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Enhancement

By:
Siti Nurani Mohd Noor
Source:
The Encyclopedia of Islamic Bioethics What is This? A comprehensive reference work covering the major issues in Islamic bioethics, including medicine, clinical practice, genetics, theology, and Islamic law.

Enhancement

Major advances in fields such as genetic engineering, neuroscience, and robotics have the potential to reengineer the human body and the human experience. They therefore challenge us to consider the ethics of human enhancement. Human enhancement can be defined as the application of technology to overcome physical or even mental limitations. This application of technology may result in either temporary or permanent augmentation of a person’s abilities and bodily features. In short, enhancement is any change in the biology of a person that increases the chances of leading what the person considers to be a good life (Savulescu et al., 2011).

Human enhancement is often associated with transhumanism, which views human nature as a work in progress, to be “remolded” into a variety of desirable and enhanced attributes. Transhumanists believe that innovations in medicine, science, and technology can transform Homo sapiens into “post-humans,” that is, beings with greater capacities than the humans of today. The transhumanist vision creates opportunities for people to live longer and healthier lives, to enhance memory and intellectual aptitude, with or without aesthetic enhancements, by overcoming basic biological limits. The US National Intelligence Council anticipates in its report “Global Trends 2030: Alternative Worlds” that implants, prosthetics, and exoskeletons will become regular fixtures of the human body. The use of psycho-stimulants will allow workers perform work better and for longer periods. Retinal implants can enable night vision, and allow people with degenerative eye diseases to maintain their sight into old age. Brain implants will “bridge the gap between mind and machine” and will provide “superhuman” abilities. Such endeavors would undoubtedly come with risks, as transhumanists themselves are aware. Social inequalities, compromised human relations, and imbalances in ecological diversity are among the morally vexing reservations associated with enhancement technologies (Bostrom, 2003).

In bioethics circles there is the argument that genetic technological intervention can enhance humanity’s ability to resist diseases, but what if it is used to modify us physically and physiologically to achieve higher standards of beauty, strength, and intelligence? There is, for example, a difference between using a biotechnology to increase the muscle mass of a patient with a degenerative muscle disease and using it to enhance the ability of an athlete to compete in a given sport (Parens, 1998).

This article discusses the Islamic ethical assessment of human enhancement. It begins with the claim that the issue may be looked at from the perspective of legal objectives (maqāṣid al-Shariʿah), an ethical framework that seeks to protect and preserve five essentials (life, faith, intellect, property, and progeny). As this article will show, Islamic law emphasizes bringing forth benefits and avoiding harms as an overarching principle. Furthermore, the matter of human enhancement may be looked at vertically, in which treatment of the matter is given categorical ethical reasoning, or horizontally, where the matter is given a broad or holistic approach.

The Convergence of Maqāṣid al-Shariʿah between Scientific Issues and Human Natural Law

Maqāṣid al-Shariʿah, also known as the objectives of Islamic law, aim to protect and preserve human life, faith, intellect, property, and progeny. These objectives form the ethical framework for determining various scientific issues, including human body enhancement, where actions are evaluated in light of anticipated benefits (maṣāliḥ) or harms (mafāsid). Maqāṣid al-Shariah are deemed in harmony with fiṭrah, which is the natural disposition and order that God has instilled in every human being. The fiṭrah thus refers to the physical and mental condition in which people have been created (Ibn Ashur, 2006).

To determine the appropriateness of bodily enhancement, a thorough scientific investigation is required. This is no simple task, especially since a “pure benefit” of the procedure is not always clearly evident. Maqāṣid are geared toward the consideration of benefits, with emphasis on long-term implications. Such benefits must also be clearly explained or defined to enable public comprehension and acceptance. Ultimately, consideration of the maqāṣid must show benefits for the society as a whole rather than to the individual only. (Ibn Ashur, 2006).

The prioritization of benefits may be divided into three categories, namely ḍarūriyyāt (the essentials), ḥājiyāt (the complements), and taḥsīniyyāt (the enhancements). Ḍarūriyyāt encompass the basic needs required for humans to live and perform religious obligations. The five essentials consisting of life, intellect, faith, property, and progeny, collectively referred to as the five essentials (al-ḍarūriyyāt al-khams), are acknowledged as critical for the protection and preservation of human dignity (Kamali, 1994). Ḥājiyāt pertains to the betterment of living, and includes the consideration of things that eliminate mild hardship and so as to allow life to flourish. Taḥsīniyyāt includes all benefits that can bring human life toward perfection, but must not deviate from acceptable norms and behaviors. It is typically a ruling of last resort, when all else fails. Many examples can be given here, among which would be organ transplant technology, which has not only saved lives but enabled people born with disabilities to lead a healthier life. Medically supervised nutritional supplements are also in this category. The consideration of matters must be made from the perspective of ḍarūriyyāt as the first order of priority, followed by the ḥājiyāt and taḥsiniyyāt (al-Qaraḍāwī, 1996).

