Transcript James Rusthoven - PowerPoint (2nd)

Islamic Traditions and Biomedical Ethics
Highlights of Islamic Bioethics Conference at U of
Michigan – Apr 2011
J Rusthoven
July 2011
Highlights – Interdisciplinary Conference
on Islamic Bioethics
• Participants: Physicians, Nurses, Islamic
Scholars, Imans, Jewish and Christian
observers
• Bioethical Discourse in the US – Howard Brody
– What role should religion play in bioethics?
– Should consider as lived experience, not static
tradition; shaped by multiple cultural inputs
– Religious vs Secular: terms are contested, in flux
Bioethical Discourse - Brody
• John Rawls as exemplar of liberal view – individual
rights
– Justice as fairness – rights equally to all – need minimum
basic moral principles via rationality and mutual
disinterestedness
– Religious views not welcomed in public square because
risk causing disruption
– All participating in public discourse leave comprehensive
doctrines (private moralities) at the door
– Later, considered advantages to sharing traditions but
must go back to reason to maintain civility
Responses to Rawls
• Martha Nussbaum
– Accept diversity, encourage honesty, humility, and
mutual respect
– Exercise right to express own views in public
• Habermas
– allows more religious views but not for policy making
– ‘institutional translational proviso’: requirement to
connect religious reasons with secular ones – secular
reasons have priority
Transplanting Bioethics into Different Cultures
Raymond De Vries (U of M)
• Ethical Ideas can be transplanted in three ways:
– Adopted wholesale
– Mold and Alter
– Principles just begin the conversation
• Compared missionary and bioethicist
– Can be helpful or harmful
– The Gospel is like the Belmont Report
• Concern about Islam
– looking too accommodating with principlism
– should make more effort to develop own ethical framework
The Uneasy Relationship between Health Care and
Religion in the US
Robert Vischer, JD
• In law, moving to professional ‘servicing’ the public
• Trend away from negative rights (don’t interfere; do no
harm) toward positive rights (right to help others)
• Trend toward providing service even if against conscience will continue to be difficult for Muslims to live out their own
consciences
How Sunnis Respond to Bioethical Dilemmas
Shaykh Musa Furber (Abu Dabbi, UAE)
• All principles can be distilled to: warding off harm – focus should
be on religious person and his Lord
• Jurist/Judge – make judgments on various issues with much
input from physicians – designated by local political authority
• Mufti – the one making a judgment – counsels individuals on
practical bioethical matters
• Mushti – the one asking for the judgment
• Figh – the body of prior judgments and ruling used for future
rulings
• Figh Council – non-binding, recommend as guidance
Recommended Research Method
• Gain understanding of issue, use local specialists
• Gather evidence and opinion
– Qur’an, prophetic narratives, scholarly consensus,
statements of Companion and successor, classical figh
literature, ruling from figh councils, etc.)
– if no precedent found, fall back on starting point of
autonomy, beneficence, justice
Recommended Research Method
• Fatwa process
– Petitioner describes problem or event
– Mufti identified known legal issue similar to the
event
– Mufti checks if precondition, essential elements have
been included
– Mufti look at petitioner’s circumstanced to ensure
they apply
– Ruling that realizes the petitioner’s needs
– Rulings non-binding; can get second Mufti opinion
Role of Shiite Iman in Bioethical Consultation
Iman Hassan al-Qazwini
• Islam very diverse; denominations within Sunni and Shia groups
• Shiite community ~ 20% of Muslims; largest communities in US
in LA and Detroit areas
• All forms of human life before and after birth of equal value
• No justification of termination of life so no forms of abortion
permitted
• Definite predestination = terminal cancer – all in hands of God
• Indefinite = patient has role and responsibility in deciding health
Shiite Perspective on Bioethical Issues
(majority of scholars)
• Must make every effort to save a life, even just extending hours or
days
• Don’t know if unconscious patient is spiritually suffering so must
keep on respirator to allow any lingering spiritual struggle
• No concept of ‘brain death’ – all signs of life must cease before
officially dead – tremendous pressure from ICU teams
• Judgment (Fatwa) of jurist is binding – Iman is bioethical leader
and reference point on where community stands on bioethical
issues
Q&A
• Q: Local Muslim MD – Why is there no ruling in Islam
on female circumcision?
• A: Sunni scholar - There is but in Arabic - go learn
Arabic! – Comment: Muslims need to be more
informed about Qur’an and other Muslims
authoritative texts
• Q: What is Sunni position on D/C respirator?
• A: Can D/C if no hope (not all Sunni scholars agree)
Q&A
• Dilemma: In Islam, taught to abide by law of the land –
brain dead = dead?
