Welcome to Mapping out an Islamic Bioethics:

An Intensive Workshop

The Initiative on Islam and Medicine at the University of Chicago

Housekeeping Items •  Registration Desk:

–  Name Badges –  Course Packets

•  Readings, Information Material, Evaluation Forms –  Box of Sweets

•  Course Evaluations –  Everyone fill out session evaluations and return to desk –  CME (APPNA Members online; Non-APPNA @ desk)

•  Food –  Refreshments outside –  Boxed Lunch & Friday Prayers

Healthcare System

Seminary

Muslim Community

Academy

Islam

American Muslim Health

Translation

The  Initiative  on  Islam  &  Medicine Methodology: -­‐‑Bring  together  religious  scholars,  Islamic  studies  experts,  medical  and  social  scientists  to  fill  in  the  knowledge  gaps  around  Islamic  bioethics -­‐‑Host  intensive  workshops,  symposia  and  conferences  that  disseminate  this  new  knowledge

 

Overarching Goals for Course •  Gained conceptual literacy in “Islamic” Bioethics

•  Equipped with tools for researching and applying Islamic moral frameworks to the practice of medicine

•  Increased interest in studying at the

intersections of Islam, healthcare, and bioethics

Words of Gratitude –  Program on Medicine & Religion

•  Dr. Dan Sulmasy •  Maha Ahmad

–  MacLean Center for Clinical Medical Ethics •  Dr. Mark Siegler

–  American Islamic College •  Dr. Ali Yurtsever

–  II&M Staff & Volunteers •  Caitlin Ajax •  Hadiyah Muhammad •  Hana Ahmed •  Milkie Vu •  Community Donors •  Others

–  All the lecturers and all my teachers/mentors

Vision  of  the  II&M

To  become  the  leading  center  for  study,  dialogue,  and  education  at  the  intersection  of  the  Islamic  tradition  and  biomedicine

Background •  Islamic Bioethics

–  Newly ‘birthed’ field of academic inquiry with interest from many corners

•  Lack of clarity about the “Islamic” –  What content qualifies as Islamic (labelling activity) à

implications for methods of derivation and research

•  Questions about scope and nature of “bioethics” –  Challenges related to the multi- and interdisciplinarity

of bioethics

Pedagogical Approach

•  Balancing Acts – Knowledge: Theoretical and Practical – Presentation: Didactic and Narrative/Case-

based – Disciplinary Focus: Theology and Sociology

Islamic Bioethics Literature

Chicago

Course Overview Day 1: Survey of the field •  Actors & Material- Practical Lens

–  Typology for end-users of Islamic bioethics literature

•  What is “Islamic” Bioethics?- Theological Lens –  Discuss moral theology à informed review

•  Many Methods…- Research Lens –  Empirical and theoretical methods of bioethics

•  Case Study of Brain Death- Applied Lens –  Dialogue between clinicians and Islamic scholars

Course Overview Day 2: Deep Dive into the Islamic tradition •  Fiqh to Tasawwuf •  Tools of Islamic Ethico-legal Tradition •  Doctrinal Considerations…

–  Locate ‘ethics’ within various aspects of the Islamic ethico-legal tradition

–  Epistemology of the normative in Islamic law

•  Lived Experiences… –  Social Historical Perspectives on “Islamic” bioethics from Iran

and Oman

Course Overview Day 3: Applied Islamic Bioethics •  A foot in both worlds- Practical Lens

– Comparative Perspective on Clinical Medical Ethics

•  Researching and Reading…- – Tie loose ends by looking at typology of Islamic

bioethics producers and literature

Anybody else?

Reporting on Islamic Bioethics in the Medical Literature: Where are the Experts?

Shanawani et al

•  Papers reviewed from 1950-2005 –  “Islam or Muslim” & “Bioethics” à 146 papers –  Authors:

•  39 from Middle East •  29 from the US

–  Content: •  Only 11 mention more than 1 ‘universal’ Islamic position •  5 mention concepts/sources of Islamic law

Who is an Islamic Bioethics Expert?

