Biomedicine itself has long been in conflict with religion. Although they intersect at key points – such as preserving life and maintaining health, biomedicine and religion are built on different foundations, and thus approach controversial topics from different standpoints. This paper will focus on the fundamental differences that biomedicine and Islam are based on, and how this defines their ethics. From these defined ethical frameworks, a few controversial topics in healthcare today will be delved into, and biomedicine and Islam will be used as lenses to approach and engage with these topics. Overall, this paper will show that for the greater than 50% of Americans who identify as being spiritual, biomedical ethics in and of itself is an inadequate system to engage these topics and one should consider approaching these topics through religious ethical frameworks such as Islam.
Spirituality and healthcare have historically shared periods of convergence and divergence. With the rise of technological advancements and research that subsequently led to pathologically centered treatments, healthcare shifted towards viewing the individual as a machine whose existence needs to be prolonged via treatment. In recent years, however, there has been a pushback in recognizing the importance of addressing the entire experience of illness, which includes addressing not just the physical, but also the emotional and psychological facets – holistic care . This has led to a conflict between the purely scientific secular based framework of thinking and the more holistic religious framework. Even though focusing on the physical trauma that accompanies illness is the priority of physicians, it is not enough for the majority of Americans who identify as being spiritual, simply because they also “have other pain as well: pain related to mental and spiritual suffering, to an inability to engage the deepest questions of life.” While there are various studies involved in the physiological effects of spiritual beliefs such as reduced pain and greater degrees of relaxation , this paper will focus on the concepts that accompany spirituality and their cognitive effects on those who identify as being spiritual.
For the purposes of this paper, biomedicine will be viewed as part of, but not the entirety, of western medicine. The reason for doing so is because western medicine is very inclusive and employs facets of all religion in order to exist in our post-modern pluralistic society. This era “has neither the convictions of religious totality that marked the Middle Ages nor the congicions of rational totality that marked the modern age.” Biomedicine is thus defined as the purely secular views that exist within medicine, where no spiritual elements are considered when engaging with ethical issues. Thus, one who takes on the views of a strict biomedical framework will be only concerned with what is physically observable. To a biomedical ethicist, there is only one plane of existence – the physical plane that human beings can observe and interact with. This framework arose naturally out of the religious division that ran rampant throughout the 16th century. Western society needed a universally binding framework to articulate the concepts of power, justice, and morality if it hoped to create a common government that ruled over people with differing religious outlooks. To overcome the differences in spiritual views, the secular bioethical mode of thinking completely ignores this facet entirely, making the process of identifying intersections of morality much easier.
The contributions of philosophers such as Immanuel Kant, John Rawls, and John Stuart Mills led to the development of the four basic principles of heathcare: non-maleficence, beneficence, respect for autonomy, and justice. Non-maleficence is best described by the axiom “do no harm”. Beneficence is the overall duty to do good. Respect for autonomy is the principle of recognizing that all individuals have rights and should never be used as a means. Lastly, justice is the principle that all treatments should be equally shared among society. These four tenets of healthcare are the basis of medical ethics and inform the controversial issues that arise.
Overall, biomedicine and the ethical framework that it operates within takes an approach that Fredrich Nietzsche summed up most aptly with his words – that “God is dead”. “Physicians, in a secular oriented environment, surround themselves with medical ethicists. God no longer exists, and a sacred world of values have replaced him.” Within this world, the only things that matter are what is directly observable by science and the moral good is one that does not need the approval of a higher power to be law. It does, however, “apply to all human beings, regardless of their genetic of social grouping.” This separation of religion from biomedicine allowed for focus to be placed on the one similarity between religious and non-religious individuals – this physical reality.
