ISLAMIC MEDICAL EDUCATION RESOURCES

PURPOSES AND PRINCIPLES OF MEDICINE,

maqsid wa qaw`id al-a
bb

By Professor Omar Hasan Kasule, Sr.

INTRODUCTION
IslamicLawiscomprehensive.Itisacombinationofmoralandpositive
laws.SecularizedEuropeanlawdeniesmoralconsiderationsassociated
with religion. Its failure to solve issues in modern medicine that
requiredmoralconsiderationsledtothebirthofthedisciplineofmedical
ethics. Muslims do not have a special discipline on medical ethics
becausemedicalethicalandmoralissuesareencompassedwithinIslamic
Law.Concernwithmoralissuesinmedicineincreasedintherecentpast
due to new medical technology and increase in moral violations by
medicalpractitioners.Europeanshavewrittenrecentlyaboutethics.In
1976 Beauchamps and Childress wrote authoritatively about ethical
theory and ethical principles. The following international declarations
coveredlegalmedicalissuesfromaEuropeanworldview:Declaration
ofGeneva,InternationalCodeofMedicalEthics,DeclarationofTokyo,
DeclarationofOslo,andDeclarationofHelsinki.Muslimsdidnotneed
topublishanynewdeclarationsbecauseprinciplesoflegalmedicineare
foundwithintheIslamicLaw.IslamicLawincorporatesmoralprinciples
directlyapplicabletomedicine.

EUROPEANETHICS
TherearethreeEuropeanapproachestoethicalanalysis:normative(what
oughttobedone)orpractical(whatmostpeopledo),andnonnormative
(what is actually going on). Europeans have a problem dealing
consistentlywithmoralissuesafterremovingreligionfrompubliclife
over the past 5 centuries of secularism. Morality became communal

consensusaboutwhatisrightandwhatiswrong.Thusethicsbecame
relativeandchangeablewithchangeofcommunityvalues.Europeanlaw
doesnotfollowaconsistentmoralguideline.Itdoesnotautomatically
banallwhatisimmoralanddoesnotautomaticallypermitallwhatis
moral.

There is no one coherent European theory of ethics because of the

historical background. During the Roman Empire a marriage of
convenienceheldbetweenJudeoChristianconceptsandpaganGreco
Roman concepts. The marriage was strained by a partial return of
Europeans to their GrecoRoman heritage and marginalization of the
ChristianChurchstartingwiththerenaissanceandreformationthrough
the enlightenment, modernism and now post modernism. In these
circumstancesitwasdifficulttodefineonecoherentEuropeanethical
theory.BeauchampandChildresslistedeightEuropeanethicaltheories
noneofwhichcanonitsownexplainallethicalormoraldilemmas.
Thesetheoriescanbelistedastheutilitarianconsequencebasedtheory,
the Kantian obligationbased theory, the rightsbased theory based on
respectforhumanrights,thecommunitybasedtheory,therelationbased
theory,andthecasebasedtheory.

Thereare4basicEuropeanethicalprinciplesaccordingtoBeachampand
Childress (1994) are: autonomy, beneficence, nonmaleficence, and
justice.

ISLAMICETHICS
MoralityinIslamisabsoluteandisofdivineorigin.TheLawisthe
expressionandpracticalmanifestationofmorality.Itautomaticallybans
allimmoralactionsasharamandautomaticallypermitsallwhatismoral
orisnotspecificallydefinedasharam.TheIslamicapproachtoethicsis
amixtureofthefixedabsoluteandthevariable.Thefixedandabsolute
setsparametersofwhatismoral.Withintheseparameters,consensuscan

bereachedonspecificmoralissues.Islamconsidersmedicalethicsthe
sameasethicsinotherareasoflife.Thereisnoneedforaspecialcode
for physicians. Islamic medical ethics is restating general ethical
principlesusingmedicalterminologyandwithmedicalapplications.The
ethicaltheoriesandprinciplesarederivedfromthebasiclawbutthe
detailedapplicationsrequirefurtherijtihadbyphysicians.

IslamhasaparsimoniousandrigorouslydefinedethicaltheoryofIslam
based on the 5 purposes of the Law, maqsid alsharat. The five
purposesarepreservationofdn,life,progeny,intellect,andwealth.Any
medical action must fulfill one of the above purposes if it is to be
consideredethical.

