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Presented at the Islamic Community of
Monte Negro on June 27, 2013 by Professor Dr Omar Hasan Kasule Sr. MB ChB
(MUK), MPH (Harvard), DrPH (Harvard) EM: omarkasule@yahoo.com.
WEB: http://omarkasule.tripod.com
1.0 SOURCES OF THE LAW, masadir al shariat
- Qur’an as a primary source of law
- Sunnat as a primary source of law
- Secondary sources of the Law: Ijma (consensus of scholars), qiyaas (analogy), Istishaab, Istihsaan, Istislaah, sadd al dhari'at
2.0 CLASSIFICATION OF REGAL
RULINGS: MEDICAL APPLICATIONS
- Obligatory, waajib
- Recommended, manduub
- Prohibited, haraam
- Offensive, makruuuh
3.0 THE 5 PURPOSES OF THE LAW IN MEDICINE, maqasid al shari’at fi al tibb
- Protection of ddiin, 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 mal
4.0 TAHARAT FOR THE SICK, TAHARAT AL MARIIDH
·
Tayammum is carried out when it is difficult to use water.
·
Fresh blood is not najs when
in the body
·
Pleural, peritoneal, pericardial, synovial, respiratory fluids are not najs
·
Vomitus that is severe may contain intestinal contents and should
always be considered najs.
·
Diarrhea is najs and
nullifies wudhu.
- Stoma have to be cleaned and salat is done with them discharging.
5.0 HAIDH
·
Artificial menopause is necessary, dharuurat, if there is
serious disease like cancer.
·
Estrogen replacement therapy (ERT) can alleviate virtually all
menopausal symptoms. The Law considers 15 days the maximum duration of the
menstrual flow. Salat and fasting are suspended during this time.
·
Prolonged bleeding, istihaadhat,
is not considered menstruation
·
The use of hormones in hajj is allowed
·
The use of hormones for Ramadhan is not allowed
6.0 SALAT OF THE SICK, salat
al maridh
- Make-up salat, qadha al salat;
- Resting for moments in a sitting position to regain energy for the next movement;
- Praying in a sitting position;
- Praying while sitting down and cross-legged;
- Praying while lying down on one side of the body;
- Resting on a staff in salat;
- Praying by gesturing with one part of the body e.g. Finger;
- Finally praying in the mind with no motions.
6.0 MEDICAL GUIDELINES ON DIET IN SAUM.
- The aim should be maintaining normal body weight or actually reducing it if overweight. Over-eating at iftaar and suhuur should be avoided. It will cause weight gain and indigestion.
- The diet should contain sufficient fiber to prevent constipation. Fiber and slowly digested foods with a long stomach transit times are preferred because they delay the feeling of hunger.
- Enough water should be taken at night both for preventing dehydration and preventing constipation.
- Adequate fluid and salt intake prevents lethargy in the afternoon caused by low blood pressure.
- Inadequate sleep is a cause of headaches.
- Intake of adequate calcium, magnesium, and potassium will prevent muscle cramps.
- Hot places should be avoided because they aggravate the dehydration.
- Cooling the body such as tepid sponging, tabarrud, is allowed during saum.
7.0 SAUM WITH DIABETES
MELLITUS
- Insulin-dependent diabetics have to reduce their insulin dose because of reduced food intake during the day. In some cases this is not possible and they have to be exempted from saum altogether
- Insulin-dependent diabetics should be monitored very carefully because hypoglycemia may arise due to insulin injections with inadequate dietary intake.
- Non-insulin diabetics can undertake saum under medical supervision. This will generally require changing times of medication, close monitoring of blood sugar levels, and being alert to any hyperglycemic or hypoglycemic crises.
- Pregnant diabetics are exempted from fasting because diabetic control is more difficult in pregnant women making fasting doubly hazardous for both the mother and the fetus.
8.0 SAUM WITH DISEASE IN GENERAL
·
The sick are allowed to
break saum if trusted physicians fear
that saum will be deleterious to good
health. The missed saum is made up
later.
·
If the illness is chronic, maradh muzmin, then there will be no
opportunity for making up. The saum
of a sick person is valid but is makruh.
·
The heirs can perform
make-up fasting, qadha al saum, for
days missed by a deceased disabled by disease in terminal illness.
·
Peptic ulcers are
aggravated by raised acid levels and could be a reason for exemption from saum.
·
Low fluid intake could
encourage growth of kidney stones and joint problems due to deposition of
excess solutes.
