search this site.
Showing posts with label Clinical Medicine: Ethico-Legal-Fiqhi Issues 2000. Show all posts
Showing posts with label Clinical Medicine: Ethico-Legal-Fiqhi Issues 2000. Show all posts

0009P - USE OF ANIMALS IN RESEARCH

Print Friendly and PDFPrint Friendly

Professor Omar Hasan Kasule, Sr.


A. ANIMALS IN THE QUR’AN AND SUNNAT
MENTION OF ANIMALS IN THE QUR’AN
Animals are an important component of human civilization and are discussed at length in various Qur'anic verses. Animals are communities like human communities, umam mithlakum (p. 383 6:38). They, like humans, were created from water. They have life but no soul. They worship Allah (24:41) but have no moral accountability. Animals are many phyla and species. Some have no legs whle others have 2 or 4 legs (p. 383 24:45). They are different colors (p 383 35:28). Some can speak with humans (27:18, 27:22-28) whereas others can not. Allah provides all of them with sustenance, rizq (p 383 29:60). Some animals were mentioned in a special way in the Qur’an. (a) Insects: mosquito, ba’udhat (p 383 2:26); fly, dhubaab (p 384 22:73); locust, jaraad (p 383 7:133, 54:7); spider, ‘ankabuut (p 385 29:41); bee, nahal (p 385 16:68); ant, namil (p 387 27:18); lice, qummal (p 385 7:133). (b) Birds, tayr (p 384 2:260, 3:49, 5:110, 6:38, 12:36, 12:41, 16:79, 21:79, 22:31, 24:41, 27:20, 34:10, 38:19, 56:21, 67:19, 105:3): raven, ghuraab (p 385 5:31), hoopie, hudhud (p 385 27:20); (c) Domestic mammals: dog, kalb (p 385 7:176, 18:18, 18:22); donkey, himaar (p 383 2:259, 16:8, 31:19), mule, bighal (p 383 16:8), horse, khayl (3:14, 8:60, 16:8, 17:64, 38:31, 59:6); (d) Live-stock, ni’am (p 385-6 3:14, 4:119, 5:1, 5:95, 6:136, 6:138-139, 6:142, 7:179, 16:5, 16:66, 16:80, 20:54, 22:28, 22:30, 22:34, 23:21, 25:44, 25:49, 26:133, 32:27, 35:28, 36:71, 39:6, 40:79, 42:11, 43:12, 47:12, 79:33, 80:32): cattle, baqar (p 386-7 2:67-71, 6:144, 6:146, 11:69, 12:43, 12:46, 51: 26); camel, ibilghanam (p 387 6:143, 6:41, 20:18, 21:78, 38:23-24); pig, khinziir (2:173, 5:3, 5:60, 6:145, 16:115);  (e) Wild mammals, wuhuush (p 387 71:5) or siba’u (p 384 5:3, 74:51); elephant, fiil (p 385 105:1);  monkey, qird (p 385 2:65, 5:60, 7:166); wolf, dhi ib (12:13-14, 12:17); (f) sea/water animals: fish, huut (p 384 7:163, 18:61, 18:63, 37:142, 68:48); frog, dhafda'u (p 384 7:133); (f) Reptiles: snake, hayyat (p 384 7:107, 20:20, 26:32). (p 386 6:144, 7:73, 7:77, 12:70, 12:82, 12:94, Hud: 64, 17:59, 26:155, 54:27, 88:17, 91:13); goats & sheep,

MENTION OF ANIMALS IN THE SUNNAT
The prophet talked about many animals in his hadith, an indication of their important role in society: Donkey, himaar, both domesticated and wild (KS 203), cat, hirrat (KS 555-556); dog, kalb (KS 461); horse, khayl/faras (KS 224); mule, bighal (KS 121); camel, ibil (KS 48); sheep/goat, ghanam (KS 417); bee, nahal (KS 533); fish, samak (KS 285); frog, dhafda’u (KS 337); dhaba’u (KS 346); ghuraab (KS 346); dhabbu (KS 346); waza’u (KS 346); rabbit, arnab (KS 347); locust, jaraad (KS 347); rat, farat (KS 347). Although both the cat and dog are household pets, the saliva of the dog is considered filth, najasat, unlike that of the cat. Vessels licked by dogs become filthy, talwiith al aaniyat (KS 460) and must be washed 7 times one of them with soil. Dogs were present in the mosque, wujuud al kalb fi al masjid (KS 460). The prophet ordered the killing of dogs, amr an naby qatl al kalb (KS 460) and forbade their sale, nahyu bay’e al kalb. Dogs can be kept for farming, hunting, and guarding, iqtinau al kalb li al harathi wa al sayd wa al hirasat (KS 461). Keeping a dog for any other purpose is offensive, makruuh (KS 460). Horses can be used for sports (KS 224) or military purposes (KS 225). The prophet loved horses, hubb al naby al khayl (KS 226). Owners are enjoined to touch the fore-locks of horses, mash nawaasi al khayl, (KS 226). Good care for a horse brings rewards (KS 226). All fish are permissible as food, hill al samak (KS 285).  (KS 461)

ENJOINING KINDNESS TO ANIMALS
The prophet on many occasions enjoined kindness to animals. Saving animals from danger is a noble act (KS 210). There is reward for kindness to animals, ajr al rifq bi al hayawaan (KS 211). Kindness is required when milking the animals, rifq fi halb al hayawaan (KS 211). When travelling with camels, the driver should not hurry them when they come to a fertile land where they find more grass to eat, i’itaa al ibl haqqaha idha saafara fi al khasiib (KS 211).

PROHIBITING CRUELTY TO ANIMALS
Cruelty and physical abuse of animals is prohibited, nahyu al muthlat wa al qaswat ala al hayawaan (KS 210-211). A woman entered hell for locking up a cat and not feeding it or allowing it to look for its own food (KS 556. Branding animals in the face is prohibited, nahyu al wasm fi al wajih (KS 211). Beating animals was also prohibited, nahyu dharb al hayawaan (KS 211). Cursing animals is prohibited, nahyu la’an al hayawaan  (KS 211). Sexual abuse of animals is prohibited and is considered a great sin (KS 212). Some animals should not be killed. The killing of frogs was prohibited (KS 337).

