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Paper presented at workshops on medical ethics and Islamic medical education at campuses in England 06-31 December 2006 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine Universiti Brunei Darussalam
ABSTRACT
This paper is very selective discussing only very few of the many values of Islam. There is no implication that the selected values are the most important. The general values presented are: correct ‘aqiidat, personal conduct, and positive social intercourse; equilibrium, balance, and moderation; quality and excellence in work performance; and self motivation in work performance. Values specific to medical practice are: respect for patient autonomy; respect for patient privacy and confidentiality; and respect for fidelity. The paper then discusses challenges to healthcare workers: maintaining their idealistic motivation in a materialistic world, inputting Islamic values into medical education, character development, self-improvement, and taking charge.
1.0 GENERAL VALUES
1.1 CORRECT ‘aqidat, PERSONAL CONDUCT, and POSITIVE SOCIAL INTERCOURSE
Imaam al Nawawi listed 23 hadiths that he called madaar al islam because they define the social culture of Islam. They can be considered under groups: ‘aqiidat, personal conduct, and social intercourse. In ‘aqiidat the Muslim knows that the fundamentals of the ddiin, usul al ddiin, are Islam, iman, and ihsan[1]. A Muslim rejects and condemns Innovations in religion, dhamm al bid’at[2]. A Muslim sticks with certainty, yaqiin, and rejects doubts, dari u al shakk[3]. He believes in pre-determination, al iman bi al qadar[4], and relies on Allah, tawakkul ‘ala al llaah[5]. He repents when he commits a sin, al taubah min al dhanb[6]. In personal conduct a Muslim is characterized by purity of intention, ikhlaas al niyyat[7], good conduct, husn al akhlaaq[8]; modesty, hayaau[9], following the right and straight path, istiqamat[10], following the rules of the permitted and avoiding the prohibited, al halaal wa al haraam[11], eating only the good, akl al taib[12]; renouncing materialism, al zuhd[13], consulting his conscience, istiftau al qalb[14], excellence in work performance, al ihsaan[15], starting with the most important work, ahamm al a’amaal[16], and fulfilling the 5 pillars of Islam, arkaan al islam[17]. In social intercourse the Muslim observes the following in dealing with others: leaving alone what does not concern him, tarku ma la ya’aniihi[18]; loving good for the others, hubb al khair li al akharin[19]; not hurting others, ‘adam al idhraar bi al akharin[20]; sincere advice for others, nasiihat[21]; calling to Islam, dawa[22]; honoring the neighbor and the guest, ikraam al jaar wa al dhayif[23]; suppressing anger, kadhm al ghaidh[24]; and respecting the sanctity of human life, ‘ismat al ddam[25].
1.2 EQUILIBRIUM, i’itidaal; BALANCE, mizan, AND MODERATION, wasatiyyat
Islam is a religion of equilibrium, al islam diin i’itidaal wa al tawazun. All forms of excess in religion[26] are shunned and are condemned, dhamm al ghuluw fi al ddiin[27]. Islam encourages the middle path of moderation and considers extremes of any kind to be unhealthy. Dr Yusuf al Qaradhawi[28] explained that Islam establishes due equilibrium between divinity, rabbaaniyyat and humanity, insaniyyat; between spirituality, ruuhaniyyat, and materialism, maadiyyat; between revelation, wahy, and intellect, ‘aql; between the afterlife, akhrawiyyat, and the earthly, duniyawiyyat; between individualism, fardiyyat, and communalism, jamaa’iyyat; between the ideal, al mithaliyyat, and the reality, waaqi’iyyat; between the past, al maadhiyyat and the futuristic, mustaqbaliyyat; between responsibility, al mas uliyyat, and freedom, hurriyyat; between following, al ittiba’u, and innovation, ibtida’u; between duties, al waajibaat, and rights, al huquuq; between stability, al thabaat, and change, al taghyiir; between knowledge, al ‘ilm and belief, imaan; between right, al haqq and might, quwwat; between al ‘aqiidat and action, ‘amal; between religion, al ddiin and state, al dawlat; between control by faith, waazi’u al iman, and control by authority, waazi’u al sultan; between material innovations, al ibada’u al maadi and moral ascendancy, al sumuwu al khulqi; between military power, al quwwat al ‘askariyyat, and morale, al ruuh al ma’anawiyyat.
