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Part I
Methodological Issues
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Deliberations within the Islamic Tradition on Principle-Based Bioethics: An Enduring Task
Mohammed Ghaly
Abstract: This introductory chapter reviews the main attempts to formulate principles of biomedical ethics that are either compatible with the Islamic tradition or directly extracted from this tradition. To my knowledge, this is the first review of available studies on this topic, which is why I tried to make it as comprehensive as possible and to refer to each available study, although some of them may include considerable overlap and sometimes even repetition. The studies reviewed in this chapter were divided into two main groups. The first group addressed a specific set of principles introduced by Western bioethicists and tried to demonstrate its compatibility with the Islamic tradition (Instrumentalist Approach). The other group tried to develop a set of principles emanating from, and rooted in, the Islamic tradition itself (Indigenous Approach).
The discipline of principle-based bioethics or principlism figured prominently in the West during the 1970s and early 1980s. Within this new discipline, specific sets of principles were introduced as frameworks of evaluative assumptions hoping that these principles will give the then embryonic field of bioethics some minimal coherence and uniformity. The four-principle theory (autonomy, beneficence, nonmaleficence, and justice) introduced by the two American philosophers Tom Beauchamp and James Childress in their work Principles of Biomedical Ethics remains one of the most widely debated theories in the field of bioethics, with arguments for and against it. One of the central propositions of Beauchamp and Childress is that the four principles have a universal character and are thus compatible with different cultures, traditions, and philosophies of life. This point is already reflected in the title of Beauchampās contribution to this volume, namely, āThe Principles of Biomedical Ethics as Universal Principles.ā The applicability of these four principles to different cultures, societies, and religious traditions has been examined and debated by a great number of researchers, and the Islamic tradition is no exception in this regard.
Despite the rich discussions within the Islamic tradition on a long array of individual bioethical issues, the attention paid to the question of its overall principles still remains immature. In a bid to fill in this gap and to trigger more in-depth discussions on this topic, the research Center for Islamic Legislation and Ethics (CILE) dedicated the first seminar in its research field āIslam and Biomedical Ethicsā to this issue. To put the published proceedings of this seminar in their broader context, this introductory chapter will give an overview of the relevant discussions that pre- or ante-dated the CILE seminar. To keep the systematic character of this overview, the studies will be examined in two separate sections: (i) Instrumentalist Approach and (ii) Indigenous Approach.
The first section will focus on the contributions whose authors tried to show the compatibility of a certain set of principles, usually developed by Western bioethicists, with the Islamic tradition. References in the Qurāan and Sunna and, much less frequently, relevant discussions among religious scholars or key (ethical) concepts in the Islamic tradition, are quoted almost exclusively as an āinstrumentā in order to justify the compatibility of these principles with the Islamic tradition. Thus, the Islamic tradition is not approached as a source of knowledge but as a possible justifier for already existing assumptions embraced by principle-based bioethics. The second section will examine the contributions whose
writers tried to search for and develop a set of principles rooted in the Islamic tradition. The starting point of the theorists of this approach is not the principles developed outside the Islamic tradition; sometimes they are even not aware of them. They try to formulate principles by fathoming out the Islamic scriptures (Qurāan and Sunna) in addition to specific genres in Islamic law (
fiqh) and Islamic legal theory (
uūl al-fiqh) such as the Islamic legal maxims (
qawÄāid fiqhÄ«yah).
Before delving into the details of the different studies that fall within either of these two sections, a brief note is due about two specific contributions with relevance to this topic. The term āprinciplesā found its way into contemporary Islamic bioethics already by the beginning of the 1980s when this new field was roughly in its embryonic phase. To my knowledge, one of the earliest examples in this regard was the short paper written by the Turkish Professor of Pediatrics, YÅ«nus Al-Muftu, entitled
MabÄdiā al-akhlÄq al-ibbÄ«yah fÄ« al-IslÄm (āPrinciples of Medical Ethics in Islamā). This paper was presented during the First International Conference on Islamic Medicine held in Kuwait during the period 12ā16 January 1981. Despite the interesting title Al-Muftu gave to the paper, he hardly said anything about what these principles are or how to construe them. The paper is considerably concise and gives a simple overview of scattered issues relevant to the history of medical ethics in the Islamic tradition espoused with references to towering figures in the field of medicine throughout Islamic history like Ibn SÄ«nÄ (Avicenna).
1 Also the criminolo-gist Muhammad Al-Khani addressed the question of principles in his article ā
Al-MabÄdiā al-akhlÄqÄ«yah allatÄ« yajib an yataallÄ bihÄ al-abÄ«b fÄ« mumÄrasatih li mihnatih al-ibbÄ«yahā (āThe Ethical Principles That a Physician Should Follow in His Medical Professionā) published in 1988. Al-Khani reviewed the international efforts to codify āprinciples of medical ethicsā especially as far as combating torture is concerned. He referred to the Declaration of Tokyo issued by the World Medical Association in 1975 and the code of āPrinciples of Medical Ethicsā adopted by the UN General Assembly in 1982. Despite scattered references to the standpoint
of Muslim religious scholars to specific bioethical issues, Al-Khani was basically interested in the influence of these principles on the codification of law within or outside the Arab world rather than the possible (in)compatibility of these principles with the Islamic tradition.
21. The Instrumentalist Approach
1.1. The Pioneering Contributions of G. Serour and K. Hasan
As far as the Instrumentalist Approach is concerned, there are two main pioneers, namely the Egyptian Professor of Obstetrics and Gynecology Gamal Serour (International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, Egypt) and the Pakistani Professor of Behavioral Sciences K. Zaki Hasan (Baqai Medical College, Karachi, Pakistan). The two professors wrote two separate chapters, respectively entitled āIslam and the Four Principlesā and āIslam and the Four Principles: A Pakistani View,ā which both appeared in the first edition of the edited volume Principles of Health Care Ethics, published in 1994.
Serour was quite aware of and was also an advocate of the four principles introduced by Beauchamp and Childress although their book does not appear in Serourās list of references. On the other hand, it seems that Serour was not aware of the contribution of the Syrian religious scholar Abu Ghuddah, which will be examined in the section āIndigenous Approach.ā The chapter starts with a couple of introductory remarks about the four principles (to which Serour suggested adding a fifth one, namely that the human person should not be subject to commercial exploitation)3 and about ...
