Islamic Traditions and Biomedical Ethics Highlights of Islamic

Islamic Traditions and Biomedical Ethics Highlights of Islamic Bioethics Conference at U of Michigan – Apr 2011 J Rusthoven July 2011

Highlights – Interdisciplinary Conference on Islamic Bioethics • Participants: Physicians, Nurses, Islamic Scholars, Imans, Jewish and Christian observers • Bioethical Discourse in the US – Howard Brody – What role should religion play in bioethics? – Should consider as lived experience, not static tradition; shaped by multiple cultural inputs – Religious vs Secular: terms are contested, in flux

Bioethical Discourse - Brody • John Rawls as exemplar of liberal view – individual rights – Justice as fairness – rights equally to all – need minimum basic moral principles via rationality and mutual disinterestedness – Religious views not welcomed in public square because risk causing disruption – All participating in public discourse leave comprehensive doctrines (private moralities) at the door – Later, considered advantages to sharing traditions but must go back to reason to maintain civility

Responses to Rawls • Martha Nussbaum – Accept diversity, encourage honesty, humility, and mutual respect – Exercise right to express own views in public • Habermas – allows more religious views but not for policy making – ‘institutional translational proviso’: requirement to connect religious reasons with secular ones – secular reasons have priority

Transplanting Bioethics into Different Cultures Raymond De Vries (U of M) • Ethical Ideas can be transplanted in three ways: – Adopted wholesale – Mold and Alter – Principles just begin the conversation • Compared missionary and bioethicist – Can be helpful or harmful – The Gospel is like the Belmont Report • Concern about Islam – looking too accommodating with principlism – should make more effort to develop own ethical framework

The Uneasy Relationship between Health Care and Religion in the US Robert Vischer, JD • In law, moving to professional ‘servicing’ the public • Trend away from negative rights (don’t interfere; do no harm) toward positive rights (right to help others) • Trend toward providing service even if against conscience will continue to be difficult for Muslims to live out their own consciences

How Sunnis Respond to Bioethical Dilemmas Shaykh Musa Furber (Abu Dabbi, UAE) • All principles can be distilled to: warding off harm – focus should be on religious person and his Lord • Jurist/Judge – make judgments on various issues with much input from physicians – designated by local political authority • Mufti – the one making a judgment – counsels individuals on practical bioethical matters • Mushti – the one asking for the judgment • Figh – the body of prior judgments and ruling used for future rulings • Figh Council – non-binding, recommend as guidance

Recommended Research Method • Gain understanding of issue, use local specialists • Gather evidence and opinion – Qur’an, prophetic narratives, scholarly consensus, statements of Companion and successor, classical figh literature, ruling from figh councils, etc. ) – if no precedent found, fall back on starting point of autonomy, beneficence, justice

Recommended Research Method • Fatwa process – Petitioner describes problem or event – Mufti identified known legal issue similar to the event – Mufti checks if precondition, essential elements have been included – Mufti look at petitioner’s circumstanced to ensure they apply – Ruling that realizes the petitioner’s needs – Rulings non-binding; can get second Mufti opinion

Role of Shiite Iman in Bioethical Consultation Iman Hassan al-Qazwini • Islam very diverse; denominations within Sunni and Shia groups • Shiite community ~ 20% of Muslims; largest communities in US in LA and Detroit areas • All forms of human life before and after birth of equal value • No justification of termination of life so no forms of abortion permitted • Definite predestination = terminal cancer – all in hands of God • Indefinite = patient has role and responsibility in deciding health

Shiite Perspective on Bioethical Issues (majority of scholars) • Must make every effort to save a life, even just extending hours or days • Don’t know if unconscious patient is spiritually suffering so must keep on respirator to allow any lingering spiritual struggle • No concept of ‘brain death’ – all signs of life must cease before officially dead – tremendous pressure from ICU teams • Judgment (Fatwa) of jurist is binding – Iman is bioethical leader and reference point on where community stands on bioethical issues

Q&A • Q: Local Muslim MD – Why is there no ruling in Islam on female circumcision? • A: Sunni scholar - There is but in Arabic - go learn Arabic! – Comment: Muslims need to be more informed about Qur’an and other Muslims authoritative texts • Q: What is Sunni position on D/C respirator? • A: Can D/C if no hope (not all Sunni scholars agree)