Moderation is the best approach. Be balanced in your attitudes and actions. Avoid extreme positions because you can never have all the facts and full understanding of a particular situation. Taking a middle path gives you a chance to change positions and follow what is right and what is best. You however should never be moderate where evil and immorality are concerned. You must take a clear and extreme position for what is moral and right. Stick your head up high to be counted among supporters of the good and the moral and among opponents of evil. Your actions regarding an evil situation should, however, be moderate to avoid creating new problems that may be worse than the original problem. Be moderate in expenditure; not wasteful and not miserly. Be calm and controlled in moments of emotional arousal, good and bad. Wrong and inappropriate decisions are likely at moments of anger or emotional excitement when the normal balance is lost
1.3 QUALITY/EXCELLENCE IN WORK PERFORMANCE
Ihsan is one of the three fundamentals of ddiin, usul al ddin, that are: Islam, Iman, and Ihsan. These three concepts taken together constitute the creed of Islam, al aqidat al Islamiyya. There is a gradation. Islam is the beginning. Iman is a higher level. Ihsan is the highest level. Islam is outward manifestation, dhaahir. Iman is in the heart, baatin. Ihsan applies to both Islam and iman. Ihsan is excellence and is the highest level of din. Ihsan is the culture of Islam. It represents perfection in both Islam and Iman. It is excellence in worship, work, and in any social action. It is worship of Allah in the full knowledge that He is seeing you even if you cannot see Him. No activity goes by without being observed by Allah. The concept of excellence extends from prescribed acts of ibadat to all human endeavors and activities. Each human activity is an act of ‘ibadat and as such should be done with excellence. The quest for excellence is a motivation for a Muslim in whatever work he or she is engaged in. It is this quest for excellence and perfection that guarantees that believers are the only ones capable of establishing the best human civilization. Islam sets quality work and excellent performance in all spheres of life as its culture. Quality must therefore permeate all activities. Allah accepts the best of work, taqabbalu ahsan al ‘amal[29] and gives rewards for it, jazau ahsan al ‘amal[30]; The prophet said that Allah loves excellence, ihsan, in everything and advised Muslims to perfect every work that they undertake including the slaughter of animals[31]. Humans in their earthly life are tested to see who performs the best, Ibtillai al naas ayyuhum ahsan ‘amalan[32]. Islam enjoins excellence in dealing with parents, ihsan al walidayn[33], excellence in greetings, ihsaan al tahiyyat[34], excellence in diin, ihsaan al ddiin[35], excellence in arguments, ihsaan al mujadalat[36]; excellence in interpretation, ihsaan al taawiil[37]; excellence in speech, ihsan al qawl[38]; excellence in reactionary response, al dafa’u bi al ahsan[39]; excellence in fulfillment of obligations, ihsaan al adau[40]; excellence in divorce, tasriiuhu bi ihsaan[41]; and excellence in following, ittiba’u bi ihsaan[42].
1.4 SELF MOTIVATION and WORK PERFORMANCE
Motivation is an internal drive, a conscious voluntary choice, a positive attitude to work, with purpose and high expectation of success. It is internal; its outward manifestation is behavior manifesting as a strong sense of direction in the work, persistence in face of obstacles and challenges, and intensity of performance. Concepts of motivation are found in the Qur’an and sunnat. Jannat is a positive motivator and jahannam is a negative motivator. Jannat is desirable, al targhiib fi al jannat[43]. Jahannam is a terror, al tarhiib min al naar[44]. Reward is according to work done[45]. The prophet exercised morale-raising at the battle of the trench, ghazwat al khandaq[46]. Omar motivated fighters of Qadisiyyah[47].
Commitment and intention are the spiritual bases of motivation. Commitment, ikhlaas, was described in the Qur’an in several verses[48]. Ikhlaas is expressed in the intention, Ikhlaas al niyyat[49]. Work is the consequence of the intention. Every work is rewarded according to the intention behind it, innama al a’amaal bi al niyaat[50]. Every person is rewarded according to his/her niyyat, li kulli imri ma nawa[51]. The amount of reward is commensurate with the intention, iqaau al ajr ‘ala qadr al niyyat[52]. The reward is given for the niyyat even if the work is not performed. The Prophet Muhammad (PBUH) said that if a person intends to do a good and but fails to carry out his intention, he gets the reward for one act. If on the other hand he manages to do only part of the work he gets the reward for the whole work. On the day of resurrection people will be resurrected with their intentions, yukhsharu al naas ‘ala niyyatihim[53]. Any work without niyyat is not recognized[54]. The niyyat must be constant and consistent throughout the whole period of performance until completion. Start must be early and serious, baadiru bi al ‘amal[55]. Work is best judged by its last stages, al ‘amal bi al khawatiim[56]. The best of work is is consistent and continuous, khayr al ‘amal adwamuha[57]. In all performance, the human performs that which he is capable of even if the niyyat envisaged more[58].
Work is a test for the human, ibtilaau al insan bi al ‘amal[59]. Work is responsibility and accountability[60]. The Qur’an emphasizes the importance of work, al hath ‘ala al ‘amal[61]. There is reward, good or bad, for work done, jazaau al ‘amal[62]. Humans have freedom to choice in the work that they do, hurriyat al insaan fi al ‘amal[63]. Work can be good, ‘amal hasan[64]. Work can also be bad, ‘amal sayyi[65]. Bad work can be decorated to make it appear good, tazyiin al ‘amal al sayyi[66]. Bad work in all its forms is condemned, dhammu al ‘amal al sayyi[67]. The reward for bad work is a bad one, jazau al ‘amal al sayyi[68]. Humans must repent from bad work, al taubat min al ‘amal al sayyi[69]. Good work reflects underlying faith, al ‘amal al saalih min al imaan[70]. Good work is rewarded in the hereafter, thawaab al ‘amal al saalih al ukhrawi[71]. It is also rewarded on earth, thawab al ‘amal al saalih fi al duniya[72]. Work must be performed with the purest of intentions. Allah knows all the work done[73]. Any form of showing off, riyaa, must be avoided. Riyaa is a type of minor shirk[74]. The Qur’an condemns those who want to be praised for work they did not do[75].
