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Ethics of the Medical Profession from the Islamic Viewpoint
Dr. Hossam Arafa
The medical profession has
been characterized since its dawn in history by the tremendous
responsibilities its practitioners shoulder: extensive knowledge,
proper morals, performance dedication, self-denial, and mercy
towards all people without discrimination.
Medical ethics draw their
essence from Islamic teachings, which call for honesty, sound
performance, and God consciousness in every act. They also
accommodate what is commonly recognized as noble characteristics and
upright traditions, evolved from local heritage and imparted from
other cultures, but not contradicting the laws of Islam.
The regulations governing the
practice of the medical profession stipulate that the physician must
practice his profession for the benefit of the individual and the
community within the framework of respecting man's right to live,
safety and dignity. And, he must observe in his practice the upheld
customs and traditions of the country.
The physician has certain
obligations towards his community, patients and colleagues.
The Honor of the Medical Profession
Islam has made the preservation and
welfare of a human being in second place after the preservation of
religion: it forbids killing except by rights; it adjudges reprisal;
and it prohibits attempts on others' lives. The Almighty says: "And
if anyone saves a life; it (his act) would be as though he has saved
the life of all people."
The medical profession
touches on the human soul, man's health and life, in order to
protect it against what may render it impaired or extinct, while it
endeavors to safeguard the human mind against what may render it
incompetent and ruined. Therefore, it has become one of the noblest
and most honorable professions. Al-Shaf`i, the renowned Muslim
scholar and jurist, said: "People cannot dispense with two groups of
individuals: the scholars for their (the people's) religion, and the
physicians for their (the people's) bodies." Since the physician is
committed to the task of preserving human life, then he holds a
matchless honor and an incomparable standing. If this is his role
and this is his standing, then he must maintain a typical, ethical
performance that distinguishes him as a practitioner of one of the
most respected and honored professions.
Physician's Personal Qualities
First: Sincerity
The physician is usually confided in
by a patient, his family, his relatives, and by the community at
large. This confidence placed in him by the community and relatives
requires him to be sincere in his treatment and counseling. He
should, above all, seek to please Allah for his efforts.
Second: Honesty
The physician is entrusted
with the souls and the privacy of others. It is a trust he should
hold properly. In describing the believers, Allah the Almighty said:
"[they are] Those who faithfully observe their trusts and their
convents." Keeping patients' information in confidence is a sign of
honesty.
Third: Truthfulness
The physician must be
truthful when he speaks, writes or testifies on any issue. He should
guard against kinship or friendship ties, or inclinations of greed
or fear that may tempt him to give a testimony, report or speech
that he knows is contrary to the truth.
The Messenger of Allah, peace and blessings of Allah be upon him, was asked what the worst thing in the sight of Allah was. He said: "Associating partners with Allah and disobeying one's parents." The Prophet kept silent for a while and then said, "And so is presenting a false statement, and so is presenting a false statement." Narrated by Al-Bukhari and Muslim.
Promise-keeping and being punctual in
appointments are signs of truthfulness.
Fourth: Compassion
and Sympathy
The physician should
be sympathetic with his patient's feelings and feel pity for his
sufferings. Apart from dealing with him gently, he must be courteous
and kind to him. When talking to him he should not incorporate
anything that may render him weak or helpless. He should note the
difference in the patient's psychological condition and administer
the proper techniques that would help relieve his fears.
Fifth: Patience and
Tolerance
The medical profession
is a demanding profession. It entails dealing with people from all
walks of life and it requires exercising a lot of patience and
tolerance. These are two qualities a physician must equip himself
with. The physician must tolerate patients' manners and must abstain
from reciprocating harm by refusing, for example, to treat a patient
or diminish his right to be cared for.
Sixth: Humility
The physician should be modest in his
practice. He must not be arrogant or disdainful to his patients, no
matter what background they come from. Rather, he should show
respect to all of those who deal with him - patients and guardians
alike. Such modesty will be met with respect from others. Besides,
he who acts modestly for the sake of Allah, Allah will raise him in
the eyes of others.
Duties of the
Physician
The physician, in
safeguarding the public's interest and through the practice of his
profession and the available resources at hand, shall spare no
effort to contribute his share in serving the community and
realizing the following objectives:
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To practice the profession
to the highest possible level of knowledge, expertise,
truthfulness and honesty. To keep abreast of advances made in his
specialization.
