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Bokek-Cohen Y, Gonen LD, Tarabeih M. The muslim patient and medical treatments based on porcine ingredients. BMC Med Ethics 2023; 24:89. [PMID: 37891587 PMCID: PMC10612269 DOI: 10.1186/s12910-023-00975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Porcine-derived products serve as an effective solution for a wide range of human ailments; however, there may be objections to their use due to Islamic religious prohibitions on consuming products derived from pigs. In order to enhance the cultural competence of medical practitioners who treat Muslim individuals, which constitute about one fifth of the world population, this study aimed at evaluating the knowledge and positions of Muslim patients on this subject. A questionnaire presenting 15 uses of porcine-derived materials was filled out by 809 Muslims. The level of knowledge about the permissibility of these uses and participants' position on whether it should be approved was assessed. Findings show that Muslims are not familiar with Islamic religious jurisprudence that permits the use of porcine products to save lives after it has undergone an essential transformation known as Istihala. The respondents expressed a negative attitude towards the medical use of porcine-derived substances based on imprecise knowledge about the permissibility of use of porcine-derived materials, devices and treatments. We offer recommendations for improving the informed consent obtained from Muslim patients prior to conducting porcine-based treatments.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- Tel Aviv University, 30 Haim Levanon Street, Tel Aviv Postal code, Tel Aviv, 6997801, Israel.
| | | | - Mahdi Tarabeih
- The Academic College of Tel-Aviv-Yaffo, 2 Rabenu Yerucham St., Tel Aviv Postal code, Tel Aviv, 6161001, Israel
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2
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Shoaib AB, Vawter-Lee M, Venkatesan C, Soliman AF. Muslim perspectives on palliative care in perinatal and neonatal patients: a mini-review. Front Pediatr 2023; 11:1204941. [PMID: 37384311 PMCID: PMC10293888 DOI: 10.3389/fped.2023.1204941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Muslims comprise nearly a quarter of the worldwide population, with significant populations in the United States, Canada, and Europe. As clinicians, it is important to be familiar with Islamic religious and cultural perspectives on medical treatment, life-prolonging measures and comfort and palliative care, but historically, this has been a gap in the literature. Recently, there have been multiple papers discussing Islamic bioethics, particularly in regards to end of life care in adults; however, there has been a lack of literature discussing the Islamic perspective on issues related to neonatal and perinatal end of life care. This paper uses clinical scenarios to review key relevant principles of Islamic law, discussing the primary and secondary sources used in formulating fatawa, including the Quran, hadith, qiyas, and 'urf, and the importance of preservation of life and upholding of human dignity (karamah). Neonatal and perinatal scenarios are used to specifically explore the Islamic perspective on withholding and withdrawal of life-sustaining measures and determining what constitutes an acceptable quality of life. In some Islamic cultures the expertise of the patient's physician is given significant weight in making these judgments, and as such, families may appreciate frank assessment of the situation by the clinical team. Because of the various factors involved in issuing religious ruling, or fatwa, there is a wide spectrum of opinions on these rulings, and physicians should be aware of these differences, seek counsel and guidance from local Islamic leaders, and support families in their decision-making process.
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Affiliation(s)
- Abdullah B. Shoaib
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Marissa Vawter-Lee
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Charu Venkatesan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ayman F. Soliman
- Division of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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Khan I, Saad A. Death Be Not Proud: A Commentary on Muslim Acceptance of Death in the Intensive Care Unit. JOURNAL OF RELIGION AND HEALTH 2022; 61:4913-4922. [PMID: 34767137 PMCID: PMC8586641 DOI: 10.1007/s10943-021-01458-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
Technologies used in medicine have meant that treatments can keep people biologically alive but often fail to provide meaningful recovery and quality of life. Many of those from the Islamic faith have relied on these technologies for recovery on religious grounds, even when it may be against clinical advice. This commentary seeks to challenge this notion among many Muslims and suggests there is a psycho-spiritual motivation within the Islamic tradition in not pursuing intensive care treatment that is deemed futile by clinicians. A wish to embrace death in these situations should be expressed to loved ones, and the dying person's loved ones should be encouraged to embrace death, in order to minimise harm from disagreements between clinical staff and family.
