Fiqh Medic Part 2

Date        : 14th April 2012

Time        : 8.00am - 1.00pm

Place       : Lecture Theatre 2, IMU

Speaker  : Ustaz Ismat Nazirin bin Mat Isa 

This time, Ustaz will mostly discuss real cases from the website (www.e-fatwa.gov.my/). 

Q: What is the hukm of using ‘Maggot Debridement Therapy’ for patient with a chronic wound? (especially diabetic ulcer)

A: The Prophet Muhammad (salallahu alaihi wasallam) was once asked about the advisability of medical treatment. He replied, "Make use of medical treatment for Allah has not made a disease without making a cure for it, with the exception of one disease, namely old age." [Sunan of Abu Dawood, Hadith 1755] 

Hardship begets facility. Thus, this case falls under the category of Ja’iz or Mubah (Harus). The obedient act such as ablution and Salah performed by this patient while on treatment is valid. 

Q: Euthanasia or Mercy Killing. What is the hukm? 

A: Euthanasia is the act of intentional killing by act or omission of a dependent human being for his or her alleged benefit. Therefore its main hukm is Haram (prohibited or forbidden). A Muslim should never give up in seeking a method of recovery for his other brother; all means and methods that does not go against Syariah should be tried before giving up. Nevertheless, if a person is declared to be brain or any other organ failure (example: heart) and he/she has to be fully dependent on a machine to stay alive; all other doctors could not find other alternative treatment nor is there any hope for a living, then euthanasia is permissible by ceasing the lifeline with the machine. In order to do this, the doctor has to be fully competent and is confident without doubt of the decision he makes. 

“It is not for a believer to kill a believer unless (it be) by mistake. He who hath killed a believer by mistake must set free a believing slave, and pay the blood-money to the family of the slain, unless they remit it as a charity. If he (the victim) be of a people hostile unto you, and he is a believer, then (the penance is) to set free a believing slave. And if he cometh of a folk between whom and you there is a covenant, then the blood-money must be paid unto his folk and (also) a believing slave must be set free. And whoso hath not the wherewithal must fast two consecutive months. A penance from Allah. Allah is Knower, Wise.” 

(An-Nisa’: 92)

Anas (b. Malik) reported Allah's Messenger (may peace be upon him) as saying. None of you should make a request for death because of the trouble in which he is involved, but if there is no other help to it, then say: O Allah, keep me alive as long as there is goodness in life for me and bring death to me when there is goodness in death for me.

(Muslim :: Book 35 : Hadith 6480)

Q: What is the hukm of eating gecko-gecko lizard (Tokay) for the purpose of medicinal therapy? 

A: Haram because of the nature of the animal itself which is khabis (or abhorrence) and it may be poisonous. This lizard has not yet been scientifically proven to be of benefit to health. Once there are hard evidence based on research regarding the health benefit this lizard carries and then only the hukm would fall under Ja’iz or Mubah (Harus). 

Q: What is the hukm of donating an organ? 

A: Organ donation is permissible for a Muslim; though it is preferred that only the important organs (eg; liver, marrow, kidney) are to be donated and in any single body, it is advisable to take only one organ. The procedure is preferred to be handled by a Muslim doctor. Nonetheless, it is haram for a living Muslim to donate an organ whilst still alive and he/she actually requires that organ to live. There are exceptions to this case (for example in liver donation), as long as after the donation the donor must not suffer any chronic side effects that could cause death. 

Q: Can a Muslim donate his whole body after death for the purpose of research/study? 

A: Haram because there are lots of other death that can be used as research purposes instead. 

Q: Is autopsy allowed in Islam? 

A: Haram. Nevertheless, it is allowed in certain emergency (Dharurat) conditions and there is a need to ensure that the real cause of suspicious death can be brought to justice. This falls under the importance of the protection of life. 

Q: Can a male doctor attend to a woman in labour? 

A: The hukm is Ja’iz or Mubah (Harus) when it is an emergency situation. 

Q: Is In-Vitro Fertilization (IVF) allowed in Islam? 

A: The procedure is permissible as long as both the egg and sperm comes from legally married couple. 

Q: Is surrogacy allowed? 

A: Haram, as it might cause confusion in the lineage. 

Q: Is abortion of a disabled foetus allowed? (eg: Down Syndrome, congenital physical defect) 

A: Haram as the disability is a fitrah (disposition). 

