Muslim perspectives on palliative care in perinatal and neonatal patients: a mini-review

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.

Cannabis Use in Muslim Youth

Cannabis is the most used illicit drug in the world. It causes impaired executive functioning, psychosis, and schizophrenia, among other impairments. It also affects reaction time, awareness, and motivation. These side effects can lead to decreased academic performance as well as social setbacks. Variance in the interpretation of whether cannabis is forbidden fuels the ongoing debate on the religious stance of cannabis use among Muslim communities across the globe. Stigma is the biggest barrier for open discussion about cannabis usage and also acts as a barrier to the implementation of harm-reductive programs in the Islamic world. There is clear evidence that due to stigma, religious beliefs, and social factors, Muslim youth are at a higher risk than their adult counterparts and that they feel unable to seek help with regard to cannabis and other drug abuse. By reviewing studies on the harmful effects of cannabis use and comparing them against notions of what is considered forbidden in the Islamic tradition and other communities, this paper explores the best ways to reduce harm from cannabis usage in the global Muslim community.

Meanings and practices of the physical activity engaged in by Moroccan women in an Islamic urban environment: A quasi-ethnography

AIM

To understand the meanings and practices of the physical activity (PA) engaged in by Moroccan women in an Islamic urban environment.

DESIGN

Quasi-ethnographical study.

METHODS

13 semi-structured interviews and 15 observation sessions of the PA engaged in by women.

RESULTS

The concept of PA fits into the holistic approach of Islam. The social and cultural conditions of those who regularly practise PA are diverse. The community collaborates to overcome difficulties involved with this practice. The flexibility of issues such as gender segregation and clothing, Islam as a stimulus for PA, health as a value, the promotion of a rights and duty-based model for health care user, the community co-creation of the PA offer, and the power of organized civil society could inspire new strategies for the promotion of PA among Muslim women in other contexts.

Religion and Measles Vaccination in Indonesia, 1991-2017

INTRODUCTION

Some Muslim religious councils in Indonesia have ruled that measles vaccines contain haram (i.e., forbidden materials). This study evaluates the changes in measles vaccination coverage between 1991 and 2017 and compares vaccination coverage between Muslims and non-Muslims in Indonesia.

METHODS

A total of 7 cross-sectional in-person surveys of mothers in 1991-2017 in Indonesia were analyzed in 2019. Participants were asked about religion in 1991-2007, and 100 data sets of religion were imputed for 2012 and 2017. In this multiple imputation analysis, binomial regression models output prevalence differences adjusted for wealth, education, child's sex, and mother's age. A quadratic term for year (year X year) and an interaction term between year and religion evaluated changes in vaccination over time by religion.

RESULTS

The 7 data sets included 23,106 children aged 12-23 months, with the proportion of those who were Muslims ranging between 85% and 89% across the survey years. Between 1991 and 2017, measles vaccination coverage increased from 57% to 79% among non-Muslims and from 59% to 79% among Muslims. In the multivariable regression model, measles vaccination coverage increased by 1.6% each year (with a quadratic term of -0.05%, indicating some leveling over time). At baseline in 1991, non-Muslims had a vaccination coverage of 6.2% higher than that of Muslims, but this disparity decreased by -0.2% each year.

CONCLUSIONS

Measles vaccination increased in both Muslims and non-Muslims in Indonesia but has stagnated in recent years. Because of increased attention among Muslim groups on haram materials in vaccines since 2017, future studies should continue to examine the relationship between religion and vaccine uptake in Indonesia.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

Singaporean Malay-Muslim Women's Lifestyle Habits and Attitudes towards Health

This article examines how the intersections of Singaporean Malay-Muslim women’s religious and gendered subjectivities influence their lifestyle habits and health attitudes. It explores the gaps between their practices, perspectives and discourses that discuss Islam’s relevance in health educational programmes. Individual semi-structured interviews with 19 local women of diverse social backgrounds show that while Islam is influential in their health conceptions, this is limited to the self-internalisation of theologically-based discourses. Discussions on how positive gender relations based on Islamic values can contribute to women’s health outcomes are lacking in their narratives, existing academic literature and public discourses. A comprehensive approach to leveraging religious concepts in advocating good health for Muslims should also include women’s empowerment and improvement of gender relations.