2.0 ETHICAL VALUES IN MEDICAL PRACTICE
2.1 RESPECT FOR PATIENT AUTONOMY
Autonomous decisions must be intentional, made with full understanding, and without external controlling influences. The principle of autonomy needs continuous emphasis because in practice physicians and other caregivers may not respect the wishes of autonomous persons. The principle of autonomy is derived from the shari’at purpose of intention, qa’idat al qasd. Among all players in a medical scenario it is the individual patient who has the best and purest of intentions. He or she is best able to make decisions in the best interests of his or her life. Others may have other personal considerations that may bias their decision-making. It is for this reason that all decisions must be referred to the patient. No medical procedures can be carried out without informed consent except in cases of legal incompetence in which case the Law provides for other persons to make decisions on behalf of the incompetent patient. Individual autonomy has 2 components: liberty and capacity. Liberty implies independence from any controlling external pressures that can influence or sway the decision. Capacity is the intellectual and physical ability to reach a decision. The physician is not obliged to follow patient wishes if they involve doing illicit, illegal, or self-destructive acts.
2.2 DISCLOSURE AND TRUTHFULNESS
As part of the professional contract between the physician and the patient, the physician must tell the whole truth. Patients have the right to know the risks and benefits of medical procedure in order for them to make an autonomous informed consent. There is no obligation to disclose information that the patient does not request or does not want. Some patients may prefer not to know the truth. There is no obligation to disclose unwanted information. Patients should be told only what they need to know or what they want to know. Partial disclosure can be considered a half truth and therefore a form of lying. Technical lies are statements that are apparently true and whose truth can be defended using data and reasoning but they contain an element of untruth that any person privy to the whole information will be able to discern. The physician should be guided in his communication by the background and understanding of a patient. Some patients can be given a lot of information and they do not get disturbed. Some types of information agitate patients. The prophet enjoined talking to each person according to his ability to understand. It may be necessary that the physician shares some confidential information with members of the family in order to get involve them in patient care. This may take the form of getting more information about the patient, consultation about the best care or trying to interpret and understand the patient’s choices and decisions. In general divulging unsolicited information to governmental or other authorities is frowned upon.
2.3 RESPECT FOR PATIENT PRIVACY AND CONFIDENTIALITY
Privacy and confidentiality are two different concepts that are sometimes confused with each another. An individual has a right to privacy that implies the right to make decisions about personal or private matters and blocking access to private information. Privacy and autonomy are closely related. Privacy rights define and protect an area in the life of the citizen from which the state is excluded. The physician can enter into this privacy only if there is an autonomous decision of informed consent. Keeping a secret, hifdh al sirr, entrusted to you in confidence is a sign of good Islamic character. The Prophet taught us to rely on keeping secrets in managing our affairs. The basic position is to keep secrets and information and not reveal them even if there is no foreseeable harm. It is part of good Islamic character not to reveal all what a person knows. The Prophet taught that people should listen more and speak less. The injunction about keeping secrets involves even probing to look for information not related to the present care because this will constitute spying, tajassus, that was prohibited by Law. It is forbidden to try digging into the privacy of another person, la yattabi’u ‘awrat akhiihi[76].
The patient voluntarily allows the physician access to private information in the trust that it will not be disclosed to others. This confidentiality must be maintained within the confines of the Law even after death of the patient. In routine hospital practice many persons have access to confidential information but all are enjoined to keep such information confidential. If the patient is not assured that information revealed to physicians will be kept in confidence, he or she will not provide sufficient information to the physician for proper diagnosis and management. It is part of the trust between the patient and physician that their professional relationship remains private. The social basis for medical confidentiality lies in the prohibition of spreading rumors, namiimat[77] and backbiting. The legal basis for medical confidentiality is based on the law of contract, and three Principles of the Law, qawa’id al sharia, and the Law of Property. Keeping medical secrets is part of the physician-patient contract; fulfilling a contract is an obligation in Islam. The Principle of Injury, dharar, states that an individual should not harm others or be harmed by others, la dharara wa la dhirar.
The principle of hardship, qa’idat al mashaqqa, states that hardship mitigates easing of the sharia rules and obligations, al mashaqqa tajlibu al tayseer. Necessity legalizes the otherwise prohibited, al dharuraat tubiihu al mahdhuuraat. Necessity is defined as what is required to preserve the five purposes of the Law (religion, life progeny, property, and intellect). If any of these five is at risk, permission is given to commit an otherwise legally prohibited action. Release of medical information can be justified on several grounds of mashaqqat. Information has to be released to other health care givers in the process of clinical management. Information release may be required by statute. In some situations public interest may necessitate information release. Crime investigation may justify information release. Judicial proceedings may require release of information to ensure justice. In cases of court litigation, the caregiver could testify in criminal cases that involve dhulm. The Qur'an forbids the revelation of the shameful unless there is dhulm[78]. The caregiver cannot give false testimony[79]. There are situations in which over-riding public interest will require refusing to release information even if the patient consents.
