Secularized European law denied moral considerations associated with ‘religion’ and therefore
failed to solve issues in modern medicine requiring moral considerations. This led to the birth of the discipline of medical
ethics that is neither law enforceable by government nor morality enforceable by conscience. On the other hand, Islamic Law
is comprehensive and encompasses moral principles directly applicable to medicine.
This paper proposes
that the theory of medical ethics in Islam should be based on the 5 purposes of the Law, maqasid al shari’at, that
are also considered the 5 purposes of medicine. The 5 purposes are preservation of religion and morality, hifdh al ddiin;
preservation of life and health, hifdh al nafs; preservation of progeny, hifdh al nasl; preservation of intellect,
hifdh al ‘aql; and preservation of wealth, hifdh al maal. Any medical action must fulfill one of the above
purposes if it is to be considered ethical. If any medical procedure violates any of the 5 purposes it is deemed unethical.
proposes that the basic ethical principles of Islam relevant to medical practice be derived from the 5 principles of the Law,
qawa’id al shari’at, that are: intention, qasd; certainty, yaqeen;
injury, dharar; hardship, mashaqqat; and custom or precedent, ‘aadat. The maqasid and qawa’id are used in a synergistic way. The basic purpose of qawa’id
is to provide robust rules for resolving situations of conflict between or among different maqasid.
before Muslim physicians is to liberate themselves from confusing and inconsistent European ethical theories and principles
and instead to work hard to develop specific regulations for various medical interventions, dhawaabit al tibaabat,
by a renewal of ijtihad. This ijtihad will be based on primary sources of the Law (Qur’an and sunnat),
secondary sources of the Law based on transmission, masaadir naqliyyat (ijma and qiyaas); secondary sources
of the Law based on reason, masaadir ‘aqliyyat (istishaab, istihsaan, & istilaah); the purposes of
the Law, maqasid al shari’at; principles of the Law, qawa’id al fiqh; as well as regulations of
the Law, dhawaabit al fiqh.
In the early period
of medical jurisprudence (0-1400 H) most issues could be resolved by direct reference to the primary sources. In the middle
period (1401 – 1420 H) issues were resolved by using ijma, qiyaas, istishaab, istihsaan, & istilaah. In the
modern period (1420 - ) medical technology is creating so many issues whose resolution will require a broad bird’s eye-view
approach that can only be found in the theory of maqasid al shari’at.
is both old and new. Some statements in the Hippocratic oath deal with professional medical ethics and Ibn Sina wrote about
ethics. Concern with ethics in the past was not as intensive as it is at the moment. It was assumed that physicians would
be ethical and moral in their work and this was true to a large extent because religiosity was a leading characteristic of
life in the past. Towards the end of the 14th hijri century ethical
considerations became a major concern for two reasons. The first reason was that developments in medical technology gave rise
to problems such as life-support, in-vitro fertilization and others that had moral dimensions. The second reason was the increase
in moral violations by medical practitioners. The European medical profession found itself in a dilemma because moral values
were not part of the secular medical tradition. The rebirth (renaissance) of the discipline of ethics thus became inevitable.
Muslims did not
face a similar dilemma because Islamic Law, unlike European secular law, is based on a complete system of morality and can
therefore handle all moral problems that arise in medicine from a legal perspective. It also is very flexible being adaptable
to many new and novel situations. Strictly speaking, Muslims do not need to talk of ethics as a separate discipline because
it is already included in their Law.
trained in the European tradition tended in the past to employ European ethical theories and principles in dealing with ethical
problems in medicine. This paper proposes that Muslims should turn to their intellectual and legal heritage as a source of
ethical guidelines. The paper critiques European ethics by pointing out conceptual and practical defects. It then presents
Islamic ethical system as a more robust and consistent guideline for ethical dilemmas in medicine.
