From Principles to Patients: Darul Qasim College’s Approach to Islamic Bioethics

Disclaimer: None of the information in this article should be used as medical advice, a health recommendation, or a fiqh ruling.

What is the ‘Muslim’ response to June 24th, when the Supreme Court overturned Roe v. Wade, allowing states to develop their own standards for abortion laws? How can shifāʾ — the all-encompassing cure mentioned in the Quran — inform the modern drug development pipeline? Where can Muslim physicians draw on their desire for ihsān (excellence) to improve care for patients, be they Muslim or not? Muslim physicians likely account for at least 4.5% of all practicing physicians in America, but beyond our strength in numbers, what else can we offer to the broader society that is informed by our Islam? [1]

Islamic intellectual history shows us that our civilizational values have always offered profound insights that improved the quality of life for all in this mundane life. Last month in Dallas, Darul Qasim College held a one-day seminar to offer physicians, physicians-in-training, and other healthcare professionals a taste of how Islamic principles and practice can effectively add value to their fields of expertise and even provide alternative paradigms of diagnosis and treatment. The lecturers included physicians and medical students who study Islamic medical ethics under Shaykh Mohammed Amin Kholwadia, the College’s Founder and President.

Conference Introduction

The conference started with a series of powerful remarks by Shaykh Amin Kholwadia. He discussed al-mafhūm al-Islamiyy, the idea that whatever has roots in a waḥy-based reality will not only benefit us in the Hereafter but also in this world, consistent with the Hanafi-Maturidi belief system. However, this can create a sense of tension in fields such as medicine where advancement comes through breaking down old traditions and creativity, not the mere following of set rules. Given this, how do we reconcile our tradition with modern scientific findings?

Shaykh Amin answered this by alluding to the treasured tradition of free-spirited, sincere debate in the Islamic intellectual tradition. While the medical community should not expect conclusive answers to every medical fiqh issue, we should also understand that fatwā is based on function, need, and circumstance.

The Wingspan of Halal Cures: A Novel Therapy in Endocarditis Inspired by ‘Do No Sin’

Dr. Umar Shakur and Dr. Yasir Akhtar, both cardiologists and long-time students of Shaykh Amin at Darul Qasim, presented about the influence of Islamic medical ethics in providing compassionate care for a population of stigmatized patients. Endocarditis is a life-threatening condition where bacteria enter the bloodstream and travel to the heart, which can lead to inflammation of the heart’s valves and chambers. Endocarditis that occurs on the right-side of the heart is commonly associated with intravenous drug use due to contaminated needles introducing bacteria into the body. While surgery can be a potential treatment for patients who fail to respond to antibiotics or develop heart complications, drug users are often turned away from this high-risk procedure due to concerns that they will return to using drugs and infect their new artificial valve.

Dr. Shakur and Dr. Akhtar noted that we can do better than this: instead of leaving patients with no option, they sought treatment options that can offer certain benefits. They utilized a device that mechanically suctions out the vegetations, irregular cell growths in the heart, for an off-label use (a high-tech vacuum, if you will). With a group of other researchers, Dr. Shakur and Dr. Akhtar published a case series of 25 patients with IV drug-use associated endocarditis of the tricuspid valve (right side of the heart) — there were no deaths or major complications from the procedure and 20 of the 25 patients survived the hospitalization. [2] 

Additionally, Darul Qasim set up a bioethics working group to further reflect and deliberate on the plight of patients such as those described above. Who has ultimate authority (wilāyah) over the patient and their medical decision-making? As a practicing clinician, is it my duty to ensure this patient lives as long as possible, and if so, to what extent can I try to save his or her life? A key lesson from this lecture is that while ethical decision-making limited to the realm of this world does not guarantee benefit for our Ākhira, decisions that account for the Ākhira can bless us both in this world and the one to come. In summary, this talk wonderfully illustrated a treatment paradigm born of an understanding of Islamic bioethics principles and a sincere desire to save lives.

