Al-Bar and Chamsi-Pasha have provided the world with a comprehensive encyclopaedia on all issues related to bioethics from an Islamic lens. This piece of work provides the reader with an all-inclusive introduction to the matters being discussed as well as a balanced approach to the Islamic opinions on selected case studies that are seen as contemporary on the current scene. This work is split into three segments, the first are labelled as introductory chapters and they discuss the definition of ethics, as chosen by the authors, as well as issues fundamental to later chapters such as the origins of Islamic morality and ethics and the oath of a Muslim physician. The second segment discusses the four principles of biomedical ethics with an Islamic perspective, namely: autonomy, nonmaleficence, beneficence and justice. Finally, the third segment collates contemporary issues related to bioethics and aims to provide Islamic evidence to the opinions of the scholars on these issues. Some of the issues Al-Bar and Chamsi-Pasha tackle are abortion, organ transplantation and end-of-life care. In the following paragraphs we will delve deeper into each of the segments to understand the opinions and facts provided by the authors on this hugely important subject.
Part 1, titled introductory chapters, is broken down into an introduction which provides a solid foundation to the book by covering the history of bioethics within Islamic literature and discussions, but it also covers the basics of religion, covering topics such as the six pillars of Islamic creed as well as other notable differences such as the foundational sources of jurisprudence in Islam and the different Sunni legal schools of thought. The authors proceed to introduce the sources of common principles in morality and ethics. They identify three main sources: intuitive reasoning (i.e. the basic innate constitution of human beings), the faculty of reason and divine revelation. The rest of chapter 2 covers specifically religious issues and providing the reader who is not learned in Islamic knowledge with the background information they would require to understand the perspectives the authors delve into in later chapters.
Chapter 3 introduces an important concept which is central to Islamic teachings. The five cardinal essentials of religion involve the preservation of all of the following: faith, life, mind, progeny and property. These are central to the majority of scholarly opinions on issues related to the worldly life in Islam. The authors quote Ibn Qayyim who said: “Al-Shari’ah fundamentals are built on keeping the interests (masalih) of the people during this life and hereafter. These objectives are built on justice, mercy, wisdom and interest of the creatures. Therefore, any situation which perverts from justice to injustice, from mercy to cruelty, from wisdom and utility to chaos and futility is outside the scope of Shari’ah.”. It is with this in mind that the authors begin to introduce the Islamic perspective on contemporary bioethical issues. Further information is given on the sources of decision making in Islam, some surplus to requirements of understanding the decisions and opinions on bioethics, but still useful to know. In chapter 4, we begin to see the medical profession being introduced. Al-Bar and Chamsi-Pasha make the observation that when it comes to moral values, the Islamic perspective is not an exclusive one, and many scholars have indeed attempted to combine the ideas of notable non-Muslim philosophers such as Aristotle and Galen. What could be considered unique to Islam, is the importance and high status given to intentions and motivations when it comes to actions and values. In the teachings of the prophet about the motivation of such values, he was reported to have said: “Deeds and acts will be judged by the intention and motive”. As is common in this piece, Al-Bar and Chamsi-Pasha include much more than Islamic perspectives on issues relating to bioethics, it is in chapter 4 that they discuss important virtues in medicine, including compassion, discernment and trustworthiness, but there is direct mention of how this relates to the Islamic perspective of bioethics.
Possibly, most useful for a Muslim reader with an interest in Islamic opinions on contemporary bioethical issues, will be part 3. Al-Bar and Chamsi-Pasha provide a comprehensive overview of each topic. They start by defining the terms related to the topic before giving multiple views, both Islamic and non-Islamic on the topic in question. For the purpose of this review we will discuss chapter 10, abortion, as well as chapter 13, organ transplantation.
Chapter 5 discusses the regulation of the medical profession and issues related to medical research. Al-Bar and Chamsi-Pasha introduce the chapter with a hugely important quote by Imam Shafi that states: ““There are two kinds of persons who are indispensable for people. The scholars (of religion and law = ulema) for dealing with their matters of religion, and physicians for dealing with their bodies.”. This quote sets the scene for their exploring of important topics related to the regulation of medicine such as medical oaths and codes, confidentiality and consent. The Hippocratic oath is probably the most popular of any medical oaths known to lay people. However, in 1981, at the First International Conference on Islamic Medicine which took place in Kuwait, Al-Bar and Chamsi-Pasha report that the conference adopted a medical oath specific to Muslim physicians, which was introduced by Dr Hassan Hatout. It was originally based on Hippocrates oath. Necessary changes were made to fit with the Islamic teachings. Many schools of Medicine adopted it in a shorter version. While there is no comment by the authors whether this is a requirement from Muslim physicians, or who enforces it, its placement in this context highlights the importance of an Islamic perspective on issues that can seem as the most mundane or can sometimes be overlooked when discussing ethics.
