Aziz Sheikh

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Aziz Sheikh Professor of Primary Care Research
Development University of Edinburgh Edinburgh, 10
October 2006

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• Why Is the subject important?
• Islam the noble art of medicine
• Sacred Law medical ethics
• Sources of Sacred Law
• Two overriding aims
• Three core objectives
• Six Universal principles
• Application of medical ethico-legal matrix
• Case discussions
• Conclusions

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Ethnic minority populations in 1991 and 2001
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Religion in the 2001 Census?

• I think it is becoming clear that more people
  are identifying themselves in terms of their
  religion or culture than ever before. That is why
  there is need to expand on the kind of ethnic
  monitoring that is carried out in the Census the
  basic classifications of Black, white or Asian
  are simply out of date.

British Home Secretary, Rt Hon. Jack Straw MP,
1998
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Religion in the UK
Religious diversity in Britain
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Poor health by sex and ethnic group, 2001
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Self-reported poor health status by religious
group
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a long-established, white-dominated
organisation (which) is liable to have
procedures, practices and a culture that tend to
exclude or to disadvantage non-white
people. British Home Secretary, Rt. Hon Jack
Straw MP
The NHS is
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Legislative policy developments

• Human Rights Act
• Race Relations Act Amendment (2000)
• NHS Patients Charter
• Equality Act

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Picture of crescent
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Physical well-being

• And whosoever saves a life, it is as if they
  have saved the whole of humankind
• Quran 532

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Spiritual well-being

• There is in the body a morsel of flesh, and if
  it is good the entire body is good.
• However if it is diseased the entire body is
  diseased and know that it is the heart.
• Prophet Muhammad

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Holiness
Healing
Wholeness
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Two overriding aims of Sacred Law

• To promote and secure the interests and
  well-being of individuals and society
• To safeguard and protect individuals and society
  from harm

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Three core objectives

• To guarantee universal human needs (darurat)
• To cater for general day-to-day requirements
  (hajiyat)
• To adorn and enhance quality of life
  (tahsiniyat)

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Six universal human needs

• Sacred Law must safeguard and preserve
• Religion
• Life
• The intellect
• Wealth and property
• Lineage
• Honour and chastity

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Islamic ethico-legal matrix4 major
considerations

• Everything is permissible, except that which is
  prohibited
• Actions are judged by intentions
• Necessity allows the prohibited
• Harm is always to be removed

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Islamic ethico-legal matrixConsideration 1

• Everything is permissible, except that which is
  prohibited
• Actions are judged by intentions
• Necessity allows the prohibited
• Harm is always to be removed

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Islamic ethico-legal matrixConsideration 2

• Everything is permissible, except that which is
  prohibited
• Actions are judged by intentions
• Necessity allows the prohibited
• Harm is always to be removed

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Islamic ethico-legal matrixConsideration 3

• Everything is permissible, except that which is
  prohibited
• Actions are judged by intentions
• Necessity allows the prohibited
• Harm is always to be removed

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Islamic ethico-legal matrixConsideration 3

• Everything is permissible, except that which is
  prohibited
• Actions are judged by intentions
• Necessity allows the prohibited
• Harm is always to be removed

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Al-Ruhawis (b.1203) Practical ethics of the
physician

• 1.The loyalty and the faith of the Physician, and
  Ethics He Must Follow
• 2. Care of the Physician's Body
• 3. What the Physician Must Avoid and Beware of
• 4. Directions of the Physician to the Patient and
  Servant
• 5. Manners of the Visitors
• 6. Care of Remedies by the Physician
• 7. What the Physician Asks the Patient and the
  Nurse
• 8. What the Patient May Conceal from the
  Physician
• 9. How the Healthy and III Must Take Orders of
  the Physician
• 10. Training of Servants by the Patient before
  Illness
• II. Patient and Visitors
• 12. Dignity of the Medical Profession
• 13. Respect for the Physician
• 14. Physicians and Peculiar Incidents to Aid
  Treatment
• 15. Medical Art for Moral People
• 16. Examination of Physicians
• 17. Removal of Corrupt Physicians
• 18. Warning against Quacks
• 19. Harmful Habits

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The Oath of a Muslim Physician

• Give us the strength to be truthful, honest,
  modest, merciful and objective. Give us the
  fortitude to admit our mistakes, to amend our
  ways and to forgive the wrongs of others. Give us
  the wisdom to comfort and counsel all towards
  peace and harmony. Give us the understanding that
  ours is a profession sacred that deals with your
  most precious gifts of life and intellect.
• Therefore, make us worthy of this favored
  station with honor, dignity and piety so that we
  may devote our lives in serving mankind, poor or
  rich, literate or illiterate, Muslim or
  non-Muslim, black or white with patience and
  tolerance with virtue and reverence, with
  knowledge and vigilance, with Thy love in our
  hearts and compassion for Thy servants, Thy most
  precious creation.
• Hereby we take this oath in Thy name, the
  Creator of all the Heavens and the earth and
  follow Thy counsel as Thou has revealed to
  Prophet Muhammad.
• "Whoever killeth a human being, not in liew of
  another human being nor because of mischief on
  earth, it is as if he hath killed all mankind.
  And if he saveth a human life, he hath saved the
  life of all mankind." (Qur'an V/35)

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1. Assisted conception

• A young Muslim couple have been unsuccessful in
  trying to conceive for 3 years. After
  investigation, their fertility specialist
  recommends assisted conception using donated
  sperm.
• Is this lawful? Is it ethical?

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2. To fast or not to fast

• Ahmad, a 14-year old Libyan boy with recently
  diagnosed insulin-dependant diabetes mellitus
  attends to enquire whether it is safe to fast
  during the forthcoming Ramadan. Looking through
  his notes, you find that his diabetes is
  well-controlled and that his only other past
  medical history of note is mild asthma controlled
  with salbutamol and beclamethasone inhalers.
• What does the Muslim fast entail?
• Should he fast?

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3. The vexed question of the veil

• Salma, a 23 year old teacher in training
  consults seeking advice about contraception, but
  wearing a niqab (veil) for the first time.
• What issues might arise?
• Should she remove it?

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4. Do we need cycle helmet legislation?
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Key messages

• Britain is now a multi-faith society
• Understanding the beliefs, values and practices
  of others is a vital ingredient to the success
  of our pluralist societies
• Law and ethics are intricately intertwined within
  the Islamic framework
• This legal/ethical framework is rational and its
  over-riding aims, objectives and principles can
  therefore be relatively easily understood
• Its application however lies in human hands which
  manifests as diverse outcomes