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ISLAMIC MEDICAL EDUCATION RESOURCES-04

0702-JURISPRUDENCE OF DISEASE CONDITIONS, fiqh al amraadh

Paper presented at a workshop on Ijtihad Maqasidi organized by the Fiqh Academy of India at Hyderabad 03-04 February 2007 by Dr Omar Hasan Kasule Sr MB ChB(MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine University of Brunei and Visiting Professor of Epidemiology University of Malaya EM: omarkasule@yahoo.com WEB: http://omarkasule.tripod.com

ABSTRACT

This paper describes the impact of various disease conditions on ibaadaat and mu’amalaat.

 

1.0 DSORDERS OF THE UROGENITAL SYSTEM

1.1 Disorders of the urinary tract, amraadh al jihaaz al bawli

In urinary incontinence or hematuria, wudhu is followed immediately by salat with no delay. Suitable urinary bags should be worn to prevent soling clothes and the place of prayer. Hematuria causing anemia exempts from saum. Patients with renal failure not in coma pray as much as they can but are exempt from saum in order to control fluids and electrolytes. In urolithiasis, movements are restricted if they trigger pain and salat is delayed while patients are under sedation to control pain. Stress of hajj movements and change in meals in a hot and dry climate may trigger pain. Patients prone to stone formation have to be careful while fasting to make sure they take plenty of fluid and avoid hot environments that lead to excessive fluid loss.

 

1.2 Disorders of the male genital tract, amraadh al jihaaz al tanaasuli al rijaali

It is offensive for a male but not a female with no libido to marry. Lack of libido is grounds for divorce or khulu’u. In cases of impotence marriage is nullified after a grace period of 1 year. Pre-mature, delayed, or no ejaculations are not sufficient grounds for divorce. Priapism causing physical harm to the wife and should be treated before coitus. Polygyny is recommended for a male with excessive unsatisfied sexual desire. Circumcision, partial or complete excision of the prepuce, is a hygienic measure highly recommended but those who cannot be circumcised should be careful to clean properly under the prepuce during istinjah. Cases of cryptorchidism should seek counseling about fertility before marriage.

 

1.3 Disorders of the female genital tract, amraadh al jihaaz al tanaasuli al nisawi

Kindness is required for wives when they experience loss of libido, lack of sexual enjoyment, dyspareunia, and vaginismus. Lack of libido and sexual interest in a woman is not considered a barrier to marriage.

 

In cases of prolonged menstruation or dysfunctional uterine bleeding, it suffices to pad the perineum, make wudhu, and pray immediately without waiting. Menstruation exempts from fasting and not DUB. Hormonal regulation is menstruation is allowed for hajj but not fasting of Ramadhan. Sexual relation can be undertaken in prolonged DUB if care is taken to prevent ascending infection. DUB is ignored in computation of ‘iddat in both pre-menopausal and post-menopausal women.

 

Surgical treatment of septate or imperforate vagina should be attempted before marriage dissolution due to non-consummation. The Law treats infertility as a disease for which surgical and medical treatment must be sought. A spouse is legally liable for transmitting infection to the partner. A proper balancing of harm, dharar, and benefit, maslahat, must be considered in treating benign malignancies because of destruction of the reproductive function. Hysterectomy for uterine fibroids destroys the reproductive function and leads to psychological problems in a woman who then can no longer menstruate.

 

The period of post-abortion bleeding is recognized as nifaas. In cases of hemostatic disorders and ecclampsia termination of the pregnancy may be the best way to save the mother’s life but it will adversely affect the fetus who may not yet be viable extra-uterine. Delivery complication may lead to difficult choices between saving losing two lives versus losing one life.

 

1.4 Gender differentiation and gender identity, ahwaal al khuntha al mushkil

The disorders are anatomical and physiological with serious behavioral and legal implications affecting marriage, procreation, and inheritance

 

1.5 Obstetric and gynecological diseases, amraadh al nisa wa al wilaadat

Radical mastectomy for breast cancer has cosmetic implications that can affect marital relation through psychological effects. Ovum donation or in invitro fertilization are prohibited for anovulatory infertility.

 

2.0 CARDIORESPIRATORY DISORDERS

2.1 Upper respiratory disorders, amraadh jihaaz al tanaffus al ‘uliyat

A person with URTI can be excused from leading salat because of difficulty in recitation of the Qur’an. Infectious patients should not pray in the mosque and should restrict their social interactions.