The Uṣūlī (Principles-based) Approach to Islamic Bioethics

This presentation focused on providing a big-picture overview of Islamic bioethics and introducing two approaches to the discipline. The speaker defined Islamic bioethics as a framework for doing the most noble thing for one’s Dunyā (mundane world) and Ākhira (Hereafter) — according to a consistent methodology by which principles are derived from the Qurʾān and Sunnah — for issues that manifest in healthcare professions. This definition aims to be consistent for whichever approach to Islamic bioethics one adopts.

Darul Qasim College’s uṣūlī approach to Islamic bioethics proposes an alternative theory to the mainstream maqāsidī (utilitarian) approach. This alternative theory does not discuss what happens in practice; rather, it encourages professionals to see how their field can benefit from a more principles-based approach than the maqāsidī approach.

A PubMed literature search of Islamic bioethics is dominated by a mention of maqāsid al-sharīʿah (objectives of Islamic Law) — in 24 publications since 2003. The maqasidī approach essentially aims to save the most lives possible at any cost. The benefits of this approach include collaboration between ʿulamāʾ and healthcare professionals, viewing Islamic guidance as beneficial to bioethics, and congregating Muslims in international conferences to reckon with bioethical issues. However, some drawbacks include a lack of discussion on the burden of sin in the Hereafter, reliance on contextual fatāwā rather than timeless fiqh principles, a lack of creativity in using Islamic principles as guidelines in seeking cures, and ultimately an incorrect usage of maqāsid al-sharīʿah (objectives of Islamic Law). 

Imām al-Ghazālī first articulated the maqāsid in the 11th century of the Common Era. They include the preservation of dīn (religion), nafs (life), ʿaql (intellect), nasab (lineage), and māl (wealth). The maqāsid outlined the purpose of the sharīʿah but they do not equal sharīʿah itself—it was never meant to evolve into its own rule-making basis. A maqsad (objective) like the preservation of life is taken as a source of law when it is used to justify practices that are contrary to the sharīʿah like the transfer of blood, an impure substance, into the human body.

Enter the uṣūlī approach to Islamic bioethics. It relies on uṣūl, or the way the ʿulamāʾ systematically derive knowledge from waḥy (revelation). It also utilizes Islamic epistemology, ontology, and metaphysics based on ʿaqīdah (creed) and kalām (discursive theology). The uṣūlī approach avoids the discussion of ḍarūrah, taking part in actions out of necessity such as consuming medicine with porcine ingredients to save one’s life. If a medication is ḥalāl from the outset, then the question of whether or not it is permissible to use becomes moot. Additionally, the uṣūlī approach reckons with the potential burden of sin in the Hereafter when deciding if a treatment should be utilized. This approach to Islamic bioethics builds on over 1400 years of Islamic scholarship and applies it to issues one would face in healthcare professions.

Islamic bioethics deals with the same issues as secular bioethics but also incorporates concepts like the role of ʿulamāʾ in patient care, porcine products in treatments, and discussions of authority between individuals, healthcare professionals, ʿulamāʾ, and governments. One case in the presentation explored the prohibition of changing the creation of Allah based on the verse [4:119]. Changing the creation of Allah is one of the deceptions of Shaytān, but what would a clinical definition of changing the creation of Allah look like? The definition would need to encompass cases like gene therapy to prevent disability, cosmetic procedures, gender-affirming surgeries, reconstructive surgeries, and mitochondrial DNA replacement. The maqāsidī individual would find it straightforward to provide care to someone if it involves saving a life whereas the uṣulī would consider if there is any element of sin or principles missing before partaking in an intervention.

Stakeholders in issues of Islamic bioethics include healthcare professionals, ʿulamāʾ, and policymakers. These individuals work together to ensure the best benefits to patients and the polity while enhancing their Ākhira. For example, a Muslim physician might ask an ʿālim about the permissibility of a vaccine made with ingredients derived from human cells. The ʿālim might say the vaccine is impermissible to take and a vaccine without impure or impermissible substances would be preferred. The physician and ʿālim would work with policymakers in a Muslim government to ensure that everyone in the country would have access to a ḥalāl vaccine, one without impermissible substances. The policymaker would listen and implement the advice to ensure the best benefit for all patients in the country, both in the Dunyā for their health and the Ākhira by avoiding the potential burden of sin associated with a vaccine containing impure substances.

