A Brief Survey on Medical Ethics Regarding the Holy Quran and Isalmic Hadith
Seyed Hassan Saadat*1, Ali Akbar Chavoshi2, Khodabakhsh Ahmadi1
Historically, Western medical ethics may be found to guidelines on the duty of physicians such as the Hippocratic Oath, and early Christian teachings. One of the first code of medical ethics was published in the 5th century, in the medieval and early modern period, the field is indebted to Muslim medicine such as Ishaq ibn Ali al-Ruhawi (who wrote the Conduct of a Physician, the first book dedicated to medical ethics) and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), both as Islamic thinkers. Both western and Islamic ethics in medicine (as one of the most important aspects of human being) have the same concerns; however, the path which guides us to the ultimate goal were different; as Islamic rules relay on The Holy Quran and Hadith. We have gathered as much data as we could find through this two most important sources of Islamic rules regarding Medical Ethics.
Keywords: survey, Medical, Ethics, Holy, Quran, Isalmic, Hadith
1. Behavioral sciences research center, Baqiyatallah Medical Sciences University, Tehran, Iran
2. School of Medicine, Baqiyatallah Medical Sciences University, Tehran, Iran
* Corresponding Author
Seyed Hassan Saadat, MD, Behavioral sciences research center, Baqiyatallah Medical Sciences University, Tehran, Iran
Submission Date: 18/12/2013
Accepted Date: 14/01/2014
In the field of human sciences, medical sciences are considered one of the most important and precious. In the philosophy of other sciences, is the humanï¿½s productivity from the blessings of life, which this goal could not be achieved unless in the light of the health of soul and body. As narrated from Emir of the Believers Ali ibn Abi Talib (peace be upon him): ï¿½Lifeï¿½s pleasure is obtained through blessing and health (motto 4207)ï¿½. Also in another narrative quoted from Ali ibn Abi Talib (peace be upon him): ï¿½there are three types of knowledge: Jurisprudence for religions, medicine for the body, and syntax for the language (Harrani 208, Majlesi 75.45)ï¿½. It is also quoted from Imam Sadegh (peace be upon him):ï¿½ People need to three things for their doings in this life and the Hereafter: a scientist and righteous jurist, a leader they can obey whom believes in charity, and a visionary and trusted doctor (Majlesi 78/235)ï¿½. It could be taken from this hadith that the doctor and medicine has been always needed by the population, and a doctor must be both visionary and seer in his/her own work, and his actions attract the peopleï¿½s trust.
Modern Medical Ethics are based on 4 major theories; Autonomy, Beneficence, Non-Maleficeince and Justice. As a skimming review we can find out that all of these 4 elements are fully projected in Islamic verses:
Doing medical duty without any influence from other but God; giving the important and full information regarding the diseases to the patients based on true and correct knowledge.
Rightfulness and trustfulness; putting the patients' benefits above anything even with their enemies.
Not using un-tested treatments in change of more money or unfaithful relation with other parties
Practicing medicine regarding social, Islamic and medical rules; avoiding as many mistakes as possible.
Therefore, it seems that medical ethics can be derived from Islamic rules and shareia. There are several fatwa from Islamic leaders such as Safi Golpaygani, Fazel Lankarani, Makarem Shirazi, Imam Khamenei and other Islamic clerics regarding Islamic "Ahkam" of medicine in Treatment, patients' secrets, physical examination, transplantation, sex change, death, blood transfusion and post-mortem use of the body and tissue and, especially in forensic medicine. However, this information has not yet been summarized into practical form and there is only found in Islamic published material which is not considered as medical proof for doctors and medical society as medical ethics guidelines. Therefore, we tried to provide cover information about Fatwa and Holy Quran Verses demonstrating medical ethics.ï¿½
Medical Ethics before Islam: Ethics have a history of over 2500 years. Before the birth of Christ (peace be upon him) the Greek and Roman cultures, which were affected by the culture from Iran and the east, were, spread across the west. Due to of the limited science of that time, doctors normally learned other sciences and educations. Therefore, the history of medical ethics is linked to the history of philosophy over the past ages. But the medical ethics, most of all were linked to the thoughts and musings of great philosophers such as Socrates, Plato and Aristotle in the fourth and fifth century BC. These Greek thinkers had learned the ethics alongside the science of medicine, and descripted it as the art of living and self-preservation. On the other hand, they said a healthy mind is in a healthy body. Hippocrates was the first person whom fused the ethical principles with medicine in the form of an oath, although there were rules even before him, such as the rules of Hammurabi, which pointed out the punishment of sinning doctors, but the aspects of medical ethics were not mentioned within. The biggest share of Hippocrates in the field of medicine is his belief in the code of ethics, which was expressed in his famous oath. The oath of Hippocrates includes the oldest rules of medical ethics within it, and among many countries, itï¿½s still read as the doctorï¿½s oath at the end of the study period. In fact, this oath is an ethical oath to accept and use the rules of ethics in the medical profession. Nowadays, medical students read the mentioned oath during their graduation ceremony. The oath is as mentioned below:
ï¿½Now that with the Godï¿½s infinite grace and consideration, and by using his many gifts, Iï¿½ve finished the doctoral course and I'm on the verge of accepting the great burden of being a doctor, I appeal to his sacred nature to help me not to shorten this sensitive duty even for a moment. Iï¿½ll try in the treatment and guiding of patients as it is worthy of the sacred Islamic order and the high place of humanity. I consider the medical holiness and spirituality in boosting the morale and health of Godï¿½s servants, and avoid polluting it with worthless and unstable material disclaims, climates and carnal temptations of evil. I swear in the presence of Quran, to the almighty God, the God whom is informed to all matters and all creatures are within his mighty grasp, that I will look with respect upon the sacred Islamic rules and Godï¿½s limitations; to abstain betraying and violating the patientï¿½s rights, and to keep their secrets unless in the time of need, and to see God as my witness, present over me at all timesï¿½. This oath, which is a blend of the wise moral teachings of Hippocrates and the Islamic culture, includes these points:
No shortenings in the performance of the sensitive medical duties, trying to cure and guide the patients, mentioning the medical holiness and spirituality in boosting the morale and preserving the health of patients, avoiding the pollution of the medical holiness with worthless and unstable material disclaims and the climates and carnal temptations of evil, resecting Godï¿½s rules and limits, seriously avoiding betrayal and the violation of the patientï¿½s rights, preserving the patientï¿½s secrets at all times unless in the time of actual need, considering God always present at witnessing us. More attention to the holy Quran and the teachings of infallible Imams (peace be upon them), could present us with a more complete collection of medical ethics in Islam. In this section, some parts of the holy Quran and Hadith from the Imams and their results are mentioned.
Medical ethics in the verses: Attending to the basics and rules of Islam in all fields, including medicine, is very effective in path of integrity and ethical perfection; because Islam is the religion of ethics, and the goal from the coming of Prophet Muhammad is to complete the ethics. The ethical points present in the affidavit of medicine, is limited to cases which were resulted from the thoughts of past philosophers, including Hippocrates. But the ethical guidelines and tips are shown at their perfection, within the hadiths from Prophet Muhammad and Infallible Imams (peace be upon them). Which as an Islamic basis for medical ethics, it can be used as an appropriate complementary or alternative for the present basics. In this section, some of the medical ethic tips are analyzed in the hadiths and verses.
1- Creating relaxation in the patient; it is quoted from Imam Sadegh (peace be upon him):ï¿½ Moses asked God: lord! Who is pain from? God answered: I. He asked: who is the cure from? God answered: I. He asked: So what are your servants doing with the cure? God answered: through them, he fills the patientï¿½s heart with joy and bliss, therefore the therapeutic was named doctor (Majlesi 59/62)ï¿½.The phrase ï¿½medicineï¿½ means integration and tolerance in working and complimenting thanks (Trihi 2/108), and we name the doctor as such because with his toleration and fairer dealing, he clears the heart from sadness, interesting that in this hadith, it is not emphasized on the issue of healing the body, as much as it is on the pacification of heart. Therefore, doctor means the pacifier of souls and hearts. Patients during the treatment, needs to talk to his/her doctor and know his/her health condition, the cure and the time it take and in addition to the illness, they face another big problem which is known as anxiety. Attending to this issue is very important in the current medical society, and doctors must constantly attend to the point that in the procedure of identifying and curing the patients were they successful in meeting the most important spiritual need of the patients, and creating peace and trust within them? Were they successful in the way of treating the patient and using kind and soothing words and phrases, and following the patientï¿½s work with patience, and boosting the patientï¿½s morale and providing hope in them? Disappointment and loosing hope leads to a resonated illness, and is more painful for the patient than the actual illness. Imam Ali (peace be upon him) said that: ï¿½the hardest pain, is losing hope (Amadi, motto 1323)ï¿½. Sometimes hopelessness causes the death of the patient, such as Imam Ali (peace be upon him) said: ï¿½whomever loses hope, kills (Amadi, motto 6823)ï¿½.