2.4 RESPECT FOR FIDELITY
The principle of fidelity requires that physicians be faithful to their patients. Fidelity includes: acting in faith, fulfilling agreements, maintaining relations, and fiduciary responsibilities. The patient-physician relationship is a fiduciary one (ie based on trust and confidence). It is not based on a written contract. Abandoning the patient at any stage of treatment without alternative arrangements is a violation of fidelity. The fidelity obligation may conflict with the obligation to protect third parties by disclosing contagious disease or dangerous behavior of the patient. The physician may find himself in a situation of divided loyalty between the interests of the patient and the interests of the institution. The conflict may be between two patients of the physician such as when maternal and fetal interests conflict. Hospital regulations may create a conflict situation for a physician when he cannot do what he thinks is the best for the patient. Physicians involved in clinical trials have conflicting dual roles of physicians and investigators. Clinical trials create several ethical problems. The ideal is a situation of equipoise (when the physician does not know which of the two treatments is better).
3.0 CHALLENGES
3.1 MAINTAINING MOTIVATION IN CHANGING CIRCUMSTANCES
Motivation to chose a career in medicine: What motivates a student to enter medical school, will affect his commitment to practice of good medicine. Medicine is a vocation and success in it requires special aptitude and motivation. Two processes are going on. Schools and society form the character of the student and knowledge base pre-medical school. During medical school and after graduation, there are influences from the profession and from colleagues that affect the physician’s motivation. The motivating factors range from the idealistic to the pragmatic material rewards. It is difficult to undertake a valid survey research of the reasons for choosing a medical career. Many students will consciously or unconsciously talk about ultruistic motivation. The real motivators may be prestige, status, family/peer pressure, and expectation of material rewards. Students are idealistic on entry into medical school. They talk about studying medicine to become physicians and serve the community. Towards the end of their education, many students talk about benefiting from their education to find a job, enjoy easy life and have a high social status.
Motivation pre-medical school: The formal education of a physician starts with the elementary school. In the elementary school a child should learn about morals, Islamic culture, adab and akhlaq, service and feeling for others. Good grounding in the Qur’an and sunnat is needed at this stage. Knowledge, values and attitudes acquired in the elementary stage of education are the basis for later studies in medicine. Thus the future physician has a solid base of Islamic culture. Choice of a medical career fulfils a fardh kifayat. In some cases it may be fard ‘ayn where there is no other physician. Families and communities should encourage children to enter the medical profession where there is a shortage of medical manpower. Imaam al Shafie underlined the importance of medicine when he said: ‘I know of no discipline of knowledge after knowing halal and haram that is more noble than medicine’. He also said that Muslims lost one third of all knowledge and left it to the Jews and Christians. He regretted the monopoly of medicine by people of the book[80]. Students should be taught that study of medicine contributes to preparing the ummah’s strength, iidaad al quwat[81] and restoring Muslim dignity.
Motivation during the medical school: Including Islamic values in the curriculum inculcates in students the culture of service and putting the public good before personal interests.
Motivation after medical school: Material motives cannot be completely ignored in the name of idealism. A minimum of comfort is necessary for the practice of virtue. The physician should be recompensed adequately for his services. Inadequate material rewards often result into frustration or even brain drain when young physicians leave their country or the medical profession to better pastures. Incentives for graduates to work in rural or depressed areas or choose unpopular but necessary specialties lie beyond the control of medical educators. The medical school can however maintain motivation for its graduates by means of continuing medical education programs. The following Islamic concepts are motivating for the physician: the search for excellence and bearing shahadat against other communities[82]. Muslims must excel in work as befits leaders who must set the example for others.
Financial compensation: The physician working in a materialistic society is torn between contradictory forces of greed and service. Service should have the higher priority but the material rights and privileges of the physician should not be forgotten because he also wants to live a happy life. The physician fee must be known in advance according to the general principle, idha istajarta ajiiran fa a’alimuhu ajrahu[83]. It is a sin to fail to agree on a fee for service in advance, ‘uqubat man lam yufi al ajiir ajrahu[84].
3.2 ISLAMIC INPUT IN MEDICAL EDUCATION
Purpose, integration, and balance:
The purpose of medicine is to restore, maintain or improve the quality of remaining life. It cannot prevent or postpone death because ajal is in the hands of Allah. The aim of medical education is producing physicians whose practice fulfills the 5 purposes of the Law within a holistic tauhidi context. They will have the following characteristics: health and not disease oriented, focused on quality and not quantity of life, humble to recognize limitations to their abilities, holistic in outlook, understand society, scientific capability, clinical expertise, and leadership.
