ISLAMIC CODE OF MEDICAL ETHICS KUWAIT DOCUMENT

Islamic Organization for Medical Sciences

1981

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The First International Conference on Islamic Medicine, held in Kuwait in January 1981, endorsed this Islamic Code of Medical Ethics with the hope that every Muslim doctor would "find in it the guiding light to maintain his professional behaviour within the boundaries of Islamic teachings." As do other Muslim medical ethics texts, the code draws on passages from the Qur'an and demonstrates an explicitly religious tone, more so even than most contemporary Judaeo-Christian medical ethics directives. The code includes an oath for physicians.

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The Oath of the Doctor

I swear by God…The Great

To regard God in carrying out my profession

To protect human life in all stages and under all circumstances, doing my utmost to rescue it from death, malady, pain and anxiety…

To keep people's dignity, cover their privacies and lock up their secrets…

To be, all the way, an instrument of God's mercy, extending my medical care to near and far, virtuous and sinner and friend and enemy…

To strive in the pursuit of knowledge and harnessing it for the benefit but not the harm of Mankind…

To revere my teacher, teach my junior, and be brother to members of the Medical Profession joined in piety and charity…

To live my Faith in private and in public, avoiding whatever blemishes me in the eyes of God, His apostle and my fellow Faithful.

And may God be witness to this Oath.

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Definition of Medical Profession

• "THERAPEUSIS" is a noble Profession. God honoured it by making it the miracle of Jesus son of Mary. Abraham enumerating his Lord's gifts upon him included "and if I fall ill He cures me."
• Like all aspects of knowledge, medical knowledge is part of the knowledge of God "who taught man what man never knew." The study of Medicine entails the revealing of God's signs in His creation. 'And in yourselves…do you not see?' The practice of Medicine brings God's mercy unto His subjects. Medical practice is therefore an act of worship and charity on top of being a career to make a living.
• But God's mercy is as accessible to all people including good and evil, virtuous and vicious and friend and foe—as are the rays of His sun, the comfort of His breeze, the coolness of His water and the bounty of His provision. And upon this basis must the medical profession operate, along the single track of God's mercy, never adversive and never punitive, never taking justice as its goal but mercy, under whatever situations and circumstances.
• In this respect the medical profession is unique. It shall never yield to social pressures motivated by enmity or feud be it personal, political or military. Enlightened statesmanship will do good by preserving the integrity of the medical profession and protecting its position beyond enmity or hostility.
• The provision of medical practice is a religious dictate upon the community, 'Fardh Kifaya,' that can be satisfied on behalf of the community by some citizens taking up medicine. It is the duty of the state to ensure the needs of the nation to doctors in the various needed specialities. In Islam, this is a duty that the ruler owes the nation.
• Need may arise to import from afar such medical expertise that is not locally available. It is the duty of the State to satisfy this need.
• It also behoves the State to recruit suitable candidates from the nation's youth to be trained as doctors. An ensuing duty therefore is to establish relevant schools, faculties, clinics, hospitals and institutions that are adequately equipped and manned to fulfill that purpose.
• "Medicine" is a religious necessity for society. In religious terms, whatever is necessary to satisfy that "necessity" automatically acquires the status of a "necessity." Exceptions shall therefore be made from certain general rules of jurisprudence for the sake of making medical education possible. One such example is the intimate inspection of the human body whether alive or dead, without in any way compromising the respect befitting the human body in life and death, and always in a climate of piety and awareness of the presence of God.
• The preservation of man's life should embrace also the utmost regard to his dignity, feelings, tenderness and the privacy of his sentiments and body parts. A patient is entitled to full attention, care and feeling of security while with his doctor. The doctor's privilege of being exempted from some general rules is only coupled with more responsibility and duty that he should carry out in conscientiousness and excellence in observing God, "excellence that entails that you worship God as if you see Him. For even though you don't see Him, He sees you."