Q: Are Muslims allowed to take medications, food, drinks, or use perfumes which contain alcohol? 

A: First of all, we have to bear in mind that all liquor is made from alcohol but not all alcohol is made into liquor. An alcohol is considered as haram as long as these two conditions is fulfilled:

i)   The level of alcohol is more than 0.5% 

ii)  The process of making the alcohol is from ensiled fruits. 

iii) The alcohol made is intended to cause a person to be drunk. 

In medication and perfumes, the alcohol used is mainly intended to be a solvent so that the whole formula is well incorporated. Therefore, it is not considered to be impure and it falls under the hukm of Ja’iz or Mubah (Harus). 

Q: Is the gelatin used in medication safe for Muslims to consume? 

A: The gelatin may come from many different resources such as bovine (cow), porcine (pig) or even avian (ducks). Therefore, only medication that has gelatin made from resources such as porcine is considered haram. Nevertheless, in times of emergency (Dharurat) and there are certainly no other medication left, then it is permissible or Ja’iz or Mubah (Harus) for a Muslim to consume it. 

Each hospital in Malaysia has its own responsibility to ensure that the medication that they ordered has to be free from any suspicious materials used and patient has the full right for information regarding the medication that they are taking. 

Q: What is the hukm of using highly purified insulin coming from a porcine source? 

A: In a critical diabetic emergency (Dharurat) case, it falls under the hukm of Ja’iz or Mubah (Harus). Nevertheless, a Muslim is obligated (Wajib and Fardh) to continue to search for other insulin medication that does not have any haram source in them. 

Ramadhan Guidelines for Patients 

Jau’f is defined as a passage that can transfer food or drinks (or any material that may nullify the fast) into the “al-mi’dah” (a reservoir or stomach) as that is the designated place where food substances is processed into products which benefits the body. In other words, it can also be denoted as inserting any items that can nullify the fast through a passage or cavity into the body. 

Acts which nullify the fast (for patient): 

1. Injecting substances which are considered as “food material” into the body. (eg: Glucose) 

2. Inserting any material through a passage into a cavity in the body (Jau’f) 

Acts which do not nullify the fast: 

1. Eye or nose drop (for medication purposes) 

2. Using an instrument to look into the throat provided that no “fluid” enters with it. 

3. Placing a medication underneath the toungue (eg: GTN for angina patient) 

4. Placing a medical instrument into the womb for the purposes of inspection or 

    treatment of a condition. 

5. Placing a medical instrument into the bladder for the purpose of treatment. 

6. Placing a medical instrument into the intestine for the purpose of inspection and 

    treatment (eg: colonoscopy provided that no “fluid” is entered into the site) 

7. Dental treatment (eg: removing tooth, plastering or cleaning) provided that no “fluid” is

    swallowed. 

8. Mouthwashing or spraying any medication into the mouth provided that no “fluid” is

    swallowed. 

9. Injection of intravascular (IV), intramuscular (IM) or subcutaneous (SC)medication is 

    allowed. 

10. Oxygen mask and nebulizer is allowed. For the usage of inhaler; there are two 

      schools of thought. Firstly, the act falls under the hukm of nullifying the fast because 

      some of the medication enters into the stomach and to certain extend can give 

      energy to the body. Secondly, the act does not fall under the hukm of nullifying the fast 

      because the main purpose of taking an inhaler medication is so that the medication

      would  majorly enter into the lung (with proper usage technique) and the minute 

      amount of medication which enters into the stomach does not provide the body

      energy during fasting. An individual is allowed to hold on to any one school of thought

      as both are generally accepted according to one’s preference and confidence. 

11. Anesthetic is allowed. 

12. Any medication/ creams / patches that are able to be absorbed into the skin is 

      allowed. 

