MEDICO-ETHICAL ISSUES

Life and Personal Dignity are Overriding Concerns in Islam
Noted Jurist Maulana Saifullah Rahmani throws light on vast number of medico-ethical issues seemingly in contradiction to several key concepts of life and dignity.

Dr. Mustaq, Director, Shifa Hospital addressing the Doctors for Humanity workshop on Sept. 11 (above). Seated on the dais are Maulana Saifullah Rahmani (Left), Dr. Saad Belgaumi (Centre) and Dr. F.M. Moinuddin. A section of the audience (right)

Sexual reassignment surgery could be permitted for trans-genders. Medical records of individuals should remain confidential.

Surrogate motherhood and sperm banks are not permitted.  Mercy killing to release an individual from intense pain is not permissible.

Islamic jurist Maulana Khalid Saifullah Rahmani expounded the Islamic juristic opinion on a host of issues pertaining to medical ethics at a workshop held under the aegis of Doctors for Humanity here on September 11. Addressing a large gathering of doctors, Rahmani said Islam provides guidance in each and every aspect of human life and medical profession was not an exception to it. Rahmani, who is currently general secretary of the Islamic Fiqh Academy and is a leading expert on Islamic jurisprudence, urged the doctors to acquire knowledge of Islamic medical ethics through profound study of Kitabut Tibb in the books of ahadith.
Rahmani said the Prophet had ruled that medical practitioners who had not acquired the knowledge of medicine properly and adequately, would be held liable for punishment if their practice harms the patients.  “In other words”, he added, “the Governments were well within their right to debar quacks and ill-trained medical practitioners from the medical profession”.  He said this was applicable with regard to even the ones who were properly trained in the profession but harmed the patients through wrong diagnosis and treatment.
Following is Maulana Rahmani’s explanation on various medical issues:
Permission for Surgery:
In normal circumstances, doctor should conduct surgery only with the permission of the patient or his guardian or caretaker. However, if emergency operation was called for in order to save the life of a patient, the doctor could go ahead even without the formal permission.
Confidentiality of medical records: 
Doctors should maintain confidentiality regarding the ailments suffered by their patients and should not reveal the medical record of their patients to others in any circumstances. However, in cases like matrimonial alliances, where confidentiality about ailments could impact the relationships in future, the same could be revealed to the people concerned.
Commission on auxiliary services:  
Medical profession has largely turned into commerce and it had become normal for doctors to receive kickbacks for unnecessary diagnostic tests and pharmacies for prescription for unnecessary drugs. All such commissions would be considered bribery and corrupt practice.
No divine punishment:  
Sicknesses or ailments should not be attributed to misdeeds of individuals. Sickness is natural for the human body and should not become a cause for casting aspersions on one’s character or accusations for divine punishment.
Contagious diseases: 
Some of the diseases are contagious and spread due to close living or coming in contact with people afflicted with them. There are four specific instructions in such conditions: 1- People suffering with contagious diseases could be isolated (or quarantined). 2- A separate colony could be set up for people suffering from such diseases. 3- Any person deliberately trying to spread virus of contagious diseases will be deemed a killer. 4- A person could seek nullification of his / her marriage if the other partner is suffering from a contagious disease.
Diagnosis and exposure of Private parts:
Doctors could expose a patient’s private parts (what is called satr in Islamic terminology) only to the extent necessary for diagnosis. It is advisable for female doctors to treat the female patients.  If indeed emergency calls for treatment of female patients by male doctors, he could expose only such parts of the body as are necessary for the diagnosis.
Humans as guinea pigs:  In some of the countries, prisoners are subjected to trials of drugs before they are released into markets (or decoded by pharmaceuticals). These could threaten the health or even lives of prisoners.  It is not permissible to conduct trials on human beings. Animals could be used for the purpose.
Euthanasia (mercy killing): Islam does not permit killing oneself in order to find release from pain and agony of sickness. Nor are the doctors allowed to administer toxic injection for the purpose of what has come to be known as euthanasia or mercy killing. Nor even the treatment can be discontinued in such cases to hasten death of patients suffering from intense pain.
Use of ventilator:  
Patients should be put on ventilators (machines that assist or carry out breathing) only when it becomes extremely necessary and only if he or she could afford its expenses. It should not be resorted to merely to enhance medical expenses of an inmate in hospital. It is advisable to remove the ventilator if the patient is brain-dead and no improvement is possible from further medical treatment. Patients should be administered medical treatment to the extent they can afford themselves. Ventilators could be removed even on the advice of doctors if they are convinced that continuance of medical treatment would bring no improvement in patient’s condition.
