Presented in absentia at a seminar on epistemology held at the Islamic University of Indonesia on 5th July 2010 by Professor Omar Hasan Kasule Sr.
ABSTRACT
The paper starts by summarizing basic concepts and paradigms of Islamic epistemology and methodology of research. It then discusses the current crisis of knowledge and education in the ummat whose resolution will be by Islamization of sciences. Islamization of sciences is defined as identifying biases in research methodology that reflect a non-tauhidi parochial world-view. This is followed by Islamization of the disciplines of knowledge which is reformulating basic epistemological concepts and paradigms of various disciplines from an Islamic tauhidi paradigm characterized by objectivity, istiqamat al ma’arifat, and universality, ‘aalamiyyat al ma’arifat, of knowledge. The paper concludes by a brief expose of the on-going experiment of an Islamic Input in the medical curricula.
1.0 BASIC EPISTEMOLOGICAL CONCEPTS
1.1 WHAT IS ISLAMIC EPISTEMOLOGY?, nadhariyat al ma’arifat al islamiyyat
Epistemology is the science of knowledge, ‘ilm al ‘ilm. It is the study of the origin, nature, and methods of knowledge with the aim of reaching certainty. Islamic epistemology, nadhariyyat ma’rifiyyat Islamiyyat, is based on the tauhidi paradigm. Its fixed parameters are from revelation, wahy. Its variable parameters are conditioned by varying spatio-temporal circumstances. Its sources are revelation (Qur’an and sunnat), empirical observation and experimentation, and human reason. Its main challenge today is achieving objectivity, al istiqamat, which is staying on the path of truth and not being swayed by whims and desires. Istiqamat comes only next to iman, as the Prophet said 'qul amantu bi al laahi thumma istaqim'.
1.2 NATURE OF KNOWLEDGE, tabi’at al ma’arifat al insaniyyat
The Qur’anic terms for knowledge are: ‘ilm, ma’arifat, hikmat, basiirat, ra’ay, dhann, yaqeen, tadhkirat, shu’ur, lubb, naba’, burhan, dirayat, haqq, and tasawwur. The terms for lack of knowledge are: jahl, raib, shakk, dhann, and ghalabat al dhann. Grades of knowledge are ‘ilm al yaqeen, ‘ayn al yaqeen, and haqq al yaqeen. Knowledge is correlated with iman, ‘aql, qalb, and taqwah. The Qur’an emphasizes the evidential basis of knowledge, hujjiyat al burhan. The seat of knowledge is the ‘aql, and qalb. Allah’s knowledge is limitless but human knowledge is limited. Humans vary in knowledge. Knowledge is public property that cannot be hidden or monopolized. Humans, angels, jinn, and other living things have varying amounts of knowledge. Knowledge can be absolute for example revealed knowledge. Other types of knowledge are relative, nisbiyat al haqiqat. The probabilistic nature of knowledge arises out of limitations of human observation and interpretation of physical phenomena.
1.3 HISTORY OF HUMAN KNOWLEDGE, tarikh al ma’rifat al insaniyat
Adam was the first human to learn actively when he was taught the names of all things. Human knowledge after that grew by empirical trial and error or through revelations. Development of language and writing played a big role in knowledge development. Publication and telecommunication are responsible for the current knowledge revolution.
1.4 SOURCES OF KNOWLEDGE, masadir al ma’arifat:
All knowledge is from Allah. Humans can get it in a passive way from revelations or in an active way by empirical observation and experimentation. Whatever knowledge they get is ultimately from Allah. Knowledge may be innate or acquired. Humans have knowledge of the creator even before birth. Some human knowledge is instinct. Most human knowledge is learned as observation, ‘ilm tajriibi; transmission, 'ilm naqli; or analysis and understanding, 'ilm 'aqli. Seeking to know is an inner human need that satisfies curiosity.
Revelation, wahy, inference, ‘aql, and empirical observation of the universe, kaun, are major sources of acquired knowledge accepted by believers. In terms of quantity, empirical knowledge, ‘ilm tajriibi, comes first. In terms of quality revealed knowledge, ‘ilm al wahy, comes first. There is close interaction and inter-dependence between revelation, inference, and empirical observation. ‘Aql is needed to understand wahy and reach conclusions from empirical observations. Wahy protects ‘aql from mistakes and provides it with information about the unseen. ‘Aql cannot, unaided, fully understand the empirical world.
There is lack of unanimity on the following as additional sources of knowledge: ‘ilm laduniy; inspiration, ilham; intuition, hadas; instinct, jabillat; geomancy, firasat; dreams, ru’uyat; and kashf. The controversy is not whether they are sources of knowledge but whether they are sources independent of the three mentioned before. Magic & sorcery, sihr; astrology, tanjiim; foretelling, kahanat & tatayur; and other forms of superstition are not sources of true knowledge. They may lead to correct and verifiable facts but only by chance and coincidence. They most often lead to wrong and misguiding facts.
1.5 CLASSIFICATION OF KNOWLEDGE, tasnif al marifat
Knowledge can be innate or acquired. It can be ‘aqli or naqli. It can be knowledge of the seen, ‘ilm al shahadat, and knowledge of the unseen, ‘ilm al ghaib. The unseen can be absolute, ghaib mutlaq, or relative, ghaib nisbi. Acquisition of knowledge may be individually obligatory, fard ‘ain, whereas other knowledge is collectively obligatory, fard kifayat. Knowledge can be useful, ‘ilmu nafiu. Knowledge can be basic or applied. There are many different disciplines of knowledge. The disciplines keep changing with advance of knowledge and understanding. A discipline is defined and is limited by its methodology.
1.6 LIMITATIONS OF HUMAN KNOWLEDGE, mahdudiyat al marifat al bashariyyat
The Qur'an in many verses has reminded humans that their knowledge in all spheres and disciplines of knowledge is limited. Human senses can be easily deceived. Human intellect has limitations in interpreting correct sensory perceptions. Humans cannot know the unseen, ghaib. Humans can operate in limited time frames. The past and the future are unknowable with certainty. Humans operate in a limited speed frame at both the conceptual and sensory levels. Ideas can not be digested and processed if they are generated too slowly or too quickly. Humans cannot visually perceive very slow or very rapid events. Very slow events like the revolution of the earth or its rotation are perceived as if they are not happening. Human memory is limited. Knowledge acquired decays or may be lost altogether. Humans would have been more knowledgeable if they had perfect memory.
2.0 METHODOLOGY OF KNOWLEDGE, manhaj al ma’arifat
2.1 CONCEPTS
Methodology started with Adam naming and classifying all things followed by trial and error discoveries and later by systematic methodological investigation. Inspired by the Qur’an, Muslims developed the empirical scientific methodology that triggered the European reformation, renaissance, and scientific and technological revolution starting in the early 16th century CE. Francis Bacon (1561-1626), the first European to write systematically about the empirical methodology was inspired by Muslim science reaching Europe in his times. Europeans copied the empirical methodology without its tauhidi context, rejected wahy as a source of knowledge, and later imposed badly-copied secularized science on the Muslim world. Ancient Muslim scientists had shown that wahy, ‘aql, and empiricism were compatible and had used methodological tools from the Qur’an to correct deficiencies and improve Greek science before passing it on to Europeans. They replaced Aristotelian deductive logic and definitions with an Islamic inductive logic inspired by the Qur’an.
