Islam and Bioethics
Technological development, the diffusion of information and constant scientific progress affect the proliferation of ethical problems. They are addressed by the arts, music, cinema, literature. They form part of our daily life. Social media platforms offer access to images and videos where stages in the development of science and the use of modern technology are presented in a slightly more entertaining form (such as the following Elon Musk’s film). Those images, which not long-ago formed part of laboratory work and were not made public, raise questions in the public sphere which previously were reserved for specialists. Is it ethical to conduct experiment on animals? Where is the line between what is acceptable and unacceptable? What should be the criteria of such investigation? Videos posted on popular websites or on social media often contain content touching on bioethics dilemmas. Although such content becomes part of students’ everyday life, it does not always make them reflective. Bioethical issues form part of these challenges and, with progressing technologization, they more and more relate to almost every aspect of daily life. Even young people are familiar with concepts such as genetic engineering, human cloning, or nanotechnology – ideas previously reserved rather to the tight groups of experts or people somehow related to the processes than teenagers. Societies assess bioethical dilemmas based on their socio-cultural background.
The perception of bioethical issues does not depend only on one’s own experience. Every culture has developed its understanding of bioethics with religion influencing people’s attitudes towards ethical dilemmas. For centuries human life and death has been at the centre of interest of religions, therefore people considering bioethical decisions may ask: what would be in line with a particular belief? What does my faith say about whether it is acceptable?
There are approximately 1.8 billion Muslims globally, representing about 24% of the total population, with about 25 million living in Europe. Abortion, in vitro fertilisation, use of alcohol, use of porcine material and blood in medicine, organ transplants, brain death or euthanasia are the dilemmas they may face any day. Islam is not a homogenous religion; it includes people from different countries with different traditions, languages, histories, and political interests (quite often mutually contradictory), therefore it is difficult to speak of a common and uniform approach to all problem issues. Within what is understood as Islam, various religious sects may differ in their interpretation of the same phenomena. Interpretation is influenced not only by the two primary textual sources of Muslim legislation (Quran and Sunna – traditions and practices of the prophet Muhammad) but by this cultural mosaic that is the essence of Islam. Therefore, the approach to bioethics from religious perspective might differ in Malaysia, Italy, the USA or Oman.
Islam is not a hierarchical religion. There is no institution overseeing the religious order and issuing official announcements concerning the faith or a person holding a position similar to that of the pope. Islam is both a faith and a political tool. Religious perspective on bioethical challenges can be quite flexible. Islamic bioethics was codified gradually. In case of any ethical dilemma, a question is sent to an Islamic jurist (faqih) or selected committee of Islamic scholars, which together with health authorities would seek the answer and create guidelines (and apply them as a ruling policy if such action is required). Depending on the Islamic fraction, scholars use different tools to create legislation. Nevertheless, it is with the same aim reflected in Muslim doctors’ oath of “protecting human life in all stages and under all circumstances, doing [one’s] utmost to rescue it from death, malady, pain and anxiety. To be, an instrument of God’s mercy all the way, extending medical care to near and far, virtuous and sinner and friend and enemy” (Wahaj D Ahmad, Ahmed Kadi, Sinai University Oath of a Muslim Physician “Journal of the Islamic Medical Association of North America”, Vol. 20, No 1, 1988, p. 11-14.)
From an Islamic perspective, gaining knowledge is a responsibility of every human being. This expertise should be used to fulfil duties towards society, which in the case of the doctors is not to harm a patient and act in his/her best interest. Among the most important rules that a doctor must follow, preventing a disease is as important as healing. In this context, it is essential to highlight that even if something is forbidden, it may be approved when necessary, as human life should be considered a top priority from Islamic perspective. God is the only one responsible for a person’s life creation and death. Life, as a gift, should be treated with dignity. Such dignity extends to the human body, which should not be deformed. The combination of caring for body and mind is also manifested in the sacred texts which promote a healthy way of living (fasting, abstinence from alcohol consumption or any psychoactive substances, bathing, ablution, diet, etc.).
