Friday, February 16, 2024

Diabetes and Fasting - Medical and Fiqh Guidelines

Diabetes and Fasting 
-Dr. Mohd. Habeeb Haris MD (Consultant Radiologist and Alim graduate)

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterised by sustained high blood sugar levels.

Fasting in Ramadhan is one of the five pillars of Islam and is an obligation on all adult Muslims in general, unless they have a valid Shara'i excuse. Fasting can be accompanied by significant changes in: both energy and nutritional intake; in the diet composition; in the working hours; and the usual way of life, which can cause significant metabolic and physiological changes to occur, leading to significant impact on the management and complications of diabetes. The drug doses and timings also would need to be altered.

Diabetic patients are at a high risk for development of a wide range of potential fasting-related complications such as dehydration, hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). It should not be overlooked, however, that fasting can be quite beneficial for certain diabetic patients provided that they strictly adhere to the evidence-based guideline and pious physicians’ advice. [Effects of Ramadan Fasting on Social, Psychological and Physical Well Being to Health. International Journal of Contemporary Microbiology. 2015;1(2):25–29]

Current world data show that 4 Muslim-majority countries are ranked within the top 10 diabetes worldwide prevalence. These countries are Pakistan (prevalence 30.8%; rank 1), Kuwait (prevalence 24.9%; rank 2), Egypt (prevalence 20.9%; rank 8), and Qatar (prevalence 19.5%; rank 10).
[Wisevoter, “Diabetes rates by country 2023- wisevoter,” 2023, https://wisevoter.com/country-rankings/diabetes-rates-by-country/]

Since a significant number of Muslims globally have diabetes, many of whom would be fasting in Ramadhan every year, the medical professionals need to be aware of their specific medical needs and the need for providing appropriate medical guidance to such patients. The most important of this is to answer the question - can the diabetic patient safely fast or not?

It's important to correctly guide these patients, based on sound medical evidence and Islamic requirements. If the doctor goes overboard and prevents all diabetics from fasting, he will be answerable to Allah for preventing people from carrying out an important religious obligation. And if he allows even high risk patients to fast due to religious zeal, he will be legally and morally responsible for any complications the patient may suffer due to it. 

Ultimately, it's for the treating physician to advise and assist the patient in deciding whether he should fast or not. However, to assist the doctors in making a sound decision, the International Islamic Fiqh Academy has given certain guidelines. But these are from 2009, and the newer treatment protocols and devices like continuous glucose monitoring devices and Insulin pumps might enable a wider range of diabetic patients to fast safely. 

The main idea behind these guidelines is to categorise the risk of developing serious adverse effects from fasting. 
The treating physicians should keep all these factors in mind and decide for themselves how much to rely on this risk categorisation while advising their patients.

Guidelines of 
International Islamic Fiqh Academy:

"The International Islamic Fiqh Academy (IIFA) of the Organization of the Islamic Conference, holding its 19th session (in Sharjah, United Arab Emirates, in April 2009) has stated the following (Resolution No. 183 (9/19) regarding diabetes and fasting:

Medical Classification of Diabetic Patients

First Category

Patients with a very high probability to encounter severe complications from fasting, as medically confirmed. The sickness state of a patient of this category falls under one or more of the following cases:

• Patients who face severe hypoglycaemia during the three months preceding the month of Ramaḍān.

• Patients who face repetitive ups and downs in the ratio of blood sugar.

• Patients who encounter the problem of hypoglycaemia unawareness (loss of symptoms of hypoglycaemia), a state which occurs in some diabetic patients, especially those who are classifiable under type I who face repetitive hypoglycemias for long periods.

• Patients who are known for facing difficulty in controlling diabetes for long periods.

• Cases of “Diabetic Ketoacidosis” complication or (Diabetic Coma) complication.

• Patients of diabetes type I.

• Patients who suffer from other severe diseases that accompany diabetes.

• Diabetic patients who have to do work that require hard physical effort.

• Diabetic patients who undergo dialysis.

• Diabetes during pregnancy.

Second Category

This category includes patients who have a relatively high probability of encountering complications on fasting according to the most-likely opinion of physicians. The sickness status of these patients falls under one or more of the following cases:

Those who suffer high levels of blood sugar as when the level of glycated hemoglobin (HbA1c) exceeds 10%.

Those who suffer renal insufficiency.