 

2.2 Lower respiratory disorders, amraadh jihaaz al tanaffus al suflah

Dypnoeic patients should limit their physical movements in salat and hajj. Repetitive cough may make recitation in salat difficult. Hemoptysis does not void wudhu and fasting. Patients with pneumonia or pneumonitis will experience pain on recitation and prostration. Patients on respiratory support cannot recite Qur’an during salat.

 

2.3 Vascular disorders, amraadh ‘uruuq al ddam

Orthostatic hypotension is avoided by shortening the recitation to avoid standing for a long time, prolonged sitting between prostrations, frequent periods of rest and sitting down during rites of hajj like tawaaf.  Syncope necessitates delay of salat, hajj rites, and judicial proceedings. Caution must be taken because physical exertion in salat, hajj and coitus may trigger a coronary attack or rupture of an aneurysm. Patients with intermittent claudification, varicose veins, phlebitis, and thrombophlebitis should make tayammum and avoid very water for wudhu and must be cautious in salat movements or sitting down for tashahhud. In DVT, movements of the lower limb in salat and hajj are limited for fear or dislodging an embolus. Prior prolonged sitting predisposes to embolus formation.

 

2.4 Diseases of the heart, amraadh al qalb

Benefits of surgical correction of congenital heart disease are weighed against the risk of surgery in small children. In cases of mitral stenosis, mitral incompetence, and restrictive pericarditis, physical exertion in salat and hajj can lead to more severe decompensation.

 

2.5 Circulatory disorders, amraadh al dawrat al damawiyat

Patients in CCF may be too weak to pray. Standing up for prolonged periods in salat may worsen the lower leg edema and compromise venous return even further. The muscle movements of salat may however have a beneficial effect in venous return. Fasting in CCF is not recommended. Hajj is better postponed in CCF because the patient may not be able to withstand the extra physical exertion involved. In states of shock the physical movements of salat and hajj are not possible and Fasting is not allowed because of the need to replace body fluids.

 

3.0 CONNECTIVE TISSUE SYSTEM

3.1 Disorders of the hematopoietic system, amraadh al dam

It is obligatory for the mother to take hematinics as directed in the interests of the fetus. It is obligatory on parents to provide sufficient nutrition to the infant to prevent anemia. Although breast-feeding is recommended for 2 years, it is not sufficient by itself after the 6th month. The father is obliged by Law to provide sufficient nutrition to the nursing mother and the infant to prevent anemia.

 

3.2 Disorders of the bony skeleton

Congenital and acquired disorders of the bony skeleton may limit the range of movements in salat: sideways movement of the neck in tasliim, prostration on the floor, raising the hands in takbir, and pointing with the finger in tashahhud, and bowing. Tawaaf in hajj may be difficult with lower limb pathology. Use of an artificial limb is no bar to hajj and tawaaf. Patients can support themselves on a stick or a pillar during salat. Pain and restricted movements of the vertebral column make bowing more difficult. Standing for prolonged periods may also be difficult. Prostration may be completely impossible. The requirement to straighten the back after bowing may be relaxed. Back pain may also interfere with sexual function. Restricted bending of the knees interferes with sitting properly. Knee problems may make tawaaf and sa’ay in hajj difficult. In case of foot problems, a pilgrim may wear sandals if he has disease that makes it impossible to walk barefoot around the ka’aba. If shoes are needed for orthopedic conditions they can be worn in hajj and salat.

 

Wudhu may not be possible with open wounds and compound fractures and resort is made to tayammum. Pain due to sprains and fractures may limit movements in salat. Movements will not be possible at all when the limbs are immobilized. When a pilgrim has a fracture or becomes lame for any other reason, he is discharged from the rites of hajj and has to repeat the hajj later. Orthopedic fixation of some joints like the hip or knee joints may limit the range of movements possible in salat. In hajj tawaaf may have to be done in a wheelchair. Wudhu can be made on a limb stump preferably washing. If washing is difficult the stump can be wiped with a wet hand. If a leg is in a cast, the rest of the organs are washed with water and tayammum is carried out for the limb in a cast

In osteomyelitis, pain may limit movements in salat. If there is a discharging wound, tayammum will be needed instead of wudhu. Care is exercised in salat and hajj to avoid pathological fractures that are common in bones with neoplastic disease. In osteoporosis care has to be taken in movements in salat and hajj to avoid fractures. Treatment of osteoporosis with hormone and mineral replacement is obligatory for postmenopausal women so that they can lead a normal life.

