Medical Ethics Questions From the Audience
During the Medical Ethics Symposium at
ISNA Convention, 1997 and answers
by *Dr. Hassan Hathout
and compiled by ** Dr. Shahid Athar
Medical Ethics is not an exercise between all black or all white, or absolute right or all wrong but, in gray areas, when it is not clear, in Medical Ethics we try to find a better answer over the worse one. The difference between what can be done and what should be done is the reason for Medical Ethics. The objectives of Islamic Shariah (Laws) is for the protection of individual life, religion, mind, property and family. In difficult cases, the rules are: a) take the lessor of the two evils, b) necessity overrides the prohibition.
Q.1. Is CPR (Cardio Pulmonary Resuscitation) part of the mandate to maintain life. What is the status of DNR and code “C”?
A. When the treatment becomes – scientifically – futile (i.e. hopeless), it is no more mandatory, and DNR would be acceptable.
Q.2. Is it OK to withdraw the life support system for example: ( A Ventilator for a patient who has no cerebral function and is in a vegetative state)?
A. Same answer as questions 1. If there is no hope of treatment, you may withdraw the life support equipment. In an attempt to prolong life without quality, one must not prolong the misery at a high cost.
Q.3. When a terminally ill patient and their families reject medical treatment saying that “it is God’s will”, what should a physician do? In the same context, if the physician suggests DNR, then what should the families do?
A. a.) Rejecting treatment; Tell them that treatment is also God’s will , that Jesus said, “I cure the sick with the leave of God”; That Mohammed said “your body has right on you, and said: seek treatment, servants of God, for every illness God created, he created a treatment for=2E (B.) The family should comply because the physician is one who knows best. But the decision is theirs.
Q. 4. What is the definition of “dead” when do you say it is OK to turn the machine off when the patient is dead? Is brain death and brain stem death the same thing?
A. Bra in death is no synonymous with brain stem death and does not mean death. Brain death including brain stem death, means death. The brain stem contains the centers for breathing and the heart. Thus brain stem death fulfills the requirements of Cardio-pulmonary death.
Q. 5. If a person is in a vegetative state on artificial life support but he is not brain dead but his survival chances are minimal, are physicians’ allowed to turn off the machine at this point?
A. If “minimal” means hopeless upon scientific assessment, one may turn off and withdraw life support.
Q.6. Should cancer patients’ requiring heavy pain medication take the medication or be in pain patiently and remember God.
A. They must be given pain medication, remember God, and be patient about residual inevitable pain that cannot be relieved medically. A heavy dose of is permitted if necessary, provided the intention (niyyah) is not to kill the patient.
Q.7. Should a Muslim patient with terminal cancer or parents of a newborn with a congenital defect with a poor chance to survive seek the most invasive and most expensive treatment and do whatever that can be done to save lives or submit to God’s will and accept death?
A. Heroic treatment with poor prognosis is not an Islamic requirement, if scientifically it has no promise of cure.
Q.8. Is organ donation permitted in Islam?
A. Certainly with the juridical safeguards. “An whoever saves a soul it would be as if he had saved all mankind”. It should be given as a gift. The sale of an organ is prohibited. (Quran 5:32)
Q.9. Is receiving organs for transplantation from an animal source permitted and especially if the animal is a pig?
A. Certainly permitted. Necessity overrules prohibitions in the juridical rule.
Q.10. Is it necessary to have the permission from the donor or a relative to receive the organ?
A. Definitely yes.
Q.11. What is the Islamic position on fetal tissue transplant?
A. As long as the procurement of the fetal tissue is legitimate, it is alright. It is not permissible to conceive or to induce abortion of a fetus for the sole purpose of taking its tissues for therapeutic use.
Q.12. What type of contraceptions are allowed in Islam?
A. As long as they are not harmful; they are not abortifacient; or they do not cause sterility.
Q.13. How come contraception is allowed and abortion is not?
A. Contraception is a prevention of pregnancy; abortion extinguishes an existing human life.
Q.14. If the fetus is diagnosed with a genetic disease such as Down’s Syndrome, can the mother have an abortion?
A. Islamically not but, also Islamically society should support the life of the child if the parents cannot.
Q.15. Would you allow an abortion for pregnancy resulting from rape?
A. No. Why ki ll an innocent life? But the baby should be the responsibility of society if the mother cannot support it. Coverage, care and sympathy are amongst her rights. I acknowledge a different position taken by other notable jurists. Why commit one crime because of another crime.
Q.16. Is giving medication like RU 486 “the morning after pill” which prevents the formation of zygote equal to causing an abortion?
A. No; unless the pregnancy has already formed or implanted.
Q.17. Is the conception without implantation an abortion?
A. I tend to take it as a different form of abortion.
Q.18. If a mother is fertile but cannot carry the child for medical reasons, is surrogacy allowed?
A. Not in Islam. Procreation emanates from a marriage contract, and a marriage contract accommodates two persons; husband and wife. Thus, assisted reproduction is allowed only between husband and wife while they are married.
Q.19. When a woman is not able to have a baby, the man has the option of marrying another woman. What happens if the man is sterile, does the woman have any options.
A. She has the legitimate option of procuring a divorce and marrying another man.
Q.20. What is your view about permanent sterilization?
A. Only for permanent medical indication or for the parous woman approaching her menopause.
Q.21. When does life begin? At inception or at 120 days “when the spirit is blown”?
A. Life and spirit are not synonymous. Life begins at the inception, fusion of sperm and egg. Abortion in both stages is a crime however, it is a more severe crime in the second stage.
Q.22. Is cloning permissible or not?
A. A short answer is no. A cell from a sterile husband to be cloned and incubated in his wife’s uterus requires independent consideration but, the “sliding slope” factor should be taken very seriously. However, genetic engineering deletion of a gene to cure a disease is acceptable.
Q.23. Is homosexuality genetic or inborn?
A. Please clarify the difference between genetic and inborn. Whatever its cause, its practice is prohibited. In Islam, the key is not “Be what you are” but “Be what you should be”, irrespective of moods and inclinations. Sometimes inborn conditions can have a genetic expression later on.
Q.24. Are Muslims allowed to consume medications which contain alcohol or pig by-products?
A. Only if it is a life saving necessity, when non-alcoholic and non-pork medicines ate not available.
= Q.25. If a Muslin doctor who is apposed to abortion and euthanasia is asked by his non-Muslim patient to perform such procedures which is also acceptable in the States, should he refuse because of his personal convictions?
A. Yes. There is room for the conscientious objector in our system.
Q.26. I am a medical student and I would like to know if it is OK for a female doctor to examine male patients private areas, or is it OK for a male doctor to be a Gynecologist?
A. It is alright, early jurists allowed it. Medical Figh Conference in Kuwait in the 80’s allowed it for the purposes of diagnosis, treatment and medical education. The Niyyah, (intention) however, is of crucial importance in the individual case. Patients’ preferences should be respected.
Q.27. Do Medical Ethics slow down medical research and progress?
A. It should not. Safeguards and regulations are necessary if medicine is to remain medicine.
**Shahid Athar, M.D., F.A.C.E., F.A.C.P. is Clinical Associate Professor of Medicine at the Indiana University School of Medicine. He is also the Chair of Medical Ethics. Committee of the Islamic Medical Association.
*Hassan Hathout, M.D., Ph.D., F.R.C.O.G. is a retired Professor of OB/GYN and now devoted full time for Islamic D’awa. He is the author of Reading the Muslim Mind (ATP)
Shahid Athar, MD
Clinical Associate Professor
Indiana University School of Medicine
8424 Naab Road
Indianapolis, IN 46260