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Presented by Professor Omar Hasan Kasule Sr at the
5th FOCUS-SOASCIS Conference on the theme ‘Islamic ethics and its
application to community development: the role of educational institutions’ held
at the Sultan Omar Ali Saifuddin Center for Islamic Studies University of
Brunei Darussalam on Friday 24th May 2013
ABSTRACT
The paper presents Islamic paradigms and shari’at doctrines
that underlie the development of a system of medical ethics (clinical,
research, public health). The motivation is dissatisfaction with the
application of contemporary ethical principles that are not consonant with the
all-embracing, comprehensive, and integrated Islamic world-view. The primary
concepts are tauhid, shumuliyat, tawazun, and tadafu’u. tauhid
provides an integrating paradigm that assures that an ethical problem is not
considered in isolation from other issues. Shumuliyat is the
comprehensiveness of the Islamic world view that embraces everything within the
Islamic system. Tawazun is a balanced moderate approach. Tadafu’u
is consideration of actions and the reactions to those actions. The theory of
the purposes of the Law, maqasid al shari’at, provides a primary source
for practical ethics by ensuring that every medical intervention or
non-intervention must fulfill or not contravene one or several of the 5
purposes of preservation of diin, hifdh al ddiin; life and health, hifdh
al nafs; progeny, hifdh al nasl; intellect, hifdh al ‘aql;
and resources, hifdh al maal. In practical application of the maqasid,
we may come across situations of perceived conflict of purposes and we need to
apply the principles of fiqh, qawa’id al fiqh, to find solutions. The 5
main principles, al kulliyaat al khams, are intentions, qasd;
certainty, yaqiin; injury, dharar; hardship, mashaqqat;
and custom, ‘aadat or ‘urf.
Subprinciples have been developed from each of these five a total of
xxxx in the majallat al ahkaam al ‘adliyyat: 99 general, and xxxx related to
business transactions. The challenge before the ummat today is to develop
detailed subprinciples of medical ethics similar to what the authors of
majallat did for business transactions. This paper will illustrate the use of
such principles using some case studies.
WHY
ISLAMIC ETHICS?
·
The paper
presents Islamic paradigms and shari’at doctrines that underlie the
development of a system of medical ethics (clinical, research, public health).
·
The motivation
is dissatisfaction with the application of contemporary ethical principles that
are not consonant with the all-embracing, comprehensive, and integrated Islamic
world-view.
·
Modern ethics
arose as a response to problems especially medical that positive law could not
resolve. This arose out of the secular paradigm that separated religion from
public life. Medical problems that required moral solutions could not be solved
because morality needs a higher authority usually religious
·
Muslims never
accepted a dichotomy between positive and moral laws the shari’at is comprehensive
so ethical issues have to be covered under the shari’at
·
In ideal
circumstances we should not talk about Islamic ethics as a separate discipline
bur we have to do so in order to communicate with others.
GENESIS
OF WESTERN MEDICAL ETHICS
·
Modern ethics arose
as reactions to ethical transgressions in research resulting in international
codes and national legislations to prevent future transgressions but this was
not successful all the time.
·
In WW2
transgressions were committed by the Nazis and the Japanese. Following trials
of Nazi doctors who had committed atrocities on prisoners at Nurenberg, the
Nuremberg code of 1947 was promulgated. The Helsinki Declaration of 1964 was an
update of the Nurenberg declaration and has itself been updated several times
·
The Belmont
report of 1979 in the US
·
Other ethical
documents were: Declaration of Geneva, International Code of Medical Ethics,
Declaration of Tokyo, Declaration of Oslo,
·
Two problems
(a) principles arose as pragmatic reactions to ethical problems with no consistent
underlying theory (b) ethics is not law: weak enforcement
EXAMPLES OF UNETHICAL RESEARCH 1: NAZI WWII EXPERIMENTS
·
High Altitude Experiments: Prisoners exposed to
low oxygen to test how long pilots ejected from fighter aircraft can survive in
air
·
Hypothermia Experiments: Prisoners submerged in
cold water to find out how long pilots can survive if parachuted into cold sea
water
·
Malaria Experiments: Prisoners infected with
malarial mosquitoes and treated with drugs to discover the effective anti-malarials
·
Typhus experiments: Injection of typhus in
subjects who had got the antityphus vaccine
EXAMPLES OF UNETHICAL RESEARCH 2: JAPANESE WWII EXPERIMENTS
·
Live
dissections of prisoners deliberately infected to study the effects of
infection
·
Exposure to freezing
temperatures to see the body response
·
Grenade tests
on human targets
·
Deprivation of
food and water to study effects and survival
·
Temperature
experiments to see the relationship between temperature, burns, and survival
·
Prisoners
placed into centrifuges and spun until death
EXAMPLES OF UNETHICAL RESEARCH 3: US violations published in journals (Dr Henry Beecher 1966)
·
Deliberately
infecting institutionalized children (intramuscular injection or oral
administration) with a mild form of the hepatitis virus
·
Injecting live
cancer cells into debilitated patients without their knowledge of the true
nature of the injected cells
·
Withholding
antibiotics from patients with rheumatic fever
EXAMPLES OF UNETHICAL RESEARCH 4:Tuskegee Syphilis Study (1932-1972):
·
400 men with
syphilis were enrolled into the study without truly informed consent over a 40
year period
·
Deception: not
told that alternative treatment was available were denied penicillin after
1940s when its effectiveness was known.