Horizontal vs Vertical

Maqāṣid al-Shariʿah are founded on the understanding that intrinsic within Islamic law is the recognition of important objectives that must be pursued. It must also be understood that interpretations among jurists often differ due to the fact that there are two approaches of moral reasoning, namely formalist (shaklī) and objectivist (maqāṣidī). Formalist thinking may be described as micro-thinking, detailed and vertical in nature (i.e., derived from authority figures). Objectivists, by contrast, offer a macro or holistic treatment of issues, often more pragmatic, more liberal, and horizontal, i.e., worked out among a group of people. Particular circumstances, however, must be given clear, careful, and balanced thought so that the maqāṣid may not be manipulated to make the “unlawful appear lawful” (Abdul Majid, 2014).

The Human Body, Enhancement, and Islam

There are several instances of medical interventions where reference to ḍarūriyyāt, ḥājiyāt, and taḥsīniyyāt is made implicitly, as is the case with vaccination and genetic screening. Both represent interventions to the natural human body system. In the Islamic tradition, the human body is acknowledged as the best of God’s creation, with no need for alterations: “….God’s handiwork according to the pattern (fiṭrah) on which He has made mankind, no change [is allowed] in the work of God; that is the standard religion, but most among [humankind] understand not” (Qurʾān 30:30). However, given the fact that vaccines and genetic therapy can prevent illness, which are anticipated harms, jurists are obligated to consider their anticipated benefits as well.

Medical treatments are often described as reactive, meaning that they are sought after a person gets sick. Vaccination presents an intervention that is typically given well before a disease sets in. It is in essence proactive, and is about managing human health in a systematic manner, such that the individual may proceed through his/her life without impediments.

Vaccination has been a subject of great controversy in contemporary Islamic discourses. Some Muslim scholars still oppose vaccination, although objections have largely been subdued, thanks in part to concerns over sustaining populations that are particularly vulnerable to pandemics. Life-threatening diseases such as polio, dysentery, and tuberculosis have been virtually eliminated in most parts of the world, and developing Muslim nations in particular have benefitted from vaccination campaigns. Such vaccinations are deemed permissible by many Islamic scholars on the basis of the principle that necessity makes the unlawful permissible (Jegede, 2007; Kaufmaan, 2009). Here is an instance where the norm of ḥājiyāt has been regarded as a ḍarūriyyāt. The permissibility of vaccines has helped Muslims to achieve the objectives or the maqāṣid. In other words, the person is able to carry on his or her normal daily activities and duties, thus preserving his or her faith, life, intellect, property, and progeny.

In this sense, vaccination (as a type of enhancement) has been helpful in bridging the gap between impoverished nations and developed nations through actions concerned with raising the quality of human lives and whole communities.

Within the general Islamic ethical framework, genetic screening (e.g., premarital genetic screening) is generally regarded as acceptable in Muslim communities. Screening is a preventive measure where the objective is to sustain certain communities or groups that may be susceptible to particular diseases. Some Muslim-majority countries (such as Bahrain, United Arab Emirates, Saudi Africa, and Malaysia) have gone further by making premarital screening mandatory so as to protect the progeny and foster the well-being of future generations. The same purpose lies behind other interventions such as prenatal screening, which includes preimplantation genetic diagnosis—particularly among high-risk groups (El-Hazmi, 2005, 2007). These sanctions represent a general acceptance of biomedical intervention to nurture health and prevent disease as well as physical abnormality or deformity.

At this point, it is necessary to mention the Qurʾānic injunction to protect and preserve human lives: “Whoever kills a soul for other than manslaughter or corruption in the land, it shall be as if he killed all of mankind, and whosoever saves the life of one, it shall be as if he saved the life of mankind” (5:35). With this foundational passage, Islamic scholars and leaders have aimed to ensure the sustainability of Muslim populations by rigorously considering, through the method of ijtihād, the permissibility of human enhancement technologies. Relevant juristic deliberations often explore the question of whether there were historical precedents that may provide support for modern enhancement procedures. This is especially important with regard to interventions that fall beyond the scope of medical needs.

