Islamic Medical Ethics Kassim Baddarni Al-Taj Organization Arraba

Islamic Medical Ethics Kassim Baddarni Al-Taj Organization Arraba, Galilee, Israel altaj@013. net 1

Islam is the Youngest 2 nd Largest Religion Every 5 th person worldwide Judaism 2000 BC Hinduism 1000 BC Buddhism Christianity Islam 563 BC 33 AD 610 AD 2008 2

Religion Spiritual Care Muslim Patient Values Beliefs 3

Islamic Law and Rules The Holy Book (Hadith), words or actions of the prophet (Ijma) of the Clerics (Ijtihad) personal study Quran Sunnah Consensus Wisdom 4

Values: Honor parents Be kind to neighbors Protect the weak Give to the poor Regulates: Marriage Divorce Inheritance Business The Qur’an Forbids: Condemns: Gambling Pork Alcohol Prostitution Murder Stealing Lying Adultery 5

Oneness of God All can, no body or sex Life after Death Sorting to Hill or Paradise Angels of God From light to serve God Internal Prophets of God Beliefs From Adam to Mohammed (25) Day of Judgment Rise of humanity Divine Decree Fate set in advance Books of God Of Abraham, David, Moses, Jesus, Mohammed 6

Health, Religion & Ethics ü Contraception ü Brain Death ü Fertility ü Organ Donation ü Cloning ü Euthanasia ü Medications ü Death ü Resuscitation ü Life after Death 7

The Sharia Law System Category Do it Not do it Fard Wajeb Reward Punishment Mustahab Mandub Reward No Punishment Mubah Halal No Reward No Punishment Discouraged (Disliked) Makruh Manboth No Punishment Reward Forbidden (Prohibited) Haraam Mahd’ur Punishment No Reward Obligatory (Prescribed) Recommended (Desirable) Permitted (Allowed) Arabic 8

Forbidden Enforcing of not Doing Discourage d Urging of not Doing Maslow Way Permitted Choice of Doing Recommended Urging of Doing Obligatory Enforcing of Doing 9

Obligatory 10

Recommended Ø Blood and organ donation. (giving and receiving). Ø Circumcision of male infants (7 th day). Controversy of female circumcision. Ø Breast feeding (two years). Ø Human skin bank: lawful for medical grafting and unlawful for cosmetics and misleading others. 11

Permitted Ø Autopsy: if for medically or by law indicated. Ø Reconstructive Surgery (post mastectomy). Ø Do Not Resuscitate order: when the treatment becomes futile. Ø Withdrawal or withheld therapy is permitted in brain death. Ø Genetic Engineering: to alter or cure diseased genes. Ø Abortion: pregnancy that risk the mother’s health, physically or mentally. 12

Permitted Ø Contraception: Islam approves all methods of contraception between husband wife which are not harmful, are reversible and are not causing abortion. Ø Artificial insemination: when using the husband’s sperm and the wife’s ovaries and uterus. Ø Death of one of the spouse terminates the marriage contract on earth, thus frozen sperm from husband can not be used. 13

Discourage Ø Forced feeding the sick. Ø Smoking Ø Divorce Ø Elective abortion before age 120 days (some sects before 40 days). 14

Forbidden Ø Surgical contraception: (Sterilization: Vasectomy & tubal ligation). Permitted for mentally sick or when another pregnancy risks mother’s life. Ø Sperm or ova donation. Ø Fetal Sex Determination. Ø Elective abortion in a healthy mother 120 days after fertilization. Ø Human milk bank. Ø Human cloning (permitted for tissues and organs). 15

Forbidden Ø Surrogacy Uterus: Surrogacy involving a third person is not permissible. (even if the woman involved is another wife of the husband). Ø Sex: Oral sex, homosexual and gay/lesbian relation, prostitution and sex outside marriage. Ø Cosmetic surgery: Changing the creation of Allah. Ø Food: not Halal meat, of pork or dead animal/bird. Ø Drink: alcohol. Ø Others: interest, theft, gambling and drugs. 16

Forbidden Ø Active Euthanasia: voluntary, non-voluntary and Involuntary are not permissible under any circumstances. Ø Passive euthanasia: treatment is not obligatory when there is no hope of survival (brain death). Patient should be provided with food, drink, nursing, and relief from pain until death. Ø Suicide: include assisted suicide and physician’s assisted suicide. Ø Murder. "take not life which Allah has made sacred" Qur’an 6: 151. 17