·
The study
continued to follow these men until 1972 when the first public accounts of the
study appeared in the national press.
·
The study
resulted in 28 deaths, 100 cases of disability, and 19 cases of congenital
syphilis
·
Ethical
violations: informed consent, deception, withhold treatment and info
EXAMPLES OF UNETHICAL RESEARCH 5: Japan
·
In 1951,
Japanese investigators undertook a study assessing carbohydrate metabolism in
which small pieces of brain tissues were surgically obtained from 70 schizophrenic
patients in a psychiatric hospital.
·
At least three
subjects died after the lobotomy, and medical records testified that two of
them probably died of excision.
·
No subjects or
their families were asked to give informed consent for the operations.
·
Nobody
criticized this experiment until 1971, when a resident of Tokyo University
Hospital reported the investigators to the Japanese Society for Psychiatry and
Neurology.
EXAMPLES OF UNETHICAL RESEARCH 6: China
·
In the 1980s, a
clinical trial was performed in several cities in China examining the
relationship between folate and neural tube defect (NTD).
·
The initial
trial proposed to enroll 65,000 pregnant women in six rural counties outside of
Beijing. The original design raised questions regarding informed consent.
·
Also, at the
time of the trial, British investigators had established that folate was
protective against NTDs. Subsequently, the clinical trial was modified to a
community intervention program.
EXAMPLES OF UNETHICAL RESEARCH 7: India
·
Between
November 1999 and April 2000, 25 patients with oral cancers at the Regional
Cancer Centre, Thiruvananthapuram (a government institution) had their tumors
injected with an experimental chemical in order to evaluate its anti-tumor
properties. The patients were not told that the use of these agents were
experimental.
·
Also, the trial
had not been approved
·
Patients were
denied the established treatment for their condition
EXAMPLES OF UNETHICAL RESEARCH 8: Africa and Thailand
·
AZT placebo
trials: In the early 1990s in trials done in the United States and France
researchers established that treating HIV-positive women with AZT decreased HIV
transmission from mother to child during birth by two thirds.
·
The ACTG 076
regimen became the standard of care for HIV-infected women and their newborns
in the US and other more developed nations.
·
Research in
Africa and Thailand tested a shorter, less intense and therefore less expensive
AZT regimen using a placebo group (denied a known effective treatment). It was
reasoned that the placebo group would not have afforded the treatment anyway.
EXAMPLES OF UNETHICAL RESEARCH 9: Latin America
·
Surfaxin study:
Surfaxin was a proven effective treatment for the infant respiratory depression
syndrome in the US
·
A trial of
surfaxin vs placebo could not ethically be carried out in the US because the
placebo would be denied an effective treatment
·
The company
proposed conducting this study in Latin America where infants with lung
illnesses do not usually have access to effective treatment.
NURENBERG CODE
·
The voluntary
consent of the human subject is absolutely essential”:
·
The Research
objective should be aimed for the good of the society.
·
Research should
be based on prior animal work.
·
The risks
should be justified by the anticipated benefits.
·
Only qualified
scientists must conduct research.
·
Physical and
mental suffering must be avoided.
·
Research in
which death or disabling injury is expected should not be conducted.
·
Facilities and
resources to conduct well-designed research should be available.
·
Subjects must
be free to stop at anytime.
·
The
investigator should stop the study if he/she believes that continuation of the
study will result in serious injury, disability or death of the research
subject.