2- Attending to the mediated role of doctors in curing illnesses; the Holy Quran says: ï¿½He is the God who cures me when Iï¿½m ill (Shoaara 82)ï¿½. This verse indicates that the healing and medicine is truly from God, and their true healer is only him. Actually it is God who placed the medicinal effects within the drugs and in the creation system, created a medicine for every illness, and granted humanity the gift of recognizing the illness, the medicine, and the cure. Thus, he placed him as the symbol for his doctor and Shafi names. Therefore in the sight of Islam, doctor and medicine, though for the soul or body, are just a tool, and their effectiveness relies on Godï¿½s will (Gharaati 8/238). The best way to bring up hope in a patient, is to boost their religious sense, belief in God, and believing that the real medicine is God for him, curing to illness is hard, and so much are the illnesses with no treatment which have only been cured through praying; God does not want anything but the good of mankind. Therefore one of the factors in medical ethics is attending to the mediating role of the doctor in curing and treating the illness. Religious beliefs of a doctor defiantly influence his method of treatment. The effects and blessings of a monotheistic view are clear in the achievements of a doctor. Trust and hope in God Almighty, whom is the true the true medicine, not only the doctorï¿½s medical activities, but also is effective in the patientï¿½s morale treatability and accelerated recovery in them. Because the desire for attention and to ask the Almighty God is placed within the human nature, and using the humanï¿½s natural tools is always the best answer in all stages of life.
3- Virtue, compassion, and seriousness in the medical business; Imam Ali (peace be upon him) said: "whomever cures, must be on the path of holy virtue and have compassion and seriousness in his work (Majlesi 59/74)ï¿½.
Therefore, medical virtue means that a doctor must not think of the profit to do his best, but must have the patientï¿½s best interest in mind. A doctor all his intellectual and practical might to cure the patient. A virtuous doctor, is someone that the patientï¿½s best interest in mind when putting time to identify the illness, prescript medicine and choose the cure, and all over the stages of treatment.
4- Seriousness and responsibility; Seriousness in medicine means having responsibility towards patients. Coming short in a medical treatment, means the doctor has contributed to his illness or even death. Therefore a doctor is responsible; to use all his/her might to cure the patient and must not shirk responsibility at this critical time. Imam Sadegh (peace be upon him) quoted from Jesus about the responsibility of a doctor: ï¿½Whoever leaves curing the wound of an injured, inevitably is the partner of the person who landed the wound on his body. Because the he wanted the destruction of the injured, while he who abandoned the treatment, did not want his recovery. Therefore if he did not want his recovery, inevitably he wanted his destruction as well (Koleini 8/345)ï¿½.
5- Following the urgency during treatment; one of the examples for a virtue spirit in the medical profession, is to comply with the urgencies during treatment and the prescription medicines. Imam Ali (peace be upon him) says in the Nahjolbalaghe: ï¿½Till the point your pain tolerates you, you tolerate it (Nahjolbalaghe, motto 26)ï¿½. It is understood from these verses and some others that the use of medicine without urgency is hazardous for health. Therefore we should not go to the doctor whenever we face the smallest problem, and should not get too far in using medicines; because the bodyï¿½s defense system could face most simple illnesses by itself. Imam Kazem (peace be upon him) said: ï¿½Until the illness has not seriously confronted you, do not get involved in the treatments of doctors because treatment, is like a building that a small amount of it, drags you towards more (Majlesi 62/63)ï¿½. Imam Sadegh (peace be upon him) also said: ï¿½Whomever his health overcomes his illness and still use medicines, has acted in favor of his loss (Haman 64)ï¿½. According to the potential implications of these hadiths, on the assumption, if some patient denies these guidelines and goes to a doctor, the promising and virtuous doctor, is the person that after examination, if he detected the illness is minor and does not need medicine, does not prescript anything, and if detected he needs medicine, does not prescript more than needed.
6- Patient privacy; another example of medical virtue, is to preserve the patientï¿½s privacy. The illness of a patient serves as his/her secret, which they mention to the doctor for the means of curing it. If a patient does not reveal all his/her secrets related to the illness to the doctor, he/she will not achieve health. Regarding this matter, Imam Ali (peace be upon him) said: ï¿½Whomever covers his hidden secret, his doctor could not cure him (Amadi, motto 8612)ï¿½. He also mentioned in another motto that: ï¿½Whomever hides his illness from the doctors, has betrayed his own body (Haman, motto 8545)ï¿½. And also said that: ï¿½There is no cure for the person whom hides his illness from the doctors (Haman, 10516)ï¿½. On the other hand, a doctor must not betray his/her patient by revealing his/her secret, as said in a hadith from Prophet Muhammad (peace be upon him): ï¿½The consults are trusted, and revealing your brotherï¿½s secret is betrayal, so avoid it (Majlesi 77/89)ï¿½.
