Darurah (Necessity) and Its Application in Islamic Ethical Assessment of Medical Applications: A Review on Malaysian Fatwa

Applying the Concepts of Benefit and Harm in Malaysian Bioethical Discourse: Analysis of Malaysian Fatwa

Rapid developments in science and technology have resulted in novel discoveries, leading to new questions particularly related to human values and ethics. Every discovery and technology has positive and negative implications and affects human lives either directly or indirectly, involving all walks of life. Bioethical discourse in Malaysia must consider the multiracial and multireligious background of Malaysia and especially the Islamic view as the majority of Malaysians are Muslims and Islam is the religion of the federation. This article discusses several selected bioethical issues in Malaysia by studying the application of maṣlaḥah (the public good) and mafsadah (evil and harms) in Malaysian Islamic rulings (fatwas). This article uses the critical interpretation approach, as this is an ethical, interpretive, textual, and contextual analysis. In a situation when there is a conflict between maṣlaḥah and avoidance of mafsadah, it is preferred to attempt to address both needs. However, if maṣlaḥah and avoidance of mafsadah are mutually exclusive, the decision to choose must be made by weighing (tarjīḥ) and choosing the one which is superior. The maṣlaḥah and mafsadah concepts play vital and significant roles in bioethical discourse to realize human essential interests, namely faith, life, lineage, intellect, and property, thus achieving maqāṣid al-sharī'ah (the ultimate goal of sharia). This concept helps in guiding bioethical discussions, especially in determining the priority between achieving benefits and avoiding harms. The application of this concept will also assist Malaysian authorities in formulating appropriate rulings, especially bioethical issues related to Malaysian Muslims' lives.

The view of the three monotheistic religions toward xenotransplantation

Xenotransplantation, transplanting animal organs into humans, may offer a solution to the shortage of organs for transplantation. This would increase the chances for scheduled, elective transplantation, even for patients currently ineligible for receiving a human organ. However, xenotransplantation raises specific ethical and philosophical issues, that is, a personal identification of the body parts with the soul and spirit, the relationships between humans and animals, and challenges related to issues of medical and social ethics. The three monotheistic religions have laws and perspectives pertaining to xenotransplantation. This scholarly review examines the theology and viewpoints of the three monotheistic religions and their concerns regarding xenotransplantation (interspecies) in terms of religious-legal rulings, the ethical considerations related to the procedure, through religious scriptures and rulings of scholars of the three faith communities. This review should be viewed as a continuation of an extensive investigation of these issues, as the field of transplantation advances toward clinical trials. It was found that there are no fundamental religious reasons presented by any of the three religions to prohibit the use of animal organs as a means of treating severe and life-threatening conditions. However, there are certain limitations prescribed by each religion relating to the treatment of the animals and the choice of organs to be transplanted.

Alzheimer's Disease and Related Dementias in Muslim Women: Recommendations for Culturally Sensitive Care

Alzheimer's disease and related dementias (ADRD) present significant challenges including cognitive and functional loss, behavioral disruption, emotional distress, and significant financial burden. These stressors are amplified in minority groups, who experience higher rates of ADRD but less frequent and later diagnosis. There is therefore a critical need to identify tangible approaches to culturally informed dementia assessment and care for patients from diverse communities. Muslim patients and particularly Muslim women are among the populations most understudied in the ADRD space. Muslim patients may hold unique religious, spiritual, and cultural beliefs and practices that can impact care-seeking for dementia symptoms, diagnostic accuracy, and treatment uptake. This paper outlines culturally informed approaches to assessing and treating Muslim women and families at each stage of ADRD care, though many recommendations extend to the broader Muslim community and others of diverse racial-ethnic backgrounds. We provide concrete suggestions for building rapport within and leveraging common family structures, respecting principles of modesty and privacy for all women including those who observe hijab or niqab, and communicating dementia diagnosis and care in the context of spiritual and ethical beliefs. While not intended as a comprehensive and prescriptive guide, this review provides important points of consideration and discussion with patients of Muslim backgrounds.