HELSINKI DECLARATION 1964: EXPANSION OF THE NURENBERG CODE
·
Research
conducted in the context of medical care
·
Human subjects
who lacked decision-making capacity
·
Research
involving vulnerable individuals
·
Independent
review by research ethics committees
THE BELMONT REPORT (1979): PRINCIPLE OF RESPECT FOR PERSONS
·
Individuals be
treated as autonomous human beings and be allowed to choose for themselves.
·
Extra
protection for individuals with impaired ability to decide for themselves.
·
Elements of
respect for persons include: obtaining informed consent from individuals who
are capable of choosing what shall and shall not happen to them.
·
Elements of
informed consent should include: disclosure of information, comprehension, voluntariness
(be free from coercive influences and undue inducement
·
For individuals
who lack decision-making capacity, extra safeguards are in place to provide
them with additional protection.
THE BELMONT REPORT (1979): Principle of Beneficence
·
While the term
“beneficence” is usually understood to cover acts of kindness or charity, in
the realm of research ethics, beneficence is understood as an obligation to:
·
Do no harm
(non-maleficence)
·
Minimization of
harms
·
Maximization of
benefits
·
Beneficence
requires that there be an analysis of the risks and benefits to the subjects,
making sure that there is a favorable risk-benefit ratio.
THE BELMONT REPORT (1979): Principle of Justice
·
The principle
of justice in the sense of “fairness in distribution” requires:
·
Research is
designed so that its burdens and benefits are shared equitably among groups of
populations.
·
Fairness in the
selection of research subjects, e.g., one should not select subjects based on
their easy availability or their compromised position (e.g., individuals in
mental institutions).
EUROPEAN ETHICAL THEORIES 1
·
According to
Beauchamp and Childress (1994) there are eight ethical theories. None of them
can on its own explain all ethical or moral dilemmas.
·
A good ethical
theory must be clear, coherent, complete, comprehensive, simple, practicable,
and able to explain and justify.
·
None of these 8
theories has all these characteristics. In practice more than one theory may
have to be combined to solve a specific ethical issue.
·
In practice use
of maqasid al shari’at is a more robust theoretical formulation as we shall see
EUROPEAN ETHICAL THEORIES 2: utilitarianism and obligation
·
According to
the utilitarian consequence-based theory, an act is judged as good or
bad according to the balance of its good and bad consequences. Utilitarianism
means attaining the greatest positive with the least negative. This theory has
a problem in that it can permit acts that are clearly immoral on the basis of
utility.
·
The obligation-based
theory is based on Kantian philosophy. Immanuel Kant (1724-1804) argued
that morality was based on pure reasoning. He rejected tradition, intuition,
conscience, or emotions as sources of moral judgment. A morally valid reason
justifies action. Acts are based on moral obligations. The problem with the
Kantian theory is that it has no solution for conflicting obligations because
it considers moral rules as absolute.
EUROPEAN ETHICAL THEORIES 3: rights-based and community-based
·
The
rights-based theory is based on respect for human rights of property, life,
liberty, and expression. The individual is considered to have a private area in
which he is master of his own destiny. Rights may be absolute or relative. A
positive right is one that has to be provided to the individual. A negative
right is one that assures prevention of or protection from harm. There is a
complex inter-relation between rights and obligations. Individual rights may
conflict with communal rights. The problem of the rights-based theory is that
emphasis on individual rights creates an adversarial atmosphere.
·
According to
the community-based theory, ethical judgments are controlled by
community values that include considerations of the common good, social goals,
and tradition. This theory repudiates the rights-based theory that is
based on individualism. The problem with this theory is that it is difficult to
reach a consensus on what constitutes a community value in today’s complex and
diverse society.
EUROPEAN ETHICAL THEORIES 3: relation-based and case-based
·
The relation-based
theory gives emphasis to family relations and the special physician-patient
relation. For example a moral judgment may be based on the consideration that
nothing should be done to disrupt the normal functioning of the family unit.
The problem of this theory is that it is difficult to deal with and analyze
emotional and psychological factors that are involved in relationships.
·
The case-based
theory is practical decision-making on each case as it arises. It does have
fixed philosophical prior assumptions.
EUROPEAN ETHICAL PRINCIPLES 1: ONE PRINCIPLE FORMULATION
·
Utilitarianism
(maximizing net utility after taking into consideration benefits and harms into
consideration),
·
Hippocratism
(focuses on the individual patient and ignores everything else),
·
The Libertarian
approach (giving the patient the right to make choices.
