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Lecture given to 1st year medical students of the Kulliyat of Medicine, International Islamic University, Kuantan on 15th November 1997 by Dr Omar Hasan Kasule, Sr; Deputy Dean for Research and Post-graduate Affairs.
OUTLINE
1.0 STRATEGIES AND APPROACHES
Basis in Qur’an and sunnat
Qadar
Preventive medicine
Curative medicine
Place of medical treatment
2.0 MODALITIES OF TREATMENT
Spiritual
Physical
Combination
3.0 HALAL & HARAM
Ends and means
Haram material
Necessity (dharurat)
4.0 SIDE EFFECTS vs BENEFITS
New molecules
Invasive procedures
Harm (dhahar) vs benefit (maslahat)
Equilibrium: tauhid, wastaiyyat, shumuliyyat
5.0 SUPERSTITION
Shirk
Dreams
Sorcery
Jinn
Astrology
1.0 STRATEGIES AND APPROACHES
Basis for medical treatment in the Quran and sunnah: The Qur’an described cure (shifa, p 637 3:49 …41:44). The Qur’an is a itself a cure (17:82). Honey is described in the Qur’an as a cure (16:69). The prophet Muhammad (PBUH) said in an authentic hadith that Allah did not reveal any disease (bau) without also revealing its cure (dawau); some people may know and others may ignore it but it nevertheless exists. The Qur’an described disease in prophet Ayyub (PBUH) and its eventual cure (21:83-84, 38:41-44). The Qur’an described how Isa (PBUH) cured chronic diseases (3:49, 5:11).
Cure is from Allah: Humans try, but it is Allah who cures (allah huwa al shafi) [p 1105 21:83-84…37:41-42]. Humans should not be arrogant by attributing cure to themselves and not Allah. In the same way humans can not refuse to take measures to cure disease claiming that Allah will take care of it. It is true that Allah cures but in some cases that cure operates through the agency of humans. Sometimes the measures that humans take to cure a disease may not be sufficient on their own to alleviate the condition; it is Allah’s divine intervention and mercy that brings about the complete cure.
Disease treatment and qadar: Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr. The principle that applies here is reversal of qadar by another qadar (rad al qadr bi al qadr) applies here.
Preventive medicine (tibb wiqa’i): The Qur’an has used the concept of wiqaya in many situations to refer to taking preventive action against entering hell-fire (wiqaya min al nar), against punishment (wiqaya min al adhaab, p 1316 2:201..70:11), against evil (wiqaya min al sharr p 1316 76:11, against greed (wiqaya min al shuhhu, p 1316 59:9 …. 64:16), against bad acts (wiqayat min al sayi’at, p 1316 40:9 …40:45), against injry/harm (wiqayat min al adha, p 1316 16:81), against jealousy (wiqayat min al hasad), and against oppressive rulers (wiqaya min al taghoot p 1316 3:28). It is therefore one of the fixed laws of Allah in the universe (sunan llah fi alkawn). Its application to medicine therefore becomes most obvious. Disease could be prevented before occurrence or could be treated after occurrence. The concept of prevention (wiqayat) does not involve claiming to know the future or the unseen (ghaib) or even trying to reverse qadar. The human using limited human knowledge attempts to extrapolate from the present situation and anticipate certain disease conditions for which preventive measures can be taken. Only Allah knows for sure whether the diseases will occur or not. The human uses knowledge of risk factors for particular diseases established empirically to predict disease risk. Preventive action usually involves alleviation or reversal of those risk factors. For example stopping cigarette smoking can prevent lung cancer and ischemic heart disease. Obeying fire regulations can prevent fire accidents. Careful driving prevents road traffic accidents and trauma. Immunisation prevents viral and bacterial infections. The concept of prevention can be understood at three levels. Primary prevention aims at making sure the disease does not occur at all. Secondary prevention aims at limiting the impact of the disease once it has occurred. This is usually by attempting to detect the disease early and instituting necessary treatment. Tertiary prevention aims at mitigating the long-term sequelae and complications of a disease. Prevention also involves avoiding any act that can hurt good health or destroy life (halaak p 1261 4:176 … 67:28). There are activities that promote good health and are part of preventive medicine because they put the body in the best possible status to be able to fight and overcome any disease that occurs. Examples of such activities are: physical exercise, rest and recreation, diet, dhikr llah, marriage and family life.
Curative medicine (tibb ‘ilaji): Every disease has a cure that must be searched for and used. Curative medicine may be invasive or non-invasive. Where possible non-invasive approaches are preferred because invasive disease treatment whatever its nature involves some element of risk to the patient. This risk is higher the more invasive the treatment modalities are. A non-invasive approach that aims at helping or assisting the body to fight the disease is the best. Many physicians forget the tremendous potential that the body has to take care of itself and cure disease with the help of Allah. Medical treatment in most cases is supportive to the body’s natural healing processes. The body’s defences against foreign bodies are in the immune system which may be humoral or cellular. The body is able to repair damaged tissue.
