Wednesday, March 23, 2016

ISLAM AND ORGAN DONATION | P.K. ABDUL RAHIMAN

Islam occupies a very significant position in the contemporary world as a faith, spirituality, and culture and continues to influence the practical dimensions of an estimated one fifth of the human race. Life’s very purpose in Islam is to realise the Divine, a purpose that is achievable only through a conscious commitment to the teachings of sacred will. Transmission and instruction in matters of spirituality, faith and law was the role par excellence of the Messengers/Prophets of God, of whom Muhammad was the last link in a chain that included Abraham, Moses, and Jesus. Sacred Law, in the Muslim worldview, is an all embracing entity, dealing with all aspects of human existence.

SOURCES OF ISLAMIC FAITH AND LAW

Islamic faith, ethics and practices are guided by the two primary sources such as the Qur’an—the Holy Text believed by Muslims to be the direct word of God, and the Sunnah—the example, whether in words or deeds, of the Prophet Muhammad. Islamic teachings stress on finding solutions to the problems of humanity within the permissible limits of religion where clear injunctions are available in the Quran or the tradition of the Prophet.  However, where there is no clear injunction or guidance available, other sources such as ijthihad, deductive logic based on independent reasoning and interpretation, and Ijma, consensus of scholars, are to be employed in order to resolve moral, legal and ethical dilemmas of Muslim societies.
The interest of the common good (isthihsan) should be kept as the guiding principle to be followed in the maters of law, where clear provisions are not available. In such scenario, since Islam admits no clergy, the “learned” are charged with interpreting and contextualising religious teachings for the wider Muslim community.

Islamic Approach to Life and Health
Islam considers human life as inviolable and treats its violation as a crime against humanity. As the Quran says:

Whosoever takes a human life, for other than murder or corruption in the earth, it is as if he has taken the life of all of mankind and whosoever saves a human life, it is as if he has saved whole of mankind. (Qur’an, 5:32)

No one is authorised deliberately to end life, whether one’s own or that of another human being. Saving life and reducing human suffering are encouraged. Withdrawal of food and drink to hasten death is therefore not allowed and Islam does not allow a human life to perish for want of material needs, be that food or care. According to the Islamic jurisprudence, sustenance of human life takes precedence over the legal and theological questions.

The Qur’an’s overall view of life is holistic. The Qur’an does not appear to subscribe to the doctrine of a mind-body dualism. The Quranic term “Nafs” refers to “person” and according to the Quran, human being is single organism functioning in a certain fashion. Furthermore, the Quran consistently links all aspects of its revelation/guidance to practical concerns for human behaviour. What we learn about God, for example, is relational; God is Creator, Sustainer, Guide, and Judge for humans, whose response is to be submissive to the divine will.

Thus, another aspect of the Qur’an’s holistic approach emerges in which the self is part of an integrated moral-physical universe. Even the Qur’an’s moral teaching brings the peace of mind necessary for good health. And since the God ordains humans to create and maintain a just social order, humans become instruments of other people’s health.

According to the Islamic perspective, health is one of the most excellent blessings of God upon humanity; for without it one can neither carry on one’s life business well nor call one to obey God’s commands. The God’s messenger said, ‘there are two blessings for which so many people are enviable, health and lack of worry’. The Islamic position on the need to preserve good health and medical treatment is evident in the statement attributed to the Prophet that “Allah has given cure for all illnesses” and another categorical statement of the Prophet that “get medical treatment”.

Islam and Medical Science: Historical Perspectives
Despite the clear teachings of the Quran and the tradition of the Prophet, the intellectual trends in the history of Islam in both theological and legal spheres had inclined towards anti-intellectualism. Fazlur Rahman, noted scholar of 20th century Islam, observes that the adoption of ‘Ash’arite Kalam’ (theology) by the Umayyads as orthodoxy marks the anti-intellectualist tradition in the history of Islam. Nevertheless, and perhaps in evidence of the rather contrived nature of the orthodox teaching, intellectual endeavors and scientific research in particular proceeded at unprecedented levels in the Muslim world.