EUROPEAN ETHICAL PRINCIPLES 2: TWO PRINCIPLE FORMULATION
·
Beneficence (do
good, bring benefit)
·
Non maleficence
(do not do harm)
EUROPEAN ETHICAL PRINCIPLES 3: THREE PRINCIPLE FORMULATION (Belmont
Report 1978)
·
Respect for
persons (autonomy),
·
Beneficence
(including nonmalificence),
·
Justice.
EUROPEAN
ETHICAL PRINCIPLES 4: FOUR PRINCIPLE FORMULATION
·
James F
Childress and Tom L Beauchamp drafted the main ideas of the book ‘Principles of
biomedical ethics’ in 1976
·
Autonomy
(respect for decision making capacities of autonomous persons)
·
Nonmalificence
(not causing harm to others)
·
Beneficence
(prevent harm, provide benefit, balance benefits against risks and cost)
·
Justice (fair
distribution of risks, benefits, and costs).
FOUR
PRINCIPLE FORMULATIONS: Critique
·
The 4
principles are derived from the common morality that sets moral norms for
society.
·
Not reflecting
clinical realities
·
Not easily
translatable into research decisions
·
Not usable
directly in decision making
·
Not easy to
translate into operational outcomes
·
All these
criticisms point to the fact that the principles were not developed by persons
in direct daily contact with practical ethical problems.
·
The principles
are universal but are not absolute (they can be specified to fit certain
circumstances).
·
Beneficence and
nonmalificence are actually two ends of the spectrum of one principle that some
authors call beneficence.
CHARACTERISTICS OF ISLAMIC BIOETHICS
·
Divine source: Morality
and ethics in Islam are absolute and are of divine origin. All what humans do
it to apply the legal and moral teachings of Islam to practical situations.
·
Law and
morality: European: legal is not always the same as moral. In Islam legal
and moral are consistent
·
Law and ethics:
Islamic law comprehensive and is a combination of moral and positive laws.
Secularized European law denies moral associated with ‘religion’.
·
Ethics, stability
and change: Fixed principles that set the parameters beyond which it is
absolutely immoral to operate. Within these parameters, consensus can be
reached on specific moral issues.
·
Moral
justification: Deduction is a top-down approach popular among Hanafi jurists. Induction
is a bottom-up approach that relies a lot on qiyaas. Inductive processes
involving many cases can lead to a generalization that is considered an ethical
theory.
·
The legal
process: European is adversarial while Islamic is problem solving,
reconciliation
ISLAMIC APPROACH TO ETHICS 1: Overriding paradigms
·
Tauhid
provides an integrating paradigm that assures that an ethical problem is not
considered in isolation from other issues.
·
Shumuliyat is
the comprehensiveness of the Islamic world view that embraces everything within
the Islamic system.
·
Tawazun is
a balanced moderate approach.
·
Tadafu’u is
consideration of actions and the reactions to those actions.
ISLAMIC
APPROACH TO ETHICS 2: maqasid al shari’at as the theory of ethics
·
Protection of
morality/hifdh al ddiin
·
Protection of
Life hifdh al nafs
·
Protection of
Progeny, hifdh al nasl
·
Protection of
the Mind, hifdh al ‘aql
·
Protection of
Wealth, hifdh al maal
ISLAMIC
APPROACH TO ETHICS 3: qawa’id al fiqh as ethical principles
·
The Principle
of Intention, qa’idat al qasd
·
The Principle
of Certainty, qa’idat al yaqeen
·
The Principle
of Injury: qa’idat an dharar: (covers the 4 principles of autonomy,
beneficence, non-malefacence, and justice)
·
Principle of
Hardship, qa’idat al mashaqqat
·
The Principle
of Custom or Precedent, qa’idat al ‘aadat
PROTECTION
OF LIFE, nafs:
·
The primary
purpose of medicine is to fulfill the second purpose, the preservation of life.
·
Medicine
contributes to the preservation and continuation of life by making sure that
the nutritional functions are well maintained.
·
Medical
knowledge is used in the prevention of disease that impairs human health.
Disease treatment and rehabilitation lead to better quality health.
PROTECTION
OF PROGENY, nasl:
·
Medicine
contributes to the fulfillment of this function by making sure that children
are cared for well so that they grow into healthy adults who can bear children.
·
Treatment of
infertility ensures successful child bearing.
·
The care for
the pregnant woman, peri-natal medicine, and pediatric medicine all ensure that
children are born and grow healthy.
·
Intra-partum
care, infant and child care ensure survival of healthy children.
