ISLAMIC CODE OF MEDICAL PROFESSIONAL ETHICS

Abdul Rahman C. Amine. M.D., and Ahmed Elkadi. M.D.

Medicine was defined by Muslim physicians such as Al-Razi (841-926 A.D.) and Ibn Sina (Avicenna.Y80-1036 A.D.) as the art concerned with the preservation of good health, combating of disease, and restoration of health to the sick. For several centuries, the world witnessed and benefitted from the great advances made by Muslim physicians in the area of health sciences. These advances were not just based on technical skill or intellectual superiority. They were equally well founded on a clear understanding of the role of the Muslim physician as derived from Islamic teachings and philosophy. For thousands of years, ethics have been recognized as an essential requirement in the making of a physician. Although the ancient codes of ethics',' have to some extent stressed this requirement, they were still deficient and contained grave errors.' Contemporary codes of ethics tend to be more liberal and less restrictive." The Qur'anic ethics, on the other hand, stand out as a perfect model for all mankind, all professions, and all time.

The medical ethical requirements proposed in this paper are primarily based on Qur'anic ethics. They include guidelines for the physician's behavior and attitude, both at the personal and professional levels. The same standard of moral and ethical values should guide the physician in his private life and while conducting his professional business. A person who lacks moral values in private life cannot be trusted in professional activities, even with the highest professional and technical qualifications. It is impossible for a person to have two different ethical standards. Truthful is God the Almighty when He says:

"God has not made for any man two hearts in his body..."

The following verses from the ()ur'an are most suited as a guide for the personal characteristics of the physician.

"Luqman admonished his son: 'My son,' he said 'Serve no god besides God for idolatry is an abominable injustice. We have enjoined man to show kindness to his parents, for with much pain does his mother bear him, and he is not weaned before he is two years of age. We said: Give thanks to Me and to your parents; to Me shall all things return. But if they press you to serve besides me what you know nothing of, do not obey them, be kind to them in this world and fellow the path of those who submit to Me; to Me you shall all return and will declare to you all that you have done.'My son, God will know about all things be they as small as a grain of mustard seed, be they hidden inside a rock or in heaven or on earth. God is wise and all-knowing. My son, establish regular prayer, enjoin what is just and forbid what is wrong; endure with fortitude whatever befalls you, for this is firmness of purpose in the conduct of affairs. Do not treat men with scorn nor walk proudly on the earth; God does not love the arrogant boaster. Rather, let your gait be modest and your voice low; the harshest of voices is the braying ofthe ass'."

God also says:

"...and those who restrain anger and forgive othel· men, verily God loves those who do good."'

God further states:

"It was the mercy of God that you have dealt with them gently and if you were severe and harsh-hearted they would have broken away from about you. Therefore forgive them, pray for their forgiveness, and consult them in the conduct of affairs: then, when you have decided to proceed, depend on God for support: verily God loves those who depend on Him.""

Based on the above, the Muslim physician must believe in God and in Islamic teachings and practice, both In private and public life. He must be grateful to his parents, teachers, and elders. He must be humble, modest, kind, merciful, patient, and tolerant. He must follow the path of the righteous and always seek God's support.

A physician equipped with these virtues is capable of complying with the needed professional requirements. The first professional requirement is to acquire and maintain proper knowledge. God makes it clear in the Qur'an:

"...Say: Are those equal, those who know and those who do not know?..."

God also states:

"...Verily, those who fear God among His servants are those who have knowledge..."

Therefore the believer is encouraged to always seek knowledge.

"...Say: O my Lord, advance me in knowledge."''

The physician must also abide by the legal rules regulating his profession provided they do not violate Islamic teachings. The need to respect law and order is reflected in the following verse:

"Oh you who believe: Obey God and obey the Apostle, and those charged with authority among you...""

Recognizing God as the maker and the owner of both patient and physician, it is only logical that the care provided by the physician to his patient must be in accordance with God's guidelines.

A subject of great importance is the subject of life. Life is given by C;od and cannot be taken away except by Him or with His permission. God says in the Qur'an:

"It is He who created death and iife, that He may try which of you is best in deed...""

He also says:

"··.Nor can they control death nor life nor resurrection."

God further states:

"...Whoever kills a human being not in lieu of another human being nor because of mischief on earth, it is as if he has killed all mankind: and whoever saves the life of a human being, it is as if he has saved the life of all mankind...""

The physician therefore has no right to terminate any human life under his care. This also applies to the unborn baby since clear evidence indicates that human life starts at the time of conception. Consequently, the physician has no right to terminate the life of the unborn baby unless it constitutes a definite threat to the mother's life.