Encouraging Indonesians to Pray From Home During the COVID-19 Pandemic

Despite the introduction of social restrictions designed to stem the spread of COVID-19, many Indonesians have continued to attend places of worship. This poses a major public health threat, as congregational prayer involves large numbers of worshippers gathering under conditions known to enable the spread of the virus. Using a nationally representative survey, we evaluated the efficacy of messages delivered from different authorities in encouraging Indonesians to worship at home. We find no consistent evidence that public health messages change Indonesians’ attitudes toward communal prayer or their willingness to forgo communal prayer during the COVID-19 pandemic. Importantly, however, looking at well-defined subpopulations – non-Muslims and supporters of the president – we find suggestive evidence that messages were effective in increasing the likelihood of individuals to indicate a willingness to forgo communal prayer in the forthcoming week. Our results suggest that public health officials should eschew blanket messaging strategies in favor of more targeted approaches.

The impact of religiously tailored and ethically balanced education on intention for living organ donation among Muslim Americans

We tested the efficacy of religiously tailored and ethically balanced education upon living kidney organ donation intent among Muslim Americans. Pre-post changes in participant stage of change, preparedness, and likelihood judged efficacy. Among 137 participants, mean stage of change toward donation appeared to improve (0.59; SD ± 1.07, P < .0001), as did the group's preparedness to make a donation decision (0.55; SD ± 0.86, P < .0001), and likelihood to donate a kidney (0.39; SD ± 0.85, P < .0001). Mean change in likelihood to encourage a loved one, a co-worker, or a mosque community member with ESRD to seek a living donor also increased (0.22; SD ± 0.84, P = .0035, 0.23; SD ± 0.82, P = .0021, 0.33; SD ± 0.79, P < .0001 respectively). Multivariate ordered logistic regression models revealed that gains in biomedical knowledge regarding organ donation increased odds for positive change in preparedness (OR = 1.20; 95% CI 1.01-1.41, P = .03), while increasing age associated with lower odds of positive change in stage of change (OR = 0.98, 95% CI 0.96-0.998, P = .03), and prior registration as an organ donor lowered odds for an increase in likelihood to donate a kidney (OR = 0.22; 95% CI 0.08-0.60, P = .003). Our intervention appears to enhance living kidney donation-related intent among Muslim Americans [Clinicaltrials.gov number: NCT04443114].

Opinions on the Legitimacy of Death Declaration by Neurological Criteria from the Perspective of 3 Abrahamic Faiths

Traditional criteria to identify death may not fit all circumstances. This manuscript explores religious jurisprudence to ascertain whether death declaration by neurological criteria (DDNC) is accepted as a valid method by 3 Abrahamic religious traditions ie. Islam, Judaism, and Catholicism. Among Islamic sources (order of primacy), neither the Qur'an, Sunnah as reported in Hadith, Ijma' (scholarly consensus), nor Qiyas (precedent-based analogy) clearly describe death determination criteria. Through Ijtihad (lowest level of Shari 'ah), 5 of 6 identified non-binding fatwa support DDNC. Faith-based medical organizations are divided. Eleven of 13 surveyed Muslim-majority countries have laws supporting DDNC. Concern exists that premature death declaration could violate the Shari'ah concept of Hifz-An-nafs (saving life). As such, DDNC remains debated in Islamic circles. Among the 3 main sources of Jewish law (Halacha), the Torah (oral and written) does not clearly define death declaration criteria. Although Talmudic interpretations of Misnah Oholot 1:6 and Gamara Hullin 21a suggest a possible justification for death determination using neurologic criteria in some conditions, the bulk of mitzvot d'rabbanan (Rabbinic Law) rejects DDNC and adheres to cardiorespiratory criteria. Lastly, Catholic Church Cannon Law and the Holy Scripture recorded in Bible does not define death determination criteria. Following the Council of Vienne, Saint Thomas's loss of integration view has predominated. In 2000, Pope John Paul II expressed tentative and qualifid support for DDNC, however the topic remains controversial. Despite dissenting opinions in each faith, DDNC is currently accepted as valid by many Muslims and Catholics, while rejected by Judaism.

