Islamic Perspectives on the Principles of Biomedical Ethics

The following sections are included:

• Dedication
• Contents
• About the Authors/Participants in the Seminar Deliberations
• Introduction

This introductory chapter reviews the main attempts to formulate principles of biomedical ethics that are either compatible with the Islamic tradition or directly extracted from this tradition. To my knowledge, this is the first review of available studies on this topic, which is why I tried to make it as comprehensive as possible and to refer to each available study, although some of them may include considerable overlap and sometimes even repetition. The studies reviewed in this chapter were divided into two main groups. The first group addressed a specific set of principles introduced by Western bioethicists and tried to demonstrate its compatibility with the Islamic tradition (Instrumentalist Approach). The other group tried to develop a set of principles emanating from, and rooted in, the Islamic tradition itself (Indigenous Approach).

As biomedicine and its research and technologies globalize, they are accompanied by Principlism, the dominant Western bioethical theory. The Muslim response has roughly taken two tracks: (i) criticism of principlism as a neo-imperialistic attempt to universalize what is specific or (ii) harmonization of principlism with Islam by showing not only that the four principles (autonomy, beneficence, nonmaleficence, and justice) are universal, but that indeed Islam had, long ago, codified them in its ethico-legal tradition. In these debates, medicine and biomedicine are conflated and bioethics is reduced to principlism. This is problematic because biomedicine is but one medical system and principlism is one among several (feminist, religious, narrative, global) theories. This chapter examines some of the relevant critical questions to bring insights from the philosophy, anthropology, and sociology of medicine and of bioethics to bear on the current discussion on Islam and bioethics and the questions posed by the research Center for Islamic Legislation and Ethics (CILE).

This chapter explores how the higher objectives of Sharia (maqāṣid al-sharī'ah) could contribute to the application of the Sharia in today's reality, utilizing a few illustrative examples in the area of bioethics. The soundness of Sharia's application and related policies is subject to the degree of universality and flexibility of the Islamic rulings with changing circumstances, discussed from various viewpoints in this chapter. After a survey of the system of values that the higher objectives of Sharia represent, two reasoning (ijtihād) methods are explored: (i) differentiating between scriptural texts that are means (wasā'il) to higher ends and those that are ends (ahdāf) in their own right, and (ii) preferring a multidimensional understanding for the conciliation of opposing juridical evidences, instead of reductionist methods such as abrogation (naskh) and giving preference to one opinion over another (tarjīh). A number of examples are provided throughout the chapter in order to explain the impact of the proposed methods on contemporary Islamic rulings.

The principal subject of this chapter is the role that principles play in the so-called four-principles approach or principlism. The historical and textual background of the positions I will defend are found in Principles of Biomedical Ethics, which I coauthored with James F. Childress and in my recent book Standing on Principles. In the first section, I investigate the nature and sources of principles in recent biomedical ethics and provide an analysis of the four-principles framework. The second section is devoted to the central role played in the four-principles account by the theory of common morality, which is comprised not only of principles (and rules), but also of virtues, ideals, and rights. The third section shows how universal principles are fashioned into particular moralities and the circumstances under which moral pluralism is consistent with universal morality. The fourth section shows how general principles are made practical for particular moralities by being made more specific, as suitable for particular circumstances. Finally, in the fifth section, I show the relevance of principles for discussions of human rights, multiculturalism, and cultural imperialism.

This chapter is a response to the research presented by Tom Beauchamp regarding The Four Principles of Biomedical Ethics. The methodology adopted by the chapter will be an examination of these principles so as to determine their legal foundation, historical background, and the extent to which they can be considered comprehensive principles. This examination will be framed within an objective, constructive discussion aiming to achieve the goals of benefit and excellence as outlined by the research Center for Islamic Legislation and Ethics (CILE).

The four-principles approach became widely used in Western healthcare and academia. However, ever since its introduction, this approach has also evoked debate. How should the principles be interpreted? Is there a hierarchy between the four principles? To whom do they apply, i.e. to whom do we owe these moral obligations and who should be included within the moral circle? How can concrete action-guides be derived from the abstract principles? Are the principles indeed universal, as proponents argue? Are these general principles sufficiently sophisticated to function as a bioethical theory — pejoratively called “principlism”? In this chapter, I examine first the premise and challenges of each principle. Subsequently, I identify three debates regarding principlism as a bioethical theory and method: (i) whether a pluralist or eclectic approach is an appropriate one and if so, whether general principles are sufficiently sophisticated to function as a bioethical theory; (ii) whether there is a hierarchy in the principles; and (iii) how to arrive at concrete moral judgments from general ethical principles. I conclude with some future directions for the four-principles approach.

In our discussions we will be focusing on two main questions:

• What are the Islamic principles in bioethics?
• Are the four principles of bioethics, as defined in the West, universal?

After Tom Beauchamp presented his paper, the following discussion took place.

