Home 
Contact 
Profile 
Videos 
Paper presented at a workshop on Cultural Aspects of Cancer Control and Palliative Care organized by the University of Melbourne Key Center for Women Health held at Noosa Queensland 12-14 June 1999 by Prof Omar Hasan Kasule, Sr. Deputy Dean for Research and Post-graduate Affairs, Faculty of Medicine, UIA, Kuantan Malaysia
ABSTRACT
The paper uses sources from the Qur'an and Islamic traditions to define the Islamic perspective of disease prevention. Prevention, wiqaya, is a general phenomenon found in all situations that could be harmful. It is therefore one of the fixed laws of God in the universe that is readily applicable to medicine. The concept of prevention does not involve claiming to know the future or the unseen or even trying to reverse pre-destination, qadar. Humans use limited empirical knowledge about the distribution of risk factors to extrapolate, anticipate, and predict disease risk. Preventive action is modification, alleviation, and reversal of the effects of risk factors. The paper uses the concepts of Purposes of the Law, maqasid al shariat, and Principles of the Law, qawaid al shariat, for legal justification of preventive prescriptions and interventions. The analysis also deals with the issue of striking the due balance between the benefits and risks of human behaviors. The problem of human will, al iradat al insaniyat, remains the weak link in disease prevention efforts; humans will not change behaviors that they know harmful to their health. The paper urges that Muslims can internalize and follow health advice if presented in the context of their religious law which they observe strictly.
1.0 CONCEPT OF PREVENTION (wiqayat)
Preventive medicine, tibb wiqa’i, is a series of pro-active measures that subsumed under the Islamic concept of prevention, wiqayat. The Qur’an has used the concept of wiqaya as taking preventive and anticipatory action against punishment (2:201, 3:16), greed (59:9, 64:16), bad acts (40:9, 40:45), injury/harm, (16:81), jealousy, oppressive rulers (3:28), annoyance (16:81), and heat (16:81). Prevention is therefore one of the fixed laws in the universe. Its application to medicine is therefore a special case of a general phenomenon.
The concept of prevention does not involve claiming to know the future or the unseen or even trying to reverse pre-destination, qadar. The human using limited empirical knowledge attempts to extrapolate, anticipate, and predict disease risk from the known distribution of risk factors. Preventive action is modification, alleviation, or or reversal of the effects of risk factors. Prevention, besides avoiding any act that can hurt good health or destroy life, halaak (4:176, 67:28), also embraces activities that promote good health like physical exercise; rest; recreation; good diet; meditation, dhikr llah; and positive social relations. These activities and states of being 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. All preventive measures that are taken against disease can be subsumed and explained by 2 major concepts in Islamic Law: the Purposes of the Law and Principles of the Law. There are 5 purposes of the Law, maqasid al shariat, and 5 Principles of the Law, qawaid al shariat.
2.0 PURPOSES OF THE LAW (maqasid al shariat)
The law was revealed to fulfil specific underlying purposes that will ensure success in this world and fulfil the interests and benefits, masaalih, of the people. The 5 Purposes of the Law, maqasid al sharia, arranged here in order of importance are: preservation of morals and religion, hifdh al diin , protection and maintenance of human life, hifdh al nafs, protection of the human intellect, hifdh al aql, protection of the progeny, hifdh al nasl, and protection of property rights, hifdh al maal. Protection of morality includes taking measures to ensure freedom, basic human rights, rule of the law, equity, and justice. Violation of these moral principles is the social root cause of much human disease. Protection of life includes health promotion, disease prevention, and treatment. Protection of the mind is avoiding what impairs human intellect like alcohol. Protection of progeny covers reproductive, fetal and child rights. Protection of property rights assures resources for health promotion and disease prevention. The 5 Purposes of the Law are permanent and are unchangeable, kulliyat abadiyat. Most of preventive medicine falls under the second Purpose of the Law. Application of this principles to public health is neither simple nor straight-forward. What we generally consider as risk factors of disease have beneficial effects as well. Cholesterol is required in metabolism but it involved in atheroma formation. Preventive measures could carry a quantum of risk such that preventing one disease creates another one. Imaam al Shatibi, the leading Muslim thinker on the Purposes of the Law, provided guidance on the resolution of such issues. He argued that there is no absolute benefit, maslahat, or harm, mafsadat. The purpose of the law is therefore to choose the best equilibrium between the harm and the benefit. It is not always true that benefits are permitted, halal, and harms are prohibited, haram; each case is considered according to its circumstances. We can safely conclude that in the field of preventive medicine, the best that humans can do is carry out empirical studies and arrive at objective conclusions but must always have the humility to admit that they could be wrong
3.0 PRINCIPLES OF THE LAW (qawaid al shariat)
Five principles are recognized by most scholars: intention, qasd, certainty, yaqueen, injury, dharar, difficulty, mashaqqat and custom or precedent, aadat .Each of the 5 Principles is a group of legal rulings or axioms that share a common derivation.
