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Secular Bioethics in Muslim Countries

By:
Anke Iman Bouzenita
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.

Secular Bioethics in Muslim Countries

This article offers insight into the background and historical context of secular bioethics and bioethics in the Islamic world. After a comparison is made between secular and Islamic bioethics in their origin, scope, and characteristics, various strategies of reception of secular bioethics in Muslim-majority countries and communities will be discussed. The final section of this article offers an outlook on expectable future developments in the field.

Background and Historical Context

In this article, “secular bioethics” is generally used as a synonym for bioethics of Western provenance, given that secularism is the foundational principle of these societies. The term “secular” in its historical meaning usually denotes the exclusion of revelation, religious scriptures, or religious institutions as a source of legislation. The notion of secularism and attitudes toward it are a highly contested field, not only in comparison between Western and Muslim-majority countries, but also within different regions and societal segments of the latter. In the West secularism is often associated with neutrality, diversity, and progress, whereas in Muslim-majority countries it is often reminiscent of a painful colonial experience and the forced alienation of Islamic concepts from the public sphere. The degrees of secularization, and responses to it, in the Islamic world vary greatly. We may showcase this phenomenon with the different strategies of reception of secular bioethics by Muslims today.

Bioethics in Western societies is a compromise arrived at via the contributions of a number of participants from various academic, institutional, legislative, religious, and professional fields. The inclusion of different religious denominations or ethnic groups does not however impair the secular character of bioethics, as the process of decision-making targets the benefit of the participants in accordance with the secular worldview.

Institutionalized bioethics and bioethics as an academic discipline have evolved since the second half of the twentieth century in the United States under particular societal circumstances, such as the civil rights discourse and the questioning of medical authority. However, concepts of bioethics are as old as human reflections on the life sciences and medical practice, and can historically be found in some form or another in every culture, religion, and legal system.

Prior to the period of European colonization, the Muslim world had a rich scientific and bioethical heritage, which included professional medical ethics. Different medical traditions existed in the Islamic world: most prominently, the Greek medical tradition (al-ṭibb al-yūnānī) and Prophetic medicine (al-ṭibb al-nabawī), which differ in their approaches and strategies for treatment. At times these traditions were blended. Certainly, the activation of this heritage was guided mainly by the Islamic worldview and embedded in different institutions in a largely Islamic culture. While hospitals were generally organized in the endowment (waqf) system and had their own budgeting and administrative structure, doctors’ professional guilds decided on questions of professional medical ethics, and state authority and the legal system controlled medical practice.

Modern technology-centered medicine and science entered the Muslim world as a Western import in the wake of colonization, decolonization, and the formation of nation-states. Along with it came bioethics as an academic discipline in its modern secular garb. As was characteristic of the era, Islam as a way of life—including Islamic bioethics—was not given broad-based attention until the 1970s and 1980s, when a renewed interest in the Islamic worldview was clearly perceivable on many societal levels and in many fields, including the medical sector. Transnational organizations such as the Kuwait-based Islamic Organization of the Medical Sciences (IOMS) and the International Islamic Fiqh Academy (IIFA) (both founded in 1981) were established in this era and began contributing to the Islamic evaluation of bioethical questions.

Bioethical discourse in Western and Islamic societies needs to be viewed against the background of their different historical perspectives and the role secularism has played in their respective development. While the Islamic experience generally saw science and technology evolving out of the Islamic way of life with medical ethics embedded in, and not hindered by, the injunctions of Islamic law, the Western (European) experience emphasizes the a priori need for secularization so as to initiate scientific development. Secularism seems therefore ingrained in Western approaches to science. Against this background, Western bioethics tends to insist on a secular imprint on bioethics. Bioethicists in Muslim-majority countries and in Muslim-minority communities elsewhere work with different historical and cultural experiences. Islam and its sources are still considered to be an important reference framework in Muslim countries and among Muslim populations. The communication of bioethical standards to various recipients therefore requires Islamic justification for legitimacy and acceptance.