Modern hospital medicine is fragmented by organ, disease process, and is not holistic. Islam can provide an integrative tauhidi paradigm to replace the European non-tauhid world-view that is atomistic, analytic, and not synthetic.
In the absence of an integrating paradigm, medicine lacks balance and equilibrium in its therapeutic approach. The Qur’anic concepts of wasatiyyat, mizaan, i’itidaal, and tadafu’u provide a conceptual framework for balanced medical practice.
Service:
Medicine should be taught as a social service with the human dimension dominating the biomedical dimension. Medicine should be practiced as of mutual social support. Medical education should prepare the future physician to provide service to the community. This will require skills of understanding and responding to community needs that can be acquired by spending part of the training period in a community setting away from the high technology hospital environment.
Leadership:
The medical school curriculum and experience should be a lesson in social responsibility and leadership. 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 as a respected opinion leader with close contact with the patients must be a model for others in moral values, attitudes, akhlaq, and thoughts. He must give leadership in preventing or solving ethical issues arising out of modern biotechnology. He must understand the medical, legal, and ethical issue involved and explain them to the patients and their families so that they can form an informed decision. He should also provide leadership in advocating for the less privileged and advocacy for human rights.
3.3 CHARACTER DEVELOPMENT
Character and positive behavior
Character is what determines what type of individual you are[85]. Character is internal and is related to basic personality. Behavior is its outward manifestation. Bad manners and behavior reflect a bad character. Good behavior reflects good character. The following are some of the components of a positive character: Piety, generosity, charity, chastity, trust, humility, balance, moderation, patience, endurance, cooperation, forgiving, ignoring stupid company, reconciliation, honor and dignity, shyness, modesty, integrity, courage, and wisdom. These traits are best manifested in an atmosphere of positive attitudes, optimism, and behavior. Positive behavior includes: controlling the appetite by eating little, fasting, sexual self-control, fulfilling needs of others, mercy, good words and acts; and good deeds which wipe out bad ones.
Developing positive personality traits
Integrity, amanat, is when actions are in conformity with your values. Values are universal. Knowledge of what is bad is innate. The Prophet (PBUH) taught that evil is what scratches your chest making you uncomfortable, al sharr ma haaka fi al sadr. Religious teachings of what is right and what is wrong only reinforce what good nature already knows. Integrity in essence means successfully carrying and discharging the trust. The trust may be moral or material. Moral trusts include being truthful, trustworthy, and keeping promises and undertakings. Material trusts are property and financial rights of others that must not be violated. A distinguishing human attribute of humans is acceptance to carry trust, haml al amanat[86]. A person with integrity fulfils the trust, adau al amanat[87]. Any breach of integrity is a breach of the trust, khiyanat al amanat[88]. Never utter an untruth. It is better to keep quiet even in situations in which silence makes you look a fool. There are no white lies. All lies are an untruth and should never be uttered. Your promises and commitments are sacred. Never make any if you are not sure of keeping them. Keeping promises indicates both integrity and efficiency. An organized person who knows what he can or can not do and who manages his time well is less likely to make promises he can not keep.
Courage, shaja'at: The essence of courage is to stand up to evil with the full realization that such a stand may invite unpleasant consequences for you. This is under the general rubric of forbidding evil, nahy al munkar[89]. The supreme level of courage is to face one self and stand up to the inner desires and passions, hiwa al nafs[90]. The high level of courage is to attempt to change evil physically. The middle level is to speak out against it evil. The lowest level is to hate evil in the heart. Courage is needed morally, physically, and emotionally. Moral courage is needed to know your-self, self-criticize, and decide to improve. Social courage is needed to stick to morally right choices in your life even though the society around you may behave differently. Physical courage is needed to stand up for your rights and face the consequences.
Wisdom, hikmat, is a sign of maturity. Being given hikmat is being given a lot of good[91]. Learn the difference between ‘ilm and hikmat. ‘Ilm is knowledge. Hikmat is a higher level of understanding and using knowledge taking into consideration previous experiences and high moral guiding principles. You are better off with less knowledge and more hikmat. A lot of ‘ilm with no hikmat is positively dangerous.
Patience, sabr, is needed to deal with problems of life. Problems must be met with inner strength and a sense of hope. Lack of patience is associated with wrong choices and moves. Endurance and perseverance are part of patience. Patience and perseverance is the ability to stick it out and weather all adversities with a strong heart. You must arm yourself to avoid the human tendency to be impatient in expectation of an event or when afflicted by a calamity.
Humility, tawadhu'u, is the beginning of wisdom and is part of iman[92]. Know that you have limitations. Do not deceive yourself that you are superior whatever you may be endowed with. Always remember that there are others who may be your equals or actually better than you. Whatever you may have, you are insignificant in front of Allah the Almighty.
Self-restraint, 'Iffat: The human has passions and inner evil promptings that if not controlled will lead to evil action. There are also many temptations in the external social environment that can lead to evil unless countered by a strong self-restraint and self-c0ntrol. Sex is the most powerful drive in humans that can lead to evil. Chastity and sexual discipline is necessary for individual and societal well being.
