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Paper presented at the 5th National Scientific Meeting of the Islamic Medical Association of Malaysia held on 29th June 2003 at Allson Klana, Seremban by Professor Omar Hasan Kasule, Sr.
ABSTRACT
Physicians are leaders who have so far been reluctant to take on their leadership roles in society preferring to serve society as skilled workers or technicians and not as leaders. The physician has grave responsibilities for the health and welfare of individuals and their families. The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health. The physician is a respected opinion leader because of intimate contact with the patients therefore his or her moral values, attitudes, akhlaq, and thoughts must be a model for others. The physician is expected to give leadership to patients on ethical issues that arise out of modern biotechnology. The physician should also provide leadership in advocating for the less privileged and advocacy for human rights. Failure of physicians to rise to the challenge of leadership can be attributed to the medical education system. Reforms are needed in the methods of student selection, the content, and delivery if the curriculum.
1.0 LEADERSHIP IN SOCIETY:
A physician is a leader. Islam teaches that everybody is a leader in one way or another. The physician has grave responsibilities for the health and welfare of individuals and their families. This is a trust, amanat, that must be fulfilled. The physician gets the reward, thawab, for any initiative that leads to introduction of something good in the community be it medical or non-medical. The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health. The medical profession must be in the forefront of social change and reform. In order for the physician to play a leadership role in society, he has to go out to the community. He cannot be a community leader if he confines himself to the 4 walls of the hospital. Inside the four walls of the hospital the physician acts as a technician and not a leader.
B. LEADERSHIP AS A MORAL MODEL:
The physician is a respected opinion leader because of intimate contact with the patients therefore his or her moral values, attitudes, akhlaq, and thoughts must be a model for others. An ideal Muslim physician is a multi-dimensional character described as having iman, taqwah, amanat, and akhlaq.
Iman: Three aspects of iman bear directly on medical practice: tauhid; qadar; and tafakkur. By internalizing these aspects the physician strengthens his iman and can lead therefore lead his patients and colleagues to improve their iman. The integrating paradigm of tauhid enables the physician to practice integrated and balanced medical care. Belief in qadar guides the physician in his work to know and understand that Life and health, and illness & cure are in the hands of Allah. As the believing physician goes about his daily chores, he contemplates, tafakkur, about all what he sees. Medical knowledge and actual clinical experiences increase iman because the physician realizes the power and majesty of Allah who created the complex human organism and who cures it from the most severe diseases.
Taqwat: A believing physician is conscious that Allah is watching and is ever-present. He will do well in public and private. He will strive to know the permitted, halal, and do it. He will even more intensely strive to know what is prohibited, haram, and avoid it. He will avoid being involved in prohibited medical procedures that result in destruction of life such as abortion, euthanasia, and assisted suicide. He will keep away from fraud, false evidence, lying and misrepresentation. He will not dispense forbidden, haram, medication.
Amanat: A believing physician will take his medical work as a trust, amanat. The trust involves three dimensions: commitment and sincerity of intentions, ikhlas al niyyat; quality work, itqan & ihsan; and social responsibility of da’awah and being a role model, qudwat. A sincere intention increases commitment. Medical practice is ‘ibadat for the pleasure of Allah. Medicine is also a form of charity. A believing physician will try to excel in his clinical responsibilities by making sure that he tries to achieve perfection, itqaan, and excellence, ihsaan. A believing physician will know that he has societal responsibilities beyond the treatment of disease. He will use any opportunities available to make da’awah to patients and their relatives.
Akhlaq: The believing physician must have humility, tawadhu’u, show brotherhood, ukhuwwat, and have social respectability, muru’at. He should avoid show-off, riyaa, in its manifest and hidden forms. Brotherhood is manifested in the humane treatment and respect for all patients regardless of their disease and social status. The believing physician gives reassurance, empathy, consolation, psychological support for patients and relatives. He has a positive and optimistic attitude in the stress of illness. He also fulfils the basic duties of brotherhood with his professional colleagues. Social respectability is acquired by good public behavior and avoiding any negative behavior that violates this respectability, khariq al muru’at. This should not be a mere show or acting in public when in private behavior is despicable. It must be sincere and consistent with an overall good behavior.