13. Contrast material for angiogram purposes 

14. Biopsy provided that no “fluid” is entered into the site. 

15. Epidural injection (into the spinal cord) is allowed. 

16. Vomiting accidently does not nullify the fast. 

17. Hemodialysis does not nullify the fast. 

References

1.   Notes and Presentation prepared by Ustaz Ismat Nazirin bin Mat Isa 

2.   Al-Maqasid Al-Shari’ah (The Objectives of Islamic Law) wriiten by Mohammed 

      Hashim Kamali (a Professor of Law at the International Islamic University Malaysia) 

3.   Qawa’id Al-Fiqh (The Legal Maxims of Islamic Law) wriiten by Mohammed Hashim

      Kamali (a Professor of Law at the International Islamic University Malaysia)

Prepared by,

Saifullah

IMU Fiqh Medic 2012

Click here for the summary of Fiqh Medic Part 1

Read More

Fiqh Medic Part 1

Date        : 30th March 2012

Time        : 8.00am - 1.00pm

Place       : Lecture Theatre 2, IMU

Speaker  : Ustaz Ismat Nazirin bin Mat Isa 

What is MAQASID SYARIAH (The Objectives of Islamic Law)? 

The main objective of Islamic Law is to “protect the benefit (of the individual and the community) and to facilitate the improvement and perfection of the conditions of human life on earth” that includes “eliminating prejudice, alleviating hardships and establishing justice”. The Quran and Sunnah is the perfect guidance to life in this world. From it, His Mercy and Compassion (Rahmah) is widely manifested in every word of the Quran and in every action of the Prophet saw. 

It is important for us to grasp the concept of the Maqasid Syariah as to ensure that all our actions and the decision we make is based on a firm understanding of the Syariah (Islamic Law) as implicated in the Quran and Sunnah. Allah does not create His Laws if not for the benefit of His Servants. 

The Classification of Benefit (Maslahah); Divisions of the Maqasid 

Firstly, the Daruriyyah (the essentials). “These are seen as absolute requirements to the survival and spiritual well-being of individuals, to the extent that their destruction or collapse would precipitate chaos and the demise of normal order in society”. In other words, the Islamic Law orders us to pay an extra attention towards 5 matters. These are: 

1. Faith (Islam) 

2. Life 

3. Intellect 

4. Lineage 

5. Property 

The calling for Jihad is an example of protecting our faith or religion whilst Qisas is a way for us to protect our life. Allah forbids us to drink liquor and take drugs as these acts puts our intellect at risk. Allah told us to stay away from any acts of adultery as to protect our lineage. He also forbids us to steal or look for income in the wrong way and this was all in order for us to protect our property in this world. 

The second benefit is known as the Hajiyyah (the complementary). These are the “benefits that seek to remove severity and hardship in cases where such severity and hardship do not pose a threat to the very survival or normal order”. One of the matters that falls under this category is rukhsah or concessions; which clearly reflects Allah’s Rahmah on His servants. A good example of this is the foregoing of fast by the sick or the shortening of Salah for the traveler. “A complimentary Maslahah may be raised to the rank of the essential Masalih (Daruriyyah) where it concerns the public at large, for example the shortening of Salah at battlefield.” 

The third benefit is the Tahsiniyyah (the desirable or embellishments) where there is “further refinement and perfection in the customs and conduct of the people, at all levels.” Good examples of acts are voluntary fasting and supererogatory prayers. 

It has to kept in mind though; in any event of contradiction between two Masalih, it is advisable to sacrifice the lesser benefit whilst assuring that prevention of evil is prioritized over the awareness of the benefit when making a decision. 

The Legal Maxims of Islamic Law (QAWA’ID FIQHIYYAH) 

1. Acts are judged by the intentions behind them (Al-umuru bi-maqasidiha): This is where Muslims are required to demonstrate consistency in faith and practice, and in words and deeds. The acts performed by two individuals may be the same, but the intention behind the act itself will determine its standing in Allah’s judgement. 

2. Harm must be eliminated (Ad-dararuyuzal): This is where unlawful acts are to be prevented irrespective of benefit. For example, a healthy person is prohibited to donate an organ (that he needs to survive) to other people while he himself is still alive. 

3. Certainty is not overruled by doubt (Al-yaqinu la yazulubish-shakk): Whereby the Islamic Law requires an individual to be firmly assertive in the act that he or she is performing as long as it is not against what the Quran and Sunnah states. 

4. Custom is the basis of judgement (Al-addatumuhakkamatun):Certain customary rules may be allowed provided that it is not contradicted with the Shariah, the act is current and is used predominantly by the people in that area. 

5. Hardship begets facility (Al-mashaqqatutujlab at-taysir): Islam is not a religion of burden; it encourages all Muslims to perform religious and righteous acts within his/her full capability. Though there are certain rules and conditions that must be followed of this relaxation in terms of difficulty or hardship (refer to Quran 2:173). 