2.2 METHODOLOGY FROM THE QURAN, manhaj qur’ani
The Qur’an provides general guiding principles and is not a substitute for empirical research. It enjoins empirical observation; liberates the mind from superstition, blind following, intellectual dependency, and whims. Its tauhidi paradigm is the basis for causality, rationality, order, predictability, innovation, objectivity, and natural laws. Laws can be known through wahy, empirical observation and experimentation. The Qur’anic teaches the inductive methodology, empirical observation, nadhar & tabassur; interpretation tadabbur, tafakkur, i’itibaar & tafaquhu; and evidential knowledge, bayyinat & burhan). It condemns blind following, taqliid, conjecture, dhann; and personal whims, hiwa al nafs. The Qur’anic concept of istiqamat calls for valid and un-biased knowledge. The Qur’anic concepts of istikhlaf, taskhir, and isti’imar are a basis for technology. The concept of ‘ilm nafei underlies the imperative to transform basic knowledge into useful technology.
2.3 METHODOLOGY FROM THE CLASSICAL ISLAMIC SCIENCES
Classical sciences and their concepts are applicable to science and technology. Tafsir ‘ilmi and tafsir mawdhu’e parallel data interpretation in empirical research. ‘Ilm al nasakh explains how new data updates old theories without making them completely useless. ‘Ilm al rijaal can ascertain the trustworthiness of researchers. ‘Ilm naqd al hadith can inculcate attitudes of critical reading of scientific literature. Qiyaas is analogical reasoning. Istihbaab is continued application of a hypothesis or scientific laws until disproved. Istihsan is comparable to clinical intuition. Istislah is use of public interest to select among options for example medical technologies. Ijma is consensus-building among empirical researchers. Maqasid al shariat are conceptual tools for balanced use of S&T. Qawaid al shariat are axioms that simplify complex logical operations by using established axioms without going through detailed derivations.
2.4 ISLAMIC CRITIQUE OF THE EMPIRICAL METHOD, naqd al manhaj al tajribi
Using methodological tools from the Qur’an and classical Islamic sciences, Muslims developed a new empirical and inductive methodology in the form of qiyaas usuuli and also pioneered the empirical methods by experimentation and observation in a systematic way as illustrated by the work on Ibn Hazm on optics. They criticize ancient Greek methodology as conjectural, hypothetical, despising perceptual knowledge, and based on deductive logic. They accept the European scientific method of formulating and testing hypothesis but reject its philosophical presumptions: materialism, pragmatism, atheism, rejection of wahy as a source of knowledge, lack of balance, rejection of the duality between matter and spirit, lack of human purpose, lacks of an integrating paradigm like tauhid, and being Euro-centric and not universal. European claims to being open-minded, methodological, accurate, precise, objective, and morally neutral have been observed not to hold in practice. In its arrogance it treats as absolute probabilistic and relativistic empirical knowledge based fallible human observation and interpretation.
3.0 CRISIS OF KNOWLEDGE and EDUCATION, azmat al ma’arifat wa al ta’aliim
3.1 MANIFESTATIONS OF THE CRISIS
There is pervasive ignorance of uluum al diin and uluum al dunia. There is little respect for scholarship. Wealth and power are considered more important than scholarship. There is neglect of the empirical sciences. There is a dichotomy in the education system: traditional Islamic vs. imported European, ulum al diin vs ulum al dunia. Integration of the 2 systems has failed or has been difficult because it has been mechanical and not conceptual. The process of secularization in education has removed the moral dimension from the education and violated the aim of Islamic education to produce an integrated and perfect individual, insan kaamil. The brain drain from Muslim countries has compounded the educational crisis.
3.2 UMMATIC MALAISE DUE TO THE KNOWLEDGE CRISES
Knowledge deficiency and intellectual weakness are the most significant manifestation of ummat’s decadence. The intellectual crisis of the ummat is worsened by copying and using poorly digested alien ideas and concepts. The prophet warned the ummat about the lizard-hole phenomenon in which the ummat in later times would follow its enemies unquestionably like the lizard running into its hole. Among the manifestations of the ummatic malaise are action deficiency, political weakness, economic dependency, military weakness, dependence in science and technology, and erosion of the Islamic identity in life-style.
3.3 HISTORICAL BACKGROUND
The generation of the Prophet (PBUH) was the best generation. The best teacher met the best students and excellent results were obtained. Companions had excellent knowledge and understanding. Seeds of the current crisis appeared towards the end of the khilafat rashidat. New social and political forces overthrew the khilafat rashidat and the ideals it represented were distorted or abolished. Then the authentic ‘ulama and opinion leaders who remained faithful to the ideals of Islam were marginalized and persecuted. Intellectual stagnation then ensued. The process of secularization of the Muslim state progressed. Widespread ignorance and illiteracy became common. Many non-Islamic ideas and facts without valid proof have found their way into the intellectual and religious heritage of the ummat making the existing intellectual crisis even worse.
4.0 PRELIMINARY STEPS TOWARDS REFORM OF KNOWLEDGE AND EDUCATION
4.1 KNOWLEDGE, A PRE REQUISITE FOR TAJDID
Reform and revival of the ummat will occur through educational and knowledge reform. Tajdid is a recurring phenomenon in the ummat and is a sign of its health and dynamism. It is a basic characteristic of the ummat that periods of reform/revival alternate with periods of decay and return to jahiliyyat. Tajdid requires knowledge, ideas and action related by the following mathematical equation: tajdid = idea + action. Action without knowledge and guiding ideas will not lead to true change. Ideas without action are not change at all. Tajdid requires and is preceded by a reform in knowledge to provide ideas and motivation on which to build. All successful societal reform starts with change in knowledge. The ideal society cannot be created without a knowledge base. That knowledge base must be correct, relevant, and useful. Successful revival movements throughout Muslim history have always been led by scholars.
4.2 A NEW KNOWLEDGE STRATEGY, nahwa istratijiyyat ma’arifiyyat jadiidat
The Muslim ummat is a potential economic and political bloc whose potential is not yet realized. The contemporary tajdid movement has a lot of strengths but also has basic deficiencies that must be corrected. The knowledge and intellectual crises are still a barrier. Reform movements unguided by correct knowledge and understanding will falter and fail or will be deviated from their paths. Social change requires change in attitudes, values, convictions and behavior of a critical mass of the population. Attitudes, values, convictions, and behaviors are determined by the knowledge base. The vision of the knowledge strategy is an upright balanced person who understands the creator, knows his place, his roles, his rights, and his responsibilities in the cosmic order. The mission of the knowledge strategy is conceptual transformation of the education system from kindergarten to post graduate studies to reflect tauhid, positive moral values, objectivity, universality, and serving the larger causes of humanity.
4.3 TOWARDS AN ISLAMIC METHODOLOGY, nahwa manhajiyyat ‘ilmiyyat islamiyyat
A tauhidi universal, objective and unbiased methodology must replace the Euro-centric and philosophically biased context and not the practical experimental methods. The precepts of tauhidi science are: unity of knowledge, comprehensiveness; causality is the basis for human action, human knowledge is limited, investigation of causal relations is based on constant and fixed natural laws, harmony between the seen and the unseen, 3 sources of knowledge (wahy, aql & empirical observation); khilafat; moral accountability; creation and existence have a purpose, truth is both absolute and relative, human free will is the basis of accountability, and tawakkul.