PROTECTION
OF THE MIND, ‘aql:
·
Medical
treatment plays a very important role in protection of the mind.
·
Treatment of
physical illnesses removes stress that affects the mental state.
·
Treatment of
neuroses and psychoses restores intellectual and emotional functions.
·
Medical
treatment of alcohol and drug abuse prevents deterioration of the intellect.
PROTECTION
OF WEALTH, mal:
·
The wealth of
any community depends on the productive activities of its healthy citizens.
Medicine contributes to wealth generation by prevention of disease, promotion
of health, and treatment of any diseases and their sequelae.
·
Communities
with general poor health are less productive than a healthy vibrant community.
·
The principles
of protection of life and protection of wealth may conflict in cases of
terminal illness.
·
Care for the
terminally ill consumes a lot of resources that could have been used to treat
other persons with treatable conditions.
·
The question
may be posed whether the effort to protect life is worth the cost.
·
The issue of
opportunity cost and equitable resource distribution also arises.
THE
PRINCIPLE OF INTENTION, qasd:
·
The Principle
of intention comprises several sub principles. The sub principle that each
action is judged by the intention behind it calls upon the physician to consult
his inner conscience and make sure that his actions, seen or not seen, are
based on good intentions.
·
The sub
principle that what matters is the intention and not the words rejects the
wrong use of data to justify wrong or immoral actions.
·
The sub
principle that means are judged with the same criteria as the intentions
implies that no useful medical purpose should be achieved by using immoral
methods.
THE PRINCIPLE OF CERTAINTY, yaqeen:
·
Medical
diagnosis cannot reach the legal standard of certainty.
·
Treatment
decisions are best on a balance of probabilities.
·
Each diagnosis
is treated as a working diagnosis that is changed and refined as new
information emerges. This provides for stability and a situation of
quasi-certainty without which practical procedures will be taken reluctantly and
inefficiently.
·
Established
medical procedures and protocols are treated as customs or precedents. What has
been accepted as customary over a long time is not considered harmful unless
there is evidence to the contrary.
·
All medical
procedures are considered permissible unless there is evidence to prove their
prohibition.
THE
PRINCIPLE OF INJURY, dharar: 1
·
Medical
intervention is justified on the basic principle is that injury, if it occurs,
should be relieved. An injury should not be relieved by a medical procedure
that leads to an injury of the same magnitude as a side effect.
·
In a situation
in which the proposed medical intervention has side effects, we follow the
principle that prevention of harm has priority over pursuit of a benefit of
equal worth. If the benefit has far more importance and worth than the harm,
then the pursuit of the benefit has priority.
·
Physicians
sometimes are confronted with medical interventions that are double edged; they
have both prohibited and permitted effects. The guidance of the Law is that the
prohibited has priority of recognition over the permitted if the two occur together
and a choice has to be made.
THE
PRINCIPLE OF INJURY, dharar: 2
·
If confronted
with 2 medical situations both of which are harmful and there is no way but to
choose one of them, the lesser harm is committed. A lesser harm is committed in
order to prevent a bigger harm.
·
In the same way
medical interventions that in the public interest have priority over
consideration of the individual interest. The individual may have to sustain a
harm in order to protect public interest.
·
In the course
of combating communicable diseases, the state cannot infringe the rights of the
public unless there is a public benefit to be achieved. In many situations, the
line between benefit and injury is so fine that salat al istikharat is needed to reach a solution since no empirical
methods can be used.
PRINCIPLE
OF HARDSHIP, mashaqqat: 1
·
Medical
interventions that would otherwise be prohibited actions are permitted under
the principle of hardship if there is a necessity.
·
Necessity
legalizes the prohibited. In the medical setting a hardship is defined as any
condition that will seriously impair physical and mental health if not relieved
promptly. Hardship mitigates easing of the sharia rules and obligations.
·
Committing the
otherwise prohibited action should not extend beyond the limits needed to
preserve the Purpose of the Law that is the basis for the legalization.
PRINCIPLE
OF HARDSHIP, mashaqqat: 2
·
Necessity
however does not permanently abrogate the patient’s rights that must be
restored or recompensed in due course; necessity only legalizes temporary
violation of rights. The temporary legalization of prohibited medical action
ends with the end of the necessity that justified it in the first place.
·
This can be
stated in al alternative way if the obstacle ends, enforcement of the
prohibited resumes/ It is illegal to get out of a difficulty by delegating to
someone else to undertake a harmful act.