KILLING DANGEROUS ANIMALS
Some animals are bad and evil, khamsu min al dawaab fasiq (KS 210). The Law explains what animals should be killed and those that can be killed, ma yajibu wa ma yajuuzu qatluhu (KS 211). Snakes in general must be killed, wujuub qatl an hayyaat (KS 206). Some animals must be killed even when in prayer for example the scorpion (KS 387) or the snake (KS 206-207). Household snakes are spared from the general order to kill, ‘adam qatl al hayyaat al manziliyyat (KS 207). Care should be taken in killing snakes, al hiitat fi qatl al hayyat (KS 207)

B. TASKHIIR: ANIMALS AT THE SERVICE OF THE HUMAN
The concept of taskhiir can be employed as a general legal basis for animal experimentation because the creator allowed humans to use and exploit all creation in the universe (45:13). Taskhiir is the basis for human civilizational growth because it allows domestication of plants and animals to enable humans live in a stable community. As part of the mission of khilafat, Allah allowed the human to use the earth and its contents, living and non-living, in fulfilling the mission of building a human civilization. Thus animals serve humans in direct and indirect ways. Directly they provide food and their muscle power is used in transportation, agriculture, transport, hunting, and guarding. Indirectly they serve humans as part of the human food web of food chain. The Qur’an has given several instances of animals serving as a source of food for humans, being a source of aesthetic enjoyment and being beasts of burden. Bees provide food and medicine (16:69). Birds provide delicious meat (56:21). Four-legged live-stock like cattle are a bounty from Allah to humans, mannu min al llaah (26:133) and are under human dominion (36:71). They provide food (16:5-7, 5:1, 6:142, 22:28, 22:30, 22:34, 40:79), milk (16:66, 23:21), transportation (6:142, 16:5-7, 23:22, 40:79, 43:21), material for tents and clothing (16:80), are a source of aesthetic pleasure (3:14, 16:5-7) and other benefits (23:21). The horse, donkey, and mule are beasts of burden and also are a source of aesthetic pleasure (16:8,?16:80, 3:14). The horse is very useful in warfare (8:60). Taskhiir has its limitations, mahduudiyat al taskhiir, based on the need to establish balance and equilibrium in the eco-system and protect humans from harm. Some animals are prohibited as food for example the pig, khinziir (p 384 2:173, 5;3, 6:145, 16:115). Taskhiir may be limited by prioritising of competing needs, for example the meat of the domestic donkey is prohibited as food, tahriim lahm al himaar al ahliyyat (KS 203) because it is more useful as a beast of burden. The meat of the wild donkey is, on the other hand, allowed (KS 203). Also prohibited is the meat of mules, tahriim lahm al bighaaltahriim lahm al khayl (KS 346). The meat of carnivorous animals is also prohibited (KS 347) presumably because of inefficiency in the food chain if humans ate carnivores while both eat the meat of herbivores. (KS 346) and the meat of horses,

C. ANIMAL RESEARCH: PURPOSE and RELEVANCE
PURPOSE
Animal research is undertaken for a variety of reasons. The most important is to spare humans from danger. This is done by carrying out the research in animals to establish preliminary findings which if promising will be the motivation for carrying out definitive research in humans. In this way humans are spared the risk of research that may have no useful follow-up in the future. Animal research plays another role in that it indicates the possible risk and side-effects from the research as a prelude to human research.

RELEVANCE
The first conceptual issue that has to be resolved with regard to animal experimentation is whether results from animal research are relevant to humans and if relevant to what extent. Relevance establishes benefit; benefit to human life establishes a situation of necessity, dharuurat, that legalizes subjecting animals to experiments that could involve permanent impairment or even death. There are two main arguments for the relevance of animal experiments to humans: (a) similarity of human and animal physiology and (b) biochemical unity of all life. The counter arguments could also be equally strong. Although human and animal physiology and biochemistry share many commonalities, findings from animal research can not be directly transferred to humans; research on humans is still necessary for a definitive conclusion. Thus animal research is exploratory and not definitive; this is not a strong enough reason to subject the animals to pain, suffering and even death when the research has no direct or indirect benefit for the animals.  The issue of relevance can not be considered in generalities. Each case has to be considered on its merits. There are some physiological systems for which given animal species are a good model for human. Relevance could also depend on the nature of the agent tested and the expected findings.

D. LEGAL BASES FOR PERMISSIBILITY OF ANIMAL EXPERIMENTATION
OVER-VIEW
The position of the Law is that animal experiments are allowed if a prima facie case can be established that the result of the research is a necessity, dharuurat. Dharuurat under the Law is what is necessary for human life. The regulations of necessity must be observed. No more than the absolute minimum necessary should be done, al dharurat tuqaddar bi qadiriha. Animal research has definite risks for the animals which are not balanced by any benefits. Thus use of animals in justifiable on the basis of taskhiir and not any benefits that accrue to the animals. The risks to humans from animal research are minimal in the short term; long-term effects are difficult to fathom.

PROTECTION OF LIFE, hifdh al nafs
Animal experimentation is allowed on the basis of searching for modalities of health promotion, disease prevention, or disease treatment that will maintain the body in the best health status thus fulfilling the legal purpose of protecting human life. Any animal experimentation whose purpose is to produce products for use in industry or some other purpose not directly related to human health would therefore be offensive, makruuh, especially if it causes pain and suffering to the animal.

PROTECTION OF PROGENY, hifdh al nasl
Animal experimentation is allowed if it is searching for better ways of treating infertility or better ways of maintaining the viability of he fetus both in utero and after birth because this would be fulfillment of the purpose of protecting human progeny. Animal experiments that aim at protecting animal progeny would also be allowed because animals provide food for humans, a necessity for continued human existence. Research aimed at animal reproduction for other purposes like breeding horses for racing would not be allowed if it causes pain and suffering to the animals.

PROTECTION OF THE MIND, hifdh al ‘aql
Pharmacological research for cures of mental illnesses is allowed because it contributes to the protection of the human mind. Also allowed are experiments that investigate effects of psycho-active substances on human intellect. It is however prohibited to conduct animal experiments on effects of alcohol and drugs with view to their commercialization or encouraging people to take what can be established experimentally as safe levels. The position of the Law is that whatever affects the mind in large concentrations is prohibited even in minute doses.

PROTECTION OF WEALTH, hifdh al mal
Animal experimentation will be allowed if the purpose is to look for treatment modalities that are cheaper that available and equally-effective cures. This will result in net saving of community or family resources which is a purpose of the Law.