5.0 DEVELOPMENT OF A SCIENTIFIC CULTURE, nahwa thaqafat ‘ilmiyyat
5.1 BASIC CONCEPTS
The Qur’an is the basis for developing a vigorous and dynamic scientific culture in the ummat. Basic concepts are the Qur’an, intellect, knowledge, fiqh, thinking, innovation and creativity. The Qur’an is not a textbook of science. It however contains many verses that train the mind to observe, analyze, think and act in a scientific manner. The Qur’anic stories have lessons, many scientific, for those who understand. Intellect is correlated with signs and with knowledge. Failure to use the intellect and blind following are condemned. Knowledge is supreme. It removes blind following. Human knowledge is limited. Knowledge is acquired by study. Humans were ordained to read. Knowledge by itself is not useful unless it is associated with work. The Qur’an has used the term fiqh to refer to understanding which is deeper than knowing. The Qur’an puts emphasis on thinking. Thinking is based on empirical observation. The Qur’an emphasizes freedom of thought in the form of freedom of belief. Innovations in religion are prohibited but creativity is encouraged.
5.2 DESCRIPTIVE KNOWLEDGE
The Qur’an described mountains, the barrier between two oceans, metal, the wind, plants, the sky, honey, and water. It described the motion of the earth, the boats, the sun, the moon, the water, and of the wind. It described processes such as making of iron, armor, dams, and boats. It described the creation of the human from dust. It describes the constant laws of nature, sunan al laah fi al kawn. The laws are fixed and stable and operate in various situations. Order is a law of nature. Recording of observations is emphasized.
5.3 ANALYTIC KNOWLEDGE
The Qur’an calls for evidence. It rejects false evidence and condemns non evidence-based knowledge such as sorcery, consulting fortune tellers, speculation or conjecture. Human thought is a tool and not an end in itself. It operates on the basis of empirical observations and revelation, both objective sources of information, thought that is not based on an empirical basis or revelation is speculative and leads to wrong conclusions. The Qur’an calls for objectivity. It condemns following subjective feelings and turning away from the truth. Reliance is on observation and not speculation. The Qur’an calls upon humans to observe Allah’s signs in the universe and in humans. The Qur’an however made it clear that human senses have limitations. Rational thinking and logical operations were described. In many prohibitions the Qur’an provides logical reasons. The use of similitude, tashbiih, of two things and phenomena is seen several verses. The Qur’an also employed many examples, mithl, to illustrate concepts. Prudence in reaching conclusions is emphasized.
5.4 ETIQUETTE OF SCIENTIFIC DISCOURSE
The Qur’an and sunnat teach the etiquette of scientific discourse. Questions can be for finding out information. The opposing opinion should be respected. Differences on scientific matters can arise and are natural. Discussion and exchange of views is a necessity for humans. Discussion has its own etiquette. Truth must be revealed. Contradictions must be avoided. Arrogance is condemned. The following are attributes of good discussion: objectivity, truthfulness, asking for evidence, and knowledge. Purposeless disputation is frowned upon. False premises should be abandoned once discovered Fear of people should be no reason for not revealing the truth. Deception is condemned. The truth of any assertion must be checked. Yaqeen is the basis of ‘ilm but dhann is not.
6.0 ISLAMIZATION OF KNOWLEDGE: CONCEPT & PRACTICE
6.1 THE CONCEPT OF ISLAMIZATION:
Islamization is a process of recasting the corpus of human knowledge to conform to the basic tenets of ‘aqidat al tauhid. The process of Islamization does not call for re-invention of the wheel of knowledge but calls for reform, correction, and re-orientation. It is evolutionary and not revolutionary. It is corrective and reformative. It is the first step in the reform of the education system as a prelude to reform of society.
6.2 HISTORY OF ISLAMIZATION
The 2-3rd centuries H witnessed a failed effort at Islamization of knowledge. Greek scientific knowledge was transferred to Muslims together with Greek philosophy and ideas that caused confusions in ‘aqiidat. Greek science depended more on philosophical deduction than experimentally-based induction. It discouraged the scientific tarbiyat of the Qur’an which emphasized observation of nature as a basis for conclusions. The recent Islamisation movement towards the close of the 14th century H aimed at de-europeanizing education systems and building an education system based on tauhid.
6.3 REFORM OF DISCIPLINES:
Islamization has to start with reforming the epistemology, methodology, and corpus of knowledge of each discipline. It must be pro-active, academic, methodological, objective, and practical. Its vision is objective, universal, and beneficial knowledge in the context of a harmonious interaction of humans with their physical, social, and spiritual environment. Its practical mission is transformation of the paradigms, methodologies, and uses of disciplines of knowledge to conform to tauhid. Its immediate goals are: (a) de-Europeanizing paradigms of existing disciplines to change them from parochiality to universal objectivity, (b) reconstruction of the paradigms using Islamic universal guidelines, (c) re-classifying disciplines to reflect universal tauhidi values, (d) reforming research methodology to become objective, purposeful, and comprehensive (e) growth of knowledge by research, and (f) inculcating morally correct application of knowledge. The Qur’an gives general principles that establish objectivity and protect against biased research methodology. It creates a world-view that encourages research to extend the frontiers of knowledge and its use for the benefit of the whole universe. Scientists are encouraged to work within these Qur’anic parameters to expand the frontiers of knowledge through research, basic and applied.
6.4 MISUNDERSTANDING THE REFORM PROCESS
Islamization has been misunderstood as rejection of the corpus of existing human knowledge and disciplines. It has been misunderstood as creation of knowledge exclusive to Muslims. It has been misconstrued as rewriting existing text-books to reflect Islamic themes without deep thought about the paradigms and methodology. It has also been confined to spiritual reform of the student, scholar, or researcher. The following superficial approaches to civilization have been tried and failed: ‘Insertion’ of Qur’anic verses and hadiths in an otherwise European piece of writing, searching for scientific facts in the Qur’an, searching for Qur’anic proof of scientific facts, establishing Qur’anic scientific miracles, searching for parallels between Islamic and European concepts, using Islamic in place of European terminologies, and adding supplementary ideas to the European corpus of knowledge.
6.5 PRACTICAL STEPS / TASKS OF THE REFORM PROCESS:
The first step is a good grounding in Islamic methodological sciences of of usul al fiqh, ‘uluum al Qur’an, ulum al hadith, and 'uluum al llughat. This is followed by reading the Qur’an and sunnat with understanding of the changing time-space dimensions. This is followed by clarification of basic epistemological issues and relations: wahy and aql, ghaib and shahada, ‘ilm and iman. This is followed by an Islamic critique of basic paradigms, basic assumptions, and basic concepts of various disciplines using criteria of Islamic methodology and Islamic epistemology. Islamic reviews of existing text-books and teaching materials are then undertaken to identify deviations from the tauhidi episteme and the Islamic methodology.
The initial output of the Islamization process will be Islamic introductions to disciplines, muqaddimat al ‘uluum, establishing basic Islamic principles and paradigms that determine and regulate the methodology, content, and teaching of disciplines. This parallels Ibn Khaldun’s Introduction to History, muqaddimat presented generalizing and methodological concepts on historical events. Publication and testing of new text-books and other teaching materials is a necessary step towards reform by putting into the hands of teachers and students reformed material. Developing applied knowledge in science and technology from basic knowledge will be the last stage of the reform process. This is because in the end it is science and technology that actually lead to changes in society.