Modesty, haya, is a very important component of character and is considered part of iman. To be modest is to set limits beyond which there is immorality and sin. A modest person stays shy of those limits and will refrain from things that are clearly permissible but if done in excess can lead to transgression of the limits. Such transgression could also occur by mistake with no malicious intent. Haya is part of iman[93]. The whole character of Islam is based on it, khulq al Islam al haya[94]. The Prophet said that if one has no haya at all then he can do anything. Haya is therefore the protecting barrier against evil. Haya is always good and can never be negative, al haya khayr kullihi[95]. Haya is the way of all messengers, al haya min sunan al mursalin[96].
Simplicity is beauty and power. Make your daily life simple; you will get strength. Do not live in much luxury or crowd your mind with so much of worldly, dunia, concerns. Consider your physical environment as an aid to fulfilling your mission and not an end in itself. Wealth and its accumulation can be a temptation, fitnat[97].
Social action
Good acts and words, al hasanaat, wipe away or neutralize the bad. You should hasten to do good. While always engaged in doing good, there is little room for the bad. Never injure anyone with your tongue. Say good or keep quiet. Learn to work with others in doing good and forbidding bad. Sharing and helping others helps you become even a better human being. It gives you a sense of mission beyond your physical needs. Give charity continuously; it cleanses both your wealth and your soul. Putting interests of your brothers in front of yours helps you discover your humanity and conquers your egoistic tendencies. Iithaar involves doing good for others at the expense of some inconvenience to yourself for the sake of brotherhood with no expectation of any reward. Good deeds also includes respecting the rights of the older people[98] and removing any annoyance from the road[99].
Keeping good company. Look for and stay in the company of wise people. You will learn the good from them. Their company will reinforce the good in you. Time spent in such good company is time taken away from possible bad company or bad influences. Do not trust or deal with bad people except in trying to correct and lead them to the right. Ignore stupid and immoral company. They will have a negative impact on you however careful you are. The least they can do is to decrease your sensitivity to evil and increase your toleration for it.
Principled and purposive life:
You must have a principled life. To succeed you must be guided in life by high moral principles and not expediency. You must make responsible choices and stick with their consequences. You must understand that there are limits to freedom. You may be constrained by previous commitments in making a new choice. After making the first choice you have only a limited range of later choices that you can make. A complete and well- balanced personality requires consistency, constancy and moving ahead following well defined goals and milestones. Life must have a purpose and goals. The highest purpose is achieving the pleasure of Allah. In addition to seeking the pleasure of Allah, you must set personal goals both long and short term. The goals have to be reasonable expectations, and imaginative. Personal goals must be specific, actionable, attainable, and challenging. You must be committed to the goals and must be attuned to any feedback that helps refine or modify goals. If you are without a clear sense of direction, you will make many mistakes and eventually fail. Personal goals should stay permanent for a reasonable period of time. Frequent shifting of goal posts is a cause of failure.
3.4 SELF-IMPROVEMENT
Effort to improve
You cannot improve yourself without effort. You must make the intention to be a better person and take action to achieve your goals. Life is not chance. Everything that occurs is pre-destined. You however do not know your predestination. You have to work hard, search for it, use your will power and choice that Allah gave you. Accept personal responsibility for mistakes. Do not blame others for your problems. Learn from your past experiences, positive and negative. Good manners or experiences should be reinforced while bad ones should be avoided.
Objectives
Ultimate objectives: Keep in mind always the three ultimate objectives: (a) the pleasure of Allah, ridha al laah & marudhaat al llaah[100], (b) wisdom, hikmah, and (c) success, falaah. The real and ultimate success is that of the hereafter[101].
Happiness: Happiness is not an objective in life. Pursuing happiness can be running after an illusion since happiness is not definable. The realistic objective is contentment and satisfaction with yourself and what you have. However contentment should not be understood in a negative sense of refusing to take active steps to improve some of the negative things in your character and behavior.
Needs vs wants: Learn to distinguish between what you want and what you need. Wants are emotional; needs are rational. Always choose needs over wants. Be realistic. Do not live in a dream world. Dreaming is good in motivating you and developing your creative thinking. Dreaming has limits if it obscures correct perception of reality. Never entertain illusions about your strengths and weaknesses. Never deceive yourself. Never allow others to deceive you by praising you and giving you attributes you lack. Such persons are your true enemies. Confront your weaknesses and do not deny them. Do something about correcting them
Inter-dependence
You can not succeed on your own; this is a world of interdependence. You must learn to net-work and collaborate with others in synergistic relations. Good manners and behavior are necessary for positive and meaningful interaction with people. You need to learn to respect and protect the rights of others so that your rights may also be respected. Every action, behavior, or habit has consequences. Always consider and think about the long-term consequences before you speak or act.
Positive attitude
Develop a positive attitude. Be optimistic and develop positive behavior. The world is essentially good and the hereafter much better. There is more good than evil. You can always succeed in the long-run if you do not become pessimistic and give up. Look at problems of life in perspective. What may look big may not be so in the long run. You may hate today what turns out to be good tomorrow. See and emphasize the positive in any problem.