Family planning
Having a child is a gift. It is viewed as a value of family life and carries a whole range of additional meanings, whereas having no offspring means stigmatisation. The status of women is built on fertility, while the status of men is built on paternity. Therefore, the lack of children is stressed, especially since it is impossible to achieve maternal status through adoption. Despite so much emphasis on having children, family planning to prevent pregnancy is allowed. The Qur’an does not explicitly refer to contraception or family planning, nevertheless as per hadith, preventing conception is acceptable, as long as it does not have a permanent effect. Natural birth control planning, condoms, and hormonal methods are allowed in such circumstances. Only irreversible means such as vasectomy or tubal ligation are not permitted unless carried out for medical reasons. Among the reasons mostly approved by scholars are health risks to the mother/child, avoiding pregnancy of a sick wife, avoiding transmission of diseases, avoiding economic difficulties that make proper raising and education of the child impossible. In some countries, responsible parenting is also promoted at the state level. In Egypt, contraceptive pills are primarily subsidised by the government (you can buy one for € 4).
Abortion
Islam prohibits abortion but allows for exceptional situations. Experts in Muslim law take different positions on the abortion of foetuses in which defects have been detected. However, it has not been expressly stated what kind of severe disorder permits abortion. Majority of scholars who allow abortion set a time limit which cannot exceed 120 days from conception. That limit is based on a reference to one of al-Bukhari’s hadis stating that “after 40 days in the womb he becomes a clot of thick blood for another 40 days, then he becomes a piece of flesh for 40 days, then the soul is breathed into the person.” For contemporary Islamic bioethicists, the most critical issue in permitting abortion is when the human being receives a soul, for only after that moment would abortion be tantamount to murder, i.e. forbidden.
In Vitro and Cryopreservation
From an Islamic point of view, the storage of embryos, sperm and ova is permitted. Embryos are considered to belong to the donors of genetic material, therefore, it is the genetic parents who decide what to do with them. The purpose of gene material is twofold. First, it can be used for subsequent in vitro fertilisation procedures. Second, it can be used for research to develop assisted reproductive techniques and treatments for infertility. Embryos can be used as long as the couple remains married. The divorce or death of one of the spouses precludes their subsequent use. However, one of the grand muftis of Egypt, Nasr Farid Wasil, allowed a widow to use the genetic material of her late husband at the request of his family. A woman is not allowed to use frozen embryos after menopause. Pregnancy at this stage of a woman’s life is considered a health risk for the mother.
From an Islamic perspective, the use of modern reproductive technologies is permitted because it is thanks to God that man could discover methods to assist in fertilisation. According to hadith, the only cure for which God has not given a remedy is old age, therefore the development of medical practice in Muslim communities is an obligation stemming from the commandments of God. In Islam, the divine mystery of creation does not cause ethical problems regarding in vitro fertilisation. Medicine itself does not serve to create but to use what God has given to human beings. Therefore, man can only combine what God created: the ova and the sperm.
The genetic material used for fertilisation must come from married persons. The collection of genetic material from third parties is prohibited, as it would constitute an act of adultery. However, in Shia perspective, it is allowed to use the sperm/ova of a stranger with the proviso that such a child will legally belong to those who donated their genetic material and may therefore be excluded from the inheritance of the parents who are raising the child.
Surrogacy
For both Sunni and Shia, surrogacy is strictly prohibited. In religious-legal texts, surrogacy is referred to as “uterine rental” and is expressly condemned. It is forbidden as it may lead to a dilemma when determining which woman is the child’s mother. It is not permitted to place sperm, ova or embryos in surrogates’ uterus. However, in 1985 the so-called “polygynous surrogacy”, i.e. a situation when one wife is a surrogate mother for another who cannot carry a pregnancy, was authorised.
Euthanasia and Suicide
The Quran does not contain a uniform description of the origin of man. In the accounts of the act of creation, emphasis is placed on the matter from which man was formed. Alongside the physical elements, such as flesh and bones, the soul is essential because it is the life-giving factor. Death consists of the separation of the soul from the body. Every human being is responsible for their life. Nevertheless, life is given by God and cannot be taken away except by him or with his permission. The human’s body is a gift from God, and such a gift cannot be devalued. Everyone who intentionally ends his life shows disobedience to Allah and won’t enter paradise. However, the martyrs, those who fight for the cause of God, seem to be an exception. In this category, it is important to point to a strict distinction between terrorists and martyrs fighting for their freedom.