7.0 STAGES IN THE ISLAMIZATION OF MEDICAL SCIENCES
7.1 HISTORY OF MEDICINE, tarikh al tibb
Pre-Islamic roots of medicine are found in ancient Egyptian, Babylon Baghdad Andalusia . Muslims made many contributions to basic sciences and the various clinical disciplines.
7.2 PROPHETIC MEDICINE, tibb nabawi
Tibb nabawi refers to words and actions of the Prophet with a bearing on disease, treatment of disease, and care of patients. The Prophet enunciated a basic principle in medicine that for every disease there is cure. The sources of tibb nabawi are revelation, empirical experience, and folk medicine of the Arabian Peninsula . Tibb nabawi can be spiritual, curative or preventive. Most of tibb nabawi is preventive medicine. Tibb nabawi is an authentic and valid medical system. The general principles of this system are applicable at all times and all places. The specific remedies taught by the Prophet (PBUH) are valid and useful. They however can not be used today without undertaking further empirical research because of changes in the human and physical environments.
7.3 ISLAMIC MEDICINE, mafhum al tibb al islami
Islamic Medicine is defined as medicine whose basic paradigms, concepts, values, and procedures conform to or to do not contradict the Qur’an and Sunnah. It is not specific medical procedures or therapeutic agents used in a particular place or a particular time. Islamic Medicine is universal, all-embracing, flexible, and allows for growth and development of various methods of investigating and treating diseases within the frame-work described above. This definition calls for basic transformation of current medical systems. Islamic Medicine thus becomes the result of an Islamic critique and reformulation of the basic paradigms, research methodology, teaching, and practice of medicine. This process is called Islamization of Medicine. The end-result of the Islamization process will not be a medical system for Muslims only but for the whole humanity because Islam is a set of universal and objective values.
7.4 ISLAMIZATION OF KNOWLEDGE IN MEDICINE, islamiyyat al tibb
Muslims failed to Islamize Greek medicine when they neglected the empirical scientific method of the Qur’an and adopted negative aspects of Greek philosophy that discouraged experimentation. Guided by empirical scientific spirit of the Qur’an, Muslims must be innovative, creative, and researchers in basic and applied medical sciences so that they may become leaders of the disciplines. A medical student starts by commitment to discipline reform process. He must master your discipline well. He should then get basics of Islamic methodology from usul al fiqh, ‘uluum al Qur’an and ‘uluum al hadith to be able to critique the basic paradigms of your discipline on the basis of tauhid and the universal and perennial values of Islam. This is followed by research, publishing, teaching, networking, and inspiring others.
7.5 THE ISLAMIC INPUT CURRICULUM
The vision of the curriculum has two closely related components: Islamization and legal medicine. Islamization deals with putting medicine in an Islamic context in terms of epistemology, values, and attitudes. Legal medicine deals with issues of application of the Law from a medical perspective. The curriculum has 5 objectives: (a) Introduction of Islamic paradigms and concepts in general and as they relate to medicine (b) strengthening iman through study of Allah’s sign in the human body (c) appreciating and understanding the juridical, fiqh, aspects of health and disease, al fiqh al tibbi (d) understanding the social issues in medical practice and research (e) professional etiquette, adab al tabiib.
8.0 THE ISLAMIC INPUT CURRICULUM IN MEDICINE
8.1 INTRODUCTION TO THE ISLAMIC INPUT CURRICULUM (IIMC)
The main motive of IIMC is to resolve the crisis of duality or dichotomy manifesting as teaching Islamic sciences separately from medical disciplines by different teachers and in different institutions. IIMC resolves the crisis of duality by insisting that Islamic concepts should be taught by the same people who teach medical disciplines. All lecturers in the Kulliyah of Medicine go through a Diploma in Islamic Studies (DIS) whose modules are exactly the same as the modules of IIMC. This prepares them to be effective teachers of IIMC.
The teaching material of IIMC has been prepared and tested over the past 7 years. Synopses of all lectures for years 1 -5 are available at http://omarkasule.tripod.com.
Since the start of the Kulliyah in 1997, we have worked towards integrating Islamic values and concepts in the teaching and examination of basic and clinical medical sciences. The expectation is that our graduates will be able to integrate Islamic moral and legal values in their practice of medicine because they went through an integrated education system.
IIMC follows the Islamic paradigm of reading 2 books, the book of revelation, kitaab al wahy, and the book of empirical science, kitaab al kawn. Both books contain signs of Allah, ayaat al llaah, and must be read together. It is a mistake to read one of the books and neglect the other. The solution to the crisis of duality in the ummah starts from joint reading of the 2 books, al jam ‘u baina al qira atain. Thus medical scientists who are involved in IIMC read the signs in both books.
The vision of IIC has two separate but closely related components: Islamization and legal medicine. Islamisation deals with putting medicine in an Islamic context in terms of epistemology, values, and attitudes. Legal medicine deals with issues of application of the Law (fiqh) from a medical perspective.
IIMC has 5 main objectives: (a) introduction of Islamic paradigms and concepts in general as they relate to medicine, mafahiim Islamiyat fi al Tibb. (b) strengthening faith, iman, through study of Allah’s sign in the human body (c) appreciating and understanding the juridical, fiqh, aspects of health and disease, al fiqh al tibbi. (d) understanding the social issues in medical practice and research and (e) Professional etiquette, adab al tabiib, from the Islamic perspective.
We feel that IIC helps the future physician prepare for the heavy trust, the amanat of being professionally competent. He must be highly motivated. He must have personal, professional, intellectual, and spiritual development programs. He must know the proper etiquette of dealing with patients and colleagues. He also must know and avoid professional malpractice. He needs to be equipped with leadership and managerial skills to be able to function properly as a head of a medical team.
8.2 DERIVATION OF MEDICAL ETHICS FROM THE MAQASID AL SHARI’AT
In my view the most significant aspect of IIMC is the derivation of medical ethics from Islamic sources as al alternative to western sources. The full impact of this will be appreciated in due course when these ideas become widely adopted.
Secularized European law denied moral considerations associated with ‘religion’ and therefore failed to solve issues in modern medicine requiring moral considerations. This led to the birth of the discipline of medical ethics that is neither law enforceable by government nor morality enforceable by conscience. On the other hand, Islamic Law is comprehensive and encompasses moral principles directly applicable to medicine.
The theory of medical ethics in Islam should be based on the 5 purposes of the Law, maqasid al shari’at, that are also considered the 5 purposes of medicine, maqasid al tibb. The 5 purposes are preservation of religion and morality, hifdh al ddiin; preservation of life and health, hifdh al nafs; preservation of progeny, hifdh al nasl; preservation of intellect, hifdh al ‘aql; and preservation of wealth, hifdh al maal. Any medical action must fulfill one of the above purposes if it is to be considered ethical. If any medical procedure violates any of the 5 purposes it is deemed unethical.