Q&A • Dilemma: In Islam, taught to abide by law of the land – brain dead = dead? • Iman Ans: can compromise with issues of state law vs Islamic law • Shiite Organ donation: – Can donate only internal organs when alive (e. g. , not eyes) – Can’t donate essential organ (heart) while alive – Sunni scholar comments: similar with Sunni but no allowance for payment for donation • Q: Muftis don’t always give informed advice • A: Get second opinion

Not Quite Dead: Why Egyptian Physicians Contest the ‘Universal’ Criteria of ‘Brain Death’ Sherine Hamdy • Increased rate in renal failure, thought due to industrial pollution, causing great need for renal transplants • Problem with cadaveric procurement of kidneys • Islamic MDs blocking nat’l legislation on brain death

Role of Muslim Physician in Bioethics Discourse: A Risk/Benefit Analysis Medicine Islamic Ethics • Life: Before and after birth • Life: Before birth, after death • Improve quality of life – extend length of life • Improve quality of life – minimize risk to life • End-of-life care • End-of-this-life care • Risk in medicine = harm • Risk for Islamic MD = concern for sin

Islamic Applied Ethics and the Future Approach Tariq Ramadan • In each generation, God will provide for experts to re-interpret written revelation in context of the day – no new revelation • Questions whether primary focus of moral knowledge should be scriptural sources – Text-context always linked – Gaps in written text where believer must sort out problem • Need to accept interpretative diversity in Islam (e. g. , 14 diff. opinions on what texts say about euthanasia) • Current state of Islamic discourse in bioethics: segregation of Islam and science – what is ‘Islamic’ in Islamic science? • Needs to be reconciliation between sciences and Islamic ethics

Islamic Applied Ethics and the Future Approach Tariq Ramadan • Islamic mission: reform self and the world • Some Suffi say just be interested in renewing self and protect self from the world • Two kinds of reform: Adaptational vs Transformational • Scholars of the context should be the authorities of the discipline such as bioethics. But no consensus on consensus • In the West, perhaps better opportunity to address contemporary challenges than in other parts of the world

Case Najah Bazzy, Nurse specialist in cultural diversity (One parent Shiite, on Sunni) • 35 y/o Muslim male with brain damage from stroke • Wife becomes uncommunicative – primary extended family killed in Iraq • Six young children unable to discuss issues of brain death • Brain dead for remaining family means only brain dead • Shiite MD in charge – uncomfortable signing off to Sunni MD who felt should D/C respirator (felt soul would be in peril if signed off) • Transcultural nurse specialist asked for scholarly review

Case (con’t) • Shiite scholar felt soul could be on journey and only God could decide time of death • Final opinion: stopping respirator would be murder • Second Shiite scholar suggested make funeral arrangements and stop ventilator – speaker suggestion: focus on patient and family desires • Stressed helping family have peace and forgive selves for not saving the life of their loved one

What Has Religion to Do With Practice of Medicine? Farr Curlin (U of Chicago) • Motivated to care for the sick and have sense of what human flourishing entails • Clinicians must act as practical moral philosophers • False sense that can keep separate private and professional parts of life (private vs professional moral beliefs) • Need to consider more public awareness of how practice affected by religion

Is There an Islamic Bioethics? Abdul Azziz Sachedina (Shiite) • Need to empower Muslim caregivers to think through bioethical issues from Islamic hermeneutic – more reliance on own conscience • Encourages interfaith cooperation • Do not harm connects all human beings • Muslims can’t live in isolation anymore (cites David Novak’s appeal to covenant) • Need to standardize responses in Islamic community (? Islamic Council)

Q&A • Furber: is each Muslim his own final judge in democratic society? • Ans: Increase exchange of knowledge and views in each community – for Sunnis, each fatwa not binding but discourages fatwa shopping • Ramadan: primary task of Muslim is to be a witness and example, not to convert – concerned many writings not used or known that may help current issues

Different Cultures – One World Dialogue between Christians and Muslims about Globalizing Technology Eds. H. Jochemsen and J. van de Stoep (Amsterdam: Rozenberg, 2010)

Extra Slides

Controversies in Islamic Law and Ethics – Sherwin Jackson • Four Historical Stages – Moral Objectivism • Reading nature objectively with help of written revelation • Currently movement back to this but acknowledging plurality of Muslim views – Theistic Objectivism (mainly Sunni tradition) • Moral judgments originate in us, not created order – no objective moral index – moral judgments are products of our culture, traditions, upbringing – Traditionalist • Situation-dependent – some situations may only need reason, intuition, or ‘common sense’ rather than revelation – Modernity/Postmodernity • Morality by consensus of informed reasonable persons