Medicine and Shariah

A Dialogue in Islamic Bioethics

Aasim I. Padela, Aasim I. Padela

• Publisher: University of Notre Dame Press
• Year: 2021
• ISBN:
  9780268108397
• Topic: Medicina
• Subtopic: Etica in medicina

Medicine and Shariah brings together experts from various fields, including clinicians, Islamic studies experts, and Muslim theologians, to analyze the interaction of the doctors and jurists who are forging the field of Islamic bioethics.

Although much ink has been spilled in generating Islamic responses to bioethical questions and in analyzing fatwas, Islamic bioethics still remains an emerging field. How are Islamic bioethical norms to be generated? Are Islamic bioethical writings to be considered as part of the broader academic discourse in bioethics? What even is the scope of Islamic bioethics? Taking up these and related questions, the essays in Medicine and Shariah provide the groundwork for a more robust field. The volume begins by furnishing concepts and terms needed to map out the discourse. It concludes by offering a multidisciplinary model for ethical deliberation that accounts for the various disciplines needed to derive Islamic moral norms and to understand biomedical contexts. In between these bookends, contributors apply various analytic, empirical, and normative lenses to examine the interaction between biomedical knowledge (represented by physicians) and Islamic law (represented by jurists) in Islamic bioethical deliberation.

By providing a multidisciplinary model for generating Islamic bioethics rulings, Medicine and Shariah provides the critical foundations for an Islamic bioethics that better attends to specific biomedical contexts and also accurately reflects the moral vision of Islam. The volume will be essential reading for bioethicists and scholars of Islam; for those interested in the dialectics of tradition, modernity, science, and religion; and more broadly for scholarly and professional communities that work at the intersection of the Islamic tradition and contemporary healthcare.

Contributors: Ebrahim Moosa, Aasim I. Padela, Vardit Rispler-Chaim, Abul Fadl Mohsin Ebrahim, Muhammed Volkan Yildiran Stodolsky, Mohammed Amin Kholwadia, Hooman Keshavarzi, and Bilal Ali.

SIX

Muslim Perspectives on the American Healthcare System

The Discursive Framing of Islamic Bioethical Discourse

AASIM I. PADELA

As I noted in the introduction to this book, Islamic bioethics remains a field under construction as scholars debate its content, scope, and research methods. Ambiguities regarding the contours of an Islamic bioethics do not stem from the lack of a moral theology outlined by scripture,¹ nor from a dearth of ethico-legal judgments pertaining to medicine and healthcare formulated by Islamic jurists. Rather, the challenge is to devise a comprehensive bioethical theory, rooted in Islamic moral theology and attentive to those juridical assessments, that can serve healthcare stakeholders (patients, health professionals, religious leaders, and others) both in pluralistic Muslim-minority contexts and in Muslim-majority contexts where Islamic law may operate.

There is ample research evidence that Islamic ethical notions impact the decisions made by patients, medical professionals, policymakers, and other healthcare actors across the world.² While the influence of Islamic ethics and law on decision-making varies and the sources of Islamic ethical guidance are multiple, the extant Islamic bioethics literature often lacks conceptual rigor and leaves critical questions unaddressed such that it provides insufficient actionable guidance for those in the trenches.³ I contend with these challenges on a daily basis in each aspect of my career; as a clinician I view my practice of medicine as part of a religious vocation and at times find the juridical rulings unclear; as a clinical ethicist I provide healthcare providers and patients in the United States (both Muslim and non-Muslim) with ethical advice and find that Muslim ethical positions are based on misrepresentations of the social, clinical, and legal contexts; and as an Islamic bioethics researcher I find that many writings lack rigor.