2.0 CRITIQUE OF EUROPEAN ETHICS
The term European
in this paper is used in a cultural and not a geographical sense to refer to people of European origin who live in the European
continent, North and South America, Australasia, and other parts of the world colonized by Europeans over the past 500 years. The European
civilization has its roots in the Greco-Roman and Judeo-Christian traditions.
had a problem dealing consistently with moral issues after removing religion from public life over the past 5 centuries of
secularism that followed the European renaissance. Morality to them is communal consensus about what is right and what is
wrong. For example codes of professional conduct are a consensus reached within
each profession. Ethical guidelines are developed while reasoning through ethical or practical dilemmas. This reasoning can
be weak and inconsistent if not based on an underlying coherent system of moral values.
European law is
not always consistent in dealing with issues of a moral nature. Unlike Islamic Law, European law is not the expression and
practical manifestation of a definable system of immorality. As a consequence European law does not always permit all morally
acceptable practices and neither does it automatically ban all immoral activities. It sometimes bans morally acceptable practices.
It also deals paradoxically with some situations. For example a man who marries 2 wives is punished severely for the crime
of bigamy. If on the other hand he co-habits with 4 women as girl friends and has children with them, he will not be penalized.
The law recognizes his paternity. It also recognizes specific financial rights of inheritance and maintenance for the women
and the children.
An ethical theory
provides a framework within which moral reasoning and judgment can be undertaken. There is no one coherent European theory
of ethics because of historical reasons. Judeo-Christian concepts were Europeanized when the Roman Empire opted for Christianity
and the system of moral values developed in Europe became a syncretic compromise between
the pagan European polytheistic Greco-roman religion on one hand and the Judeo-christian religion on the other hand. During
the renaissance the Christian church was relatively marginalized. There was a partial return to Greco-roman ideas and practices
starting with the renaissance. This resulted into a complex mosaic of moral and philosophical concepts of secular Europe. In these circumstances it became difficult to define or follow one coherent ethical theory.
encroached on civil life starting with the renaissance. By the 20th century, all aspects of European life including
medicine had become secularized. The practical manifestation of this secularization was the marginalization of religious and
moral values and confining them to the private arena of individual belief. Secularized European law is in essence a denial
of moral considerations in law because morality is associated with ‘religion’. However application of the secularized
law in medicine showed its deficiencies because issues arose that required moral considerations. The medical profession and
society at large were not ready to face the new challenges. The existing positive secular laws lacked a moral spine. It became
necessary to develop secular medical ethics as a new discipline to deal with the challenges. Unfortunately this discipline
was not wholly effective because it neither law enforced by the authority of the state and neither morality enforced by conscience.
It was unfortunate that Muslims with the rich intellectual heritage of usul al fiqh
followed the European into the lizard hole by copying and uing inferior European
ethical theories, principles, and rules.
consider the Hippocratic oath as the starting point of ethical reasoning. This is supplemented by views of European philosophers
and thinkers to develop ethical theories used to solve practical problems. Starting in about 1976M TL Beauchamps and JF Childress were pioneers in systematically laying down theories and principles of European medical
According to Beauchamp
and Childress1 there are eight ethical theories. None of them can singly explain all ethical or moral dilemmas.
None of them taken singly has the attributes of a good ethical theory: clear, coherent, complete, comprehensive, simple, practicable,
and able to explain and justify. In practice more than one theory may have to be combined to solve a specific ethical issue.
This is cumbersome and confusing.
