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Background reading material for the medicine & fiqh panel held on 29th April 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA by Professor Omar Hasan Kasule Sr.
OUTLINE
14.5.1 EXAMINATION AND INVESTIGATION
A. History
B. Clinical And Mental State Examination
C. Laboratory Investigations
D. Radiological/Imaging Investigations
E. Invasive Investigations
14.5.2 MEDICAL TREATMENT
A. Destruction
B. Replacement
C. Modification of Biological Response
D. Psycho-active
E. Supportive
14.5.3 SURGICAL TREATMENT
A. Resection
B. Restorative/Reconstructive
C. Replacement
D. Anesthesia And Critical Care
E. Emergency Treatment/Critical Care
14.5.4 PSYCHOTHERAPY
A.
B.
C.
D.
E.
14.5.5 OTHER TREATMENT
A. Spiritual, Traditional, Alternative, And Complementary Therapy
B. Supportive Treatment
C. Irradiation
D. Immunotherapy
E. Genetic Therapy
14.5.1 EXAMINATION AND INVESTIGATION
A. HISTORY
Consent & Confidentiality
Ibadat: history as a form of taubat
Munakahaat: discovering foster relations during history-taking
Muamalaat: discussing costs of medical care with the patient
Jinayat: patient volunteering information about crimes
B. CLINICAL and MENTAL STATE EXAMINATION
Consent & confidentiality
Situations in which consent is not obtained because of necessity, dharurat
Examination by a care giver of the opposite gender
C. LABORATORY INVESTIGATIONS
PURPOSE
(a) Provide base-line information. (b) Establish diagnosis and exclude alternative diagnosis. Process of decision making. Decision tree. Provisional diagnosis and final/discharge diagnosis. (c) Evaluate severity. (d) Plan treatment. (e) Predict prognosis
TYPES OF INVESTIGATIONS
Hematological: anemia, hemoglobinopathies, bleeding disorders, blood grouping, blood compatibility
Histopathological:
Microbiological: bacteriological, virological, parasitological, etc
Biochemical: RFT, LFT, fluids, electrolytes, acid-base balance
Genetic/chromosomal analysis
Biological markers: Trophoblastic tumors & HCC: hCG; Germ cell tumors: AFP, hCG, HBD, PLAP; GIT tumors: CEA; Ovarian cancer: CA125; Prostate cancer: PSA; Breast cancer: CA and S-3; and Skin cancer: SCC
D. RADIOLOGICAL/IMAGING INVESTIGATIONS
X-ray, MRI, ultra-sound, radio-imaging
E. INVASIVE INVESTIGATIONS
Endoscopy (GIT, Colposcopy, peritoneal)
Coronary angiography
Biopsy
Autopsy
Diagnostic laparatomy
14.5.2 MEDICAL TREATMENT
A. DESTRUCTION
Antibiotics
Cytotixics
Anti-metabolites
Antagonists
Antitoxins
Binding and removal
Detoxification
B. REPLACEMENT
Hormones
Stimulation of natural secretion
Fluids and electrolytes
C. BIOLOGICAL MODIFICATION & MODULATION
Modification of biological response by interferons
D. PSYCHOACTIVE
E. OTHER
Diet
14.5.3 SURGICAL TREATMENT
A. RESECTION
SURGERY: curative or palliative
Physiological response to surgery: sympathetic nervous system, acute phase response, endocrine, vascular
B. RESTORATIVE/RECONSTRUCTIVE
PLASTIC SURGERY
Close wounds that fail to heal. Hand surgery for reconstruction, reduction, and augmentation
COSMETIC SURGERY
SEX CHANGE
C. REPLACEMENT
TRANSPLANTATION
Organs: kidney, heart, kidney
Rejection: hyperacute, acute, chronic; prevention: hla tissue typing & immune suppression
Ethical issues: definition of death, commercial and criminal exploitation, cost
TRANSFUSION
Types: RBC transfusion, plasma substitutes, platelets transfusion
Problems of transfusion: immune complications & transfer of infection
D. ANESTHESIA and CRITICAL CARE
PRE-OPERATIVE TESTS:
biochemical, CBC, CXR, HIV, ECG
ASSESSMENT OF RISK FOR SURGERY:
CVS, Respiration, obesity, diabetes mellitus
PRE-MEDICATION:
anxiolytics, drying secretions, analgesia
GENERAL ANESTHESIA:
induction, maintenance, reversal and recovery
LOCAL ANESTHESIA:
local infiltration, field block of nerves, spinal, epidural, para-vertebral
OPERATING THEATER:
antiseptic environment, mixing of male and female in confined space
E. EMERGENCY TREATMENT/CRITICAL CARE
SITUATIONS
Respiratory failure: Adult RDS is sue to sepsis, trauma, emboli, severe head injury, aspiration, near drowning, irritant gas or chemical, drug overdose, liver failure, transfusion reaction, diabetic keto-acidosis
Multiple organ failure:
Cardiac failure:
Circulatory shock:
CARDIO-RESPIRATORY SUPPORT
Mechanical ventilation. Intubation. Arterial gas monitoring.
14.5.4 PSYCHOTHERAPY
14.5.5 OTHER TREATMENT
A. SPIRITUAL, TRADITIONAL, ALTERNATIVE, and COMPLEMENTARY THERAPY
Blood-letting in Ramadhan, hukm al haajim wa al mahjuum fi ramadhan (KS 333)
B. SUPPORTIVE TREATMENT
FLUIDS and ELECTROLYTES
NUTRITIONAL SUPPORT:
Enteral & parenteral
Patient can not be forced to eat, la yukrahu al mariidh ala al ta’am wa al sharaab (KS 505). The patient should be given any food that they like, idha ishtaha marridh ahadukum shai’an faliyuti’imuhu (KS 505)
Some food should be avoided, ma yajibu tajannubuhu min al ta’am (KS 506)
MONITORING NUTRITION: diet charts, weight, hematology, biochemistry, anthropometry
EXERCISE
The best medicine is walking, khayru ma tadaawaytum bihi al mashyu
C. IRRADIATION
D. IMMUNOTHERAPY
E. GENETIC THERAPY
DISCUSSION
EXAMINATION and INVESTIGATION
Consent and confidentiality
Ruling on patient volunteering information about past criminal activity
Ruling about a patient revealing information about anticipated criminal activity
Ruling on medical examination by a person of the opposite gender
MEDICAL TREATMENT
1. Shariat guidelines for assessing comparative benefits and disadvantages of medications
SURGICAL TREATMENT
Rulings on cosmetic surgery
Rulings on sex change surgery
Ruling on the ethical issue of definition of death in transplantation
Ruling on possible criminal actions encouraged by wide-spread availability of transplantation
OTHER TREATMENTS
1. Ruling on forcing a patient to eat or drink