THE PRINCIPLE OF INTENTION, qaidat al maqsad
The basic principle is that each action is judged by the intention behind it, al umuur bi maqasidiha. Those undertaking animal experimentation have a moral responsibility to ensure that their work is done for a purpose valid under the Law. Intentions are what matter and not literal interpretations of  research objectives. It is possible to state good and acceptable objectives when the underlying intentions are different. Means are judged with the same criteria as the intentions, al wasail laha hukm al maqasid. If the intention, qasd, is wrong the means, wasiilah, is wrong. Thus un-ethical animal research can not be justified on the basis of some benefits at the end.

THE PRINCIPLE OF CERTAINTY, qaidat al yaqeen
The main principle is that certainty can not be removed by doubt, al yaqeen la yazuulu bi al shakk. Certainty, yaqeen, is a situation when there is no doubt or hesitation, taraddud. Doubt, shakk, is a situation in which there are two or more competing options with no sufficient evidence to prove one of them as the most valid. Shakk is the opposite of yaqeen. Animal experimentation is allowed on the basis that there is a need or necessity, dharuurat. It is often difficult in practice to establish necessity. In cases of doubt about usefulness of the research to human health, it is better to desist from any further animal experimentation. Existing assertions should continue in force until there is compelling evidence to change them, al asl baqau ma kaana ala ma kaana.

THE PRINCIPLE OF INJURY, qaidat al dharar
The basic principle is that injury, if it occurs, should be relieved, al dharar yuzaal. Animal experimentation to solve health problems is considered an effort to remove injury. Prevention of a harm has priority over pursuit of a benefit of equal worth, dariu an mafasid awla min jalbi al masaalih. If the  benefit from animal experimentation has far more importance and worth than the harm, then the pursuit of the benefit has priority. In this case we are talking about benefit and harm to human health and are not comparing human benefit to the harm cause to the animal because of the experimentation.

PRINCIPLE OF HARDSHIP, qaidat al mashaqqat
Some of the hardships that were considered valid by classical scholars were: travel, illness, and general disasters. This list can be extended by adding anything that threatens any of the 5 purposes of the law, diin, life, progeny, intellect, and wealth. Hardship mitigates easing of the sharia rules and obligations, al mashaqqa tajlibu al tayseer. Pain and suffering can be inflicted on the animal if there is a necessity that relates to human life and one of the 5 purposes of the Law. Necessity legalizes the prohibited, al  dharuraat tubiihu al mahdhuuraat. If any of the 5 necessities, al dharuraat al kahmsat, is at risk permission is given to commit an otherwise legally prohibited action. Committing the otherwise prohibited action should not extend beyond the limits needed to preserve the Purpose of the Law that is the basis for the legalization, al dharuraat tuqaddar bi qadriha. Necessity however does not permanently abrogate others’ rights which must be restored or recompensed in due course; necessity only legalizes temporary violation of rights, al idhtiraar la yubtilu haqq al ghair. The temporary legalization  of the prohibited action ends with the end of the necessity that justified it in the first place, ma jaaza bi ‘udhri batala bi zawaalihi. As soon as alternbative means of getting the research results are available, it becomes illegal to violate the right of the animal to enjoyment of a full and healthy life.

THE PRINCIPLE OF CUSTOM or PRECEDENT, qaidat al ‘urf
The basic principle is that custom or precedent is a legal ruling or precedent, al aadat muhakamat. What is considered customary is what is uniform, wide-spread, and predominant, innama tutabaru al aaadat idha atradat aw ghalabat. No animal experimentation should go beyond the limits of what is normally recognized as appropriate by consensus of leading researchers in the field.

E. OUTSTANDING ETHICO-LEGAL ETHICAL ISSUES
LIMITS OF TASKHIIR
There are ethical issues that need discussion. We have established that under taskhiir humans are given the right to exploit animals and other things in the universe for their benefit. This exploitation has generally been considered to refer to using animals for food, transportation, and other work that requires animal muscle power. The question that can be paused is whether taskhiir can validly be extended beyond eating and transportation to animal experimentation?. As explained above if the results of animal experimentation will lead to protection of human life, then it is no different from food and can be allowed. If it is for general scientific curiosity unrelated to any tangible human benefit, then it is beyond the authorization of taskhiir. As explained above there are limits to taskhiir. Humans were not given a carte blanche to exploit the universe in any way they liked. They have to conform to the Law and moral guidelines.

DIFFERENCES AMONG ANIMALS
We have seen above that some animals are considered dangerous and must be killed. Use of such animals for research should therefore raise fewer ethical objections than others since they were due to die anyway. They however can not be subjected to unnecessary pain and suffering. Use of animals that are haram like the pig should be avoided as much as possible.

WELFARE OF THE ANIMALS
Animals, like humans, have rights to enjoyment of life and good health. The prophet emphasized good and kind treatment of animals. The researcher must therefore follow Islamic etiquette to minimize animal suffering such as pain, psychological anguish, and long-term effects of experimentation on health. Like the slaughter of animals or start of a meal, the basmalah must be said in recognition of the fact that the experiment is carried out with the permission of the creator under the requirements of taskhiir. The animals must be shown kindness and respect. They should not subjected to the psychological pain of seeing other animals in pain or being sacrificed. Pain must be minimized both during the experiment and when the animal is being terminally sacrificed. This is based on the legal requirement of slaughtering animals using a sharp knife and as quickly as possible to prevent pain and suffering. The long-term effects of the experiment on the animal must be considered and efforts made to decrease suffering and pain. The nutritional and medical needs of the animal must be taken care of before, during, and after the research.

000106L - ACTIVITY and REST, Nashaat & Raahat

Print Friendly and PDFPrint Friendly

Lecture for 3rd year medical students on 6th January 2000 by Professor Omar Hasan Kasule Sr.

