220604P - EPISTEMOLOGY OF ISLAMIC INTEGRATION OF KNOWLEDGE IN MEDICINE

Presentation at the 3^rd Decades of Medical Faculty of Universitas Muslim Indonesia (UM) and 68^th Anniversary of UMI international seminar on 04 June 2022 at 9.30 AM Indonesian Central Time. By Prof. Omar Hasan Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics

 
THE MOTIVATION OF INTEGRATION:

• Islam is not a state of being but an action to improve and get better towards the pleasure of Allah. This means that all human endeavors including medicine require the integration of Islamic values to get better.
• Integration is infusing the moral teachings of Islam deriving from the ‘aqiidat and the practical regulations of the shari’at into medicine.
• Integration is not parochializing medicine or creating medicine for Muslims only. It is the universalization of medicine because Islamic values are universal.
• This universality though obvious is misunderstood or distorted by Muslims and non-Muslims.
• A lot has been achieved in the endeavor of Integrating medicine over the past endeavor over the past half century as will be explained below but a lot remains to be done.

HISTORICAL DEVELOPMENTS PRE-1980:

• The concept of Islam in medicine was not crystallized at this period. There was however a general interest in relating Islam to medicine as part of the general Islamic awakening that was taking place.
• Islamic medical associations were formed to bring Muslim physicians together for example the Islamic Medical Association of the US and Canada was formed in 1967 to be followed by others in other countries.
• Once the physicians got together, they started asking themselves the ultimate questions: who are we? What is our mission? What is our origin and what is our future? These questions drew them closer to the integration of Islam into their profession, but the nature of the integration was not yet clear.

HISTORICAL DEVELOPMENTS 1980-1995:

• During this period developments occurred in medical relief, medical education, and defining Islamic medicine. More IMAs were formed at national and local levels. Medical relief efforts of IMAs became more extensive and sophisticated with major activities in the US, Pakistan, and South Africa.
• The budgets and coverage of these programs grew bigger with coverage of more regions all over the world.
• The IMAs of different countries started working together in networks and eventually formed the Federation of Islamic Medical Associations (FIMA).
• At the same time, interest in the religious education of future physicians picked up with some faculties of medicine such as YARSI in Jakarta and AZHAR in Cairo prescribing an Islamic religious education curriculum.

DEFINITION OF ISLAMIC MEDICINE JULY 1995

• Islamic Medicine is defined as Medicine whose basic paradigms, concepts, values, and procedures conform to or do not contradict the Qur'an and Sunnah.
• It is not specific medical procedures or therapeutic agents used at a particular place or a particular time.
• Islamic medicine is universal, all-embracing, and flexible, and allows for the growth and development of various methods of investigating and treating diseases within the framework described above.
• This definition calls for the basic transformation of medical systems. Islamic medicine thus becomes the result of an Islamic critique and reformulation of the basic paradigms, research methodology, teaching, and practice of medicine. This process of conceptual transformation also called the Islamization of medicine, is described in detail in the paper^[1].

NOTE:

1. https://omarkasule-tib.blogspot.com/2011/05/950709p-islamic-medicine-concept.html

HISTORICAL DEVELOPMENTS AFTER 1995:

• This period witnessed the establishment of many Islamic hospitals and polyclinics in Muslim-majority and Muslim-minority countries. The main motivation was practicing medicine from an Islamic perspective.
• The challenge was that the Islamization paradigm was still in its infancy, and they did not want to wait and decided to move ahead and solve problems as they appeared.
• The first step was to make hospitals ibadah-friendly and shari’at compliant with standard operating procedures.
• In this period medical education from an Islamic perspective became a reality as faculties changed their curricula to reflect Islamic values with a focus on medical fiqh (al fiqh al tibbi) and medical ethics.

ORGANIZATIONS OF ISLAMIC MEDICINE:

• Local Islamic Medical Associations (IMAs)
• Federation of Islamic Medical Associations (FIMA)
• Islamic Hospitals Consortium (IHC)
• Consortium of Islamic Medical Colleges (CIMCO)

Islamic Hospital Amman, Jordan:
 
Islamic Specialist Hospital Kuala Lumpur:
 
Islamic Hospital Bandung
 
Saidina Abubakar Islamic Hospital Uganda:
 
International Islamic Hospital Yogyakarta:
 
Kulliyyah of Medicine Kuantan Malaysia:
 
IIUM Medical Centre:

THE FUTURE:

• Genetic engineering, new reproductive technologies, and gene therapy are producing new ethical dilemmas that will require solutions. Traditional fiqh rulings will not be able to resolve these new challenges and ijtihad based on maqaasid (ijtihad maqaasidi) will have to be used extensively.
• Medical care is a big business. Islamic hospitals must think about Islamizing their business models following fiqh and mua’amalaat. They will need to develop new models of financing health care most likely developing takaful insurance.
• The area of pharmaceutical research and distribution of pharmaceutical has many ethical challenges that will require Islamic solutions.