9.0 MEDICAL EXAMINATION AND INVESTIGATIONS IN SAUM:
- Taking blood, urine, and stool samples for investigation does not nullify saum.
- Diagnostic enemas and barium meal examinations nullify saum.
- Esophagoscopes, gastroscopes, and sigmoidoscopes that have lubricants or other substances that will remain in the jawf nullify saum.
- Digital rectal examination involves inserting substances into the jawf and may nullify saum.
- Vaginal examination may nullify saum but the reasoning involved is more complicated. Examination of the external auditory canal, endoscopy and catheterization of the urethra and the urinary bladder should in normal circumstances not nullify saum because they do not involve entry into the jawf.
- Imaging that does not involve using contrast media in the jawf does not nullify saum. IVP uses contract media injected in the blood stream and not the jawf.
10.0 MEDICAL TREATMENTS AND SAUM
- Drugs of whatever form taken orally, per anus, nullify fasting. The medication schedule can be modified such that drugs are taken only during the night hours.
- Sub-lingual medication absorbed from the oral cavity with none entering the esophagus may not nullify saum.
- All drugs that are applied externally on the skin do not nullify fating.
- Use of eye drops does not nullify fasting.
- Nose drops may nullify fasting because they could drop into the pharynx and be swallowed.
- Inhalants may nullify saum if they have droplets of water that can enter the jawf.
- Injections (sub-cutaneous, intra-muscular, and intra-venous) do not nullify saum because they do not involve putting substances into the jawf. However nourishing and rehydrating injections nullify the purpose of saum.
- Hormonal preparations should not be used to delay menstruation in order to avoid interrupting saum of Ramadhan.
11.0 ASSISTED REPRODUCTION
- In vivo insemination, al talqiih al istinaa’e al daakhilii: Artificial intra-uterine insemination with husband’s sperm, talqiih sina’i dhaati is permitted
- In vitro fertilization, al talqiih al istinaa’e al khaariji: The Law permits in vitro fertilization (IVF) if the sperm and ovum are from legally wedded husband and wife and the zygote is implanted in the same wife.
12.0 CONTRACEPTION
- Overview: There is basic permissibility of contraception from the hadith on coitus interruptus, tarkhis fi al ‘azal. This is permission for each individual couple. Contraception as a national or community policy is repugnant to the purposes of the Law and could lead to demographic disequilibrium.
- Decisions on contraception must be by mutual consent of the spouses. If contraception is a dharuurat for preserving the life of the mother, the husband’s agreement is not required. There is no consensus among jurists on sterilization as a method of contraception.
- Contraception as part of a national population control policy is prohibited by Law.
- The permissible reversible methods for males are the condom, coitus saxanicus, coitus reservatus, and coitus interruptus.
- Permissible reversible methods for females are either mechanical (the diaphragm, the cervical cap, the vaginal sponge) or chemical (spermicides, oral contraceptive pills). Some forms of IUD are not permitted because they cause early abortion.
13.0 ABORTION
- Abortion is criminal homicide because life is considered to start at conception.
- Abortion is immoral because it encourages sexual immorality and promiscuity without fear of pregnancy.
- Abortion is the lesser of two evils in cases of serious maternal disease because one life is lost instead of two.
14.0 ARTIFICIAL LIFE SUPPORT
- The aim of palliative care is pain control, psychological support, emotional support, and spiritual support.
- Withholding is easier than withdrawing
- Euthanasia is haram
- Brain stem death is accepted as death
15.0 SOLID ORGAN TRANSPLANTATION
- Transplantation is allowed from a living or dead donor with consent
- Selling organs is forbidden
16.0 COSMETIC AND
RECONSTRUCTIVE SURGERY
- The concept of change of Allah’s creation
- Beautification
- Reconstructive/restorative surgery
- Cosmetic surgery
17.0 ISSUES AFTER DEATH
- Embalming
- Autopsy
18.0 CONSENT AND REFUSAL OF TREATMENT FOR COMPETENT ADULTS’
- No medical procedures can be carried out without informed consent of the patient except in cases of legal incompetence.
- The patient is free to make decisions regarding the choice of physicians and treatments. Consent can be by proxy in the form of the patient delegating decision making or by means of a living will.
- The patient must be free and capable of giving informed consent.
- Spouses and family members do not have an automatic right to consent for a competent patient. A spouse cannot overrule the patient’s choice.
19.0 CONSENT AND REFUSAL OF TREATMENT FOR INCOMPETENT
- Consent for children
- Mental patients
- The unconscious
- Obstetrics