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Paper Presented by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine at Universiti Brunei Darrussalam at the Annual Health Islamic Conference held at Faculty of Medicine University of Indonesia Jl Salemba Raya No 6 Jakarta Pusat held on 3-5 February 2006 and organized jointly by Forum Ukhuwah Lembaga Dakwah Facultas Kedoketran se-Indonesia and Forum Studi Islam Kedokteran Universitas Indonesia.
CONFUSION BETWEEN MUSLIM AND ISLAMIC
The concept of Islamic medicine has been understood to mean different things by different people at different times. The greatest confusion has been semantic with many dire practical manifestations. ‘Islamic’ and ‘Muslim’ Medicine has been confused. The terms ‘Islamic’ and ‘Muslim’ are used interchangeably as if they mean the same. Traditional medicine practiced by Muslim communities at some epochs in history or in our times has erroneously been called Islamic medicine. ‘Islamic’ refers to values, ideals, guiding principles, and application of the Qur’an and Sunnah. ‘Muslim’ refers to people who self-identify as Muslims as well as their activities and institutions. They may not fully follow all the teachings of Islam. Thus Islamic Medicine (the ideal) is not the same as Muslim medicine (the actual historical or contemporary reality of Muslim societies). Islam is objective and universal. Islamic Medicine would therefore be the true and objective medicine that all people would accept irrespective of their geographical location, cultural or religious background. The continuing confusion in the minds of many Muslim physicians about what constitutes Islamic Medicine calls for this fresh attempt at definition and conceptualization of Islamic Medicine.
ISLAMIC MEDICINE AS PARADIGMS, METHODOLOGY, & VALUES
The following definition of Islamic Medicine is proposed after consideration and rejection of the alternatives described above. Islamic Medicine is defined as medicine whose basic paradigms, concepts, values, and procedures conform to or to do not contradict the Qur’an and Sunnah. It is not specific medical procedures or therapeutic agents used in a particular place or a particular time. Islamic Medicine is universal, all-embracing, flexible, and allows for growth and development of various methods of investigating and treating diseases within the frame-work described above.
This definition calls for basic transformation of current medical systems. Islamic Medicine thus becomes the result of an Islamic critique and reformulation of the basic paradigms, research methodology, teaching, and practice of medicine. This process of conceptual transformation, also called Islamization of Medicine. The end-result of the Islamization process will not be a medical system for Muslims only but for the whole humanity because Islam is a set of universal and objective values. Islamization is not theologizing, localizing or parochializing medicine but making it excellent for all.
The above-mentioned understanding of Islamic medicine is gradually changing the practice of medicine in the ummat. Islamic hospitals and clinics are being established in many Muslim and non-Muslim countries. Faculties of medicine are starting to teach curricula with an Islamic input. There is increasing research inspired by the Islamic medicine movement. In years to come, Muslim physicians will be able to make a marked impact on mainstream medical practice by introducing Islamic values to it.
THE NEED FOR REFORM IN MEDICINE
Conceptual and Moral Problems: Modern medicine has some paradigms that we do not accept as Muslims. Death is rejected as a natural phenomenon and resources are wasted in terminal illnesses. Aging is also not accepted as a normal process and research is now being undertaken to reverse its course. There is no balance and equilibrium in selecting treatment modalities. Treatments are selected for their effectiveness against the condition without regard to what other harm they may cause to persons and the eco-system. Some treatments of yesterday are the diseases of today. Too much narrow specialization leads to lack of a holistic approach to the patient. The physician turns a blind eye to moral and social issue of the day that affect the health of his patients and claims that his responsibility is medical care only. The secularized medicine has no consistent set of ethics. Malpractice, fraud, physician misbehavior are common. Materialistic pursuits are predominant. The highly secular environment does not acknowledge a spiritual or a religious dimension in medicine. There are biases in selecting, funding and publication of research. Powerful political, economic forces that reflect the secular world-view and philosophy of life are involved.
