ISLAMIC CODE OF MEDICAL ETHICS

ISLAMIC CODE OF MEDICAL ETHICS

“Therapeutic” is a noble profession God honoured it by making it the miracle of Isa son of Mariam. Prophet Ibrahim enumerating his Lord’s gifts upon him included “and if I fall ill He cures me”. Like all aspects of knowledge, medical knowledge is part of the knowledge of God “who taught man what man never knew”. The study of Medicine entails the revealing of God’s signs in His creation. ‘And in yourselves do you not see?’. The practice of Medicine brings God’s mercy unto His subjects. Medical practice is therefore an act of worship and charity on top of being a career to make a living. The provision of medical practice is a religious dictate upon the community, ‘FardhKifaya’, that can be satisfied on behalf of the community by some citizens taking up medicine. It is the duty of the state to ensure the needs of the nation to doctors in the various needed specialties. In Islam, this is a duty that the ruler owes the nation. Need may arise to import from afar such medical expertise that is not locally available. It is the duty of the state to satisfy this need. It also behaves the state to recruit suitable candidates from the nation’s youth to be trained as doctors. An ensuring duty therefore is to establish relevant schools, faculties, clinics, hospitals and institutions that are adequately equipped and manned to fulfill that purpose. 

          ‘Medical’, is a religious necessity for society. In religious terms, whatever is necessary to satisfy that “necessity” automatically acquires the status of a , ‘necessity’. Exception shall therefore be made from certain general rules of jurisprudence for the sake of making medical education possible. One such example is the intimate inspection of the human body whether alive or dead, without in any way compromising the respect befitting the human body in life and death, and always in a climate of piety and awareness of the presence of God. The preservation of man’s life should embrace also the utmost regard to his dignity, feelings, tenderness and the privacy of his sentiments and body parts. A patient is entitled to full attention care and feeling of security while with his doctor. The doctor’s privilege of being exempted from some general rules is only coupled with more responsibility and duty that he should carry out in conscientiousness and excellence in observing God. Excellence that entails that you worship God as if you see Him. For even though you don’t see Him, He sees you, “Al-Ghazali considered the profession of medicine as (fardh – Kifaya), a duty on society that some of its members can carry in lieu of the whole. This is natural since the need of health is a primary need and not an anything in life remains enjoyable”. That it is permissible for the purpose of treatment to look at hidden and private parts of the body, derives from the rule of jurisprudence ‘necessities override prohibitions’ and complies to the teachings of the Quran when “compelled to doo something but without ill-intention”. Since the early days of Islam the Lady-Healer’s corps joined the Prophet’s army to battle caring for the casualties and dressing their wounds on whatever part of the body. This provoked no dispute or divergence of opinion. To import medical expertise and to treat Muslims by non-Muslim physicians should be decided only by the condition of the patient and the capability of the doctor. Since an early time the Muslim state employed Christian doctors from Jundishapur and treated them very generously. In this context it is also worth remembering that the Prophet’s guide on the journey of Hijrah was Abdullah IbnUraikit, a non-Muslim, chosen by the Prophet. 

The physician should be amongst those who believe in God, fulfill His rights, are aware of His greatness, obedient to His orders, refraining from His prohibitions and observing Him in secret and in public. The physician should be endowed with wisdom and graceful admonition.He should be cheering not dispiriting, smiling and not frowning, loving and not hateful, tolerate and not edgy. He should never give up to a grudge or fall short of appealing. He should be an instrument of God’s justice, forgiveness and not punishment, coverage and not exposure. He should be so tranquil as never to be rash even when he is right , chaste of words even when joking , tame of voice and not noisy or loud, neat and trim and not shabby, conductive of trust and inspiring of respect, well mannered in his dealings with the poor or rich, modest or great, in perfect control of his composure, and never compromising his dignity, however modest and forbearing. The physician should firmly know that ‘life’ is God’s awarded only by Him and that ‘Death’ is the conclusion of one life and the beginning of another. Death is a solid truth and it is the end of all but God. In his profession the physician is a soldier for ‘Life’ only defending and preserving it as best as it can be, to the best of his ability. The physician should offer the good example by caring for his own health. It is not befitting for him that his “do’s” and don’ts, are not observed primarily by himself. He should not turn his back on the lessons of medical progress, because he will never convince his patients unless they see the evidence of his own conviction. God addresses us in the Quran by saying, “and make not your own hands throw you into destruction”. Prophet says “your body has a right on you and the know dictum is no harm or harming in Islam”. The physician should be in possession of the threshold knowledge of jurisprudence, worship and essentials of Fiqh enabling him to give counsel to patient seeking his guidance about health and bodily conditions with a bearing on the rites of worship. Men and women are subject to symptoms, ailments or physiological situations like pregnancy and would wish to know the religious law pertaining to prayer, fasting, pilgrimage and family planning. Although ‘necessity overrides prohibition’, the Muslim physician nevertheless should spare no effort in avoiding the recourse to medicines or ways of therapy be they surgical, medical or behavioral that prohibited by Islam. 

