This document provides an overview of medical ethics from an Islamic perspective. It defines medical ethics and ethical issues. It discusses various schools of ethical thought, including utilitarianism, deontology, and virtue ethics. Tools for ethical analysis are presented, including analyzing medical, legal, and quality of life factors. The document then discusses Islamic approaches to ethics, including sources like the Quran and hadiths. Principles like intention and harm are explained. The document concludes with a case study on terminating a pregnancy due to cancer and the ethical issues involved.

1. 4th year medical students (May 14, 2012)
Prepared and presented by:
Dr. Ghaiath Hussein
ghaiathme@gmail.com

2. A less embarrassing
choice…

breast bud


3. Outline
 What is medical ethics?
 What is an ethical issue?
 Schools of thought (Philosophies)
 Tools for ethical analysis and decision
making
 Islamic approach to ethical decision
making

4. What is clinical/medical
ethics?
 It is that branch of bioethics that is
related to the
identification, analysis, and resolution of
moral problems that arise in the
healthcare of individual patients.

5. Questions answered by
Bioethics
○deciding what we should do
(what decisions are morally right or
acceptable);
○explaining why we should do it
(how do we justify our decision in moral
terms); and
○describing how we should do it
(the method or manner of our response
when we act on our decision).

6. What is an “ethical issue” or
a “moral problem”?
 There is an ethical issue when:
 …we encounter conflicting
values, beliefs, goals, or responsibilities
 …we are concerned that persons or their
rights are not being respected
 …we are concerned about fairness and
justice
 …we are unsure what we should do or why
we should do it, morally speaking

7. What else could it be?
 Miscommunication stands for 70-80%
of problems in healthcare
 E.g. Doctors don’t know to tell medical info
 Management issue
 “when shall I get promoted? All my
colleagues did. This is not ethical!”
 Financial issue
 “I am underpaid for my workload. This is not
ethical!”

8. Schools of thought in moral reasoning (how right and
wrong are distinguished?)

9. How to approach an ethical
issue?

10. I- Set of Ethical standards
Secular
Most western
philosophies
• Utilitarianism
• Ethical Egoism
• Deontology
• Social contracts
• Humanism
Religious
(Oriental)
Bhudism
Confucian
ethics
Daoist ethics
Hindu ethics
Religious
(Abrahamic)
Jewish ethics
Christian ethics
Islamic ethics

11. Schools of thought in moral reasoning
the value of an action is
determined by its utility; all actions should be
directed toward achieving the greatest happiness
for the greatest number of people.
 actions are judged based upon
inherent right-making characteristics or principles
rather than on their consequences. Emphasis on
duty, rules and regulations, principles and moral
obligations which govern ones right action

12. Schools of thought in moral reasoning
(cont.)
(Ethics of Care)
commitment to correcting male biases (e.g.
women’s subordination is morally wrong) and that
the moral experience of women is as worthy of
respect as that of men.
The greatest confidence in our
moral judgments resides not at the level of
theory, where we endlessly disagree, but rather at
the level of the case, where our intuitions often
converge without the benefit of theory.

13. Schools of thought in moral reasoning
(cont.)
It emphasizes the
virtues, or moral character
 A patient should not comply with a “don’t
smoke” advice from a smoking doctor!

14. Schools of thought in moral reasoning
(cont.)
 Autonomy: respect humans'
ability to choose,
 Beneficence: Do Good for others,
 Nonmaleficence (Do No Harm), &
 Justice

15. II- Tools for Ethical
Analysis
 Why do we need tools for ethical
analysis?
 To make sure we do not miss any
information or possible factor that could
affect the decision we take
 How do they help us reach ethical
decision?
 Tools that helps us have information about
all those involved in the decision
 Who is involved in ethical decision?
(what do you think?)

16. Who (&what) affects ethical
decision making?

17. Tools & frameworks for ethical
analysis
Consider each medical condition and its
proposed treatment. Ask the following
questions:
Does it fulfil any of the goals of medicine?
With what likelihood?
If not, is the proposed treatment futile?
Address the following:
What does the patient want?
Does the patient have the capacity to decide?
If not, who will decide for the patient?
Do the patient's wishes reflect a process that
is informed? understood? voluntary?
Patient's quality of life in the patient's
terms.
What is the patient's subjective
acceptance of likely quality of life?
What are the views of the care providers
about the quality of life?
Is quality of life "less than minimal?"
Social, legal, economic, and institutional
circumstances in the case that can:
influence the decision
be influenced by the decision
e.g., inability to pay for treatment;
inadequate social support

18. CLEO Approach
Legal:Clinical:
Legally required process for treatment
decision making when a patient lacks
capacity to do so
Family involvement: who to involve?
when and how substitute treatment
decisions are to be made?
Diagnoses: Irreversible? Progressive?
Permanent?
Prognoses: Disabling? Terminal?
clinicians’ level of certainty?
Organizational:Ethical:
Any institutional pressures to not have
a bed blocked by someone whose
recovery will be long and slow or the
benefits seemingly small?
Any other healthcare facilities better
able to provide palliative/rehabilitative
care for longer periods of time?
Any different views as to diagnosis,
prognosis, next steps among the team or
other physicians
The patient’s will, desires, perception of
life, relationship with their family? What
cultural or religious beliefs involved?
Family’s stand: why? To show their
fidelity to the patient and/or deal with
their individual and collective
sadness/shock/grieving?
No longer sure what is really going on or
who to trust