The basic ethical principles of Islam relevant to medical practice are

derivedfromthe5principlesoftheLaware:intention,qasd;certainty,
yaqn;harm,arr;custom,urfandhardship,mashaqqt.TheIslamic
principlesarewiderinscopeanddeeperthantheEuropeanprinciples.

PURPOSESOFMEDICINE
PROTECTIONOFDN
Protectionof dn isessentiallyinvolves`ibdat inthewidesensethat
every human endeavor is a form of `ibdat. Thus medical treatment
makesadirectcontributionto`ibdatbyprotectingandpromotinggood
healthsothattheworshipperwillhavetheenergytoundertakeallthe
responsibilitiesof`ibdat.Theprincipalformsofphysical`ibdatarethe
4 pillars of Islam: prayer, alt; fasting, siym; pilgrimage, ajj, and
jihd. A sick or a weak body can perform none of them properly.
Balanced mental health is necessary for understanding `aqdah and
avoiding false ideas that violate `aqdah. Thus medical treatment of
mentaldisordersgreatlycontributesto`ibdat.Generalpublichealthhas
aspecialrelationto jihd. Ifthegeneralhealthofapopulationisnot
satisfactory,therewillnotenoughyouthstoberecruitedintothearmed
forces.Therewillalsonotbeenoughhealthyworkerstoprovidethe

materialandlogisticsrequiredforsuccessfulprosecutionofwar.Ifthe
obligation of jihd is not fulfilled, the Muslim community will be
defeatedandsubjugatedbyotherswhowillnotgiveMuslimsfreedomto
practicereligion.

PROTECTIONOFLIFE,hifdhalnafs
Theprimarypurposeofmedicineistofulfillthesecondpurposeofthe
shar`ah,thepreservationoflife,hifdhalnafs.Medicinecannotprevent
orpostponedeathsincesuchmattersareinthehandsofAllahalone.It
howevertriestomaintainashighaqualityoflifeuntiltheappointedtime
of death arrives. Medicine contributes to the preservation and
continuationoflifebymakingsurethatthenutritionalfunctionsarewell
maintained.Medicalknowledgeisusedinthepreventionofdiseasethat
impairshumanhealth.Diseasetreatmentandrehabilitationleadtobetter
qualityhealth.

PROTECTIONOFPROGENY,hifdhalnasl
Medicinecontributestothefulfillmentofthisfunctionbymakingsure
thatchildrenarecaredforwellsothattheygrowintohealthyadultswho
can bear children. Treatment of infertility ensures successful child
bearing. The care for the pregnant woman, perinatal medicine, and
pediatricmedicineallensurethatchildrenarebornandgrowhealthy.
Intrapartum care, infant and child care ensure survival of healthy
children.

PROTECTIONOFTHEMIND,hifdhalaql
Medicaltreatmentplaysaveryimportantroleinprotectionofthemind.
Treatment of physical illnesses removes stress that affects the mental
state. Treatment of neuroses and psychoses restores intellectual and
emotional functions. Medical treatment of alcohol and drug abuse
preventsdeteriorationoftheintellect.

PROTECTIONOFWEALTH,hifdhalml

Thewealthofanycommunitydependsontheproductiveactivitiesofits
healthycitizens.Medicinecontributestowealthgenerationbyprevention
ofdisease,promotionofhealth,andtreatmentofanydiseasesandtheir
sequelae.Communitieswithgeneralpoorhealtharelessproductivethan
ahealthyvibrantcommunity.Theprinciplesofprotectionoflifeand
protectionofwealthmayconflictincasesofterminalillness.Careforthe
terminallyillconsumesalotofresourcesthatcouldhavebeenusedto
treatotherpersonswithtreatableconditions.Thequestionmaybeposed
whether the effort to protect life is worth the cost. The issue of
opportunitycostandequitableresourcedistributionalsoarises.

PRINCIPLESOFMEDICINE
THEPRINCIPLEOFINTENTIONalniyah
The Principle of intention comprises several sub principles. The sub
principlethateachactionisjudgedbytheintentionbehinditcallsupon
the physician to consult his inner conscience and make sure that his
actions,seenornotseen,arebasedongoodintentions.Thesubprinciple
whatmattersistheintentionandnottheletterofthelawrejectsthe
wronguseofdatatojustifywrongorimmoralactions.Thesubprinciple
thatmeansarejudgedwiththesamecriteriaastheintentionsimpliesthat
no useful medical purpose should be achieved by using immoral
methods.