According to the
utilitarian consequence-based theory, an act is judged as good or bad according to the balance of its good and bad
consequences. Utilitarianism aims at attaining the greatest positive with the least negative. Utilitarianism has the disadvantage
of permitting acts that are clearly immoral on the basis of utility. The obligation-based theory is based on Kantian
philosophy. Immanuel Kant (1724-1804M) argued that morality was based on pure reasoning. He rejected tradition, intuition,
conscience, or emotions as sources of moral judgment. He argued that a morally valid reason justifies action and that acts
are based on moral obligations. The problem with the Kantian theory is that it has no solution for conflicting obligations
because it considers moral rules as absolute. The rights-based theory is based on respect for human rights of property,
life, liberty, and expression. The problem of the rights-based theory is that emphasis on individual rights creates an adversarial
atmosphere. Individual rights may conflict with communal rights. Rights of one individual may conflict with those of another
one. According to the community-based theory, ethical judgments are controlled by community values that include
considerations of the common good, social goals, and tradition. This theory repudiates the rights-based theory that
is based on individualism. The problem with this theory is that it is difficult to reach a consensus on what constitutes a
community value in today’s complex and diverse society. The relation-based theory gives emphasis to family relations
and the special physician-patient relation. For example a moral judgment may be based on the consideration that nothing should
be done to disrupt the normal functioning of the family unit. The problem of this theory is that it is difficult to deal with
and analyze emotional and psychological factors that are involved in relationships. The case-based theory is practical
decision-making on each case as it arises. It does have fixed philosophical prior assumptions. It can give contradictory conclusions
for cases of a similar nature and is very vulnerable to bias.
EUROPEAN ETHICAL PRINCIPLES
are specific axioms that simplify ethical reasoning. There are 4 basic European ethical principles according to Beauchamp
and Childress1. The principle of autonomy is the power of the patient to decide on medical procedures. The principle
of non-maleficence is avoiding causation of harm. The principle of beneficence is the providing benefits and balancing them
against risks and costs. The principle of justice is distribution of benefits, costs, and risks fairly.
principles are not based on a comprehensive ethical theory comparable to the theory of purposes of the Law, maqasid al
shari’at, found in Islam. There is correspondence between these
principles and some of the qawai’d al shari’at. Compared to the qawa’id the principles of Beauchamp and Childress are limited in scope of coverage.
According to Beauchamp
and Childress1, application of the above principles requires ethical rules. The European ethical rules may be substantive
rules, authority rules, or procedural rules. The substantive rules deal with veracity, confidentiality, privacy, and fidelity.
The authority rules deal with surrogacy, professional authority, and rationing. The procedure rules are specific on procedures
to be followed. The European ethical rules can be related to regulations of Islamic Law, dhawaabit
al fiqh. The European rules are very narrow in scope compared to the dhawaabit
3.0 ISLAMIC ETHICS: GENERAL CHARACTERISTICS
Morality and ethics
in Islam are absolute and are of divine origin. Human consensus not deriving from divine legislation cannot be a source of
binding ethical guidelines. All what humans do it to apply the legal and moral teachings of Islam to practical situations.
Islamic Law automatically bans all immoral actions as haram and automatically permits
all what is moral as mubaah.
are both fixed and variable. The fixed moral and legal principles are broad enough to encompass the needs of all times and
places. The detailed applications are variable and change with the growth of science and technology. The fixed principles
set the parameters beyond which it is absolutely immoral to operate. Within these parameters, consensus can be reached on
specific moral issues.
Islam holds that
ethics cannot be divorced from morality. Ethics can also not be divorced from Law. Islamic Law is a compendium of ethics,
morality, and legal rules. The purposes of the Law, maqasid al shari’at, the principles of the Law, qawa’id al fiqh, and the regulations of the Law, dhawaabit al fiqh3, are therefore
the basis of ethics. Islam holds that the human mind, unless corrupted by shaitan,
is capable to working out rationally what is right and what is wrong for most problems of life. There are however a few gray
areas for which moral reasoning needs to be guided by revelation, wahy, to reach
medical ethics the same as ethics in other areas of life. There is no special code for physicians. What we call medical ethics
is restating general ethical principles using medical terminology and with medical applications. The medical ethical codes
can be derived from the basic law but the detailed applications require further intellectual effort, ijtihad, by physicians.
Strange as it
may sound, some ethical problems are solved by avoiding them. This is part of the Islamic teaching of avoiding doubtful things.