Problems in the Use of the Scientific Method: There is no problem with the scientific method in its essence. Problems arise in the way it is used. The present use of the scientific method has several limitations that many physicians are not aware of: limitations of observation, limited sources of knowledge, no positive moral context, no complete understanding of the human being, not being part of a holistic system and a parochial or local Euro-centric context. Human observation and senses have limitations in observing and interpreting phenomena. Some phenomena cannot be observed / perceived correctly. The priority assumptions, biases, and knowledge that the observer has affect the observation, perception and conclusions. It is therefore wrong to rely on empirical observation as the sole source of knowledge. The two sources of knowledge in Islam are revelation, ‘ilm al wahy, and the empirical world, ‘ilm al kawn. Intellect, ‘aql, is a tool given to the human race to use both sources. Secularized epistemology denies wahy as a source of knowledge. It denies a role for religion and sometimes is seen to be anti-religion. It does not accept the unseen, al ghaib
Moral problems: Secular science denies morality as a factor in its work. It operates in a presumed moral vacuum. There is no recognition of absolute morality. It has adopted an even more dangerous concept by attempting to solve social and medical problems of a moral or spiritual nature by use of technology. Empirical observation is in itself not sufficient to fully describe and understand the human being and his society. Values, motivation, attitudes, beliefs are difficult to measure let alone understand from empirical study. The tools available to the scientist, human senses and instruments (extensions of senses) have an inherent inability to see the whole human picture. Additional guidance and information from the Creator, the all-knowing, is needed. Only Allah knows and understands humans fully. Thus knowledge of humans that can come only from revelation must be considered alongside the empirical observations for valid understanding.
ISLAMIZATION OF KNOWLEDGE IN MEDICINE
Lessons from the Past: European renaissance in Medicine after the 16th century N can be attributed to medical knowledge preserved and developed by Muslims and passed on to Europe. While Europeans made great strides in medical knowledge, Muslims declined. There are several explanations for the complex phenomenon of decline. It was partly due to the general decline of the Muslim polity and the social instability that occurred. On the other hand we can see the seeds of decline in the transfer of Greek knowledge. Greek science was very deductive and did not emphasize experimentation and observation. Muslims transferred this Greek knowledge and Islamized it as much as they could. The process of Islamization was however not completed. The scientific spirit of observation, logical reasoning and drawing conclusions that is enshrined in the Qur’an was neglected several times when Muslims followed Greek assertions on medicine blindly without subjecting them to experimental verification.
New beginning: The Kulliyah of Medicine of the International Islamic University, Malaysia, is currently experimenting with an approach to Islamization in medicine similar to that pioneered by Ibn Khaldun. It has a 5-year program of Islamic input into the Integrated Medical Curriculum. The program runs parallel to the medical curriculum. Relevant Islamic concepts on medical conditions are introduced before the students study those conditions. The purpose of medical treatment can be used to illustrate this approach. The western (Euro-American) world-view is that the purpose of medicine is to prevent premature death, prolong life, and may be at some stage in the future discover the cause of aging and thus be able to eliminate death altogether. Medical students at Kuantan are taught that the timing of death, ajal, is in the hands of Allah and that no human, physician or not, can delay or advance it. People will die when their term arrives. The purpose of medicine is therefore not to prevent death but to maintain the human in the best quality of life for the remainder of their life on earth. Since the moment of death is never known to any human with any certainty, the physician will strive his utmost until the last minute to ensure the highest possible quality of life. The two approaches, European and Islamic, will lead to differences in the attitudes and behaviors of Muslim and non-Muslim physicians although they have the same quantum of medical knowledge, skills, and technology.
The challenge to excel: Our situation today was described correctly by Imaam al Shafe’i more than a thousand years ago as quoted by Jalaluddin al Suyuti in his book al Tibb al Nabawi. Imaam Shafe’i ‘…after the science which distinguishes between what is halal and what is haram, I know of no science which is nobler than that of medicine.... Truly the people of the Book have overcome us and overtaken us in this supreme art”. We feel that the process of Islamization will provide the intellectual stimulation and practical motivation for us to work hard in medical research so that we may become leaders of the field.
What can you do as an individual? You must develop commitment to the discipline reform process. You must master your discipline well; you can not reform or improve what you do not know. If you did not get a traditional Islamic education endeavor to get the minimum essential knowledge of usul al fiqh, Qur’an and hadith methodology. Critique the basic paradigms of your discipline on the basis of tauhid and the universal and perennial values of Islam. Orient your research and teaching to Islamization priorities. Write and publish your ideas and experiences. Network with others who hold similar views and are engaged in similar endeavors. Teach and inspire others to take up the challenge of educational reform.