 

OUTLINE

A. SPEAKING

PURPOSE OF SPEECH
  • Speech can be sorcery, inna min al bayaan lasihrun (KS 462)
THE GOOD WORD
  • The good word is charity, al kalimat al tayyibat sadaqat (KS 462)
THE BAD WORD
  • Allah does not like fahsh and tafahhush (KS 462)
  • Type of talk to be avoided (KS 462)
ETIQUETTE OF SPEAKING
  • The older ones speak before the younger ones (KS 462)
  • Speak little of keep silent (KS 461)
  • The merit of speaking little (KS 461)
  • Being humble and speaking less is a sign of iman (KS 462)
  • Mention of Allah during conversation, dhikr al Llaah athnaa al kalaam (KS 462)
RULINGS ABOUT SPEAKING
  • Fear of people should not deter from saying the truth, rahbat al naas la yamuna'u qawl al haqq (KS 461)
  • Lying to reconcile
  • Exaggeration in conversation
  • Compulsion to lie
  • Mujamalat
  • Self-incrimination
  • Revealing secrets
  • Silence and consent


B. SLEEPING

THE DAY
  • Nahar mubsirat (p 542 10:67, 17:12; p 542 27:86).
  • Nahar ma'aashan (p 543 78:11).
THE NIGHT:
  • Al layl sakanan (p 538 6:96, 10:67, 37:86; p 542 40:61).
  • AL layl libaasan (p. 538 25:47, p. 539 78:10)
  • Night prayer is not obligatory, salat al layl laisat waajibat (KS 471)
  • Merit of prayer at night, fadhl salat al llayl (KS 469)
  • Merit of recitation of the Qur'an at night, fadhl tilawat al Qur'an fi al llayl (KS 469)
  • What is said on waking up for tahajjud (KS 469).
PURPOSE OF SLEEP
  • Sleep is a sign of Allah (p. 1273 30:23)
  • Sleep is rest (p. 1273 25:47, 78:9)
ETIQUETTE OF SLEEPING, Adab Al Nawm
  • Before: Sleep with wudu, facing qibla in sleep, what to say when you go to sleep
·        During: Sleeping on the right hand side, al naum ala al janb al ayman (KS 552).  Do not sleep on the face, la yarqudu ala al wajih (KS 552). What to say when alarmed in sleep. Adab of yawning. Adab al ‘atas wa al tashmiit:
  • Etiquette of waking up: What to say in the morning, washing face and hands on waking up from sleep
RULINGS ABOUT SLEEP
  • Sleeping on the side nullifies wudhu, al naum ala al janb yanqudhu al wudhu (KS 551)
  • A person in ritual impurity, janaba, makes wudhu before sleeping, yatawadhuu al mujnib idha araada al naum (KS 551).
  • Sleeping before salat nullifies wudhu, al naum qabla al salat yanqudhu al wudhu (KS 551)
  • Salat and sleep, al salat wa al nawm (KS 551 Bukhari K4 B53; Nisai K1 B116; Nisai K4 B29)
  • Sleeping in salat is from shaitan, al naum fi al salat min al shaitan (KS 551: Ibn Majah K5 B42, Muwatta K1 H26).
  • Night prayer is abandoned if sleep is overwhelming (KS 471)

 

C. WALKING

WALKING COMPANION
  • Bipedal walking of humans
  • Walking on earth, Mashyu ala al ardh p 1118 25:63
  • Walking in the earth, Mashyu fi al ardh p 1118 17:37, 17:95, 31:18
  • Walking in the markets, mashyu fi al aswaaq  p 1118 25:7, 25:20
  • Walking in homes, mashyu fi al masaakin,  p. 1118 20:128, 32:26
  • Allah made the roads (p557 16:15; p 558 20:53, 21:31; P 558 43:10)
  • Ability of the road for hajj, istitaa’at al sabiil (p. 557 3:97)
  • Knowing the direction of the road, ihtidaau ila al sabiil (p 557 4:98)
PURPOSES
  • Purposive walking, al qasd fi al mashy p 1118 31:19
  • Walking for jihad p 1118 28:25
  • Walking for employment
  • Walking for ibadat: merit ofa long walk to the masjid
  • Walking for knowledge
  • Walking for exercise
  • Walking for social visit
ETIQUETTE OF WALKING
  • Quick walking, harwalat
  • Big steps
  • Firm steps, thubuut al aqdaam p 280 2:250, 3:147, 8:11, 47:7
  • Walking on feet p 1112 7:195, 24:45
  • Walking straight, mashyu sawiy (p 1118 67:22)
  • Walking with etiquette, mashy wa al adab (p 1118 25:63, 31:19)
  • Walking with shyness, mashyu & hayaa (p. 1118 28:25)
  • Walking and difficulty, mashyu & haraj (p 1118 17:37, 31:18)
  • Woman not to make sound with her walking p 280 23:31
ETIQUETTE OF THE ROAD, Adab Al Tariiq
·        The rights of the road, haqq al tariiq, are ghadh al basar, kaff al adha, and radd al salaam (KS 342: Bukhari K79 B2)
FOOT RACING, musabaqat
  • Prohibition of foot racing unless wearing khuff or bare footed (KS 281: Ahmad 2:256, 358, 385, 424, 505; Ahmad 3:190)

 

D. SITTING

SITTING COMPANION
·        Jaliis al khayr & jaliis al suu
  • Sitting with the righteous, salihiin
  • Sitting with the transgressors, al qu’ud ma’a al dhaalimiin (P 956 4:140, 6:68)
·        Sitting on graves, al juluus ala al qubuur
PHYSIOLOGICAL PURPOSES
  • Sitting to rest
  • Sitting to relax: BP, muscle tension, metabolism
  • Sitting in a calamity, al juluus ‘inda al musiibat (KS 153: Abudaud K20 B21)
SITTING AND IBADAT
  • Remembering Allah sitting down, dhukr al laah qu’udan (p 956 3:191, 4:103, 10:12)
SITTING AND LEARNINGE.
·        Majlis al ‘ilm
ETIQUETTE OF THE ASSEMBLY
  • Priority for the first come
  • Prohibition of making a man stand up to take his seat
  • Reclaiming a seat after going out for a short time
  • Special rights for the handicapped
  • Sitting of women
  • Sitting of children

E. STANDING
PHYSIOLOGICAL PURPOSES
·        Standing as preparation for walking
THE UNIQUE HUMAN UPRIGHT POSTURE
STANDING AND IBADAT
  • Qiyaam al llayl p 970 3:113, 25:64, 39:9, 52:48-49, 73:1-4, 73:20
  • Qiyaam li dhikr al laah p 970 3:191, 4:103,
  • Qiyaam al salat p 969-970 4:102, 4:142, 5:6, 22:26, 26:21
  • Wuquuf Arafat
  • Wuquuf muzdalifat
POSTURAL HYPOTENSION
ETIQUETTE OF STANDING
  • Qiyaam al ihtiraam
  • Qiyaam li al janazat

000212L - HYGIENE, Nadhaafat

Print Friendly and PDFPrint Friendly

Background reading material for medicine & fiqh session held at the Kulliyah of Medicine, International Islamic University, Kuantan on 12th February, 2000 by Professor Omar Hasan Kasule Sr.