The prophet taught us to leave what causes us doubts to what does not cause such doubt, da’ ma yuribuuka ila ma la
theory of Islam is found in the 5 purposes of the Law, maqasid al shari’at. The five purposes are preservation
of ddiin, life, progeny, intellect, and wealth. Any medical action must fulfill
one of the above purposes if it is to be considered ethical. The basic ethical principles of Islam relevant to medical practice
are derived from the 5 principles of the Law are: intention, qasd; certainty, yaqeen; harm, dharar; hardship, mashaqqat; and custom, and ‘aadat.
4.0 PURPOSES OF MEDICINE = maqasid al shari’at
purpose is protection of ddiin, hifdh al ddiin. It involves both physical health and mental health.
Protection of ddiin essentially involves ‘ibadat
in the wide sense that every human endeavor is a form of ‘ibadat. Thus medical
treatment makes a direct contribution to ‘ibadat by protecting and promoting
good health so that the worshipper will have the phusical and mental energy to undertake all the responsibilities of ‘ibadat. The principal forms of physical ‘ibadat
are prayer, salat; fasting, siyaam;
and pilgrimage, hajj. A sick or a weak body can perform them properly. Balanced
mental health is necessary for understanding ‘aqiidat and avoiding false
ideas that violate ‘aqiidat because ‘aqiidat
is the basis of ddiin.
The second purpose
is protection of life, hifdh al nafs, the primary purpose of medicine. Medicine cannot prevent or postpone death since such matters are in the hands
of Allah alone. It however tries to maintain as high a quality of life until the appointed time of death arrives. Medicine
contributes to the preservation and continuation of life by making sure that physiological functions are well maintained.
It also relieves pathophysiological stress by preventive, curative, and rehabilitative measures.
The third purpose
is protection of progeny, hifdh al nasl. Medicine contributes to
the fulfillment of this function by making sure that children are cared for well so that they grow into healthy adults who
can bear children. Treatment of male and female infertility ensures successful reproduction. The care for pregnant women,
perinatal medicine, and pediatric medicine all ensure that children are born and grow healthy.
The fourth purpose
is protection of the mind, hifdh al ‘aql. Medical treatment
plays a very important role in protection of the mind. Treatment of physical illnesses removes stress that affects the mental
state. Treatment of neuroses and psychoses restores intellectual and emotional functions. Medical treatment of alcohol and
drug abuse prevents deterioration of the intellect.
The fifth purpose is protection of wealth, hifdh al maal.
The wealth of any community depends on the productive activities of its healthy citizens.
Medicine contributes to wealth generation by prevention of disease, promotion of health, and treatment of any diseases and
their sequelae. Communities with general poor health are less productive than healthy vibrant communities. The principles
of protection of life and protection of wealth may conflict in cases of terminal illness. Care for the terminally ill consumes
a lot of resources that could have been used to treat other persons with treatable conditions. Resolution of such contrasts
requires resort to the principles of the Law, qawa’id al shari’at,
that are described below.
5.0 PRINCIPLES OF MEDICINE = qawai’d al shari’at
PRINCIPLE OF INTENTION
The first principle
is the principle of intention, qa’idat al qasd. It gives rise to several
sub-principles applicable to medical practice. The sub-principle ‘each action is judged by the intention behind it,
al umuur bi maqasidiha’ calls upon the physician to consult his inner conscience.
There are many issues about medical procedures and medical decisions that are hidden from public view. A physician may carry
out a procedure for a stated reason that seems plausible on the outside but he may have a different but hidden intention.
A practical example is use of morphine for pain relief in terminal care when the actual intention may be to cause respiratory
depression that will lead to death. The sub-principle 'what matters are the intentions and not the literal meaning –
maqasid wa ma’aani la alfaadh wa mabaani’ is used to refute use of
legal arguments based on literal translation of the text to justify immoral acts. An example is the interpretation of the
hadith on embryological development to justify abortion on demand before ensoulment. The sub-principle ‘means are judged
with the same criteria as the intentions – al wasail laha hukm al maqasid’
implies that no useful medical purpose should be achieved by using immoral methods.