7- Necessary expertise and analysis; another example of medical virtue, is the necessity of expertise in a doctor when treating an illness. In the view of Islam, the medical work of a non-specialist is prohibited, and the Islamic system is responsible to prevent their work and if they disobey, imprison them. Imam Ali (peace be upon him) said: ï¿½It is the imamï¿½s responsibility to imprison criminal scholars and ignorant doctors (Tousi 6/319). According to this verse, physical posing doctors are as dangerous for the Islamic society as are the spiritual posing doctors and a non-specialist doctor, if practiced medicine and harmed a patient, in addition to the sin he has made, according to the responsibility act law, is answerable. Imam Sadegh (peace be upon him) said: ï¿½Each worker and professional who accepts the payment for a correct job and does not do so, is responsible (Hindi 10/32).
8- Responsibility in screening for patients; recognizing the ill and the phenomenon of patient screening, is one of the important factors which has a basic role in the doctorï¿½s spirit of seriousness and compassion. One of the important traits that Imam Ali (peace be upon him) has mentioned for a true doctor, is circulation, or in other words, him being constantly in movement to find the ill. He said: ï¿½There is a doctor who constantly circulates with his medicine and cure, creates and uses his medicine strongly and with wisdom, and prepares his burning tools. Wherever needed, he places his ointments and burning tools on it, which includes blind eyes, deaf ears, and closed tongues. This spiritual doctor follows and treats the illnesses below, with his medicines and cures. Positions of ignorance and bewilderment resources, which their owners were not enlightened by the light and wisdom, and not provoked from the burners which are science and brilliant education; so they are like cattle eating, or impenetrable like hard stones (Nahjolbalaghe, sermon 107). In this word, the circulating doctor could be the Prophet Muhammad (peace be upon him), or Imam Ali (peace be upon him) himself, which were constantly circulating with their medicine, and went to the ill and patients themselves. Ibn Abi al-Hadid stated in the explanation of this speech, that because every itinerant doctor has more experience; the circulating trait has been chosen for the doctor, and continues: ï¿½The righteous circulate so they could now the illness in their heart, and cure them (Ibn Abi al-Hadid 7/183)ï¿½. Therefore each doctor must be in constant circulation. It is quoted from Jesus (peace be upon him) that said: ï¿½The doctor must go to his patient (Haman)ï¿½. This matter indicates that sometimes it is needed for the doctor to go to his patient, because when the illness is physical, based on the body symptoms, the patient feels the need to go to a doctor, but many illnesses which affect the heart, spirit and soul, have no physical symptoms; Imam affects the life of the patient in a vast area. The patient does not know his/her illness. Itï¿½s like he/she does not see any illness to feel the need toward a doctor. This is when a true and spiritual doctor must go after the patient himself, detect their illness and cure them.
9- Seriousness of the disease diagnosis; in the Holy Quran and honorable hadiths, the seriousness and effort of the human have been heavily emphasized. The Holy Quran says: ï¿½There is no interest for a human besides from his diligence (Najm 39)ï¿½. Also Prophet Muhammad (peace be upon him) said: ï¿½Whomever of you does something, must secure (firm) that action (Koleini 3/262). These verses emphasize the need of diligence and seriousness to induct a good job; but because the issue is saving the life of a human being, the emphasis on the diligence and seriousness is doubled. Maybe we could affidavit to this holy verse about the need of seriousness in the case of human life and health, which said: ï¿½Whoever kills someone without the right, or without it corrupting and intriguing the earth, it is like he killed all the people, and whoever saves one (from death), itï¿½s like he saved all the people (Maedeh/32).
One of the most important customs proposed in the field of medical ethics, and has a basic role in doing a good job and compliance of medical ethics, is caring about the correct disease diagnosis. Imam Sajjad (peace be upon him) said: ï¿½Whomever his illness is not recognized, will be destroyed by his medicine (Maedeh 32)ï¿½. Nowadays, itï¿½s constantly heard that because of a wrong diagnosis from a doctor and the prescription of inappropriate medicines, an illness is resonated, or sometimes even the patient has died. Following medical ethics demands the doctor, to use all his might in diagnosing the disease, and avoid the prescription of medicine before the correct diagnosis, and if he does not have the required time, or he is tired, or for any other reason, he is not prepared to comment on the matter, and must seriously avoid examining the patient and prescribing medicine.
The above summery was a skimming on the true treasurer of The Holy Quran and Hadith from the imams regarding medicine ethics basics; which demonstrates that this issue was a true concern over centuries and is can be categorized into 3 subjects: virtue, well-wishing and enthusiasm; mostly derived from Imam Ali (Peace be upon him) words. These concerns can be the basis of medical ethics educations and propagate a more global medical oath under Islamic ethic rules. As demonstrated ethical codes have resulted from pre-Islam era; however, the final goal is to make guidelines which benefits most for humanity itself and the patients as well. The "Ahkams" which are the "Islamic Rules" are derived from similar information. Thus, we can concluded that by assisting Islamic rules, we can find an old brand-new medical ethic codes; which of course, needs a full supervised investigation in all Islamic recourses by both Islamic and Medical professionals.
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