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Characters of the Physician

• The physician should be amongst those who believe in God, fulfill His rights, are aware of His greatness, obedient to His orders, refraining from His prohibitions, and observing Him in secret and in public.
• The physician should be endowed with wisdom and graceful admonition. He should be cheering not dispiriting, smiling and not frowning, loving and not hateful, tolerant and not edgy. He should never succumb to a grudge or fall short of clemency. He should be an instrument of God's justice, forgiveness and not punishment, coverage and not exposure.
• He should be so tranquil as never to be rash even when he is right…chaste of words even when joking…tame of voice and not noisy or loud, neat and trim and not shabby or unkempt…conducive of trust and inspiring of respect…well mannered in his dealings with the poor or rich, modest or great…in perfect control of his composure…and never compromising his dignity, however modest and forebearing.
• The physician should firmly know that "life" is God's…awarded only by Him…and that "Death" is the conclusion of one life and the beginning of another. Death is a solid truth…and it is the end of all but God. In his profession the Physician is a soldier for "Life" only…defending and preserving it as best as it can be, to the best of his ability.
• The Physician should offer the good example by caring for his own health. It is not befitting for him that his "do's" and "don'ts" are not observed primarily by himself. He should not turn his back on the lessons of medical progress, because he will never convince his patients unless they see the evidence of his own conviction…God addresses us in the Qoran by saying "and make not your own hands throw you into destruction." The Prophet says "your body has a right on you"…and the known dictum is "no harm or harming in Islam."

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• The role of Physician is that of a catalyst through whom God, the Creator, works to preserve life and health. He is merely an instrument of God in alleviating people's illness. For being so designated the Physician should be grateful and forever seeking God's help. He should be modest, free from arrogance and pride and never fall into boasting or hint at self glorification through speech, writing or direct or subtle advertisement.
• The Physician should strive to keep abreast of scientific progress and innovation. His zeal or complacency and knowledge or ignorance, directly bear on the health and well-being of his patients. Responsibility for others should limit his freedom to expend his time. As the poor and needy have a recognized right in the money of the capable, so the patients own a share of the Doctor's time spent in study and in following the progress of medicine.
• The Physician should also know that the pursuit of knowledge has a double indication in Islam. Apart from the applied therapeutic aspect, pursuit of knowledge is in itself worship, according to the Qoranic guidance: "And say…My Lord…advance me in knowledge." and: "Among His worshippers…the learned fear Him most"…and: "God will raise up the ranks of those of you who believed and those who have been given knowledge."

Doctor–Doctor Relationship

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• Physicians are jointly responsible for the health care of the Nation…and complement one another through the variety of their medical specialization be they preventive or therapeutic, in the private sector or in State employment…all abiding by the ethics and rules of their profession.

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Doctor–Patient Relationship

• For the sake of the patient the Doctor was…and not the other way round. Health is the goal and medical care is the means…the "patient" is master and the "Doctor" is at his service. As the Prophet says "The strongest should follow the pace of the weakest…for he is the one to be considered in deciding the pace of travel." Rules, schedules, time-tables and services should be so manipulated as to revolve around the patient and comply with his welfare and comfort as the top and overriding priority…other considerations coming next.

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• The sphere of a Doctor's charity, nicety, tolerance and patience should be large enough to encompass the patient's relatives, friends and those who care for or worry about him…but without of course compromising the dictates of "Professional Secrecy".
• Health is a basic human necessity and is not a matter of luxury. It follows that the Medical Profession is unique in that the client is not denied the service even if he cannot afford the fee. Medical legislature should ensure medical help to all needy of it, by issuing and executing the necessary laws and regulations.

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Professional Secrecy

Keeping other persons' secrets is decreed on all the Faithful…the more so if these were Doctors, for people willfully disclose their secrets and feelings to their doctors, confident of the time old heritage of Professional Secrecy, that the medical profession embraced since the dawn of history. The Prophet (peace be upon Him) described the three signs of the hypocrite as: "He lies when he speaks, he breaks his promise and he betrays when confided in." The Doctor shall put the seal of confidentiality on all information acquired by him through sight, hearing or deduction. Islamic spirit also requires that the items of the Law should stress the right of the patient to protect his secrets that he confides to his Doctor. A breach thereof would be detrimental to the practice of medicine, beside precluding several categories of patients from seeking medical help.

