CHAPTER FIVE

Islamic Ethics in Engagement with Life, Health and Medicine

Adi Setia

Worldview of Islam Research Academy

Abstract

Salient aspects of modern medicine pose serious intellectual and ethical challenges to the Islamic
conception of life, health and general wellbeing. These challenges need to be systemically engaged with
first and foremost at the conceptual and scientific level of first principles, theories and methodologies and
then at the pragmatic level of ethico-moral and legal praxes. Such a constructive engagement can and
should be carried out by (i) drawing pertinent insights from the rich history of the mutakallimūn‖s analytic
theologico-scientific engagement with the received Greek medico-philosophical tradition, and by (ii)
thorough familiarity with current wide-ranging critique and rethinking of the premises, theories,
methodologies, institutions and practices of modern, western medicine. Aspects of how this systemic
engagement is to be undertaken are illustrated by looking briefly into the debates over medical
education, iatrogenesis, medical monopoly, medicalization of health, animal trial, biotechnology and
genetic engineering. The chapter concludes with a proposal for an Islamic Medical Research Program
(IMRP) that is informed and guided by critical, constructive engagement with both traditional Islamic
and modern medicine.

Introduction

To frame the discourse, we may note that salient aspects of modern medicine pose
serious intellectual and ethical challenges to the Islamic value system and its definition
of ―medicine‖ (ḓibb)1 itself, and, consequently, its conception of life, health, disease and
general well-being. These challenges, which are largely generated by the current

1
In the Islamic medical tradition, ḓibb (medicine) has generally been defined as a vocation (kasb) that
integrates art (ḑināăa/ăamal) and science (ăilm) in the service of preserving and restoring bodily health
(ḑiḏḏa); e.g., as can be gleaned from Ab˅ al-Farajʿ Al˂ Ibn Ḥusayn Ibn Hind˅ (2011), 3-6; see also Abdul
Ghani Hussain (2015), xv-xvii, for a good elegant elucidation as to why medicine, properly conceived, is
at once, art, science and vocation.

1
hegemony of the biomedical paradigm in modern western medicine,2 need to be
systemically engaged with first and foremost at the conceptual and scientific level of first
principles (uḑūl),3 theories and methodologies,4 and then, at the pragmatic level of
ethico-moral conduct5 and legal praxis.6
Such a constructive engagement can and should be carried out by (1) drawing
pertinent insights from the rich history of the theologico-scientific7 engagement of the
ḏukamāĂ8 and mutakallimūn9 (including the fuqaḏāĂ)10 with the received Greek medico-
philosophical tradition;11 (2) a thorough critical familiarity with current profound and
wide-ranging critique and rethinking of the premises, methods, practices, and even
social and institutional culture of modern, western medicine; 12 and (3) cross-cultural
and comparative religious perspectives on healing and medical ethics.13 Aspects of how
this systemic engagement is to be undertaken are outlined here by, inter alia, looking
critically (albeit briefly) into current debates over medical education, iatrogenesis,

2
For a discussion of the nature of this hegemony, see Daniel Weber (2016): 1-2; for a case study of the
impact of this hegemony, see Anwaar Mohyuddin, et al (2004): 59-67.
3
The question of ―first principles‖ here refers to the axiomatic bases (tacit or explicit) of any systematic
intellectual inquiry into the sciences, including those pertaining to religious, ethical and moral issues. It
bears relation also to the traditional ten foundational principles or aspects (al-mabādiĂ al-ăashara) of any
discipline that are to be considered upon embarking on it so as to acquire a clear idea of its scope and
nature; see Haleem (1991): 5-41.
4
I have in mind here the Lakatosian concept of ―methodology of scientific research programs‖, which I
find to be most in congruence with the nature of scientific research in Islamic intellectual history, see
Setia (2017), 23-52; and Lakatos (1978).
5
On the relation between religion and ethics in Islam, see Syed Naquib al-Attas (1976); and al-Attas
(1995), 41-90.
6
Specifically, the axio-teleology of ethico-legal praxis, see Saʿ˂d Ramāˀān al-B˅˄˂ (1966), cited and
discussed in Setia (2016), 127-157. The term ―axio-teleology‖ refers to the ultimate moral direction and
purpose of ethics, law, science and medicine.
7
The conjuctive term ―theologico-scientific‖ here refers to the critical integration of Hellenistic
philosophy and science into the framework of Islamic natural theology; see Setia (Winter, 2005).
8
Peter Adamson and Peter E. Pormann (eds.) (2017).
9
For example, see Mohaghegh (1988): 207-212; Mohaghegh (1993); and Schwarb, ―Early Kalām and the
Medical Tradition,‖ in Adamson and Pormann, eds. (2017), 104-169; cf. Setia (2005), 127-151.
10
As reflected in say, al-Suy˅˄˂ in his Ḓibb al-nabawī and Ibn Naf˂s in his Sharḏ Tashrīḏ al-Qanūn, but see
specifically Shihadeh (2013), 135-174.
11
And also to a significant extent, Indian, Persian, indigenous Arabian healing tradition, and even
Chinese; see Oliver Kahl (2007), 2-3; Mojtaba Heydari, et al, (2015): 363; Maidin (2018), 8-9 on 8-54.
The qualifying term ―medico-philosophical‖ refers to the fact that traditionally medicine has always been
treated as part of natural philosophy and its application to healing.
12
Marcum (2008); cf. Ivan Illich (1976); Robin (1984); Le Fanu (2011).
13
Veatch (2000); cf. Tarakeshwar and Stanton (2003), 377-394.

2
medical monopoly, medicalization of health, animal testing (or vivisection),
biotechnology and genetic engineering.
It concludes with a proposal for an Islamic Medical Research Programme
(IMRP)14 that is informed and guided by critical, constructive engagement with both
traditional Islamic and modern medicine. Hence, instead of a largely ad hoc,
intellectually impoverished ―fire engine‖ legalistic and fatwā-issuing culture that simply
reacts hastily to whatever challenges posed by some new-fangled biomedical
developments (such as gene therapy15), the generative16 IMRP integrates into its hardcore
axio-teleological first principles as informed by the worldview of Islam,17 such that it
leads to systematic, prospective research into treatment and healing modalities that are
intrinsically sound ethically, epistemically and medically.18

The Question of First Principles

The position that this chapter takes is that medicine is concerned with the truth insofar
as it pertains to the application of useful knowledge to attain beneficial results relevant
to the preservation of health or its restoration after illness, and the prevention of
disease. Its telos is, as Pellegrino puts it, the caring of the physician for the patient‖s
healing.19

14
This is conceived as part of an overarching Islamic Science Research Program (ISRP), see Setia, ―Islamic
Science as a Scientific Research Program,‖ (2017), 93-101. The concept of ―research program‖ here
largely follows Imre Lakatos‖s notion of ―methodology of scientific research programs‖ (MSRP); for MSRP
as applied to medical research, see J. Cabaret and G. Denegri (2008), 501-505.
15
A good critical survey of the medical and ethical debate over gene therapy is Evelyn Kelly, Gene Therapy
(London: Greenwood Press, 2007).
16
Following Lakatos, the qualifier ―generative‖ or ―progressive‖ as opposed to ―degenerative‖ or ―regressive‖
refers to the nature of a scientific research programme that is, inter alia, making progress in developing
new theories and hypotheses that can predict and account for facts not accountable in competing research
programs, thus productive of new cognitive and empirical content that further enriches and fleshes out the
program rather than merely increase the stock of linguistic interpretations or reinterpretations.
17
See al-Attas (1995), 1-40.
18
Further elaboration on the IMRP will have to be the subject of a separate paper.
19
Pellegrino (1998): 315-336, cited in Marcum (2008), 6-7. A similar focus on caring for the patient is
articulated in Williams (2005), 6.