Bioethical insights from the Fiqh Council of North America's recent ruling on medical cannabis

There is growing momentum to legalize medical cannabis across the United States. Positive public attitudes and permissive policies are based on growing anecdotal experiences and medical evidence that enumerate the health benefits of cannabis. Against this backdrop, Muslim stakeholders are (re)-evaluating their stance on the issue for Muslim patients who may benefit from such novel treatments, Muslim physicians who could incorporate the provision of cannabis into practices, and Muslim entrepreneurs who may seek to engage with the pharmaceutical and business aspects of the growing industry. Given this renewed interest, the Fiqh Council of North America (FCNA), a deliberative body comprised of Islamic jurists and medical consultants, examined the medical as well as religious evidence surrounding medical cannabis in order to furnish Muslim Americans with religious guidance. In 2018, they resolved that, while the use of intoxicating substances is proscribed by Islamic law, medical cannabis was permissible for Muslims to use with the following stipulations: Non-psychoactive preparations of cannabis are permitted to treat illnesses for which therapeutic effects of cannabis are certain, and psychoactive preparations are contingently permissible in cases of dire necessity. In this paper we first discuss the deliberative process and ethico-legal rationale brought to bear in furnishing the ruling, and then proceed to critically examine its conceptual gaps, practical limitations, and future implications. Clarifying the nuances around the religious permissibility of medical cannabis is important for Muslim patients and providers whose attitudes and behaviors may be informed by the ruling, as well for stakeholder groups within pharmaceutical and health policy circles who aim to address the needs of the global Muslim community that may stand to benefit from advances in medical cannabis research and therapeutics.

Producing Parenthood: Islamic Bioethical Perspectives & Normative Implications

Biomedicine has opened up new possibilities for parenthood. Once resigned to remaining childless or pursuing adoption, infertile couples can now pursue options such as gamete donation, in-vitro fertilization, and uterine transplantation, as well as surrogacy. Muslim thinkers have viewed these strategies with both promise and caution given new types of kinship and parenthood result. By drawing upon leading medical fiqh academy resolutions this paper critically analyses Islamic normative views on the production of parenthood. We start with an overview of the Sunni rulings on gamete donation, gestational surrogacy and uterus transplantation, and the rationale and scriptural sources that undergird these moral assessments. Next, we discuss the contested relational bonds in light of larger discussions on genetics and the preservation of lineage. Finally, we comment on how scientific data, social imaginaries, and empirical gaps impact Islamic normativity regarding the production of parenthood so as to inform more holistic Islamic bioethical assessments.

Islamic Perspectives on CRISPR/Cas9-Mediated Human Germline Gene Editing: A Preliminary Discussion

The recent development of CRISPR/Cas9 technology has rekindled the ethical debate concerning human germline modification that has begun decades ago. This inexpensive technology shows tremendous promise in disease prevention strategies, while raising complex ethical concerns about safety and efficacy of the technology, human dignity, tampering with God's creation, and human genetic enhancement. Germline gene editing may result in heritable changes in the human genome, therefore the question of whether it should be allowed requires deep and careful discussion from various perspectives. This paper explores Islamic perspectives on the concerns raised and highlights the ethical principles in Islam that should be taken into consideration when assessing the permissibility of CRISPR/ Cas9-mediated human germline gene editing. As argued in this paper, human germline gene editing would be considered lawful for medical purpose under certain conditions. It should not be applied on humans until the safety and efficacy issues are resolved. Robust ethical guidelines and strict regulations are necessary to preserve human dignity and to prevent premature and misuse of the technology. Maqasid al-shariah's principles of preservation of human life, lineage, and dignity and 'preventing harm takes precedence over securing benefit' are among the guiding principles in assessing the permissibility of CRISPR/Cas9-mediated human germline editing from an Islamic perspective. Further discussions are important to address the controversies as well as to explore the related ethical principles.

Profile and Motivations of Registered Whole-Body Donors in Turkey: Istanbul University Experience

Little is known regarding the profiles of whole body donors in Muslim majority countries where donation is scarce. Therefore, this study aims to profile registered donors in Turkey by means of a survey. The explored data could be used to improve ongoing campaign efforts and ethical practices such as commemoration services. Registered donors of the donation programs at the two faculties of medicine of Istanbul University were compared with the national population and a cluster analysis was performed to reveal any concealed sub-groups. Data from 188 respondents were analyzed. The majority of registered donors were married (42%), male (65.4%), aged over 50 years (76%), held a tertiary education degree (49.7%), and were irreligious (58.5%). Cluster analysis revealed two groups with significantly different educational levels, marital statuses, and religious choices. Regarding whether their bodies could be used for education or research, the majority (64.5%) of the respondents left the decision to the anatomy department. Similarly, 73.8% approved indefinite use of their organs, body parts and/or skeletons. The respondents were also willing to share their medical history (94.2%) and personal information (81.6%) if needed. Motivational themes for body donation including usefulness, impermanence, religion, awareness, and kinship were devised after a thematic analysis. Among the respondents, 56.5% were registered organ donors and 63.3% were frequent blood donors. The results of this study provide data that may help revising informed consent forms, developing and implementing thanksgiving ceremonies, and selecting additional targets for supporting body donation campaign activities such as organ and blood donation units.

