Transcript aksoy-ABC2007

Public Health and Its Ethical Aspects in Ottoman State
-Some Good Examples for the Modern Age-
Sahin Aksoy M.D., Ph.D.
Harran University Faculty of Medicine
Department of Medical Ethics and History of Medicine,
Sanliurfa-TURKEY
[email protected]
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Bursa
Ottoman State (1299-1923)
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Turkish Republic
[29 October 1923]
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Ottoman State had been governed by Islamic Law
(Sharia).
Ottoman State had a unique social, legal and
governmental system.
Ottoman Sultan had been the leader (Khaliph) of
Muslim Nations for centuries.
Ottoman State was a typical Islamic State, and its
application can be considered as the prototype of
Islamic understanding on public health care.
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Public Health in Islam
Public Health Applications in the Ottoman State
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Although it is possible to argue that public health is
as old as humanity, the public health we know is
originated during the industrial revolution of the 19th
Century.
Health care has been sick care, disease care, health
restoration rather than ‘health care’ and health promotion
as an emerging concept for a New Public Health
represents a venue of hope.
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“Nothing can change without changing the whole”
“The body of the Muslim community is just like the body of
the human being: if one organ got diseased, the whole body
will suffer and develop fever, sleeplessness and weakness.”
Prophet Muhammad
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Distribution of health services is central to the new
health promotion.
Justice and equity at all levels of human relations
and interactions are the basic message of Islam.
It is the most important of the supreme values of
Islam and is the first principle of social life.
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Three Main Institutions
 Hisbah
 The Muhtasib
 Waqf
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Hisbah
In an Islamic State, in order to make sure that the
system works perfectly Hisbah system should be allowed
to function.
The Hisbah is a religious institution under the
authority of the state that appoints people to carry out the
responsibility of enjoining what is right and forbidding
what is wrong.
The purpose of this is to safeguard society from
deviance, protect the faith, and ensure the welfare of the
people in both religious and worldly manners according
to the Law of God (Allah).
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Muhtasib
If Islamic law is applied properly, then inequities in
health care provision should not be allowed. This is a
function that requires direct attention of the head of state
and his subordinates, high judiciary system and Muhtasib.
The Muhtasib is a municipal officer responsible for
public morals and regulation of markets.
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Muhtasib
He should make sure and report about that safe water
supply is provided to people, sanitary conditions are
adequate, living and housing conditions are satisfactory,
provision of food to the markets is flowing, drugs are
available, and prices are reasonable and are not a cause for
depriving the people from the essentials.
He should collect data and monitor the feelings and
satisfaction of people towards the basic public services and if
they have any complaints.
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“The Muhtasib"
by Caroline Stone,
illustrated by Penny Williams
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Waqfs
Another important aspect in the reorientation of
health services is the financing constraints facing
governments.
Islamic system of Waqfs (endowments) was an
important means of ensuring and granting revenues for
all vital social and health services in Muslim
communities.
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Waqfs
The great Islamic libraries of the 10th and 11th
centuries, the foundation of mosques, hospitals, health
care institutions and the pay for the health
professionals and their needs for scientific writings and
publishing as well as teaching students during an
extended period of Islamic governance from the 9th
and up to the 18th century, all ensured their functions
actively through Waqf as well as Zakhat funds.
Zakhat: Every adult Muslim is obliged to
donate 1/40 of his/her personal wealth each year to
some in need or to an institution.
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Environment
The protection of natural environment and the
conservation of natural resources are top issues to be
addressed in any health promotion strategy.
Although Islam suggests humans as having
dominance on nature, it is not through opposition; its
sacred views stress the complementarity of all
phenomena.
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Islam makes emphasis that people should live in
an environment that is clean, beautiful and peaceful.
“God loves those who keep themselves pure and clean.”
Holy Qur’an; Chapter: 3, Verse: 104
‘God is beautiful and loves beauty.’
‘Purity/Cleanliness is half of the faith.’
Prophet Muhammad
Prophet Muhammad
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Ottoman Empire
The Ottoman Empire had a long history of
tending to the health of its population through
subsidized health institutions.
Sultans
endowed
religious
charitable
foundations (waqfs) that sponsored medical and social
service complexes.
Records show that the most significant portion
of hospitals’ expenses went simply to the provision of
food for patients.
There is also evidence that the state attempted
to regulate public nuisances, such as slaughterhouses,
that could pose a threat to sanitation and health.
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Ottoman Empire
The
Provincial
Municipal
Law,
which
restructured local government throughout the Ottoman
Empire, entrusted municipalities with significant public
health duties.
The general duties of municipal councils covered
a wide array of public health responsibilities, including:
 The removal of refuse;
 The establishment of suitable public markets:
 The supervision of inns, coffee shops, festivals, and
other public places;
 The verification of the weight and cleanliness of
bread and flour;
 The prohibition of the sale of spoiled meat; and
 The supervision of sanitation in slaughterhouses. 20
Ottoman Empire
Although municipal government, and not the
central government, was the primary enforcer of public
health standards under this system, the presence of a
national law setting the standards for public health and
hygiene is significant.
With the Provincial Municipal Law, the central
government thrust itself into the field of public health,
even if it would rely on municipalities to work out the
details and to exercise primary enforcement power.
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As a conclusion, it is possible to argue that
Islamic principles and institutions are ideal to
provide a well organized and ethical public health
services. This was demonstrated in different Muslim
communities since 10th Century, and Ottoman
Empire was a good example among these states.
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