Secular and Islamic Bioethics

Secular bioethics has hosted a variety of approaches. Deontological approaches, such as the Kantian approach in ethics, apply strict moral rules to concrete cases. Utilitarian approaches, built on the core principles of consequence, utility, hedonism, and universality, are very prominent in secular bioethics (Gordon, 2018). The principlism approach as developed by Beauchamp and Childress—with its reliance on the four principles of autonomy, non-maleficence, beneficence and justice—may be deemed the most influential approach in contemporary secular medical ethics. The model supposes the existence of a common morality that is presumably applicable to all persons in all places, and of particular moralities stemming from different sources that are needed to specify and complement the common morality (Beauchamp and Childress, 2012).

Islamic bioethics largely depends on Islamic law and its structure and is therefore characterized by the same casuistic approach, evaluating every case in light of the Islamic sources: the Qurʾān, the ḥadīth, or sunnah of the Prophet, and other accepted sources. In the absence of definitive texts from the Qurʾān and the sunnah to answer a particular question, there is ample potential for a variety of verdicts on any given case. The potential for diversity of opinion at the intersection of different legal schools and methodologies is inherent to Islamic bioethics. Different views therefore exist in more or less all bioethical questions. Choices made by transnational bioethical organizations, such as IOMS; by institutions involved in giving bioethically relevant verdicts, such as IIFA; or by local and national religious institutions in Muslim countries, are recommendations and do not abrogate the existence or legitimacy of divergent scholarly views. For instance, definitions of brain death have been adopted by most official institutions in Muslim-majority countries and jurisprudential authorities, yet various scholarly views may still contradict these guidelines.

Secular and Islamic bioethics differ in character, underlying worldview, and sources. They also differ in their ultimate goals. Secular bioethics aims primarily at achieving what is deemed the best solution for the participants involved, with no attention to any but the temporal (this-world) dimension. Islamic bioethics, on the other hand, never loses sight of the other-world dimension. From the Islamic point of view, each human being will be held accountable for his or her own deeds in the hereafter; thus it is vital to act according to the Creator’s demand. The bioethical arena, in that sense, does not differ from the spheres of worship, marriage, financial transactions, or any other human activity.

While the secular worldview generally places the body of a human person under the autonomy of that same individual, the Islamic worldview focuses on the human body as an entrusted good given by the Creator. The individual does not own it—neither during its lifetime nor after death—and can therefore only use it within the limits set by the Creator. Knowledge of these limits is essential from the Islamic point of view. The Code of Ethics of the Pakistan Medical Council (2001, art. 7) summarizes: “If secular Western bioethics can be described as rights-based, with a strong emphasis on individual rights, Islamic bioethics is based on duties and obligations (e.g., to preserve life, seek treatment)” (Atighetchi, 2007, p. 228).

Strategies of Reception

With regard to its impact in the Islamic world, the principlism approach as formulated by Beauchamp and Childress (2012) seems to be most influential in academic and professional circles. This prevalence may be inferred from the contemporary bioethical literature and the adoption of this approach in Islamic medical codes. The reason for the preference of this model can be traced back to the globalized structure of medical training and institutions, which follow Western standards. Personal and institutional networking through the training of medical staff in North American and other international universities may have also assisted in propagating the principlism model.

Strategies of reception of principlism and other secular approaches among Muslim representatives of bioethics usually vary according to the recipients’ attitude toward secularism. A generally favorable view of the secular worldview may lead to the explicit acceptance of this secularly derived model. Other strategies of engaging with secular bioethics include rejecting it on the grounds that it is secular, appraising it as universal, and attempting to indigenize or Islamize it. These strategies will be exemplified below.

The outright defense of secular bioethics by its representatives in the Islamic world is rather exceptional in the literature and will typically be found in regions with a strong secular tradition, such as Turkey. Secularism is seen in this context as the essential guarantor for scientific practice, individuality, autonomy, and the coexistence of different beliefs. From this perspective, secular bioethics can contribute to solving real-world problems associated with the healthcare systems in Muslim-majority countries. For example, the often paternalistic treatment of patients in these systems should be solved through the introduction of the principle of autonomy in healthcare (Arda, 2006).