Uterine Transplant: A Risk to Life or a Chance for Life?

Being inherently different from any other lifesaving organ transplant, uterine transplantation does not aim at saving lives but supporting the possibility to generate life. Unlike the kidneys or the liver, the uterus is not specifically a vital organ. Given the non-lifesaving nature of this procedure, questions have been raised about its feasibility. The ethical dilemma revolves around whether it is worth placing two lives at risk related to surgery and immunosuppression, amongst others, to enable a woman with absolute uterine factor infertility to experience the presence of an organ enabling childbirth. In the year 2000, the first uterine transplantation, albeit unsuccessful, was performed in Saudi Arabia from where it has spread to the rest of the world including Sweden, the United States and now recently India. The procedure is, however, still in the preclinical stages and several ethical, legal, social and religious concerns are yet to be addressed before it can be integrated into the clinical setting as standard of care for women with absolute uterine factor infertility.

The Development and Validation of a Modesty Measure for Diverse Muslim Populations

This paper reports on the multi-phase development of an English-language modesty measure for use among Muslim populations. The process yielded a 10-item measure that has high levels of internal consistency reliability (Cronbach's α of 0.83), and has acceptable discriminant and predictive validity. Specifically although our modesty measure for Muslim women was found to be significantly correlated with measures of positive and negative religious (Islamic) coping, it was not significantly correlated with religious practice-based religiosity (discriminant validity). Further logistic modeling revealed higher modesty levels positively associated with forgoing mammography because of concerns about lack of same-sex providers (predictive validity).

Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa

Rapid development in the area of assisted reproductive technology (ART), has benefited mankind by addressing reproductive problems. However, the emergence of new technologies and techniques raises various issues and discussions among physicians and the masses, especially on issues related to bioethics. Apart from solutions provided using conventional bioethics framework, solutions can also be derived via a complementary framework of bioethics based on the Higher Objectives of the Divine Law (Maqasid al-Shariah) in tackling these problems. This approach in the Islamic World has been applied and localised in the Malaysian context. Thus, this paper highlights a conceptual theoretical framework for solving current bioethical issues, with a special focus on ART in the Malaysian context, and compares this theory with conventional theories of bioethics.

Ethical Concerns About Human Genetic Enhancement in the Malay Science Fiction Novels

Advancements in science and technology have not only brought hope to humankind to produce disease-free offspring, but also offer possibilities to genetically enhance the next generation's traits and capacities. Human genetic enhancement, however, raises complex ethical questions, such as to what extent should it be allowed? It has been a great challenge for humankind to develop robust ethical guidelines for human genetic enhancement that address both public concerns and needs. We believe that research about public concerns is necessary prior to developing such guidelines, yet the issues have not been thoroughly investigated in many countries, including Malaysia. Since the novel often functions as a medium for the public to express their concerns, this paper explores ethical concerns about human genetic enhancement expressed in four Malay science fiction novels namely Klon, Leksikon Ledang, Transgenesis Bisikan Rimba and Transgenik Sifar. Religion has a strong influence on the worldview of the Malays therefore some concerns such as playing God are obviously religious. Association of the negative image of scientists as well as the private research companies with the research on human genetic enhancement reflects the authors' concerns about the main motivations for conducting such research and the extent to which such research will benefit society.

Predictors of Physician Recommendation for Ethically Controversial Medical Procedures: Findings from an Exploratory National Survey of American Muslim Physicians

Physician religiosity can influence their ethical attitude toward medical procedures and can thereby impact healthcare delivery. Using a national survey of American Muslim physicians, we explored the association between physician recommendation of three controversial medical procedures--tubal ligation, abortion, and porcine-based vaccine--and their (1) religiosity, (2) utilization of bioethics resources, and (3) perception of whether the procedure was a medical necessity and if the scenario represented a life threat. Generally, multivariate models found that physicians who read the Qur'an more often as well as those who perceived medical necessity and/or life threat had a higher odds recommending the procedures, whereas those who sought Islamic bioethical guidance from Islamic jurists (or juridical councils) more often had a lower odds. These associations suggest that the bioethical framework of Muslim physicians is influenced by their reading of scripture, and the opinions of Islamic jurists and that these influences may, paradoxically, be interpreted to be in opposition over some medical procedures.