PRINCIPLE OF CERTAINTY
The second principle
is the principle of certainty, qaidat al yaqeen. In both the diagnosis of disease
and choice of treatment, modern medicine does not reach the standards of yaqeen
demanded by the Law. It operates at the level of predominant conjecture, ghalabat al
dhann. It cannot operate at the level of conjecture, dhann, or pure doubt,
shakk. Legal certainty, yaqeen, a situation
when there is no doubt, shakk, or second thoughts, taraddud, does not exist in medicine. Ghalabat al dhann is when there
is preponderant evidence for one option and not the other. In dhann there is inclination
to one option but there is not enough evidence for that option. In shakk the evidence
for the 2 options is of equal weight. Experimental therapies are used without certainty of the effect. In many cases a presumptive
diagnosis is made and treatment proceeds. Treatment may be symptomatic where there is no clue to the cause. Everything in
medicine is probabilistic and relative. Treatment decisions are best on a balance of probabilities. When a diagnosis is made,
it should be treated as a working diagnosis until new information is obtained to change it. This provides for stability and
a situation of quasi-certainty without which practical procedures will be taken reluctantly and inefficiently. Existing assertions
should continue in force until there is compelling evidence to change them, al asl baqau ma kaana ‘ala ma kaana.
of certainty also applies to consideration of pathological conditions A pathological or clinical event is considered of recent
occurrence unless there is evidence to the contrary, al asl idhafat al haadith ila aqrab waqtihi. An acquired attribute
or change is not accepted as normal unless there is compelling evidence, al asl fi al umuur al ‘aaridhat al ‘adam.
An existing condition whose origin or cause is not known should be left as is until there is evidence to the contrary, al
qadiim yutraku ala qadamihi. This principle protects against unnecessary medical interventions in long-standing anomalies
or deformities that do not appear to cause any discomfort. What has been accepted as customary over a long time is not considered
harmful unless there is evidence to the contrary, al qadiim la yakuun dhararan.
According to the
principle of certainty all medical procedures are considered permissible unless there is evidence to prove their prohibition,
al asl fi al ashiya al ibaaha. Exceptions to this rule are conditions related to the sexual and reproductive functions.
All matters related to the sexual function are presumed forbidden unless there is evidence to prove permissibility, al
asl fi al abdhai al tahriim.
PRINCIPLE OF INJURY
The third principle is the principle of injury, qa’idat
al dharar. Medical intervention is justified on the basic principle that injury, if it occurs, should be relieved, al
dharar yuzaal. The physician should however cause no harm in the course of his work according to the principle of la
dharara wa la dhirar. Injury should be prevented or mitigated as much as is possible, al dharar yudfau bi qadr al imkaan.
When an injury is found in a patient it is presumed to be of recent origin unless there is evidence to the contrary, al
dharar la yakuun qadiiman, and therefore must be alleviated. An injury
should not be relieved by a medical procedure that leads to an injury of the same magnitude as a side effect, al dharar
la yuzaal bi mithlihi. In a situation in which the proposed medical intervention has side effects, we follow the principle
that prevention of a harm has priority over pursuit of a benefit of equal worth, dariu an mafasid awla min jalbi al masaalih.
If the benefit has far more importance and worth than the harm, then the pursuit of the benefit has priority.
Physicians sometimes are confronted with medical interventions that are double edged; they
have both prohibited and permitted effects. The guidance of the Law is that the prohibited has priority of recognition over
the permitted if the two occur together and a choice has to be made, idha ijtama'a al halaal wa al haram ghalaba al haraam
al halaaal. If confronted with 2 medical situations both of which are harmful and there is no way but to choose one of
them, the lesser harm is committed, ikhtiyaar ahwan al sharrain. A lesser harm is committed in order to prevent a bigger
harm, al dharar al ashadd yuzaalu bi al dharar al akhaff. In the same way medical interventions that are in public interest have priority over consideration of individual interest, al maslahat al aamat muqaddamat
ala al maslahat al khaassat. The individual may have to sustain a harm in order to protect public interest, yatahammalu
al dharar al khaas li dafu’i al dharar al aam. In the course of combating communicable diseases, the state may have
to restrict movements of a citizen or even destroy his property. The state cannot infringe on the rights of the public unless
there is a public benefit to be achieved, al tasarruf ala al ra'iyat manuutu bi al maslahat. Many situations, the line
between benefit and injury is so fine that salat al istikharat is needed to reach
a solution since no empirical methods can be used.