Principles of Medical Ethics Ø Necessity overrides prohibition (insulin from pork, medications with alcohol). Ø Remove harm at every cost if possible (quit smoking, risk factors, disease therapy). Ø Accept the lesser of two harms if both cannot be avoided (abortion in risk to the pregnant woman). Ø Public interest overrides individual interest (blood and organ donation). 18

Female Modesty Ø Dress: Provide a long-sleeved gown or allow to wear her own cloths. Ø Examination: exposure of the patient’s body parts should be limited to the minimum necessary. Ø Sex: sensitivity when asking a single, widow or a divorced about sexual habits. Ø Respect privacy and do not touch while talking. Ø Should not be placed in mixed rooms. Ø Avoid eye contact and shaking hands to prevent unnecessary embarrassment. 19

Cancer Ø Result of Divine Will or a spiritual trial (not a product of a carcinogen or risk behavior). Ø Cancer is often referred to as “that disease” followed by “God keep it away”. Ø Cancer kept confidential, fear that it may affect their daughters marriage. Ø Pain: analgesic to prevent suffering include morphine is allowed and recommended. Suffering delete sins. 20

Palliative Care Ø When death is inevitable, Islam directs that the patient be allowed to die without heroic measures. Ø Muslims disapprove of any medical care that may hasten the death of a patient. Ø Muslims prefer to die at home if possible with the family providing comprehensive physical and spiritual support. Ø Death is not prepared for with prior funeral arrangements and viewed as an interference in God’s will. 21

Death Ø Death definition: when spirit leave’s the body. Ø Death is Inevitable: “ Every soul shall have a taste of death: In to Us shall you be brought back. " the end Qur’an 29: 57 Ø The dying person: should sit up or lie with their face towards Mecca. Ideally one should die with the Declaration of Faith on the lips (Shahada). Ø When death occur: eyes should be closed; all connected tubes removed; all limbs flexed and the body straightened. 22

After Death Ø Washing and burying the body as soon as possible (same day). On the right side, facing Mecca. Ø Respect for the body and prayers over the dead. Ø Recitation of the whole Quran if possible. Ø Mourning should not be excessive, as this would disturb the dead as well as show lack of acceptance of God’s will and purpose regarding death. 23

Funeral & Mourning Period Ø Funeral is simple and every human is equal. Ø Deceased buried in a white shroud (men 3 pieces, women 5 pieces) without a coffin. Islam forbids cremation. Ø Women are not allowed to attend the funeral, non. Muslim men may attend. Ø Mourning period 3 days. Wife mourn her husband 4 months and 10 days. She is not to remarry, leave her home, or wear decorative clothing. Pregnant widow may remarry 42 days after childbirth. 24

Life After Death Ø Angels visit the dead in grave during the first night. Ø Believers are comfortable waiting till judgment day. Ø Judgement Day: resurrection of bodies. The good cross to Paradise, The bad fall off into Hell. Ø Child is regarded sinless until the age of maturity. The soul /spirit of the child is automatically transferred to paradise. 25

Family Duties After Death Ø Payment of Funeral expenses. Ø Payment of his/her debts. Ø Execution of his/her will. Ø Distribution of the remaining estate. 26

Spiritual History Ø Ask: About life & death meaning. Ø Observe: Dressing, praying, reading Ø Listen: Reactions, answers, remarks 27

Barriers of Spiritual History and Therapy Ø Lack of time. Ø Lack of training. Ø Discomfort with the subject. Ø Fear of activity outside area of expertise. Ø Lack of interest or awareness. 28

Final Words Ø Listen to patient and family. Ø Demonstrate sensitivity. Ø Respect Patient’s Values and Beliefs. Ø Remain Flexible. Ø Avoid Speculation. Ø Respond to Who, What, Where, When? Ø Provide Reassurance. 29

Al-Taj for Health and Heritage Mission: health promotion by raising awareness for prevention, early detection and improve management and outcome of cancer and diabetes in the Arab sector, Israel Tel/Fax +972 -4 -6747737 altaj@013. net 30

Some Projects “Palliative Care Manual” “Diabetes Mellitus – the Era Plague 31

Some Projects Breast Cancer lecture Palliative Care conference 32

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