THE
PRINCIPLE OF CUSTOM or PRECEDENT, ‘aadat:
·
The standard of
medical care is defined by custom.
·
The basic
principle is that custom or precedent has legal force.
·
What is
considered customary is what is uniform, widespread, and predominant and not
rare.
·
The customary
must also be old and not a recent phenomenon to give chance for a medical
consensus to be formed.
CASE ANALYSIS#1:
A 60-year old comatose accident victim suffering from severe
multi-organ traumatic injury and with a signed organ donation card was
evaluated in the ER of a remote rural hospital. Most clinical signs of brain
death were positive but two were not. The doctor at the insistence of the
family declared death to enable a teenage cousin to obtain a transplant kidney
CASE ANALYSIS #2:
A 40-year old billionaire stage 4 cancer victim with multi organ
failure in ICU and on artificial life support was determined clinically dead on
the basis of clinical signs repeated after 6 hours. Confirmatory tests were
negative. Family members, ready to pay extra ICU costs, begged the physicians
to delay death declaration until the wife arrived from overseas
CASE ANALYSIS #3:
A 90-year old deeply comatose man with multiple organ failure was
admitted to the last available ICU bed and was put on artificial life support
minutes when the family refused a DNR order. A few minutes’ later ambulances
started bringing in over 100 casualties from an air crash site. The head of the
ICU carried out a rapid assessment of the comatose man showed equivocal
clinical signs of brain death; some indicating death and others not. None of
the confirmatory tests was positive.
CASE ANALYSIS #4:
In a measles mini-epidemic the MOH orders
vaccination of all children with no immunization records. A pediatrician living
at the KSU campus with non-school going toddlers refuses to take his children
for vaccination arguing that the risk of vaccination complications was higher
for his children than the risk of measles infection.
CASE ANALYSIS #5:
A mentally retarded Down syndrome youth aged 15
years had been to court several times for sexual attacks on toddlers. The judge
ordered the doctors to suppress his sexual aggression by use of hormones and if
that was not effective to remove his testes.
CASE ANALYSIS #6:
A 50-year old with 3 young wives complained of
erectile dysfunction caused by his anti-hypertensive medication. When the
government hospital refused to provide free Viagra he stopped his
anti-hypertensive medication and suffered a stroke.
CASE ANALYSIS #7:
An elderly patient with advanced esophageal
cancer refused insertion of a nasogastric feeding tube and insisted on taking
sold food that he could not swallow. He said he would prefer to die from
starvation than accept the tube. The surgeons sedated him and inserted the tube
without his consent and kept him under sedation so that he cannot complain
CASE ANALYSIS #8:
A 30 year old soldier with insulin dependent
juvenile diabetes asked for free Viagra from a government clinic before his
second marriage and was denied. He did not have enough money to buy the drug
for himself. He claims that his first marriage was destroyed by erectile
dysfunction
CASE ANALYSIS #9:
In a chemical disaster, there was limited
antidote and a decision was made to give it only to children aged below 5
years. Health workers, emergency workers, and the police were angry at this
prioritization refusing to work
CASE ANALYSIS #10:
A 90
year old 100% dependent on a respirator with no hope of independent life asks
the doctor to disconnect the machines so that he can die in peace but the
doctor refuses. He has no serious disease; he had become dependent on the
respirator during a prolonged and poorly managed episode of pneumonia.
CASE ANALYSIS #11:
A socially respected elderly businessman with
frequent travel overseas is in terminal illness due to sexually acquired HIV.
On discharge from hospital he asks the doctors not to disclose his status to
his family because of the shame involved but the doctor refuses
CASE ANALYSIS #12:
A child is seriously ill and requiring
immediate blood transfusion and surgery but both parents refuse any
intervention saying they know the child is going to die and that is the will of
Allah. The doctor decides to respect the parents’ wishes
CASE ANALYSIS #13:
A woman fully competent in slow labor with no
impending fetal distress refuses cesarean section but the doctor insists
because of fear for his reputation if the delivery gets complicated. He forces
the woman to accept a Cesarean section immediately.
CASE ANALYSIS #14:
The MOH imposed a fee on circumcision of boys
in all its hospitals. Parents complained on the grounds that circumcision was a
medical and not a religious necessity
THE FUTURE CHALLENGE
The challenge before the ummat today is to develop detailed
subprinciples of medical ethics similar to what the authors of majallat did for
business transactions. This paper will illustrate the use of such principles
using some case studies.