OVERVIEW OF INTEGRATION:

• Integration of Islamic values into medical education, training, and practice is a prerequisite for quality healthcare in Muslim communities.
• No community or civilization can succeed without basing its development on its own values.
• We can now see the fruits of efforts integration starting in Malaysia more than 20 years ago.
• Integrated medicine is being taught to doctors and nursing and we have several Islamic or shari’at-compliant hospitals.
• We are looking forward to integrated healthcare systems including health insurance, integrated research, and an integrated pharmaceutical industry.
•  Integration of Islamic values in the medical faculty ensures integration of those values in the hospitals by future doctors.

5 COMPONENTS OF INTEGRATION:

• Conceptually we need to teach the Islamic concepts of life, death, disease/illness, and treatment.
• We then need to teach basic medical sciences as evidence of the well-coordinated and well-proportioned perfect creation by Allah and that life processes follow the physical laws (sunan Allah) that the creator set.
• After that, we need to teach the Islamic ethical and fiqh aspects of diagnosing, preventing, and treating disease.
• After that, we need to teach the Islamic concepts of a healthy and balanced family and community and how dysfunctions are the root causes of many human diseases.
• The future of integrated medicine is very bright not only for Muslims but for the whole of humanity because Islamic values are universal and not parochial. It must also be understood that integration is putting value in scientific medicine and not inventing a new type of medicine.

TAUHID IS THE BASIS FOR INTEGRATION:

• Tauhid is the basic paradigm of Islamic thought (fikr), civilization (hadharat), and knowledge (ma’arifat).
• There is one Creator (tauhid al rubuubiyyat) for the whole universe therefore everything living or non-living and every phenomenon must have meaningful integration with everything else because the source is the same.
• We will focus on the integration of Islamic values (qiyam islamiyyat) in medicine in the knowledge that there are other forms of integration.
• Integration of Islamic values into medical education, training, and practice is a prerequisite for quality healthcare in Muslim communities. No community or civilization can succeed without basing its development on its own values.

PROBLEMS OF CURRENT CURRICULA WITH NO INTEGRATION

• Basic medical sciences are not taught as signs of Allah manifesting the structure and function of the human body as a biological miracle of unity (tauhid), perfection (kamal), balance (tawazun), equilibrium (I’itidaal), incomparability (),
• Phenomena of life & death, health & disease, and environmental interactions are not taught within their Islamic epistemological contexts
• Disease management is not taught from a holistic perspective that encompasses spiritual and psychosocial dimensions
• Community health is actually not taught instead community ill-health is taught; we should start by teaching the normal qariyat tayyiba.

TEACHING BASIC SCIENCES AS THE BIOLOGICAL MIRACLE MANIFESTING SIGNS OF ALLAH (AYAT ALLAH)

• Perfection (kamal alkhalq):
• Beauty (jamal al khalq):
• Optimality (ahsan taqwiim)
• Incomparability (‘ajz al shurakaa)
• Balance (miizaan)
• Equilibrium (e’tidal)
• Parity (zawjiyat)
• Environment: physical, biological, chemical

CONCEPTS OF PERFECTION AND OPTIMALITY IN BASIC SCIENCES TAUGHT AS SIGNS OF ALLAH AND TAFSIR AL QUR’AN - 1

• Allah is the best creator, Ahsan al Kahliqin 37:125.
• أَتَدْعُونَ بَعْلًۭا وَتَذَرُونَ أَحْسَنَ ٱلْخَـٰلِقِينَ
• Perfect creation Kamal al Khalq 95:4.
• لَقَدْ خَلَقْنَا ٱلْإِنسَـٰنَ فِىٓ أَحْسَنِ تَقْوِيمٍۢ
• Beauty of creation (best picture) Ghaffir 64
• اَللّٰهُ الَّذِىۡ جَعَلَ لَـكُمُ الۡاَرۡضَ قَرَارًا وَّالسَّمَآءَ بِنَآءً وَّصَوَّرَكُمۡ فَاَحۡسَنَ صُوَرَكُمۡ وَرَزَقَكُمۡ مِّنَ الطَّيِّبٰتِ ؕ ذٰ لِكُمُ اللّٰهُ رَبُّكُمۡ ‌ ۖ فَتَبٰـرَكَ اللّٰهُ رَبُّ الۡعٰلَمِيۡن
• Best image (ahsan surat) Infitaar:6-8 passing through stages of creation (khalq), making due proportions (taswiyat), balancing (t’adiil), and best image (ahsan surat)
• يَـٰٓأَيُّهَا ٱلْإِنسَـٰنُ مَا غَرَّكَ بِرَبِّكَ ٱلْكَرِيمِ ٱلَّذِى خَلَقَكَ فَسَوَّىٰكَ فَعَدَلَكَ فِىٓ أَىِّ صُورَةٍۢ مَّا شَآءَ رَكَّبَكَ