PRINCIPLE OF HARDSHIP
The fourth principle
is the principle of hardship, qa’idat al mashaqqat. Medical interventions that would otherwise be prohibited
actions are permitted under the principle of hardship if there is a necessity, dharuurat. Necessity legalizes the prohibited,
al dharuraat tubiihu al mahdhuuraat. In the medical setting a hardship is defined as any condition that will seriously
impair physical and mental health if not relieved promptly. Hardship mitigates easing of the sharia rules and obligations, al mashaqqa tajlibu al tayseer. This is predicated on the general principle
of Islam as an easy religion that cannot be made difficult and a burden for its followers, al ddiin yusr wa lan yashaada
hadha al ddiin illa ghalabahu.
of the principle of hardship need to be observed. Committing the otherwise prohibited action should not extend beyond the
limits needed to preserve the Purpose of the Law that is the basis for the legalization, al dharuraat tuqaddar bi qadriha.
Application of the principle of hardship is of limited duration. Necessity however does not permanently abrogate the patient’s
rights that must be restored or recompensed in due course; necessity only legalizes temporary violation of rights, al idhtiraar
la yubtilu haqq al ghair. The temporary legalization of prohibited medical action ends with the end of the necessity that
justified it in the first place, ma jaaza bi ‘udhri batala bi zawaalihi. This can be stated in al alternative
way if the obstacle ends, enforcement of the prohibited resumes, idha zaala al maniu, aada al mamnuu’u. It is
illegal to get out of a difficulty by delegating to someone else to undertake a harmful act, ma haruma fi’iluhu,
PRINCIPLE OF CUSTOM
The fifth principle
is the principle of custom or precedent, qa’idat al urf. The generally accepted
standard of medical care is defined by custom. The basic principle is that custom or precedent has legal force, al aadat
muhakamat. What is considered customary is what is uniform, widespread, and predominant, innama tu’utabaru al
‘aadat idha atradat aw ghalabat, and not rare, al ibrat li al ghaalib al shaiu la al naadir. The customary
must also be old and not a recent phenomenon to give chance for a medical consensus to be formed.
6.0 REGULATIONS OF MEDICINE = dhawaabit al fiqh
Dhaabit fiqhi is a general principle that applied to specific situations in one chapter of the law. Dhaabit is narrower in scope than the qaidat. The dhaabit deals with
only one chapter of fiqh whereas qa’idat
deals with several chapters. The dhaabit fiqhi is narrower in scope and admits
fewer exceptions than the qa’idat fiqhiyyat.
The physician must have technical competence, itiqaan, and aim at excellence
and quality work, ihsaan. He must have balance, tawazun, in actions and attitudes. He must realize that he is carrying a great trust, amanat, and must continuously undertake self-criticism, muhasabat.
Imaam al Nawawi in his book al Adhkaar recorded over 30 hadiths that cover the core values around which Islam revolves, madaaru
al islam. These values are general guidelines for medical work. All work
is recognized according to the intention behind it. Doubtful things are better avoided. Leave alone what does not concern you. Love for others what you love for yourself. Cause no harm. Give sincerity advice. Avoid what is prohibited and do as much as is possible of what is enjoined
and avoiding too much sterile argumentation and questioning. Renounce longing for the material goods of the world and the property of
other people. Do not take life except by judicial execution. Claims or allegations must be supported by evidence. In matters of right and wrong, the dictates of the conscience should be
followed even if others say otherwise; the righteous act outs the heart at ease, the evil causes it distress. Excellence and quality work are needed in all endeavors. Guard the tongue. It is better to keep silent than to speak evil. Avoid anger and rage. Do not transgress limits set by Allah. Have consciousness of Allah in all circumstances. Perform good acts to wipe out bad ones and treat people with the best of
manners. Exercise restraint and modesty. Maintain objectivity. Seek help from Allah. Avoid oppression or transgression.