To be sure, an Islamic bioethics that accounts for the theological and ethico-legal frameworks of Islam could, for instance, enable the composition of Islamic bioethics manuals similar to the Encyclopedia of Jewish Medical Ethics.⁴ Just like this Jewish encyclopedia, an Islamic encyclopedia could provide a comprehensive review of classical ethico-legal deliberations over, as well as modern perspectives on, pressing bioethical dilemmas.⁵ Such a resource would, from my perspective, meet the needs of patients and healthcare providers seeking actionable guidance. More than that, however, such a manual would also provide an invaluable starting point for academic research into the field and enable the generation of a comprehensive bioethical theory that provides an “Islamic” telos for modern biomedicine. Moreover, a comprehensive, consistent, and cogent theoretical framework for Islamic bioethics would empower both the producers and the consumers of this field to address the multilayered ethical questions resulting from technological advancements that provide humans with increasing mastery over the body. It would also help them to consider the proper organization and prioritization of our increasingly complex array of different healthcare services and treatment modalities.⁶

Yet, prior to developing such resources and deriving such a theory, it is necessary for us to clarify the nature of what makes Islamic bioethics “Islamic.” Indeed, the choice of methods applied to Islamic bioethics and the selection of sources for the study of it arguably depend on an a priori definition of what Islamic bioethics is. The present study works toward this end by examining divergent constructions of the “Islamic” in the bioethics-related discourse produced by two Islamic bioethics producers in the American context. As we will see, identifying what makes “Islamic bioethics” distinctively Islamic is not as straightforward as it might at first appear to be.

This project of constructing the field and discipline of Islamic bioethics faces a variety of challenges emerging from the respective disciplines invoked by each of the two terms “Islamic” and “bioethics.” Beginning with the latter, Islamic bioethics as a subfield of bioethics faces the same challenge of multidisciplinarity and interdisciplinarity that modern bioethics faces. While bioethical discussions were originally the domain of religious experts and clinicians, the field has grown to involve secular philosophers, sociologists, anthropologists, policy experts, and lawyers.⁷ As the expertise brought to bear upon bioethics has multiplied, so, too, have the measures and contents of the ethical. The nature of modern bioethical inquiry feeds into the epistemic and legitimacy crises confronting the field, and these crises are made more acute because of the purported religious claims the field makes.

For example, it is not clear how much weight should be accorded to the reality on the ground (what is) when considering the moral ordering of society (what should be). Hence, an overstated, but nevertheless pertinent, tension exists between religious authorities and philosophers, on the one hand, who consider moral reasoning to have normative value independent of social reality, and social scientists on, the other, who describe contextually driven human ethical decision-making. These debates bleed over into the realm of religious studies because Islamic bioethics claims to draw from the font of the religious tradition. As the academic study of religion has come to deploy social science–based methods for examining the lived experiences and meaning-making activities of religious communities, the primacy of the analysis of religious texts for understanding religion has become contested.⁸ This methodological divide has at its root an epistemic quandary similar to the “is” and “ought” divide mentioned above. Finally, the contestations over what comprises the “Islamic” component of Islamic bioethics run deeper still to include debates surrounding the applicability and authority of the inherited Islamic legal canon and its juridical devices in addressing modern-day concerns.⁹

Suffice it to say that a demarcation of the posited content of Islamic bioethics and a delineation of its “Islamic” aspects is necessary to generate methodological guides and practical resources that facilitate both scholarly engagement and healthcare stakeholders’ input into the emerging field. The present study works toward this end by examining the divergent constructions of the “Islamic” in Islamic bioethics discourse in a certain context, that of the United States, and by commenting on the social considerations that may influence such conceptions.

Using critical discourse analysis (CDA) approaches as an inspiration,¹⁰ I apply both sociological and Islamic ethico-legal lenses to examine select writings of two kinds of producers of Islamic bioethics literature in the United States: national Muslim organizations and Islamic jurists. My focus is on health insurance, a somewhat neglected topic in the academic literature on Islamic bioethics, despite its obvious importance.¹¹ I will compare the discursive frames used by several national American Muslim organizations to craft an “Islamic” argument for healthcare reform in the United States—reform termed “Obamacare” in the popular press but formally known as the Patient Protection and Affordable Care Act (PPACA)—with the Islamic legal opinions (fatāwā) of Islamic jurists regarding the permissibility of purchasing health insurance in the United States. Press releases and reports in support of healthcare reform and fatāwā providing religious guidance about health insurance may appear to be sufficiently dissimilar as discursive genres to render a comparative examination of their Islamic nature and bioethical framing methodologically contestable. However, I will argue that they in fact display conceptual connections directly relevant to the question of the nature of a putative Islamic bioethics.

