221028P - PROMOTING THE UNDERSTANDING AND APPLICATION OF ISLAMIC PRINCIPLES IN MEDICINE – HAVE WE DONE ENOUGH?

Presentation at the Convention of the Islamic Hospital Consortium (IHC), Federation of Islamic Medical Associations (FIMA) and the Pakistan Islamic Medical Association (PIMA) on 28 October 2022. By Dr Omar Hasan Kasule Sr MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics

 

HISTORICAL PERSPECTIVE

THE CONCEPT OF ISLAMIZATION:

• 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 Islamization. Islam = ‘aqiidat + shari’at.
• Islamization is infusing the moral teachings of Islam deriving from the ‘aqiidat and the practical regulations of the shari’at into medicine.
• Islamization 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 Islamizing medicine over the past endeavor over the past half century as will be explained below but a lot remains to be done.

DEVELOPMENTS PRE-1980 – ISLAMIC MEDICAL ASSOCIATIONS:

• The concept of Islamization of 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 integration of Islam in their profession but the nature of the integration was not clear.

DEVELOPMENTS PRE-1980 – ISLAMIC MEDICAL ASSOCIATIONS:

• Some looked at IMA as a normal medical association with Muslim members and thus drew criticism from the general medical associations.
• Some looked at IMA as a forum for providing help and support to students and young physicians.
• Some looked at IMA as a forum for medical and relief programs for Muslim communities suffering from the effects of poverty or social instability.

DEVELOPMENTS 1980 - 1995: Medical Relief and Networking

• 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.

DEVELOPMENTS 1980 - 1995:  Towards the Concept of Islamic Medicine

• This was accompanied by a general return to religious practice and religious propagation among youths in universities and physicians in hospitals.
• Following 2 international conferences in Kuwait in 1981 and 1982 the concept of Islamic medicine as traditional Muslim medicine evolved and excited many people.
• Traditional Muslim medical practices were survivors of the medicine practiced in the first centuries of hijra. It was a mixture of Prophetic medicine (tibb Nabawi), traditional herbal medicine, and Greek medicine (tibb Yunani). It was preserved and was developed to a high level of sophistication in India and Pakistan.
• There were frustrations with the paradigm of traditional medicine being the representative of Islamic medicine, especially in view of its incompatibility with scientific medicine.

DEFINITION OF ISLAMIC MEDICINE IN 1995:

• A seminar on medicine organized by the Islamic Medical Association of Malaysia discussed the issue of what is Islamic medicine.
• Muslim physicians in Malaysia at that time were going through turbulent arguments with practitioners of traditional medicine who were convincing many patients not to go to hospitals (non-Islamic medicine) but to seek medical care from them.
• This had resulted in disease diagnosis being delayed and a solution was needed.
• A paper presented at that conference offered a definition of Islamic medicine and part of its abstract is reproduced here.

DEFINITION OF ISLAMIC MEDICINE IN 1995, con’t.:

• 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].

DEVELOPMENTS AFTER 1995: Islamic Hospitals

• 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.
• This was followed by developing standard operating procedures and criteria based on the shari’at. These were recognized officially and the hospitals started designating themselves as shari’at-compliant hospitals.
• These hospitals experienced severe financial problems at the start because they were small but as they became more popular and attracted more clients, they improved their financial situation.

DEVELOPMENTS AFTER 1995: Shari’at Compliant Hospitals

• By 2000 the concept was implemented in practice at Islamic clinics and hospitals.
• Patients were drawn to these facilities because they solved their spiritual, ibadat, and fiqh problems. The person-centered approach of these facilities emphasizing ‘ukhuwah’ above everything gave immense satisfaction to patients.
• The general social environment of the facility resonated with Islamic culture making patients feel more at home.
• These hospitals are expanding after overcoming initial problems of financial health (because of their small size) and are reaching out to a wider community of patients Muslims and non-Muslim.
• The wider outreach has forced the Sultan Ahmad Shah Hospital in Kuantan to add provisions for non-Muslim patients in its policies and procedures.

DEVELOPMENTS AFTER 1995: Islamic Medical Education

• In this period medical education from an Islamic perspective became a reality as faculties changed their curricula to reflect Islamic values.
• Focus was on two areas: medical fiqh (al fiqh al tibbi) and medical ethics.
• Medical fiqh dealt with the impact of disease on regulations of taharat, ibaadat.
• At a later stage regulation of munakahaat and mu’amalaat were covered.
• Existing fiqh rulings or new ijtihad by the jurists solved these problems by qiyas and ijma and physicians and patients would be satisfied.

DEVELOPMENTS AFTER 1995: Medical Ethics

• Developments in medical ethics in teaching and practice were more complex because medical technology created new dilemmas that could not be solved purely by fiqh because they had a moral dimension.
• The first was organ donation and organ transplantation.
• This was followed by assisted reproduction such as in vitro fertilization that developed tangential issues of ovum and sperm donation, surrogate motherhood, and disposal of excess fertilized embryos.

DEVELOPMENTS AFTER 1995: Medical Ethics, con’t.