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To care for community
health through proper health education.
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To contribute in improving
the health services that are provided to the community in his
place of work or by other health institutions.
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To contribute, whenever
possible, in studying health problems in the community, and to
propose the relevant proper solutions, for example smoking, drug
addiction, road traffic accidents, and infectious diseases.
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To actively participate in
medical research and surveys that yield benefit to the community.
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To be committed in
cooperating with the authorities entrusted with the task of
health, and safeguarding and notifying them of communicable
diseases or epidemics.
Duties of the Physician Towards Patients
The
physician is expected to fulfill, skillfully and proficiently, the
necessary medical service to his patients via the following:
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Being a good listener to a
patient's complaints and understanding his suffering.
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Avoidance of arrogance or
contempt towards the patient or dealing with him as an object of
ridicule or mockery, whatever his educational or social background
may be.
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Respecting the patient's
views and in particular views that touch him personally. This
respect should not dissuade the physician from advising the
patient on his disease.
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Treating the patient
equally without any discrimination on grounds of their difference
in social position, rank, or personal feelings towards him.
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Examining the patient
gently, observing the "patient undressing code", and limiting the
examination to the necessary parts of the body to reach a proper
diagnosis. (Necessity is measured by its extent.)
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Requesting only the needed
investigation without adding additional tests not warranted by the
patient's condition.
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Restricting the
prescription of medication, or surgically operating on him, to
what the patient's condition warrants.
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Abstaining from any
practices that may harm the patient such as the utilization of
scientifically unrecognized diagnostic or therapeutic procedures.
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Striving to be open and
truthful in advising the patient or his trustee of the illness,
its causes, complications, benefits of the diagnostic and
therapeutic procedure, and explaining to him clearly the available
alternative diagnostic and therapeutic approaches.
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Resorting to his humane
judgement in deciding the merit of either telling a terminally ill
patient of the whole or partial truth about his prognosis and
complications; or only telling patient's next of kin if he finds
it is in the patient's best interest.
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Exerting utmost care in
writing medical reports that serve the right purpose. He should
neither exaggerate nor diminish the problem.
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Abstaining from committing
infringements of religious rules, such as staying alone with a
woman behind closed doors or inspecting the genitalia and such
like alone under the pretext of doctor-patient relationship.
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Referring the patient to
another physician who can provide specialized treatment, if he is
unable to provide it. The physician should not hesitate to refer
the patient to another physician if his condition demands so.
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Furnishing the necessary
information needed for the treatment of the patient when he refers
him to another physician.
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Helping the patient in
obtaining the necessary reports and information, should the
patient seek the opinion of another physician in respect of his
illness.
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Allowing the patient to
consult an alternative physician and to have information in his
file or a detailed medical report explaining his medical
condition.
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Prescribing continuous,
quality medical care to patients with terminal or incurable
diseases until the last moments in their lives.
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Ensuring that the patient
receives the necessary medical care even during his absence, and
extending the necessary treatment to the patient in emergency
conditions till he is relieved or the care is transferred to
another qualified physician.
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Reporting any practice,
which conflicts with the law or the ethics of the profession once
he becomes certain of its occurrence.
Keeping a Patient's
History Confidential and Protecting it
Islam has commanded to keep secret and not
disclose any wrong doing as long as it will not lead to mischief in
society. Knowing a patient's secrets does not entitle the physician
to divulge or hint at them in any way that exposes those secrets
except in the following situations.
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If disclosure to the
patient's relatives or others is beneficial to the patient's
treatment or to those who come into contact with him, in order to
protect them from e.g., infectious diseases or drug addiction. In
this case disclosure should be limited to those who may be harmed
or should know the patient's condition.
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If disclosure will benefit society or remove any harm. Disclosure of data can be communicated to the authorities concerned and in instances such as:
A. Notification of death resulting from criminal
act, or for preventing a possible act of crime.
B. Notification of
communicable or contagious
diseases.
C. Refutation of
an allegation raised against the physician by the patient or his
relatives, smearing his proficiency and the way he practices
medicine. Disclosure shall take place only before the authorities
concerned. -
Responding to a court order.
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Sufficing educational needs and only within the
necessary limits.
Patient's Consent
The physician
must obtain consent from the patient he is treating. Consent may
assume the following forms:
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Consent of a
patient of legal age (male or female) or his
agent - if the patient's will is passive - shall be obtained
prior to any surgical or medical procedure and in accordance with
the health authority concerned.