THEPRINCIPLEOFCERTAINTY,q`idatalyaqn
Medical diagnosis does cannot reach the legal standard of yaqn.
Treatment decisions are best on a balance of probabilities. Each
diagnosisistreatedasaworkingdiagnosisthatischangedandrefinedas
newinformationemerges.Thisprovidesforstabilityandasituationof
quasicertainty without which practical procedures will be taken
reluctantlyandinefficiently.Existingassertionsshouldcontinueinforce
untilthereiscompellingevidencetochangethem.Establishedmedical
proceduresandprotocolsaretreatedascustomsorprecedents.Whathas
beenacceptedascustomaryoveralongtimeisnotconsideredharmful

unless there is evidence to the contrary. All medical procedures are

considered permissible unless there is evidence to prove their
prohibition.Exceptionstothisruleareconditionsrelatedtothesexual
andreproductivefunctions.Allmattersrelatedtothesexualfunctionare
presumedforbiddenunlessthereisevidencetoprovepermissibility.

THEPRINCIPLEOFINJURY,qidatalarr
Medicalinterventionisjustifiedonthebasicprincipleisthatinjury,ifit
occurs,shouldberelieved.Aninjuryshouldnotberelievedbyamedical
procedurethatleadstoaninjuryofthesamemagnitudeasasideeffect.
Inasituationinwhichtheproposedmedicalinterventionhassideeffects,
we follow the principle that prevention of a harm has priority over
pursuitofabenefitofequalworth.Ifthebenefithasfarmoreimportance
andworththantheharm,thenthepursuitofthebenefithaspriority.
Physicianssometimesareconfrontedwithmedicalinterventionsthatare
double edged; they have both prohibited and permitted effects. The
guidanceoftheLawisthattheprohibitedhaspriorityofrecognitionover
thepermittedifthetwooccurtogetherandachoicehastobemade.If
confrontedwith2medicalsituationsbothofwhichareharmfulandthere
isnowaybuttochooseoneofthem,thelesserharmiscommitted.A
lesserharmiscommittedinordertopreventabiggerharm.Inthesame
waymedicalinterventionsthatinthepublicinteresthavepriorityover
consideration of the individual interest. The individual may have to
sustain a harm in order to protect public interest. In the course of
combatingcommunicablediseases,thestatecannotinfringetherightsof
the public unless there is a public benefit to be achieved. In many
situations,thelinebetweenbenefitandinjuryissofinethat alt al
istikhrt isneededtoreachasolutionsincenoempiricalmethodscan
beused.

PRINCIPLEOFHARDSHIP,q`idatalmashaqqt
Medical interventions that would otherwise be prohibited actions are
permittedundertheprincipleofhardshipifthereisanecessity.Necessity

legalizestheprohibited.Inthemedicalsettingahardshipisdefinedas
anyconditionthatwillseriouslyimpairphysicalandmentalhealthifnot
relieved promptly. Hardship mitigates easing of the sharia rules and
obligations. Committing the otherwise prohibited action should not
extendbeyondthelimitsneededtopreservethePurposeoftheLawthat
isthebasisforthelegalization.Necessityhoweverdoesnotpermanently
abrogatethepatientsrightsthatmustberestoredorrecompensedindue
course; necessity only legalizes temporary violation of rights. The
temporarylegalizationofprohibitedmedicalactionendswiththeendof
thenecessitythatjustifieditinthefirstplace.Thiscanbestatedinal
alternative way if the obstacle ends, enforcement of the prohibited
resumes/Itisillegaltogetoutofadifficultybydelegatingtosomeone
elsetoundertakeaharmfulact.

THEPRINCIPLEOFCUSTOMorPRECEDENT,q`idatal`urf
Thestandardofmedicalcareisdefinedbycustom.Thebasicprincipleis
thatcustomorprecedenthaslegalforce.Whatisconsideredcustomaryis
what is uniform, widespread, and predominant and not rare. The
customarymustalsobeoldandnotarecentphenomenontogivechance
foramedicalconsensustobeformed.

(c) Professor Omar Hasan Kasule Sr. 2004