[The representation of the body in Islam]

Science and Islamic culture incorporate the sacred and the profane. For a Muslim, science must be useful for humanity, and scientists must take responsibility, commensurate with their knowledge, for the potential consequences of their research. In this context, questions relating to the body in Islam take into account the Quran, hadiths and elements of established precedents.

The effect of religion on the perception of health states among adults in the United Arab Emirates: a qualitative study

OBJECTIVES

Investigate how religion may affect the perception of health states among adults in the United Arab Emirates and the implications for research on self-reported health and quality of life and the use of values in cost-effectiveness analysis.

DESIGN

Qualitative analysis of short-structured interviews with adult Emiratis carried out by a market research agency.The COREQ criteria have been used where appropriate to guide the reporting of our findings.

SETTING

Participants were recruited from shopping malls and other public places in the cities of Al Ain and Abu Dhabi.

PARTICIPANTS

Two hundred adult Emiratis broadly representative of the Emirati population in terms of age and gender.

RESULTS

Eighty one per cent of participants said that their perception of health states was influenced by their spiritual or religious beliefs. The two overarching themes that seemed to explain or classify these influences were 'fatalism' and 'preservation of life'. Subthemes included powerlessness to change what is preordained by God, fear of disability (particularly diminished mobility) and appreciation of health and life and the requirement to look after one's health. A final theme was that of acceptance, with respondents expressing a willingness to endure suffering and disability with patience in the expectation of rewards in the hereafter.

CONCLUSIONS

Our results emphasise the need for further work to establish locally relevant value sets for Muslim majority countries in the Middle East and elsewhere for use in health technology assessment decision-making, rather than relying on value sets from other regions.

Suicide and Its Legal Implications in Pakistan: A Literature Review

In recent decades, great strides have been made in understanding the science of suicide. Thus, it is imperative that Pakistani legal systems bridge the gap between Pakistani law and science. For instance, recent discoveries in public health, psychology, and neurobiology have shaped the etiological model of suicidal behavior and highlighted the high preponderance of certain psychiatric patients towards suicide. We present here a brief overview of psychiatric evidence implicated in suicides to better inform the Pakistani legal system of advances in the psychiatric literature.

[New ways of believing in globality]

To understand Islamism and jihadism in the context of globality, it is firstly necessary to analyse the ways of "believing" in Islam and the differences in attitudes with regard to religion. Notions which will encourage discussion around the reasons why young people can be attracted to a form of Islamism structured around armed action.

[Religious conversion, psychological construction and holy violence]

The adolescent process is the theatre for the confrontation of oneself with the formation of identity, the learning of limits and psychological compromises as attempts at psychological regulation. Religious radicalisation appears on stage, offering ways of responding to anxieties fuelled by the global socio-political context. Adolescent vulnerability is studied through the prism of all these different conflicting tensions.

[Islam and caring]

There are more and more followers of the Muslim religion in France. All caregivers need to understand the fundamental principles that their Muslim patients hold sacred in the area of health and care. For Muslims, it is of utmost importance to observe the fundamentals of Islam and the values of brotherhood, tolerance, fairness and truth are essential.

Associations between religion-related factors and breast cancer screening among American Muslims

American Muslims have low rates of mammography utilization, and research suggests that religious values influence their health-seeking behaviors. We assessed associations between religion-related factors and breast cancer screening in this population. A diverse group of Muslim women were recruited from mosques and Muslim organization sites in Greater Chicago to self-administer a survey incorporating measures of fatalism, religiosity, discrimination, and Islamic modesty. 254 surveys were collected of which 240 met age inclusion criteria (40 years of age or older). Of the 240, 72 respondents were Arab, 71 South Asian, 59 African American, and 38 identified with another ethnicity. 77% of respondents had at least one mammogram in their lifetime, yet 37% had not obtained mammography within the past 2 years. In multivariate models, positive religious coping, and perceived religious discrimination in healthcare were negatively associated with having a mammogram in the past 2 years, while having a PCP was positively associated. Ever having a mammogram was positively associated with increasing age and years of US residency, and knowing someone with breast cancer. Promoting biennial mammography among American Muslims may require addressing ideas about religious coping and combating perceived religious discrimination through tailored interventions.