The Principle of Motive states that each action is judged by the intention behind it, al umuur bi maqasidiha. Means are judged with the same criteria as the intentions, al wasail laha hukm al maqasid, If the intention, qasd is wrong the means, wasiilah, is wrong. What matters are intentions, maqasid, and underlying meanings, ma’aani, and not literal terms, alfaadh, or structures, mabaani. The principle of motive applies to disease prevention messages. The recipients of the message must understand the purposes behind the behavioral change that is requested. We can speculate that failures of health education programs are due to health educators providing information and instructions on behavioral change without taking time to make sure that the recipients understand the underlying motives.
The Principle of Certainty, yaqeen, states that a certainty can not be voided, changed or modified by an uncertainty, al yaqeen la yazuulu bi al shakk. The principle of certainty finds application in preventive prescriptions that seek to change people's behavior based on new evidence that is not at the level of certainty. Existing assertions should continue in force until there is compelling evidence to change them, al asl baqau ma kaana ala ma kaana. Frequent changes in preventive prescriptions could lead disinterest among the general public about disease prevention. This could have been avoided if changes were based only on evidence of highest certainty.
The Principle of Injury, dharar, states that an individual should not harm others or be harmed by others, la dharara wa la dhirar. This principle is the basis for pro-active action to prevent or treat disease rather than being fatalistic. Injury should be mitigated as much as is possible, al dharar yudfau bi qadr al imkaan and should be relieved, al dharar yuzaal, if possible. An injury should not be relieved by a similar injury, al dharar la yuzaal bi mithlihi.
The Principle of Hardship, mashaqqa states that necessity legalizes the prohibited, al dharuraat tubiihu al mahdhuuraat. Necessity is defined as what is required to preserve the 5 Purposes of the Law. If any of these 5 is at risk, permission is given to commit an otherwise legally prohibited or commonly unacceptable things like violation of individual rights. Coercive public health measures are permitted under this rubric. Prevention of a harm has priority over pursuit of a benefit of equal worth, dariu an mafasid awla min jalbi al masaalih. If the benefit has far more importance and worth than the harm, then the pursuit of the benefit has priotity. The lesser of two harms is selected, ikhtiyaar ahwan al sharrain. A lesser harm is committed in order to prevent a bigger harm, al dharar al ashadd yuzaalu bi al dharar al akhaff. Public interest has priority over individual interest, al maslahat al aamat muqaddamat ala al maslahat al khaassat.
The Principle of custom, aadat should be studied and used more by practitioners of preventive medicine. What is considered customary is what is uniform, wide-spread, and predominant, innama tutabaru al aaadat idha atradat aw ghalabat, and not rare, al ibrat li al ghaalib al shaiu la al naadir... Customs are not static, they eventually change with time and place, la yunkiru taghayyur al ahkaam bi taghayyuri al azmaan wa al ahwaal wa al aadaat wa a’raaf. Most customs are not harmful if they were they would not have survived. The aim should be the identification of those aspects that are injurious to good health rather than condemning all the customs of the people. We should be very circumspect before declaring common customs as dangerous to health. In the same way if we want our preventive messages to have an impact, we should try to include them in what is considered customary.
References
Holy Qur'an (references in the text are chapter:verse
Sheikh Ahmad bin al Sheikh Muhamad al Zarqa: Sharh al Qawaid al Fiqhiyyat [Explanation of the Principles of the Law]. Dar al Qalam. Beirut. 1996 CE/1417 AH
al Shatibi,Abu Ishaq: Al muwafaqat fi usul Al Sharia Vol.2 : Kitaab Al Maqasid. Dar Al fikr Al Arabi. No date.