The Declaratory Law or Secondary law in the USUL FIQH of Islam has many branches and two of them are Azimah and Rukhsah. Azimah is a strict general rule that has been imposed and Muslims are obliged to perform acts that fall under this category. For example, each Salah falls on its own specific range of time and Muslims are obliged to follow them accordingly. On the contrary, Rukhsah is a concessionary law whereby in specific conditions, Muslims are given exemptions or relaxation due to certain reasons. From the Quran, verse 2:185 clearly gives an example of how a certain obligatory act as a Muslim is given relaxation in performing it due to some impediment. 

As soon-to-be medical practitioners, we must always keep in mind that patients are in a state of emergency (Darurat), therefore certain obligatory acts has to be given some relaxation. This is clearly explained together with the fifth Legal Maxims of the Islamic Law; Hardship begets facility. 

The first FIQH MEDIC mostly discusses on various conditions which hinders the patient’s ability to perform a complete perfect ibadat; from the act of performing ablution to Salah itself. Here are some of the examples of cases: 

Q: The patient’s wounds are covered with a bandage at a site of ablution. How can the patient perform a perfect ablution? 

A: The patient should perform ablution normally and skip the area that is covered by bandage. Water should only reach areas of the skin which is visible. If patient is having a difficulty in performing ablution from a water tap, the medical practitioner may assist the process using a normal spray bottle. This is fairly helpful as the water for ablution would still be flowing on the skin and is able to cover a large surface area at any one time. 

Q: If a patient is having a colostomy bag (which contains his urine or feces), would the ablution be valid? 

A: Yes, as long as there is no leakage from the bag. Nevertheless, the patient has to ensure that the rest of his clothing is free of any excrement. A suspicious stain is considered as excrement if its colour, smell and taste is similar to a normal excrement. 

Q: If the patient is wearing clothes that has stains of blood and he has no other extra clothing, are his prayers valid? 

A: If the blood is still flowing, according to The Schools of Syafie, the patient has to stop the bleeding first, then, he or she may continue to pray or perform a new ablution. Though if the patient clearly has no other outfit, then he is allowed to pray in the outfit that he has on provided that it tallies with the requirement of the Islamic Law (not showing any aurat). 

Q: If the patient is not allowed to have water on his skin, how can he perform ablution? 

A: The patient is allowed to perform Tayammum or dry ablution using particles of dust or powder that is literally present on all flat surfaces. It is advisable to use a very fine powder that is visible with the naked eye. A burned patient for example need not have to perform any ablution and he may perform Salah even if some parts of is aurat is seen (as those burned skin cannot be covered with any cloth as it may further cause harm to the delicate skin). 

Q: What is the various position of Salah that is available for different conditions of patients? 

A: A patient capable of standing up should perform his Salah while standing up. If he is incapable to do so, then he may sit. If performing Salah by sitting is hard, then the patient should lie on his right side and pray. If all else fails, or the patient is unable to perform these positions of Salah, then he may lie flat on the bed and perform prayers. Nevertheless, Salah should be performed in a way that one is able differentiate between qiam, ruku’ and sujud. 

Q: If a women is in labour (bear in mind that giving birth to the first child can be as long as 19hours); can she still performs Salah? 

A: There are three types of bleeding (discharge) which makes it ‘haram’ for women to perform Salah. These are the haid (monthly menstrual period), wiladah (the blood that comes out with the baby) and nifas (the thick reddish blood discharge that comes out after labour). If there is any other blood than the ones stated; provided that the labour hours are long and the mother is able tolerate with the labour condition, then it is advisable for her to perform Salah. Nevertheless, if the mother is not in a state of clear thinking due to intense amount of pain, then it is forgiven for her as giving birth is also part of Jihad.

References

1.   Notes and Presentation prepared by Ustaz Ismat Nazirin bin Mat Isa

2.   Al-Maqasid Al-Shari’ah (The Objectives of Islamic Law) written by Mohammed

      Hashim Kamali (a Professor of Law at the International Islamic University Malaysia)

3.   Qawa’id Al-Fiqh (The Legal Maxims of Islamic Law) written by Mohammed Hashim

      Kamali (a Professor of Law at the International Islamic University Malaysia)

Prepared by,

Saifullah

IMU Fiqh Medic 2012

Click here for the summary of Fiqh Medic Part 2

Read More