Those who suffer large artery diseases (such as cardiovascular diseases).

Those who live alone and receive medication through injection of insulin or by sugar control medicines, which reduce sugar through stimulation of the insulin producing cells in the pancreas.

Those who suffer other diseases, making them vulnerable to additional risks.

Old patients who suffer other diseases.

Patients who receive medical treatments that affect the brain.


Shariah Rulings regarding Patients in Categories I and II

Cases of these two categories are based on certainty or “high probability” that fasting will cause grave harm to them, as per the judgement of specialised and trustworthy physicians. Therefore, a patient who faces any of the cases cited above for identification of patients in these two categories should not fast. It is not permissible for him to fast in order to avoid inflicting harm upon himself. Allāh the Almighty said, «And make not your own hands contribute to your destruction,» (Al-Baqarah, 195) and He سبحانه وتعالى also said, «Nor kill (or destroy) yourselves for verily Allāh hath been to you Most Merciful.» (Al-Nisāʾ, 29) The treating physicians should explain to patients of these two categories how fasting is risky for them and enlighten them about the high probability that they may face complications which could – most likely – be serious to their health or lives. Physicians should also adopt all possible suitable medical procedures, which could enable the patient to fast without facing harm.

Rulings that relate to non-fasting in Ramadan for sickness excuse shall apply to patients in categories I and II in compliance with the directives of Allāh the Almighty Who said, «But if any of you is ill, or on a journey, the prescribed number (should be made up) from days later and for those who can do it (With hardship), is a ransom, the feeding of one that is indigent.» (Al-Baqarah, 184)

If the doctor (after a thorough medical assessment) warns the patient that there is a high or very high risk of serious complications, then the patient would be sinful for fasting against such advise, but his fasting is valid.

Third Category

These are patients who have the medium probability of encountering complications from fasting. This category includes diabetic patients whose cases are stable and well controlled through suitable medicines that reduce sugar by stimulating the insulin producing cells in the pancreas.

Fourth Category

Patients who have low probability to encounter complications from fasting. This category includes diabetic patients whose cases are stable and well-controlled through diet only or by using medicines that reduce sugar by increasing the efficacy of the insulin in the body without stimulating the insulin-producing cells in the pancreas.

Shariah Rulings Regarding Patients in Categories III and IV

Leaving the Fast during the month of Ramaḍān is not allowed for patients in these two categories since medical findings do not indicate harmful complications that could affect their health or lives. Contrarily, some of these patients could even benefit from fasting. So, they should fast.
Physicians have to stick to these rulings and decide suitable treatment for each case separately.

Recommendations

1. Physicians are required to have a suitable degree of knowledge about Shariah rulings relating to this subject. This necessitates the preparation of such material by relevant bodies and disseminating it among those who need it.

2. Fiqh scholars and Islamic preachers are requested to advise fatwa seekers to consult physicians who know medical and religious dimensions of fasting and who fear Allah the Almighty in providing advice on a case by case basis.

3. Due to the severity and seriousness of dangers that could originate from complications of diabetes in case of fasting, and which could badly affect the health and lives of diabetic patients, guidance and information should be provided through all possible means, including sermons at mosques and through mass media, in order to enlighten patients about the rulings above; raising awareness about the disease and how it can be dealt with is essential to mitigate its effects and make it easy to accept Shariah rulings and medical advice pertaining to it.

4. IOMS, in cooperation with the Academy, should assume the task of preparing an information booklet on this subject in Arabic and other languages (spoken by Muslims) and work for its dissemination among physicians and Fiqh scholars, and make it available online for patients to benefit thereof.

5. Calling upon ministries of health in Muslim countries to launch national programs in areas of prevention, medical treatment, medication and awareness about diabetes and their Shariah rulings." [End of quote from IIFA]

Conclusion:
So, before deciding whether to fast or not, the patient should consult a knowledgeable and God-fearing doctor and also consult a good Islamic scholar, so that a correct decision can be taken from both medical and Islamic perspective.

                       
 Summary chart from Shaikh Dr. Rafaqat Rasheed's lecture on Fiqh of fasting.

Trial Fasting when in doubt:

When there is some doubt on the ability (and safety) of the patient to fast, Shaikh Dr. Rafaqat Rasheed (General Practitioner and Islamic scholar from UK) suggests trial fasting for diabetics and patients of other chronic diseases before the month of Ramadhan (preferably in Shaban) so that they can get an idea if they can safely fast or not. 