The main premise of this chapter is that ethics is an indivisible whole and thus cannot be divided into various segments, each of which may fit within a specific aspect of life such as medicine, politics, finance, or social relations. However, specific principles and values can be more highlighted in particular fields because they will work more efficiently and be more productive than other clusters of values and principles. This chapter is divided into two main sections. The first section elaborates on the position of ethics in Sharia and its higher objectives arguing that life in its totality must be based on ethics. The second section focuses on ethics in the field of medicine arguing that the medical field in particular cannot survive unless it is based on ethics. Two main virtues are highlighted in this chapter because of their relevance to the field of medicine, both of which constitute two major principles of Islamic ethics as well, to wit, God-consciousness (taqwá) and mercy (raḥmah). The chapter also touches upon the overlap between the higher objectives of Sharia and those of medicine. The main objectives of Sharia are protecting (ḥifẓ) the so-called five necessities, namely religion, life, offspring, intellect, and wealth. Three of these five represent the main objectives of medicine, viz., protecting life, offspring and intellect.

I read with great interest the paper of Sheikh Ahmed Raissouni who laid down an approach to medical ethics based on the higher objectives of Sharia. Sheikh Raissouni is an authority in the field of the fundamentals of Islamic jurisprudence (uṣū l al-fiqh) and the higher objectives of Sharia; hence his paper reflects his deep knowledge and understanding of this subject. I would like to emphasize a few points in relation to the issues discussed in his paper.

After Abdul Sattar Abu Ghuddah presented his paper, the following discussion took place.

This chapter is divided into three main sections. In the first section, the focus is on the great attention paid by Islamic Sharia to ethics as compared with schools of law from outside the Islamic tradition, which are usually exclusively concerned with rights and obligations from a judiciary perspective. The second section is dedicated to terminology and especially the distinction between two types of ethics, namely philosophy-based ethics and religion-based ethics. The third section introduces a list of the basic Islamic ethics in medicine, extracted from Islamic sources including the Qur'ān, the Sunna, and the writings of early Muslim physicians, especially the work of Abu Bakr Al-Razi Akhlāq al-ṭabīb (The Ethics of the Physician). The list consists of nine items: developing medical experience; the conformity of the physician's practices with the professional standards; having knowledge of Sharia-based rulings related to practicing medicine; God-consciousness (taqwá) and fear of Him; sincerity and dedication to work; modesty towards God and compassion towards the patients; truthfulness and honesty; practicing medicine within the limits of one's own medical specializations; and confidentiality.

I read with great interest the paper of Sheikh Abdul Sattar Abu Ghuddah entitled “The Governing Principles of Islamic Ethics in Medicine.” It is very well written and reflects the high scholarly standing of Sheikh Abu Ghuddah.

After Ahmed Raissouni presented his paper, the following discussion took place.

This chapter is divided into three main sections. The first section is an attempt to explain how the higher objectives of Sharia can be utilized to draft an Islamic version of biomedical ethics. Besides the well-known six higher objectives (viz., protecting religion, life, intellect, wealth, offspring, and honor), the author adds two others, namely preserving the integrity of the legitimate state and the integrity of society. The second section is dedicated to a number of legal maxims and rules by which the objectivesbased approach for the principles of biomedical ethics can be specified and applied with a considerable degree of precision. In this context, reference is made to legal maxims like, “There should be neither harming nor reciprocating harm,” and “Certainty cannot be overruled by doubt.” The author also makes reference to the so-called “jurisprudence of balances (fiqh al-muwāzanāt)” by which the possible clash between benefits and harms in specific cases can be avoided or resolved. The third section provides a list of virtues and etiquettes to which physicians should adhere, most of which can be summed up into two, namely professionalism (ikhtiṣāṣ) and sincere devotion (ikhlāṣ). The percept of confidentiality and the duty to keep all information between physician and patient private are also underscored.

After Ali Al-Qaradaghi presented his paper, the following discussion took place.

Tariq Ramadan

Our primary purpose here at the research Center for Islamic Legislation and Ethics is to address Muslims and Muslim societies, not to address the West. The West has arrived at principles of biomedical ethics, and we as Muslims living in Muslim countries are in need of a set of universal biomedical ethics produced from an Islamic framework. This is helpful in understanding our goals during this seminar.

We have been discussing the four-principle theory, which began in the West and eventually spread to the rest of the world. We will start this round of discussions with Dr. Bredenoord presenting a basic idea of the theory. If possible, she will also provide us with specific terms used in the English language and explain how we can classify them into main principles and subcategories so that we have a better understanding of some aspects about this theory that we have been struggling with so far. After Dr. Bredenoord's presentation, I will open the floor for discussion and commentary regarding the universal nature of these principles and whether they are compatible with Islam. This is the first point of discussion.

Taken as a field bioethics has its own history, one inextricably linked with advances in medical science in the West. As scientific and technical mastery have grown, medical researchers and physicians have been confronted with new ethical questions. At the same time, in an increasingly secularized world, religion has proved unable to be a reference for all and to answer these questions satisfactorily. Construction of an ethical framework, of a new norm of operational responsibility for contemporary society, became an indispensable task. Thus emerged ethics, and particularly bioethics, which concern us here: constructs derived naturally from the precepts of collective rationality, as distinguished by its internal logic and its autonomous moral justification, through which, to paraphrase Rawls, overlapping consensus can be reached.

The following sections are included:

• Glossary
• Index