whole Quran if possible.
 Mourning should not be excessive, as this would
  disturb the dead as well as show lack of acceptance
  of God’s will and purpose regarding death.
                                                    23
Funeral &
                      Mourning Period
 Funeral is simple and every human is equal.
 Deceased buried in a white shroud (men 3 pieces,
  women 5 pieces) without a coffin. Islam forbids
  cremation.
 Women are not allowed to attend the funeral, non-
  Muslim men may attend.
 Mourning period 3 days. Wife mourn her husband 4
  months and 10 days. She is not to remarry, leave her
  home, or wear decorative clothing. Pregnant widow
  may remarry 42 days after childbirth.            24
Life After Death
 Angels visit the dead in grave during the first night.
 Believers are comfortable waiting till judgment day.
 Judgement Day: resurrection of bodies. The good
  cross to Paradise, The bad fall off into Hell.
 Child is regarded sinless until the age of maturity.
  The soul /spirit of the child is automatically
  transferred to paradise.

                                                    25
Family Duties
               After Death
 Payment of Funeral expenses.
 Payment of his/her debts.
 Execution of his/her will.
 Distribution of the remaining estate.



                                      26
Spiritual History

 Ask: About life & death meaning.
 Observe: Dressing, praying, reading
 Listen: Reactions, answers, remarks




                                        27
Barriers of Spiritual
             History and Therapy
 Lack of time.
 Lack of training.
 Discomfort with the subject.
 Fear of activity outside area of expertise.
 Lack of interest or awareness.

                                            28
Final Words
 Listen to patient and family.
 Demonstrate sensitivity.
 Respect Patient’s Values and Beliefs.
 Remain Flexible.
 Avoid Speculation.
 Respond to Who, What, Where, When?
 Provide Reassurance.
                                          29
30