3
 This definition of medicine which focuses on the physician‖s care for the patient
as individual person, based as it were on the rational or philosophical aspects of
Hippocratic-Aristotelian-Galenic virtue-based medical ethics, dovetails very well with
that of the Islamic medical tradition, in which ḓibb (medicine) has generally been
defined as a vocation (kasb) that integrates art (ḑināăa/ăamal) and science (ăilm) in the
service of preserving and restoring the bodily health (ḑiḏḏa) of the patient,20 where
health here is understood as referring to a state of equilibrium, moderation and balance
in bodily functions and movements.21 For Ibn Hind˅ (d. 423/1032), ―Health is the
condition of the body when all its functions follow a normal course … Disease is an
abnormal condition of the human body, which causes harm to the body‖s functions.‖ 22
Ibn S˂na in his Canon of Medicine gives a similar definition.23
This is obviously in broad accord with the much more ambitious definition given
by the World Health Organization (WHO): ―Health is a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity.‖24
Guaranteeing ―complete‖ social well-being as implied by the WHO definition can very
well run the risk of compelling medicine to become sociology and much else besides
(such as conflating health with medicalization or even ―disease mongering‖). 25 Without
going into too much pedantic comparative analysis of the merits and demerits of the
Islamic and WHO definitions, for our purpose here we may opt to focus on health as
constituted by the functional integrity of the body as the minimalist definitional common
ground that gives a more realistic and pragmatic rather than an utopian understanding
of what medicine can or cannot do as a distinct field of human endeavour. 26

20
Ibn Hind˅ (2018), 15-16; cf. N˅r al-D˂n al-Rānir˂ (2018), 97.
21
Ibn Hind˅ (2-18), 8-9 and 21-22.
22
Ibid., 69.
23
Mones Abu-Asab, Avicenna’s Medicine (Rochester, VA: Healing Arts Press, 2013), 34-35.
24
World Health Organization (2006).
25
An interesting critique of the WHO definition is Machteld Huber, et al (2011): 1-3. See also Moynihan,
et al. (2002), 886-891; and Casell (2004).
26
The basic idea here is that once the patient as person is restored to optimal functioning then he or she
can be more ready to tackle the ills of society or improve their own fortunes in society.

4
 Being critically particular about definitions (and thereby conceptualizations) may
seem trivial to many in the current hegemony of the biomedical (or biomechanical)
model of medicine,27 but if doctors and medical researchers fail to be critically conscious
and articulate about their definitional and conceptual commitments28 in relation to the
various scientific and operational aspects of healthcare, they risk reducing the rich,
social ecological meaning of medicine as the science, art and vocation of healing the
patient to the mechanical techniques of applied biology.29 With a view towards reducing
this risk and recovering the original multi-layered meaning of medicine by encouraging
a healthy dialectical engagement with that multi-layeredness, what follows are some
preliminary, somewhat rambling thoughts on first principles as they relate to medicine
and healthcare.

Axiological Commitments

We may begin by briefly making a distinction between epistemic (or cognitive and
methodological) and ethical values even while recognizing and acknowledging the
manner in which the one may presuppose, entail or overlap with the other, as has been
elaborated at some length by al-Ghazāl˂ (d. 505/1111). To paraphrase Honerkamp, al-
Ghazāl˂ juxtaposes epistemological principles within a semantic field governed by
ethical concepts thereby rendering the pursuit of knowledge as an inherently critical
and ethical undertaking.30 Here, it will suffice us to observe in passing that the
intellectual integrity of a science is but a function of the ethical propriety of the scientist
as knowing subject and moral agent, who must not only observe accurately but also
report and act honestly. In the case of physicians and medical researchers, this means

27
A wide-ranging critique of the biomechanical model is Jacques Kriel (2000); see also Derick T. Wade
and Peter W. Halligan (2004), 1398-1401.
28
Ibn Hind˅ (2018) devotes the last and longest chapter of his Miftāḏ to the definitions of medical terms,
43-99. For a modern discussion see Caplan (2004).
29
See Joseph Grzywacz (2000), “The Social Ecology of Health,” in Behavioral Medicine, 26:3, 101-115.
30
al-Ghazāl˂ (2015).

5
in practice cultivating personal vocational commitment31 to the care of patients, and
avoiding conflict of interest.32
If this principle of intellecto-ethical integrity is compromised (say, by the practice
of medical ghost writing)33 then much of the scientific and medical journal industry that
underpins, say, the so-called evidence-based medicine (EBM)34 approach of the
Cochrane Collaboration will be in vain.35 Therefore, scientific knowledge is very much
as personal and subjective as it is impersonal and objective.36 In relation to medicine
(ḓibb) in the Islamic tradition, these questions of medical axiology37 have been elaborated
at some length by, among others, al-R˅ˁaw˂ (ca. 9th cent.) in his well-known treatise on
the Ethics of the Physician (Ādāb al-ḓabīb).38
Epistemic or intellectual value pertains to knowing what is true or is actually the
case. This knowledge is ascertained through the various methods of discovery and
justification normally accepted and applied in scientific research, i.e., research
pertaining to any systematic field of study in either the natural or social sciences.39 In
the case of the knowledge of medicine, this is ascertained according to the ḏukamāĂ and
aḓibbāĂ (philosophers and physicians) of yore by means of observation, experience,
experimentation, intuition,40 examination and reliance on expert and trustworthy

31
Personal vocational commitment arises from finding both personal meaning and social relevance in
one‖s occupation; see E. F. Schumacher, Good Work (1979); and Karim Lahham, The Vocational Society
(2013).
32
On this danger see, Rodwin (2011); see also, Bernard Lo and Marylyn J. Field (eds.) (2009).
33
Gøtzsche, et al (2009): 122-125.
34
A critical appraisal of EBM is Howick (2011).
35
For the website: www.cochrane.org. A recent board crisis has raised questions about Cochrane‖s
integrity and freedom from conflict of interest, especially in its funding sources; see Gøtzsche (2019).
36
See Polanyi (2015); cf. Jenkins (1981). An application of Polanyi‖s notion of ―personal knowledge‖ to
medical practice is McHugh and Walker (2015): 577-585; cf. Henry (2010), 292-297; and Jha (1998), 547-
568.
37
For a discussion, see Marcum (2008), 189-205.
38
See Isˁāq ibn ʿAl˂ al-R˅ˁāw˂, Ādāb al-ḓabīb (Dār al-Shuʾ˅n al-Thaqāfiyya, 1991); see also Martin Levey
(1967).
39
For an overview of the methodologies of research in the Islamic tradition, see ʿAl˂ Sām˂ al-Nashshār
(1983).
40
A modern medical analogue is P. B. Medawar (2009); cf. Braude (2012); Quirk (2006).

6
authority.41 All these are well in accord with the basic parameters of Islamic
epistemology42 and have their analogues in modern scientific epistemology and
methodology,43 which are beyond the remit of this chapter to elaborate in any detail.
Ethical value pertains to the imperative of good and right conduct in appropriate
response to true knowledge; hence, the principle of iqtiḍāĂ al-ăilm al-ăamal (knowledge
mandates action).44 Knowing what a thing is or consists of in reality is prior to or a
prerequisite for deciding on the appropriate course of action in respect thereof, hence
the dictum that a statement (kalām) or judgement (ḏukm) about something is a function
of the understanding or conceptualization (taḑawwur) of its essence or real nature
(māhiyya).45
How one ought to act or conduct oneself towards something is dependent on
what one reliably knows about it and about how it relates to other things in a given
context. The human mind organizes out of relevant facts and information knowledge
he recognizes to be valid and true and then acknowledges that truth by actualizing it in
his attitude and conduct. Hence, knowledge in the mind is actualized as adab (virtuous
comportment) in the manner one relates in conduct to oneself, other people, the
general environment and to God.46 In this respect, Islamic medical ethics is a creative
integration of formal legal rulings (fiqh) into the virtue ethical conceptual and practical
framework of adab, in which knowledge serves a clear moral purpose (maqḑid).47 As al-
Attas puts it succinctly, ―Adab is right action that springs from self-discipline founded
upon knowledge whose source is wisdom.‖48 The Islamic value system as a whole
seamlessly integrates cognitive values into ethical values, and hence knowledge, insofar

41
A discussion of medical epistemology is in Ibn Hind˅ (2018), 23-30; see also Abdullah (2017), 2-3; Setia
(2003), 165-214. Cf. Kathryn Montgomery, How Doctor Thinks (2005).
42
An exposition is Ismail (2002).
43
I have in mind, especially, Lakatos (2008).
44
This is actually the title of a book by al-Kha˄˂b al-Baghdād˂ (d. 463/1071).
45
al-Ghazāl˂ (2015), 23.
46
al-Attas, Prolegomena, 16-20.
47
For an elaboration, see Sartell and Padela (2015): 756-761. A comprehensive philosophical exposition
of adab virtue ethics is al-Attas (1980), which is largely inspired by the IḏyāĂ and other works of al-Ghazāl˂.
48
al-Attas (1995), 16.