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Woman's consent:
A woman of legal
age may give her consent to have any medical procedure done to
her including a surgical procedure. Consent of the husband regarding reproductive
issue should be obtained.
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Consent of an incompetent person:
Consent from the legal guardian of
a patient who cannot give his consent because he is either unconscious,
a minor, or mentally incompetent must be obtained; otherwise, consent must
be obtained through government.
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Consent in emergency situations:
If the
patient's life is in imminent danger, the physician may carry out a
medical or surgical procedure without waiting to obtain his
permission if it is established by him that this procedure will save
the patient's life or remove the hazard, provided that the observed
rules are adhered to.
Apology to Patient
for not Treating Him
A physician, in non-emergency
situations, may abstain from treating a patient for personal or
professional reasons provided that such abstinence will not harm the
patient's health and an alternative physician is available.
The Physician and his
Professional Colleagues
The
relationship of the physician and other members of the medical and
paramedical practitioners shall be based on brotherhood,
co-operation and mutual
respect. The physician must refrain from scoring, belittling or undermining
other colleagues' abilities, scientific, or experience with the aim of luring
patients away from his colleagues.
The physician should look
upon other physicians and medical colleagues as members of a
brotherhood working together for a noble goal. In fact, they are
working together with their varied medical specialties for the
welfare of community health. Some members of this team work out the
preventive aspects of medical practice, while others engage in the
active management of diseases,
but both
contribute to the patients' wellbeing.
Therefore a
physician shall observe the following:
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Good behavior with other colleagues and treating them the way
he likes to be treated.
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Refraining from malicious acts against his colleagues,
backbiting or following their pitfalls.
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Avoiding direct criticism
of his colleagues, especially in the presence of their patients in
order
to convince the patients to change their physician, or out
of sheer envy. Constructive scientific criticism shall be kept strictly within
scientific meetings, conferences and periodicals.
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Due efforts shall be paid to aspects of training
and educating his medical team.
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Care shall be exercised to benefit them with his experience,
knowledge and skills. Moreover, they should be given ample chance to
learn and enhance their skills.
Continuing Medical
Education
The constant change in
medical knowledge makes it incumbent upon the physician to continue
learning throughout his life. This is an individual responsibility requiring
him to acquaint himself with recent advances made in medicine in
general, and those pertinent to his specialty in particular. He should
not lose any chance to increase his knowledge because
his competence in treating patients is affected by his diligence, literacy or
ignorance.
He should realize
that learning, in addition to its value when employing it in
diagnosis and treatment, is in itself a supplication and a tangible
implementation of the Glorious Qur'anic guidance revealed by Allah
the Almighty in his saying: "And say, O' My Lord, increase my
knowledge."
Conducting Research and Studies on Human Subjects
It
is not permissible to conduct medical studies on a
human subject, honored by Allah the Almighty, unless certain
strict conditions are met:
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Conducting such
studies should not entail any harm on man's life,
health, or sexual reproduction.
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Informed consent should be
obtained from the subject and he must be made fully
aware of consequences and the possible harm, if any,
that may affect him.
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The subject should be
legally competent, i.e. an adult of statutory age and sane in
mind. Consent of legal guardian of a legally incompetent
person should be obtained.
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It is totally unallowable
to resort to pressure, force, or exploitation of one's need
for money or medication when obtaining the consent to
carry out a study.
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Permission must be obtained from the
designated authority trusted with research and experiments in the
institution where he works.
Conducting Research
and Experiments on Animals
Islam
has commanded kindness to animals. It is reported that the Prophet,
peace and blessings of Allah be upon him, said: "A woman is taken to
Hell because she locked up a cat: she neither fed it nor left it to
eat what sustenance it might find on the ground."
The
Prophet, peace and blessings of Allah upon him, said: "Allah has
demanded skillful accomplishment in everything: when you kill, kill
skillfully; and when you slaughter, slaughter skillfully; [Should
you do it] sharpen your blade and soothe your kill."
In
view of this, conducting experiments on animals should:
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Be validated by a noble
objective that contributes to medical advances.
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Not cause any torture to
the animal and the pain should be alleviated whenever possible.
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Not to be carried out
aimlessly.
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Permission to perform experiments on animals must be obtained from the designated authority in the institution where he works
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