Islamic Bioethics Experts? •  Knowledge Requisites

–  Medical Science •  Muslim MDs and Professional Organizations

–  Islamic Ethics & Law •  Imams who counsel Muslim populace •  Professors of Islamic Studies

–  Bioethicists •  JDs, PhDs, MDs

Current State of Discourse •  Producers of discourse:

–  Many different disciplines engage with different goals and expertise à“Silo” problem with little cross-talk

•  Contestations over “Islamic” and “Bioethics” •  No central repository of material •  Writings often do not meet practical needs nor are

scholarly robust

National  Survey  of  American  Muslim  physicians

 64%  never  or  rarely  consult  Islamic  jurists

55%  never  or  rarely  read  Islamic  bioethics  books

 79%  never  or  rarely  look  to  Islamic  medical  fiqh  academy  verdicts

95%  of  Muslim  docs  never  assist  Imams  with  bioethics  cases

77%  never  or  rarely  seek  guidance  from  Imams  when  facing  a  bioethics  challenge  

Many Consumers •  Muslim patients

–  Concordance between medical care and Islamic regulations •  Muslim healthcare providers

–  Islam does influence medical practice - an “Islamic” ethos •  Religious leaders

–  To advice clinicians and patients regarding biomedicine •  Healthcare institutions

–  Culturally-sensitive care that improves quality •  Policy and Community Stakeholders

–  Advocate for a more culturally accommodating healthcare system

Social Science

Medical Sciences

Philosophy & Bioethics

Health Policy

Ethics (Adab)

Moral Theology

(usul al fiqh)

Islamic

Law (fiqh, hukm)

Clinical Practice

An Islamic

Bioethics

Discursive Partners

Inputs

Terminology •  What is Islam?

– Tradition with community •  Bearers of understanding •  Living out practice

– End-goal

•  What makes something “Islamic”? – Sources – Signification

Terminology •  What is (Bio)ethics?

– Conduct with a goal in mind •  Right/Good

– Relating to bio/med/health

Core Concepts •  Revelation (wahy)

– Matloo à Qur’an – Ghayr matloo à Sunnah

•  An “Islamic” “Bioethics” – Revelatory guidance for human behavior

relating to bio/med/health that accords with the “good”/”right”

Ethics in Islam •  What is right/good?

– Labelling authority vs. Characteristic of action –  ‘Ashari vs. Mu’tazali; Maturidi theology

•  Theological voluntarism or Deistic Subjectivism

•  God’s commands are purposeful and generally for the benefit of mankind

End Goals

•  What is the result/aim of ethical action?

Ethics in Islam

•  What can I do à What should I do?

•  Islam (minimum) à Ihsan (optimum) •  Role of fuqaha = move community from

sin

Forbidden

Discouraged

Permissible

Supererogatory

Obligatory

Islamic ethico-legal deliberation

Usul (sources)

•  Textual- Quran & Prophetic example •  Formal- Qiyas (analogy) & Ijma (consensus) •  Secondary Sources- Istishab, Urf

Maqasid (objectives)

•  Protection of life, religion, intellect, property, honor

•  Maslaha (public interest)

Qawaid (maxims)

•  Hardship calls for license •  Dire necessity renders prohibited things

permissible

Terminology •  Islamic Bioethics:

– Tied scriptural sources & bearers of tradition with 2 genres

•  Fiqhi Literature = permissibility of therapies along an ethico-legal gradient

•  Adabi Literature = inculcating of virtue-based practices

•  Muslim Bioethics: – Sociological study of how Muslims respond to

ethical challenges with ‘Islam’ as one input

Terminology •  Muslim Bioethics:

– Sociological study of how Muslims respond to ethical challenges with ‘Islam’ as one input

•  Applied Islamic Bioethics Research: – Bridges Islamic & Muslim bioethics

methodologically – Examining the ways in which material of Islamic

bioethics is understood and applied by consumers

– Examining the translation of biomedical concepts into edifice of Islamic law

End-of-Life Care Ethics

•  What are the relevant questions? – Goals of care – Moral culpability of actions

•  Patient •  Family/Surrogate •  Physician

31  %  Do  Not  Know  if  life  support  can  be  discontinued  at  the  end-­‐‑of-­‐‑life  in  Islamic  law

70%  are  psychologically  troubled  by    withdrawing  life  support

54%  Brain  Death  Not  =  Cardiac  Death

31%  Do  Not  Know  whether  tube  feeding  can  be  withheld  at  the  end-­‐‑of-­‐‑life

National  Survey  of  American  Muslim  physicians

Harvard Criteria- 1968 •  Purpose:

–  “…to define irreversible coma as a new criterion for death.”