 

3.3 Cartilage and ligament disorders, amraadh al mafaasil

Laryngeal, pharyngeal, or other oral diseases may impair the ability to recite the Qur’an. Patients with such conditions cannot be prayer leaders, imaam al salat. Public duties like leadership that require communication may be impaired. Pleas and evidence in court may also be affected. Salat is intimately related to joints because of the physical movements involved. Osteoarthritis and rheumatoid arthritis cause pain and limitation of movement. These limit the physical actions needed for salat and hajj. Degenerative disorders of the vertebral column such as spondylosis (arthritis of the spine), intervertebral disc disease (herniation), spondylolisthesis (anterior displacement) impair ability to stand for long periods in salat as well as tawaaf and sa’ay. Tayammum is carried out in cases in which either hot or cold water worsen the pain of rheumatism.

 

3.4 Muscular disorders

Injury to muscles will necessitate limitation of movements in salat while they heal. Some diseases of muscle weakness like myasthenia make it impossible to make the full range of movements required in salat.

 

3.5 Skin disorders, amraadh al jild

Skin lesions such as eczema, dermatitis, itch, discharges, rashes, and chronic ulcer are a reason for tayammum. If the skin is bandaged, the bandage is wiped with the wet hand. Shaving or cutting hair is forbidden in hajj. An exemption is made for those with lice in their hair but a fidyat has to be paid. Injury to ligaments may limit movements in salat.

 

4.0 ALIMENTARY DISORDERS

4.1 Gastro-intestinal tract (GIT) disorders, amraadh jihaaz at ta’am

Patients with an acute abdomen are immediately excused from the obligation of saum until full recovery. Salat can be performed as much as their physical condition allows. Saum may not be possible in advanced stages of peptic ulcer disease. The impact of GIT neoplasms on saum and salat is variable depending on the complications. Conditions of the oropharynx interefere with eating and drinking as well as recitation of the Qur’an in salat. Esophageal disorders may have implications for fasting patients. Esophageal varices may lead to hematemesis that voids fasting. Patients with malabsorption may be exempted from fasting while they are on treatment with special diets that have to be taken during the day or if their nutritional status requires regular food intake. Use of a hernia belt is allowed in hajj for those whose small intestine herniates.

 

Diseases of the large intestine interfere directly with fasting if they are associated with vomiting which voids fasting. Continuous diarrhea may make the maintenance of wudhu difficult. Stoma created after operation for cancer of the colon do not normally interfere with saum, salat, or hajj. Constant flatulence may make maintenance of wudhu difficult. It is recommended that salat is performed immediately after wudhu. If flatulence is continuous it can be ignored but efforts at finding a treatment should be continued. In cases of bleeding due to hemorrhoids and anal fissures, wudhu will have to be made immediately before the salat and for that salat only. It has to be repeated for every salat. Care must be taken during instinjah not to cause undue pain in case of anal fissures. Extreme obesity makes salat difficult because of body weight, physical weakness, and restricted movements. Saum is good for the obese.

 

4.2 Impact of GIT symptoms and signs on ‘ibaadat

Salat is delayed while anticipating vomiting because vomiting is najasat and will nullify the salat anyway. Vomiting nullifies fasting; it is recommended to continue fasting even after an episode of vomiting but make up the day after. Hiccup in salat may make recitation of the Qur’an impossible. If the hiccup persists it is preferable to terminate the salat and wait until it subsides. In extreme cases of peptic ulcer disease the patient is exempted from fasting. Any incidence of audible smelt flatus nullifies wudhu. A general feeling of flatulence does not nullify wudhu. Salat should not be terminated on mere suspicion of passing flatus.

 

A situation of continuous diarrhea makes it difficult to maintain a state of wudhu or to pray in congregation. When an episode of diarrhea is impending, salat is terminated by tasliim at any stage and is resumed after defecation and a new wudhu. In cases of anal incontinence, wudhu is made immediately before each prayer.

 

Upper GIT bleeding that does not cause visible blood at the anal opening does not nullify wudhu. If it leads to hematemesis, saum is void and has to be made up later. Fresh bleeding from hemorrhoids and anal lesions does not nullify wudhu but must be washed away immediately and before salat commences.