• Advanced life support technology created issues of deciding to withhold/withdraw life support and how to use brain death as a criterion of death.
• In the genetic area issues arose regarding gene therapy and genetic engineering. These issues could not be resolved using traditional fiqh and recourse was to new tools.
• Starting in 2004 the theory of maqasid al shari’at emerged as the main guide in the area of medical ethics.^[2,3]

PHASES OF DEVELOPMENT OF ISLAMIC HOSPITALS:

• Starting in the 2000s more hospitals were established and they sought to define a niche for Islamic medicine.
• In the beginning, they promoted the concept of an ‘ibadat-friendly hospital that offered an Islamic environment to the patients.
• They then moved a step further by developing criteria, standard operating principles, and standards some of which were officially recognized and the label shari’at-compliant hospitals became official and popular in Malaysia and Indonesia.

STANDARDS FOR HOSPITALS BASED ON FIQH AND MUAMALAAT:

• The standards developed were not always comprehensive and shari’at advisory boards were required in each hospital to provide continuous guidance about issues that would arise.
• These hospitals applied Islamic fiqh in their operations and training: fiqh al taharat, fiqh al ibadat, fiqh al ‘aadaat, and aspects of fiqh al mu’amalaat.

STANDARDS FOR HOSPITALS BASED ON MAQASID AL SHARI’AT:

• They also developed wider concepts based on maqasid al shari’at to handle complex multi-faceted issues that do not have direct textual evidence from the Qur'an and sunnat or the writings of the jurists.
• The five objectives of dinn, nafs, nasl, aql, and maal.
• Wider scope of ijtihad.

 

CHALLENGES OF ISLAMIC HOSPITALS:

• In the beginning, they faced many financial challenges because they had few patients and did not enjoy the economies of scale of bigger hospitals.
• They have been able to attract a loyal clientele of Muslim patients and some non-Muslims who prefer to be treated in an Islamic atmosphere.
• Since 2010 many have stabilized financially but still face an upward struggle.

THE NEXT STAGE OF HOSPITAL DEVELOPMENT:

• The next challenge facing these hospitals is developing a business model that will accommodate shari’at compliance in patient care.
• We need a model that will involve shari’at-compliant financing of health care by some form of community takaful health insurance.
• This model will require amalgamation into bigger units or setting up cooperative operational models.

GENERAL AWARENESS OF ISLAMIC PRACTICE:

• The proto-concept of Islamic medicine arose during the start of the 15th century of hijra and became concrete by 1995 when it was realized that modern scientific medicine could be practiced within the ethical and legal paradigms of Islam.
• The realization led to several consequences: medical fiqh, Islamic medical ethics, ibadah-friendly hospitals and shari’at-compliant medical practice all supported by teaching and training in Islamic aspects of medicine
• The awareness has been extended and expanded by discussions at seminars and conferences and is spreading and taking root in many Muslim societies and countries.

DEMAND FOR ISLAMIC ALTERNATIVES:

• Developments in medical technology such as organ transplantation, artificial life support, and reproductive technologies created many ethical and fiqh issues that further reinforced the need for further thinking and research on Islamic aspects of medicine.
• Dissatisfaction with current medical practices led many to look at alternative/complementary medical practices and this encouraged Islamic medicine even more.
• The main drivers of this demand are the person-centered approach and the solution of religious and social problems in medical practice.

TEACHING ABOUT ISLAMIC SHARI’AH COMPLIANCE AT FACULTIES OF MEDICINE AND NURSING, PHARMACY, AND DENTISTRY:

• Starting in 1997 the concept became part of the curriculum of several faculties of medicine while it was also propagated at seminars, workshops, and training programs.
• The Kulliyah of Medicine at the International Islamic University in Kuantan Malaysia was the first to incorporate Islamic input in all 5 years of its medical course.
• Graduates of IIUM over the past 25 years have spread the concept of a shari’at-compliant hospital wherever they went to work within Malaysia and outside.
• Graduates of IIUM also made contributions by working in shari’at-compliant hospitals.

OFFICIAL SUPPORT FOR SHARI’AT-COMPLIANT HOSPITALS:

• The concept of shari’at-compliant hospitals was promoted further by official recognition when shari’at standard operating procedures and standards were recognized in Malaysia (SIRIM) and Indonesia.
• This recognition further stimulated public demand for ibadah-friendly hospitals with the Malaysian Ministry of Health taking the lead in responding to this demand and making its hospitals ibadah-friendly.
• The shari’at-compliant hospitals have asserted themselves further by forming coalitions and associations that represent their interests.

RESEARCH:

• The intellectual and professional dimensions of the concept are being expanded by many researchers in health and shari’at-related faculties writing master's and doctoral theses on the concept.
• Members of the faculties of medicine, pharmacy, nursing, and science produce books, papers, theses on the integration of Islam in medicine and shari’at-compliant practice.
• Cross-disciplinary research involving faculties of shari’at and Islamic studies on practical problems arising out of applications of modern medical technology.

EXPANSION AND GROWTH OF THE CONCEPT OF SHARI’AH COMPLIANCE:

• The concept is being expanded outside the clinical domain to cover management, finance, pharmaceuticals, and public health.
• The concept has a great future in many Muslim and non-Muslim countries.
• Of all factors of sustainability discussed above the most important has been and will continue to be the education and training of future professionals on shari’at-compliant health care.

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.

THE BALANCE SHEET: Achievements

• The concept of Islamic medicine is well established.
• Islamic shari’at compliant hospitals have become a reality.
• Fiqh tibbi has developed to become an independent discipline.
• Islam has been integrated into the faculties of medicine and nursing.

THE BALANCE SHEET: Shortcomings

• Limited coverage: we have not reached all Muslim physicians.
• Small institutions are not yet part of the mainstream.