OUTLINE
1.0 FECAL HYGIENE, nadhaafat min al ghait
A. Hadath and najasat
B. Excreta disposal, qadhau al haajat
C. Materials for cleansing, istinjah
D. Toilette Etiquette, adab qadhau al haajat
E. Washing hands

2.0 URINARY HYGIENE, nadhaafat min al bawl
A. Safeguarding from urine, wiqayat min al bawl
B. Etiquettes of urinating
C. Cleansing urine
D. Infant urine
E. Non-human urine

3.0 PHYSIOLOGICAL SECRETIONS
A. External secretions: skin and eye
B. Ear, nose, throat, and alimentary secretions
C. Uro-genital secretions: vaginal and penile discharges
D. Internal secretions: Intravascular fluids, Membranous cavity secretions
E. Non-human secretions

4.0 SKIN HYGIENE, nadhaafat al jild
A. Hair: scalp, beard, armpit, pubic
B. Nails
C. Exposed skin
D. The trunk
E. Perineum

5.0 PATIENT HYGIENE, nadhaafat al mariidh
A. Intra-vascular fluids:
B. Interstitial space fluids
C. Intubation and Catheterization:
D. Stoma:
E. Fistulae:

1.0 FECAL HYGIENE
A. HADATH & NAJASAT:
Hadath (excreta) abrogates/nullifies wudhu (MB#138). A Muslim must be in a state  of ablution, wudhu, all the time. Hadath is of three types: flatus, riih al dubr, (MB#110), stool, ghait or buraaz (p 860 4:43, 5:6, BG#66), and urine, bawl. In cases of occurrence of hadath, ibadat is not possible before cleansing, taharat. The following acts of ibadat are specifically forbidden: prayer, salat, prostration during Qur'anic recitation, sajdat al tilawat, prostration for thanksgiving, sujuud al shukr, circumbulation of the ka'aba, tawaaf, carrying the mushaf, haml al mushaf. It is however allowed to carry books that contain Qur'anic verses provided they are not more than 50% of the material. Exceptions are allowed for children who have to study the Qur'an and are not able to maintain ablution all the time. Sleep abrogates wudu because flatus may be passed during sleep and the person is not aware (BG #75). Flatus is always passing but in small quantities that should be ignored. The only amount of flatus that is taken seriously is when a clear sound is heard or when there is a smell (BG#76). Non-human excreta: Excreta of animals are treated as human excreta.

B. CONCEPT OF NAJASAT:
Najasat refers to: feces, al ghait/al buraaz (p 860 4:43, 5:6);  human urine, bawl;  arterial or venous blood, dam (2:173, 5:3, 6:145, 16:115); menstrual discharge, dam al haidh (383 2:222); pus/discharge of infected wounds, qaih;  vomitus, qay'i; intoxicants, khamr (5:90); saliva of some animals, suur al hayawaan;;the dog and its  moisture of dogs, su ur al kalb,  the pig and its moisture of pig, su ur al khanzir (2:173, 5:3, 6:145, 16:115);  prostatic fluid, wadi; and urethral fluid, madhi; animal not slaughtered according to Law; dead animals, maitat (2:173, 5:3, 6:145, 16;115), or dead tissues and organs from living animals; milk of inedible animals, and hair of inedible animals. Smoke from burning of a najasat material is also najasat.

Two types of blood are not najasat and are edible: the liver and the spleen (KS 235: Ibn Majah K26 B31; Ahmad 2:97). Prayer is allowed with a wound that has blood (KS 235 Bukhari K4 B34). In general solids are not najasat because when touched nothing is transferred, al jaf bi al jaaf tahirun bila khilaaf. When impurities are dry they can be touched without making the person impure, al yaabis la yanjis. The human, dead or alive, is not najasat but can be contaminated with najasat especially if he does not follow the Islamic hygienic code (MB#200). The following human emissions that are not considered impurities, najasat: saliva, nasal discharge, throat clearings, sweat, 'irq; tears, dummu'u; fresh blood, fresh internal body fluids (cerebro-spinal, peritoneal, pericardial, pleural, and amniotic fluids),  semen,  and the normal vaginal discharge (BG 121). Human sexual discharges, the male seminal fluid and the female sexual discharge are not najasat. Milk, human or non-human, is also not najasat.

A distinction must be made between najasat which must always be cleaned and without which acts of ibadatnajasat. Non-najasat material that could encourage infection should not be left unwashed on the argument that it was nor specifically mentioned as najasat.  Both najasatnajasat material must be cleaned away; the difference is that the former nullifies wudhu but the latter does not. are not valid and other causes of dirt such as sweat that have to be washed away anyway. Thus not everything that has to be washed is considered and non-

The term najasat, like taharat, has both a physical and moral dimension. The discussion above refers to the physical najasat (najasat hissiyat). The moral dimension, najasat ma'nawiyat, is discussed elsewhere.

C. EXCRETA DISPOSAL, qadhau al haajat:
Relieving one-self of body wastes is a physiological necessity. It however must be done in such a way that infection and toxic material will not pollute the environment or cause harm to humans and other living things. Proper excreta disposal also has a social purpose of making sure there are no bad smells when the waste products putrefy. Proper excreta disposal also has an aesthetic dimension to make sure that the environment is pleasing to look at. Isitnjah refers to cleansing oneself of all traces of the excreta. Cleansing is needed for stool and urine but not for flatus. In case of flatus, no physical cleaning is necessary in the anal area; only the wudhu is repeated.

C. MATERIALS FOR CLEANSING, istinjah:
Water and solid cleansers are used. The solids may be paper, stones (istijmar MB#124), or other plant material. Human bones and material known to be najasat are not allowed (MB#125, BG 84, BG#88, 89). It is preferred to use a solid followed by water (BG#93). Water is the universal and best cleanser Water being a universal cleanser is preferred after defecation and urination (MB#117, 121, 122, 125, BG#1,2,3). Other liquids like milk or vinegar can not be used for cleansing.