 

Any cause of abdominal discomfort such as pain, cramps, spasms, and digestive disorders make it difficult to concentrate in salat. It is recommended to delay salat until the discomfort is treated. Pain of gallstones in an acute attack makes concentration in salat difficult. Associated vomiting may void saum.

 

The colostomy site is kept as clean as possible all the time. Wudhu is made before each salat. Normally there is no interference with saum. Halitosis, bad oral smell due to caries, gingivitis, and oral ulcer; is a reason for keeping away from public assemblies until the condition is cured.

 

Disease transmission by feco-oral route requires special measures to protect public health in the food service industry. Islamic teachings about personal hygiene play a role in preventing the spread of infection.

 

5.0 THE SENSORY SYSTEMS

5.1 Vision disorders, amraadh al basar

A blind person is not obliged to attend salat al jama'at, salat al jumu'at, and hajj if he no guide. He can be a muaddhin only if someone to tell him the correct time. He can also be imaam. He can be a political leader if the visual impairment does not impair performance of leadership functions. He cannot be a judge because of inability to see witnesses and assess their demeanor. He can be a scholar or a mufti. He can testify if the evidence does not involve sight. He can marry if measures are taken ensure enough mutual knowledge of the future spouses based on other senses information from third parties. He can be wali in marriage if he knew the spouses before getting blind and can recognize both using other senses. Selling and buying by a blind person can take place in transactions where fraud is unlikely. Blind persons can offer professional services if there is no possibility of harm due to their lack of sight.

 

5.2 Hearing disorders, amraadh al sama’u

A deaf person is obliged to attend salat al jumu’at if others hear adhan and inform him. He can be muaddhin if others tell him the correct time. He can be imaam. He can follow by imaam by watching what the imaam. He can teach Qur’an but it is preferred he does not do so because he cannot hear and correct mispronunciations. He is not obliged to return greetings because he cannot hear but is obliged to respond to sign language of greeting if he is sighted. Deafness reduces competence as a leader but is not an absolute contra-indication. A deaf judge will not be able to discharge duties fully. A deaf person can be a scholar and can give religious rulings if he can read the questions and answer by writing or by sign language. He cannot be a witness over matters that required perfect hearing. He can contract a marriage by use of reading or sign language. He can declare divorce but. He can buy and sell as long as he understands the transaction and can communicate in writing or by sign language. It is forbidden for a deaf person to engage in any professional work for which hearing is necessary. In vestibular disturbances standing up in salat or tawaaf may require support.

 

5.3 Olfactory disorders, amraadh al shumm

In hyposmia the victim may not be able to smell flatus and thus may continue praying with an invalid wudhu. Hyperosmia and parosmia may results in unnecessary concern about presence of najasat where it is insignificant. The halitosis associated with fasting is due to reduced oral cleansing action of saliva. It can be reduced by increased oral hygiene. Impairment of the taste sensation may reduce enjoyment of food. It may also impair ability to discriminate dangerous things and avoiding swallowing them. Halitosis due to disease or poor oral hygiene may make social intercourse difficult. It is especially offensive in the mosque. Use of perfume to control body odor in public places like the mosque is mandatory to avoid annoying others. Body or oral odor may cause so much distress in a marriage that it may lead to divorce. Impaired smell may make transactions involving perfumes invalid because the buyer cannot identify what is being bought. Similarly impaired smell may lead to buying of rotten products without knowing their true state. Court evidence based on smell may not acceptable in situations of olfactory disorders.

 

5.4 Taste disorders, amraadh al dhawq

If taste is defective, it will not be possible to tell that water is polluted and is not suitable for wudhu. Enjoyment of food decreases when the sense of smell is defective. Dangerous food may also be consumed if it cannot be tasted. In selling food and drinks, the buyer may use taste to make sure the product is wholesome. This is not possible when the sense of taste is defective. Evidence in court based on taste of products may not be accepted in cases of a defective taste sense.