Precedents of Human Bodily Enhancement and Contemporary Islamic Bioethical Discourses

The subject of human enhancement in Islam may be related to specific historical events and precedents. For example, Mohammad Albar (1996) and others found that classical juristic discussions on bone and tooth transplantation provide important precedents in support of transplantation in general. Starting in the 1960s, the use of skin grafts from corpses to repair disfigurement was largely accepted in the Islamic world. In another example, the Grand Mufti of Egypt approved of corneal transplants on the ground that the practice was “a means to regain and accentuate a person’s vision” (Albar, 1996). Cadaveric organ donation, however, raises concerns over desecration of the dead body, which is frowned upon in Islam. Notions of bodily integrity, human dignity, and moral existence are closely related in Islam (Alahmad and Dekkers, 2012). The integrity of the human body is commanded even after death, as given in rulings that call for the respect of human corpses. Procuring of organs from deceased persons is seen as problematic when linked to these Prophetic reports: “Breaking the bones of a dead man is [as forbidden as] breaking the bones of a living man.” This particular ḥadīth is invoked by many scholars to imply that the body of the dead must be treated with gentleness as the dead are regarded as sentient beings that feel pain. This argument has been the basis for many objections against postmortem procedures on Muslims (Gatrad, 1994; Gatrad and Sheikh, 2001; Gurley et al., 2011). At present the rule regarding the sanctity of the human body still holds in many Muslim-majority countries. In general, organ transplantation is allowed only when it is explicitly established that transplantation is the final attempt after other treatment methods have proved futile. In these cases, utmost respect and procedural care must be given to the deceased donor especially when extracting organs.

These examples may illustrate the Islamic sanction of human enhancement technologies that aim to maximize human benefits (al-Qazwīnī, 1978). Moreover, use of forbidden materials, such as animal tissues, has been approved by some scholars, as demonstrated in the example of porcine bone grafts rather than other types of xenografts (Padela et al., 2014). The intention to maximize human benefits is in keeping with the Qurʾānic passages indicating that the human being is created in the ideal form (95:4, 32:9, 67:23, 82:7) and humans are entrusted to take care of the body (Sachedina, 2009). Muslims are encouraged to seek medical intervention to promote health and cure illnesses (24:61, 2:10, 2:196, 24:50). The Prophet is further known to have said: “There is no disease that God has created, except that He also has created its treatment” (al-Bukhārī, 2000, ḥadīth 5678) These statements in the Qurʾān and the ḥadīths are to be regarded as strong propositions to safeguard the health and welfare, both physically and spiritually, of human populations. The issue of organ transplantation must be taken as reflective of the aims of maqāṣid al-Shariʿah to protect and preserve human lives.

Bodily Bodification and Fiţrah

The issue of needs (ḥājiyāt) cannot be discussed separately from the issue of luxuries (taḥsīniyyāt) when considering the ethics of human enhancement technology. Human enhancement may be regarded as a human need and not strictly human refinement. For this purpose, one would have to consider Prophetic injunctions regarding surgery performed on healthy, functional parts of the body, and here we will address the ethics of male circumcision.

Some sources indicate that the return of humankind to the state of “fiţrah,” which is the original state in which humans are born, entails following hygienic practices. Among these practices, many consider male circumcision to be essential for promoting hygiene. While the ethics of male circumcision may be seen as a ruling related to hygienic reasons, the notion of cutting a part of human body is viewed in the Islamic tradition as returning the body to the state of fiţrah—its natural, uncontaminated state. One ḥadīth in particular is often cited to clarify the issue: “Five practices are characteristics of the fiţrah; circumcision, shaving the pubic hair, trimming the moustache, clipping the nails, and depilating the hair of the armpits” (al-Bukhārī, 2000, ḥadīth 5891).

Cutting the penile foreskin is regarded as obligatory by Shāfiʿī and Ḥanbalī jurists. It is, however, considered non-obligatory but highly recommended by Mālikī and Ḥanafī jurists (Gatrad and Sheikh, 2008)

The permissibility of orthodontic or cosmetic transformation of the teeth is another example of enhancement intended to promote hygiene and aesthetic appearance. In the past, jurists excluded the trimming of the eyebrows, which constitutes changing the physical appearance of the face of a person.

