ISLAMIC PERSPECTIVE OF FOUR

PRINCIPLES OF BIOMEDICAL ETHICS

Shafa Elmirzana
CBMH
UNIVERSITAS GADJAH MADA
YOGYAKARTA
2018
QUR’AN AND HEALTH CARE

 “And when I am ill, it is God who

cures me” (Qur‟an [26:80]).
 The role of a physician in treatment
is of an intermediary
 MAQASID AL SHARIA
 Pioneered by Abu Hamid al
Ghazali (d. 1111 CE), and Abu
Ishaq al Shatibi (d. 1388 CE).
 It states that the basis of the
shari´a lies in promoting five
purposes: dın̄ (religion), nafs
(life), nasl (progeny), `aql
(intellect) and māl (wealth).
 MAQASID
AL-SHARIA
(OBJECTIVE
OF SHARIA)

Protection
of
human
existence

Protection
of
religion

Protection
Al- of
progeny
daruriyyah
(necessary Protection
factors) of
human
intellect

Protection
of
wealth
 MAQASID SHARIA AND
MEDICINE
Anything that preserves one
of these five purposes is
regarded as beneficial.
Anything that contributes to
its detriment is immoral, and
preventing it is deemed good.
ISLAMIC LEGAL FOR NOVEL
ISSUES
 Using the maqāsị d al sharı`a and,
applying the principles of qiyās
(analogical reasoning), `urf (custom),
istiḥsān ( juristic preference), istiṣḥab
(presumption of continuity) and
maṣlaḥa mursala (considerations of
public interest), specific Islamic legal
rulings could be produced on novel
unprecedented issues.
 The Five Qawā`id
Fiqhiyya Of
Islamic Medical
Ethics

Qasd Yaqin Darar

(Intention) (certainty) (Injury)

Darura „Urf
(necessity) (custom)
 1. Principle of Qaṣd (intention):

 Al umūr bi maqāsị dihā-> (al wasạ ´̄ il lahā

hukm al maqāsị d)
 The same act will be judged differently
depending upon the intention.
 Pain relief in terminal care, the prescription of
morphine-> intention of causing respiratory
depression ->premature death is euthanasia->
impermissible.
 Providing analgesia with respiratory
depression as an unintended consequence->
permissible=the principle of double effect.
2. Yaqın̄ (certainty):
 Evidence-based medicine.
 Yaqın̄ (certainty) is theoretically
the ideal, sound medical
judgement as a minimum should
be based on ghalabat al ẓann
(predominant belief), which is
superior to zann (mild
inclination) or shakk (doubt).
Sub-priciples:
 Al yaqın̄ la yazūlu bi al shakk
(certainty is not removed by
doubt)
 Al aṣl fi al ashya`i al ibaḥa (all
medical procedures are deemed
permissible unless their
prohibition is certain), although
there are exceptions.
3. Ḍarar (injury):
 Al ḍarar yuzāl (injury should be relieved),
thus, providing the justification for medical
intervention.
 Al ḍarar yudfa`u bi qadr al imkān (any
harms of a therapy should be minimised).
 Al ḍarar la yuzāl bi mithlihi (If they are
unavoidable, then the side effects should
always be less in magnitude than the
benefits).
 The avoidance of harm has priority over the
pursuit of a benefit of equal or lesser worth.
 A lesser of two evils approach
 Harm may not be removed by a
similar harm, and that if two harms
coincide, then a „lesser of two evils‟
approach should be opted for to
prevent greater harm.
 Example: infectious disease, where
the public interest takes priority over
individual interest, and confidentiality
can be superseded by a public health
concern.
4. Ḍarūra (necessity):
 Al ḍarūrāt tubıh̄ u
̣ al maḥḍūrāt (cases of
necessity can render an otherwise prohibited
action as permissible).
 Example: sterilization which is absolutely
prohibited in Islam, but which may become
permissible if a potential pregnancy severely
threatens a woman‟s life, for example due to
previous caesarean operations.
 Idhā zāla al māni`u, `āda al mamnū`u. (if
the necessity finishes, enforcement of the
default prohibition resumes)
5. `Urf (custom):
Al`āda muḥakkama
Requirement: the customary
practice must be the
predominant and widespread
practice of medical
practitioners in order to be
rendered valid.
There is a considerable degree
of adaptability for Islamic
ethics to provide coherent and
strong answers to a wide
range of novel ethical
dilemmas.
Beauchamp and Childress
and Islamic perspectives
Beauchamp and
Childress Islamic