Why Muslim women in Northern Ghana do not use skilled maternal healthcare services at health facilities: a qualitative study

BACKGROUND

Muslim women are one sub-population in Ghana among whom the rate of skilled maternal health services accessibility and utilisation is very low. However, there are no studies in Ghana that explore the maternity needs and care experiences of Muslim women, and why they do not utilise maternal healthcare services at health facilities. The purpose of this paper is to explore the maternity healthcare needs and care experiences of Muslim women and the barriers to accessing and using maternal health services.

METHODS

Qualitative research was conducted with 94 Muslim women in three communities in northern Ghana between November 2011 and May 2012. Data were analysed using the Attride-Stirling's thematic network analysis framework.

RESULTS

Findings suggest that although Muslim women do want to receive skilled care in a health facility, they often experience difficulties with accessing and using such services. These difficulties were often conditioned by a religious obligation to maintain bodily sanctity through modest dressing and the avoidance of unlawful bodily exposure or contact with certain people including male or alien caregivers. Other related access barriers include lack of privacy, healthcare providers' insensitivity and lack of knowledge about Muslim women's religious and cultural practices, and health information that lacked the cultural and religious specificity to meet Muslim women's maternity care needs.

CONCLUSION

Maternal healthcare services designed to meet the needs of mainstream non-Muslim Ghanaian women might lack the flexibility and responsiveness to meet the unique maternity care needs of Muslim women. Recommendations for change include cultural competence training for healthcare providers and cultural/religious matching to meet Muslim women's care needs and to enhance their care experience.

An explanation and analysis of how world religions formulate their ethical decisions on withdrawing treatment and determining death

INTRODUCTION

This paper explores definitions of death from the perspectives of several world and indigenous religions, with practical application for health care providers in relation to end of life decisions and organ and tissue donation after death. It provides background material on several traditions and explains how different religions derive their conclusions for end of life decisions from the ethical guidelines they proffer.

METHODS

Research took several forms beginning with a review of books and articles written by ethicists and observers of Bön, Buddhism, Christianity, Hinduism, Indigenous Traditions, Islam, Judaism, Shinto and Taoism. It then examined sources to which these authors referred in footnotes and bibliographies. In addition, material was gathered through searches of data bases in religious studies, general humanities, social sciences and medicine along with web-based key word searches for current policies in various traditions.

RESULTS

Religious traditions provide their adherents with explanations for the meaning and purpose of life and include ethical analysis for the situations in which their followers find themselves. This paper aims to increase cultural competency in practitioners by demonstrating the reasoning process religions use to determine what they believe to be the correct decision in the face of death.

CONCLUSION

Patterns emerge in the comparative study of religious perspectives on death. Western traditions show their rootedness in Judaism in their understanding of the human individual as a finite, singular creation. Although the many branches of Western religions do not agree on precisely how to determine death, they are all able to locate a moment of death in the body. In Eastern traditions personhood is not defined in physical terms. From prescribing the location of death, to resisting medical intervention and definitions of death, Eastern religions, in their many forms, incorporate the beliefs and practices that preceded them. Adding to the complexity for these traditions is the idea that death is a process that continues after the body has met most empirical criteria for determining death. For Hinduism and Buddhism, the cessation of heart, brain and lung function is the beginning of the process of dying--not the end.

Associations between religion-related factors and cervical cancer screening among Muslims in greater chicago

OBJECTIVE

This study aimed to assess rates of Papanicolaou (Pap) testing and associations between religion-related factors and these rates among a racially and ethnically diverse sample of American Muslim women.

MATERIALS AND METHODS

A community-based participatory research design was used in partnering with the Council of Islamic Organizations of Greater Chicago to recruit Muslim women attending mosque and community events. These participants self-administered surveys incorporating measures of fatalism, religiosity, perceived discrimination, Islamic modesty, and a marker of Pap test use.

