Isamic medicalethics

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Islamic Islamic Medical EthicsMedical Ethics

Kassim Kassim BaddarniBaddarni

Al-Taj Organization Al-Taj Organization Arraba, Galilee, IsraelArraba, Galilee, Israel

[email protected]@013.net

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Islam is the Islam is the Youngest Youngest 22ndnd Largest Largest

ReligionReligion Every 5th person

worldwide

2000 BC 1000 BC

563 BC

33 AD

610 AD 2008

Judaism

Hinduism

Buddhism

Christianity

Islam

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Values Beliefs

Religion

Muslim

Patient

Spiritual Spiritual Care Care

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Islamic Law and Islamic Law and RulesRules

The Holy Book Quran(Hadith), words or actions of the prophet

Sunnah

(Ijma) of the ClericsConsensu

s

(Ijtihad) personal study Wisdom

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Values:Honor parentsBe kind to neighborsProtect the weakGive to the poor

Condemns:MurderStealingLyingAdultery

Regulates:MarriageDivorceInheritance Business

Forbids:GamblingPorkAlcoholProstitution

The Qur’an

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Internal

BeliefsBooks of GodOf Abraham, David,

Moses, Jesus, MohammedDivine Decree

Fate set in advance

Oneness of GodAll can, no body or sex

Prophets of GodFrom Adam to Mohammed (25)

Angels of GodFrom light to serve God

Life after DeathSorting to Hill or Paradise

Day of JudgmentRise of humanity

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Health, Religion & Health, Religion & EthicsEthics

Contraception

Fertility

Cloning

Medications

Resuscitation

Brain Death

Organ Donation

Euthanasia

Death

Life after Death

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The Sharia Law The Sharia Law SystemSystem

Category Arabic

Do it Not do it

Obligatory(Prescribed)

FardWajeb Reward Punishment

Recommended(Desirable)

MustahabMandu

bReward No

Punishment

Permitted(Allowed)

MubahHalal No Reward No

Punishment

Discouraged(Disliked)

MakruhManboth No

PunishmentReward

Forbidden(Prohibited)

HaraamMahd’ur Punishment No Reward

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Maslow Maslow WayWay

Forbidden

Discouraged

Permitted

Recommended

Obligatory

Choice of Doing

Urging of not Doing

Enforcing of not Doing

Enforcing of Doing

Urging of Doing

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1-91-9

Copyright 1995 Prentice Hall

5 Pillars5 Pillars

FastingSawm

FastingSawm

CharityZakat

CharityZakat

PilgrimageHajj

PilgrimageHajj

PrayerSalat

PrayerSalat

Testimony of FaithShahadah

Testimony of FaithShahadah

ExternalBeliefs

(Ibada)

1-91-9

Copyright 1995 Prentice Hall

5 Pillars5 Pillars

FastingSawm

FastingSawm

CharityZakat

CharityZakat

PilgrimageHajj

PilgrimageHajj

PrayerSalat

PrayerSalat

Testimony of FaithShahadah

Testimony of FaithShahadah

ExternalBeliefs

(Ibada)

ObligatoryObligatory

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Blood and organ donation. (giving and receiving).

Circumcision of male infants (7th day). Controversy of female circumcision.

Breast feeding (two years). Human skin bank: lawful for medical grafting

and unlawful for cosmetics and misleading others.

RecommendedRecommended

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Autopsy: if for medically or by law indicated. Reconstructive Surgery (post mastectomy). Do Not Resuscitate order: when the

treatment becomes futile. Withdrawal or withheld therapy is

permitted in brain death. Genetic Engineering: to alter or cure

diseased genes. Abortion: pregnancy that risk the mother’s

health, physically or mentally.

PermittedPermitted

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Contraception: Islam approves all methods of contraception between husband and wife which are not harmful, are reversible and are not causing abortion.

Artificial insemination: when using the husband’s sperm and the wife’s ovaries and uterus.

Death of one of the spouse terminates the marriage contract on earth, thus frozen sperm from husband can not be used.

PermittedPermitted

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Forced feeding the sick.

Smoking

Divorce

Elective abortion before age 120 days (some sects before 40 days).

DiscourageDiscourage

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Surgical contraception: (Sterilization: Vasectomy & tubal ligation). Permitted for mentally sick or when another pregnancy risks mother’s life.

Sperm or ova donation.

Fetal Sex Determination.

Elective abortion in a healthy mother 120 days after fertilization.

Human milk bank.

Human cloning (permitted for tissues and organs).