Non-maleficence
(avoiding the risk of harm al ḍarar yuzāl (harm is to be removed) and it
to others). takes priority over an act with a comparable
benefit.

example, an elective abortion of a viable foetus that

Islamically has a soul, in an otherwise healthy
mother, is considered a reprehensible crime,
equitable to murder.
The situation is not as straightforward if the
aforementioned principle of ḍarūra (necessity) is
appropriately applied.
The physician is encouraged to become a master of
his or her field. Given that medicine is an arena in
which decisions can have life-threatening
consequences, the Prophet gave a warning to those
who would practice this art without sufficient
knowledge: “Any doctor who starts the practice of
medicine, and is not competent
as a doctor, and he makes a mistake, then he will
be held responsible”
 Beauchamp
Islamic
and Childress
“If you judge, judge in equity
between them. For God loves

Justice those who judge in equity”15 and

“God commands justice and
good deeds” (Q: 27:90).
Salman al Farsi:
to ensure fairness and equity “O Abu ad-Dardaa, your Lord has a right over you. Your family has
(distributive justice: where a right over you and your body has a right over you. Give to each
its due”.(Bukhori).
limited resources are Each person is also to be treated equally, and no distinction is made
based on culture orethnicity. The Prophet Muhammad said: “All
distributed fairly; rights-based mankind is from Adam and Eve, an Arab has no superiorityover a
justice: respect for people‟s non-Arab nor a non-Arab has any superiority overan Arab; also a
White has no superiority over a Black nor a Black has any
rights; and legal justice: superiority over a White except by piety and good action”.(Ibn
respect for morally acceptable Hanbal)
Maslaha Mursala (public interest or common good=>Distributive
laws. justuce
 Man is created as God‟s vicegerent on earth, God
endowed humans with intellect and accountability for
Autonomy=self-rule their actions, and honoured their status: “We have
honoured the sons of Adam”.(Q: 17:70)
(acknowledgement of, and There is no clergy in the Islamic tradition: each
respect for, each individual person is directly accountable for his/her actions
before God without intermediary.
having the entitlement to The importance of`ilm (knowlledge) is essential in
hold views, decide and act coming to a reasoned decision, allowing for informed
consent.
according to their beliefs and Just as seeking knowledge is obligated, similarly that
value systems, provided that which may cause detriment to the intellect or to one‟s
decision-making capacity is strictly prohibited, namely
this does not cause harm to alcohol and other intoxicants.
or impinge upon the rights of The autonomy of man to choose his own path
others.). manifestly evident in the story of the first man to be
created, Adam, whose first act of free will was to
disobey and eat of the forbidden fruit of paradise.
CONCLUSION
 Like in many areas of Islam, within Islamic
medical ethics, a diversity of opinions and
views on a particular matter are often found
and are apparent within the fatāwa (legal
judgement) collections.
 Islam does not have a singularly developed
clergy system, and what maintains scholarly
standards is a peer-reviewed adherence to
the established systems of uṣūl al fiqh and
the accepted maxims of legal theory.
 Using the uṣūl al fiqh (principles
of jurisprudence), maqāsị d al
sharı`̄ a (purposes of Islamic
law) and qawā`id fiqhiyya
(Islamic legal maxims) allows
Islam to adapt to the needs of
the changing ethical landscape.
 Islamic tradition has much evidence
in support of four-principles
approach by Beauchamp and
Childress.
 Autonomy takes on a more nuanced
role and is best interpreted in view of
the individual as a member of the
family and society.