Welcome to Mapping out an Islamic Bioethics: An Intensive Workshop The Initiative on Islam and Medicine at the University of Chicago
Housekeeping Items Registration Desk: Name Badges Course Packets Readings, Information Material, Evaluation Forms Box of Sweets Course Evaluations Everyone fill out session evaluations and return to desk CME (APPNA Members online; Non-APPNA @ desk) Food Refreshments outside Boxed Lunch & Friday Prayers
Seminary T ran s l a t i o n Muslim Community Healthcare System I s l a m Academy American Muslim Health
The Initiative on Islam & Medicine Methodology: - Bring together religious scholars, Islamic studies experts, medical and social scientists to fill in the knowledge gaps around Islamic bioethics - Host intensive workshops, symposia and conferences that disseminate this new knowledge
Overarching Goals for Course Gained conceptual literacy in Islamic Bioethics Equipped with tools for researching and applying Islamic moral frameworks to the practice of medicine Increased interest in studying at the intersections of Islam, healthcare, and bioethics
Words of Gratitude Program on Medicine & Religion Dr. Dan Sulmasy Maha Ahmad MacLean Center for Clinical Medical Ethics Dr. Mark Siegler American Islamic College Dr. Ali Yurtsever II&M Staff & Volunteers Caitlin Ajax Hadiyah Muhammad Hana Ahmed Milkie Vu Community Donors Others All the lecturers and all my teachers/mentors
Vision of the II&M To become the leading center for study, dialogue, and education at the intersection of the Islamic tradition and biomedicine
Background Islamic Bioethics Newly birthed field of academic inquiry with interest from many corners Lack of clarity about the Islamic What content qualifies as Islamic (labelling activity) à implications for methods of derivation and research Questions about scope and nature of bioethics Challenges related to the multi- and interdisciplinarity of bioethics
Pedagogical Approach Balancing Acts Knowledge: Theoretical and Practical Presentation: Didactic and Narrative/Casebased Disciplinary Focus: Theology and Sociology
Islamic Bioethics Literature
Chicago
Course Overview Day 1: Survey of the field Actors & Material- Practical Lens Typology for end-users of Islamic bioethics literature What is Islamic Bioethics?- Theological Lens Discuss moral theology à informed review Many Methods - Research Lens Empirical and theoretical methods of bioethics Case Study of Brain Death- Applied Lens Dialogue between clinicians and Islamic scholars
Course Overview Day 2: Deep Dive into the Islamic tradition Fiqh to Tasawwuf Tools of Islamic Ethico-legal Tradition Doctrinal Considerations Locate ethics within various aspects of the Islamic ethico-legal tradition Epistemology of the normative in Islamic law Lived Experiences Social Historical Perspectives on Islamic bioethics from Iran and Oman
Course Overview Day 3: Applied Islamic Bioethics A foot in both worlds- Practical Lens Comparative Perspective on Clinical Medical Ethics Researching and Reading - Tie loose ends by looking at typology of Islamic bioethics producers and literature
Anybody else?
Reporting on Islamic Bioethics in the Medical Literature: Where are the Experts? Shanawani et al Papers reviewed from 1950-2005 Islam or Muslim & Bioethics à 146 papers Authors: 39 from Middle East 29 from the US Content: Only 11 mention more than 1 universal Islamic position 5 mention concepts/sources of Islamic law
Who is an Islamic Bioethics Expert?
Islamic Bioethics Experts? Knowledge Requisites Medical Science Muslim MDs and Professional Organizations Islamic Ethics & Law Imams who counsel Muslim populace Professors of Islamic Studies Bioethicists JDs, PhDs, MDs
Current State of Discourse Producers of discourse: Many different disciplines engage with different goals and expertise à Silo problem with little cross-talk Contestations over Islamic and Bioethics No central repository of material Writings often do not meet practical needs nor are scholarly robust
National Survey of American Muslim physicians 55% never or rarely read Islamic bioethics books 64% never or rarely consult Islamic jurists 79% never or rarely look to Islamic medical fiqh academy verdicts
77% never or rarely seek guidance from Imams when facing a bioethics challenge 95% of Muslim docs never assist Imams with bioethics cases
Many Consumers Muslim patients Concordance between medical care and Islamic regulations Muslim healthcare providers Islam does influence medical practice - an Islamic ethos Religious leaders To advice clinicians and patients regarding biomedicine Healthcare institutions Culturally-sensitive care that improves quality Policy and Community Stakeholders Advocate for a more culturally accommodating healthcare system
Discursive Partners Social Science Clinical Practice Islamic Law (fiqh, hukm) Inputs Medical Sciences An Islamic Bioethics Moral Theology (usul al fiqh) Philosophy & Bioethics Health Policy Ethics (Adab)
Terminology What is Islam? Tradition with community Bearers of understanding Living out practice End-goal What makes something Islamic? Sources Signification
Terminology What is (Bio)ethics? Conduct with a goal in mind Right/Good Relating to bio/med/health
Revelation (wahy) Core Concepts Matloo à Qur an Ghayr matloo à Sunnah An Islamic Bioethics Revelatory guidance for human behavior relating to bio/med/health that accords with the good / right
What is right/good? Ethics in Islam Labelling authority vs. Characteristic of action Ashari vs. Mu tazali; Maturidi theology Theological voluntarism or Deistic Subjectivism God s commands are purposeful and generally for the benefit of mankind
End Goals What is the result/aim of ethical action?