Transplantation
Bioethical dilemmas regarding the transplantation of organs are related to the Islamic understanding of death and the idea of the Last Judgement. As per Islamic law, cremation is forbidden because the body which human was given raises the responsibility before God. It was delivered with trust from God and it cannot be changed without God’s will. It cannot be deformed nor mutilated as such an act would be considered an aggression. Moreover, scholars do not agree whether it should be treated as death (most transplants are carried out from patients with brain death). The classical interpretation is based on the idea that human dies when the soul leaves the body. Quran and Sunnah are silent on both matters.
Nevertheless, Islamic scholars agree that in the moment of death, the soul separates from the body to be reunited on Judgment Day and therefore the body shouldn’t be mutilated. At the same time, people are obliged to take care of their lives and do everything to preserve the life. This obligation is used by many scholars to accept transplantation upon specific condition: it may be performed if it is the will of an alive donor to save a life (except for vital organs such as heart). In such case, a transplantation cannot put a patient at risk. Post-mortem transplantations are also allowed, but only when the donor had previously agreed. Transplantations from brain dead patients are still controversial with Islamic fractions intensely disagreeing.
Genetic engineering/research
As is the case with the above-mentioned contemporary bioethical dilemmas, there is no unity regarding the acceptance of genetic engineering. Most scholars agree that it should be allowed as a disease prevention, but only if such actions cannot cause any damage. Moreover, genetic engineering must not be used as a tool to improve humans or in any illegal activity. For example, genetic material for research procedures can be obtained and used only with the consent of the donors. Research on embryos should be limited to therapeutic purposes. If embryos are used for another research, implantation is prohibited. Research for commercial purposes is not permitted. Moreover, it should be carried out only by qualified professionals in research centres.
Cloning belongs to the group of procedures considered the most controversial. First, reproductive cloning is tantamount to going against the fundamental belief that God is the only and the best creator. Only God may give life and may take it back. Additionally, in the case of a genetic replica of a human being, the lineage becomes broken, leading to many socio-cultural consequences. Moreover, such procedures could increase interest in creating perfect children which is against Islam rules. Creation is based on existing differences, whereas cloning may lead to elimination of them. Some scholars are interested in allowing therapeutic cloning. It is permitted to apply genetic engineering processes (and cloning) in the fields of microorganisms, plants, and animals.
Animal testing
Bioengineering is strictly related to animal testing. As per Islamic teachings, people should be responsible for taking care of animals because God loves all creatures. Nevertheless, human life has a priority and has more value. Therefore, animals may be used to save human life. The possibility of saving human life is of such great importance that in order to achieve it, even process which normally is forbidden becomes sanctioned. For example, the Quran explicitly states that “Forbidden to you (for good) are: dead meat, blood” (5:3) and that “He has only forbidden you what has died by itself, blood and pork” (2:173). Nevertheless, if it’s required to save a life, the forbidden becomes licit. If a medical procedure requires applying substances of animal origin (such as pigs), they may be used. Ingredients of animal origin are often used in medicine, e.g. insulin, heparin, gelatine-coated tablets. Islamic scholars approve their usage when there are no substitutes. Moreover, as the awareness among Muslim patients and doctors of the need for medicines and medical materials to be “halal” (i.e. compatible with Islamic teachings) grows, so does the pressure at researchers to develop alternative solutions.
Research based on forbidden animals is licit because animals can be used for human benefit. If all precautions are taken to prevent harming animals, Islamic scholars allow bioengineering plants and animals. Doubts are solved by fatwas (legal opinions) issued by the most reputable legal centres in different parts of the world. Such opinions serve to confirm which procedures can be used, to assure their safety and concordance with religious teachings. Recently such a fatwa, regarding treatment of those suffering due to COVID-19, was issued in the United Arab Emirates. It confirmed that no controversial ingredients were used to produce the vaccine and stressed that even if such materials were used, administration of the vaccine would still be permissible.