In practical detailed situations, legal axioms called Principles of the Law or qawa’id al shari’at need to be used to resolve mostly situations of apparent conflict between maqasid or to assist logical reasoning. Principles of the Law, qawa’id al shari’at, when applied to the medical area can also be referred to as Ethical Principles of Medicine, qawa’id al tibb. The basic ethical principles of Islam relevant to medical practice be derived from the 5 principles of the Law, qawa’id al shari’at, that are: intention, qasd; certainty, yaqeen; injury, dharar; hardship, mashaqqat; and custom or precedent, ‘aadat. The maqasid and qawa’id are used in a synergistic way. The basic purpose of qawa’id is to provide robust rules for resolving situations of conflict between or among different maqasid.
The challenge before Muslim physicians is to liberate themselves from confusing and inconsistent European ethical theories and principles and instead to work hard to develop specific regulations for various medical interventions, dhawaabit al tibaabat, by a renewal of ijtihad. This ijtihad will be based on primary sources of the Law (Qur’an and sunnat), secondary sources of the Law based on transmission, masaadir naqliyyat (ijma and qiyaas); secondary sources of the Law based on reason, masaadir ‘aqliyyat (istishaab, istihsaan, & istilaah); the purposes of the Law, maqasid al shari’at; principles of the Law, qawa’id al fiqh; as well as regulations of the Law, dhawaabit al fiqh.
In the early period of medical jurisprudence (0-1400 H) most issues could be resolved by direct reference to the primary sources. In the middle period (1401 – 1420 H) issues were resolved by using ijma, qiyaas, istishaab, istihsaan, & istilaah. In the modern period (1420 - ) medical technology is creating so many issues whose resolution will require a broad bird’s eye-view approach that can only be found in the theory of maqasid al shari’at.
9.0 CURRICULUM CONTENT
9.1 Basics of laws
Fundamentals of the Law: Sources of Islamic Law (Qur’an, sunnat, ijma, qiyaas etc). Sources of European Law (statute, case law). Purposes of the Law: maqasid al shari’at (morality, life, progeny, intellect, resources). Principles of the Law: qawa’id al shari’at (intention, certainty, injury, hardship, custom). Types of legal rulings (halal, haram, mubaah, makruh, aziimat & rukhsat), Relation of ethics to law (the Islamic vs European perspectives). The law and human rights (Islamic vs the European perspectives). Equality before the law (non discrimination on grounds of race/ethnicity, national origin, creed, political affiliation, gender, age, and disability status).
National legal systems: civil and shari’at laws: The national civil and criminal justice system (sources of the laws, types of courts and their jurisdiction, difference between civil and criminal procedures, process of trial, judgment and punishment, legislation specific to medical practice). National laws related to health. The national shari’at legal system (types of courts and jurisdictions, enabling legislation, the office of the State Mufti and medical fatwas).
9.2 Theories and principles of medical ethics
Theories of medical and biomedical ethics: Islamic theory: maqasid al shari’at (morality, life, progeny, intellect, and resources). European theories (deontology vs. teleology, consequentialism / utilitarianism, principlism, Kantian, virtue, relationship, and casuistry, communitarian ethics, feminist ethics, empirical).
Principles of medical and biomedical ethics: Islamic (intention, certainty, harm, hardship, custom) and secular European (autonomy, beneficence, nonmalefacence, justice), Christian, Buddhist, Jewish, and empirical. International ethical codes (Hippocratic, Nurenberg, Helsinki
9.3 Issues of consent
Medical consent for competent patients: Patient autonomy (definition, legal and conceptual basis, significance in health care, limitations, patient autonomy vs physician paternalism, second opinion, conflict between human rights and requirements of medical treatment). Physician autonomy (forcing a procedure on a physician). Competence / capacity (definition, conditions, testing). Informed consent (definition, process, who asks?). Scope of consent (physician choice, physician of a different gender, treatment, refusal). Conditions for validity of consent (understanding, disclosure, weigh info, voluntary, aware can refuse). Information for informed consent (diagnosis, prognosis, treatment alternatives, risks and benefits). Capacity to consent (global vs specific, tests for capacity, enhancing capacity). Consent / refusal for the competent (process).
Medical consent for incompetent patients: Consent / refusal for the incompetent (young children, older children, the mentally ill, the unconscious). Consent in emergencies (competent patient but no time for consent, incapacitated patients, resuscitation after attempted suicide, carrying out an unauthorized /unfamiliar procedure to save life, refusal of emergency treatment by a competent / incompetent person, advance refusal, forensic search of unconscious patients, off duty doctor in an emergency, disclosure of emergency room information to the police, forensic searches of emergency patients: blood alcohol levels, domestic violence and child abuse in ER, admission of relatives into ER). Physician assessment of best interests of the patient. Proxy decisions (parents, relatives, designated person). Advance statements (definition, scope, format, witnesses, advantages, and disadvantages). Consent by the court. Treatment options (economic and other considerations).
9.4 Privacy, confidentiality and disclosure
Privacy and confidentiality: Privacy (definition, relation to patient autonomy). Confidentiality (definition, what information is considered confidential, anonymized information, violation with / without consent, disclosure about the deceased). Basis/ rationale / justification of confidentiality (clinical care. Autonomy and privacy, fidelity, social basis, legal basis). Truthfulness (obligation to tell the truth, information patient does not need/want to know, partial disclosure / white / technical lies, giving bad news, the physician’s body language).
Disclosure: Disclosure (by the patient, with consent for education, research, and insurance; without consent to other healthcare professionals and in the public interest). Conflict of duties regarding confidentiality and disclosure to: insurance, employer, HIV, witness in litigation (with consent, without consent). Disclosure of family history / genetic information (by the patient vs by the physician, request by the employer, request by the police).Generation and handling of medical records (SOAPIE, various forms of records, ideal record, omitting or removing information, legal ownership of records, ensuring record security, period of retention of records, patient access to records, access to records of the incompetent, issues in storage and retrieval of records). Disclosure to the mass media (public vs individual interest). Disclosure by doctors with dual obligations: occupational, army, police, prisons, sports, hospital manager (with consent, without consent). Physician in court: as a witness of facts vs expert witness (duty to patient vs public duty to justice, testifying for vs testifying against the patient).
9.5 Research
Research policies and procedures: Composition of Institutional research committee. Functions of an Institutional research committee / basis for ethical approval (scientific merit, competence of researchers, social value, risks vs benefits, informed consent, confidentiality, conflict or interests / roles, transparency, disclosure, publication / funding bias). Types of fraud in research (not following GCP guidelines, no consent, data falsification, plagiarism, including names that did not participate, researchers not trained, falsifying authorship). Avoiding research fraud / malpractice (training in GCP, ethical and scientific review of research proposal, detailed recording of all research activities, researchers must be personally involved, quality assurance and audit, encourage whistle blowing.
Animal research: Handling animals before, during, and after research (kindness and good treatment, forbidding cruelty, nutrition, minimize pain, respect even in death). Purposes of animal research (spare humans from risk, the doctrine of taskhiir). Purposes and principles of the Law in animal research. Relevance to humans (similar physiology, findings not definitive human research still needed). Choice of animals for research (edible vs non-edible, pets, wild vs domestic, big vs small, dangerous vs innocuous).