7
as it is true, 49 must necessarily include moral purpose activating right action as adab.50
Inasmuch as true knowledge demands as its right or due (ḏaqq) right action (ăamal ḑāliḏ),
then, to know is to be what you know.51
This principle of adab is important because questions of ethics (including
questions of formal legal rulings that may proceed therefrom) that arise in response to a
particular situation must already assume that its cognitive value or content has been
determined in order for those questions to be resolved satisfactorily. If that assumption
is unexamined or mistaken, then that response would be in vain, misplaced or faux, i.e.,
responding to a pseudo or misconceived problem. Hence, if the epistemic status or
cognitive content of a medical issue is yet to be established, then ethico-legal (fiqh)
questions regarding it do not arise, and even if they should arise, their resolutions are
to be put in abeyance (tawaqquf) until such time as when a proper, thorough
disinterested scrutiny (tabayyun)52 of that issue is completed and concluded. This issue of
the intimate link between the cognitive and the ethical is of paramount importance for
evidence-based medicine, given recent disclosure that ―most published research findings
are false‖:

There is increasing concern that most current published research findings

are false. The probability that a research claim is true may depend on
study power and bias, the number of other studies on the same question,
and, importantly, the ratio of true to no relationships among the
relationships probed in each scientific field. In this framework, a research
finding is less likely to be true when the studies conducted in a field are
smaller; when effect sizes are smaller; when there is a greater number and
lesser preselection of tested relationships; where there is greater flexibility

49
We shall not here digress into discussing the various theories of truth (and related theories of meaning
and reality), but it suffices here to say that in general the Islamic viewpoint on the matter is that the
pragmatic and correspondence theories of truth are to be integrated into an over-arching, transcendent
coherence theory of truth (understood as the Islamic vision of truth and reality) grounded in Revelation.
For an involved discussion of truth, facts, meaning and reality within the conceptual framework of the
worldview of Islam, see al-Attas (1995), 123-135.
50
Ibid., 16.
51
Or, al-ḏaqqu min ḏaqqihi an yataḏaqqaqa taḏaqquqan (the truth as its due is to be actualized).
52
That is, one that is not motivated by extra-medical or extra-scientific considerations such as commercial
or political interests, but is focused on tackling cognitive problematics intrinsic to the issue at hand.

8
 in designs, definitions, outcomes, and analytical modes; when there is
greater financial and other interest and prejudice; and when more teams
are involved in a scientific field in chase of statistical significance.
Simulations show that for most study designs and settings, it is more likely
for a research claim to be false than true. Moreover, for many current
scientific fields, claimed research findings may often be simply accurate
measures of the prevailing bias.53

Generally, physicians have both a cognitive and moral obligation to apply well-honed
critical thinking skills in their clinical practice,54 and to identify and weed out as far as
possible the “fifty cognitive and affective biases in medicine.” 55
Another consideration to bear in mind in this regard is that of the relation
between ethics and techniques. Given that the end does not justify the means,56 it follows
that the techniques or methods designed and applied to the solution of a well-defined
problem must embody and realize in themselves ethical values. Since all techniques are
conceptualized and invented by technologists, and all technologists are individual
human beings having moral agency and hence personal ethical commitments, it stands
to reason that these commitments are expressed tacitly or explicitly in the very
conceptualization and development of new technologies. Technologists as moral agents
deploy their personal ethical commitments in the very act of making decisions as to why
and which particular techniques or applications should be invented and how these are
to be formulated, developed and actually deployed. To the extent that they are
conscious decision makers and to that extent they exercise foresight into the
consequences, intended or unintended, good or bad, of the techniques and methods
they have brought into existence, they are responsible and accountable for those
consequences. As Mario Bunge points out,

53
Ioannidis (2014): 1-6. A book length treatment for tackling bias in biomedical research is Rothstein
(2005).
54
Groopman (2011) and Montgomery (2005).
55
Croskerry (2013): 1-7.
56
That is, if the ends are moral, then the means must also be moral, a key first principle of virtue ethics.
This is in contrast to the tendency in bioethics, constrained as it were to serve open-ended biomedical
progress, in which the utilitarian-consequentialist ethos predominates leading to the justification of even
clearly immoral means (such as vivisection or animal testing) in terms of some self-proclaimed individual
or societal good.

9
 …the technologist must be held not only technically but also morally
responsible for whatever he designs or executes: not only should his
artefacts be optimally efficient but, far from being harmful, they should be
beneficial, and not only in the short run but also in the long term. 57

As for the Islamic point of view on this question (as articulated by, among others,
al-Ghazāl˂), praiseworthy technologies (ḑināăāt maḏmūda) are those that serve to realize
the duty of sufficing the public good (farḍ al-kifāya) through the cultivation of the
wholesome vocations (makāsib ḓayyiba) by which the affairs of the world are put in good
order (mā yatarattabuăalayhi maḑāliḏ al-dunyā). It goes without saying then that those
technologies, techniques and methods that bring about disruption or even destruction
(fasād, mafāsid) to the good ordering of people‖s lives are blameworthy (madhmūma) and
censured in the Revealed Law (al-Sharīăa).58 This means that ethical considerations
come into play not only at the downstream level of application in the actual
therapeutical deployment of biomedical techniques or results of clinical trials, but also
at the midstream and upstream levels of their design, fabrication and deployment in
research, including the whole process of decision making these involve.
This issue of the increasing divergence between medical ethics and the
techniques of biomedical technology and genetic engineering (with its problematic
underlying commitment to genetic reductionism59) is such that the latter now largely
defines the parameters of the problematic context within which the former is to exercise
its evaluative prerogative, while the very possibility of these techniques and parameters
being themselves subject to moral analysis (due to biosafety60 and similar concerns about
potential hazards61) is overlooked, ignored or even dismissed outright in public

57
Bunge (1975), 69-79.
58
Al-Ghazāl˂ (2015), 38-39 and 78-86. Here, I translate shariăa as revealed law (i.e., revealed in the
Qurāʾn and Sunna) to contrast it with fiqh, which refers to the particular rulings derived therefrom
through a process of legal reasoning guided by usūl al-fiqh (principles of jurisprudence).
59
See Carrier (2007); van Regenmortel (2004).
60
Burrows (2001).
61
Regal (1998). In general, since the 1970s, the rest of the world, especially Europe and Japan, has
followed the lead of the US in policy-framing relating to biotechnology due to its geo-political and
economic hegemony.

10
discourse as ―irrational.‖62 This problem of divergence between technics and ethics has
also become acute, for instance, in the current era of big data research in the sciences,
including medicine, with its tendency to overlook or downplay the reality that ethics
concern human rather than machine agency and accountability. 63 The biomechanical
model of medicine tends to marry biological to technological determinism, and it is
both unintellectual and unethical to allow this double-determinism to subvert the
traditional Islamic understanding of human nature, namely that man is a free moral
agent capable of choice (ikhtiyār = to choose for the better) and hence of responsibility
and accountability for the consequences of his actions.64
Hence, if ethics is to be taken seriously then it has to be taken structurally as a
proactive point of departure and applied consistently throughout the ―value chain‖ of
any medical procedures and techniques, from upstream to midstream to downstream,
otherwise ethics runs the risk of becoming a mere afterthought, an ad hoc, overly
reactive though necessary appendage to an essentially amoral structure in which the
technical systemically overrides the ethical by subsuming it, as in the manner the
biomedical now subsumes the bioethical. So, we either insist on, and submit to the
principle that the ethical leads the technical, or we surrender to the crass
consequentialist utilitarianism of the hegemony of the technical over the ethical, in
which the role of ethics is reduced to the sorry task of mopping up as best as it can the
ever mounting moral debris spawned by the run-away tyranny of technique. Hence, it is
important to make ethical awareness and commitment integral to the initial
development of bio-techniques in order to ―recognize and anticipate potential risks and
unintended consequences.‖65

62
Burrows (2001), 244. A fuller treatment is Hilary Rose (2014).
63
A general, introductory discussion of the problem is Markham, Tiidenberg and Herman (2018), 1-9.
64
Al-Attas (1995), 143-176.
65
Vayena, et al. (2015), 1-7 on 1; cf. I. D. Norman, ―Ethics and Electronic Health Information
Technology: Challenges for Evidence-based Medicine and the Physician-patient Relationship,‖ in Ghana
Medical Journal 45:3 (September 11, 2011), 115-124.