Futuristic outlook
You should consider yourself as living in the future. Life on earth is just a transition. Always prepare for the future (both what remains of your life on earth and life in the hereafter). A futuristic outlook will enable you to deal with setbacks of life. You should always know that the future could always be better.
3.5 TAKING CHARGE
Assertiveness
Assertiveness: Assertiveness is a feeling of self-worth in dealing with others. It involves a lot of self-control. Non-assertive people may end up being influenced by a bad environment or they may make wrong choices that they regret later. Non-assertive persons can not interact well with others because they can not state their opinions or advance their interests or the interests of the group they belong to. A non-assertive attitude becomes in the long run a feeling of inferiority that could be exploited. Non-assertive persons may feel so bad about themselves that they eventually react in socially destructive ways. Non-assertive persons are easily influenced by bad company and end up committing evil. Assertiveness is not aggression but is closely related. Do not cross the line between the two. You can show anger without being bad. Learn to state your opinion without being hostile. Learn to defend your position without being defensive.
Self-control: Being assertive is learning to take control. A person who has self-control can stand up to the temptations of shaitan. The following are needed for you to take control of your self: self- confidence, self-esteem, self-reliance, self-control, self-discipline, and self-development.
Self-discipline: Self discipline is needed for success. Control your whims and emotions. Stickability is a good trait; do not accept defeat easily. Act according to long-term and not short-term interests. Do not act impulsively. Follow your head and not your emotions. Trust your instincts.
Self confidence and self esteem
Self-confidence: Self-confidence is to know yourself, your strengths and weaknesses, to be comfortable with what you are, and to be psychologically secure. Children are born with a lot of self-confidence. They lose it as they grow through various negative experiences. Others’ views and comparing one self with others are among the causes of loss of self-confidence. True confidence is expressed and shows quietly. Many in-confident people make noise to hide their inner weakness.
Self-esteem: You can raise your self-esteem by being secure psychologically about yourself. You must accept and appreciate what you are. You have to love yourself and know that whatever Allah endowed you with is the best for you. Look around you and identify people you admire. Try to emulate the qualities you admire in them. Stay with good people who radiate self-esteem and confidence. Congratulate and encourage yourself on any progress you make in emulating good behavior. Learn to compliment and congratulate others who have traits and behaviors that you admire. This will keep you from negative attitudes and diseases like envy and will push you along on the road to developing your own self-esteem. Avoid people with bad character and behavior. Others who do not know will consider you to be one of them. It is easier for a big mountain to move than for bad character to change. Do not repeat a mistake. Remember that character is consistent. Bad behavior is rarely an accident. It can be forgiven but can not be erased
Self-reliance:
Self-help and self-improvement are very important for the individual. They are in essence taking charge of your life, relying on yourself in solving problems, and taking the initiative to improve. It is only emotionally mature individuals who can rely on themselves. Dependency is childhood. Self-help and self-reliance should however not be taken to the extreme. There are occasions when you need help and must have networks for providing this help. Refusing to ask for help when needed is a cause of stress and is not wise. Economic self-reliance is necessary in order not to be a burden on others and also to assert your self-esteem. However the need to keep your self-esteem should never make you refuse to seek help when you actually need it. A vital distinction must be made between being childish and child-like. Childishness is dependency and inability to achieve emotional maturity, self-confidence, and self-esteem. Child-like on the other hand is a very positive attribute. It emphasizes being explorative, taking initiative, being bold to experiment, being optimistic, and not feeling defeated or cornered. These behaviors are found in children and tend to annoy parents. They are very useful for the adult. The mistake is for children to grown up too soon or for adults to regress to childhood in the way they use these attributes.
Projecting a positive image
Projecting a positive image helps build credibility and leads to success. We are not talking about a phony image that is discovered sooner or later with disastrous consequences. The image must be backed up by real achievements. It is better to under promise but over deliver. Perceptions are very strong determinants of behavior. You have to keep away from negative perceptions and cultivate positive ones. Two individuals looking at the same reality have different perceptions because of their prior life experiences. Always evaluate yourself. The perceived image may not be the intended image. The difference is crucial. Self-confidence and self-discipline are ingredients of a positive image. You have to start by discovering your strengths and enhancing them. You have to acknowledge your weaknesses and compensate for them. A positive image needs maintenance by regular self-evaluation and taking corrective action where needed. A positive image must be maintained in difficult times; this will require extra effort. Keeping company with people who have a positive self-image will help you develop your own image. Positive thinking is contagious; it spreads to those around. Your communication with others (letter, fax, telephone, and conversation) is an exercise in image projection. Physical appearance (clothes, hair, and cleanliness) also project image. Dress well but not for arrogance. Good manners, correct etiquette, and sensitivity enhance the image. Your voice, handshake, smiles, body language, and eye contact can make or unmake your image. Your posture and manner of walking can tell a lot about you. Solving your personal problems and keeping out of depression, anxiety or stress help maintain your positive self-image.