Doctor's Role During War

• Since the earliest battles of Islam it was decreed that the wounded is protected by his wound and the captive by his captivity. The faithful are praised in the Qoran as: "they offer food—dear as it is—to the needy, orphan or captive, (saying) we feed you for the sake of God without seeking any reward or gratitude from you." The Prophet (peace be upon Him) said to his companions: "I entrust the captives to your charity"…and they did…even giving them priority over themselves in the best of the food they shared. It is of interest to note that this was thirteen centuries prior to the Geneva Convention and the Red Cross.

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• The Medical Profession shall not permit its technical, scientific or other resources to be utilized in any sort of harm or destruction or infliction upon man of physical, psychological, moral or other damage…regardless of all political or military considerations.

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Responsibility and Liability

• The Practice of Medicine is lawful only to persons suitably educated, trained and qualified, fulfilling the criteria spelt out in the Law. A clear guidance is the Prophet's tradition: "Who-so-ever treats people without knowledge of medicine, becomes liable".
• With the availability of medical specialization, problem cases shall be referred to the relevant specialist. "Each one is better suited to cope with what he was meant for".
• In managing a medical case the Doctor shall do what he can to the best of his ability. If he does, without negligence, taking the measures and precautions expected from his equals then he is not to blame or punish even of the results were not satisfactory.
• The Doctor is the patient's agent on his body. The acceptance by the patient of a Doctor to treat him is considered an acceptance of any line of treatment the Doctor prescribes.
• If treatment entails surgical interference the initial acceptance referred to should be documented in writing, for the sake of protecting the Doctor against possible eventualities. If the patient declines or refuses the Doctor's prescribed plan of treatment, this refusal should also be documented by writing, witnesses, or patient's signature as the situation warrants or permits.
• When fear is the obstacle preventing the patient from consent, the Doctor may help his patient with a medicine such as a tranquilliser to free his patient from fear but without abolishing or suppressing his consciousness, so that the patient is able to make his choice in calmness and tranquillity. By far the best method to achieve this is the poise of the Doctor himself and his personality, kindness, patience and the proper use of the spoken word.
• In situations where urgent and immediate surgical or other interference is necessary to save life, the Doctor should go ahead according to the Islamic rule' 'necessities override prohibitions'. His position shall be safe and secure whatever the result achieved, on condition that he has followed established medical methodology in a correct way. The "bad" inherent in not saving the patient outweighs the presumptive 'good' in leaving him to his self-destructive decision. The Islamic rule proclaims that "warding off" the 'bad' takes priority over bringing about the 'good'.

The Prophetic guidance is "Help your brother when he is right and when he is wrong". When concurring with helping a brother if right but surprised at helping him when wrong, the Prophet answered his companions: "Forbid him from being wrong…for this is the help he is in need of".

The Sanctity of Human Life

• "On that account we decreed for the Children of Israel that whoever kills a human soul for other than manslaughter or corruption in the land, it shall be as if he killed all mankind, and who-soever saves the life of one, it shall be as if he saved the life of all mankind." 5–32
• Human Life is sacred…and should not be willfully taken except upon the indications specified in Islamic Jurisprudence, all of which are outside the domain of the Medical Profession.
• A Doctor shall not take away life even when motivated by mercy. This is prohibited because this is not one of the legitimate indications for killing. Direct guidance in this respect is given by the Prophet's tradition: "In old times there was a man with an ailment that taxed his endurance. He cut his wrist with a knife and bled to death. God was displeased and said 'My subject hastened his end…I deny him paradise.'"

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• The sanctity of human Life covers all its stages including intrauterine life of the embryo and fetus. This shall not be compromised by the Doctor save for the absolute medical necessity recognised by Islamic Jurisprudence.

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• In his defence of Life, however, the Doctor is well advised to realize his limit and not transgress it. If it is scientifically certain that life cannot be restored, then it is futile to diligently keep on the vegetative state of the patient by heroic means of animation or preserve him by deep-freezing or other artificial methods. It is the process of life that the Doctor aims to maintain and not the process of dying. In any case, the Doctor shall not take a positive measure to terminate the patient's life.
• To declare a person dead is a grave responsibility that ultimately rests with the Doctor. He shall appreciate the seriousness of his verdict and pass it in all honesty and only when sure of it. He may dispel any trace of doubt by seeking counsel and resorting to modern scientific gear.
• The Doctor shall do his best that what remains of the life of an incurable patient will be spent under good care, moral support and freedom from pain and misery.
• The Doctor shall comply with the patient's right to know his illness. The Doctor's particular way of answering should however be tailored to the particular patient in question. It is the Doctor's duty to thoroughly study the psychological acumen of his patient. He shall never fall short of suitable vocabulary if the situation warrants the deletion of frightening nomenclature or coinage of new names, expressions or descriptions.
• In all cases the Doctor should have the ability to bolster his patient's faith and endow him with tranquility and peace of mind.