Another strategy for engaging with secular bioethics is to proclaim the personal belief in universal moral values while postulating the necessity to give these universal values “culture-specific guidance in Muslim societies to resolve practical quandaries” (Sachedina, 2009, p. 8). This is an important strategy in increasing the level of adoption of the standards set by secular international institutions, such as the WHO, UNESCO and CIOMS, by a Muslim audience. This strategy may include a call for activating approaches in the legal theoretical framework of Islamic law that are part of Islamic heritage, but which historically may not have found mainstream acceptance in Islamic legal thought. An example of this would be to revive the concept of the human mind being able to declare things as “good” or “bad” by reason (al-taḥsīn wa-al-taqbīḥ al-ʿaqliyyān), so as to assert the place of human intellect in decision making (Sachedina, 2009).

An additional method of engaging with secular Western bioethics, particularly in the form of the principlism approach, is to assert the possibility of their identification in the Islamic sources (the Qurʾān, the sunnah, and Islamic teachings throughout history), while insisting that the criteria governing what is “moral” and what is not must be based on Islamic principles. Attention is given to the differences between secular Western and Islamic bioethics in their respective understanding of the four principles (Chamsi-Pasha and Albar, 2013).

Some contributors state that while intersections between “Western secular” and Islamic bioethics may exist in practice, the differences between secular and Islamic bioethics in their foundational principles render them irreconcilable. A universal standard of medical ethics is described as unwarranted (Rathor, et al., 2011). In this vein, the universalist approach of bioethics is understood as a call for ethical relativism, where differences between diverse worldviews are deliberately overridden in order to broaden the scope of secular thought.

Arguments against claims to the universality of secular bioethics are often accompanied by demands for the indigenization of bioethics or the acknowledgment of ethical diversity. This criticism is not unique to Muslim voices, but is frequently made in bioethical literature (Landman and Schüklenk, 2005). Attempts at practical implementation may involve various approaches. Narrative bioethics, for instance, works with the cultural and religious practices of a particular Muslim country as they present themselves on the ground (through Muslim patients’ Islamically influenced convictions and concepts) in order to facilitate medical treatment (Jafarey and Moazam, 2010; Hamdy, 2012).

By engaging with secular bioethics and its institutions, Islamic transnational organizations like the IOMS have contributed by inserting some Islamic bioethical concepts in international standards and definitions. The inclusion of the spiritual component in defining the human being through the WHO may be such an example (Al-Awadi, 2000). Still, the lack of a spiritual dimension in secular bioethics is frequently criticized (Rathor, et al., 2011).

An important milestone for the development of bioethics in the Islamic world was the 2004 Cairo conference on the Islamic Code of Medical Ethics. The conference presented three important documents, the first of which is called the “Islamic Code for Medical and Health Ethics.” It comprises 108 articles in ten chapters, offering supportive evidence for such a code and its regulations from the Qurʾān and the sunnah. The second, “International Ethical Guidelines for Biomedical Research Involving Human Subjects: An Islamic Perspective,” is the result of the cooperation of IOMS with the CIOMS and WHO in Geneva in 2004. It attempts to provide an Islamic justification for the CIOMS declaration by adding “The Islamic Point of View” to the guidelines, quoting widely from Islamic culture and bioethical heritage. This document therefore propounds a strategy of Islamizing international secular bioethical standards. The third document provides ample discussion of a variety of bioethical issues, from mixed milk banks to the definition of death. This contribution sees itself firmly within the tradition of Islamic law, evaluating case studies in the light of the Islamic sources and Islamic legal methodology (www.islamset.net/ioms/code2004/index.html, accessed 20 Aug. 2018).

The 2006 “International Seminar on Human Genetic and Reproductive Technologies: Comparing Religious and Secular Perspectives,” organized by IOMS, explicitly invited contributions from different religious and secular perspectives. The draft declaration of principles clearly gives preference to a religious point of view without specifying it as particularly Islamic, while also making references to the secular discourse (human rights, fundamental freedoms, etc.). In contrast, the Tehran Statement on Bioethics, issued at the conclusion of the International Congress of Bioethics held in Tehran in 2005, confers intellectual leadership in the field of bioethics to UNESCO through the Declaration on Universal Norms on Bioethics (art. 4), while calling for a multidisciplinary and multicultural approach (art. 1) and consideration of different religious creeds, moral values, and cultures (art. 2) (The Tehran Statement, 2005).