The Oath of a Muslim Physician: In the name of Allah, Most Gracious, Most Merciful. Praise to Allah, the Sustainer of His Creation, the All-Knowing. Glory to be Him, the Eternal, the All-Pervading. O Allah, Thou art the only Healer, I serve none but Thee, and, as the instrument of Thy Will, I commit myself to Thee. I render this Oath in Thy Holy Name and I Undertake: To be the instrument of Thy Will and Mercy, and, in all humbleness, to exercise justice, love and compassion for all Thy Creation; To extend my hand of service to one and all, to the rich and to the poor, to friend and foe alike, regardless of race, religion or color; To hold human life as precious and sacred, and to protect and honor it at all times and under all circumstances in accordance with Thy Law; To do my utmost to alleviate pain and misery and to comfort and counsel human beings in sickness and in anxiety; To respect the confidence and guard the secrets of all my patients; To maintain the dignity of healthcare, and to honor the teachers, students, and members of my profession; To strive in the pursuit of knowledge in Thy name for the benefit of mankind and to uphold human honor and dignity; To acquire the courage to admit my mistakes, mend my ways and to forgive the wrongs of others; To be ever-conscious of my duty to Allah and His Messenger (PBUH), and to follow the precepts of Islam in private and in public. “O Allah grant me the strength, patience and dedication to adhere to this Oath at all times”.
Part 2, discussing the four principles of biomedical ethics with an Islamic perspective, is the shortest of the three segments and discusses in detail the topics of autonomy of the medical professional as well as the patient, nonmaleficence (i.e. doing no harm), beneficence and justice. For each of these topics Al-Bar and Chamsi-Pasha provide the religious opinion on them, as well as providing historical western context on their incorporation within contemporary medicine.
Al-Bar and Chamsi-Pasha break down autonomy into two essential conditions; free will and the capacity of intentional action. The authors point to the importance of recognising cultural differences when practicing medicine to patients from different cultural backgrounds to the medical professional. Part of these cultural differences might mean the amount to which family and close friends impact a patient’s decisions. Multiple cases from the past are noted in this chapter where operations were undertaken in Muslim countries with only the consent of the family sought, with the patient unaware while being in a state to be able to give or refuse consent. This has been condemned by the majority of scholars and classed as impermissible. On the topic of nonmaleficence, Al-Bar and Chamsi-Pasha give 13 axioms dealing with warding harm in the Islamic jurisprudence, most interestingly however is that; the greater harm can be replaced by a lesser harm’ and ‘the prohibited is allowed if there is a necessity’. An additional axiom is mentioned, that is important in the case of bioethics is that the harm befalling a whole community is worse than the harm befalling an individual. This is referred to by Al-Bar and Chamsi-Pasha when discussing the issue of forcefully treating patients with contagious diseases, that they harm they possess to their community and the potential of spreading diseases outweighs the issue of consent.
In part 3, Al-Bar and Chamsi-Pasha provide case studies of contemporary bioethical issues, some of which have seen significant controversy in Muslim communities. On the issue of abortion, the authors provide the reader with the definition of abortion in all its potential stages and provide the Islamic opinion on it for its multiple potential reasons. The opinion stated in this chapter is that abortion is allowed only if continuation of pregnancy would be dangerous to the expectant mother, or if there is proven serious congenital anomaly in the embryo or fetus. The time limit for carrying out such abortions is 120 days computed from fertilization, which is considered the time of ensoulment according to the Hadith (saying) of the Prophet (PBUH). This is equivalent to 134 days from the Last Normal Menstrual Period. The only other reason added by following fatawa, gave permission for abortion after an incident of rape, where the Islamic Fiqh council of Islamic World League encouraged it should be performed as early as possible and in the first 40 days of pregnancy. The second case study to be discussed in this review is that of organ transplantation. In chapter 13, Al-Bar and Chamsi-Pasha provide a comprehensive discussion on organ transplantation, in its multiple variations (i.e. autograft, allograft and xenograft), as well as a brief history of transplantation procedures and advancements. Al-Bar and Chamsi-Pasha provide various Fatwas and opinions on all variations of organ transplants and donation, but eventually concluding that it is a highly complicated issue and any answer to it must include the important issues around informed consent, providing psychological care where required, as well as the greater good argument of requiring greater donated organs to meet demand, whilst ensuring no exploitation takes place.
The book is a dense read, and at times spends too much time explaining topics before providing the Islamic perspective, leaving the reader covering things that may be basic. However, for a novice on this topic, this book ensures that they are well equipped with all the information on the subject and case studies before providing the reader with the Islamic opinions. I suggest utilising the contents page on this matter, this is not necessarily a book that has to be read from cover to cover but can be picked up and utilised for deep reading depending on the requirement of the reader. Al-Bar and Chamsi-Pasha have done a huge service to the Muslim, and non-Muslim, communities by compiling this literature together, as this area is at times a hugely controversial subject with little expert opinions dominating the discussions. By providing this work free through open-access, Al-Bar and Chamsi-Pasha have shown their true hope of ensuring this work brings real evidence to these discussions and can be used by any one on their quest of learning.
To read this book please head to https://www.springer.com/gp/book/9783319184272 for the open access eBook version.