11
 To sum up, the basic axio-epistemic framework66 guiding this enquiry into
Islamic ethical engagement with modern medicine is that the technical is to be in
accord with the ethical so as to embody and realize it, and that moral conduct is to be in
appropriate response to the ascertained, multidimensional reality of a given medical
situation. The call here is for the creative integration of virtue ethics with critical
realism67 in order to realize afresh a systematic medical ethics that truly informs and
guides the field of medicine as science and art, 68 as well as vocation.69 This means that
we need to subsume bioethics into medical ethics.

Teleological Commitments

The ethical considerations outlined above is of pertinence to what is called virtue ethics,
namely the understanding that, through the conscious inculcation of virtuous character
traits (makārim al-akhlāq), a good person will be a good doctor who will practice good
medicine and develop good relationship with his or her patient. Instead of regarding
any particular action (and by extension, technique) to be ethical or otherwise in
reference to some imperative, principle or consequence external to the content of
character of the moral agent, virtue ethics focuses systemically on the personal integrity
of the physician or medical researcher inasmuch as he or she possesses the faculty for
choice and foresight (ikhtiyār), namely, the capacity to tell right from wrong and choose
and act accordingly by exercising their moral agency in a given healthcare context. The
idea here is that prudent decisions, right actions and thereby appropriate techniques
embodying the virtues will naturally or normally arise from persons who comport
themselves virtuously, thereby leading to the production and deployment of virtuous
sciences, virtuous technologies and virtuous vocations.70

66
i.e., cognitive (or epistemic) and ethical value system.
67
Bhaskar (2008).
68
Panda (2006), 127-138.
69
Laurel (2018), 126-131. For the notion of virtuous vocational individuals constituting the vocational
society, see Lahham, (2013).
70
A good short overview is in Walker (2010), 1-2.

12
 A corollary of this is that good people will see it to be their personal
responsibility to take due care in the maintenance of their good health as a virtue in
itself, and if nevertheless, they should fall sick, they will make it a point to be good
patients careful to follow the instructions of good doctors in the framework of a virtuous
doctor-patient relationship. In short, for medicine to serve its purpose, both doctors
and patients as moral agents exercising moral agency need to observe medical ethical
decorum, or to be more specific, the personal and interpersonal ethics pertinent to the
maintenance or recovery of health and the pre-emption of disease.71 What guides that
relationship is the end or purpose of medicine—the healing bond. Hence, we can
agree with Dr Pellegrino that, ―Medicine in its function as medicine resides in making of
a prudent healing decision for a specific person.‖72
Needless to say, it is also the personal responsibility of people before they fall ill to
cultivate the prudential foresight necessary for acquiring an adequate degree of
cognitive discernment to tell true physicians from charlatans, and this in turn requires
of them the acquisition of the virtue of knowledge as it pertains to the nature of the
medical vocation sufficient enough for them to tell the difference between doctors
practicing vocational integrity and those concerned with narrow commercial returns in
their clinical practice or afflicted otherwise with conflict of interest. Ab˅ Bakr Rābiʿ al-
Akhwin˂ al-Bukhāri (d. 371/983), student of the famed Abu Zakariyyā al-Rāz˂ (d. ca.
313/925), is of the view that just as people are expected to know the basics of Revealed
Law so as to safeguard their spiritual health, so too they are expected to know the basics
of medicine to safeguard their bodily health from destruction at the hands of quack
doctors.73 As Dr Eugene D. Robin has so forthrightly put it,

As a patient you influence your doctor by your attitude, by your

expectations, and by the degree to which you take responsibility for your

71
Sobree (2018), 23-34.
72
Cited in Marcum (2008), 307.
73
In al-Akhwin˂ al-Bukhāri‖s Hidāyat al-mutaăallimīn, as cited in Rahman (1989), 39 and 136 n. 28.

13
 own treatment. The greater the interest on the part of patients, the more
aware the medical system will become of the need to correct its flaws. 74

This sentiment of taking a certain degree of personal responsibility for one‖s health is
quite in accord with that expressed in the traditional ḓibb nabawī (Prophetic medicine)
texts.75
Virtue ethics in Islam overlaps with what has been called divine-command (or
religious deontological) ethics, since the Qur‖an and Sunna command believers to
cultivate both personal and social virtues (faḍāĂil, makārim al-akhlāq) by patterning
themselves on the ethico-moral comportment of the Prophet, peace and blessings of
Allāh be on him.76 Both concern too teleological ethics,77 namely, the cultivation of the
good life leading to enduring happiness (saăāda),78 and the attainment of divine
pleasure (marḍātillāh); and in the case of medicine as such, the maintenance and
attainment of health and well-being as part and parcel of realizing that good life.79 This
fits very well into the notion of ḏifẓ al-nafs, the preservation of life, one of the five
maqāḑid, or overriding objectives of the Revealed Law.80
In general, it can be said that in Islam, virtue ethics translates into adab (virtuous
comportment), divine-command (as religious deontological) ethics into fiqh (ethico-legal
rules of conduct), and teleological ethics into maqāḑid and maḑāliḏ (objectives and
benefits) discourses. In this integrative, transcendental ethical vision rooted in and
derived from the primordial Covenant (al-mīthāq) between God and man, the notion of
utility (manfaăa, maḑlaḏa) and thereby self-interest (maḑlaḏa nafsiyya) is at once de-
secularized and re-sacralized through its systematic reconceptualization within the

74
Robin, Matters of Life and Death, 177.
75
For example, Ibn al-Qayyim al-Jawziyya, Healing with the Medicine of the Prophet, tr. Jalal Abu al-Rub
(2003), 121, 124-130, on the imperative of seeking and identifying good doctors; cf. Fries (2017).
76
See al-Ghazāl˂ (2019).
77
For a study, see Shihadeh (2006).
78
al-Attas (1995), 91-110.
79
Ibn Hind˅ (2018), 17.
80
Padela (2018), 121-132.

14
framework of an expanded,81 spiritual psychology of the self and a vision of the soul‖s
transcendent identity and destiny. 82
It is in the light of these axio-teleological commitments that the ḏukamāĂ and
aḓibbāĂ of yore are in accord on the definition of medicine in terms of its telos or goal
(maqḑid or ghāya), namely, medicine as the science of the preservation of health, the
prevention of disease and the restoration of health should it be lost. 83 And if this should
beg the question of what is the goal of health, they further say that it is so that one
cultivates soundness of both body and mind in order to render worship (ăibāda) to Allāh
in the most optimal manner. Hence, the telos of medicine is health (ḑiḏḏa), and the telos
of health in turn is the good life (ḏayāt ḓayyiba) lived in private and in public in perpetual
mindfulness (taqwā) and remembrance (dhikr) of the Creator.84 This religiously rooted
teleologico-virtue ethics underpinning Islamic medicine critically subsumes within its
framework the core ethical substance of the Hippocratic-Aristotelian-Galenic medico-
virtue ethical system that it finds accord with, 85 and thereby it is not at all unexpected
that one finds much concord between it and the Christian scholastic virtue ethics
underpinning Edmund Pellegrino‖s philosophy of medicine.86
The Islamic ethico-scientific engagement with modern bioethics and medical
ethics in general will have to argue for and insist on the revival and re-articulation of
this historical cross-cultural, virtue ethical common ground87 of departure if any
meaningful progress is to be made in the systemic resolution of any medico-ethical and

81
That is, expanded beyond the ego.
82
al-Attas (1995), 143-176.
83
Abu-Asab (2013), 35-36.
84
Ibn Hind˅ (2018), 15-16; al-Suy˅˄˂ (2015), 6-7; and Ibn al-Qayyim al-Jawziyya (1985), 11-16; and Ibn
Jumayy (1983), 8-9.
85
For example, Ab˅ al-ʿAlā Ibn Jābir al-Ba˃r˂, al-Bayān fī tashrīḏ al-abdān, cited in Farida Jamal, ―Anatomy
and Physiology in Medieval Islam,‖ in al-Tibb: Healing Traditions in Islamic Medical Manuscripts, 74. For the
Arabo-Islamic reception to the Hippocratic aphorisms, see Pormann (2013), 412-415 and see also
Chapter 2, ―Medical Epistemology in Arabic Discourse: From Greek Sources to the Arabic Commentary
Tradition,‖ by Pormann in this volume; for a good modern discussion, see Jotterand (2005), 107–128;
and Miles (2004).
86
See Pellegrino (1993).
87
Baltussen (2015), 47-66.