Though some debates remain, plastic surgery to improve a person’s appearance have been generally accommodated on the grounds that God appreciates beauty (Rispler-Chaim, 1993). The removal of a facial mustache on a woman is encouraged, in part so that there is no confusion over her gender. Sex reassignment surgery on infants with ambiguous genitalia or DSD (disorder of sex development) is allowed for Muslims (Mohamed and Noor, 2014). In 1989 The Permanent Scientific Research and Iftaʾ Committee or al-Lajnah al-Dāʾimah li-al-Buḥūth al-ʿIlmiyah wa-al-Iftāʾ in Saudi Arabia declared that sex assignment surgery (SAS) is allowed only for the intersexed or DSD individuals if “there is high guarantee of the proper establishment of the ‘rightful’ sex of the individual postsurgery.”

In contrast, some have argued that sex reassignment surgery is in fact compatible with fiţrah, as the procedure can be considered a returning to the rightful place. This interpretation emphasizes the idea that changing the human form in this manner benefits the person in a way that allows them to gain a stronger sense of their (true) gender identity.

Islamic ethics of human enhancement must hence be substantially developed to support preservation and maintenance of good life not only on an individual level, but on a communal and global one as well. Considerations of public good or public interest is referred to as maṣlaḥah. It covers unrestricted benefits, which have not been regulated in the Qurʾān and the Sunnah, and for which no textual authority can be found. Kamali (1989) notes that this is synonymous with istiṣlāḥ (meaning to arrive at a decision by considering people’s well-being). Many modern Muslim scholars argue that we should therefore allow options for human enhancement technologies to protect and facilitate human cognitive, emotional, and physical well-being. But in doing so, scientists should be aware that such technologies should be used only to achieve and maintain a minimum level of accentuated health and fitness.

If human enhancement or bodily modification can bring forth the accentuation of the livelihood of the individual Muslim, or whole Muslim populations, it may be considered permissible. Regimented inoculation and immunization programs by health organizations in many Muslim nations are clear examples.

Some may argue that a brain implant to improve memory and academic performance could be equated with prescribing drugs to improve a child’s attention and concentration, or even with prescribed antidepressants for adults. Within the Islamic ethical framework, however, enhancement of the human intellect with the use of brain implants must be evaluated carefully in light of rigorous assessment trials. All the above considerations must be delicately considered with inference to the Prophetic command to protect and care for the human body: “…Your body has a right over you, your eyes have a right over you and your wife has a right over you…” (al-Bukhārī, 2000, ḥadīth 133).

Conclusion

Despite the varying opinions mentioned above, it is perhaps possible for bioethicists and scholars of Islam to agree that categorical prohibitions on bodily modifications may not work. The way to ethically address this issue is to ensure that good policies and governance are put in place to monitor the safety of the application of such innovations on the human body. The stark reality is that humanity in the early twenty-first century is poised to change at unprecedented speed with the advent of technological innovations, especially nanotechnology. Kurzweil (2006) aptly puts this in context:

This merger of man and machine, coupled with the sudden explosion in machine intelligence and rapid innovation in the fields of gene research as well as nanotechnology, will result in a world where there is no distinction between the biological and the mechanical, or between physical and virtual reality. These technological revolutions will allow us to transcend our frail bodies with all their limitations. Illness, as we know it, will be eradicated. Through the use of nanotechnology, we will be able to manufacture almost any physical product upon demand, world hunger and poverty will be solved, and pollution will vanish. Human existence will undergo a quantum leap in evolution. We will be able to live as long as we choose.

As science and technological innovations advance further, even newer ethical issues will be raised. Now is the time to be realistic and not deal with this issue from the vantage of whether it is right or wrong for individuals to undergo bodily modifications using this technology, but whether it will at all benefit communities, nation-states, and future populations. Vertical thinking must be balanced with horizontal and holistic application of the maqāṣid when discussing the implications of human enhancement technologies. Abū Isḥāq al-Shāţibī (d. 1388) warned that scholars who fail to make references to maqāṣid al-Shariʿah will be guilty of gross errors in their ijtihād (al-Qaraḍāwī, 2001).

An ethical framework that proceeds from the five necessities as pronounced by maqāṣid al-Shariʿah must encompass all implications of such a technology on the human race and human societies, and not merely focus on the individual person. At stake is the preservation of Islam; the survival of communities; the psycho-social health of human minds; the maintenance of legal social institutions; and the protection of the environment.

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