The physician must realize that God is watching and monitoring every thought and deed. This was clearly indicated in the verses quoted earlier from Chapter 31 of the Qur'an.'6 The same verses also indicate that the parents' demands are not to be obeyed if they are in violation of God's orders, in spite of the fact that parents are considered to be the most important persons to their children after God. Following the same principles, the physician has no right to allow popular demand or his patient's wishes if they are in violation of God's orders.

Based on sound logic and clear Islamic teachings, the physician has no right to recommend or administer any harmful material to his patients. The most concise yet comprehensive guide in this matter is found in the following verse ofthe Qur'an:

"...and He makes for them good things lawful, and bad things forbidden..."

This implies that anything forbidden by God must be bad or harmful; and anything proven to be bad or harmful must be forbidden.

The humanitarian aspect of the medical profession must never be neglected nor overlooked. The physician must render the needed help regardless of the financial ability or ethnic origin of the patient. A beautiful hint is found in the following Qur'anic verses:

"And they feed, for the love of God, the indigent, the orphan, and the captive, (saying) 'We feed you for the sake of God alone: no reward do we desire from you, nor thanks'."

When entrusted with the care of a patient, the physician must offer the needed advice with consideration for both the patient's body and mind, always remembering his basic obligation to enjoin what is just and forbid what is wrong.

The physician must protect the patient's confidentiality, reflecting God's description of the believers:

"...Those who faithfully keep their trusts and their covenants.""

The physician must adopt an appropriate manner of communication and be reminded of the ethics of speech referred to in the Qur'anic verses quoted earlier in this paper.'" God also describes the good believers in the Qur'an and says:

"For they have been guided to the purest of speeches...'"'

Situations requiring the physician to examine patients of the opposite sex are always a test of his moral character and his strength. A basic instruction is found in the following Qur'anic verses:

"Say to the believing men that they should lower their gaze and guard their modesty; that will make for greater purity for them, for God is well acquainted with all that they do. And say to the believing women that they should lower their gaze and guard their modesty..."'

God further says:

"God does wish to lighten your burden, for man was created weak.""

It is therefore advisable that the physician examine patients of the opposite sex in the presence of a third person whenever feasible. This will be an added protection for the physician and the patient.

The physician must not criticize another physician in the presence of patients or health personnel, remembering the Qur'anic advice:

"0 you who believe, let not some men among you make fun of others: it may be that they are better than them; nor let some women make fun of others; it may be that they are better than them: nor defame, nor be sarcastic to each other, nor call each other by offensive nicknames""

God further says:

"God does not love that evil be voiced in public speech, except where the person has suffered injustice..."

The physician must refuse payment for the treatment of another physician or his immediate family. There is no specific instruction regarding this particular matter in the Qur'an or Islamic tradition. However, reference is made to another situation which may be used in analogy. God says regarding Zakat money:

".Alms are for the poor, the needy. and those employed to administer the funds..."'"

Here is a situation where the persons providing a certain service are entitled to the use of the same service at the time of need. Applying the same principle, the physician who provides the health service to others is entitled to the use of the same service at the time of need.

Last, but not least, the physician must always strive to use wisdom in all his decisions and the reward will be great. Truthful is God the Almighty when He says:

"...and he whom wisdom is granted he receives indeed a great deal of good indeed..."

In closing, reference is made to the Oath of the Muslim Physician adopted by the Islamic Medical Association'" in 1977 which reflects the spirit and philosophy of the Islamic code of Medical Professional Ethics Proposed in this paper.

In summary, the Muslim physician must believe in God and in the Islamic teachings and practice it in private and public life; be grateful to his parents, teachers, and elders; be humble, modest, kind, merciful, patient, and tolerant; follow the path of the righteous; and always seek God's support. The Muslim physician must stay abreast of current medical knowledge, continuously improve his skills, seek help whenever needed, and comply with legal requirements governing his profession; realize that God is the maker and owner of his patient's body and mind and treat him within the framework of God's teachings; realize that life was given to man by God, that human life starts at the time of conception, and that human life cannot be taken away except by God or with His permission; realize that God is watching and monitoring every thought and deed; follow God's guidelines as his only criteria, even if they differ with popular demand or the patient's wishes: not recommend nor administer any hanllful material: render needed help regardless of financial ability or ethnic origin of the patient; offer needed advice with consideration for both the patient's body and mind; protect the patient's confidentiality; adopt an appropriate manner of communication; examine a patient of the opposite sex in the pl·esence of a third person whenever feasible; not criticize another physician in the presence of patients or health personnel, refuse payment for treatment of another physician or his Immediate family; and strive to use wisdom in all his decisions.