Human research: History (historical evolution, historical ethical violations). Phases of clinical trials (1,2,3, and 4). Therapeutic vs non-therapeutic research. Good clinical practice guidelines. Autonomy / informed consent (research on humans, research on records, postmortem research). Information given to patients before consent (the treatment, available information, missing information necessitating research, difference between the new and the standard treatments, alternative treatments, risks and benefits, measures to ensure safety). Freedom to withdraw. Material inducements. Confidentiality (anonymized data, personal details disclosed with consent). Research in emergency rooms. Inclusion of women and minorities. Research on the mentally incompetent. Record based research. Research on cadavers. Research on Children (consent by competent children endorsed by parents, parental consent for incompetent children, children’s physiological vulnerability, parental consent for research in child’s interest. Parental consent for research not in the child’s interests, benefits > risks, child overriding parental consent). Research on the elderly. Research on the mentally incapacitated. Research on prisoners. Research on students and employees. Research on members of uniformed services, army and police (consent vs obeying chain of command). Research on biological samples, organs, and tissues from living donors (informed consent if not anonymous, storage of material, benefits and risks, confidentiality). Research on organs and tissues from dead donors (consent by family, storage, confidentiality). Research on embryos (sources of embryos, types of disease that benefit). Research on fetal tissues (spontaneous abortions, induced abortions, financial inducements). Biomedical research. Public health research. Health services research.
9.6 Issues at the beginning and end of life
Beginning of life issues: Prenatal / pre-implantation gender testing in IVF. Induced abortion (maternal disease, unwanted pregnancy, gender selection, congenital anomalies).
Stem cell technology: Stem cells (definition, methods, use in disease therapy, use in research, sources of stem cells and ethical controversies).
Embryo/fetal research: Sources of embryos. Types of research that uses embryos (contraception, sterilization, reproductive cloning). Ethical guidelines and controversies.
Genetic technology: Genetic therapy. Genetic banks and patenting issues. Human-animal hybrids. The Human genome project. Genetic testing. Genetic screening. Pre-implantation diagnosis. Genetic engineering and therapy.
End of life issues: Terminal illness (definition). Palliative care (definition, content, organization, institutional vs home, modalities, ethical and legal issues). Diagnosis of brain death (whole brain & higher brain). Initiating / withdrawing artificial life support (principles of saving life, certainty, resource conservation, autonomy). Euthanasia (definition, purpose of life, difference between legal withdrawal and euthanasia, acts of omission and commission). Physician assisted suicide. Solid organ transplantation (living and cadaver donor, xenotransplantation, use of anencephalic donor, neural transplantation, fetal transplantation). Post-mortem examination (purposes, process, ethico-legal controversies). Cadavers (research on cadavers, display and teaching on cadavers, dissection of cadavers, storage and use of human tissue
9.7 Ethico-legal-fiqh issues in medical practice
Issues in normal reproduction: Menstruation (salat, puasa, recitation, use of hormones to delay menses in Ramadhan and hajj, activities allowed/prohibited during menstruation). Pre-menstrual tension (impact on social and religious obligations). Irregular menstruations in the climacteric period (impact on salat, puasa, sexual life). Prolonged menstruation (puasa, salat, coitus). Dysmenorrhea (salat). Menopause (definition, early induction medically or surgically, artificial delay, HRT). Human sexuality & sexual behavior (forms sexual expression and behavior, regulation of human sexuality, guidelines on coitus, moral/cultural relativism regarding sexual behavior). Contraception (legal permissibility, autonomy decisions: individual choice vs public policy, disagreement between spouses, risks and benefits of various methods, allowed and prohibited methods, contraception for the unmarried, sterilization of the mentally retarded, relation to sexual promiscuity, demographic impact, parental consent for minors). Pregnancy (legal minimum and maximum duration). Prenatal screening & diagnosis genetic/non-genetic (benefits & risks, non-therapeutic abortion, human rights of the embryo). Labor (puasa and salat). Delivery (autonomy in choice of method, refusal of CS, request for CS, maternal-fetal conflict). Postnatal care (iqamat and adhan at birth, naming, aqiiqat). Breast-feeding (duration, foster feeding).
Issues in activities of normal living: Physiological secretions and wudhu / salat (skin and integuments, hair, ear, nose, throat, mouth, urogenital, intravascular, interstitial, pathological secretions, & intubation, and catheterization). Environmental hygiene (bad odors in mosque and public gatherings). Foods & drinks (sources, halal & haram, etiquette of meals, food hygiene, control of the appetite, waste of food, hunger and thirst). Physical activity (difference between physical activity and physical exercise, health, recreational, and other benefits). Standing, sitting, walking and running (purposes, bipedal locomotion, upright posture, dynamic and static balance, postural hypotension in prolonged salat). Sports (traditional, violent, participatory & non-participatory), sleep and rest (definition, a form of death, purposes, etiquette, dreams, disorders, legal competence of the sleeping person).
Diagnostic procedures: History (consent, scope, lifestyle questions, confidentiality, nasiha). Physical examination (consent, uncovering awrat, physician of opposite gender). Radiological examination (consent, confidentiality of images). Laboratory tests (consent, confidentiality, disclosure). Esophagoscopy and colonoscopy (wudhu, salat, puasa). Aggressive investigation of common symptoms (cost vs risk of missed diagnosis, legal liability for missed diagnosis). HIV testing (compulsory mass testing, compulsory testing of a suspect, targeted testing of high risk groups, testing at the workplace, pre-marital testing, anonymous testing for epidemiological purposes, disclosure to the employer and the spouse).
Therapeutic procedures: Balance of benefit and injury (benefit>injury, benefit<injury, benefit=injury, choice between 2 evils, choice between legality and benefit, individual vs public interest, prohibited vs necessary, double effect). Prescriptions and administration of medications (ethico-legal issues, financial violations, conflict of interests, pharmacogenetics, regulations of drug administration, request for lifestyle drugs, porcine derived anticoagulants). Medication and wudhu (oral and rectal routes, vomiting after medication). Medication and puasa (oral, rectal, intramuscular, intravenous, sublingual). Surgical procedures (disclosure of surgical risk, consent). Anesthesia (consent, wudhu, salat). Blood transfusion (safety, cross matching errors, consent/refusal, selling/buying, unwilling donors, donation by relatives, prisoners, and drug addicts). Resuscitation (without consent, principle of certainty about nett benefit, doctrine of futility). Cosmetic / reconstructive surgery (concept of changing Allah’s creation, beautification, prostheses, gender change, results less than desired, injury). Solid organ transplantation (indications, preventive transplantation, sale of organs, informed consent for donor and recipient, friend and family donors, living will on organ donation, issues of organ harvesting and determination of death, minor donors and recipients, ownership of organs, decision to donate for incompetent terminally ill and the dead, condemned prisoners as donors, opt-in and opt-out systems, organ donor card, organ donor register). Doctrine of double effect. The slippery slope. Ordinary vs heroic means in treatment. Acts of omission vs acts of commission. Use of drugs in sports. HIV treatment (compulsory treatment of pregnant HIV+ve, free retroviral drugs for HIV +ve)
Physical Acts Of Worship For The Sick: Toilet hygiene (istinjau, colostomy, urinal, discharging fistula). Wudhu (conditions that do/do not nullfy wudhu, wudhu with skin conditions, wounds, bleeding, urinary, and fecal incontinence; wudhu for immobilized patient, wudhu for hemiplegics, wudhu with extreme sensitivity to cold or heat, wudhu with dysfunctional bleeding). Tayammum (definition, conditions of recommendation: skin and cold, etiquette, soil / sand in the hospital), Ghus for the sick., salat (salat with musculoskeletal and neurological disability, joining and shortening salat for a reason; salat for immobilized patient, salat for the blind and deaf, salat in extreme cold/hot weather, salat with extreme thirst or hunger, salat with hemiplegia, vestibular disorders, postural disorders, dysfunctional bleeding). Puasa (diabetes, ulcers, vomiting, diarrhea), zakat, and hajj (muscoskeletal and neurological disability, hajj for the blind and deaf, vestibular disorders, postural disorders
Input/output systems disorders: alimentary and urinary: Upper GIT conditions: nausea, vomiting /hemetamesis, peptic ulcer (wudhu, salat, pausa). Lower GIT conditions: rectal bleeding, incontinence, fistulae (wudhu, salat, puasa, and hajj). Urinary symptoms and signs: dysuria, pyuria, urgency, incontinence, hesitancy, strangury, terminal dribbling, tenesmus, urethral discharge, colored urine, hematuria (wudhu, salat, haj, coitus). Chronic renal failure (dialysis, renal transplantation). Urinary fistulae and catheters (wudhu, salat, and hajj). Renal colic (salat, hajj). Prostate disease: symptoms and signs, screening: PSA, treatment options: watch, bilateral orchidectomy, chemical orchidectomy wioth LHRH agonist, non-steroidal anti-androgen, radiotherapy +/- adjuvant LHRH, chemotherapy,
Transport systems disorders: cardiovascular & respiratory: Dyspnea due to cardiovascular causes: (salat, hajj, puasa). Dyspnea due to respiratory causes: pneumothorax, pulmonary embolism, chronic bronchitis, emphysema (salat, hajj, puasa). Congestive cardiac failure (puasa).