Water is a universal purifier. In relation to purification it is divided into three categories: pure water, tahuur; purifying water, mutahhir, and impure water, ghayr tahuur. Water may appear pure but can not be used for purification because of pollutants like filth, micro-organisms, and other hazardous solids and liquids. Sea water is generally taken to be purifying (BG 1). Water is purifying unless contamination is beyond a reasonable limit such as when the color, smell, or taste of the water changes (BG 3). A big amount of water is generally considered purifying because the concentration of pollutants is low. Ancient jurists had opined that 2 qullatain of water can not be polluted (BG 4). With present-day sewage and industrial discharges into water, even amounts beyond 2 qullatain can be made impure. Polluted stagnant water is not purifying while running water may be (BG 5). There are limits of microbiological and hazardous material contamination beyond which water should not be used for purification.

Water that has been used already in wudhu or cleaning najasat, mau musta'mal, is not usable in istinjahkullatain). This is on the basis that a lot of water does not become najas (al mau al kathiir la yanjis). It is not usable if there are easily visible signs of pollution such as change of color, taste or smell even if it is more than 216 liters. We can extrapolate and say that water that appears normal and is more than 216 liters should not be used if bacterial assays indicate that it has more than the allowable coliform content.    because it could transfer infection. Water that has any filth dumped into it can not be used for cleansing if it is less than 216 liters (

D. TOILETTE ETIQUETTE, adab qadhau al haajat:
Islam has emphasized toilet hygiene for this purpose and treats it as part of religious duty. The Prophet took great care to teach his followers the main principles of hygiene. All books of fiqh start with the chapter on cleansing (taharat).

Islam has taught toilet etiquette to protect both human dignity and also prevent infection. The following are forbidden: facing the qibla (MB#118), facing Jerusalem al quds, conversation in the toilet (BG#82), use of golden or silver utensils, or containers belonging to persons whose hygienic standards can not be ascertained. It is recommended to be in an isolated place, al khala (BG#86), to use the left hand (MB#123, BG #83) so that the right hand is used only for feeding thus preventing spread of infective and toxic material to human food, to enter the toilet  with the left foot and to exit with the right foot, to expose the minimum of nakedness as necessary, even if no other human is in the vicinity. Defecation must be in special places to avoid environmental contamination. Excretion is forbidden on the road, shades where people sit, and on the banks of rivers (BG#81). The toilet is an undesirable place (MB#116). Stay in it must be as short as possible and the stay should never be prolonged beyond need. Shoes or sandals must be worn to prevent the feet from being soiled by filth. A dua must be recited on entering on entering (BG#78) and expression of gratitude to Allah must be recited on exiting (  ).

Istinjah is the process of cleansing oneself of filth and its details have been given by Islam to make sure that there is personal hygiene that prevents infection. Ritual ablution for prayer can not be valid before istinja (MB # 138 p 119).

Etiquette: Persons defecating or urinating must hide where others do not see them (BG 82, 86). They can not face the qiblat (BG 84, GB 85). Defecating or urination is forbidden on the roadway, under the shed where people sit (BG 81). It is forbidden to defecate or urinate in water.

Removal of other types of impurities: Menstrual blood is washed off the cloth. If dry it is scraped off the cloth. The cloth can then be used for prayer even if traces of the blood can be seen (BG 27, BG 28). Blood is washed away (MB 170). Semen if wet can be washed off the cloth and if dry can be scraped off and the cloth is used for prayer (BG 25). If a dog licks a vessel it is purified by washing 7 times one of them using soil (BG 8). The saliva of cats is not considered an impurity (BG 9).

E. WASHING HANDS:
Hands play a big role in the spread of feco-oral infection. Islam therefore emphasizes their regular cleansing. After istinjah and before start of wudu the hands must be washed. Hands are also washed on waking up from sleep because they might have touched the anal or urethral openings (MB#131, BG #35).




2.0 URINARY EXCRETION
A. SAFEGUARDING FROM URINE:
It is a great sin not to protect the body and clothes from urine, istibrau min al bawl  (KS ? Ibn Majah K1 B19, Muwatta K2 H112, MB#164, BG#90). Care must be taken not to be contaminated by urine, al  tawaqqi min al bawl  (KS 124 Bukhari K4 B55, 56; Muslim K2 H111; AbuDaud K1 B11; Tirmidhi K1 B53; Ibn Majah K1 B26; Darimi K1 B61; Ahmad 4:396, 399, 414; Ahmad 5:35, 39, 266; Ahmad 5:382; Tayalisi H519. Care must be taken to avoid splashing urine. In cases of urinary incompetence, the person is exempted and can pray even if the clothes are contaminated.

B. ETIQUETTES OF URINATING:
The regulations about urine are logical measures to prevent urinary contamination and infection. Attempts must be made to empty the bladder fully to prevent spotting after urination (BG#92). Urethral massage for both the male and the female is recommended for this purpose. Urethral massage should be repeated three times to ensure complete emptying of the penis (BG 92). The following are prohibited: urination on hard ground, urination in a vessel, urinating in a bath, urinating in a hole, urinating in stagnant water (MB#177, KS 123 Bukhari K4 B68; Muslim K2 H94-96; Abu Daud K1 B36; Tirmidhi K1 B51; Nisai K1 B30, 45; Ibn Majah K1 B25; Ahmad 3:341, 356), urination on any edible material, and facing Makka or Jerusalem. It is prohibited to urinate while standing (KS 123 Tirmidhi K1 B8; Nisai K1 B24; Ibn Majah K1 B14,26; Ahmad 6:136, 192, 213; Tayalisi H155, MB#168) if it is feared that it will cause splashing of urine. In some cases it is better to sit when urine splashing is less likely away. Urination is a vessel is forbidden (KS 123: Abudaud K1 B13; Abudaud K1 B14, 16; Nisai K1 B29; Nisai K1 B27).

C. CLEANSING URINE:
Urine of adults, male and female, is washed away (MB 165). Floors contaminated by urine are washed with water (MB #166).