Some contributors to the discourse argue that bioethics may provide a vehicle for the introduction of value relativity into the internal Islamic discourse and thereby into its law. This could take place by expanding the traditional scope and methodology of legal scholarship, or accepting convergences between the reference to the Higher Objectives of Islamic Law (maqāṣid al-Sharīʿah) and utilitarian or natural law concepts. The attempt to answer bioethical questions that arise from a secular materialistic system often involves pervasive reference to the maqāṣid (the higher objectives of the Sharīʿah), maṣāliḥ mursalah (unspecified benefits), and ḍarūrah (necessity). These legal tools are sometimes used in a way that is more reminiscent of secular materialism than of the Islamic concept of benefits and harms. For example, the contemporary discussions on organ transplantation, brain death, stem cell research, and other issues reflect these mechanisms (Bouzenita, 2011).

Contributions discussing the Beauchamp-Childress approach generally try to substantiate the existence of the four values (beneficence, non-maleficence, autonomy, and justice), providing evidence for these values in the Qurʾān and the sunnah, or in secondary legal sources. Authors relating to these values from an Islamic perspective do not necessarily discuss the incompatibility of their origin and methodology with that of the Islamic approach. Criticism of the principlism model is directed at its methodological shortcomings in cases where values conflict; in particular, the value of autonomy itself is criticized as being firmly embedded in a Western, secular, individual rights-based paradigm, one in conflict with community- and duty-based approaches to which societies in the Islamic world aspire (Chamsi-Pasha and Albar, 2013). Beneficence and non-maleficence are in some cases given priority over autonomy (Rathor, et al., 2011).

Assessment and Outlook

The article has outlined the historical background and main differences between secular and Islamic bioethics. It has presented various strategies of reception of secular bioethics in the Islamic world. The prevalent characteristic in Muslim bioethical treatises is their engagement with the secular paradigm, whether to critically appraise or reject it. Secular bioethics has to date remained a point of reference in Muslim-led bioethical discourse.

Due to the demand by the Muslim public for Islamic legitimacy and the perceived unsuitability of non-Islamic bioethical models for the Islamic world, it is not likely that an openly secular bioethical model will prove successful in Muslim-majority countries. Even though the decision-making legislative bodies in those countries may be predominantly secular, the respective Muslim populations will look to the Islamic religion and those identified as its representatives to answer any bioethical questions. At the interface of a religious Muslim audience and a secular legislation, the Egyptian public’s reception of the issue of organ transplantation may be mentioned. While the (secular) official state authorities, supported by al-Azhar (traditionally, the most prestigious theological institution of Sunnī Islam), explicitly condoned transplants, it was the popular preacher Muḥammad Mitwally al-Shaʿrāwī’s criticism—“Our bodies belong to God”—that found more resonance among the masses (Hamdy, 2012).

A stated preference for either secular or Islamic bioethics in the Islamic world is often an expression of the existing priority given to the underlying worldview, and priorities may at times be realigned more closely to one or the other side. In a contemporary Muslim world characterized by a dichotomy between secular systems and a Muslim public, between imported Western secular curricula and medicine on one hand and the universal claim of Islam and its (scholarly) representatives on the other, bioethics in the Islamic world can be an instrument to gain intellectual leadership, a vehicle to induce change by either introducing Islamic concepts or secularizing Islamic thought. For Muslim scholars, the field may provide a welcome terrain on which Islamic legal teachings can regain attention and be brought back into the public sphere. In this context, the opposition to secular bioethics may also be used as a framework of self-identification vis-à-vis secular capitalist modernism and its effects.

Ideas of secular provenance may permeate academic circles under the pretense of Islamic legitimacy, disregarding the differences in sources and methodology, to be incorporated in official bioethical dicta and codes. However, as incongruity is already evident between the official bioethical dicta, their application (or non-application) through various institutions in the field, and the bioethical expectations and comportment of the public, it remains to be seen whether bioethics will prove to be a catalyst for either secular or Islamic thought to prevail.