RESULTS

A total of 254 survey respondents were collected with nearly equal numbers of Arabs, South Asians, and African American respondents. Of these respondents, 84% had obtained a Pap test in their lifetime, with individuals who interpret disease as a manifestation of God's punishment having a lower odds of having had Pap testing after controlling for sociodemographic factors (odds ratio [OR]=0.87, 95% CI=0.77-1.0). In multivariate models, living in the United States for more than 20 years (OR=4.7, 95% CI=1.4-16) and having a primary care physician (OR=7.7, 95% CI=2.5-23.4) were positive predictors of having had a Pap test. Ethnicity, fatalistic beliefs, perceived discrimination, and modesty levels were not significantly associated with Pap testing rates.

CONCLUSIONS

To our knowledge, this is the first study to assess Pap testing behaviors among a diverse sample of American Muslim women and to observe that negative religious coping (e.g., viewing health problems as a punishment from God) is associated with a lower odds of obtaining a Pap test. The relationship between religious coping and cancer screening behaviors deserves further study so that religious values can be appropriately addressed through cancer screening programs.

Prenatal screening for congenital anomalies: exploring midwives' perceptions of counseling clients with religious backgrounds

BACKGROUND

In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives' perceptions and practices regarding taking client's religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives' knowledge of whether pregnancy termination is allowed in Islam.

METHODS

This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in The Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study.

RESULTS

Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client's religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives' own religious backgrounds were independent of whether they paid attention to the clients' religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups.

CONCLUSION

While many midwives took client's religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.

The doctor's medicine and the ambiguity of amulets: life and suffering among Bangladeshi psychiatric patients and their families in London--an interview study--1

An interview study of 44 Bangladeshi patients and relatives in London demonstrated simultaneous trust in psychiatrists as well as in the widespread use of healing amulets. At the same time, local Islamic clerics and traditional healers were seen by many with some degree of suspicion. The authors offer an interpretation in which local healers and their methods are regarded ambivalently: the more distant biomedical framework fits with the newer modernising 'High' Islam (literate, scripturalist, puritanical, unitarian, urban, clerical, perhaps masculinist), as opposed to Hindu-inflected traditional Sufi Islam in Bangladesh (peasant, popular, syncretic, saintly, magical, ecstatic and possibly more sympathetic to women's experience).

Patient centred care in diabetology: an Islamic perspective from Iran

Patient-centred system of care is essential in managing many disorders such as diabetes mellitus. The cultural and religious context can influence the involvement of patients and their families in such a care. We intend to discuss patient-centred care in diabetology in view of Islam. For more clarification, we will take into consideration a few illustrative lines of argument in detail about situation in Iran. In conclusion, dynamic spirit of Islamic jurisprudence is reflected in its adaptability to change in medical practice. In recent decades, Iranian religious scholars have provided scientists in new fields of science and research with appropriate directions and guidelines. Decree issued by Iranian religious leaders permitting research on stem cells for therapeutic purposes in many disorders including diabetes mellitus is one example. Understanding of the nature of Islam is importance for communication with patients in Islamic countries.

Theodicy and end-of-life care

This article examines theodicy-the vindication of God's goodness and justice in the face of the existence of evil from the perspectives of Judaism, Christianity, and Islam. We focus on the thought processes that chaplains, social workers, and other professionals may use in their care interventions to address issues of theodicy for patients. Theodical issues may cause anxiety and distress for believers, but they can also potentially be a source of relief and release. Palliative care patients with a religious worldview often struggle with whether God cares about, or has sent, their pain. How social workers and other clinicians respond to such questions will have a great impact on how patients express themselves and use their religious beliefs to cope with their situations. For patients holding religious/spiritual perspectives, discussion of theodicy may facilitate closer relationships between patients and their caregivers and result in more compassionate and empathic care.

'They say Islam has a solution for everything, so why are there no guidelines for this?' Ethical dilemmas associated with the births and deaths of infants with fatal abnormalities from a small sample of Pakistani Muslim couples in Britain