CONCEPTS OF PERFECTION AND OPTIMALITY IN BASIC SCIENCES TAUGHT AS SIGNS OF ALLAH AND TAFSIR AL QUR’AN - 2

• Incomparable (‘ajz al shurakjaa) 7:191
• أَيُشْرِكُونَ مَا لَا يَخْلُقُ شَيْـًۭٔا وَهُمْ يُخْلَقُونَ
• All what Allah created has a purpose (23:115).
• أَفَحَسِبْتُمْ أَنَّمَا خَلَقْنَـٰكُمْ عَبَثًۭا وَأَنَّكُمْ إِلَيْنَا لَا تُرْجَعُونَ
• Parity in general 51:49
• وَمِن كُلِّ شَىْءٍ خَلَقْنَا زَوْجَيْنِ لَعَلَّكُمْ تَذَكَّرُونَ
• Parity of gender Najm: 45
• وَأَنَّهُ خَلَقَ الزَّوْجَيْنِ الذَّكَرَ وَالْأُنثَىٰ 
• Physiological unity… Bukhari 6011
•  مثل المؤمنين في تواددهم وتراحمهم وتعاطفهم مثل الجسد إذا اشتكى منه عضو تداعى له سائر الجسد بالسهر والحمى

CONCEPTS OF PERFECTION AND OPTIMALITY IN BASIC SCIENCES TAUGHT AS SIGNS OF ALLAH AND TAFSIR AL QUR’AN - 3

• The Qur'anic term rizq means sustenance. It refers to to food useful to the body. Rizq is from Allah alone and He provides for all.  Isra: 30
•  إِنّ رَبّكَ يَبْسُطُ الرّزْقَ لِمَن يَشَآءُ وَيَقْدِرُ إِنّهُ كَانَ بِعِبَادِهِ خَبِيرًا بَصِيرًا».
• The alimentary canal is a tube outside the body in direct contact with the external environment. Some food ingested at the mouth exits at the anus without entering the body. Digested food is absorbed by the intestines to enter the internal environment.
• The alimentary canal has a role in balancing the internal and external environments. It takes material from the environment, processes it, and returns it to the environment.
• Human appetite for food (a requirement for survival) is so strong that prayer is delayed when food is presented.
•  إذا أقيمت الصلاة ، وحضر العشاء ، فابدءوا بالعشاء.

CONCEPTS OF PERFECTION AND OPTIMALITY IN BASIC SCIENCES TAUGHT AS SIGNS OF ALLAH AND TAFSIR AL QUR’AN - 4

• Nutritional habits reflect underlying visions, beliefs, and cultural experiences.
• The alimentary system can be looked at as the final pathway for human corruption because food security is the underlying but often unstated purpose behind a crime, corruption, treachery, amassing of wealth, aggression, and many other transgressions.
• Believers eat to get energy for ‘ibadat; non-believers may eat for enjoyment or to get energy for evil. A believer is satisfied with less food than a non-believer.
• The search for food and its ingestion is part of ‘ibadat. The human is rewarded for efforts to feed himself or herself. The ‘ibadat aspect is emphasized by the fact the feeding starts with the basmalah and end with the hamd.

CONCEPTS OF LIFE - 1

• Life is a complex phenomenon with biological, chemical, and spiritual components.
• Both life and death are earthly phenomena. Life exists in the hereafter, but death does not.
• Humans share biological life with plants and animals. They share spiritual life with angels.
• No other creation of Allah resembles humans in having physical and spiritual life at the same time.
• Levels of life: ruh, the whole living organism, the organ, the tissue, the cell, sub-cellular structures, the molecule, and the atom.
• Humans are temporary custodians of life enjoined to take good care of it. Humans have no control over life or death (25:3).

CONCEPTS OF LIFE - 2

• There is a continuum in human life: ‘adam. hayat al duniyat. hayat al barzakh, hayat al akhirat.
• Human life on earth has a definite time span, ajal. No human endeavor including the most advanced medical procedures can shorten or extend this time span.
• The whole purpose of medicine is to exert maximum efforts to improve the quality of remaining life since Allah alone knows the timing of the ajal.
• The first and most important purpose of life is the worship of Allah, ‘ibadat.  Life can be a happy one, hayat saidat/hayat taibbat, or unhappy, hayat dhankat. A good life is related to good deeds (16:97). Success and failure are experienced both on earth and in the hereafter.

