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Paper presented by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine at the Institute of Medicine University of Brunei and Visiting Professor of Epidemiology at University Malaya. WEB: http://omarkasule.tripod.com at the Scientific and Islamic Medicine Seminar organized by the Students’ Executive Board Faculty of Medicine Deponegoro University held on Sunday 19th October 2008n at the Central Java Governors’ Hall Semarang Java Timur Indonesia
1.0 FUTURE VISION: ISLAMIC HEALTH CARE INDUSTRY
I am talking about the future. My futuristic vision is that in the next 15-20 years a vigorous Islamic healthcare industry will have emerged and will be well established. There will be many Islamic hospitals, polyclinics, free standing diagnostic centers, rehabilitation centers, and palliative care centers.
The Islamic healthcare industry is part of a general trend that started growing stronger with the dawn of the 15th century of hijra to rebuild Muslim civilizational institutions such as Islamic economics, Islamic banks, Islamic insurance, Islamic schools, Islamic universities, and Islamic nutrition (halal food).
The Islamic healthcare industry will in my vision outperform the Islamic banking industry in terms of revenue generation and contribution to GDP. This is because Islamic health care is an added value. Patients are dissatisfied with the biomedical model of medical care delivery because of its emphasis on technology at the expense of the human dimension that would be obtained in an Islamic holistic care that takes into consideration spiritual, psychological, and social dimensions of health care.
The emergence of the Islamic health care industry necessitates a theoretical definition and refining of the concept of the Islamic perspective of medicine as well as the training of physicians and nurses to deliver care from an Islamic dimension.
2.0 ISLAMIC INPUT IN MEDICAL EDUCATION
The Islamic Input into the Medical Curriculum (IIMC) has become a reality in several medical schools over the past decade. The Kulliyah of Medicine of International Islamic University Malaysia taught medicine with embedded Islamic values was taught at Kuantan from July 1997 to date. IIMC involved integrating Islamic values and Law in the teaching and practice of medicine.
At the Institute of Medicine, Universiti Brunei Darussalam, the Islamic perspective of medicine (Islamic Medicine) has been an integral part of the curriculum since August 2005 until now with IIMC being taught under the theme of Personal and Professional Development (PPD).
IIMC in various forms was adopted by other medical schools at various universities such as the Universiti Sains Islam, Malaysia, Riphah International University Islamabad, Peshawar Medical College, and the 14 schools that are members of FOKI (Forum Kedokteran Islam Indonesia).
IIMC is based on 3 assumptions: (a) that Islam has moral values that are universal and, being found in other religions and belief systems, can be taught to and be appreciated equally well by Muslim and non-Muslim students;. (b) a physician must understand Islamic Law relating to medicine, fiqh tibbi, in order to practice successfully in a Muslim community whose culture and social norms are shaped by the shari’at that is a comprehensive code affecting all aspects of the life of the individual and the community; and (c) a successful physician must be equipped with personal, communication, leadership, and management skills based on Islamic teachings and empirical social and managerial sciences.
IIMC teaches the Islamic epistemological perspective of basic medical sciences so that students can appreciate the signs of the Creator, ayat al allah, from the book of empirical scientific observation, kitaab al kawn, alongside appreciating the signs of the Creator from the book of revelation, kitaab al wahy.
IIMC in the clinical phase teaches students to help patients solve practical problems related to ablution, wudhu, prayer, solat, fasting, puasa, pilgrimage, hajj & umrah; and what is permitted, halal, as medicine, physical activities, nutrition, and other activities of daily living.
IIMC uses the theory of the purposes of the Law, maqasid al shari’at, principles of the Law, qawa’id al shari’at, specific legal rulings from the Qur’an and sunnat, and comparing with European ethico-legal sources as bases for discussing medical ethico-legal issues such as autonomy, privacy & confidentiality, professionalism, animal and human research, resource allocation, end of life issues, and medical malpractice. Also covered are issues that arise out of modern medical technology such as assisted reproduction, genetic testing, and transplantation. An emphasis is made on a holistic and balanced approach to medicine by reference to Prophetic medicine, tibb nabawi, and traditional / complementary medical systems such as unani, ayurdevic, and Chinese medicine.
The futuristic vision of IIMC is that Islamic medical practice will in the next 20 years grow and reach or even the exceed the achievements of Islamic banking. The Islamic hospitals and clinics that will be established will need medical professionals trained to practice medicine according to the Qur’an, sunnat, and the purposes of the Law, maqasid al shari’at.