Doctor and Society

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• The Medical Profession shall take it as duty to combat such health-destructive habits as smoking, uncleanliness, etc.

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The combat and prevention of environmental pollution falls under this category.

The Doctor and Biomedical Advances

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There is no censorship in Islam on scientific research, be it academic to reveal the signs of God in His creation, or applied aiming at the solution of a particular problem.

Freedom of scientific research shall not entail the subjugation of Man, telling him, harming him or subjecting him to definite or probable harm, with holding his therapeutic needs, defrauding him or exploiting his material need.

Freedom of scientific research shall not entail cruelty to animals, or their torture. Suitable protocols should be laid upon for the uncruel handling of experimental animals during experimentation.

The methodology of scientific research and the applications resultant thereof, shall not entail the commission of sin prohibited by Islam such as fornication, confounding of genealogy, deformity or tampering with the essence of the human personality, its freedom and eligibility to bear responsibility.

The Medical Profession has the right and owes the duty of effective participation in the formulation and issuing of religious verdict concerning the lawfulness or otherwise of the unprecedented outcomes of current and future advances in biological science. The verdict should be reached in togetherness between Muslim specialists in jurisprudence and Muslim specialists in biosciences. Single-sided opinions have always suffered from lack of comprehension of technical or legal aspects.

The guiding rule in unprecedented matters falling under no extant text or law, is the Islamic dictum: "Wherever welfare is found, there exists the statute of God".

The individual patient is the collective responsibility of society, that has to ensure his health needs by any means inflicting no harm on others. This comprises the donation of body fluids or organs such as blood transfusion to the bleeding or a kidney transplant to the patient with bilateral irreparable renal damage. This is another 'Fardh Kifaya', a duty that donors fulfil on behalf of society. Apart from the technical procedure, the onus of public education falls on the medical Profession, which should also draw the procedural, organizational and technical regulations and the policy of priorities.

Organ donation shall never be the outcome of compulsion, family embarrassment, social or other pressure, or exploitation of financial need.

Donation shall not entail the exposure of the donor to harm.

The Medical Profession bears the greatest portion of responsibility for laying down the laws, rules and regulations organizing organ donation during life or after death by a statement in the donor's will or the consent of his family; as well as the establishment of tissue and organ banks for tissues amenable to storage. Cooperation with similar banks abroad is to be established on the basis of reciprocal aid.

On Medical Education

In planning the making of a Doctor, a principal goal is to make him a living example of all that God loves, free from all that God hates, well saturated with the love of God, of people and of knowledge.

The Medical Teacher owes his students the provision of the good example, adequate teaching, sound guidance and continual care in and out of classes and before and after graduation.

Medical Education picks from all trees without refractoriness or prejudice. Yet it has to be protected and purified from every positive activity towards atheism or infidelity.

Medical Education is neither passive nor authoritarian. It aims at sparking mental activity, fostering observation, analysis and reasoning, development of independent thought and the evolvement of fresh questions. The Qoran blamed those who said: " As such we have found our fathers and we will follow on their footsteps" an attitude which is only conductive to stagnation and arrest of progress.

"Faith" is remedial, a healer, a conqueror of stress and a procurer of cure. The training of the Doctor should prepare him to bolster "Faith" and avail the patient of its unlimited blessings.

Medical school curricula should include the teaching of matters of jurisprudence and worship pertaining to or influenced by various health aspects and problems.

Medical School curricula should familiarise the student with the medical and other scientific heritage of the era of Islamic civilization, the factors underlying the rise of Muslim civilization, those that lead to its eclipse, and the way(s) to its revival.

Medical school curricula should emphasize that medicine is worship both as an approach to belief by contemplation on the signs of God, as well as from the applied aspect by helping Man in distress.

Medical school curricula should comprise the teaching and study of this "Islamic Code of Medical Ethics".