NOTES
[1] Hadith Jibril in Muslim H8
[2] Kitaab Al Adhkaar By Imaam Nawawi 1063
[3] Kitaab Al Adhkaar By Imaam Nawawi 1066
[4] Kitaab Al Adhkaar By Imaam Nawawi 1065
[5] Kitaab Al Adhkaar By Imaam Nawawi 1090
[6] Kitaab Al Adhkaar By Imaam Nawawi 1091
[7] Kitaab Al Adhkaar By Imaam Nawawi 1061
[8] Kitaab Al Adhkaar By Imaam Nawawi 1085 & 1086
[9] Kitaab Al Adhkaar By Imaam Nawawi 1086
[10] Kitaab Al Adhkaar By Imaam Nawawi 1088
[11] Kitaab Al Adhkaar By Imaam Nawawi 1082, 1072, 1064
[12] Kitaab Al Adhkaar By Imaam Nawawi 1069
[13] Kitaab Al Adhkaar By Imaam Nawawi 1073
[14] Kitaab Al Adhkaar By Imaam Nawawi 1078
[15] Kitaab Al Adhkaar By Imaam Nawawi 1079
[16] Kitaab Al Adhkaar By Imaam Nawawi 1083 & 1087
[17] Kitaab Al Adhkaar By Imaam Nawawi 1075
[18] Kitaab Al Adhkaar By Imaam Nawawi 1067
[19] Kitaab Al Adhkaar By Imaam Nawawi 1068
[20] Kitaab Al Adhkaar By Imaam Nawawi 1070
[21] Kitaab Al Adhkaar By Imaam Nawawi 1071
[22] Kitaab Al Adhkaar By Imaam Nawawi 1077
[23] Kitaab Al Adhkaar By Imaam Nawawi 1080
[24] Kitaab Al Adhkaar By Imaam Nawawi 1081
[25] Kitaab Al Adhkaar By Imaam Nawawi 1074
[26] Ahmad 1:215, 347
[27] Qur’an Surat Nisa:171, Surat Maidat:77
[28] Speech at 5th Conference of the International Organization of Medical Sciences 1985
[29] Qur’an 46:16
[30] Qur’an 29:7, 39:35
[31] Hadith ‘Inna al llaaha yuhibbu al ihsaan fi kulli shay…idha dhabahtum fa ahsinu al dhabhat’.
[32] Qur’an 11:7
[33] Qur’an 29:8
[34] Qur’an 4:86
[35] Qur’an 4:125
[36] Qur’an 16:125
[37] Qur’an 17:35
[38] Qur’an 41:33
[39] Qur’an 41:34
[40] Qur’an 2:178
[41] Qur’an 2:229
[42] Qur’an 9:100
[43] Qur’an 2:25
[44] Qur’an 2:24
[45] Qur'an 46:19
[46] Bukhari 4:64, hadith # 87
[47] Tabari 12:99
[48] Qur’an 2:139, 4:146, 7:29, 10:22, 12:24, 15:40, 19:51
[49] Ahmad 3:225
[50] Bukhari K1 B1
[51] Bukhari K1 B1
[52] Bukhari K24 B15
[53] Ibn Majah K37 B26
[54] Darimi K20, B12
[55] Muslim K1 H186
[56] Bukhari K81 B33
[57] Bukhari K2 B32
[58] Bukhari K19 B18
[59] Qur’an 10:14, 11:7, 18:7, 67:2
[60] Qur’an 3:25
[61] Qur’an 6:135, 9:105
[62] Qur’an 11:111
[63] Qur’an 17:84
[64] Qur’an 29:7
[65] Qur’an 11:78
[66] Qur’an 8:48
[67] Qur’an 5:62
[68] Qur’an 4:123
[69] Qur’an 3:135
[70] Qur’an 2:25
[71] Qur’an 2:25
[72] Qur’an 16:97
[73] Qur’an 2:96
[74] Ahmad 5:428
[75] Qur’an 3:188
[76] Abudaud K40 B37
[77] Mukhtasar al Bukhari 2032
[78] Qur’an 4:148, 24:19
[79] Mukhtasar al Bukhari 1176
[80] Al Tibb al Nabawi by Jalaluddin al Suyuti
[81] Qur’an 8:60
[82] Qur’an 2:143
[83] Nisai K35 B44
[84] Bukhari K37 B10
[85] MB 4:1362 H6221
[86] Qur’an 33:72
[87] Qur’an 2:283
[88] Qur’an 8:27
[89] Qur’an 3:104
[90] Qur’an 79:40
[91] Qur’an 2:269
[92] Tirmidhi K25 B80
[93] Bukhari K2 B3
[94] Ibn Majah K37 B17
[95] Muslim K1 H60
[96] Tirmidhi K9 B1
[97] Ahmad 4:160
[98] Tirmidhi K25 B15
[99] Bukhari K10 B32
[100] Qur’an 2:207
[101] Qur’an 3:185