3.0 TRAINING OF HEALTHCARE WORKERS ON ETHICO-LEGAL-FIQHI ISSUES: FROM AN ISLAMIC PERSPECTIVE
3.1 Overview
The following is a brief presentation of the prototype training program undertaken by the author on teaching ethico-legal knowledge and practice in 3 continents and 11 countries over a 3-year period, 2005-2008. The vision is to expand the outreach of this program to cover as many Muslim healthcare workers in Indonesia as possible. If such a wide coverage is achieved, it will be possible to reform healthcare delivery and actualize Islamic medicine in Indonesia.
The training programs conducted by the speaker consisted of 3 phases. The first phase was presentation of the basic ethico-legal theory and principles. The second phase was small group discussions of cases with illustrative ethico-legal problems. The third phase was a plenary session at the end that provided an opportunity for discussing outstanding issues.
The training programs used a theory of ethics derived from the Higher Purposes of the Law as well as the Major Principles of the Law. Medical procedures deemed ethical promote and do not violate the 5 purposes of preserving religion, life, progeny, intellect, and resources. The 5 legal principles / legal axioms (intention, certainty, injury, difficulty, and custom) aid in legal reasoning of complicated ethico-legal issues.
Physicians, nurses, nurses, and medical students who participated in the training programs completed pre- and post- training questionnaires that challenged them to identify and resolve ethico-legal violations and dilemmas in various clinical case scenarios. Questionnaire data was analyzed to describe variations of ethical knowledge by country and by professional status as well as determining the impact of training on the participants.
3.2 Countries covered (2005-2008 N)
- SOUTH-EAST ASIA: Malaysia (many), Brunei (many), Indonesia (many)
- SOUTH ASIA: India (4), Bangladesh (4), Pakistan (1)
- WEST ASIA: Turkey (1) and Yaman (1)
- EUROPE: UK (6 programs)
- AFRICA: South Africa (2), Nigeria (8), Kenya (2)
3.2 THE CURRICULUM OUTLINE
3.2.1 Theories and principles of medical ethics
v Purposes and Principles of Medicine and ethics, maqasid wa qawa’id al tibaabat
v Regulations of Medical Procedures, dhawaabit al tatbiib
v Regulations of Research Procedures, dhawaabit al bahath
v Regulations of Physician Conduct, dhawaabit al tabiib
v Regulations about Professional Misconduct, dhawaabit al inhiraaf al mihani
3.2.2 The etiquette of the physician, adab al tabiib
v Etiquette with Patients and Families, adab al tabiib ma’a al mariidh
v Etiquette with the Dying, adab al tabiib ma’a al muhtadhir
v Etiquette with the Health Care Team, adab fariiq al tibb
v Etiquette of Research on Humans, adab al bahth al ‘ilmi
3.2.3 Issues in disease conditions, fiqh al amraadh
v Uro-Genital System, jihaaz bawli & jihaaz tanaasuli
v Cardio-Respiratory System, qalb & jihaaz al tanaffus
v Connective Tissue System,
v Alimentary System, jihaaz al ma idat
v Sensory Systems, al hawaas
v Patho-physiological Disturbances
v General Systemic Conditions
v Psychiatric conditions, amraadh nafsiyyat
v Neurological conditions, amraadh al a’asaab
v Age-Related Conditions, amraadh al ‘umr
3.2.4 Issues in modern medicine fiqh mustajiddaat al tibb
v Assisted Reproduction, taqniyat al injaab
v Contraception, mani’u al haml
v Reproductive Cloning, al istinsaakh
v Abortion, isqaat al haml
v Genetic Technology, taqniyat wiraathiyyat
v Artificial Life Support, ajhizat al in’aash
v Euthanasia, qatl al rahmat
v Solid Organ Transplantation, naql al a’adha
v Stem Cell Transplantation, naql al khalaayat
v Change of Fitra, taghyiir al fitrat
3.3 METHODOLOGY OF TRAINING
3.3.1 Closing the gap: The ethico-legal training program starts from the premise that there is a gap between what is and what ought to be and that this gap can be closed by training.
3.3.3 Practical on-the-job training: Training is learning on the job and is therefore very practical in nature. The trainers do not give lectures but rather facilitate discussion and interaction among participants that leads to learning. The training is based entirely on study and discussion of cases of actual ethical problems that are encountered in hospital practice. Source material is provided in advance of any workshops. As far as possible training is brought to each health center of hospital in order to reach as many professionals as possible.
3.3.4 Details of the training workshop: A total of 5 workshops each lasting 2-3 hours is needed to cover the curriculum. So far one round of introductory workshops has been done in each of the countries. Later workshops will cover other aspects of the curriculum. Workshop participants receive the training material at least a month in advance. Each workshop is opened by a short introduction from the workshop facilitator. Then the participants are divided into discussion groups each dealing with a group of related cases. Groups present their findings in the plenary session followed by a general discussion. The facilitator summarizes the principles learned as well as corrects any misunderstandings.