• Iman Ans: can compromise with issues of state law vs
Islamic law
• Shiite Organ donation:
– Can donate only internal organs when alive (e.g., not eyes)
– Can’t donate essential organ (heart) while alive
– Sunni scholar comments: similar with Sunni but no allowance
for payment for donation
• Q: Muftis don’t always give informed advice
• A: Get second opinion
Not Quite Dead: Why Egyptian Physicians Contest the
‘Universal’ Criteria of ‘Brain Death’
Sherine Hamdy
• Increased rate in renal failure, thought due to
industrial pollution, causing great need for renal
transplants
• Problem with cadaveric procurement of kidneys
• Islamic MDs blocking nat’l legislation on brain death
Role of Muslim Physician in Bioethics Discourse:
A Risk/Benefit Analysis
Medicine
Islamic Ethics
• Life: Before and after birth
• Life: Before birth, after
birth, after death
• Improve quality of life –
extend length of life
• Improve quality of life –
minimize risk to life
• End-of-life care
• End-of-this-life care
• Risk in medicine = harm
• Risk for Islamic MD =
concern for sin
Islamic Applied Ethics and the Future Approach
Tariq Ramadan
• In each generation, God will provide for experts to re-interpret
written revelation in context of the day – no new revelation
• Questions whether primary focus of moral knowledge should be
scriptural sources
– Text-context always linked
– Gaps in written text where believer must sort out problem
• Need to accept interpretative diversity in Islam (e.g., 14 diff.
opinions on what texts say about euthanasia)
• Current state of Islamic discourse in bioethics: segregation of
Islam and science – what is ‘Islamic’ in Islamic science?
• Needs to be reconciliation between sciences and Islamic ethics
Islamic Applied Ethics and the Future Approach
Tariq Ramadan
• Islamic mission: reform self and the world
• Some Suffi say just be interested in renewing self and protect
self from the world
• Two kinds of reform: Adaptational vs Transformational
• Scholars of the context should be the authorities of the
discipline such as bioethics. But no consensus on consensus
• In the West, perhaps better opportunity to address
contemporary challenges than in other parts of the world
Case
Najah Bazzy, Nurse specialist in cultural diversity (One parent
Shiite, on Sunni)
• 35 y/o Muslim male with brain damage from stroke
• Wife becomes uncommunicative – primary extended family killed
in Iraq
• Six young children unable to discuss issues of brain death
• Brain dead for remaining family means only brain dead
• Shiite MD in charge – uncomfortable signing off to Sunni MD who
felt should D/C respirator (felt soul would be in peril if signed off)
• Transcultural nurse specialist asked for scholarly review
Case (con’t)
• Shiite scholar felt soul could be on journey and only God could
decide time of death
• Final opinion: stopping respirator would be murder
• Second Shiite scholar suggested make funeral arrangements and
stop ventilator – speaker suggestion: focus on patient and family
desires
• Stressed helping family have peace and forgive selves for not
saving the life of their loved one
What Has Religion to Do With Practice of Medicine?
Farr Curlin (U of Chicago)
• Motivated to care for the sick and have sense of what
human flourishing entails
• Clinicians must act as practical moral philosophers
• False sense that can keep separate private and professional
parts of life (private vs professional moral beliefs)
• Need to consider more public awareness of how practice
affected by religion
Is There an Islamic Bioethics?
Abdul Azziz Sachedina (Shiite)
• Need to empower Muslim caregivers to think through bioethical
issues from Islamic hermeneutic – more reliance on own
conscience
• Encourages interfaith cooperation
• Do not harm connects all human beings
• Muslims can’t live in isolation anymore (cites David Novak’s
appeal to covenant)
• Need to standardize responses in Islamic community (? Islamic
Council)
Q&A
• Furber: is each Muslim his own final judge in
democratic society?
• Ans: Increase exchange of knowledge and views in
each community – for Sunnis, each fatwa not binding
but discourages fatwa shopping
• Ramadan: primary task of Muslim is to be a witness
and example, not to convert – concerned many
writings not used or known that may help current
issues
Different Cultures – One World
Dialogue between Christians and Muslims
about Globalizing Technology
Eds. H. Jochemsen and J. van de Stoep (Amsterdam: Rozenberg, 2010)
Extra Slides
Controversies in Islamic Law and Ethics – Sherwin Jackson
• Four Historical Stages
– Moral Objectivism
• Reading nature objectively with help of written revelation
• Currently movement back to this but acknowledging plurality
of Muslim views
– Theistic Objectivism (mainly Sunni tradition)
• Moral judgments originate in us, not created order – no
objective moral index – moral judgments are products of our
culture, traditions, upbringing
– Traditionalist
• Situation-dependent – some situations may only need
reason, intuition, or ‘common sense’ rather than revelation
– Modernity/Postmodernity
• Morality by consensus of informed reasonable persons