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Affiliation(s)
- Imran Khan
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
| | - Ahmed Saad
- Ihsan Institute of Islamic Studies, Birmingham, UK
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Padela AI. Designing academic career trajectories: identifying internal assets and evaluating external challenges. Transl Behav Med 2021; 10:890-895. [PMID: 33030526 DOI: 10.1093/tbm/ibaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
When I joined the Society of Behavioral Medicine's Mid-Career Leadership Institute in 2016, I was at an academic crossroads where my motivation to pursue a research career was waning. Specifically, I was challenged in obtaining funding for my unique research focus, and by the loss of institutional mentors and sponsors. In this commentary, I describe how I utilized components of the SBM Leadership Institute, specifically executive coaching and peer mentorship, as well as introspection to identify career trajectories that align with my internal motivations, as well as acknowledge dynamics in my scholarship area and at my institution. By specifying several concrete possibilities for career advancement that are both personally meaningful and institutionally practical, I have been better able to focus my scholarly pursuits and seek out leadership positions. In general terms, the leadership institute helped me to evaluate my own internal assets (e.g., skills and passions), to critically examine trends in my area of scholarship, and to delineate alternative career pathways. In my view such periodic introspection and evaluation is critically important for maintaining a fulfilling academic career.
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Affiliation(s)
- Aasim I Padela
- Department of Medicine, The University of Chicago, Chicago, USA.,Program on Medicine and Religion, The University of Chicago, Chicago, USA.,MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, USA
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Mohiuddin A, Suleman M, Rasheed S, Padela AI. When can Muslims withdraw or withhold life support? A narrative review of Islamic juridical rulings. Glob Bioeth 2020; 31:29-46. [PMID: 32284707 PMCID: PMC7144300 DOI: 10.1080/11287462.2020.1736243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/15/2020] [Indexed: 11/12/2022] Open
Abstract
When it is ethically justifiable to stop medical treatment? For many Muslim patients, families, and clinicians this ethical question remains a challenging one as Islamic ethico-legal guidance on such matters remains scattered and difficult to interpret. In light of this gap, we conducted a systematic literature review to aggregate rulings from Islamic jurists and juridical councils on whether, and when, it is permitted to withdraw and/or withhold life-sustaining care. A total of 16 fatwās were found, 8 of which were single-author rulings, and 8 represented the collective view of a juridical council. The fatwās are similar in that nearly all judge that Islamic law, provided certain conditions are met, permits abstaining from life-sustaining treatment. Notably, the justifying conditions appear to rely on physician assessment of the clinical prognosis. The fatwās differ when it comes to what conditions justify withdrawing or withholding life- sustaining care. Our analyses suggest that while notions of futility greatly impact the bioethical discourse regarding with holding and/or withdrawal of treatment, the conceptualization of futility lacks nuance. Therefore, clinicians, Islamic jurists, and bioethicists need to come together in order to unify a conception of medical futility and relate it to the ethics of withholding and/or withdrawal of treatment.
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Affiliation(s)
- Afshan Mohiuddin
- Initiative on Islam and Medicine, Program on Medicine and Religion, The University of Chicago, Chicago, IL, USA
- Department of Internal Medicine, University Hospitals Regional Medical Center, Macomb Township, MI, USA
| | | | - Shoaib Rasheed
- Department of Internal Medicine, Henry Ford Macomb Hospital, Chicago, IL, USA
| | - Aasim I. Padela
- Initiative on Islam and Medicine, Program on Medicine and Religion, The University of Chicago, Chicago, IL, USA
- Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
- MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
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6
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Padela AI. Using the Maqāṣid al-Sharī'ah to Furnish an Islamic Bioethics: Conceptual and Practical Issues. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:347-352. [PMID: 31578666 DOI: 10.1007/s11673-019-09940-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
The field of Islamic bioethics is currently in development as thinkers delineate its normative content, ethical scope and research methods. Some scholars have offered Islamic bioethical frameworks based on the maqāṣid al-Sharī'ah, the higher objectives of Islamic law, to help advance the field. Accordingly, a recent JBI paper by Ibrahim and colleagues describes a method for using the maqāṣid al-Sharī'ah to provide moral end-goals and deliberative mechanisms for an Islamic bioethics. Herein I highlight critical conceptual and practical gaps in the model with the hopes of fostering greater discussion about how maqāṣid al-Sharī'ah frameworks may fit within Islamic bioethics deliberation.