This paper presents ethical dilemmas concerning the termination of pregnancy, the management of childbirth, and the withdrawal of life-support from infants in special care, for a small sample of British Pakistani Muslim parents of babies diagnosed with fatal abnormalities. Case studies illustrating these dilemmas are taken from a qualitative study of 66 families of Pakistani origin referred to a genetics clinic in Southern England. The paper shows how parents negotiated between the authoritative knowledge of their doctors, religious experts, and senior family members in response to the ethical dilemmas they faced. There was little knowledge or open discussion of the view that Islam permits the termination of pregnancy for serious or fatal abnormality within 120 days and there was considerable disquiet over the idea of ending a pregnancy. For some parents, whether their newborn baby would draw breath was a main worry, with implications for the baby's Muslim identity and for the recognition of loss the parents would receive from family and community. This concern sometimes conflicted with doctors' concerns to minimize risk to future pregnancies by not performing a Caesarean delivery if a baby is sure to die. The paper also identifies parents' concerns and feelings of wrong-doing regarding the withdrawal of artificial life-support from infants with multiple abnormalities. The conclusion considers some of the implications of these observations for the counselling and support of Muslim parents following the pre- or neo-natal diagnosis of fatal abnormalities in their children.

Religious values and healthcare accommodations: voices from the American Muslim community

BACKGROUND

Minority populations receive a lower quality healthcare in part due to the inadequate assessment of, and cultural adaptations to meet, their culturally informed healthcare needs. The seven million American Muslims, while ethnically and racially diverse, share religiously informed healthcare values that influence their expectations of healthcare. There is limited empirical research on this community's preferences for cultural modifications in healthcare delivery.

OBJECTIVE

Identify healthcare accommodations requested by American Muslims.

METHODS

Using community-based participatory research (CBPR) methods, we partnered with four community organizations in the Greater Detroit area to design and conduct thirteen focus groups at area mosques serving African American, Arab American, and South Asian American Muslims. Qualitative content analysis utilized a framework team-based approach.

KEY RESULTS

Participants reported stigmatization within the healthcare system and voiced the need for culturally competent healthcare providers. In addition, they identified three key healthcare accommodations to address Muslim sensitivities: the provision of (1) gender-concordant care, (2) halal food and (3) a neutral prayer space. Gender concordance was requested based on Islamic conceptions of modesty and privacy. Halal food was deemed to be health-promoting and therefore integral to the healing process. Lastly, a neutral prayer space was requested to ensure security and privacy during worship.

CONCLUSIONS

This study informs efforts to deliver high-quality healthcare to American Muslims in several ways. We note three specific healthcare accommodations requested by this community and the religious values underlying these requests. Healthcare systems can further cultural sensitivity, engender trust, and improve the healthcare experiences of American Muslims by understanding and then attempting to accommodate these values as much as possible.

Religio-ethical discussions on organ donation among Muslims in Europe: an example of transnational Islamic bioethics

This article analyzes the religio-ethical discussions of Muslim religious scholars, which took place in Europe specifically in the UK and the Netherlands, on organ donation. After introductory notes on fatwas (Islamic religious guidelines) relevant to biomedical ethics and the socio-political context in which discussions on organ donation took place, the article studies three specific fatwas issued in Europe whose analysis has escaped the attention of modern academic researchers. In 2000 the European Council for Fatwa and Research (ECFR) issued a fatwa on organ donation. Besides this "European" fatwa, two other fatwas were issued respectively in the UK by the Muslim Law (Shariah) Council in 1995 and in the Netherlands by the Moroccan religious scholar Mustafā Ben Hamza during a conference on "Islam and Organ Donation" held in March 2006. The three fatwas show that a great number of Muslim religious scholars permit organ donation and this holds true for donating organs to non-Muslims as well. Further, they demonstrate that transnationalism is one of the main characteristics of contemporary Islamic bioethics. In a bid to develop their own standpoints towards organ donation, Muslims living in the West rely heavily on fatwas imported from the Muslim world.