Reproductive system disorders: Menopausal disorders (artificial menopause, osteoporosis, benefits and risks of HRT, preventive hysterectomy +/1 ovariectomy). Dysfunctional uterine bleeding: peri-menopausal, pre-menopausal, post-menopausal, malignancy (salat, puasa, hajj, coitus, hysterectomy +/1 ovariectomy). Erectile dysfunction: definition, causes, treatment (marital dissolution). Sexually transmitted disease (pre-marital screening, condoms for sexually active teenagers, confidentiality in treatment, partner tracing and notification). Pre-natal diagnosis / screening / genetic testing/treatment (indications, methods, test performance, counseling pre and post, informed consent, risks and benefits, relation to abortion, human rights of the embryo/fetus). Assisted reproduction for infertility: in vivo and in vitro insemination (basic permissibility for a married couple, prohibition of ovum or sperm donation, premarital disclosure of infertility, postmortem IVF, masturbation, paternity and maternity disputes, disposal/use of unused fertilized ova, pre-implantation sex selection and diagnosis, selective fetal reduction, developing embryos for non reproductive purposes, IVF for sibling benefit, using fertilized embryos for cloning
Locomotion, support, and connective system disorders: Orthopedic problems: sprains & fractures, orthopedic fixation, osteomyelitis, osteoporosis, malignant bone neoplasms (salat, hajj, work-related injury, workmen compensation, factory work with tremors, physical activity, rest, and sleep). Limb disorders (salat and hajj), Gait disorders (salat and hajj). Involuntary movements:chorea, athetosis, spasciticity etc (salat, hajj, work with moving machinery, driving, accidents in activities of normal living). Myasthenia gravis (salat, puasa, hajj). Joint disorders with restricted/painful movements: osteoarthritis and rheumatoid arthritis (tayammum if cold exercabates the pain, salat, hajj, risk-benefit analysis of chronic pain medication, addiction to analgesics and opiates). Vertebral column pain: spondylosis, intervertebral disease, sponylolidthesis, ankylosing spondylitis, root compression, etc (salat, hajj). Laryngeal, pharyngeal, or oral disease (recitation of Qur’an, public duties like judging, leadership, and court testimony
Sensory system disorders: Blindness and deafness (salat, hajj, court testimony, marital contracts, civil contracts, financial contracts, leadership, judgeship, employment). Olfactory disorders (wudhu, salat, halitosis in puasa, use of perfume in public). Taste disorders (selling and buying food). Tactile disorders (work accidents). Temperature disorders (heat stroke in hajj, salat and puasa in extreme temperatures, work accidents). Pain disorders: headache (salat in extreme pain, dyspareunia and marital stress). Hunger and thirst (delay of salat for hunger, puasa with extreme hunger/thirst)
Neurological disorders: Stroke (salat, puasa, hajj, civil transactions). Epilepsy (salat, hajj, driving, factory work, job discrimination, injury due to inadequate anti-convulsive therapy). Parkinson disease (salat, hajj, employment). Dementias (salat, puasa, hajj, legal competence, civil and financial transactions, court testimony, tests of capacity). Brain tumors. Brain /skull trauma. Spinal cord injury: lower motor vs upper motor, hemiplegia/hemiparesis, paraplegia/paraparesis (salat, hajj, marriage). Aphasia/dysphasia (marriage and contracts, evidence, public leadership). Vestibular disturbances (salat, hajj). Peripheral neuropathies: diabetic neuropathy
Psycho-social conditions: Legal impact of loss of competence (salat, hajj, zakat, marriage contract, divorce, wills and testament, financial transactions, legal proceedings). Human drives and the genesis of emotions positive and negative. Anxiety disorders (unbalanced drives, classification of anxiety: normal and pathological, anxiety vs fear and depression, normal and pathological anxiety, spiritual malady and cognitive impairment as causes of anxiety, salat in extreme anxiety, wudhu/salat with compulsive/obsessive disorders, prevention of anxiety by renewal of aqidat, ibadat, doa, and removal of stressors, socialization). Stress (competence, spiritual treatment of stress, salat with stress, prevention of stress, salat as cure of stress). Loss of consciousness: sleep, forgetfulness, anesthesia, coma (salat, puasa, zakat, civil, financial, and judicial transactions, proxy decisions by the guardian, wali). Personality disorders (salat, puasa, hajj, marriage). Psychiatric conditions /psychosis/schizophrenia (salat, zakat, hajj,stigmatization, compulsion:, Brunei Lunacy Act 1984, psychosurgery, ECT, confidentiality). Depression and suicide / para-suicide / harm to self and others (compulsory detention and treatment, process of mental committal, liability of physician who fails to identify potential suicide, conflict on suicide religious prohibition vs autonomy rights). Psychogenic sexual disorders (definition: lack of libido, sexual dysfunction, sexual deviation, treatment, impact on marriage and divorce: divorce or khulu’u). Neurotic / anxiety / compulsive-obsessive disorders (salat, marriage and divorce, civil and judicial transactions).
Other conditions: Patho-physiological disturbances: fever, dehydration, infecrtions, (wudhu, salat, hajj, civil and financial transactions). Hematological disorders: anemia, leukemia, lymphoma, coagulation disorders. Skin disorders: eczema, psoriasis, SLE, etc. Diabetes mellitus (puasa).