Place of medical treatment: For millenia the home has been the site of treatment. Increasing sophistication of medical treatment eventually led to opening hospitals. The first hospital in Europe was Hopital de Dieu opened in Paris in 600 AD. The first Muslim hospital was opened in … For a long time hospitals were looked at as places where people went to die and not a place for recovery. The bad reputation arose from the fact that most of those who went to hospitals did not return. The situation has now improved with available technology that the hospital makes a major difference
2.0 MODALITIES OF TREATMENT
Spiritual: Among spiritual approaches to disease management is use of dua from the Qur’an (17:82) and hadith as ruqiy. A strong iman and trust in Allah plays a role in the cure of diseases. Psychosomatic diseases affect the immune functions and other metabolic functions of the body. A believer who is spiritually calm will have positive psychosomatic experiences and not negative ones because he or she will be psychologically healthy and at ease. Faith can change the very perception of disease symptoms. Pain is for example subjective. A believing person who trusts in Allah may feel less pain from an injury than a non-believer.
Physical: Among physical approaches to disease management are: diet, natural agents (chemical, animal and plant products), manufacturers chemical agents, surgery (jiraha), and physical treatment e.g. heat. Physical approaches can reverse disease pathology, mitigate its effects or just stop farther progression.
Multiple/combination of spiritual and physical: There should no dichotomy between spiritual and physical. Both approaches should be used for the same condition. Each cures the disease each using a different pathway. There is no contradiction but there is always synergy. It is a mistake to use one and reject the other.
3.0 HALAL AND HARAM THERAPEUTICS
While seeking treatment, the moral teachings of Islam must be respected. The end never justifies the means. Haram material is not allowed as medicine except is special circumstances where the legal principle of necessity (dharurat) applies. Alcohol is for example not an accepted cure for any disease; it is actually itself a disease.
4.0 SIDE-EFFECTS OF MEDICATION VS BENEFITS
The discovery of antibiotics and other powerful agents and procedures effective against disease has changed the face of medical care for the better in the past 50 years but has brought with it many iatrogenic problems. They are always associated with side-effects or unwanted effects that a good physician should be aware of and should look out for. These problems are two-fold: introduction of new molecules in drugs into the body and the environment. The long-term effect of such ‘unnatural’ molecules is not known. Invasive technology makes drastic changes to human anatomy and physiology with its long-term consequences still unknown.
The practitioners of homeopathic medicine rightly criticise allopathic medicine for its aggressive approach that is associated with many side-effects and unwanted effects in the long and short terms. Homeopathic medicine practised in some societies and is thought to have less side effects but is clearly less effective.
Harmful treatments are not allowed in situations in which the cure is worse than the disease. Choice of what treatment modality to use should involve a careful weighing of benefits and possible harm or injury. It is a prevention of Islamic law (sharia) to give priority to preventing harm over accruing a benefit.
The equilibrium between benefit and harm of treatment modalities should be looked at using three Islamic principles: tauhid, wasatiyyat, & shumuliyyat. The concept of tauhid motivates looking at the patient, the disease, and the environment as one system that is in equilibrium; thus all factors that are involved with the three elements are considered while making decisions. The concept of wastiyyat motivates the need for moderation and not doing anything in excess. The concept of shumiliyyat extends the tauhidi principle by requiring an overall comprehensive bird’s view of the disease and treatment situation.
5.0 SUPERSTITION
Many people in disease resort to superstition, magic, sorcery and divination. These superstitions nullify ‘aqidat al tauhid. Superstition is distraction from seeking true treatment. Patients delay in coming to hospital and by the time they come the disease is too advanced for easy cure.
Shirk: Manifestations of shirk practices in disease treatment include: magic, sorcery, amulets, tamaim, kahanah, and worshipping or asking cure from humans called awliyaa.by living or visiting their graves. Other superstitious practices usually associated with shirk are: claiming knowledge of the unseen and claiming supernatural powers by any human. A fortune teller (kahin) is a liar who pretends to know the future or the unseen and provide information to their clients.
Dreams (ru’yat manamiyat): Superstition could also be in the form of dreams and their interpretation (tafsir al ahlam). It is true that humans dream. Most dreams are related to the daily human experiences. Sometimes because of the state of sleep the facts become distorted such that a person can not relate the dream or understand it. In such cases the Qur’an tells us that only Allah knows for sure the correct interpretation of dreams (p 516 8:43…52:32).
Sorcery (sihr): Some people practice witchcraft or sorcery (sihr) (p 1248 113:4, p 566 2:102…74:24). These are superstitious practices that believers should avoid.
Talismans: There are people who hang objects on their body (azlaam) for protection instead of relying on Allah (p 97 5:3…5:90). Such actions are very demeaning to humans. How can a human who possesses an intellect rely for protection on a small object that he manufactures himself and hangs around his neck?
Involvement of jinn: power of jinn used to misguide and give credibility to shirk. The jinn do not know the unseen ( p 289-9 15:17-18…72:8). A good Muslim should not be involved with jinns and should ask Allah for protection against them (p 288 3:36…11:1-6).
Astrology (tanjim): Astrology is the belief that movement of planets, stars, the sun, the moon can affect peoples’ lives. The astrologer uses these phenomena to make predictions about disease or its cure. The astrologer (munajjim) is a liar because he or she is trying to appropriate Allah’s prerogative of knowing the unseen (ghaib).