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Affiliation(s)
- Aasim I Padela
- The University of Chicago, 5841 S. Maryland Ave., MC 5068, Chicago, IL, 60637, USA.
- Faculty, Maclean Center for Clinical Medical Ethics, The University of Chicago, 5841 S. Maryland Ave., MC 5068, Chicago, IL, 60637, USA.
- Associate Faculty, Divinity School, The University of Chicago, 5841 S. Maryland Ave., MC 5068, Chicago, IL, 60637, USA.
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Padela AI, Duivenbode R. The ethics of organ donation, donation after circulatory determination of death, and xenotransplantation from an Islamic perspective. Xenotransplantation 2018; 25:1-12. [DOI: 10.1111/xen.12421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/03/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Aasim I. Padela
- Initiative on Islam and Medicine; University of Chicago; Chicago IL USA
- Department of Medicine; Section of Emergency Medicine; University of Chicago; Chicago IL USA
- MacLean Center for Clinical Medical Ethics; University of Chicago; Chicago IL USA
| | - Rosie Duivenbode
- Initiative on Islam and Medicine; University of Chicago; Chicago IL USA
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Paris W, Seidler RJH, FitzGerald K, Padela AI, Cozzi E, Cooper DKC. Jewish, Christian and Muslim theological perspectives about xenotransplantation. Xenotransplantation 2018; 25:e12400. [PMID: 29687920 DOI: 10.1111/xen.12400] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/23/2018] [Accepted: 03/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND This paper is based on a theological symposium presented at the International Xenotransplantation Association's 14th Congress held in Baltimore, MD, September, 2017. METHODS The information explores the Jewish, Christian and Muslim theological perceptions and perspectives about cross-species (ie pig-to-human) organ transplantation, the genetic alterations required in the organ-source pig, and their potential to influence individual acceptance of the procedure. RESULTS/CONCLUSIONS This work should not be considered as the ultimate word about individual theological views, but rather as part of an ongoing conversation that will hopefully lead to wider consideration and exploration of these issues as xenotransplantation science advances towards clinical trials.
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Affiliation(s)
- Wayne Paris
- School of Social Work, Abilene Christian University, Abilene, TX, USA
| | | | - Kevin FitzGerald
- Dr David Lauler Chair of Catholic Care Ethics in the Center for Clinical Bioethics, Georgetown University, Washington, DC, USA.,Department of Oncology, Georgetown University, Washington, DC, USA
| | - Aasim I Padela
- Initiative on Islam and Medicine, Section of Emergency Medicine, Faculty, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Emanuele Cozzi
- Transplantation Immunology Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Hospital, Padua, Italy
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama Birmingham, Birmingham, AL, USA
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Arousell J, Carlbom A. Culture and religious beliefs in relation to reproductive health. Best Pract Res Clin Obstet Gynaecol 2015; 32:77-87. [PMID: 26542927 DOI: 10.1016/j.bpobgyn.2015.08.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/19/2022]
Abstract
An increasing number of contemporary research publications acknowledge the influence of religion and culture on sexual and reproductive behavior and health-care utilization. It is currently hypothesized that religious influences can partly explain disparities in sexual and reproductive health outcomes. In this paper, we will pay particular attention to Muslims in sexual and reproductive health care. This review reveals that knowledge about devout Muslims' own experience of sexual and reproductive health-care matters is limited, thus providing weak evidence for modeling of efficient practical guidelines for sexual and reproductive health care directed at Muslim patients. Successful outcomes in sexual and reproductive health of Muslims require both researchers and practitioners to acknowledge religious heterogeneity and variability, and individuals' possibilities to negotiate Islamic edicts. Failure to do so could lead to inadequate health-care provision and, in the worst case, to suboptimal encounters between migrants with Muslim background and the health-care providers in the receiving country.