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Isamic medical Ethics

  • 2. Islam is the Youngest 2nd Largest Religion Every 5th person worldwide Judaism Hinduism Buddhism Christianity Islam 2000 BC 1000 BC 563 BC 33 AD 610 AD 2008 2
  • 3. Spiritual Religion Care Muslim Patient Values Beliefs 3
  • 4. Islamic Law and Rules The Holy Book Quran (Hadith), words or actions of the prophet Sunnah (Ijma) of the Clerics Consensus (Ijtihad) personal study Wisdom 4
  • 5. Values: Regulates: Honor parents Marriage Be kind to neighbors Divorce Protect the weak Inheritance Give to the poor Business The Qur’an Forbids: Condemns: Gambling Murder Pork Stealing Alcohol Lying Prostitution Adultery 5
  • 6. Oneness of God All can, no body or sex Life after Death Angels of God Sorting to Hill or Paradise From light to serve God Internal Prophets of God Beliefs From Adam to Mohammed Day of Judgment Rise of humanity Books of God Divine Decree Of Abraham, David, Fate set in advance Moses, Jesus, Mohammed 6
  • 7. Health, Religion & Ethics  Contraception  Brain Death  Fertility  Organ Donation  Cloning  Euthanasia  Medications  Death  Resuscitation  Life after Death 7
  • 8. The Sharia Law System Category Arabic Do it Not do it Obligatory Fard Wajeb Reward Punishment (Prescribed) Recommended Mustahab Mandub Reward No Punishment (Desirable) Permitted Mubah Halal No Reward No Punishment (Allowed) Discouraged Makruh Manboth No Punishment Reward (Disliked) Forbidden Haraam Mahd’ur Punishment No Reward (Prohibited) 8
  • 9. Forbidde Enforcing of not n Doing Maslow Discourage d Urging of not Doing Way Permitted Choice of Doing Recommended Urging of Doing Obligatory Enforcing of Doing 9
  • 10. 5 Pillars 5 Pillars Obligatory 1-9 1-9 Testimony Testimony Pilgrimage Pilgrimage of Faith Hajj of Faith Hajj Shahadah Shahadah External Charity Beliefs Prayer Charity (Ibada) Prayer Zakat Zakat Salat Salat Fasting Fasting Sawm Sawm © Copyright 1995 Prentice Hall 10
  • 11. Recommended  Blood and organ donation. (giving and receiving).  Circumcision of male infants (7th day). Controversy of female circumcision.  Breast feeding (two years).  Human skin bank: lawful for medical grafting and unlawful for cosmetics and misleading others. 11
  • 12. Permitted  Autopsy: if for medically or by law indicated.  Reconstructive Surgery (post mastectomy).  Do Not Resuscitate order: when the treatment becomes futile.  Withdrawal or withheld therapy is permitted in brain death.  Genetic Engineering: to alter or cure diseased genes.  Abortion: pregnancy that risk the mother’s health, physically or mentally. 12
  • 13. Permitted  Contraception: Islam approves all methods of contraception between husband and wife which are not harmful, are reversible and are not causing abortion.  Artificial insemination: when using the husband’s sperm and the wife’s ovaries and uterus.  Death of one of the spouse terminates the marriage contract on earth, thus frozen sperm from husband can not be used. 13
  • 14. Discourage  Forced feeding the sick.  Smoking  Divorce  Elective abortion before age 120 days (some sects before 40 days). 14
  • 15. Forbidden  Surgical contraception: (Sterilization: Vasectomy & tubal ligation). Permitted for mentally sick or when another pregnancy risks mother’s life.  Sperm or ova donation.  Fetal Sex Determination.  Elective abortion in a healthy mother 120 days after fertilization.  Human milk bank.  Human cloning (permitted for tissues and organs). 15
  • 16. Forbidden  Surrogacy Uterus: Surrogacy involving a third person is not permissible. (even if the woman involved is another wife of the husband).  Sex: Oral sex, homosexual and gay/lesbian relation, prostitution and sex outside marriage.  Cosmetic surgery: Changing the creation of Allah.  Food: not Halal meat, of pork or dead animal/bird.  Drink: alcohol.  Others: interest, theft, gambling and drugs. 16
  • 17. Forbidden  Active Euthanasia: voluntary, non-voluntary and Involuntary are not permissible under any circumstances.  Passive euthanasia: treatment is not obligatory when there is no hope of survival (brain death). Patient should be provided with food, drink, nursing, and relief from pain until death.  Suicide: include assisted suicide and physician’s assisted suicide.  Murder. "take not life which Allah has made sacred" Qur’an 6:151.17
  • 18. Principles of Medical Ethics  Necessity overrides prohibition (insulin from pork, medications with alcohol).  Remove harm at every cost if possible (quit smoking, risk factors, disease therapy).  Accept the lesser of two harms if both cannot be avoided (abortion in risk to the pregnant woman).  Public interest overrides individual interest (blood and organ donation). 18
  • 19. Female Modesty  Dress: Provide a long-sleeved gown or allow to wear her own cloths.  Examination: exposure of the patient’s body parts should be limited to the minimum necessary.  Sex: sensitivity when asking a single, widow or a divorced about sexual habits.  Respect privacy and do not touch while talking.  Should not be placed in mixed rooms.  Avoid eye contact and shaking hands to prevent unnecessary embarrassment. 19
  • 20. Cancer  Result of Divine Will or a spiritual trial (not a product of a carcinogen or risk behavior).  Cancer is often referred to as “that disease” followed by “God keep it away”.  Cancer kept confidential, fear that it may affect their daughters marriage.  Pain: analgesic to prevent suffering include morphine is allowed and recommended. Suffering delete sins. 20
  • 21. Palliative Care  When death is inevitable, Islam directs that the patient be allowed to die without heroic measures.  Muslims disapprove of any medical care that may hasten the death of a patient.  Muslims prefer to die at home if possible with the family providing comprehensive physical and spiritual support.  Death is not prepared for with prior funeral arrangements and viewed as an interference in God’s will. 21
  • 22. Death  Death definition: when spirit leave’s the body.  Death is Inevitable: “ Every soul shall have a taste of death: In the end to Us shall you be brought back." Qur’an 29:57  The dying person: should sit up or lie with their face towards Mecca. Ideally one should die with the Declaration of Faith on the lips (Shahada).  When death occur: eyes should be closed; all connected tubes removed; all limbs flexed and the body straightened. 22
  • 23. After Death  Washing and burying the body as soon as possible (same day). On the right side, facing Mecca.  Respect for the body and prayers over the dead.  Recitation of the whole Quran if possible.  Mourning should not be excessive, as this would disturb the dead as well as show lack of acceptance of God’s will and purpose regarding death. 23
  • 24. Funeral & Mourning Period  Funeral is simple and every human is equal.  Deceased buried in a white shroud (men 3 pieces, women 5 pieces) without a coffin. Islam forbids cremation.  Women are not allowed to attend the funeral, non- Muslim men may attend.  Mourning period 3 days. Wife mourn her husband 4 months and 10 days. She is not to remarry, leave her home, or wear decorative clothing. Pregnant widow may remarry 42 days after childbirth. 24
  • 25. Life After Death  Angels visit the dead in grave during the first night.  Believers are comfortable waiting till judgment day.  Judgement Day: resurrection of bodies. The good cross to Paradise, The bad fall off into Hell.  Child is regarded sinless until the age of maturity. The soul /spirit of the child is automatically transferred to paradise. 25
  • 26. Family Duties After Death  Payment of Funeral expenses.  Payment of his/her debts.  Execution of his/her will.  Distribution of the remaining estate. 26
  • 27. Spiritual History  Ask: About life & death meaning.  Observe: Dressing, praying, reading  Listen: Reactions, answers, remarks 27
  • 28. Barriers of Spiritual History and Therapy  Lack of time.  Lack of training.  Discomfort with the subject.  Fear of activity outside area of expertise.  Lack of interest or awareness. 28
  • 29. Final Words  Listen to patient and family.  Demonstrate sensitivity.  Respect Patient’s Values and Beliefs.  Remain Flexible.  Avoid Speculation.  Respond to Who, What, Where, When?  Provide Reassurance. 29
  • 30. 30