Communicating with Muslim parents: "the four principles" are not as culturally neutral as suggested

The "four principles approach" has been popularly accepted as a set of universal guidelines for biomedical ethics. Based on four allegedly trans-cultural principles (respect for autonomy, nonmaleficence, beneficence and justice), it is supposed to fulfil the need of a 'culturally neutral approach to thinking about ethical issues in health care'. On the basis of a case-history, this paper challenges the appropriateness of communicating in terms of these four principles with patients with a different background. The case describes the situation in which Muslim parents bring forward that their religion keeps them from consenting to end-of-life decisions by non-religious paediatricians. In a literature analysis, the different meanings and roles of the relevant principles in non-religious and Islamic ethics are compared. In non-religious ethics, the principle of nonmaleficence may be used to justify withholding or withdrawing futile or damaging treatments, whereas Islamic ethics applies this principle to forbid all actions that may harm life. And while the non-religious version of the principle of respect for autonomy emphasises the need for informed consent, the Islamic version focuses on "respect for the patient". We conclude that the parties involved in the described disagreement may feel committed to seemingly similar, but actually quite different principles. In such cases, communication in terms of these principles may create a conflict within an apparently common conceptual framework. The four principles approach may be very helpful in analysing ethical dilemmas, but when communicating with patients with different backgrounds, an alternative approach is needed that pays genuine attention to the different backgrounds.

"I am a Muslim and My Dad is an Alcoholic -- What Should I Do?": Internet-Based Advice for Muslims about Alcohol

This article analyzes 113 fatwas (pieces of advice from Muslim scholars) in response to Internet user-contributed questions about correct behavior in situations involving alcohol. The fatwas are from IslamOnline.net, a popular Islamic Web site. Most of the questions on the English site are submitted by individuals living in non-Muslim countries, who are more likely to confront difficult situations relating to alcohol. In spite of the general condemnation of alcohol consumption in Islam, many individuals face ethical dilemmas and feel the need to request advice about proper behavior in situations involving alcohol, relating to the family, society, work, and bodily purity, as well as more abstract theological questions.

Urinary incontinence in Moroccan and Turkish women: a qualitative study on impact and preferences for treatment

AIM

To gain insight into the impact of urinary incontinence on the daily lives of Moroccan and Turkish women and their preferences for treatment.

DESIGN OF STUDY

A qualitative analysis of data from semi-structured in depth interviews with 30 Moroccan and Turkish migrant women with urinary incontinence.

SETTING

Six general practices with large numbers of immigrant families in four cities in the Netherlands.

METHOD

Semi-structured in depth interviews were conducted with Moroccan and Turkish migrant women, who presented with complaints of urinary incontinence in six general practices with large numbers of immigrant families on the practice list in four different cities in the Netherlands.

RESULTS

All the women adhered closely to bodily cleanliness and considered incontinence to be dirty. As Muslims, they were obliged to perform ritual prayers preceded by ablution five times per day and the urinary incontinence breached their status of ritual purity. Therefore, they had to wash more often and experienced this as a heavy burden. In a number of the women, shame formed a reason why they could not talk to anybody about the incontinence, not even with the doctor. One-third of the women felt that their GP had not taken them seriously. Knowledge about anatomy, physiology and available treatments was mostly lacking. In addition, the women did not understand the aim of the exercises from the physiotherapist. The majority of women gave preference to help from a female doctor.

CONCLUSION

Urinary incontinence in Moroccan and Turkish migrant women formed a considerable problem in their daily following of the Islam faith. Shame on the part of the patient and miscommunication at the doctor's surgery led to inadequate care.

Making Muslim babies: IVF and gamete donation in Sunni versus Shi'a Islam

Medical anthropological research on science, biotechnology, and religion has focused on the "local moral worlds" of men and women as they make difficult decisions regarding their health and the beginnings and endings of human life. This paper focuses on the local moral worlds of infertile Muslims as they attempt to make, in the religiously correct fashion, Muslim babies at in vitro fertilization (IVF) clinics in Egypt and Lebanon. As early as 1980, authoritative fatwas issued from Egypt's famed Al-Azhar University suggested that IVF and similar technologies are permissible as long as they do not involve any form of third-party donation (of sperm, eggs, embryos, or uteruses). Since the late 1990s, however, divergences in opinion over third-party gamete donation have occurred between Sunni and Shi'ite Muslims, with Iran's leading ayatollah permitting gamete donation under certain conditions. This Iranian fatwa has had profound implications for the country of Lebanon, where a Shi'ite majority also seeks IVF services. Based on three periods of ethnographic research in Egyptian and Lebanese IVF clinics, this paper explores official and unofficial religious discourses surrounding the practice of IVF and third-party donation in the Muslim world, as well as the gender implications of gamete donation for Muslim marriages.