Islamic bioethics, as its names suggests, is the ethical framework that is centered on the religion of Islam. This framework is rooted in two primary sources. First is the Quran, which is the holy book that Muslims view to be the word of God that was revealed to Mohammed verbatim over the course of his life. It is widely regarded as the finest work in Arabic literature. The second is the Sunnah, which is a collection of the deeds, sayings, and teachings of the prophet Mohammed. Combined, these two works are referenced to in order to develop an overall understanding of the concept of life, illness, and healthcare. Before delving into the specifics of Islamic bioethics, great care needs to be taken to avoid certain traps when trying to understand a foreign framework. Firstly, there is often an unconscious desire to apply ideals from the framework that the individual is accustomed to. This will often lead to a misrepresentation or an outright incorrect assumption made about the framework in question. For example, if one were to only look for the four axioms of secular healthcare within the Quran and Sunnah, they would find that the two texts do not directly address or mention aspects of them and can easily make the incorrect assumption that they do not exist within Islamic faith. Secondly, one should be aware that “Islam is not a monolithic faith [and] embraces nearly 1.6 billion followers, close to one-fourth of the human race, with a variety of schools of jurisprudence; it is not confined to one group or one culture.” Therefore, if one was looking to understand the tenants of Islamic ethics, other societal and geographical questions also need to be answered in conjunction. Thirdly, even if one simply focuses on the literal text, there is the fact that these texts are subject to multiple forms of interpretation. These differences in interpretation thus led to the formation of multiple schools of thought when it comes to what the Quran and Sunnah actually mean. Overall, this presents a challenge when attempting to identify and label aspects of Islamic teachings, since so many factors have to be considered to arrive at one of the many interpretations of the works. Therefore, this paper will focus on the ideals mentioned in the Quran and the Sunnah and attempt to be as objective as possible in order to determine a baseline of conduct that would be feasible to apply to all schools of thought within the Islamic faith.
The Quran speaks towards an all-knowing supreme being – Allah. Within Islam, Allah is the one who owns the universe, and humans are by extension owned by Allah. Therefore, in placing meaning to one’s life, the Quran teaches that being human is a gift from Allah himself, and it is a responsibility for the owner of the life to keep it safe. On the surface, this seems to come into direct conflict with the secular concept of autonomy, which says that the owner of the body has full control over his or her decisions. However, acknowledging a lack of full “ownership” encourages the individual to take much better care of his or her body because they should want to maintain its healthiest form. The sacredness of life is also reflected within the Quran, where it says that “One who kills a person not in retaliation for murder, or to avoid mischief on the land; it is as if he killed all mankind. One who saves a life; it is as if he saved the life of all mankind.” Islam views life itself as a sacred gift, one bestowed out from Allah himself. It follows, that because this is a gift from God, effort needs to be put in in order to maintain the purity of the life. This idea is pervasive in how Islam views the world, and there are identifiable acts that pose a threat to this purity. This is important to understand in the context of medicine because in secular bioethics, great care is taken that decisions be made in the best interest of the individual whom the life belongs to. However, Islam teaches that the life is a gift and therefore does not belong to the individual. Therefore, whatever the motive – be it reverence or fear of God, those involved in medical decision making do so in a framework that holds them accountable to a higher being.
Islamic views on sickness are also intertwined with their belief in a higher being. Firstly, the concept of sickness within Islam and other major religions involve a spiritual component that is missing from the secular bioethical approach. The latter views the body as a collection of parts, and that sickness is defined by William Boyd as “physiology (natural state) gone wrong” . So while secular medicine would seek to replace or fix the broken part, Islamic care focuses on both the physical and spiritual aspect of a sickness. This view is also intertwined with the idea that the body is a gift from Allah. In times of sickness, the Quran advises individuals to seek out medical treatment because it is their obligation to maintain the gift that Allah has given. Although it is acknowledged that sickness itself is not brought about by Allah, he possesses all cures. Historically, Islamic practice has been and continues to be very integrated with healthcare. In fact, some attribute the development of modern medicine to Islam. “During the early Islamic civilizations, advances in medicine, mathematics, physics, astronomy, geography, architecture, art, literature and history, algebra, the arabic numerals and the concept of zero (vital to the advancement of mathematics) were transmitted to medieval Europe from the Islamic world” . This relationship has allowed the religion to be well integrated into healthcare practices in primarily Muslim countries. So pervasive is this integration that Muslim physicians have their own version of the Hippocratic Oath, that reads:
Praise be to Allah (God), the Teacher, the Unique, Majesty of the heavens, the Exalted, the Glorious, Glory be to Him, the Eternal Being Who created the Universe and all the creatures within, and the only Being Who contained the infinity and the eternity. We serve no other god besides Thee and regard idolatry as an abominable injustice.