Bibliography

  • Al-Awadi, Abdul Rahman. “The Role of the Islamic Organization for the Medical Sciences in Reviving Islamic Medicine.” Journal of the Islamic Medical Association of North America 32, no. 2 (2000): 68–72.
  • Arda, Berna. “The importance of secularism in medical ethics: the Turkish example.” Reproductive BioMedicine Online (Oct. 2006): 24–28. One of the rare voices explicitly supporting secular bioethics, with special reference to Turkey.
  • Athar, Shahid. “Human Genetic and Reproductive Technologies: A Muslim’s Understanding of the Secular Perspective.” Journal of the Islamic Medical Association of North America 39, no. 4 (2007): 168–172.
  • Atighetchi, Dariusch. “Problems of Islamic Bioethics and Biolaw.” Derecho y Religión 2 (2007): 222–229. A resourceful analysis of the relation between contemporary Islamic and secular bioethics.
  • Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2012.
  • Bouzenita, Anke Iman. “The Dilemmas of Islamic Bioethics in the Twenty-First Century: ‘Being a Stranger in a Strange Land’ (Or: Procrustes ‘Islamized’).” American Journal of Islamic Social Sciences 28, no.1 (Winter 2011): 45–75.
  • Chamsi-Pasha, Hassan, and Mohammed Ali Albar. “Western and Islamic bioethics: How close is the gap?” Avicenna Journal of Medicine 3, no.1 (Jan.–Mar. 2013): 8–14.
  • Gordon, John-Stewart. “Bioethics.” In The Internet Encyclopedia of Philosophy. https://www.iep.utm.edu/bioethic. Retrieved 20 Aug. 2018.
  • Hamdy, Sherine. Our Bodies Belong to God: Organ Transplants, Islam and the Struggle for Human Dignity in Egypt. Berkeley: University of California Press, 2012.
  • Islamic Organization for Medical Sciences (IOMS). International Ethical Guidelines for Biomedical Research Involving Human Subjects: An Islamic Perspective. Geneva: CIOMS, 2004. www.islamset.net/ioms/code2004/Islamic_vision1.html. Retrieved 20 Aug. 2018.
  • Jafarey, Aamir M., and Farhat Moazam. “‘Indigenizing’ Bioethics: The First Center for Bioethics in Pakistan.” Cambridge Quarterly of Healthcare Ethics, 19 (2010): 353–362. This paper reports on the indigenizing experience with special reference to Pakistan.
  • Landman, Willem, and Udo Schüklenk. “UNESCO ‘declares’ universals on bioethics and human rights – many unexpected universal truths unearthed by UN body.” Developing World Bioethics 5, no. 3 (2005): iii–vi.
  • Rathor, Mohammad Yousuf, et al. “The Principle of Autonomy as Related to Personal Decision Making Concerning Health and Research from an ‘Islamic Viewpoint.’” Journal of the Islamic Medical Association of North America 43, no. 1 (2011): 27–34.
  • Sachedina, Abdulaziz. Islamic Biomedical Ethics: Principles and Application. New York: Oxford University Press, 2009.
  • Sajoo, Amyn B. “Negotiating Virtue: Principlism and Maslaha in Muslim Bioethics.” Studies in Religion 43, no.1 (2014): 53–69.
  • Shabana, Ayman. “Religious and cultural legitimacy of bioethics: lessons from Islamic bioethics.” Medicine, Health Care and Philosophy 16, no. 4 (2013): 671–677. (Published online 9 Feb. 2013). A resourceful paper including a bibliography for further reading.
  • The Tehran Statement, International Congress on Bioethics, Tehran, 26–28 Mar. 2005.
  • Westra, Anna E., Dick L. Willems, and Bert J. Smit. “Communicating with Muslim parents: ‘the four principles’ are not as culturally neutral as suggested.” European Journal of Pediatrics 168, no. 11 (2009): 1383–1387.
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