19. III- Modalities of resolving ethical
issues

20. Collect
information
• Medical
• Non-
medical
Meet
involved
parties
• Doctors
• Nurses
• Patient (&
family)
Ethical
Analysis
• Weighing
collected
info. vs.
ethical
principles
(& laws)
Decision
Making
• Single
decision;
or
• Provide
alternativ
es
Follow-Up
• How
decisions
are
implement
ed?
• Lessons
learned

22. Ethics in Islam… not a separate
entity!
Law
Ethics
Religious
Practice
Economy
Social
Relations

23. How should Muslims decide their acts?
 “And I (Allâh) created not the jinn and mankind except
that they should worship Me (Alone)” (51:56).
 Worship in Islam includes the duty to follow the
orders of Allah and His Prophet Mohamed
(PBUH)
 “And whosoever does not judge by what Allâh has
revealed, such are the Kâfirûn (i.e. disbelievers - of a lesser
degree as they do not act on Allâh’s Laws” (5: 44); “And
whosoever does not judge by that which Allâh has
revealed, such are the Zâlimûn (polytheists and wrong-doers - of
a lesser degree)” (5: 45); “And whosoever does not judge by
what Allâh has revealed (then) such (people) are the Fâsiqûn
[the rebellious i.e. disobedient (of a lesser degree)” (5: 47); “And
whatsoever the Messenger (Muhammad
gives you, take it; and whatsoever he forbids you, abstain (from

24. Koran and Sunna
 Unanimous agreement of Islamic jurists (Ijmaa)
 Acceptance by the majority of trusted scholars
(Rayul Jomhour)
 Measurement/Analogy (Qiyas),
 Remediation (Maslaha), (Istishab)

25.  The are to
preserve person’s:
1. Religion;
2. Soul;
3. Mind;
4. Wealth; &
5. Progeny.
All Islamic legislations came to achieve
these goals.

26.  It is the methodology of
 defining, analysing and resolving the ethical
issues that arise in healthcare practice, or
research;
 based on the Islamic moral and legislative
sources (Koran, Sunna & Ijtihad); and
 aims at achieving the goals of Islamic morality
(i.e. preservation of human’s
religion, soul, mind, wealth & progeny )

27. 1. The principle of Intention (Qasd): Each
action is judged by the intention behind it
2. The principle of Certainty (Yaqeen):
Certainty can not be removed by doubt
3. The principle of Injury/Harm (Dharar):
 Injury should be relieved; An individual should not
harm others or be harmed by others
 - An injury is not relieved by inflicting or causing a
harm of the same degree
 - Prevention of harm has priority over pursuit of a
benefit of equal worth
 - the lesser harm is committed

28. 4. The principle of Hardship (Mashaqqat):
Difficulty calls forth ease, Necessity
(Dharuraat) legalizes the prohibited
5. The principle of - Custom or precedent (Urf):
 Custom is recognized as a source of law on
which legal rulings are based unless
contradicted specifically by text from the main
legislative sources, i.e. Koran and Sunna.

29.  What are the facts (medical/scientific)?
 Is there a text on the issue from Koran and/or
Sunna?
 Which Sharia Goals are involved?
 Which fiqhi principles are applicable?
 Weighing of principles?
 Applying the relevant secondary sources
(matching the scripts to goals and principles)
 Is there a previous Fatwa on similar issue?

30. Summary of Islamic
Analysis
1- Which Sharia goal(s) is involved?
Religion Soul Mind Money Progeny
2- Which Grand Fiqhi Principle(s) involved?
Intention Hardship Harm/Injury Certainty Custom
3- Which Fiqhi Maxims are involved?

31. Case for discussion
 Batoul is a 36 years old Saudi lady. She is a mother
of 2 children (8 & 10 years old), and she is now
pregnant in her 15th week of gestation with a
normal and viable fetus.
 Two weeks ago, she was found to have a huge
ovarian mass (19 X 12 cm) found to be a
cystoadenocarcinoma with features of metastasis.
 She is a candidate for chemotherapy. Thus, the
oncology board of the hospital recommended the
termination of pregnancy. Three
consultants, including her following obstetrician and
an oncologist, had approved this recommendation.

32. Case for discussion…cont.
 She did not accept to terminate the pregnancy.
Accordingly, the husband was approached, he
approved and signed the consent on her behalf.
 Batoul felt terribly upset from what happened, and
refused to start the chemotherapy. The case was
submitted to the ethics committee of the hospital in
which you are a member.
 You were delegated by the ethics committee to
resolve the case.

33. Discussion questions:
 What are the ethical issues involved in this
case?
 Describe in details the steps you will
take, including what are the information that
you will collect, who you will meet, what are
the questions that you may want to ask, what
are the factors
(medical, ethical, religious, legal, etc.) that
you will consider as you recommend a
decision.
 Describe briefly the modality that you will
suggest to implement and follow-up the

34. Download more lectures from:
https://sites.google.com/site/medicalethicscourse/
More Resources:
http://med-ethics.com/
http://omarkasule.tripod.com/
http://www.islamset.com/ethics/index.html