3.0 LEADERSHIP ON MEDICO-LEGAL AND ETHICAL ISSUES:
There is an increasing interest among Muslim physicians and lawyers, fuqaha, in legal and ethical issues that arise due to recent advances in medical technology. The physician is expected to give leadership to patients on ethical issues that arise out of modern biotechnology. He must be prepared not as a mufti who gives legal rulings but as a professional who understands the medical, legal, and ethical issue involved and can explain them to the patients and their families so that they can form an informed decision. In order to play this role well, the future physician must have sufficient grounding in Islamic law and other Islamic sciences. Unfortunately medical curricula do not prepare the future physician to be a leader in ethics. They give information about ethics but cannot make him an ethical person. Ethical values cannot be taught as an academic discipline. They have to be internalized so that they may inspire and guide. The initial ethical values of a student are important. A course in ethics is just an addition and a reinforcement.
4.0 LEADERSHIP IN ADVOCACY FOR THE LESS PRIVILEDGED
A Muslim physician must be deeply concerned about the plight of the underprivileged. They come into daily contact with patients who are suffering from diseases related to poor socio-economic conditions. Many of these are victims of inadequate social support systems. Physicians can play a leadership role in helping the underprivileged by fostering mutual social support, takaful ijtima’e, in the community based on the teachings of Islam. Islam teaches mutual social support within the family by calling for good treatment of parents, birr al waalidayn[1] & Ihsaan al waalidayn[2] and giving charity to relatives, itaau dhawi al quruba[3]. Islam also teachers mutual social support in the community. Believers are like a building supporting one another[4]. You are not a believer until you love for your brother what you love for yourself[5]. If you relieve a stress for a Muslim Allah relieves a stress for you in the hereafter[6]. Islam encourages feeding the needy[7]. It calls for kindness[8] and warns that he who does not help people is not helped by Allah, man la yaruhamu al naas la yaruhamuhu al llaah[9]. It emphasizes the rights of the beggar and the deprived, haqq al sail wa al mahruum[10]. Special groups are singled out because of additional vulnerability and rights: the traveler, itaau ibn al sabiil[11] , the weak, the widow and the orphan, haqq al dhaifain al yatiim wa al mar at[12].
Islam fosters an economic system that ensures mutual social support. Not all people can earn maal to support themselves and the government may have to step in and help those in distress. Omar made provisions for an elderly Jew he found begging. When there was a famine at Madina Omar provided free food. Omar set up a register, diwan al infaq, to facilitate giving financial support to poor citizens. Giving in charity, infaaq, is encouraged from the best of the wealth, infaaq min taib al maal[13]. Giving is in all good causes, infaaq al maal fi al khair[14] such as giving relatives, infaaq ala dhi al qurba, the orphan, infaaq ala al yatiim, and the indigent, infaq ala al masaakiin. Feeding the poor is expiation of sins, kaffaarat[15]. Working to help the indigent is like engagement in jihad[16]. The Qur’an condemns miserliness, al bukhl bi al maal[17]. Zakat and sadaqat are formal means of wealth transfer from those who have a lot to those who do not have. Zakat is taken from the rich and is given to the poor[18]. Poverty can be relieved by zakat and sadaqat, ‘ilaaj al faqr bi al zakat wa al sadaqat[19]. We have to look out for the needy because some of them out of self-respect do not ask, maskin yata’afaf[20].
5.0 LEADERSHIP IN ADVOCACY FOR HUMAN RIGHTS
Physicians are witnesses of gross violations of human rights because they treat victim of physical and psycho-emotional violence. They have to understand the causes of rights violation and must play an active role in protecting and promoting human rights based on Islamic Law.
