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Presented at a workshop at Mombasa Kenya on Saturday 29th February 2020 by Professor Omar Hasan Kasule Sr MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics Riyadh.
ISLAMIC ETHICS: GENERAL CHARACTERISTICS - 1
• Morality and ethics in Islam are absolute and are of divine origin. Human consensus not deriving from divine legislation cannot be a source of binding ethical guidelines. All that humans do it to apply the legal and moral teachings of divine origin to practical situations.
• The Law automatically bans all immoral actions as haram and automatically permits all that is moral as mubaah.
• Ethical guidelines are both fixed and variable. The fixed moral and legal principles are broad enough to encompass the needs of all times and places. The detailed applications are variable and change with the growth of science and technology.
ISLAMIC ETHICS: GENERAL CHARACTERISTICS - 2
• The fixed principles set the parameters beyond which it is absolutely immoral to operate. Within these parameters, consensus can be reached on specific moral issues.
• Ethics cannot be divorced from morality. Ethics can also not be divorced from Law. Islamic Law is a compendium of ethics, morality, and legal rules.
• The purposes of the Law, maqasid al shari’at, the principles of the Law, qawa’id al fiqh, and the regulations of the Law, dhawaabit al fiqh3, are therefore the basis of ethics.
PURPOSES OF THE LAW = maqasid al shari’at
• The first purpose is protection of ddiin, hifdh al ddiin.
• The second purpose is the protection of life, hifdh al nafs,
• The third purpose is the protection of progeny, hifdh al nasl.
• The fourth purpose is the protection of the mind, hifdh al ‘aql.
• The fifth purpose is the protection of wealth, hifdh al maal.
PRINCIPLES OF MEDICINE = qawai’d al shari’at
• The first principle is the principle of intention, qa’idat al qasd.
• The second principle is the principle of certainty, qaidat al yaqeen.
• The third principle is the principle of injury, qa’idat al dharar.
• The fourth principle is the principle of hardship, qa’idat al mashaqqat
• The fifth principle is the principle of custom, qa’idat alk urf / aadat
THE PRINCIPLE OF INJURY, QAIDAT AL DHARAR IN MEDICAL APPLICATIONS - 1
• Medical intervention is justified on the basic principle that injury, if it occurs, should be relieved, al dharar yuzaal.
• The physician should however cause no harm in the course of his work according to the principle of la dharara wa la dhirar.
• Injury should be prevented or mitigated as much as is possible, al dharar yudfau bi qadr al imkaan.
• When an injury is found in a patient it is presumed to be of recent origin unless there is evidence to the contrary, al dharar la yakuun qadiiman, and therefore must be alleviated.
THE PRINCIPLE OF INJURY, QAIDAT AL DHARAR IN MEDICAL APPLICATIONS - 2
• An injury should not be relieved by a medical procedure that leads to an injury of the same magnitude as a side effect, al dharar la yuzaal bi mithlihi.
• 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, dariu an mafasid awla min jalbi al masaalih. If the benefit has far more importance and worth than the harm, then the pursuit of the benefit has priority.
THE PRINCIPLE OF INJURY, QAIDAT AL DHARAR IN MEDICAL APPLICATIONS - 3
• 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, idha ijtama'a al halaal wa al haram ghalaba al haraam al halaaal.
• 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, ikhtiyaar ahwan al sharrain. A lesser harm is committed in order to prevent a bigger harm, al dharar al ashadd yuzaalu bi al dharar al akhaff.
THE PRINCIPLE OF INJURY, QAIDAT AL DHARAR IN MEDICAL APPLICATIONS - 4
• Medical interventions that are in public interest have priority over consideration of individual interest, al maslahat al aamat muqaddamat ala al maslahat al khaassat.
• The individual may have to sustain a harm in order to protect public interest, yatahammalu al dharar al khaas li dafu’i al dharar al aam.
• In the course of combating communicable diseases, the state may have to restrict the movements of a citizen or even destroy his property.
• The state cannot infringe on the rights of the public unless there is a public benefit to be achieved, al tasarruf ala al ra'iyat manuutu bi al maslahat.
• 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.
CASE STUDIES OF THE PRINCIPLE OF INJURY IN MEDICAL APPLICATIONS
• Case 1: Immediate surgery in a case of spinal injury with a 10% chance of success and 90% chance of permanent paraplegia. If surgery is not carried out paraplegia will occur after 6 months
• Case 2: Writing a DO-NOT-RESUSCITATE (DNR) order for a conscious patient with no hope of recovery
• Case 3: Abortion of a fetus with a congenital abnormality incompatible with life
CASE STUDIES OF THE PRINCIPLE OF INJURY IN SOCIAL INTERVENTIONS
• Case 1: Family formation and higher professional education
• Case 2: Premarital screening for disease
• Case 3: Marrying within vs marrying outside the family circle
• Case 4: Denying TV and mobile from teenagers
• Case 5: ostracizing or otherwise punishing addicts