Science in general and medicine in particular were highly valued in medieval Islam. The great 12th century philosopher al-Ghazali (d.1111) counts medicine as ‘’Fard Kifaya,” i.e. a collective religious duty incumbent on a sufficient number of Muslims “to look after the needs of the community.” Medicine was so highly valued that some, like Ibn al-Qifti in his Tarikh al Hukama opines that medicine was first revealed through a prophet. Similarly, Ali ibn al-’Abbas al Majus (d.994) says that ‘the basic superiority of people over other animals is their reason, and medicine is the most perfect fruit of reason’2. There have been many medical scholars in the medieval period who saw their work as religious duty as the medical science was seen as a means to reduce human suffering and save human lives. Al Dhahabi (d.1348) introduces his Prophetic Medicine, saying: “It is incumbent upon every Muslim to seek nearness to God in every possible way that can bring him/her near unto God and to do his utmost in obediently carrying out God’s commands. Now the most beneficial of such means and the most consequential approaches to God is that which benefits humanity in terms of preserving their health and treating their ailments, since health is among those things which have been required in the prayer form of worship laid down in the Sacred Law.”3Further we find a statement attributed to the founder of the Shafi school of Islamic law (d 819) that “I do not know any type of knowledge, after what is lawful and unlawful, more noble for a Muslim to acquire than that of Medicine but, alas, they have neglected it-they have neglected one third of human knowledge-and abandoned it to Jews and Christians”4. The classical Islamic approach to scientific study of medicine and health care can be evidenced from the scientific output and the proliferation of hospitals and health care facilities across this region during the period spanning between 9th and 14th centuries.  Thus it is possible to argue that the anti-intellectual orthodox position on health care and medicine do not gel well with the Islamic tradition and history. While the Islamic traditions that encouraged the deductive logic and rational approach to its textual traditions helped develop inclusive religious positions on wide range of issues including medical science and medical ethics, the orthodox anti-intellectual positions remained locked in the reductive literalism.

Islam and Organ Donation
Recent scientific and technological advances have resulted in a range of complex issues and the fields of biomedical sciences and health care has been one such area that has produced ethical dilemmas for common Muslim masses and Medical practitioners alike. The issue of organ donation and transplant has been such a matter that has generated great debate among the Islamic scholars from around the globe. The Islamic theological position on organ donation and transplant had two dichotomous positions: one that opposes the organ donation, particularly cadaver donation and transplant and the other that considers them permissible within the framework of Islamic theology and law. It will be worthwhile to examine these positions to develop comprehensive understanding of the issue.

Arguments against Organ Donation
The arguments against organ donation within the framework of Islam can be summed up as follows:
a) God has honored humans (Quran, Surat al Isra: 70), and human body is considered sacred, and tampering with that is prohibited in Islam.

b) Allah has made humans the best of creations and created everything for their benefit (Quran, 2: 229), therefore, it is permissible for a human to take benefit from every creation of Allah which includes animals, plants and inanimate things. As such, it would be unreasonable to place humans in the same category of the above things by giving permission to use parts and derive benefit out of their body that necessitates cutting, chopping and amputating parts of the body.

c) The Jurists have stated that in the case of extreme necessity and when there is no alternative available, even unlawful things, such as pork and alcohol, become permissible. However, even in such a situation, consuming or deriving benefit from a human body still remains unlawful5.

d) Human body and parts are not in our ownership in that we may fiddle with them as we desire. It is a trust (amanah) that has been given to us by God. As such, it will be impermissible for one to sell, give or donate any organs of his body.

e) Islam does not allow the violation of the sanctity of the living or the deceased, thus, the same respect accorded to someone who is alive has to be accorded to someone who is dead, as has been explained by the Prophet Mohammed:

“Breaking the bones of a corpse is similar to breaking the bones of someone who is alive.” (Hadith narrated by Ibn Majah)

f) The principle of Islamic jurisprudence states: When the evidences of prohibition conflict with the evidences of permissibility, preference is given to prohibition.66

Ibn Nujaym, al-Ashbah wa al-Nazair.In view of the above, it is argued by some that it is unlawful to transplant organs, whether it be of a living person or a dead body, and whether there is a need or otherwise. In other words, there is no permissibility whatsoever for the transplantation or donation of organs. These juristic positions have had immense bearing on the way common Muslims relate to the issue of organ donation and transplant.

Organ Donation and the Moral Dilemmas of Common Muslims
While there exists religious decrees and scholarly works that endorse the permissibility of organ donation, lack of awareness and influence of religious dogmas among the common Muslims have deterred them from making positive decisions related to organ donation and transplantation. For many common Muslims, questions such as ownership of human body, the sanctity of human corpse being violated, delay in performing the last rites, the moral responsibility of the donor, if the recipient commits wrongdoings, or whether organ can be donated to non-Muslims have played highly detrimental role in their decisions.