The role of physician is that of a catalyst through whom god, the Creator, works to preserve life and health. He is merely an instrument of God in alleviating people’s illness. For being so designated the physician should be grateful and forever seeking God’s help. He should be modest, free from arrogance and pride and never fall into boasting or hint at self glorification through speech, writing or direct or subtle advertisement. The physician should strive to keep following of scientific progress and innovation. His spirit and knowledge or ignorance, directly bear on the health and well-being of his patients. Responsibility for others should lime his freedom to expend his time. As the poor and needy have a recognized right in the money of the capable, so the patients own a share of the doctor’s time spent on study and in following the progress of medicine. The physician should also know that the pursuit of knowledge has a double indication in Islam. Apart from the applied therapeutic aspect, pursuit of knowledge is in itself worship, according to the Quran guidance and say, “My lord, advance me in knowledge”  and “ Among His worshippers the learned fear Him most” and “God will raise up the ranks of those of you who believed and those who have been given knowledge”. 

          A doctor is a brother to every doctor and a fellow companion in the noblest mission that is a direct answer to God’s commandment in the Quran, ”And help one another in charity and piety but help not one another in sin and rancor”. Physician are jointly responsible for the health care of the Nation and complement one another through the variety of their medical specialization be they preventive or therapeutic, in the private sector or in state employment all abiding by the ethics and rules of their profession. As a professional group in the nation, doctor’s are collectively responsible for drawing plans and taking measures and developing traditions and regulations that are necessary to enable them collectively and individually to carry out their duties as best as possible. Within their fraternity, a doctor should respect his fellow doctor in his absence. He should offer him advice and/or help whenever sought. A doctor shall not eat his brother’s flesh by speaking ill of him from being his back nor shall he pursue his shortcomings his reputation his deficits. The mutual relation between physician is additive and not competitive and collaboration in good faith for the best interests of the patient. If more than one doctor handle the patient medical data should not be with-held from the treating doctors. 

These data should be kept in confidence, within the boundaries of the medical circle without leakage. If in doubt, it is the duty of the doctor that consultation should be arranged or the case referred to a specialist. This is also inspired by the Quran saying, “Ask of the people who possess the message if you do not know”. The specialist will take whatever steps he deems necessary but he shall keep the referring doctor informed about the current and subsequent happenings. It is a doctor’s duty to avail his juniors of the fruits of his experience, knowledge and acumen. He should provide for their education and training for “The concealer of knowledge is cursed”, and because it is in answer to the rights of colleagues, patients and the profession at large from one generation to another. In this context it is worth to remember the Prophet’s saying, “when the son-of-Adam dies he is completely cut off except from three things that are a running charity, knowledge that be had taught and remains put to good use and virtuous progeny praying God for him. Doctors shall be also mutually cooperative and shall promptly rally to the aid of one another if inflicted by sickness affecting a colleague or a member of his family, as well as under conditions of stress, need, disability or death. At this age the doctor is hardly the individualist he was in old for medical care nowadays is given by a team comprising apart from the doctor-nursing, laboratory, physiotherapy, social service and other personnel. The doctor shall foster the team spirit and perfect cooperation so that the team achieves best results in patient care. This code shall be binding also to all personnel of all ranks in all fields of health care. 

          For the sake of the patient the doctor was and not the other way round. Health is the goal and medical care is the means the “patient” is master and the “doctor” is at his service. As the Prophet says, “The strongest should follow the pace of the weakest for he is the one to be considered in deciding the pace of travel. Rules, schedules, time-tables and services should be so manipulated as to revolve around the patient and comply with his welfare and comfort as the top and overriding priority other considerations coming next. That top-priority status is conferred on the patient because and as long as he is a patient no matter who he is or what he is, a patient is in the sanctuary of his illness and not of his social eminence, authority or personal relations. The way doctor deals with his various patients is a perfect portrayal of his personal integrity. The sphere of a doctor’s charity, nicety, tolerance and patience should be large enough to encompass the patient’s relatives, friends and those who care for or worry about him but without of course compromising the dictates if “Professional Secrecy”. 