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Affiliation(s)
- Jonna Arousell
- Department of Women's and Children's Health (IMCH), Uppsala University, Sweden.
| | - Aje Carlbom
- Faculty of Health and Society, Malmö University, Sweden
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Sartell E, Padela AI. Adab and its significance for an Islamic medical ethics. JOURNAL OF MEDICAL ETHICS 2015; 41:756-761. [PMID: 25934319 DOI: 10.1136/medethics-2014-102276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 04/02/2015] [Indexed: 06/04/2023]
Abstract
Discussions of Islamic medical ethics tend to focus on Sharī'ah-based, or obligation-based, ethics. However, limiting Islamic medical ethics discourse to the derivation of religious duties ignores discussions about moulding an inner disposition that inclines towards adherence to the Sharī'ah. In classical Islamic intellectual thought, such writings are the concern of adab literature. In this paper, we call for a renewal of adabi discourse as part of Islamic medical ethics. We argue that adab complements Sharī'ah-based writings to generate a more holistic vision of Islamic medical ethics by supplementing an obligation-based approach with a virtue-based approach. While Sharī'ah-based medical ethics focuses primarily on the moral status of actions, adab literature adds to this genre by addressing the moral formation of the agent. By complementing Sharī'ah-based approaches with adab-focused writings, Islamic medical ethics discourse can describe the relationship between the agent and the action, within a moral universe informed by the Islamic intellectual tradition.
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Affiliation(s)
- Elizabeth Sartell
- Divinity School, University of Chicago, Chicago, Illinois, USA Initiative on Islam & Medicine, Program on Medicine and Religion, University of Chicago, Chicago, Illinois, USA
| | - Aasim I Padela
- Initiative on Islam & Medicine, Program on Medicine and Religion, University of Chicago, Chicago, Illinois, USA Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
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Padela A, Mohiuddin A. Islamic goals for clinical treatment at the end of life: the concept of accountability before God (taklīf) remains useful: response to open peer commentaries on "Ethical obligations and clinical goals in end-of-life care: deriving a quality-of-life construct based on the Islamic concept of accountability before God (taklīf)". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:W1-W8. [PMID: 25562245 DOI: 10.1080/15265161.2015.983353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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12
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Miller AC, Ziad-Miller A, Elamin EM. Brain death and Islam: the interface of religion, culture, history, law, and modern medicine. Chest 2014; 146:1092-1101. [PMID: 25287999 PMCID: PMC4188144 DOI: 10.1378/chest.14-0130] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/15/2014] [Indexed: 11/01/2022] Open
Abstract
How one defines death may vary. It is important for clinicians to recognize those aspects of a patient's religious beliefs that may directly influence medical care and how such practices may interface with local laws governing the determination of death. Debate continues about the validity and certainty of brain death criteria within Islamic traditions. A search of PubMed, Scopus, EMBASE, Web of Science, PsycNet, Sociological Abstracts, DIALOGUE ProQuest, Lexus Nexus, Google, and applicable religious texts was conducted to address the question of whether brain death is accepted as true death among Islamic scholars and clinicians and to discuss how divergent opinions may affect clinical care. The results of the literature review inform this discussion. Brain death has been acknowledged as representing true death by many Muslim scholars and medical organizations, including the Islamic Fiqh Academies of the Organization of the Islamic Conference and the Muslim World League, the Islamic Medical Association of North America, and other faith-based medical organizations as well as legal rulings by multiple Islamic nations. However, consensus in the Muslim world is not unanimous, and a sizable minority accepts death by cardiopulmonary criteria only.
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Affiliation(s)
- Andrew C Miller
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
| | | | - Elamin M Elamin
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, James A. Haley Veteran's Hospital and University of South Florida, Tampa, FL
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