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 Mohammad (pbuh).
“Whoever killeth a human being, not in lieu 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.”
Immediately, it is evident that the role of a physician in the Islamic context is much more different compared to that of secular physicians. While secular physicians focus on themselves as practitioners of medicine and take on the burden of being the best physician they can be for their own sakes, Muslim physicians have a much more humbled view of their role – that they are simply conduits for Allah to work through.
They take an oath to “follow thy counsel” in their actions shows a reverence towards the almighty being that they view to be in control of everything.
Now that both frames of reference have been identified and their foundations explained, we can see how they serve to illuminate a topic that remains at the center of debate between both the secular and Islamic bioethicists – end of life care. The three areas that will be focused on within the topic of end of life care are palliative care (making death more comfortable), life support (such as feeding tubes), and euthanasia.
Like many current controversial topics in healthcare, this topic has become more and more talked about due to the technological advancements and pain management techniques that allow a life to be prolonged in spite of physical suffering. The topic is not just limited to prolonging life, but also the notion of prematurely ending a life – euthanasia. We will attempt to analyze potential decisions made within both frameworks in a hypothetical example of an individual who is on life support and how it relates to end of life care, and an example of an individual who has a terminal illness.
To look at these issues, one should take the perspective of someone who would choose consider the two options listed above. In the case of one who operates within the purely secular framework, we can guess that his intention is to hold on to the only form of existence that he believes to exist. Therefore, it would make sense that when faced with the threat of death, it would illicit a response of desperation despite being conditioned to believe that death is an inevitable consequence of life. In the case of the individual who is facing a terminal illness, there is inevitably a feeling of losing control. Therefore, being able to dictate the terms of one’s death could be appealing to some, while others might opt for euthanasia simply to escape any form of mental or physical suffering that tends to accompany these diseases. In recent years, the debate regarding an individual’s right to die with dignity was put at the forefront of American viewership with the case of Brittany Maynard. Diagnosed with a grade 4 astrocytoma and given six months to live, Maynard moved to Oregon from California in order to take advantage of the state’s Death by Dignity laws. Despite the 1,749 people who have used prescription medication to die under the Death with Dignity Act since its passing in 1997, the median age of individuals who opted to do so as of 2016 was 73 years old. Among these people, a large majority of them had terminal cancer.
Maynard’s story was so compelling because she was only 29 at the time of her death. As an advocate for the right to die with dignity, she was active in sharing her thoughts with the world. Through a story published by CNN, Maynard explained her rationale for choosing to end her life through the means of physician-assisted suicide. Maynard described the horrendous physical effects of her disease, citing “increasingly severe seizures and head and neck pains which had at times limited her ability to speak”. To Maynard, being able to reclaim some sort of control from a disease that robbed her of her basic mental faculties, even if it was something as morbid as determining the way in which she could end her life, provided her with “a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty, and pain”. Overall, her actions reflect decision-making principles that life is the only plane of existence and that “suffering borne by her body and her loved ones’ [suffering] were not worthwhile if she were no longer living, thinking, acting as herself.” Though her spirituality was never explicitly dismissed, her reasoning spoke towards a very secular view of life as defined in the earlier parts of this paper.