Organ Donation and Ownership of Human Body
According to Islam, human beings are the vicegerent (Khalifa) of God on earth. As vicegerents, human being cannot claim the ownership for anything including their body. However, the God has made everything on earth subservient to human beings and permitted them to use it for the benefit of humanity. This principle applies to the human body as well and Islam permits human beings to utilize his/her body for their benefit. It is similar to the wealth which God has given to a human, and he is permitted to utilize it and give it in charity or as a gift. Thus, one is permitted to use or donate his body as a whole or in parts to reduce the sufferings of the humanity. 

Does organ transplant violate the sanctity of human body?
Islam forbids mutilating corpses as was practiced in the pre-Islamic era, especially done to those who died in battles. The mutilation of corpse referred to by the Prophet is an act meant to humiliate and violate the honor and sanctity of the deceased. As any action is judged in Islam on the basis of its intention, the organ transplant processes can never be compared to the pre-Islamic practice of mutilation of human body. Islamic law allows performing surgeries of various kinds on living human bodies in case of medical needs and exigencies. This permission can be extended to corpses for the purpose of saving a human life and is not seen as an act of disrespect to the dead. If a pregnant woman died and the child in her stomach is still alive, her stomach will be cut open in order to take the child out, for in there is saving the life of a human7. Dr. Yusuf Al-Qaradhawi explains as follows:

“Removing a body part from a corpse does not violate the sanctity of the dead. The sanctity of the body is preserved and has not been violated. This is because the operation performed on the corpse is similar to that done on those who are alive, that is with care, meticulousness and respect.”8
Unlawful Becomes Permissible

The famous principles of Islamic Jurisprudence based on the teachings of the Quran and Sunnah permit the use of unlawful things in cases of extreme need and necessity. In case of necessity, when the life of a person is threatened the prohibition of eating carrion or drinking wine is suspended, and the Quran permits utterances of disbelief in order to save one’s life. (Quran, Surat al Nahl:106). Therefore it is argued that, in cases of need and necessity, when impure, unlawful things become permissible, in a situation where a person’s life is in danger and he is in dire need for transplantation, the transplantation of organs will be permissible.

Is it permissible to delay the funeral rites?
In Islam, funeral rites should not be delayed without valid reasons. This Islamic position has to be seen as a sign of respect to the dead. As there are instances where mortal remains of people who died abroad are brought home for the last rites, which takes many days together, that is not seen as a problem from the religious standpoint, the delay, much less in time, in carrying out organ transplant procedures for the purpose of saving human lives should be considered to be a valid reason that permits delayed performance of rites within the framework of Islamic law. However, it is important that the medical system addressed this issue and took adequate measures to minimize the time taken to complete the cadaver transplant procedures.

Is a brain dead “really dead”?
There exists a moral dilemma that whether a brain dead can be considered actually dead. This concern is a result of the lack of knowledge regarding the scientific understanding. However, in 1987, Fazlur Rahman, like many other Islamic scholars, expressed the view that relentless artificial prolongation of life is not in keeping with Islamic ethos unless there is evidence that a reasonable quality of life would result. The majority of Muslim scholars will consider brain death as an acceptable ground to discontinue life support therapy. A minority opinion is that the notion of brain stem death is inappropriate, for it is rooted in the dualism that characterizes biomedicine.

Moral Dilemma of being an Accomplice
For many, there is an apprehension that an organ donor will be considered as an accomplice and will be in a state of sin by donating his/ her organs to a person who may commit misdeeds after the transplant. This causes a moral dilemma in their decision on organ transplant. However, it has to be understood that in Islam, there is no such issue of one becoming a moral accomplice for another person’s misdeeds and is incorrect as Islam holds every individual responsible for his/her actions. The Quran says:
“No person earns any (sin) except against himself (only), and no bearer of burdens shall bear the burden of another.”

Can Muslims donate organs to non-Muslims?
The issue of donating organs to non-Muslims also has been a moral dilemma for many. This is not because of their communal mindset, rather is a result of a distorted understanding of spirituality. Islamic ideas of compassion, mercy and social good are not defined by the identities of the beneficiaries. Islam does not consider the religious identity of the beneficiaries in matters of charity. Further, the Prophet is referred to as mercy for the humanity sent to bring blessings to humanity at large, which includes non-Muslims who live alongside Muslims in peace and harmony. The Holy Quran enjoins Muslims to do good, to offer help and to co-operate in all things that will benefit mankind. Quran says:

“Allah does not forbid you respecting those who have not made war against you on account of (your) religion, and have not driven you forth from your homes, that you show them kindness and deal with them justly; surely Allah loves the doers of justice.”  (Quran, Surat al-Mumtahana: 8)   

Considering various aspects of the above principles, many important bodies of Islamic law and jurisprudence have issued religious decrees on the issue of organ donations. The Islamic Fiqh Academy, a subsidiary organ of the Organization of the Islamic Conference (OIC), established in January 1981, drawing its members and experts from across the Islamic world decreed in the year 1988 in favour of organ donation and transplant:

“Organs from the deceased can be transplanted to a patient, where the life of the recipient depends on the transplant, or if the continuation of the basic bodily functions of the recipient depends on the transplant. This is however, dependent on the deceased’s consent, or that of his next-of-kin after his death, or by the decision of the leaders of the Muslim community, should the deceased be unidentified, or does not have any next-of-kin”9.