 

5.5 Other sensory disorders, amraadh al hawaas al ukhrah

Loss of tactile sensation does not affect wudhu and salat. It can lead to ingesting rough and dangerous materials. It impairs sexual sensation may lead to stresses in marital life. Loss of tactile sensation may be a cause of accidents at work. The integrity of the tactile sensation is considered when assessing certain types of court evidence. An impaired sensation of temperature may result in unnecessary exposure and heat stroke during hajj. Hot and therefore harmful food may be eaten when temperature sensation is impaired. Inability to adjust to extreme climatic conditions may be grounds for divorce if a promise was made in the marriage contract that the spouse will not be taken to another country. Workers must not be exposed to extremes of temperature. Extreme pain may prevent concentration in salat. Pain may cause insomnia. Chronic pain due to PID and other causes of dyspareunia may create marital stress. Chronic pain may lead to psychological stress. Severe pain may lead to criminal behavior. Salat is delayed in cases of extreme hunger sensation. Loss of the hunger sensation is dangerous to life. Inability to extinguish the feeling of hunger with food intake may lead to loss of appetite control. Children may be severely undernourished when they do not feel hungry and refuse to eat food. Extremes of pain may lead to crime. Concentration in salat is impaired in extreme thirst

 

6.0 GENERAL BODYSYMPTOMS,  , a’araadh al jism kullihi

6.1 General ill feeling and general weakness, al dhu’ufu al ‘aam

Non-obligatory duties are delayed but obligatory acts like salat, saum, and hajj are delayed only for physical inability to perform. The physically disabled is allowed to pray sitting or lying down. Exemption from saum is only for potential physiological harm. The weak can leave Muzdalifah earlier. Travelers may shorten and/or combine salat or break the fast and make up later. Salat, saum, and hajj rites are delayed for high fever. Non-obligatory fasting is recommended for the obese but is discouraged for the under-weight and the pregnant. Obligatory fasting and jihad are delayed in cases of extreme malnutrition and cachexia. The obese are obliged to reduce weight especially if they have impairments in salat, sexual function, and jihad. The underweight are obliged to seek nutritional treatment. Extreme fatigue necessitates delay of salat for lack of concentration, delay of saum, delay of hajj rites except standing at Arafat. Acts of ‘ibadat cannot be delayed in the chronic fatigue syndrome. The victim of this condition should try to perform as many acts as are possible and in the meanwhile try to seek treatment. Supplications, dua, and recitation of the Qur’an are highly recommended because diseases of the heart may be an underlying cause of the chronic fatigue syndrome.

 

6.2 Fever, al humma

High fever may be reason for delaying salat because of generalized weakness and discomfort. Saum with high fever aggravates dehydration and may have to be delayed. In cases of high fever, hajj may be difficult due to general weakness and lack of physical energy to complete the rites of pilgrimage. Fever aggravates dehydration in the dry climate of Hejaz. Care must be taken to prevent spread of contagious diseases because most cases of fever are due to infection.

 

6.3 Pain, al alam /al waja’u

Salat is delayed for severe acute headache, acute backache, and skin itch until the patient is able to concentrate. Salat is not delayed for chronic backache or skin itch but should be made as short as possible. Salat is interrupted for an anginal attack to rest and use medication and is continued after that with sujuud al sahaw at the end. Use of sub-lingual medication does not nullify the salat of a patient with chronic angina. Arthritic joint pain necessitates restricting movements during salat. If the pain is severe, the guidelines for the salat of the sick are followed. Patients with chronic pain on regular twice or thrice daily medication are exempted from fasting. Joint or back pain in hajj is an exemption to allow the pilgrim to be carried or to be put on wheeled transport during tawaaf and sa ay.

 

6.4 Disorders of high altitudes and space, amraadh al muratafa’aat wa al fadhaa

Concentration is salat at high altitude is impaired of low oxygen concentration. Salat in weightless space is feasible but the physical movements may be restricted and the guidelines of the salat of the sick may have to be employed. Saum at high altitudes is a challenge because of the cold that requires high and regular food intake to generate enough metabolic heat to keep the body warm in the cold atmosphere. The impact of weightless ness in space on saum has not yet been studied.

 

6.5 Adverse environment, haalaat al taqas al qaasi

Salat is delayed on a hot day until the temperature cools down to what is reasonable. Tayammum is carried out on cold days even if water is available. Cooling the body is permitted in saum. Saum can be broken on very hot days for fear of severe dehydration. Special protection is needed against heat stroke and dehydration during hajj. Tayammum is prescribed if the extreme cold may aggravate peripheral vascular disease. If the floor is too cold to stand during prayer, wearing of sandals or khuff is allowed. If frostbite or hypothermia occurs as a result of cold exposure, fasting is broken to eat food to generate enough metabolic heat to raise body temperature. Saum may be broken on cold days for fear of severe dehydration and due to increased calorie requirements to maintain body temperature. Salat on a cold day is preferably offered in the home to avoid cold exposure in the atmosphere. In case of fear of light injury it is recommended to pray inside a house, use a shelter, or wear special headgear and eye wear to avoid cosmic radiation. Photo dermatitis in hajj is avoided by avoiding going out during the middle of the day.