In addition to examining the discursive framing present in these textual sources, I will also call attention to the discursive “gaps” between them: that is, considerations that appear in the Muslim organizations’ material but not in the jurists’ fatāwā, and vice versa. This is to highlight the compartmentalized nature of Islamic bioethics discourse, in which different producers of Islamic bioethics material fail to address key considerations that emerge when the problem is analyzed using a different analytic vantage point. Further, by doing so, I hope to stimulate a (re)construction of the field of Islamic bioethics: Once the gaps and discontinuities in the extant discourse have been underscored, scholars should be motivated to undertake multidisciplinary efforts that can accomplish a more wide-reaching theorization of the nature and scope of Islamic bioethics, craft outputs that clarify the Islamic aspects of their bioethics writings, and be attentive to the needs of the multiple different stakeholders that seek out guidance on Islamic bioethics.

THE SOURCES

The sources for this study include press releases and other communiqués concerning American healthcare reform produced, or contributed to, by American Muslim Health Professionals and the Islamic Society of North America.¹² I also analyze online fatāwā proffered by scholars at the Fatwa Center of America and the Assembly of Muslim Jurists of America (AJMA), along with Dr. Monzer Kahf, a widely cited scholar of Islamic economics residing in California.¹³ These materials are supplemented by selected e-fatāwā from outside the United States, but only when these juridical opinions are given in response to a questioner from America. Although the sampling frame is somewhat artificially bounded, since internet fatāwā are available globally and some research suggests that juridical decrees from one part of the world influence fatāwā and Muslim behavior in other, more distant, parts, restricting the sampling frame to American fatāwā in the first instance seems sensible, if only because research has not yet been carried out on which juridical bodies or jurists are most often sought out by American Muslims for bioethical guidance.¹⁴ Furthermore, my recent national survey of American Muslim physicians found that international juridical bodies are looked to for ethical guidance by only a small minority. I present findings from this empirical study in more detail in the next chapter.

Again, with Muslim organizations authoring press releases and reports in support of healthcare reform, on the one hand, and jurists providing religious guidance about health insurance, on the other, these writings may appear to be of different genres, each addressing different situations and divergent audiences. Yet the materials are conceptually linked in at least four ways that are directly relevant to the present study.

For one, both types of producers make “Islamic” moral assessments of the prevailing American healthcare system. Accordingly, the particular religious values that are highlighted in these public communiqués provide insight into what each of these actors considers to be sources of Islamic ethics and their Islamic moral reasoning processes. In other words, the choice of religious values from which to construct the arguments and the language used to communicate these values evidence a particular reading of the Islamic tradition. These readings, in turn, represent different ways of making meaning from sacred source texts and different views on the nature of what constitutes an “Islamic” ethical value. As such, they are a vantage point from which to describe and to critique what an “Islamic” bioethics represents to each of these producers.

Second, both types of producers seek to motivate Muslim behavior. The fashioning of an “Islamic” argument by Muslim organizations results from the aim of spurring American Muslims to support healthcare reform. Likewise, the jurist’s reasoning is written into the fatwā, at least in part, to persuade the Muslim questioner to act in accordance with the jurist’s “Islamic” opinion. We can therefore examine what each group considers aspects of Islam that hold motive force and persuasive power to compel Muslim action.

Third, both sets of Islamic bioethics producers engage a public audience with their materials. While the writings of the national Muslim orga...

Table of contents

• Title
• Copyrights
• Contents
• Foreword
• Preface
• An Introduction to Islamic Bioethics: Its Producers and Consumers
• One The Relationship between Religion and Medicine: Insights from the Fatwā Literature
• Two The Islamic Juridical Principle of Dire Necessity (al-ḍarūra) and Its Application to the Field of Biomedical Interventions
• Three A Jurisprudential (Uṣūlī) Framework for Cooperation between Muslim Jurists and Physicians and Its Application to the Determination of Death
• Four Considering Being and Knowing in an Age of Techno-Science
• Five Exploring the Role of Mental Status and Expert Testimony in the Islamic Judicial Process
• Six Muslim Perspectives on the American Healthcare System: The Discursive Framing of Islamic Bioethical Discourse
• Seven Muslim Doctors and Islamic Bioethics: Insights from a National Survey of Muslim Physicians in the United States
• Eight Jurists, Physicians, and Other Experts in Dialogue: A Multidisciplinary Vision for Islamic Bioethical Deliberation
• List of Contributors
• Index