Medicinal ingredients: All ingredients from plants or minerals could be used for the purpose of formulating medicine. However, ingredients that are intoxicating or are poisonous (toxic) in nature should be avoided.  If any medicine contains alcohol, and there is no substitute, such medicine could be used.
Use of animal products in or for medicine:  
1- As a general rule, parts of animals that are halaal or permissible for eating, could be used for formulation of medicine. 2- Medicine extracted from dead animals even if they are halaal, should not be used. 3- Certain parts of even halaal animals are prohibited for the purpose of consumption and treatment. 4- If a patient is advised by a doctor to consume blood in order to escape certain death, it becomes permissible as concern for life overrides the prohibition against haraam(impermissible). It should however not exceed the quantity that is required. Blood transfusion is permitted.
Organ transplantation: 
Artificial organs could be implanted into human beings. Even organs from animals could be transplanted on humans. Even organs from one person to another could be transplanted provided the exchange does not involve any commercial deal. Sale of human parts or organs is totally prohibited.
Organs from Dead Humans:
The ulema (scholars) of Islam are still not unanimous about transplantation of parts of organs from dead (cadaver) persons or the circumstances in which such organs could be removed from the dead.
Birth Control:
As a general rule, sterilization or permanent birth control is not permitted as a Muslims should have faith in the divine planning rather than their own. However, contraception could be resorted to if spacing between two deliveries is required. Any of such contraceptives could be used for the purpose. Birth control is not permitted merely with the objective of limiting the size of the family. A Muslim should believe in Allah being the sole sustainer or fosterer (Raziq). It is therefore not permissible to control births merely guided by the fear of poverty or unaffordability.
Abortion: 
As a general rule it is presumed that the pulmonary (breathing) system becomes functional after 120 days of conceiving by a female. Abortion of foetus could be resorted to within this period in case such births pose any danger to the mother’s health.  It is not permissible to abort the foetus thereafter. However, if medical evidence indicates symptoms of malfunctioning of brain in the foetus or any danger to the mother’s health, abortion could be opted in order to avert danger to the mother’s life. Abortion of foetus could be resorted to in case a woman has conceived following rape. (Social stigma is a valid concern in this regard.)  As a general rule, abortion should not be opted for by women. It is useful to be reminded that abortion is turning into a sex selection method in states like Punjab and Haryana where gender ratio has become adverse inasmuch as there are no more than 650 females to 1,000 males.
Vasectomy and Tubectomy:
It is not permissible to conduct permanent sterilization of men (vasectomy) or women (tubectomy) in pursuit of limiting population.  However, in cases where a woman is insane or cannot raise a family or nurture children, permanent sterilization could be resorted to. 
Sperm Banks, surrogacy and Assisted Reproductive Technology:
It is not permissible to store human reproductive material known as sperms or ova.  Similarly, surrogate motherhood too is also not permitted. However in-vitro fertilization could be resorted to as a treatment of infertility of women if the ova and sperms from the same couple are fertilized outside the body. It is not permissible to use sperms from males who are not husbands for assisted pregnancies. Even in cases where an individual has two wives, it is not permissible to use the fertilized ova from one wife to inseminate the other wife. 
Surgery for Sex change is Haraam:  
It is prohibited to undergo and conduct surgeries to change sex of individuals. However, if an individual is a transgender or transvestite, sexual reassignment surgery could be performed in order to lend a definite direction to such individual. In such matters, the dominant natural preference towards gender of the individual concerned should be taken into consideration. All such surgeries would be deemed treatment of an abnormal condition.
Plastic and Cosmetic Surgery: It is permissible to undergo plastic surgery in order to remove physical flaws. But it should not be done with the intention of enhancing physical appeal and attraction. Women who shave off eyebrows have been cursed.
Convener Dr. F. M. Moinuddin, ophthalmologist welcomed the gathering on behalf of the Doctors for Humanity. The workshop was also addressed by Drs. Muhammad Saad Belgami, Tahaa Matheen, Mushtaq, Shakeel  and Khursheed.
(Proceedings of this important seminar were conducted in Urdu  and the rendering into English for the sake of this report is by Maqbool Ahmed Siraj.  We have tried to stay faithful to the Urdu text. However, inadequacies are subject to correction.)