Islamic law recognizes legal personhood, dhimmat, for every human whether a fetus or a newborn. A person cannot lose dhimmat under any circumstances. Even a condemned prisoner who is waiting execution does not lose all aspects of dhimmat. Even a dead corpse retains some aspects of the dhimmat. Dhimmat therefore guarantees some inalienable rights for humans. We can talk of natural rights as being those deriving directly from the dhimmat. Acquired rights arise due to interactions with specific spatio-temporal circumstances. The former are natural rights and the latter are acquired rights. The natural rights are permanent but the acquired rights can change from time to time.
The basic human rights are derived from the purposes of the Law. The right to freedom of conscience is under hifdh al ddiin, the right to life is hifdh al nafs, the right to procreation and rearing a family is under hifdh al nasl, the right to freedom of thought is under hifdh al ‘aql, and the right to property is under hifdh al maal. Other rights are considered secondary and are derived from the needs, haajiyaat, and embellishments, tahsinat. The secondary rights such as freedom of speech, freedom of movement, and freedom of work etc all are necessary for the preservation of the basic rights. Islamic Law also has provisions for the rights of special groups such as the family unit, the fetus, infants and children, women, the elderly, and minorities.
6.0 REFORM OF MEDICAL EDUCATION
Failure of physicians to rise to the challenge of leadership can be attributed to the medical curriculum that prepares them to be technicians and not as leaders. The medical school takes the blame for not producing ethical leaders who have the guts to change and improve society. The traditional medical school curriculum does not equip the future physician with leadership skills in the form of courses or actual field experience. A reform is needed so that the medical school curriculum and medical school experience can become a lesson in social responsibility and leadership. The medical school should also consider no-academic criteria in its admission policies. Many of the qualities of leadership needed in a future physician are not identifiable from the academic record. It is risky to admit students without the required personal and ethical qualities in the hope that they will be taught by the medical school. The medical school can not teach all these qualities. Students admitted, in addition to academic competence, should possess the following qualities: a comprehensive holistic approach based on tauhid, a service vocation, ethical and community leadership. Once admitted the student should be reminded often of social leadership through courses and experience.
[1] An’am:151-152
[2]isra 22-38
[3] isra 22-38
[4] Bukhari and Muslim
[5] Bukhari and Muslim
[6] Muslim
[7] surat al maa’uun, safaat:30-34
[8] balad:11-18
[9] Bukhari and Muslim
[10] ma’arij:19-35
[11] isra 22-38
[12] KS579 Ahmad 2:439
[13] 2:267, 3:92
[14] 2:3, 2:177, 2:195, 2:245, 2:261-262, 2:265, 2:270-274, 3:134, 4:39, 8:3, 9:34, 9:99, 9:103, 22:35, 24:33, 28:54, 32:16, 34:39, 51:19, 57:7, 57:10-11, 57:18, 59:9, 63:10, 64:16-17, 90:14, 92:5-7, 92:18
[15] Bukhari K30
[16] Bukhari K69 B1
[17] 4:37, 17:100, 36:47, 47:36-37, 92:8-10
[18] Bukhari K24 B1,18,63, Abudaud K9 B39, Tirmidhi K5 B21, Ibn Sa’ad J4 Q2 p76
[19] 2:83, 2:177, 2:184, ?3:315, 2:271-273, 4:6, 4:8, 4:36, 5:89, 5:95, 8:41, 9:60, 17:26, 18:79, 22:28, 22:36, 24:22, 30:38, 51:19, 58:4, 59:7-8, 69:34, 70:24-25, 74:44, 76:8, 89:18, 90:14-16, 93:8, 93:10, 107:3
[20] Bukhari K24 B53, K65 S2 B48, Muslim K12 H101, 102, Abudaud K9 B24, Tirmidhi K5 B22, Nisai K23 B76, 87, 89, Ibn Majah K8 B26, 27, Darimi K3 B2, 15, Muwatta K49 H7, Ahmad 1:384, Ahmad 1:446, Ahmad 2:260, Ahmad 2:316, Ahmad 2:393, Ahmad 2:395, Ahmad 2:445, Ahmad 2:449, Ahmad 2:457, Ahmad 2:469, Ahmad 2:505