Ethics in Islam What can I do à What should I do? Islam (minimum) à Ihsan (optimum) Role of fuqaha = move community from sin
Obligatory Permissible Forbidden Supererogatory Discouraged
Islamic ethico-legal deliberation Usul (sources) Textual- Quran & Prophetic example Formal- Qiyas (analogy) & Ijma (consensus) Secondary Sources- Istishab, Urf Maqasid (objectives) Protection of life, religion, intellect, property, honor Maslaha (public interest) Qawaid (maxims) Hardship calls for license Dire necessity renders prohibited things permissible
Terminology Islamic Bioethics: Tied scriptural sources & bearers of tradition with 2 genres Fiqhi Literature = permissibility of therapies along an ethico-legal gradient Adabi Literature = inculcating of virtue-based practices Muslim Bioethics: Sociological study of how Muslims respond to ethical challenges with Islam as one input
Terminology Muslim Bioethics: Sociological study of how Muslims respond to ethical challenges with Islam as one input Applied Islamic Bioethics Research: Bridges Islamic & Muslim bioethics methodologically Examining the ways in which material of Islamic bioethics is understood and applied by consumers Examining the translation of biomedical concepts into edifice of Islamic law
End-of-Life Care Ethics What are the relevant questions? Goals of care Moral culpability of actions Patient Family/Surrogate Physician
National Survey of American Muslim physicians 31 % Do Not Know if life support can be discontinued at the end- of- life in Islamic law 70% are psychologically troubled by withdrawing life support 54% Brain Death Not = Cardiac Death 31% Do Not Know whether tube feeding can be withheld at the end- of- life
Purpose: Harvard Criteria- 1968 to define irreversible coma as a new criterion for death. Ethical Premise Medical care is futile and a waste of resources Medical experimentation, e.g organ transplant, is ethically sound in order to bring benefit to others
Signifies: Constructing Brain Death complete loss of the brain s critical functions a prognostic masquerading as a diagnostic entity It is NOT total brain failure Pituitary gland, hypothalamus may continue to function Some brain functions may return
Brain Death complete loss of critical functions of the brain Conceptualization à Diagnostic Criteria Legal Community à Whole-Brain (US) Medical Community à Brain-Stem (UK) Philosophers à Higher-Brain Brain-death = death in West [cultural consonance?]
Death In the Islamic Tradition Death is the occasion for several communal and individual obligations Theologically Legal Death occurs upon departure of the soul Dying is not dead Intermediate states- hayat ghair al mustaqirr
Applying The Verdicts OIC-IFA BD is Legal Death all vital functions of brain cease irreversibly and the brain has started to degenerate IOMS unstable life if a person has reached brain-stem death some of the rulings of unstable life apply Withdrawal of life support is permitted
Proponents Ethico-legal Frames Maslaha used for creating BD on account of organ transplant Qa ida- Living take precedence over death Death determination is purview of MDs Detractors Istishab presume living until traditional criteria of death fulfilled Qa ida Certainty not eroded by doubt
Is BD truly dead? Jurists Concerns Communal Obligations ensue at death Moral Culpability for quickening death Medical Certainty
Vital Functions Gaps in OIC-IFA What are the vital functions? Irreversibility Some brain functions return No natural history of BD patients Verifying degeneration of the brain No protocol mandates tissue visualization
Gaps in IOMS What are the rights of and obligations due to someone in unstable life (dying)? What interventions can or cannot be performed? Maintain life support for pregnancy or organ preservation
Why the Gaps? Fatawa and their producers Practical Legists use machinary of fiqh to remove sin Deference to ahl al-khibrah for details Conceptualization May occur prior to fatwa and not written into Or systematized after collation of juridical opinions performed Hukm al-shay far tasawurih
When are Muslims obligated to seek treatment? Wajib/fard: Care is life-saving AND cure is certain Yacoub says this is consensus of early Sunni jurists
Contemporary Fatwa Council of the Fiqh Academy (Jeddah) about medicine: Obligatory (wajib or fard), if neglecting the treatment may result in the person s death, loss of an organ or disability, or if the illness is contagious and a harm to others Recommended (mandub), if neglecting the treatment may weaken the body Optional (mubah) if not covered by the preceding two cases Reprehensible, (makruh) if treatment causes worse complications than the illness itself
When are Muslims obligated to seek treatment? Answer: when treatment is life-saving When are Muslim physicians obligated to offer treatment? Answer: when treatment is life-saving
Other Conceptual Tools Life-saving in this context Quality of life Mukhallaf status is one where one is liable and can accrue acts of afterlife benefit Where there is doubt/difference of opinion no definite sin
Discursive Partners Social Science Clinical Practice Islamic Law (fiqh, hukm) Inputs Medical Sciences An Islamic Bioethics Moral Theology (usul al fiqh) Philosophy & Bioethics Health Policy Ethics (Adab)
Resources for Guidance Islamic fiqh academiesà qararat Fuqaha à fatawa Framing is everything!
Limitations of Fatwa-Hunting Method à Publication Bias Tool for Policy à Context-driven Ethico-legal Source à subject to the inherent limitations of the constructs Recognizing these shortcomings is necessary for Avoiding misapplication & misreading
Level 1: Research Methodology Encyclopedia of Islamic Bioethics Fiqh Academies Dar al Ifta Al Misrriyah Islamic Fiqh Academy of the Muslim World League (Jeddah) Islamic Fiqh Academy (India)
Level 2: Research Methodology Review Books by Islamic legal experts Topical reviews in Islamic Medical and Scientific Ethics Research Library at Georgetown University Level 3: Individual fatwas or opinion pieces Qibla for the Islamic Sciences (formerly Sunnipath) IslamQA,
Resources