Issues in Islamic bioethics may be approached proactively or reactively. A proactive approach would be necessary to develop ḥalāl medicine that does not carry any burden of sin. A reactive approach would include physicians providing their medical knowledge and expertise to muftīs who would rule on the permissibility of new technology like xenotransplantation or vaccines with porcine products.

The presentation ended with the reasons why Muslim healthcare professionals and students should be involved in Islamic bioethics. First, actions have consequences in the Ākhira for the practitioner and patient. A physician should care about their patients’ and own Ākhira by crafting and implementing ḥalāl solutions. Second, ḥalāl (legally permissible) solutions are superior to any other solution as they do not require a question of whether they are ḥalāl or ḥarām (forbidden) — they are ḥalāl from the outset. Lastly, it is a farḍ ʿayn (individual obligation) for every Muslim to know how Islam incorporates into their profession. Every Muslim has the same farḍ ʿayn knowledge that they need to know. Muslims should also know how that farḍ ʿayn knowledge applies to their profession. For example, knowing that Allah is the Cause and Creator of everything is a primary point of ʿaqīdah. Knowing that Allah creates shifā’ (comprehensive cure) either directly or through means, like medicine, is an extension of that point of ʿaqīdah. The uṣūlī approach to Islamic bioethics provides a framework for Muslim healthcare professionals to provide the best care for their patients while enhancing their Ākhira.

The Lives of Women: Reproductive Rights from an Islamic Ontological Perspective:

Two clinicians — Dr. Deena Kishawi, a senior-level OB/GYN resident, and the other, Sara Alattar, a third-year medical student — reviewed the consequences of overturning Roe v. Wade, beginning with the legal inconsistencies it creates based on where a patient lives and where clinical decisions are based on the government. In response to the overturning, Darul Qasim College recruited a team of scholars, legal experts, and medical professionals with the goals of publishing a legal policy analysis from a Muslim perspective and how Muslim professionals can influence political discussions surrounding abortion. The team first sought to elucidate how foundational Islamic principles derived by Islamic scholars from wahy are applied to provide guidance on pregnancy decision-making through patient case studies.

Under the guidance of an Islamic jurist, the inter-professional team analyzed patient-case scenarios involving abortion decisions and the Islamically-principled guidance that the jurist would provide in such cases. Example of cases reviewed included: a fetus diagnosed with genetic anomalies incompatible with life, pregnancy resulted by sexual assault, wishes to terminate pregnancy due to financial hardship, life-threatening conditions for the mother, and others. 

One finding from the ongoing analysis is that four key principles have generally been used by scholars in pregnancy decision-making:

  1. Ontology of mankind and the stages of human existence
    • There are six stages of human existence. The first is pre-conception, in ‘ālamul arwāh (the realm of the souls) in which the human exists as a soul without yet having a biological life. This is the stage in which mankind makes the Divine Covenant to Allah and bears witness to His Lordship (Surat Al Araf 7:172). This stage begins to assign value to human life before it bears biological existence. The second stage is post-conception in al-rahim, or the womb. The soul is blown into the fetus 120 days after conception and the fate of the human being is written during this stage. The third stage begins after the fetus is born, and is in ad-dunyā (the worldly life) and the human being becomes aware and accountable for their actions. The fourth stage is in al-barzakh, the grave, after the human being’s biological death. The fifth stage is on yawm al-qiyāmah, the Day of Judgement, in which the body and soul are resurrected. The sixth stage is al-ākhirah, the eternal life. 
  2. Prohibition of taking life without justification and the proactive effort to preserve life; fear of poverty is not a justification and is explicitly mentioned in the Qur’an.
  3. Promotion of life through permissible means is welcome and beloved in the religion.
  4. Certainty is not overridden by doubt.
    • A decision in the law hinges whether we are certain of something or not, we rely upon that which we are more certain of to make our decision.