D. INFANT URINE
The urine of babies still breast-feeding is treated differently because it has less content of impurities; for boys splashing of water is enough but for girls washing is necessary (KS 124: Bukhari K4 B59; Muslim K24 H101-104; Tirmidhi K1 B54; Nisai K1 B188, 189; Ibn Majah K1 B77; Darimi K1 B63; Muwatta K2 H109-110; Ahmad 1:86, 97, 137, 302; Ahmad 6:46, 52, 210, 212, 339, 355, 356, 422, 440, 464; Tayalisi H1636; MB#167, BG#26). There is a difference in the composition of the urine of male and female infants (KS 124 Ibn Majah K1 B77). Touching the penis requires repeat of wudhu (BG #68).

E. NON-HUMAN URINE:
Prophet ordered people to drink camel urine for medicinal reasons (MB#173). Dog's urine in the mosque was not washed away (MB#137) whereas human urine was. Human urine can not be used as medicine (KS? Bukhari K74 B15). This may indicate higher infectivity of human urine and that animal urine may contain organisms generally not pathogenic to humans.

3.0 PHYSIOLOGICAL SECRETIONS
A. EXTERNAL SECRETIONS: SKIN &  EYE
Skin secretions: Washing of the whole body (ghusl) is obligatory in connection with many acts to make sure that the body is regularly cleared of accumulated secretions. In wudhu, it is recommended to pass fingers between the bases of toes and fingers to clear away collected secretions that can be a substrate for infection. Rings and other coverings on the body must be removed before wudhu and washing to make sure that all parts of the body are washed.

Eye secretions: Tears are not najasat but should be wiped or washed away. Normal eye discharge seen in the morning is also not najasat but must be washed away quickly because it could be a focus of infection.

B. EAR, NOSE, THROAT, AND ALIMENTARY SECRETIONS
Ear secretions: The secretions of the external ear can accumulate and become ear wax or could facilitate bacterial infection leading to otitis media. It is recommended in wudhu to clean the external meatus and the ear canal as deep as is safe. This regular cleaning prevents ear infection.

Nasal Secretions: Nasal secretions are not najasat (MB#179). The Prophet recommended blowing the nose three times on waking up, istinshaar (BG#34) to clear away secretions and accumulated infectious and toxic material. During wudhu washing the inside of the nostrils (istinshaaq) removes secretions and infections (BG#36). Care should be taken not to blow the nose in the open air because that spreads air-borne infections.

GIT secretions: Contents of the upper GIT are mostly recently ingested food. Vomiting is not najasat and does not nullify wudhu. The lower GIT especially the lower intestine has fecal excretory material that is najasat. Vomitus that is severe may contain intestinal contents in which case it may be considered vomitus

Throat secretions: Throat clearings are not najasat but should be disposed of carefully because they transmit air-borne bacterial and viral infections.

Oral secretions: Saliva, su'ur, is the main oral secretion. It is not najasat (MB#179). It is useful for lubricating food, initiating the digestive process, keeping the oral mucosa well moistened, and being an anti-microbial. Spitting saliva should however be discouraged because it leads to spread of air-borne infection. Spitting in the mosque or the public highway is esthetically not acceptable. Use of the tooth-pick, siwaak, is emphasized (MB 181-182). The prophet would have ordained it for every salaat were it not for fear of burdening people (BG 29). The prophet emphasized regular use of the tooth-pick to maintain oral hygiene and prevent infection.  It is recommended to use the tooth-pick in the following cases: when entering the mosque, reading Qur'an, after eating, before salat, and on waking up at night. The tooth-pick must be washed between uses. It is also recommended to rinse the inside of the mouth during wudhu, madhmadha, (BG #48).

C. URO-GENITAL SECRETIONS: VAGINAL AND PENILE DISCHARGES
Vaginal discharges:  The vaginal canal has no glands but there is moisture that is a transudate. The cervix secretes some fluids. Bartholin's glands near the introitus are also secretory. The moisture inside the vaginal canal is not najasat as long as it is inside the vaginal canal. Inter-menstrual vaginal discharges are not najasatnajasat. All vaginal discharges and any other fluids in the perineal area should be washed away very quickly because of the high potential of infection. Chronic vaginal discharges or bleeding do not prevent a woman from praying. She should wash her vagina, pad it, make wudhu, and pray immediately. Any delay nullifies the wudhu. Touching the perineal area of one self or someone else nullifies wudhu. This also applies if the perineum is of a child or an animal. (MB #219). Washing is needed when there is a vaginal discharge following a wet sexual dream (BG #96, 97) although the fluid itself is not

Penile discharges: There are three types of penile discharges: seminal fluid (mani), prostatic discharge (madhi), and urethral discharge (wadi). Semen is not najasat because it contains sperms that are living human hereditary material. Dry semen on a cloth is rubbed away while the wet one is washed with water (MB #172) and the cloth can be used for prayer. Wudhu has to be repeated when prostatic fluid (madhi) is passed (BG #69). Touching the penis or self or another person nullifies wudhu.

D. INTERNAL SECRETIONS: INTRAVASCULAR FLUIDS, MEMBRANOUS CAVITY SECRETIONS
Intravascular fluids: There are 2 types of intra-vascular fluids: blood (hemorrhage, epistaxis, menstruation) and lymph. Blood is cleaned away with water (MB#171). The liver and spleen are not considered blood and can be eaten (BG#11). Menstrual blood on a cloth is washed away if wet and rubbed if dry (BG#27, 28) and the cloth can be used for prayer. Blood of epistaxis is not najasat (BG #69) but must be washed away immediately.

Membranous cavity secretions: Pleural, peritoneal, pericardial, and synovial fluids are not najasat and must be washed away if they are outside their cavities.

E. NON-HUMAN SECRETIONS
Non-human secretions: The saliva of a dog is considered dirty and has to be washed with water 7 times one of them with soil (MB #136). On the other hand cat saliva (BG #9) and camel saliva (BG#24) are not considered najasat. The same ruling applies to domestic animals whose meat is edible.

4.0 THE SKIN
A. HAIR
SCALP HAIR
Scalp hair can trap and accumulate infectious and toxic material from the atmosphere because of its continuous exposure. Rubbing the hair with wet hands in wudhu (mash al ra'as) helps remove accumulation of possible air-borne pathogens. Scalp hair must be washed and combed regularly to prevent any accumulation of filth. Dyeing, plaiting, hair locking of hair are permissible provided they do not prevent proper cleaning. Proper cleaning of hair requires that water reaches the root of the hair. Hair of both men and women can only be dyed with colors other than black. Black dyeing or plucking away white hair is considered deception about the age of a person. The only exception is in situations of jihad when enemies are made to believe that Muslim soldiers are young and therefore strong. Shaving scalp hair is needed when lice and other ecto-parasites are feared to grow in it. It is however offensive (makruh) to shave only part of the head unless there is a medical indication. Shaving of scalp hair for women is discouraged without the consent of the husband.