CONCEPTS OF DEATH - 1

• Death can be defined as moral, legal, or biological death. Death could be permanent with cessation of all physiological functions. It could be temporary such as in sleep (Zumar:42).
•  There is a continuous cycle involving life and death. Life arises from death and vice versa (3:27 & 10:31).
• All humans will eventually die, shumuliyat al mawt (55:26). In view of the inevitability of death, hatmiyyat al mawt, it is futile to attempt to avoid death or think of its removal, istihalat daf'u al mawt (62:8).
• The process of death is long. It starts with the humanly understood causes like infection or trauma. The body progressively fails until a point of no return is reached. There is a point during this process when the angels take away the ruh thus separating the essence from the body.
• The process of terminal death following Allah's laws, sunan al llaah, can not be reversed except in exceptional cases of divine intervention such as when Allah gave the prophet Isa (PBUH) the ability to revive the dead.

CONCEPTS OF DEATH - 2

• Death is a transition to life after death, al hayat ba'da al mawt (30:40).
• Death could therefore be a welcome event for good people who look forward to a better life in the future.
•  Death and its occurrence are in the hands of Allah
• Good people welcome death as a rite de passage to a better existence in the hereafter.
• The approach of death is an opportunity for repentance, tawbat.
• Humans are apprehensive about death and fear it
• Wishing for death, isti’ijaal al mawt, tamanni al mawt, in desperation with severe painful illness is discouraged.
• The wish for death, tamanni al mawt can be negative for the escapist who looks to death as a relief from present psychological or physical distress
• Committing suicide, qatl al nafs & intihar, is definitely forbidden and puts someone outside the fold of Islam.
• Death is a trial, ibtila’a bi al mawt and is a calamity, musibat al mawt.

CONCEPTS OF DISEASE TREATMENT - 1

• Every disease has a treatment. Allah did not reveal any disease without also creating its cure. Humans are encouraged to seek treatment. Some people may know the cure and others may ignore it, but it nevertheless exists.
• Humans try, but it is Allah who cures. Al Shuara: 80
• وَإِذَا مَرِضْتُ فَهُوَ يَشْفِينِ
• Disease treatment is part of qadar. Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr and is a reversal of qadar by another qadar, rad al qadr bi al qadr.
• Preventive medicine, tibb wiqa’i, is covered under the Qur’anic concept of wiqayat.
• The concept of prevention, wiqayat, does not involve claiming to know the future or the unseen, ghaib, or even trying to reverse qadar.
• The human using limited human knowledge attempts to extrapolate from the present situation and anticipates certain disease conditions for which preventive measures can be taken. Only Allah knows for sure whether the diseases will occur or not.

CONCEPTS OF DISEASE TREATMENT - 2

• Curative medicine, tibb ‘ilaj, may be spiritual, physical, or both. Non-invasive approaches aiming at assisting the body fight disease are preferred to riskier invasive approaches.
• Among spiritual approaches to disease management is the use of dua from the Qur’an and hadith as ruqiy.
• Islamic Law gives priority to preventing harm over accruing a benefit.
• There should no dichotomy between spiritual and physical modalities of treatment. Both approaches should be used for the same condition; they are complementary. Each cures the disease using a different pathway. There is no contradiction but there is always synergy. It is a mistake to use one and reject the other.
• Shirk arises when humans seek and expect a cure for a disease from anything other than Allah. Forbidden shirk practices.

A NEW APPROACH TO TEACHING COMMUNITY HEALTH: FAMILY INSTITUTION:

• Gender: each gender has competencies that the other lacks leading to a strong pair.
• Family as a Natural Social Unit: the family must be preserved as the basic unit of society.
• Marriage: start of family formation.
• Parents and Relatives are part of the extended family support system.
• Children: The next generation.

A NEW APPROACH TO TEACHING COMMUNITY HEALTH: COMMUNITY INSTITUTION:

• Masjid: center of the community
• Ukhuwwat: natural relation among people
• Takaful: a mutual self-help
• Shuura: mutual consultation
• Maal:  economic system

A NEW APPROACH TO TEACHING COMMUNITY HEALTH: COMMUNITY PROBLEMS:

• Life-Style
• Sexual Perversions
• Addiction
• Poverty
• Violence

A NEW APPROACH TO TEACHING COMMUNITY HEALTH: COMMUNITY ACTIONS:

• Dawa
• Enjoining the good and forbidding the bad, amr & nahy
• Social change, taghyiir ijtima’e