IIslamic slamic PPerspective on erspective on PPublicublicHHealthealth

Ghaiath Hussein

MBBS, MHSc. (Bioethics)

Objectives

• Introduce the basic principles on which Islamic philosophy is based

• Discuss how these principles affect its approach to public health issues

• Case Study

Basic Resources of Islamic philosophy & legislation:

• The Koran:The Koran: believed by Muslims to be the book whose chapters and verses (Ayat) are from God (Allah), on His prophet Mohammed

• The Sunna:The Sunna: term that comprises all the deeds, and sayings that the prophet said, did, or agreed upon

• Unanimity of scholarsUnanimity of scholars on whether the discussed issue is allowed (Halal), or forbidden (Haram)

• acceptance by the majority of acceptance by the majority of trusted scholars trusted scholars on a given issue to be permissible;

• MeasurementMeasurement, i.e. to measure a newly introduced issue on previously known agreed on issues;

• RRemediationemediation, which is to build jurisprudence on an issue, which was neither reflected on nor discarded by previous scholars, on an appropriate interest (Maslaha)

Ultimate Goals of Islamic Shariaa• Preservation of Self

• Preservation of Money

• Preservation of believes

• Preservation of mind

• Preservation of heritage

Islamic Ethical values • 1- Human Dignity:1- Human Dignity: The human quality that

encompasses the concept of the ideal ethical value summed up by the term (taqwa)

• 2- Economic and social life:2- Economic and social life: distribution of wealth on: family, orphans, poor, the traveling homeless, the needy, freeing of the enslaved.

• 3- Responsibility to develop a social 3- Responsibility to develop a social conscienceconscience and to share individual and communal resources. the duty of (Zakat)

Islamic Ethical values…

• 4- Social Value:4- Social Value: Quran give concern to the family to ameliorate the status of the women through abolition of pre-Islamic practices (female infanticide)

• Giving women rightsGiving women rights to inherit, ownership of property, the right to contract marriage and initiate divorce and maintain one’s own dowry.

• 5- A main Islamic ethical message is to command the right and prevent the wrong.

Basic principles of Islamic philosophy on LIFE and death

• Lives and bodies are ultimately owned by their Creator

• humans are only “vicegerents” so their

possession of their bodies is not absolute

• human life is a gift of God that should be respected and preserved as long as possible

From Koran and Sunna

• “he who saved one life should be regarded as though he had saved the lives of all mankind.” TMQ [5:32]

• No harm to oneself, “… (And) make not your own hands contribute to (your) destruction” TMQ [2:195]

• The Hadith: "There is no (harm) injury nor return of (harm) injury." [Malik's Muwatta, Book 36: 1429]

Basic principles of Islamic philosophy on Life and death

• No clear cut “religious” definition of death • Contemporary scholars came to adopt the

following definition • “ The death of that part of the brain

responsible for the primary vital functions, which is called the brain stem, is a reliable indicator of the occurrence of death”

(Statement of The Islamic Organization for Medical Sciences About the Medical Definition of Death, 1996)

Public health ethics

• the identification, analysis, and resolution of ethical problems arising in public health practice and research.

Public health ethical concerns

• Individualism:

• contradicting values of the individual rights, particularly autonomy, and the paternalistic approach of "public" rights to attain the public good.

Public health ethical concerns

• Paternalism

is the usurpation of decision-making power, by preventing people from doing what they have decided, interfering in how they arrive at their decisions, or attempting to substitute one's judgment for theirs, expressly for the purpose of promoting their welfare.

Other ethical concerns

• producing benefits; • avoiding, preventing, and removing harms; • producing the maximal balance of benefits over

harms (utility); • justice (distributive and procedural); personal

freedom; • privacy and confidentiality;• the need to ensure a just distribution of burdens

and resources

Deontological (Kantian) approach to public health• humans as moral agents who should

not be treated as means to an end. • it is this that the moral worth of an

action is judged according to, regardless the consequences.

• Paternalism, from a deontological perspective, interferes with the value of humans as moral agents capable of taking their decisions by themselves.

Utilitarian approach to public health• (consequentialism) holds that the

morality of actions depends on the extent they maximize the happiness/pleasure of the greatest number (act utilitarianism), or

• they conform to a valid moral rule; i.e. a rule that is followed by greatest happiness to greatest number in the long run (rule utilitarianism).

Utilitarian approach to public health• public health is regarded

consequentialistic

• maximizing benefit on largest scale of people for longer time by keeping them healthy.

principal-based approach

• Childress et al. have specified 5 "justificatory conditions" that indicate when public health interventions that infringe on individual autonomy are ethically warranted.

• The criteria are: (1) effectiveness, (2) proportionality, (3) necessity, (4) least infringement, and (5) public justification

Islamic approach to PH

• The Shariya adopted a preventive approach that depends on preventing exposure to harm, and not only prohibiting the harmful act itself.

• the concept of quarantine as stated by the prophet, "If you hear of an outbreak of plague in a land, do not enter it; but if the plague breaks out in a place while you are in it, do not leave that place."

Islamic approach to PH

• Communitarian Solidarity:• This solidarity of faithful people is resembled

by the prophet to the relation of the different organs in a single body, "The believers as regards their being merciful; showing love; and being kind among themselves, are resembling one body, so that, if any part of the body is not well then the whole body shares with it the sleeplessness (insomnia) and fever."

Communtarian solidarity

• Islamic approach links the well-being of a human to the well-being of others in the community.

• Moreover, it holds the meaning that the collective wellbeing of the whole body,

• the community, might necessitate potential sacrifices of a single organ, for the sake of the whole body.

No harm, No harassment:

• This principle is stated by the prophet, "Do not cause harm, nor return harm [for harm]".

• Avoiding the public harm by causing individual harm is sometimes acceptable,

• public health restriction of the person's freedom e.g. restricted movement in quarantines and detentions.

Necessity Dictates Exceptions

• This principle is mentioned more than once in Koran," ...He [Allah] has explained to you what He has made forbidden (haram) for you, except that to which you are compelled... " [6:119].

• scholars put clear conditions to the concept of "compelling necessity“:

• a direct threat to one's wellbeing; and

• that the exception is achieved to the minimal limit that keeps the person alive.

Exceptions are proportional to necessities• The exceptions to norms should only

be targeting the addressed necessity, and when the necessity ends the exceptions ends as well.

What is needed to achieve a must is a must in itself• Preservation of one's health is both a

personal and community mandate.

• The prophet ordered Muslims to “seek medical treatment; for Allah has not made a disease without appointing a remedy for it, except for ageing and death”.

Implementation to Public Health • instructions of the public health

authorities to achieve and maintain the public good should be followed if they represent a "must" to achieve the ultimate "must" of preserving health.

Choosing the least of two evils• This principle states that if anyone is

faced by two evils, s/he should follow the least evil act, i.e. the act with the least harm.

• From public health perspective, public health authorities are faced by hard choices among many harms, or "evils", thus should confine to the interventions least "evil" to people.

Challenges to Islamic Bioethics in PH• Value laden and doctrine-based

(secular?)

• Where to draw the line? And who draws it?

• Abuse by governoments

DISCUSSIONQ & A