•  Ethical Premise

•  Medical care is futile and a waste of resources •  Medical experimentation, e.g organ transplant, is ethically

sound in order to bring benefit to others

Constructing Brain Death •  Signifies:

–  complete loss of the brain’s critical functions –  a prognostic masquerading as a diagnostic entity

•  It is NOT total brain failure –  Pituitary gland, hypothalamus may continue to function –  Some brain functions may return

Brain Death •  “complete loss of critical functions of the brain” •  Conceptualization à Diagnostic Criteria

–  Legal Community à Whole-Brain (US) –  Medical Community à Brain-Stem (UK) –  Philosophers à Higher-Brain

•  Brain-death = death in West [cultural consonance?]

Death In the Islamic Tradition •  Death is the occasion for several communal and

individual obligations •  Theologically

–  Legal Death occurs upon departure of the soul

•  Dying is not dead –  Intermediate states- hayat ghair al mustaqirr

Applying The Verdicts •  OIC-IFA – BD is Legal Death

–  all vital functions of brain cease irreversibly and the brain has started to degenerate

•  IOMS – unstable life –  “if a person has reached brain-stem death some of the

rulings of unstable life apply” –  Withdrawal of life support is permitted

Ethico-legal Frames •  Proponents

– Maslaha used for ‘creating’ BD on account of organ transplant

•  Qa’ida- Living take precedence over death – Death determination is purview of MDs

•  Detractors –  Istishab – presume living until traditional

criteria of death fulfilled •  Qa’ida Certainty not eroded by doubt

Jurists’ Concerns

•  Is BD truly dead? – Communal Obligations ensue at death – Moral Culpability for quickening death – Medical Certainty

Gaps in OIC-IFA •  Vital Functions

–  What are the ‘vital’ functions? •  Irreversibility

–  Some brain functions return –  No natural history of BD patients

•  Verifying degeneration of the brain –  No protocol mandates tissue visualization

Gaps in IOMS

•  What are the ‘rights of’ and obligations due to someone in unstable life (dying)?

– What interventions can or cannot be performed? •  Maintain life support for pregnancy or organ preservation

Why the Gaps? •  Fatawa and their producers

– Practical •  Legists use machinary of fiqh to ‘remove’ sin •  Deference to ahl al-khibrah for details

– Conceptualization •  May occur prior to fatwa and not written into •  Or systematized after collation of juridical opinions

performed – Hukm al-shay far tasawurih

When are Muslims obligated to seek treatment?

•  Wajib/fard: Care is life-saving AND cure is

certain – Yacoub says this is consensus of early Sunni

jurists

Contemporary Fatwa •  Council of the Fiqh Academy (Jeddah) about

medicine: – Obligatory (wajib or fard), if neglecting the

treatment may result in the person’s death, loss of an organ or disability, or if the illness is contagious and a harm to others

– Recommended (mandub), if neglecting the treatment may weaken the body

– Optional (mubah) if not covered by the preceding two cases

– Reprehensible, (makruh) if treatment causes worse complications than the illness itself

When are Muslim physicians obligated to

offer treatment?

When are Muslims obligated to seek

treatment?

Answer: when treatment is “life-saving”

Answer: when treatment is “life-saving”

Other Conceptual Tools •  Life-saving in this context

– Quality of life – Mukhallaf status is one where one is liable

and can accrue acts of afterlife benefit •  Where there is doubt/difference of opinion

no definite ‘sin’

Social Science

Medical Sciences

Philosophy & Bioethics

Health Policy

Ethics (Adab)

Moral Theology

(usul al fiqh)

Islamic

Law (fiqh, hukm)

Clinical Practice

An Islamic

Bioethics

Discursive Partners

Inputs

Resources for Guidance

•  Islamic fiqh academiesà qararat •  Fuqaha à fatawa

•  Framing is everything!

Limitations of “Fatwa-Hunting” •  Method à “Publication” Bias •  Tool for Policy à Context-driven •  Ethico-legal Source à subject to the

inherent limitations of the constructs •  Recognizing these shortcomings is

necessary for – Avoiding misapplication & misreading

Research Methodology •  Level 1:

– Encyclopedia of Islamic Bioethics – Fiqh Academies

•  Dar al Ifta Al Misrriyah •  Islamic Fiqh Academy of the Muslim World League

(Jeddah) •  Islamic Fiqh Academy (India)

Research Methodology •  Level 2:

– Review Books by Islamic legal experts – Topical reviews in Islamic Medical and

Scientific Ethics Research Library at Georgetown University

•  Level 3: –  Individual fatwas or opinion pieces

•  Qibla for the Islamic Sciences (formerly Sunnipath) •  IslamQA,

Resources