Secular framework based physicians have also spoken out towards advocating for their belief that patients have a right to dictate their death. Though aiding a patient in their desire to end their lives might seem to violate the “do no harm” aspect of the Hippocratic Oath, pro-physician assisted suicide (PAS) physicians have argued that there are cases in which prolonging suffering is more harmful that a merciful and painless death. These ongoing arguments have led to the differentiation of passive and active euthanasia, volunteered stoppage of eating and drinking, and a multitude of other derivatives under the umbrella of euthanasia. This shows that even within secular bioethics, there is constant debate on the axioms set in place and the framework continues to evolve.
When it comes to someone who operates within the Islamic faith, the motivations for prolonging life and euthanasia are very different. As mentioned earlier, a spiritual element is not considered within the confines of the secular mode of healthcare decision-making. With one who identifies with Islam, “illness and health are not exclusive to the physical-biological sphere but also the psychological-spiritual sphere” . This introduces a lot more to be considered when making medical decisions. Therefore, in the case of prolonging a life with life support, one would take into consideration the sacredness of a life and the law that a person should never cause the death of another. This is different from the secular approach in that the overall decision is based around the concept of absolute autonomy. Although the Quran never explicitly details what to do, its verses are used as guidelines that speak towards how to act when faced with medical dilemmas. In addition, the concept of an afterlife is also one that needs to be accounted for in Islamic bioethics. This is important to consider because “some scholars, such as Mawdudi, submit that Islamic ethics are rooted in this belief. Rejecting the certainty of resurrection, accountability before God, punishment and reward weakens the motive to abide by the rules of God and the ability to resist temptations to act unrighteously.” It is also worth noting that the Quran’s mentioning of death is in the context of a transition point where all the person’s actions are scrutinized before Allah. These spiritual considerations then are an incentive for the individual to think more holistically when it pertains to their treatment options, especially in controversial situations such as withdrawing life support for a loved one. In addition, “Islamic bioethics is based on duties and obligations (e.g. to preserve life, seek treatment)…” as well as an importance of the family in making medical decisions. As such, both physicians and family members focus on the intention behind the actions. For example, “in the case of suffering of the use of analgesics which reduce the psychological and physical suffering of the patient but which can, at the same time, accelerate death, the decisive element in Muslim reflection is the doctor’s intention” . This places a responsibility on the physician to follow the will of Allah in always making medical decisions that seek to help the patient.
In the case of euthanasia, the Islamic bioethical doctrine is straightforward. Despite there being many distinctions drawn within what constitutes euthanasia, such as understanding the difference between passive and active euthanasia within the secular view, Islamic ethicists still maintain that anything that involves a life being ended is prohibited. This includes removal of life support such as feeding tubes if the intention is to hasten death. To them, the Quran speaks out very clearly about prohibiting man from taking a life, and so euthanasia is very adamantly rejected within the Islamic sphere. The Quran states: “You shall not kill yourselves. Surely Allah is ever Compassionate to you.” While one operating within a secular mode of thinking would cite the escape from physical pain and ability to dictate the terms of a dignified death as just cause for euthanasia, the Islamic view on suffering combined with the sacredness of life can alleviate any feelings of loss of dignity a patient might be feeling. For example, the Quran states that illness and suffering are part of Allah’s plan, and offers encouragement in the face of adversity by saying “Be sure we shall test you with something of fear and hunger, some loss in goods or lives or the fruits of your toil, but give glad tidings to those who patiently persevere. Who say, when afflicted with calamity: “To God we belong, and to him is our return””. From this verse alone, we see that the general view of suffering is one that is a necessary part of life it functions as not just a test, but an opportunity for individuals to affirm their faith in Allah. The understanding that Allah is ever compassionate to his creations also seeks to forward the idea that there is something meaningful to be found in suffering. The silent prayer that is mentioned seeks to reinforce the idea that this physical life is temporary, and that there is more beyond this life. In addition, the Hadith also speaks towards the understanding that the physical life is temporary by stating:
The Messenger of Allah (peace and blessings of Allah be upon him) took hold of my shoulder and said, ‘Be in the world as if you were a stranger or a traveler along the path.” And ibn Umar would say, “If you survive till late afternoon, do not expect [to be alive in] the morning. If you survive till morning, do not expect [to be alive in] the late afternoon. Take from your health before your sickness and your life before your death.”