A sole medical
practitioner is a community is individually obliged to provide medical benefit and relief as fard ‘ain. The obligation
becomes fard kifayat is there are other equally competent caregivers. However if a patient has already started getting
medical benefit from a particular physician, the individual responsibility of that physician remains even if there are other
equally competent ones in the community.
RESPECT FOR PATIENT AUTONOMY
The principle of autonomy is derived from the shari’at
principle of intention, qa’idat al qasd. Among all players in a medical scenario it is the individual patient
who has the best and purest of intentions. He or she is best able to make decisions in the best interests of his or her life.
Others may have other personal considerations that may bias their decision-making. It is for this reason that all decisions
must be referred to the patient. No medical procedures can be carried out without informed consent except in cases of legal
incompetence in which case the Law provides for other persons to make decisions on behalf of the incompetent patient.
part of the professional contract between the physician and the patient, the physician must tell the whole truth. Patients
have the right to know the risks and benefits of medical procedure in order for them to make an autonomous informed consent.
The physician should be guided in his communication by the background and understanding of a patient. Some patients can be
given a lot of information and they do not get disturbed. Some types of information agitate patients. The prophet enjoined
talking to each person according to his ability to understand, kalaam al naas hasba ‘uquulihim.
patient secrets violates fidelity which is the private and privileged relationship of trust between the patient and the caregiver.
Revealing secrets harms the patient under the principle of Injury, qa’idat dharar.
Under the principle of hardship, qa’idat al mashaqqa, secrets may be revealed
under necessity, dharuurat. The injunction to keep secrets is binding on both the
caregiver and the patient. The patient should not make unnecessary revelation of negative things about himself or herself,
satr al mumin ala nafsihi. In cases of court litigation, The caregiver could testify in criminal cases that involve dhulm. The Qur'an forbids the revelation of the shameful unless there is dhulm. The caregiver cannot give false testimony.
of fidelity requires that physicians be faithful to their patients. Fidelity includes: acting in faith, fulfilling agreements,
maintaining relations, and acting in trust and confidence. Abandoning the patient at any stage of treatment without alternative
arrangements is a violation of fidelity. The fidelity obligation may conflict with
the obligation to protect third parties by disclosing contagious disease or dangerous behavior of the patient. The physician
may find himself in a situation of divided loyalty between the interests of the patient and the interests of the institution.
The conflict may be between two patients of the physician such as when maternal and fetal interests conflict. Physicians involved
in clinical trials have conflicting dual roles of physicians and investigators. These issues can be resolved by reference
to the maqasid and qawa’id.
 (Beauchamp & Childress. Principles
of Biomedical Ethics. Oxford University
Press 1979, 1994)
 Se details in: Abu Ishaq al Shatibi.
Al Muwafaqaat fi Usuul al Shari’at. Dar al Kitaab al ‘Aalamiyyat. Beirut.
 See details in: Ali Ahmad al Nadawi. Al Qawa’id al Fiqhiyyat. Damascus 1414H
 (Bukhari Kitaab al Buyuu’u Baab 2)
 al Nawawi. Al Adhkaar. Dar Ibn Kathiir. Beirut.
 (Bukhari Kitaab Badiu al Wahy Hadith 1)
 (Tirmidhi Hadith 2520)
 (Tirmidhi Hadith 2318)
 (Bukhari Kitaab al Iman Hadith 13)
 (Muslim H55, Abudaud H4944, Nisai 7:152, Ahmad 4:102)
 (Bukhari H7288, Muslim H137, Nisai 5:110)
 (Bukhari Kitaab al Adab Baab 60)
 (Qur’an 4:148, 24:19)
 (Mukhtasar Bukhari Hadith No. 1176)