 

7.0 GENERAL SYSTEMIC CONDITIONS, amraadh kaamil al jism

7.1 Endocrine disorders, amraadh ajhizat al hormonaat

In diabetes mellitus, blindness exempts from salat al jama’at. Diabetics with leg ulcers make yatammum instead of wudhu and adopt the most confortable salat position. Insulin-dependent diabetics and pregnant diabetics are exempted from saum. Diabetics controlled on oral medication and diet can fast under physician supervision. Patients anterior hypoparathyroidism and hypothyroidism offer salat and saum depending on clinical severity. They are treated sexual failure before marital dissolution is considered. They perform tayammum instead of wudhu for cold intolerance. The default age of 15 is used to define adulthood if puberty is delayed. They can use growth hormones can be used for growth retardation. Wet nurses, milk banks, or artificial formula are used for lactation failure. In cases of amenorrhoea, the presumptive period of 4 months + 10 days is used as the ‘iddat. Patients with diabetes insipidus are exempted from saum until electrolyte and fluid imbalances are corrected. Patients with hyperthyroidism with restlessness preventing concentration offer brief salat with short recitation. Patients with Addison’s disease offer salat sitting down to avoid postural hypotension and delay saum and hajj until correction of fluid and electrolyte imbalances. Patients with primary hyperaldosteronism exempted from saum until correction of electrolyte imbalances. In adreno-cortical excess standing and posture of salat are altered (because of myopathy and possibility of fractures due to osteoporosis), saum is delayed during the treatment, hajj is delayed, and legal competence in impaired if psychotic symptoms are severe. Hormonal treatment of testicular and ovarian disorders, pseudohermaphroditism, gynecomastia, and hirsuitis is allowed if benefits outweigh risks. Legal liability is decreased if criminal behavior is due to hormonal status.

 

7.2 Infection, al ‘adwah

Infectious persons may be excluded from hajj and congregational salat. Under the principle of public interest superseding private interest, the following are allowed in an epidemic: restriction of movement, quarantines, involuntary measures (mass immunization, treatment, and prophylaxis), destruction of property (eg infected animals). Premarital screening is obligatory in places with endemic infectious diseases. Conjugal sexual rights can be denied for fear of infection. Conviction for zina cannot be based on incidental finding of STD in an unmarried person. Seeking divorce or khulu’u can be based on discovery of STD in a spouse. A spouse is legally liable for transmitting STD. Islam gave detailed teachings on personal hygiene, food hygiene, excreta disposal, and waste disposal in order to keep the environment clean and healthy.

 

7.3 Neoplasia, al sarataan

Intervention against cancer risk factors is based on the principle that harm should be relieved, al dharar yuzaal. Laws on sexual, body, and environmental hygiene decrease risk exposure. The tobacco-cancer link is considered yaqeen by physicians making tobacco haram. It is considered ghalabat al dhann by jurists making tobacco makruuh. The diet-cancer link does not reach the level of yaqeen or ghalabat al dhann. The Law can regulate institutional but not home diets. Parents are liable for child malnutrition due to negligence. Early disease screening is is obligatory if scientific evidence shows benefit. Treatment of advanced disease is based on the bakance of harm and benefit, both immediate and long term.

 

7.4 Genetic conditions, amraadh wiraathiyyat

Jurists are not unanimous on the obligation of pre-nuptial genetic testing and advice. Results of genetic testing could be used as a basis for refusing marriage or refusing to get pregnant. Pre-natal genetic screening in the form of amniocentesis for sex selection may encourage illegal abortion. Amniocentesis for disease detection may be of benefit to the parents to make preparations to take care of sick newborns. Marriage of close relatives has to be considered in the light of the balance of disease risk due to consanguinity and social advantages of marrying within the family. Treatment by genetic engineering is allowed under the rubric of permissibility of change of fitra as long as it is not done with the purpose of defying Allah’s creation. Widespread genetic testing may introduce systematic social discrimination based on gene profile for diseases and provide a false scientific basis for racial discrimination

 

7.5 Traumatic injury, al juruuh

It is allowed to wash a patient in ablution. Tayammum is preferred for cases of profuse or active bleeding at sites of wudhu. In cases of wounds, a wet hand is rubbed on the bandage. Tayammum is carried out instead of ghusl in cases of burns or other conditions preventing use of water. Patients with physical disabilities pray in the most comfortable position. The disabled are exempted from physical participation in jihad; they can however make monetary and other contributions. Impotence in paraplegia and physical disability preventing working to support the family are grounds for marriage nullification if the wife requests. The Law provides for financial compensation in cases of accidental injuries.

 

8.0 PSYCHIATRIC CONDITIONS, amraadh ‘aqliyyat

8.1 Disturbance of consciousness, fuqdaan al shu’uur /al mughmi ‘alaihi

Forgetfulness in salat is remedied by the prostration of forgetting. A forgotten salat is offered when remembered. In complete loss of consciousness, there is no obligation to pray. In semi-coma, syncope, or stroke the patient tries to pray as much as they can. Stroke patients must be careful not to fall down during salat due to the limb paralysis or paresis. A dozing person stops salat, sleeps, and resumes when conscious of what he is reading. In fright or inability to concentrate, salat is shortened. A person who forgets and eats in Ramadhan just resumes fasting and completes the day. The obligation of fasting is dropped if the patient is in coma or is fully unconscious. Hajj is delayed if consciousness is impaired. Hajj rites are delayed in case of syncope following postural hypotension  Semi-conscious patients or those in coma are fed without their consent under the purpose of preserving life. Pronouncements of divorce or khulu’u, marriage, or contracts under psychosocial stress or impaired consciousness have no legal effect because of legal incompetence. However a guardian, wali, on behalf of the unconscious, can conclude valid contracts. Court testimony by a semi-conscious person is not allowed. There is reduced legal or civil liability for crimes and contracts under the influence of ordinary psychiatric medication. Liability is not reduced for crimes and contracts committed under the influence of alcohol or illegal drugs.

 

8.2 Personality disorders, amraadh al shakhsiyyat

Personality disorders not accompanied by cognitive effects have no impact on ‘ibadat. Severe personality disorders exempt from hajj for fear of crises. Preventive measures are needed to protect the public from psychopaths. Severe personality disorders are a contra indication for marriage. Personality disorder may be considered as legal incompetence in contracts and criminal prosecution.

 

8.3 Neurotic and psychotic disorders, amraadh al junuun

Neurotic and psychotic disorders: Obligatory salat is anxiety due to inability to concentrate. Compulsive-obsession about passing flatus in salat should be ignored. It may also cause forgetfulness in salat. Psychiatric disease does not affect the obligation of paying zakat because zakat is related to the wealth and the not the individual. Psychiatric illness that affects legal competence exempts from salat and hajj. Attempts are made to treat psychiatric illness before resort to divorce. A marriage contract is deemed void or irregular because of mental incompetence. Divorce pronouncements by an insane person have no immediate legal effect unless confirmed by a competent court. Contracts by a schizophrenic or a patient with mood disorders clouding clear thinking are void. Evidence by a psychiatric patient is evaluated in view of the type of cognitive or personality defects because some may be acceptable. The evidence of patients with mood disorders must be considered in the light of their clinical conditions.

 

8.4 Sexual disorders, amraadh al jimaa’e

Sexual disorders: Sexual disorders usually have no direct impact in ‘ibadat, aadaat, or mu’amalaat; they however are intimately related with marriage and divorce. Divorce or khuluu can be considered for lack of libido, sexual deviation (e.g. sadism or masochism), transsexual behavior, male impotence, and female vaginismus/frigidity. Fasting may help control sexual desire.

 

8.5 Stress disorders, amraadh dhiiq al nafs

Stress can be controlled internally salat, dhikr, and i’tikaf. It may lead to wrong unintended decisions in transactions, produce adverse effects on marriage leading to divorce, affect appetite, and impair concentration in salat. Hajj and saum may increase the stress level. Salat generally decreases stress levels.

 

9.0 NEUROLOGICAL CONDITIONS, amraadh al a’aswaab

9.1 Epilepsy

Epileptics under control can pray, fast, and undertake hajj but have to take medication and avoid triggers of attacks.

 

9.2 Degenerative conditions, amraadh talaf al dumaagh

Salat and hajj may be difficult in advanced Parkinson’s disease. Demented patients cannot be leaders in salat because of confabulation. Dementia that does not impair cognition does not exempt from salat, saum or hajj. Court testimony of elderly demented patients is evaluated in light memory and cognition. Since dementia is incipient, special tests of competence are needed before court testimony. Dementia is a reason for exclusion from leadership.

 

9.3 Central neurological conditions, amraadh al a’aswaab

Head injury may be associated with paralysis, impaired consciousness, or loss of sensation affecting salat and hajj obligations. Brain tumors affect salat, hajj, marriage contracts, and judicial proceedings depending on the severity. Mental clouding from brain infection affects salat, saum, hajj, and witnessing in court. Spinal cord injuries may lead to quadriplegia and paraplegia that limit movements in salat. Tawaaf is undertaken on a vehicle.

 

9.4 Peripheral neurological conditions, amraadh a’aswaab al a’adha

Disease such as myasthenia gravis limits salat movements and may make hajj difficult. Pain from neuropathies may be increased during salat movements.

 

9.5 Other disorders, amraadh ukhrah

Aphasia and dysphasia affect conclusion of marriage contracts, witnessing in courts of law, and public leadership duties. Vestibular disturbances necessitate support to stand in salat and tawaaf.

 

10.0 AGE-RELATED CONDITIONS, amraadh al ‘umr

10.1 Pregnancy & and delivery, amraadh al haml wa al wilaadat

Pre-natal diagnosis could be prohibited under the principle of closing the door to evil if it leads to abortion. Amniocentesis to determine life and gender at time of father’s death determines fetal inheritance rights. Consideration of maternal interest has priority over consideration of fetal interests in medical and surgical interventions in pregnancy and delivery. Adhan and iqamat are required for the newborn. The ‘aqiiqah ceremony for the newborn is a social occasion for introducing the baby as a new member of the community. Circumcision can be delayed for fear of neonatal bleeding. Neonatal disease screening and immunization are encouraged by the Law. Breast-feeding is mandatory for 2 years according to Qur’anic injunction. Foster breast-feeding is allowed but it creates relations like those of a biological mother that restrict marriage. Use of artificial formulas is allowed but milk banks are discouraged. Payments are made to a divorced mother for breast-feeding their babies. Post-partum hemorrhage has the same legal rulings as menstruation. Post-natal depression may constitute deficient legal competence for making treatment decisions for the mother and baby.

 

10.2 Infancy, al khadhaanat

Nafaqat includes all material sustenance needed for the infant such as food, clothing, and medical care. The father is responsible for nafaqat during marriage and also after divorce. The extended family and the state are responsible for financial maintenance of single poor mothers. Child abuse and neglect can be physical, sexual, or psychological. Vaccination of infants is obligatory.

 

10.3 Childhood, al tufuulat

Hormonal treatment of slow growth is allowed. The age of 15 years indicates legal maturity even if sexual maturation is not complete. The rules of hijaab and male-female interaction are applied earlier in precocious growth to avoid transgression. Younger girls growing precociously are not married off because they are immature. Parents can consent on behalf of young children for urgent cosmetic surgery but should wait until children reach the age of consent for non-urgent surgery. Children are ordered to pray at the age of 7 and punished for missing prayer at the age of 10. Children who grow rapidly could be allowed to undertake some transactions if their cognitive skills are judged to be like those of adults.

 

10.4 Adolescence and youth, sinn al muraahaqat wa al shabaab

Adolescent and youth behavioral problems are best resolved by preventive tarbiyyat. Intervention when they are already grown up is sometimes too late.

 

10.5 Old age, al shaykhuukhat

The elderly, like the sick, are exempted from fulfilling all the acts and conditions of the physical acts of ‘ibadat, salat, saum, and hajj. They pray sitting down or lying on the side. They can make tawaaf carried by a person or a vehicle. They are exempted from the obligation of jihad and they can deny permission for their only son from joining jihad. In cases of urinary or fecal incontinence, they wear a retainer, made wudhu and pray immediately without waiting. Mental competence of the elderly is considered in marriage, divorce, transactions, evidence, and criminal liability. Both males and females experience sexual problems.

ŠProfessor Omar Hasan Kasule, Sr. February 2007