From this hadith, it is evident that Islam views this physical world as a mere rest stop before continuing with the journey of eternal life. It also strikes a balance between illustrating that the physical world is unpredictable and encourages the reader to entertain and accept the concept of death. At the same time, it speaks out against passivity by asking that the reader make the most of this time on Earth. So while there is an acceptance of death, there is also an understanding that it has to be due to natural causes and not through the direct intentions of another human being.
Overall, the Quran and Sunnah encourage practitioners of Islam to accept death when it approaches because it is not the abrupt end that the secularist believes. This acceptance makes the process of death less scary compared to someone who believes that they are facing an absolute end to their existence. Not only does this reduction in stress allow for a more peaceful passing, it alleviates the stress experienced by loved ones if they too believe that they will one day see that person in the afterlife. In times of loss, research has shown that acceptance can have tremendously alleviate the mental stress experienced by families.
To look at how the spiritual individual should consider a religious framework such as Islamic ethics in making decisions regarding end of life care, we must first define what it means to be spiritual. The term “spiritual” and “religious” have historically been used interchangeably. However, social evolution and rise of scientific emphasis in the developed western world have brought about a separation of the two terms. Furthermore, there have been attempts to define what being spiritual but not religious means in the context of 21st century America. There are even subtle distinctions within this group, with “some being strongly influenced by modern secular thought and have only mild spiritual impulses. Others, however, are deeply interested in pursuing spiritual growth.” This paper focuses on the latter group that does not hold on to traditional rituals and beliefs (that would fall under the term “religious”) and assumes that they “view their lives as spiritual journeys, hoping to make new discoveries and gain new insights on an almost daily basis…Importantly, the terms they adopt in their effort to understand such things as the nature of God, the essence of the human soul, and the practices that promote spiritual growth are almost all drawn from spiritual philosophies outside of [the] dominant religious institutions.” Overall, individuals who identify as being spiritual but not religious are willing and able to base their beliefs off multiple different religions because they perceive themselves as not being bound to any one religion and its practices.
For someone who identifies as being spiritual, the methodologies employed by secular bioethics to arrive at the various decisions regarding end of life care would not be enough and can even be irrelevant. For example, Brittany Maynard arrived at her decision to end her life because of the dignity it would give her in regaining control of her life. Her intentions seemed to focus on escaping the pain and debilitating effects of her illness in order to maintain a level of aesthetic control. This does not discount her reasoning and is an understandable mode of thinking. For someone who identifies as a secularist, Maynard’s explanation would be more than enough justification to make similar decisions when faced with such a scenario. However, a spiritual individual might consider the overall reason behind the illness itself and would identify more with a framework that acknowledges the possibility that it serves a purpose and places a focus on attempting to understand the meaning behind the illness. Suffering itself does not just manifest physically. The overall condition involves mental and emotional trauma that demands to be acknowledged. For the spiritualist, these facets also have their own separate meaning outside of being an effect of the physical suffering that can serve to illuminate deeper purposes that the secularist would ignore completely. For example, the state of the human soul is a facet of suffering that a spiritualist would want included in their overall care. Such considerations line up with Islamic concerns of the state of the soul because it is a gift from a higher power – and a spiritualist also believes in such a higher power.
Therefore, the spiritualist would have a stake in preserving some sort of health or balance with their perceived soul. All of these aspects of suffering are in line with the Islamic modalities of thought.
Both secular and Islamic frameworks are valid modes of thinking. From the evidence presented above, both contribute and inform decisions based on valid ethics and sound reason. However, for the majority of Americans that identify as being spiritual, Islamic bioethics approaches the concept of end of life care as well as other controversial healthcare topics from a perspective that would be more relevant to them because it engages with aspects of their overall experience that secular ethics disregards. Therefore, for their full worldview to be taken into consideration, spiritualists should seek to inform their medical decisions through the lens of religious frameworks such as Islam.
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