Health is a basic human necessity and is not a matter of luxury. It follows that the Medical Profession is unique in that the client is not denied the service even if he cannot afford the fee. Medical legislature should ensure medical help to all needy of it, by issuing and executing the necessary laws and regulations. In Private Practice the doctor’s fees are his lawful right and his earnings are legitimate and his conscience is his censor, aware that God’s eye is ever watching. If medical necessity or emergency, however, puts a needy person under his care, it should be the doctor’s duty to be considerate and kind, and avoid his fees if any being a further burden atop of the ailment. For as you give the poor it is God you are giving and alms giving is not only due on material possessions but on knowledge and skills.The Medical Profession is fundamentally the vocation to help man under stress and not to exploit need. Fully entitled to make a decent living and earn a clean income a doctor shall always honour the high standards of his profession and hold it in the highest regard, never prescribing to activities of propaganda, receiving a commission or cutting earnings or similar misdoings. 

The general philosophy is Islamic medicine is that the healer is Allah and the doctor is the instrument that Allah uses to heal the people. The doctor patient relationship is a stronger in Islam than it is in West now. The relationship now in the west is medical or legal. The emphasis has become one that has slipped into more materialism. Because the relationship between doctor and patient has become one that is based more on money than before, the level of trust has been decimated between the doctor and his or her patients. There is also more sensitivity on the part of the patient, both man and woman, in the Islamic ethics. The patient is dealt with having more consideration. The patient does not want to be looked at completely naked when being examined, so their interest and privacy is considered more. A Muslim doctor examining a female patient must have a third party in room, for example, a nurse in order to have a go between so that the issue of sexual harassment will not arise. Also, there is extreme sensitivity about the question of virginity in the unmarried Muslim girl. The rate of virginity in Muslim girls at the age of marriage is in the region of 100% and so it should only be a last resort to do a vaginal examination to the unmarried girl. 

A Muslim patient usually would like to know the direction of the Qibla in order to pray and have access to water in order to make wudu’. Also, when you are taking the medical history of a patient, Islamically, it should be done in private. For example, if you ask an American unmarried girl if she has children, she would not be offended. However, if you ask an unmarried Muslim girl the same question, she would take offense to this due to the fact that she does not participate in relations outside of wedlock. Abortion is generally prohibited with certain exceptions and so is reproductive technology, which includes more than the husband and the wife, such as artificial insemination from a donor or using semen or ovum or uterus from a different person that the spouse. Muslim patients would rather have treatments with non-alcoholic medicines because Islam prohibits alcohol. Also, Muslim does not eat pork, so that must be taken as a consideration. Suicide and assisted suicide have no place in Islam. 

Keeping other persons' secrets is decreed on all the Faithful, the more so if these were Doctors, for people willfully disclose their secrets and feelings to their doctors, confident of the time old heritage of Professional Secrecy that the medical profession embraced since the dawn of history. The Prophet (peace be upon Him) described the three signs of the hypocrite as: "He lies when he speaks, he breaks his promise and he betrays when confided in". The doctor shall put the seal of confidentiality on all information acquired by him through sight, hearing or deduction. Islamic spirit also requires that the items of the Law should stress the right of the patient to protect his secrets that he confides to his doctor. A breach thereof would be detrimental to the practice of medicine besides precluding several categories of patients from seeking medical help.

Islam considers access to health care a fundamental right of the individual. In medicine, there are sometimes difficult decision making situations for choosing better options for the patient’s care. Thus, a physician at times has to decide for his /her patient in light of available knowledge, his/her experience, his/her peers and consensus of the community. In addition, a Muslim physician derives his /her conclusion from rules of Islamic laws (Shariah) and Islamic medical ethics. Hopefully we can apply Islamic Code of Medical Ethics that have been delivered at the top and into our daily behavior. 

 

References 

1. http://rajabekam.info/islam/islamic-code-of-medical-ethics/

2. http://www.members.tripod.com/PPIM/kodetika.htm#12

3. http://www.monthlycrescent.com/islamic-perspective/medical-ethics-islam/

4. http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml