Towards Implementing an Islamic Framework in Medicine

A transcript of Shaykh Amin Kholwadia’s lecture delivered in Amman, Jordan in 2017 regarding the impact of Maturidi kalam on bioethics was published this month.[1] Earlier this summer, I released an article on challenges and opportunities for Muslims to become live players in American healthcare. For the theoretical frameworks of scholars and researchers to manifest, Muslims must focus on practical applications and initiatives that reflect the ethos of Islam. I continue the path along this dialectic by digging deeper on three important themes from the Shaykh’s lecture: 1) creating a living tradition, 2) applying sound epistemology, and 3) applying amr bil maruf wa nahi anil munkar (commanding the good and forbidding the evil).

Creating a living tradition

When somebody converts to Islam, you teach them through the oral tradition; you don’t stack books of Bukhari, Muslim, Tirmidhi, and say based on these hadith, you are now going to make wudu or do the salah. The oral tradition is still very much alive in our communities, but a lot of the academic learning comes from the written tradition.[1]

Following along Shaykh Kholwadia’s emphasis on oral tradition, lay Muslim clinicians cannot acquire knowledge of Islamic bioethics through mere autodidacticism. The true signs of a tradition of knowledge include master-apprentice relationships that lead to a shared nexus of concepts, methodologies, and theories.[2] In our context, this means experts convening to create a tailor-made curriculum for healthcare professionals to impart themes of Islamic bioethics, everyday solutions for patient care decisions (ex. gender interactions, end-of-life care, procedure referral), and general understanding of who Muslim American care providers and patients are and what challenges they face. The ability for this to transpire becomes easier as new institutions emerge in cities such as Chicago (the Initiative on Islam and Medicine at University of Chicago, along with the Darul Qasim seminary) and Palo Alto (Muslims and Mental Health Lab, led by Dr. Rania Awaad), and online platforms (Al Balagh Academy offers numerous courses on Islam and medicine). 

The demand for an Islam and medicine curriculum is likely to be significant – a study of 626 Muslim physicians in America found that 89% report Islam as being very or the most important part of their life; interestingly, the same study found that “physicians who reported consulting Islamic bioethics literature more often had higher odds of recommending active treatment over hospice care in an end-of-life case vignette.”[3] Another worldwide study of 1,366 physicians found that healthcare practitioners who self-identify as strongly religious may be more likely “to include factors in their decision-making that fall into the domain of spirituality or abiding by certain rules than do those without strong religious beliefs.”[4] The conclusion goes on to state that, “Religion appears to be an attribute given to individuals at birth without their own deliberation whereas ‘religiosity’ requires a personal inner deliberation.”[4]

Applying sound epistemology to current issues

…you must understand, based on your epistemology, the value of your theology. What does your theology say, and how does your theology relate to your profession on a daily basis? For instance, if you were to see somebody that was on life support, how would you visualize the theology coming down to the level of whether or not you can pull the plug? ‘Can I terminate this person’s life?’ [1]

If bioethicists and scholars fail to signify the role of dīn outside of matters of worship and personal affairs, then the foundation of Islamic bioethics will crumble into a dead tradition of knowledge. Signs of a body of knowledge being unsuccessfully transferred include the inability to deploy original arguments with the same strength and the mimicry of one’s intellectual ancestors without deep understanding. [2] Today, it feels like Muslims aren’t even at the level of knowledge to mimic our intellectual predecessors. Among 557 Turkish intensive care unit physicians in a survey, there was a split among respondents who were against the legalization of Do Not Resuscitate based only on ‘humanitarian reasons’ or ‘both humanitarian reasons and religious beliefs.'[5] Even when Muslim clinicians happen to adopt a stance in line with Islamic norms, it may not originate from an Islamic framework. 

This is why, even after creating a structured course for Muslim physicians, scholars and academics must meaningfully integrate this knowledge in contemporary bioethics. Ideally, Muslim researchers and clinicians will harness an Islamic worldview in deliberating first principles of medical practice and topics of intellectual inquiry. A perusal of the latest issue of the American Journal of Bioethics provides some inspiration: decision-making competence, refusing medical care, blood products management, drug liberalization, standards of care when hospitals are at surge capacity during the COVID-19 pandemic, and conscience clauses.[6]

Commanding the good and forbidding the evil

In a non-Muslim society you will engage in discussions with the non-Muslim. You will engage in discussion in mainstream society where you can build not only a foundation but build many bridges whereby you will have these fruitful discussions in legislation, policymaking, academia, in writing books and textbooks. We are part of not just the ummah, but also part of an-Nas [mankind]. This would be the way forward for Muslims, not just in bioethics but any ethics.[1]

As I have written earlier, Muslims have made important contributions to American healthcare “through smaller organizations and individual efforts, particularly in developing free clinics and sponsoring relief trips for underserved populations in the United States and abroad.”[7] In fact, “One study found that free Muslim-led clinics across the nation serve over 50,000 patients a year, half of whom are not believers.”[7][8] The next step is to accelerate this work to a large-scale and institutional level, where beneficiaries are not perceived as only generous clinicians of foreign descent who happen to be Muslim people, but rather as followers of Islam first and foremost. 