15
healthcare issues in a manner that is faithful to the worldview of Islam.88 Minus this
shared, objective medico-ethical conceptual point of departure for dialogue, the
alternative will be surrendering to an ever shifting moral relativism and arbitrary
subjective consequentialist utilitarianism, which is, in fact, not really an alternative for
conscientious Muslims who care for their belief and value system and the manner it
should impact on their understanding of their transcendent identity and destiny as
individuals and as communities, inasmuch as this understanding pertains to the domain
of healthcare.

Cosmological Commitments

The human being as microcosm reflects the macrocosm, which is the universe, and both
points to the reality of their Creator.89 The cosmos or universe is seen as niăam āfāqiyya
or the divine blessings manifest externally in the cosmic horizons, while the niăam
anfusiyya are the divine blessings manifest internally in the constitution of man himself.
The whole universe is thus understood as having been created to facilitate (taskhīr) the
blossoming of human life on earth that they may show gratitude to their Creator. 90
In Islamic cosmology, nature is then ultimately only a symbolic form manifesting
divine creativity at the level of phenomenal sensible reality. Instead of an unconscious
―event—>event‖ causality giving rise to emergent meaning and order, there is rather at
every instant a self-expressing intelligent ―agent—>event‖ causality, such that events as
are but intertwining networks of causes and effects brought about in relatively stable
conjunction by a transcendent knowing and willing agent.
Consequently, things in the world are not independent, self-subsisting, self-
organizing essences having persistence in absolute time and space, but rather they
perish upon coming into existence and are continually being recreated by the Creator,

88
An introductory outline of this worldview is in al-Attas (1995), 1-39.
89
See Chapter 4, ―The Concept of a Human Microcosm: Exploring Possibilities of a Synthesis of
Traditional and Modern Biomedicine,‖ by Osman Bakar in this volume.
90
Setia (2004).

16
hence the absence of a necessary connection between cause and effect in the processes
of nature. Everything, from the tiniest particular part to the greatest universal whole, is
both proximately and ultimately caused by Allāh alone, continuously and at every
instant. The implication of such a cosmology is that ontologically causes and effects are
created and correlated within an order or integral system in which the causes are but
concomitant conditions for the effects. This order or integral system is perceived
through scientific observation and inquiry as natural patterns and regularities, as so-
called ―laws of nature‖, which in reality are but expressions of God‖s ―manner of creation‖
or His ―custom‖ (sunnatullāh). God creates both causes and effects and connects them
together within a dynamic unified network of events, processes and relations.
Scientists, including physicians and medical researchers, perceive, describe and
account for aspects of this total integral system in terms of a certain lineal spatio-
temporal order of priority and posteriority governing natural entities and processes,
some of which they posit as antecedent ―causes‖ for others, the consequent ―effects‖,
whereas in reality all causal efficacy lies with God alone. Causes and their perceived
effects are, in the final analysis, only more or less stable intertwining networks of
probabilistic conjunctions, associations and correlations.91 For all practical purposes,
this cosmological vision poses no problem for applying broad principles of
methodological naturalism92 in medical research and healthcare as the methodological
common ground of both Islamic and modern, western medicine, thus allowing for their
mutual engagement. This is because Islamic teachings do accord due consideration to
the observed regularities in the phenomena of nature as a guide to decision and action
in the pragmatic dimensions of life, including healthcare.
The conclusion from this cosmological vision is that natural laws and
regularities—including those that obtain in medical phenomena—are not inherent,
necessary properties of natural phenomena, but are properties designed for and

91
Setia (2003), 179-187.
92
Methodological naturalism as a research strategy per se is the practical commitment in scientific and
medical research to opt for explanations in terms of some regularities or patterns in nature or culture,
regardless of one‖s philosophical or theological commitment; see the critical discussion in Okello (2015).

17
imposed on the natural world (taskhīr)93 by a Unique, Transcendent Intelligent Being of
Knowledge, Will and Power—properties which are somehow perceived and correlated
by the human mind in terms of causes and their effects through its committed
involvement in the systemic study of nature. Hence, though Islamic teachings (as
expressed in the ḓibb nabawī texts) do encourage believers to seek medical treatment and
pursue healthcare, ultimately Muslims believe in the transcendental truth of the
Qur‖anic verse, ―When I fall sick, He heals me.‖94

Ontological Commitments

The term ontological here refers to what is understood to be extra-mentally and

existentially real or existing (ḏaqīqī, wujūdī) about the nature of man (ḓabīăat/ḏaqīqat al-
insān), and by extension, the nature of his health and sickness. Although medicine as
such is concerned with bodily health and wellness, it has also to take into consideration
that the patient qua human being is at once biological, psychological, and social, as well
as spiritual, intellectual, emotional and religious (i.e., personally committed to a set of
values rooted in belief in a transcendent Reality). This holistic consideration has been
referred to in current parlance as the biopsychosocial perspective95 that the patient is
much more than their biophysical disease or biomedical symptoms. In other words, the
patient as well as the state of his health or illness are not reducible to, and hence
transcend, the biomechanical aspects of the functional integrity of his body. 96
The very notion of the ethical, as outlined above, already assumes that man, as
moral being and thus moral agent, is possessed of a cognitive mind (ăaql), understood as

93
On taskhīr, or the divine subjection of nature for the benefit of man, see Setia (2004), 7-32.
94
Qur‖an 26:80 (al-ShuăarāĂ).
95
Engel (1977), 129-136; see also Richard M. Frankel, et al. (2003); and White 2005). For good
examples of Muslim doctors‖ engagement with the biopsychosocial model, see, Chapter 7, ―At the
Meeting of the Two Seas: The Value of Integrating Philosophy of Science and Religion in Determining
the Nature and Purpose of the Human Self,‖ by Asim Yusuf; and Chapter 8, ―Muslim Values and End of
Life Healthcare Decision-making: Values, Norms and Ontologies in Conflict?‖ by Mehrunisha Suleman;
both in this volume.
96
Cf. Chishti (1985), 11-38; Ahn (2006); Knox (2010).

18
a spiritual (i.e., non-material) substance inhering in the heart (qalb), which is the
spiritual organ of cognition by which the rational soul (al-nafs al-nāḓiqa) recognizes and
distinguishes truth from falsehood. Here, the real existence of the soul or mind is
affirmed as an autonomous substantive entity distinct from the physical brain and body,
and not a mere epiphenomena or emergent property of the latter; on the contrary, the
mind controls the brain. Therefore, ethics as it pertains to personal conduct and
evaluation of right and wrong is grounded in a psychology of the nature and scope of
the intellect by means of which man apprehends his relation to himself, to fellow
human beings, to God and to the world.97
In practical healthcare terms, this would mean that medicine is less concerned
about treating or managing the disease or pathological condition than caring for and
healing the patient qua physical body yet spiritual being; and that the patient‖s
subjective experience of his illness is just as significant as the doctor‖s objective
diagnosis of it, such that the former goes into informing the latter. Hence, the wisdom
necessary for efficacious application of medical knowledge is obtained from years of
caring for patients as persons with real non-physical feelings, beliefs and aspirations,
and not simply as just so many diseased somatic parts impacted by this or that
pathogens that are in turn further reduced to their biomolecular and biochemical
states, processes and structures. This also entails that physicians cannot allow
themselves to be reduced to mere bio-technicians whose access to their understanding
of what ails their patients are largely impersonally mediated by biomedical tests,
instruments and machines.98
The growing realization over the past two decades or so that medical reality or
the reality of the factors leading to health or illness is much too multi-layered and
systemically complex to be exhausted by the currently dominant biomechanical model
of healthcare has led to the rise, articulation and institutionalization of alternative

97
See Attas (1993). For a wide-ranging discussion of the relationship between self, mind and the brain
largely compatible with traditional Islamic faculty psychology, see Popper and Eccles (1985); see also,
Beauregard and O‖Leary (2007). See also, Chapter 7 by Asim Yusuf in this volume.
98
A relevant discussion is Montgomery (2006) and Groopman (2007).