Similar religious decrees endorsing the permissibility of organ donation have been issued by many other reputed bodies from all over the Muslim world such as Highest Council of Scholars, Riyadh10, Fatwa Committee of Kuwait11, and The National Fatwa Council of Malaysia12. The Islamic Religious Council of Singapore (MUIS) in 1973 issued a fatwa, prohibiting the organ donation on the ground that human beings do not own their body or any parts thereof. However, the Council reversed this fatwa 1986 in line with the position permitting organ donation for saving human life.

Islamic Social Responsibility and the Need to Move Forward:
The Quran has repeatedly stressed on the principles of ta’awun, helping one another, Ihsan, and rahmah (compassion). The Prophet has said:

“…..Show compassion to those on earth, and He in the heavens (i.e. God) will show His compassion to you.”

Islam has encouraged the collective responsibility of a society towards its members. The Prophet said: ‘The faithful in their mutual love and compassion are like the body if one member complains of an ailment all other members will rally in response. Another tradition says, “The faithful to one another are like the blocks in a whole building they fortify one another”. The Quran describes the faithful as those who “… give priority over themselves even though they are needy”13. The Prophet has said “help in good deeds and piety and do not help in sin and animosity”. The ethical stand point in Islam on the social responsibility to provide care and sustenance to the needy can be seen in the history of Islam as Umar ibnul -Khattab, second Caliph, decreed that “if a man living in a locality died of hunger being unable of self-sustenance, then the community should pay his money ransom (fidyah) as if they had killed him”. Using the deductive logic, it is possible to derive a similitude to people dying due to lack of blood transfusion or non-availability of organs for transplantation. As medical education is seen as a Fard Kifaya, collective responsibility of the community, so is the care of individual patient the collective responsibility of society, that has to ensure his/her health needs. This was the guiding principle in the way hospitals were established and run as endowments in the medieval Islamic period, where medical care was provided free of cost to people without considering their nationality or economic status14. This approach will help us develop a paradigm that promotes organ donation as a collective social responsibility. As the benefit of the donation continues to exist as long as the recipient lives, it can also be treated as sadakat jariya, continues charity, which is highly rewarded in Islam. 

Though the juristic position that ‘unlawful becomes permissible in case of necessity’ in relation to organ donation opens up the possibility of organ donation, it still carries an element of negativity. This has to be reconsidered in order to develop a more affirmative approach to organ donation. As organ donation is a noble act that exemplifies the Quranic position of saving a human life being equated with saving the whole of humanity, the jurists need to revisit their position on the issue to capture the spirit of the donation. That will help create a social consciousness providing a new lease of opportunity for patients to live and alleviate pain and suffering that Quran seek from its followers.

(P.K. Abdul Rahiman is an Assistant Professor and Head at the JBAS Centre for Islamic Studies, University of Madras.)

Reference :
2 .Tamara Sonn, Health and Medicine in the Islamic Tradition: Fazlur-Rahman’s View, Journal of Islamic Medical Association,
Volume 28, 1996 - Page 191.
3 Ibid
4 Fazlur Rahman, Health and Medicine in the Islamic Tradition: Change and Identity, ABC International Group Inc, 1998, p 48.
5 al-Fatawa al-Hindiyya, 5/310
7 .Samarqandi, Tuhfat al-Fuqaha, 4/261 & Badaii al-Sanai.
8 Dr. Yusuf Al-Qaradhawi, Fatawa Mu’asarah, vol.3, pp. 665-666.
9 Please see page 58 of “Majma’ Al-Fiqh al-Islami: Qararat Wa
Tausiyat, 1985-1988.”
10 Decision of the scholars in the Highest Council of Scholars in Riyadh, Saudi Arabia. Please see decision no. 99, 6 Zulqaedah 1402H.
11 Decision no. 132 issued by the Fatwa Committee of Kuwait in 1979.
12
The declaration made on The First Meeting of the National Fatwa Council of Malaysia for Islamic Affairs on the 23-24th of June 1970.
13 Quran, 59:9
14 Fazlur Rahman, p.70.

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