In the West, religious bioethics has been in conversation with secular bioethics from the time of its inception when bioethics became a subject of public enquiry. In cultures where democratic governance and public discourse were considered to be rights of citizenry, any matter of critical significance connected with people’s healthcare could not pass without public debate and scrutiny. From its initial formulations, secular bioethics became entangled in religious valuations of human wellness and sickness, the role of suffering and affliction caused by prolonged illness, and the limits of medical intervention in treating incurable diseases.
An Unmistakable Absence of Input by Muslim Thinkers
Although often marginalized from matters of public policy, religious leaders could not be ignored when the issues at stake were related to ultimate questions about life and death. The cloning debate in the late 1990s saw the noticeable participation of multi-faith and multi-cultural leaders in informing governments about the moral implications of human cloning, and ultimately influencing policies against human cloning in a number of western countries. Muslim participation in this global debate was circumscribed by an unmistakable absence of public input by Muslim thinkers. The judicial decisions (fatawa) that came out of some Sunni centers of Islamic learning, such as Cairo and Mecca, revealed a general lack of interest in using scientific data to guide legal-ethical deliberations, which were undertaken hurriedly in response to media queries about the successful cloning of Dolly the Sheep and future projections in human cloning.
Until that time, Muslim physicians and scientists had used either English or translated bioethics textbooks, mostly brought back to Muslim countries by physicians trained in the West. Obviously, there was a cultural disconnect about what these physicians had learnt in the secular environment and what they found in their own religiously sensitive Muslim culture. Their endeavors to find specifically Islamic responses to earlier debates about abortion or organ donation, to appease the fears and anxiety of their religious-minded Muslim patients, led to new chapters in the compilation of the rulings (fatawa) of selected jurists that were circulated among interested Muslim healthcare providers.
Authoritative Guidance
This responsa literature consisted of varied opinions ascribed to prominent jurists, which functioned as the authoritative and authentic guidance in a number of clinical situations that demanded religious resolution. They were part of the “Contemporary Issues” (masail mustahdathat) that could be used by Muslim medical practitioners. Although the opinions were originally derived by taking into consideration principles and rules that were operative in Islamic legal methodology, their ethical dimensions were not brought out for public discussion. These opinions strictly functioned as “Mufti’s law”, with the implicit warning that those trusting a jurist’s authority should follow these rulings, otherwise such rulings should be ignored. The agnostic and paternalistic professional environment of the healthcare institutions in the Muslim world (as in other countries at large) hardly cared for the religious sensibilities of its population. Unlike the western culture of questioning authority, Muslim healthcare culture was yet to empower patients to question the medical procedures and treatments that were determined solely by medical teams.
The Standardization of Technology & Medical Procedures
Biomedical technology is in some sense universal because of the standardization of technology and medical procedures all around the world. The infrastructure of hospitals in Riyadh or Tehran differs very little from that of hospitals in New York or London. For this reason, moral dilemmas that confronted patients in Europe or America were also experienced by patients in the Muslim world. Moreover, the ability of medical sciences to preserve human organs, blood, and milk, and use them to save lives had reached its peak in the 1970s and 1980s. Hence, around the world there was an upsurge in demand for religious points of view on matters that until that time were confined to secular healthcare institutions, which were not always in a position to respond to questions of life and death faced by a patient’s family.
Islamic juridical sciences had developed a morally-sensitive methodology to derive fresh rulings in the area of medical practice. Principles like “No harm, no harassment” or “Aversion of corruption is more important than promotion of benefit” provided groundbreaking judicial decisions without any reference to moral justificatory reasoning. Muslim jurisprudence was, and remains, essentially religious-text based with the assumption that what God commands is good and permissible, and what God forbids is evil and must be avoided. Consequently, while other religion-based bioethics deliberations were in conversation with secular bioethics, Islamic responsa literature remained confined within the Shari’a-centered discourse. Until now, Muslim bioethics has essentially been based on legal decisions without any reference to ethics as understood in secular discourses of bioethics.
A New Moral Discourse
In the last decade, some Muslim jurists have begun to understand the need to discuss their rulings in light of ethical considerations of right and wrong. The result has been that in some Muslim countries (Iran, Egypt, Saudi Arabia, Oman and Jordan) a new moral discourse has found support among religious thinkers who are engaged in placing their rulings within deontological and teleological ethics of the Shari’a methodology. More pertinently, intellectual efforts are moving towards identifying religiously sensitive principles that can be applied in practical ethics at all levels of human interaction. Some jurists have adamantly resisted the new requirement to equip themselves with an understanding of the ontology and teleology of human action in order to underscore the universal and, hence, generalizable moral language of Islamic theological ethics that is firmly grounded in human ability to know right from wrong intuitively. The process of rehabilitating Islamic ethics as a critical part of juridical studies has just begun. It is hoped that the next batch of graduates of bioethics centers in Muslim countries will assume the critically needed new leadership role in facilitating a global religious ethics of care and compassion.
Very important issue indeed. Bioethics controversies cannot be discussed aside from a number of relevant considerations, religion being one of them. Patients often find themselves in moral quandaries because they are not sure what is the standpoint of their religion on certain matters. For better patient centered care and for a better technologically driven future, Muslim Jurists, like their colleagues in Christian theology, need to be involved in bioethics discourse.