19
healthcare paradigms and frameworks which are nonetheless just as evidence-based99
and clinically successful or even more so than the currently dominant biomedical
model. This critical realism100 as applied to medical practice and research can only serve
to help conscientious physicians, specialists and medical researchers to be further
committed to realizing the moral imperative of maximizing care and minimizing harm
by acquiring the cognitive capacity to choose the best or most optimal amongst
competing healthcare paradigms, like those that come under the rubric of what is called
complementary and alternative medicine (CAM).101
To conclude, it is always important for doctors and medical researchers to be
sufficiently trained to give due, critical realist consideration to the ontological status of
the concepts, terms and processes invoked in the course of describing or explaining the
state of health or sickness of the patient.102

Bioethics versus Medical Ethics

Medical ethics can be understood as that branch of ethics that is concerned with ethico-
moral issues that arise in the course of clinical practice and research, and, as such, it has
a rich and long intellectual and civilizational history.103 In contrast, bioethics—or more
accurately, the ethics of the biomechanical model of medicine—Is a new, largely post-WWII
discourse that is primarily motivated by and concerned with the moral, legal and
political implications of the rapid developments in biomedical and biotechnological
sciences (such as genetics) over the past few decades and their possible or actual
applications to medical research and clinical practice. Due to the current dominance of
the biomedical paradigm in healthcare protocols, there is a growing tendency for

99
See, for instance, the journal Evidence-Based Complementary and Alternative Medicine:
https://www.hindawi.com/journals/ecam/.
100
Critical realism is an approach in philosophy of science that shows that reality or what exists cannot be
reduced or restricted to, or exhausted by whatever we can know about it through our methods, models
and theories; for what is real and existing is always much more than what we can ever know about it.
101
Tataryn (2004).
102
A good, wide ranging discussion is Caplan (2004).
103
Baltussen (2015), 47–66.

20
bioethics to dominate and even supplant medical ethics. Bioethics is a very broad
subject that is concerned with the moral issues raised by developments in the biological
sciences more generally‖.104 However, insofar as these developments impact for good or
bad on medical practice and research, bioethics has to be seen as subsumable under the
overarching conceptual framework of medical (or healthcare) ethics.
Now, given all the above considerations in respect of first principles, there is
much that can be criticized about the current reduction of medical ethics to bioethics
and then to ultra-utilitarian, consequentialist principlism.105 It is further deplorable to
observe the largely unthinking and hence tacit reception of this reductionism by many
writers, Muslims and non-Muslims, as well evidenced by their largely uncritical
appending of the qualifier ―Islamic‖ to the term ―bioethics‖, 106 hence unwittingly
legitimizing it as congenial to the worldview of Islam. Even a cursory research into the
background of the rise of bioethics and the current marginalization, even eclipse, of
medical ethics will show that the former is largely a narrow politically and then
commercially driven consequentialist utilitarian ethics formulated in haste to response
to the rapid rise of the biomedical and biotechnological (including genetic engineering)
paradigm in medical research and its commercial promise for the private
corporatization of healthcare.
Although at its inception the term ―bioethics‖ connotes the imperative of the
ethico-moral attitude towards all life forms and their ecosystems (hence in effect
synonymous with ecological ethics),107 its discursive scope was later reduced to purely the
consideration of the ethical implications and impact of the rise of the biomedical

104
Williams (2005), 8.
105
A critique of principlism is Traphagan (2013).
106
For instance, Mohammed Ali Al-Bar and Hassan Chamsi-Pasha, Contemporary Bioethics: Islamic
Perspective (2015). The title of the book itself is telling in the manner bioethics is taken for granted as
largely unproblematic at core, while the role of Islamic ethics and law is basically to comment on it and
maybe mollify some of its more unpalatable aspects; it never really asks the important question of why
bioethics was generated in the first place, by whom and for what ultimate purpose. This core uncritical
attitude is also discernible in Abdulaziz Sachedina, Islamic Biomedical Ethics: Principles and Applications
(2009) and others, amongst the numerous papers and monographs on the subject of Islamic bioethics I
have had the opportunity to peruse in the course of researching the issue for this chapter.
107
Goldim (2009), 377–80.

21
paradigm in medical research and clinical practice. Hence, although the original term
was retained, it has since been largely taken to specifically refer to biomedical ethics. In
short, bioethics is official shorthand for biomedical ethics to concord with the molecular
biological and biochemical turn in medical research and practice.
The dominance of biomedicine and the concomitant utilitarian bioethical
discourse that it generated has largely displaced the notion of traditional virtue-based
medical ethics with its more holistic concern with the proper personal relationship
between physician and patient as it pertains to palliative care and the healing process.
Now however, the focus is on treating the disease and its symptoms by utilizing various
biomedical technologies developed from the technical disciplines of microbiology,
genetics, biotechnology and biochemistry. This conceptual shift in focus from patients
as persons to diseases as microbiological phenomena resulted also in the axiological
shift from medical ethics to biomedical ethics and thence to bioethics. 108
These developments which occurred over several decades post WWII (especially
from the 1970s onwards) have caused many philosophers of medicine as well as
practicing doctors to express concern that this techno-scientific turn in modern
medicine has diverged so far from the art and vocation of medicine that the physician
risks being reduced from wise doctor to bio-technician or even drug dispenser. This
development has been detrimental to the cultivation of the capacity for and practice of
clinical judgement among physicians, nurses and medical professionals in general.109
For the medical vocation to recover its original ethico-cognitive physician-patient
relationship as a key element in palliative care and the healing process, there is an
urgent need to revive the concept of ―medical ethics‖ as the overarching axiological
discursive framework subsuming within its fold as sub-ethical categories such specialized
ethics as biomedical ethics, nursing ethics, medical professional ethics and medical
research ethics.

108
See the important overview of the history and nature of bioethics in Irving (2002), 1-84.
109
Relevant discussions in Kienle (2011); Croopman (2007); and Montgomery (2006).

22
 FuqahāĂ and muftīs sitting on the various global, regional and local fiqh and fatwā
councils simply cannot go on conducting themselves, wittingly or unwittingly, as
procedural bureaucrats, largely signing forms and papers in moving the whole
bioethical and hence biomedical process along, all the while assuming that whoever has
originally set the agenda has done it rightly with the purest of intentions for the progress
of objective medical science and the best of aspirations for the well-being of humanity.
Sadly to say, recent well documented expose of the political economic underbelly of the
modern medical industrial complex provides compelling reasons to question such
innocent, misplaced assumptions.110

Case Examples

What follows are outlines of some selected case examples serving to illustrate briefly the
manner in which the conceptual matter of first principles explored above is to be
translated into an integrative ethical engagement with the whole structure of
biomedicine that underpins the bioethical discourse, instead of the currently reactive
and intellectually shallow fiqho-legalistic approach that takes for granted as largely
unproblematic current norms in biomedical research and clinical practice.
Animal Testing: The prominent Italian doctor, professor and medical researcher
from Milan, Pietro Croce111 (as well as many others)112 has tackled the problem of live
animal experimentation (or vivisection) from the scientific, methodological and medical
rather than from the ethico-moral point of view. He highlights the increasing dangers
to human health resulting from the animal experimenter‖s unexamined and unproven

110
Brown (1981); Fisher (2009); Doyal (1991).
111
Pietro Croce, Vivisection or Science? An Investigation into Testing Drugs and Safeguarding Health (London:
Zed Books, 1999). He sets out with detailed argumentation and documentation the pseudo-scientific
nature of animal experimentation in general, by drawing detailed attention to several cases in point such
as the pseudo-scientific nature of most cancer research, birth defects due to thalidomide and the
vivisective approach to surgical training, and then proceeds to explain many proven and promising
methodological alternatives to vivisection such as the epidemiological method, computer simulation and
in vitro techniques.
112
Such as in Greek and Greek (2000).

