Our bodies belong to God, who has entrusted people with their care. As such, we aren’t completely free to treat their bodies however they wish
By Hossam Fadel
November/December
Islamic scholars have identified the Sharia’s objectives as preserving religion, life (and health), intellect, property and progeny.
This article focuses mainly on the second objective. Muslims believe that their bodies belong to God, who has entrusted people with their care. As such, they aren’t completely free to treat their bodies however they wish. Rather, they must act in accordance with the instructions of its owner — God. And God says in the Quran, “Whosoever killed a person … it shall be as if he had killed all humanity” (5:32) and “Do not kill yourselves [or one another]. Indeed, God is to you ever Merciful” (4:29).
We are supposed to take care of our bodies by preserving our physical and mental health. Several ritual practices involve health-promoting actions, among them making ablutions before the five obligatory daily prayers, bathing, using a miswak (toothbrush/floss) to clean our teeth and eating “from the good produce that God provided” (2:172), such as dates, grapes, figs and pomegranates.
Other injunctions are in part meant to preserve health (e.g., the prohibition of intoxicants and illicit sexual behavior) and promote mental health via prayer, supplication and submission to God: “Verily, with the remembrance of God do hearts find peace” (13:28).
Prophet Muhammad (salla Allahu ‘alayhi wa sallam) also recommended health-promoting actions, including various forms of physical exercise, such as swimming, archery and horseback riding.
But even if we follow these and the other relevant guidelines, we may still get sick because God ordains all diseases. However, these are not necessarily punishments, for “We will certainly test you with a touch of fear and famine and loss of property, life, and crops. Give good news to those who patiently endure…” (2:155) and “Be sure We shall test you with something of fear and hunger, some loss in goods, lives, and the fruits of your toil. But give glad tidings to those who patiently persevere” (2:155).
Disease and Treatment
Muslims believe that disease is part of destiny. Yet this is not the same as fatalism, because, as Abu Darda (radiy Allahu ‘anh) narrates, “The Messenger of God said, ‘God has sent down both the disease and the cure and appointed a cure for every disease. So treat yourselves medically, but use nothing unlawful’ (“Sunan Abi Dawud,” Tibb 11, [3874]).
Muslims strongly believe that God is the ultimate healer and that seeking medical advice is required to facilitate this healing process. Abu Hurayra (radiyallahu ‘anh) narrated, “There is no disease that God has created, except that He also has created its treatment” [The following addition exists in Abu Dawud and Tirmidhi: “There is no cure for only one illness.” He [the Prophet] was asked, “What disease is it?” He answered, “Old age.” [“Sahih al-Bukhari,” Tibb 1).
God does not cure you with what He otherwise made forbidden. For example, do not use medications that contain alcohol or pork products (e.g., porcine insulin). But there are exceptions to this rule if it’s a matter of life and death, for a cardinal Sharia rule is that necessity overrides prohibition.
The Prophet told people to seek the most experienced best qualified healer. Nobody should claim expertise in medicine when they are untrained and unqualified. The Messenger is reported to have said, “Whoever claims to be a physician, though unknown to such profession, is subject to personal liability.” Medical liability is divided in different categories depending on the situation (Ibn Qayyim al-Jawziyya, Muhammad al-Akili (tr.). “Natural healing with the medicine of the Prophet”. Philadelphia: Pearl Publishing House; 1993:98-102).]
The Prophet also stressed the spiritual merits of visiting the sick on the grounds that it contributes to the latter’s well-being. He recommended that the visit should occur after the third day if the illness appears to be serious, be short and include words of encouragement and supplication. Abu Musa al-Ash‘ari narrated that the Prophet said, “Feed the hungry, visit the sick and set free the captives” (“Sahih al-Bukhari,” 5649).
Doctors and medicines are but tools in God’s hands. Doctors, despite being qualified and experts in their fields, can do nothing without His will and consent, for He ordains the cure. Prophet Ibrahim (‘alayhi as salam) proclaims, “And when I sicken, then He heals me (26:80).
Muslims’ belief in the hereafter enables them to bear the pain and suffering related to disease or other calamities more readily.
While the default rule is to seek treatment, all patients have the right to refuse a diagnostic or therapeutic procedure, as long as they are mentally competent and fully informed about its purpose, alternatives and potential harm.
One can refuse treatment in the case of a terminal illness if applying the recommended therapy may not cure the illness or if it has serious side effects. However, in emergency situations, a life-saving treatment (e.g., a blood transfusion) cannot be refused.
Physicians cannot predict when one will die. Nevertheless, it must be determined as precisely as possible because some rituals and legal decisions are based on the exact moment of death. Examples of rituals include janazah and burial, and examples of legal decisions include `idda for widowed women and inheritance, when the obligatory shares change depending on whether the husband or wife died first in an accident in which both were killed.
Muslims must ascertain the status of their actions before undertaking them. Generally, any action that is not explicitly prohibited is permissible. Even though this includes most aspects of medical care, many modern medical practices and procedures need to be examined to determine their permissibility.
During this process, Islamic scholars consult either the Quran or the Sunna. If a definite answer can’t be found, those who are qualified to do so engage in ijtihad (personal judgment) based on secondary sources. The most common method used here is qiyas (analogy with a previously reported precedent or similar action), followed by consensus (ijma‘), reason (istihsan), the presumption of continuity (istishab), consideration of the public interest (istislah) and custom (‘urf).
If still no answer can be found, they then resort to judgment based on whether the recommendation enhances one or more of the Sharia’s objectives without violating any known Islamic rule. In all such cases, scholars will usually seek the opinions of scientists and physicians who specialize in the concerned field to better understand the intricacies involved and why their proposed solution is necessary or better than traditional procedures.
Death
Muslims believe that death is no more than a step on their way to the hereafter, where they will meet God and be judged, “You were lifeless and He gave you life, then He will cause you to die and … Then He will give you death, then life again, and then unto Him ye will return” (2:28) and “Truly, we belong to God and indeed to Him we shall return” (2:156).
While death itself is scary, Muslims aspire to achieve an eternal happy afterlife. Therefore, they tend to be more peaceful as their earthly life is ending. Ideally, they will engage in more prayer, supplication, reading and listening to the Quran, along with giving more charity. In addition, they will try to pay off all their debts; seek the forgiveness of those they have offended, hurt and wronged; and correct their mistakes and repent.
God determines both our birth and death dates, “It is God Who gives you life, then gives you death; then He will gather you together for the Day of Judgment about which there is no doubt: But most people do not understand” (45:26) and “…nor does anyone know in what land he or she is to die …” (31:34).
These are some basic general concepts. Islamic scholars continue to work on more specific concepts, such as end-of-life care, artificial life support, brain death and artificial reproductive techniques.
Hossam Fadel, M.D., Ph.D. (clinical professor, Obstetrics and Gynecology Department, The Medical College of Georgia, Augusta) is a past president and chair of the Islamic Medical Association of North America’s board of trustees, a past editor of its journal (JIMA) and a past chair of its ethic committee. He is a life member of ISNA.
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