The scope of opportunities is truly limitless here. Muslims don’t need to reinvent the astrolabe, we can duplicate existing (and well-functioning) organizations with an Islamic bent. An analysis of 50 Catholic health system mission statements revealed that words such as heal, Jesus Christ, God, ministry, and others were central words in the statements.[9] While Muslims may not have the capital to own hospital systems currently, many other initiatives are possible in the interim: hospital visitation programs for Muslim patients, health endowments based on the Islamic institution of Waqf, a volunteer ambulance system that serves both Muslim and non-Muslim patients in a locality, and patient advocacy organizations that communicate with providers to navigate end-of-life decisions for Muslim patients. 

Several other glaring examples have been reported in the literature. One investigation of end-of-life care among Muslim patients, mainly during the COVID-19 pandemic, states that, “In Muslim countries, optimal utilization of specialized spiritual and palliative care has been historically lacking and our study reflects the same findings that the deficiency still exists during the COVID pandemic… These vital aspects of supportive, spiritual, and palliative care desperately need to be improved among Muslim patient populations as they have shown to exert a positive impact.”[10]

Conclusion

Muslim Americans in medicine are trapped in a paradox: while we make up at least 4.5% of the total US physician workforce, the medical literature commonly portrays being an observant Muslim as “[posing] health risks” and that “‘Islam’ is a problem for biomedical healthcare delivery”.[11][12] To solve this dilemma, Muslims in healthcare must actively collaborate with Muslim scholars and academics to create curricula for healthcare practitioners, offer Islamic solutions to contemporary medical quandaries, and become movers and shakers in the capital side of healthcare. Knowledge production in Islamic bioethics is an important first step; the second is to grant intellectual legitimacy to this milieu, and that will only come with the will-power and drive of Muslims by the help of Allah.

Works Cited:

[1] “Shaykh Amin Kholwadia on Maturidi Kalam and Bioethics”. 2021. Traversing Tradition. Accessible at: https://traversingtradition.com/2021/08/04/shaykh-amin-kholwadia-on-maturidi-kalam-and-bioethics/ 

[2] Burja, Samo. 2018. “On the Loss and Preservation of Knowledge”. https://medium.com/@samo.burja/on-the-loss-and-preservation-of-knowledge-66e4a6b4d27d [3] Duivenbode R, Hall S, Padela AI. Assessing Relationships Between Muslim Physicians’ Religiosity and End-of-Life Health-Care Attitudes and Treatment Recommendations: An Exploratory National Survey. Am J Hosp Palliat Care. 2019 Sep;36(9):780-788. doi: 10.1177/1049909119833335. Epub 2019 Feb 27. PMID: 30813738. 

[4] Sprung CL, Jennerich AL, Joynt GM, Michalsen A, Curtis JR, Efferen LS, Leonard S, Metnitz B, Mikstacki A, Patil N, McDermid RC, Metnitz P, Mularski RA, Bulpa P, Avidan A. The Influence of Geography, Religion, Religiosity and Institutional Factors on Worldwide End-of-Life Care for the Critically Ill: The WELPICUS Study. J Palliat Care. 2021 Apr 5:8258597211002308. doi: 10.1177/08258597211002308. Epub ahead of print. PMID: 33818159.

[5] Baykara N, Utku T, Alparslan V, Arslantaş MK, Ersoy N. Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey. PLoS One. 2020 May 20;15(5):e0232743. doi: 10.1371/journal.pone.0232743. PMID: 32433670; PMCID: PMC7239490. 

[6] The American Journal of Bioethics. Accessible at: https://www.tandfonline.com/toc/uajb20/current 

[7] Haque, Waqas. 2021. “Islamic Investment in US Healthcare”. Traversing Tradition. Accessible at: https://traversingtradition.com/2021/06/14/islamic-investment-in-us-healthcare/ 

[8] Quigley, Fran. 2019. “Muslim Health Care for All”. Foreign Policy. Accessible at: https://foreignpolicy.com/2019/06/27/muslim-health-care-for-all/ 

[9] White KR, Dandi R. Intrasectoral variation in mission and values: the case of the Catholic health systems. Health Care Manage Rev. 2009 Jan-Mar;34(1):68-79. doi: 10.1097/01.HMR.0000342982.14802.47. PMID: 19104265.

[10] Khalid I, Imran M, Yamani RM, Imran M, Akhtar MA, Khalid TJ. Comparison of Clinical Characteristics and End-of-Life Care Between COVID-19 and Non-COVID-19 Muslim Patients During the 2020 Pandemic. Am J Hosp Palliat Care. 2021 Sep;38(9):1159-1164. doi: 10.1177/10499091211018657. Epub 2021 May 27. PMID: 34039050; PMCID: PMC8160924.

[11] Boulet JR, Duvivier RJ, Pinsky WW. “Prevalence of International Medical Graduates From Muslim-Majority Nations in the US Physician Workforce From 2009 to 2019”. JAMA Network Open. 2020;3(7):e209418. doi:10.1001/jamanetworkopen.2020.9418 

[12] Laird LD, de Marrais J, Barnes LL. Portraying Islam and Muslims in MEDLINE: a content analysis. Soc Sci Med. 2007 Dec;65(12):2425-39. doi: 10.1016/j.socscimed.2007.07.029. Epub 2007 Sep 4. PMID: 17767988.

About the author: Waqas Haque is an editor for Traversing Tradition. He recently completed medical school and is an Internal Medicine resident at New York University. Previously, he studied public health and also obtained an M.Phil. from Cambridge University. He is broadly interested in tafsir, Hanafi fiqh, and clinical drug development.

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