23
assumption that the biological systems of the various test animal species and human
beings are sufficiently similar for valid biomedical translation from the former to the
latter. He provides for the medical researcher an introduction to the range of
alternative truly scientific methods, including epidemiological research, computer
simulation and in vitro techniques.
In this regard it should be noted too that in the Islamic tradition of
pharmacology (ăilm al-ḑaydala or al-adwiya), prospective medicinal drugs are to be tested
on human subjects, for animal testing would produce unreliable results. 113 ―Unreliable
results‖ is in fact quite an understatement here, for patients and research volunteers are
easily exposed to serious harms and even death resulting from the systemic biases, flaws
and failures inherent in preclinical animal research. These include:

(1) bias and poor practice in research methodology and data analysis; (2)
lack of transparency in scientific assessment and regulation of the
research; (3) long-term denial of weaknesses in cross-species translation;
(4) profit-driven motives overriding patient interests; (5) lack of
accountability of expenditure on animal research; (6) reductionist-
materialism in science which tends to dictate scientific inquiry and control
the direction of funding in biomedical research.114

Many have argued that an ethical attitude towards animal welfare would a priori
preclude them from being subjects of life experimentations that distress, harm, maim or
kill them. This ethical preclusion is reinforced by the fact that medically and scientifically
animal trials have no relevance for human healthcare. Hence, animal experiments in
biomedical research are both unscientific as well as unethical. In fact, the immoral and
unethical nature of animal experimentation is amplified by its pseudo-scientific nature,
113
See Mohd. Affendi Mohd. Shaffri, ―Pharmacy and Its Offshoots,‖ in Maidin, al-Tibb: Healing Traditions
in Islamic Medical Manuscripts, 108, specifically citing the Ḓibb al-Adwiya of Khuzr Ibn Mubārak al-
Muta˄abbib. See also, Avicenna‖s arguments against animal testing in Chapter 2, ―Medical Epistemology
in Arabic Discourse,‖ by Pormann in this volume.
114
Green (2015), 1-14; see also Ioannidis (2012), 1-4; and Akhtar, (2015), 407-419.

24
since it would be unethical to waste precious research resources into pursuing a
methodology that has so clearly proven to be both mistaken and unproductive, even if
no suffering and death was inflicted on the test animals.
From the above scientific and ethical considerations, it should be quite obvious
that the fiqh argument regarding the lesser of two harms, namely, that human subjects
would be harmed in experiments, wouldn‖t animal models be better since one must
reject harm, would not be applicable at all, since there is no scientific basis for the
animal models anyway. Hence, invoking the fact that animal trials come before human
trials in contemporary medicine precisely for this reason of the lesser harm is misplaced
since the reasoning itself is scientifically baseless.115
Apart from the well-known concern for animal welfare in the Islamic ethical and
cultural tradition, the rights of kept animals are also formally well protected in Islamic
jurisprudence (fiqh).116 Given both the immoral and pseudo-scientific nature of animal
experimentation and animal testing, it would be intellectually, morally and legally
imperative to pursue viable alternatives and/or create them. All ethically humane and
truly scientific methods of biomedical research to replace the intolerable cruelty and
wastefulness of pseudoscientific vivisection are certainly well in accord with the
philosophy of medicine in Islam.117
Biotechnology and Genetic Engineering: The past three decades or so have also
witnessed rising wide-ranging criticism over the hyperbolic, pseudo-scientific claims and
promises of biotechnology and genetic engineering to promote healthcare and food

115
Arguments, such as from gene knockout models to simulate human physiology, or from genetic and
other sciences showing similarities in drug effect, are invalid here because they already assume the prior
validity of results from animal trials, which is precisely the assumption contested here. Given the
foundational epistemic and ethical objections to animal trials, such arguments need to be re-examined.
Critical discussions in this regard include von Scheidt (2017); Eisener-Dorman (2009); see also the
―Knockout Mice Fact Sheet‖ issued by the NIH, https://www.genome.gov/about-genomics/fact-
sheets/Knockout-Mice-Fact-Sheet (accessed March 28 2020).
116
Furber (2015); see also, Foltz (2006);Masri(2007).
117
Bakar (1999), 103-130; and his ―Islam and Bioethics,‖ in ibid., 173-200.

25
security. 118 Many studies have documented the global negative impact of the present-
day overly-commercialized model of biotechnology/genetic engineering (BT/GE)
research on medicine, agriculture and rural agrarian economies. They call into
question the scientific integrity of the overly optimistic claims of BT/GE to enhance food
production and overcoming diseases, including treating genetic disorders. 119 While
these critiques fall short of advocating a wholesale abandonment of the BT/GE
programme, they do emphasize that it is high time for scientists and medical
researchers in the public interest to apply the precautionary principle of biosafety first
in order to do a systemic, disinterested review of BT/GE, including a thorough scrutiny
(tabayyun) of all its theoretical assumptions, research methods, objectives and overall
agenda.
Unfortunately, current fiqh debates and rulings on biomedical interventions
resulting from BT/GE are overly caught up in dealing in a haphazardly ad hoc manner
with the endless ethico-legal enigmas generated by these biotechnological and genetic
engineering interventions in clinical practice. Consequently, there is little or no
intellectually detached and systemic investigation into the provenance and nature of the
underlying technology itself,120 in terms of its very scientific integrity or lack thereof or
even in terms of its actual medical or palliative efficacy. 121 If BT/GE ―is, like any
technology, a social creation that reflects the interests and perceptions of its creators‖
and funders,122 the medical and healthcare community would be duty-bound to find out
and know if these interests and perceptions are benign or otherwise, science-driven or

118
See, for instance Brian Tokar (2001), 1-16. On the largely speculative and pseudo-scientific nature of
current research in medical genetics, see Ioannidis, et al. (2001), 306-309; and Ioannidis (2007), 203-13;
and Ioannidis, (2013), 1-3; Roberts (2012); and Kaplan (2013).
119
Fagan (2014)
120
Such as gene therapy and its tacit assumption of genetic reductionism; a critique is Strohman (2003),
169-191.
121
A particular case in point is the scientific and ethical issues pertaining to genetic medical treatment for
mitochondrial diseases as lucidly discussed in Zoloth (2015).
122
Brian Tokar (2001), 67-68.

26
finance-driven, especially in the light of what we now do know about the techno-
scientific and socio-historical development, and the political economy, of BT/GE.123
In many respects BT/GE encapsulates the intellectual conceit and big business
tyranny of a run-away technology that has gone way off-track in its unthinking
eagerness to reduce all life to a set of objects and codes to be taken apart and
reconfigured just so that it can be patented (a.k.a., commercially monopolized),
repackaged and sold in the name of scientific and medical advancement for some pre-
conceived greater good of society. It is a technology that has to be done simply because
it can be done and society will, whether it likes it or not, simply have to adjust or even
transform altogether its age-old values and traditions to the coercive absoluteness of the
ever-shifting consequentialist-utilitarian ethos of mainstream bioethics. The more we
look into it, the more we are brought to the conclusion that bioethics was invented to
make the world safe for biotechnology and the genetic manipulation of life-forms for
private profit.124
Other Ethico-Legal Concerns: Here I would like to outline briefly the ethico-legal
dimensions of current debates over issues pertaining to medical education and research,
iatrogenesis, patents and biomedical monopoly, and the medicalization of health.
(1) Medical education, research and funding: In general, mainstream medical
schools do not train their students in nutrition and dietary therapy, 125 which are
foundational to preventive healthcare,126 and there is relatively little funding for
research in these areas, especially under the current hegemony of high-tech
interventive biomedicine and biotechnology. This deplorable medical educational
framework results in a systemic, de facto, and, arguably, unprincipled and unethical
preference for expensive high-tech biomedical interventive over non-invasive preventive

123
Drucker (2015), 9-60. Although the focus of the book is on the genetic engineering of food, the
underlying systemic problems also apply to medical genetics, especially given the intimate relation
between good nutrition and good health, as shown in Chapter 3 of Drucker‖s book, ―Disappearing a
Disaster: How the Facts About a Deadly Epidemic Caused by a Genetically Engineered Food Have Been
Consistently Clouded,‖ 61-86.
124
A discussion is Coletta (2000).
125
Mogre, et al. (2018), 2-11.
126
Pellegrino (1974), 19-38.