Issues of special age and gender groups: Women and maternal conditions. Neonatal and infant conditions. Congenitally abnormal fetii / infants: anencephaly, spina bifida, hydrocephalus (delivery time: before or at term?, delivery method: vaginal or Ceserean?, CPR at birth, long-term life support). Child conditions. Geriatric physical dysfunction: musculoskeletal, falls, fractures, senses, nutrition (taharat, wudhu, salat, puasa, hajj). Geriatric psychoneurological conditions and dementias (civil and financial transactions, salat, puasa, hajj). Geriatric psychosocial dysfunction (depression, dependency/loss of self esteem, sexual dysfunction, quality of life, civil transactions). Disabilities: rights and obligations. Research on the elderly. Drug prescriptions for the elderly.
9.9 Ethico-legal-fiqh issues in psychosocial applications
The Family Institution: Gender. Family as a natural social unit. Marriage. Parents and relatives. Child protection (definition of child protection, limits to parental rights, state intervention to protect children)
Community Problems: Description of culture (definition, relativism, relation to personality, ethnocentrism). Trans-cultural ethics. Life-style (essentials of life, dress and ornamentation, entertainment, social failure). Sexual perversions (background, antecedents, adverse effects, prostitution, abnormal coital behaviors, sexual paraphilias, and criminal sexual aggression, abnormal marital arrangements). Unwanted pregnancy (determinants and causes, adverse effects, relation to abortion, alternatives to abortion, prevention and mitigation). Addiction and substance abuse: nicotine, drugs, alcohol (causes, prevention and treatment, rehabilitation). Poverty. Violence. Child abuse & neglect (definition and classification of abuse, sexual exploitation, child protection, best interests, physician reporting /non-reporting of abuse to authorities: benefits and risks). Issues of women (discrimination)
Community Action: enjoining the good and forbidding the bad, health promotion, social change, professional and occupational organizations, social welfare, disaster relief, refugees,
Civil Transactions: Health-related ethico-legal issues in marital contracts (selection of a spouse, forbidden spouses, marriage contract conditions, conjugal rights and responsibilities). Divorce & annulment (divorce in menstruation and pregnancy, purposes of post-dicorce waiting period). Inheritance. Endowments & gifts,
Occupational health issues: Pre-employment testing (infectious disease, addiction to drugs and alcohol, genetic, psychological). Testing during employment (purposes, disclosure to employer, sick leave, random test for drugs, removal of hazards).
Judicial transactions: legal competence: ahliyyat
Public health ethics: Public health measures in an epidemic without consent (quarantine, isolation, mass immunization, mass treatment). Disease screening and surveillance. Control of infectious disease (control and eradication, infectious disease control Act). HIV (premarital testing, voluntary testing, counseling, confidentiality), HIV prevention (free condoms in schools, sterile needles for IV drug users). HIV: discrimination in employment, immigration, and healthcare. Vaccination / immunization (cost benefit analysis).
9.10 Professionalism
Professional physician etiquette / conduct with patients: Physician competence, responsibility, and accountability. Doctor-patient relationship (compassion, competence, disclosure & truthfulness, confidentiality, etiquette of the patient, bedside visit, uncovering awrat, interaction with the opposite gender, interaction with the family). Fidelity obligations (patient-doctor contract, dual obligations: army, police, prisons, sports, factory, school & university, conflict of duties and conflict of interests). The disabled patient.
Professional etiquette with the terminally ill/dying: palliative care. The terminally ill / dying (comfort, hygiene, alleviation of pain, acts of worship, legal preparation, spiritual preparation). Death. Burial (customs, mourning,). Bereavement.
Collegial relations / etiquette in a health team: principles of successful group work. General and special group dynamics. Student-teacher relation. Mutual respect and cooperation. Conflict resolution. Whistle blowing on unethical behavior. Cooperation with traditional healers.
Professional misconduct: Abuse of privileges (unethical research, unnecessary treatment, iatrogenic infection, misuse of controlled drugs, false documentation). Private misconduct derogatory to the profession (sexual transgression, abuse of trust, violence and felonies). Financial misconduct (kick-backs and fee splitting, conflict of interest). Un-ethical business practices. Felonies. Dealing with the pharmaceutical industry. Conflict of financial interests (physician as a manager, occupational physician employed by the company, sports physician). Licensing and registration (specialist practice without certification). Promises of wonder cures.
Malpractice & negligence. Definition of negligence/malpractice. Ingredients of a negligence suite. Avoiding negligence suits. Bolam principle as modified by Bolitho. Patient complaint / grievance system as a tool to prevent malpractice.
10.0 IMPLEMENTING THE CURRICULUM
10.1 Setting the vision for Islamic health care in the future.
The overall vision of the curriculum is based on fulfilling purposes, maqasid. These can be visualized at the level of the whole society or community. As a society, medical practice must be visualized within the 3 major purposes of khilafat al insan fi al ardh, imarat al ardh, and taskhiir al ardh lim al insaan. As an individual medical practice must be situated within the purposes of ubudiyyat (‘ibaadat & taqwa) and tazkiyat al nafs. In a practical and legal way medical practice must fulfill or not violate the 5 cardinal purposes of the Law: hifdh al ddiin, hifdh al nafs, hifdh al nasl, hifdh al aql, and hifdh al maal.
10.2 Maqasid al shari’at in health care
Islam has a parsimonious and rigorously defined ethical theory of Islam based on the 5 purposes of the Law, maqasid al shari’at. Any medical action must fulfill one of the above purposes if it is to be considered ethical. Healthcare workers in their conduct and decision making must constantly be aware of the maqasid to practice medicine in an ethical and legal way accepted by the shari’at.
10.3 The emerging Islamic healthcare industry
Several factors combine to foster the development of an Islamic health care industry. There is frustration with existing health care delivery due to human factors and not technology. There is a desire to explore the Islamic alternative: Muslim patients prefer an Islamic environ. The parallel of Islamic banking and finance also motivates Islamic healthcare. Lessons from Islamic banking: sufficient theory before & personnel training before practice
10.4 The process of curriculum change
Islamic input must have a relation to the national competence curriculum. It supplements and does not supplant the national goals. It is an added value to the process of medical education. At the start of the curriculum reform process we must decide what changes are to me made. These changes must be integrated in a harmonious way into the existing structures. The process should be gradual being more evolution than revolution.
10.5 Methods of teaching
The following methods have been used either singly or in combination to deliver the curriculum.
- Full integration into the lectures and PBL
- Case scenarios or case studies
- Clinical ethical rounds
- Practical training: taharat and ibadat
- Field visits: clinics, courts, research centers etc
The most effective approach has been the use of case studies.
10.6 Reading materials
Shortage of reading material has been a recurring problem. There are hardly any books or journals dealing with the Islamic input in the curriculum. It is suggested that specialized workshops be held at which experts present papers for discussion that are compiled into books and manuals. Efforts can also be made to translate existing material.
10.7 Teacher training
Success of the curriculum will require well trained teachers. It is suggested that some universities volunteer to provide the following programs:
- Diploma / masters in Islamic Healthcare Delivery
- Masters and doctorate by research on specific ethical issues
10.8 Curriculum evaluation: annual conference.
Annual curriculum review conferences can cover the following:
- Methods of teaching
Reading - Teacher training
10.0 Output evaluation
- Alumni association to maintain contact / tracer studies
- Questionnaire surveys: how are these graduates different from others
