On Saturday 25th May 2013, the Al-Mahdi Institute in conjunction with Imamia Medics International (IMI) held a conference entitled ‘Moral Dilemmas in a Medical Context from an Islamic Perspective’. IMI is a global medical professional organisation that derives its inspiration from the above verse of the Qur’an in the quest to enhance the physical, mental, social and spiritual wellbeing of human beings all over the world, and its activities range from professional educational programs, community based clinics, maternal and child care programs, disaster relief operations and international health policy work at the UN and similar agencies. The conference was presented on behalf of IMI by Dr Ali Mehdi, an Orthopedic surgeon based in Scotland, and consisted of a panel of medical and scholarly experts, including Dr Syed Qasim Jaffery, Urologist and Co-ordinator of IMI Europe, Dr Wasi Hayder, Co-ordinator of IMI UK, Dr. Shabih Hayder Zaidi, Dean of the American University of Barbados, Shaykh Alireza Bhojani and Dr Ali Fanaei of the Al-Mahdi Institute, Dr Mohammed Walji, Senior Medical Practitioner, and Dr Esan Zafar Sairi, Consultant Surgeon.
This enlightening conference held by the Al-Mahdi Institute was primarily aimed towards considering the current moral and ethical dilemmas that are being faced in the medical field, and how new emerging medical issues can be addressed from an Islamic perspective, specifically within the realm of Shi’ism. In order to provide insight into the function of morality and the derivation of law within Shi’ism, Shaykh Alireza Bhojani, a researcher and lecturer at the Al-Mahdi Institute, presented a paper entitled ‘Itjihad and the Scope for Ethical Reasoning in Shia Thought’, which particularly focused on the area of medical dilemmas. He highlighted that in order to proficiently deal with new medical ideas such as embryo implantation or surrogacy, which are not directly addressed by the primary sources of law of the Quran and Sunna, there is a necessity for dialogue between both people from the medical profession, and people who engage with theoretical questions in understanding Islam and the interpretation of religion.
Shaykh Alireza also stressed the need of using moral rationality as a third primary source of law, which is currently a practice that is largely confined to interpreting existing textual evidences as opposed to actually addressing new ethical challenges arising in society. As he stated: “rational morality is the key to answering questions on medical ethical questions, such as organ donation, and across the broad spectrum of biomedical ethical issues.”
Dr Shabih Hayder Zaidi then moved on to consider specific medical, ethical and moral dilemmas that exist in society today, and how these have been addressed from a Shia perspective. Interestingly, Dr Shabih’s paper entitled ‘Social Anthropology and its Impact on Medical Ethics’ primarily focused on the role that culture plays in this context, and highlighted how the four key principles of medical ethics in Islam – autonomy, beneficence, non-munificence and justice – can be significantly affected by the changing nature of society and culture over time. For example, he considered the issue of medical consent, which falls under the ethical principle of autonomy, in order to highlight the impact of moral relativism; i.e. whilst in the UK, the consent to treatment is required from the patient itself (or the mother if the patient is underage), in Eastern countries such as Pakistan it is common practice for the patient to notbe made aware of their medical condition and treatment, with surrogate consent taking place instead – is this ethically tolerable? Or based on the notion of moral cultural relativism, should such distinctions between medical practices be viewed as morally acceptable.
Dr Shabih nonetheless highlighted that certain ethical principles are universal in nature, especially the principle of justice. After pointing out a number of medical dilemmas that require further dialogue, such as the provision of non-Muslim organ transplants in Muslim patients, the use of embryo eggs for stem cells research, cloning, and the level of access to medical resources granted to individuals of differing medical needs, Dr Shabih concluded his paper by stating: “If knowledge and skill and your conscience allows that you are doing something for the good, then that act is ethical. If not, then it is unethical”.
The audience at the conference, consisting of both people from a medical background and members of the public, raised a number of thought-provoking questions to the panel. It was queried whether the issue of providing an organ donation to a non-Muslim could be allowed for under the discourse of Fiqh. Dr Ali Fanaei of the Al-Mahdi Institute re-emphasised the importance of using rationality as an objective source for deriving Islamic law, and stated that: “if we acknowledge that reason is an independent source of sharia on the one hand, and on the other hand if we acknowledge that morality is prior to religion and sharia, then by putting together these two presuppositions, we can justify this practice.”
Other members of the audience were also keen to discuss the ethical issue of the extent to which medical resources should be expended to prolong a patient’s life, especially in contentious situations such as when their overall condition is unlikely to improve. In response to the question of how is a doctor to justify when to essentially ‘give up’ on a patient’s treatment, Shaykh Alireza critically pointed out that whilst possessing this level of moral consciousness is good in itself, the pressure for resources is also a moral issue amongst higher level hospital management, and an appropriate level of distribution of these resources is an ethical decision that they have to take, which cannot be overlooked when considering this issue from an individual standpoint.
In essence, this conference highlighted that in order to deal with emerging new issues, Muslim scholars should be scientifically, medically, economically and politically informed when deriving Sharia law, as if someone is not informed enough of the subject matter at hand, then this type of itjihad is not acceptable. Furthermore, Shaykh Alireza stated that: “Ethical reasoning is complex, is contextual and is situational, which means that a religious scholar alone cannot give prescription for it”.
Thus, whilst the process of itjihad is undoubtedly dynamic in Shia thought, this insightful discussion held at the Al-Mahdi Institute established that there is both a need and a demand for its further development when addressing ethical dilemmas in the medical context from an Islamic perspective. Indeed, it became evident that this requires interaction from both religious scholarly audiences and medical professional audiences, whilst using moral rationality as a basis to deal with new emerging issues.
As concluded by Dr Ali Mehdi, in light of significant recent turmoil’s, “we as a community need to come together for the common good, to help not just our community but the wider course of mankind”. Undoubtedly, the Al-Mahdi Institute aims to play a key role in addressing these emerging ethical and moral challenges through its commitment to bringing the traditional resources of Muslim religious thought into dialogue with emerging paradigms of knowledge with a view to providing practical solutions to both Muslim and non-Muslim societies. Shaykh Alireza elucidated that whilst disciplines such as Bioethics are pushing the current Fiqhī discourse to its limts, there nonetheless exists great scope in a dynamic and evolving system of itjihad within the Shia thought to respond, and the Al-Mahdi Institute aspires to continue contributing to filling the demand for further cutting-edge research regarding the moral dilemmas found in medical contexts.
“…And he who saveth the life of one, it shall be as if he had saved the life of mankind…” (Qur’an 5:32)