27
therapy, and in the diversion of precious resources from research into low-tech primary
healthcare.127 They also do not educate medical students in philosophy and history of
medicine, not even history of Islamic medicine in the case of Muslim universities. Such
an education in what is called the medical humanities128 would have inculcated a healthy
dose of critical attitude towards the promises and limits, and the benefits and risks of
modern western medicine, as well as an intellectual exposure to and familiarity with
well-proven alternative healthcare modalities. 129
(2) Iatrogenesis: The term refers to diseases or adverse effects caused to patients
due to the individual random mistakes or carelessness of their doctors (or their nurses);
or due to ―systematic errors incorporated into medical practice,‖ in which case Dr. Robin
calls it iatroepidemics.130 Many studies have shown that mishaps even deaths due to
iatrogenesis have occurred all too frequently in hospitals.131 Without going into detail
into the various clinical practice contexts in which iatrogenesis (such as adverse effects
of prescription drugs) occurs, suffice to say that it is only ethical for the healthcare
system to openly recognize and acknowledge the high incidence of iatrogenesis and
take concrete steps to minimize if not eliminate them altogether. 132
(3) Patents and biomedical monopoly (iḏtikār) by private, pharmaceutical
corporations: The basic premise of intellectual property rights and the granting of
patents as protection and execution of those rights is that for medical science to
progress in overcoming ever more new diseases, it is imperative for biomedical
researchers and corporations to have exclusive ownership of their biomedical
discoveries and their potentially profitable commercialization in order to recover their
financial investment in them. But this premise has lately come under intense, detailed
scrutiny.133

127
Kriel (2000), 34-35.
128
Bleakley (2015); Cole (2014); Epstein (2017).
129
Such as those comprehensively surveyed in some detail in Diamond (2001).
130
Robin (1984), 65-86.
131
Milligan (1980), 42-64.
132
For a detailed multi-layered investigation, see Sharpe and Faden (1998); Campanile (2018).
133
Kinsella (2015); Boldrin (2018).

28
 Specifically in this context, the main problem is that this commercial framework
as applied to healthcare has led in fact to a global monopolistic commodification of
health to maximize corporate profits from out of people‖s concern for their well-being
and their fear of illness and disease. In many cases, even biomedical discoveries in
research carried out at publicly funded universities and government medical research
institutes have been allowed to be privatized for the sake of the corporate bottom-line.
The monopolistic nature of patent laws and licensing rights have been shown to lead (i)
to exorbitant prices for much needed drugs, (ii) actual stifling of further useful research
into realizing the full medical potential of the patented discovery, (iii) global
phenomena of biopiracy euphemized as bioprospecting, and (iv) overall socio-economic
inequality in people‖s access to affordable and reliable healthcare services. It is clearly
immoral to have a legal and regulatory regime in place that encourages even protects
monopolistic commercial practices that result in high prices for basic goods and services
that are needed by people on a daily basis, like food, and, in this case, access to
affordable healthcare for society as a whole.134
(4) Medicalization of health: The state of being in overall good health and well-
being should be the normal state of affairs amongst individuals and communities in any
society, and illness should thus only be a medical situation requiring in-patient
hospitalization in relatively rare cases. Hence, the first line of defence against disease
and loss of health lies in taking personal responsibility for one‖s dietary habits and
lifestyle.135 This will result in fewer or even no visits to doctors, medical clinics or
hospitals and thereby less exposure to iatrogenesis resulting from invasive tests and
treatments, many of which are completely unnecessary. However, the currently overly
commercialized biomedical paradigm of healthcare tends to medicalize completely
healthy people, through unnecessary tests, screenings and check-ups, leading to

134
A critical overview of the issue is Gold, et al. (2009): 1-5; see also Johnston (2008), 93-96.
135
In the Islamic medical tradition good eating from good cooking contributed to good health; see Nwal
Nasrallah, ―Eating and Good Health in Medieval Islam,‖ in Maidin, al-Tibb: Healing Traditions in Islamic
Medical Manuscripts, 144-149; cf. Ibn Qayyim al-Jawziyya, Healing with the Medicine of the Prophet, 22-24 and
29-30. In general, a balanced nutritious diet is considered the first line of defence against illness and
disease thereby pre-empting medicalization as far as possible.

29
“disease mongering,”136 and thus ―making patients out of normal human beings.‖137 If health
is an individual virtue as well as a public good, then health is or should be the normal
state of affairs, but if health is medicalized and thus commodified through the
corporatization of biomedicine then illness and disease will be the new norm. 138

Conclusion

If the ethical enigmas brought into stark relief from these robust debates on the
scientific and ethical aspects of biomedicine are rooted in the very institutional
structures and/or research programs underpinning it, then the current reactive fatwā-
issuing activities of fiqh councils in the course of resolving these enigmas will only serve
to encourage the generation of more of the same. Such a situation will in effect
reinforce the validity and legitimacy of those institutional structures and research
programs, thereby rendering what is de facto de jure through unthinking, mechanical
fatwa-issuing. That is the inevitable pitfall of narrow, formal fiqho-legalism when it is
harried by the rush of biotechno-innovations into shallow formal casuistic evaluations
and justifications without prior proper conceptualization and identification of medical
problems and their contexts, despite the legal maxim that the legal evaluation of a
problem is but a function of its cognitive conceptualization. Hence, epistemic-cognitive
mis-conceptualization leads to ethico-legal mis-evaluation.
In the deluge of ever novel biotechnological interventions in institutionalized
healthcare generating ever more moral problems impacting on Muslims that demand
urgent fatwās (formal juristic rulings) for their resolutions, current fiqh of medicine and
its practitioners, the fuqaḏāĂ, as well as Muslim ―bioethicists,‖ will need to stand back and
decide if their job is to be mere reactive ethico-legal apologists, even enablers and
justifiers of the results of biomedical science, or to say, ―Enough is enough,‖ and set
about to embark on creative work in articulating a proactive deep-fiqh of medicine, one

136
Moynihan (2002); Wolinsky (2005); Payer (1994); and Moynihan (2008).
137
Robin (1984), 119-148.
138
A recent overview is Clark (2014), 1-6.

30
that is systematic and rigorous enough to generate a long term medical research program
that consciously takes the Islamic axio-telelogical value system as its core point of
departure.
A proactive deep-fiqh of medicine will entail the conceptualization of an Islamic
Medical Research Programme (IMRP)139 along Lakatosian lines that is informed and
guided by critical, constructive engagement with both tradition and modernity, taking
as its cue the engagement that is reflected in, say, the ḓibb nabawī texts,140 and in the
grand critical synthesis of the Avicennan Canon of Medicine, including the post-
Ghazālian responses to that Canon on the part of the mutakallimūn.141 Instead of a
largely ad hoc ―fire engine‖ ethics that simply reacts hastily to whatever challenges posed
by some new-fangled biomedical developments in modern western medicine, such a
generative142 research program will lead to a revived autonomous Islamic Medicine
capable of generating effective treatment and healing modalities that are intrinsically
sound ethically and epistemically, and thereby free Muslims from the unceasing
onslaught of medico-moral dilemmas imposed on them by a run-away
biotechnologization of medicine and healthcare.143

139
Conceived as part of an overarching Islamic Science Research Programme (ISRP), see Setia (2017), 93-
101. The concept of ―research program‖ here largely follows Imre Lakatos‖s notion of ―methodology of
scientific research programs‖ (MSRP); for MSRP as applied to medical research, see, Cabaret and Denegri
(2008), 501–505.
140
I have in mind in particular al-Suy˅˄˂‖s Ḓibb al-Nabī. A brief overview of ḓibb nabawī (Prophetic
medicine) is ―Prophetic Medicine: al-Tibb al-Nabawi‖ in Shaffri (2018), 56-57.
141
See Setia (Summer, 2012), 25-73. This call for contemporary Muslim theologians to engage in ―new
dialectics‖ and/or ―Kalām of the Age‖ is precisely that which Afifi al-Akiti invites us to heed in his important
article, ―The Negotiation of Modernity through Tradition in Contemporary Muslim Intellectual
Discourse: The Neo-Ghazālian, Attasian Perspective, (2010), 119–134.
142
See note 14 above.
143
Details of this research program will understandably be the subject of a separate paper.

31
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