The presenters reviewed five different patient case studies and analyzed how each principle was utilized to bring guidance to the patient, and demonstrated that consistent principles founded in Islamic law bring morally-coherent solutions across all types of scenarios.

Epistemology and Ontology: Applications to Alzheimer’s Disease

The final talk was by Dr. Ahsan Arozullah, a physician working in the pharmaceutical industry, regarding how Islamic medical ethics’ view of epistemology and ontology can inform drug development funding for Alzheimer’s disease, the most common form of dementia. The speaker noted that over 42 billion dollars of federal money has been spent trying to develop a cure for Alzheimer’s with no clear panacea in sight. [3] But just like any other condition, Alzheimer’s as a clinical diagnosis did not spring out of thin air. It was Auguste Deter (1850-1906), a German seamstress who exhibited rapid escalation in memory loss in her later years, who was the first person officially diagnosed with Alzheimer’s; one of Dr. Alois Alzheimer’s mentees named the condition after his mentor.

In Islamic epistemology, in addition to the five senses and intellect, our worldview is informed by waḥy. In the fifth āyah of ṣūrah 22, Allah discusses the natural course of human life, stating that “some of you may die young, while others are left to reach the most feeble stage of life so that they may know nothing after having known much”. [4] If the “reversal of human beings” at the end of life, returning to their innocence and naïveté of infancy, is what Allah holds for some of His creation, should Alzheimer’s be considered a disease that can be completely “cured”? Or is the surplus of 42 billion federal dollars of funding by the American government better suited for solving more immediate problems, like world hunger (a director of the U.N. World Food Programme estimated that it would take “$40 billion each year to end world hunger by 2030”)? [5]

All of this is not to say that we should withhold drug development funding for therapies that target the initiation and progression of Alzheimer’s disease. At the same time, as Muslim clinicians and scientists, we should have a realistic expectation of the likelihood in finding a cure that is bound by our waḥy-informed worldview. Most Muslims would probably agree that there is no cure for death. Going back to what Shaykh Amin refers to as ‘Islamic civilizational values’, perhaps what we really need to prioritize at the end of life is not another daily pill, but intimate care and affection and duʿāʾ (supplication) for patients and one’s own parents. This is a message that can benefit both Muslims and non-Muslims.

How to Learn More About Bioethics
  • To learn more about Islamic bioethics, one can visit the conference website
  • If one would like to study Islamic bioethics with Shaykh Amin Kholwadia and the bioethicist-physicians at Darul Qasim College, one can register for the Introduction to Islamic Bioethics Seminar that is ongoing. Past sessions are recorded and new students can register. 
  • If one would like to read more about Islamic bioethics, one can view peer-reviewed research publications, articles, and videos produced by Darul Qasim College and its affiliates. 
  • Otherwise, one can view the 2022 Dallas conference link and look at other materials related to Islamic bioethics offered by Darul Qasim College.
  • To connect with other Muslims in the medical field interested in bioethics, you can leverage the social media platforms offered by Muslims in Medicine

References:

[1] 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 Netw Open. 2020;3(7):e209418. doi:10.1001/jamanetworkopen.2020.9418
[2] Akhtar YN, Walker WA, Shakur U, Smith G, Husnain SS, Adigun SF. Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users. Catheter Cardiovasc Interv. 2021 May 1;97(6):1290-1295. doi: 10.1002/ccd.29584. Epub 2021 Mar 1. PMID: 33645916.
[3] https://alzimpact.org/research 
[4] Quran 22:5
[5] https://www.wfpusa.org/articles/how-much-would-it-cost-to-end-world-hunger/ 


About the Authors:

Waqas Haque is an editor for Traversing Tradition. He is a second-year medical 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, oncology and entrepreneurship.

Samer Wahood is a student of traditional Islamic disciplines and a medical student at the Warren Alpert Medical School of Brown University in Providence, RI, USA. Previously, he studied public policy and obtained an A.B. from Brown University. His interests include bioethics, dermatology, and political advocacy.

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