ForbiddenForbidden

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Surrogacy Uterus: Surrogacy involving a third person is not permissible. (even if the woman involved is another wife of the husband).

Sex: Oral sex, homosexual and gay/lesbian relation, prostitution and sex outside marriage.

Cosmetic surgery: Changing the creation of Allah.

Food: not Halal meat, of pork or dead animal/bird.

Drink: alcohol.

Others: interest, theft, gambling and drugs.

ForbiddenForbidden

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Active Euthanasia: voluntary, non-voluntary and Involuntary are not permissible under any circumstances.

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.

Suicide: include assisted suicide and physician’s assisted suicide.

Murder. "take not life which Allah has made sacred" Qur’an 6:151.

ForbiddenForbidden

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Principles of Medical Principles of Medical EthicsEthics

Necessity overrides prohibition (insulin from pork, medications with alcohol).

Remove harm at every cost if possible (quit smoking, risk factors, disease therapy).

Accept the lesser of two harms if both cannot be avoided (abortion in risk to the pregnant woman).

Public interest overrides individual interest (blood and organ donation).

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Female Female ModestyModesty

Dress: Provide a long-sleeved gown or allow to wear her own cloths.

Examination: exposure of the patient’s body parts should be limited to the minimum necessary.

Sex: sensitivity when asking a single, widow or a divorced about sexual habits.

Respect privacy and do not touch while talking.

Should not be placed in mixed rooms.

Avoid eye contact and shaking hands to prevent unnecessary embarrassment.

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CancerCancer Result of Divine Will or a spiritual trial (not a

product of a carcinogen or risk behavior).

Cancer is often referred to as “that disease” followed by “God keep it away”.

Cancer kept confidential, fear that it may affect their daughters marriage.

Pain: analgesic to prevent suffering include morphine is allowed and recommended. Suffering delete sins.

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Palliative Palliative CareCare

When death is inevitable, Islam directs that the patient be allowed to die without heroic measures.

Muslims disapprove of any medical care that may hasten the death of a patient.

Muslims prefer to die at home if possible with the family providing comprehensive physical and spiritual support.

Death is not prepared for with prior funeral arrangements and viewed as an interference in God’s will.

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Death definition: when spirit leave’s the body.

Death is Inevitable: “ Every soul shall have a taste of

death: In the end to Us shall you be brought back." Qur’an 29:57

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).

When death occur: eyes should be closed; all connected tubes removed; all limbs flexed and the body straightened.

DeathDeath

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After DeathAfter Death

Washing and burying the body as soon as possible (same day). On the right side, facing Mecca.

Respect for the body and prayers over the dead.

Recitation of the whole Quran if possible.

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.

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Funeral & Funeral & Mourning Mourning

PeriodPeriod Funeral is simple and every human is equal.

Deceased buried in a white shroud (men 3 pieces, women 5 pieces) without a coffin. Islam forbids cremation.

Women are not allowed to attend the funeral, non-Muslim men may attend.

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.

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Life After DeathLife After Death Angels visit the dead in grave during the first night.

Believers are comfortable waiting till judgment day.

Judgement Day: resurrection of bodies. The good cross to Paradise, The bad fall off into Hell.

Child is regarded sinless until the age of maturity. The soul /spirit of the child is automatically transferred to paradise.

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Family Duties Family Duties After Death After Death

Payment of Funeral expenses.

Payment of his/her debts.

Execution of his/her will.

Distribution of the remaining estate.

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Spiritual Spiritual HistoryHistory

Ask: About life & death meaning.

Observe: Dressing, praying, reading

Listen: Reactions, answers, remarks

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Barriers of Spiritual Barriers of Spiritual History and TherapyHistory and Therapy

Lack of time.

Lack of training.

Discomfort with the subject.

Fear of activity outside area of expertise.

Lack of interest or awareness.

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Final Words Final Words Listen to patient and family.

Demonstrate sensitivity.

Respect Patient’s Values and Beliefs.

Remain Flexible.

Avoid Speculation.

Respond to Who, What, Where, When?

Provide Reassurance.

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Al-Taj for Health and Al-Taj for Health and HeritageHeritage

Tel/Fax +972-4-6747737 [email protected]

Mission:Mission: health promotion by raising awareness for prevention, early detection and improve management and outcome of cancer and diabetes in the Arab sector, Israel

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Some Some ProjectsProjects

“Palliative Care Manual”

“Diabetes Mellitus – the Era Plague

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Some Some ProjectsProjects

Breast Cancer lecture

Palliative Care conference

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