BEARD
The male beard must be kept to maintain gender identity. It is recommended to cut the moustache and grow the beard. The beard should be trimmed and not left to grow wild. The beard should not be allowed to grow beyond the size that can be maintained hygienically. Grey hair can be dyed with any color but black.  The beard should be washed during wudhu. Regular combing of the beard is necessary to prevent accumulation of dirt.

ARMPIT HAIR:
cut axillary hair, natf al ibt

PUBIC HAIR:

TRUNK HAIR:
Skin hair can be shaved as needed for cleanliness
Regular washing and shaving of  abdominal, chest hair, pubic hair, and axillary hair is recommended for hygiene.

BODY HYGIENE
Natural/normal hygienic acts: circumcision, khitan, , shaving pubic hair, cutting nails,

Hand-washing: On waking up from sleep, the hands can not put into any utensil until they are washed three times.

Hygiene of nostrils: Blowing the nostrils, istinshaar,  is required on waking up from sleep (BG 34)

B. NAILS
Nails (adhfar): It is sunnat to trim finger-nails and toe-nails. If left to grow, nails accumulate dirt and pathogens. Some of the excreta may lodge under the nails during istinjah and be a nidus for infection.

C. EXPOSED SKIN
Ablution (wudhu): Regular ablution involves washing the parts of the body  that are most likely exposed to environmental pollution. The exposed organs that are washed are the face, the forearm, hands, the feet, and the head. It is recommended to wash or pass the wet hand over parts of the body that are normally exposed to the atmosphere such as the nostrils, the ear, and the back of the neck.

D. THE TRUNK
Bathing(ghusl): Washing of the whole body is obligatory after menstruation (haidh), post-natal bleeding (nifaas), and coitus (janaba). Bathing is also undertaken before for hajj, umrah, and on Fridays. Bathing should not be in the open. Nudity must not be exposed at any cost.

E. PERINEUM
Circumcision (khitaan): circumcision is obligatory for males and is recommended for females. In men only the prepuce is removed. In females circumcision should not involve clitoridectomy and should not cause any disfigurement of the perineal area. Circumcision is a hygienic measure to prevent accumulation of urethral discharges and urine under the prepuce. This can lead to infection.

5.0 PATIENT HYGIENE, nadhafat al mariidh
A. INTRA-VASCULAR FLUIDS:
Phlebotomy is one of the commonest procedures in medicine. Venepuncture for diagnostic or therapeutic purposes is more common that operations on arteries. Lymphatic channels are rarely operated on. Surgery and catheterization also involve dealing with blood. Blood is not  najasat when in the body. At the time of the prophet the therapeutic procedure of cupping (hijaamah) was common and the blood was not treated as najasat (BG #74).

B. INTERSTITIAL SPACE FLUIDS
Diagnostic and therapeutic procedures are carried out involving pleural, peritoneal, pericardial, cerebro-spinal, and synovial cavities and spaces. The fluids and effusions are generally not considered najasat. Amniotic fluid in amniocentesis is treated in the same way.

C. INTUBATION AND CATHETERISATION:
INTUBATION
Esophageal, gastric, and naso-gastric tubes are inserted for diagnostic or therapeutic purposes. The fluids involved are not najasat but must be washed away to prevent their becoming nidi of infection. A tracheostomy tube may be inserted in cases of respiratory distress and respiratory secretions may accumulate in it. These secretions are not najasat.

CATHETERISATION:
Catheters can be introduced into the heart and the bladder for diagnostic or therapeutic purposes.

D. STOMA:
Stomas are an opening of the GIT onto the surface of the abdomen. It may be temporary as esophagostomy, gastrostomy, jejunosotomy, and cecostomy. It may be permanent as in ileostomy and colostomy.  Ileostomies are usually constructed following proctocolectomy. They discharge small amounts of liquids continuously. They do not need irrigation but an appliance must be worn all the time. Colostomies may be sigmoid or transverse. The sigmoid colostomy discharges solid stool on an average once a day and a pattern similar to normal defecation may develop. An appliance is not needed but a pouch must be worn for reassurance. Irrigation is achieved by use of a catheter. A transverse colostomy discharges liquid foul-smelling stool and is best avoided.  The fluids from an ileostomy are not najasat but those from the colostomy are definitely najasat and must be dealt with accordingly. Enterostomy therapy is a specialized area of nursing that involves, inter alia, post-operative education and counseling of patients and their families (b) care of the stoma (c) dealing with long-term emotional and physical problems.

E. FISTULAE:
Bladder fistulae may join the vagina (vesico-vaginal fistula) or the colon (vesico-intestinal fistula). They usually follow trauma, infection, or irradiation.  Rarely intestinal fistulae may discharge to the outside. Urethral fistulae may open into the vagina (urethro-vaginal), the rectum (urethro-rectal) or the skin (urethro-cutaneous). The contents of the fistula must be washed away. Those that contain stool or urine are treated as najasat and they can nullify wudhu.

DISCUSSION ON HYGIENE
Ruling on flatus and wudhu: flatus is released continuously in normal situations
Microbiological basis for stool being najasat
Microbiological basis for urine being najasat
Physiological basis for considering vomitus from upper GIT non-najasat and that from lower GIT najasat
Microbiological basis for wadhi and madhi being najasat
Basis for why semen is not considered najasat
Rulings on blood transfusion
Microbiological basis for dead animals being najasat
Properties of water that make it a universal cleanser
Microbiological and toxicological standards for water purity
Microbiological basis for prohibition of conversation in the toilet
Scientific basis for prohibition of excreta disposal in public places
Basis for prohibition of using the right hand in the toilet
Rulings on wudhu and salat for patients with urinary incontinence
Urethral massage
Basis for prohibition of urinating on hard ground, in vessels, in the bath, in a hole, in stagnant water
Microbiological basis for different treatment of urine of breast-feeding boys and girls
Rulings on spitting
Rulings on the use of the tooth-pick
Wudhu with open wounds
Wudhu with bandaged wounds
Wudhu and ghusl in patients with stoma
Wudhu and ghusl for patients with fistulae