Diabetes education and Ramadhan fasting

"In all patients with diabetes, Ramadhan-focused education is of paramount importance for heightening their awareness of the possible associated risks, and formulation of effective strategies to minimise them. High-risk individuals who choose to fast should have access to ample education and support so that the potential risks, particularly those of hyper- and hypoglycaemia can be minimised. It should be emphasised that in all educational programs, optimal blood glucose monitoring should be considered as the principal consideration for minimisation of the risk of complications.

Prior to Ramadan, clinicians should perform a comprehensive evaluation and assessment for all patients with diabetes who intend to fast during Ramadan, and consider individualised approaches for their patients.

Lifestyle and diet modification
can be considered as another key component of Ramadan Fasting education in individuals with diabetes. The fasting-feeding nature of the ritual can predispose diabetic patients to hypoglycaemia during the day and hyperglycaemia after iftar at night. In most Islamic cultures, consumption of high-calorie, high-fat, and carbohydrate-rich meals, confectionaries, and beverages is commonplace in Ramadan, which can adversely affect blood glucose levels and increase the risk of development of hyperglycaemia and related complications. This should be strongly discouraged in all educational programs.

Moreover, due to the high risk of hypoglycaemia and dehydration, patients with diabetes should be prohibited from strenuous exercise, particularly late in the evening and before iftar. Patients should also be informed that consumption of large amounts of high glycemic index (GI) carbohydrates and alternations in physical activity and sleeping patterns can lead to weight gain during Ramadan.

 Symptoms of hypoglycaemia and hyperglycaemia should be clearly explained to diabetic patients, and they need to be thought to measure their blood sugar and immediately discontinue fasting if they develop.  They also need to be advised that, in case of hypoglycaemia, a small amount of a fast-acting carbohydrate (a glass of fruit juice) should be consumed, and they need to retest their blood glucose levels again after 20 min."

"Drinking large amounts of water and liquids before dawn (at suhur time) should be discouraged, and instead, moderate and continuous consumption of water and beverages during non-fasting hours should be promoted."

"The advantages of the use of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) systems need to be mentioned to them, so that they procure and use them if affordable.

The type, dose, and timing of the anti-diabetic medications each patient takes is immensely influential in the management of potential risks involved in their use, but most antidiabetic agents used for treatment of type 2 diabetes are generally considered safe. It should be mentioned, however, that in patients who take several glucose lowering medications, the risk of hypoglycaemia may be amplified. Particularly, in patients who take a basal insulin in combination with a DPP4I, metformin, or other glucose lowering agents, the risk of hypoglycaemia can greatly increase."
(Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update
Ali Tootee and Bagher Larijan- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088403/#CR3 -This article has good details about the management of type 1 and type 2 diabetes in fasting. I recommend it to all doctors treating diabetics)

Fiqh Ruling
(From 'Islamic guidelines on contemporary medical issues' by Mufti Abu Bakar Qasmi)

Concession for Diabetic Patients:

If the doctor opines that fasting is harmful for a patient of diabetes, the patient is allowed to skip or break the fast. If Allah grants him health, he must observe the missed fasts later. If there is no hope of recovery, he should pay fidyah for every fast missed.

Diabetes patient can pay the expiation for fast:

If someone is very old and is having uncontrolled diabetes and is medically not expected to be able to fast in the future too, then he/she is allowed to pay the expiation (fidyah) instead of fasting. (derived from Radd Al-Muhtar: 2/427)

Quantity of Fidyah:

The expiation (fidyah) is to give one Sadaqat al-Fitr or its monetary equivalent to the poor for each missed fast. The expiation amount is half saa’ of wheat, which is equivalent to 1 kilogram 574 grams and 640 milli-grams. (Idhah Al-Masa’il: 90)

Saturday, January 27, 2024

The Talaq and polygamy "bombs":

The Talaq and polygamy "bombs":
-Dr Habeeb Haris

Some husbands and in-laws loosely use the threats of "talaq" and/ or "second marriage" in arguments/disputes with the wife in order to pressurise her for various things. This is the most ignorant and stupid thing to do as it destroys the family life and causes:

-The wife to forever distrust her husband and makes her feel unstable and vulnerable.

-She will lose all love and respect for the husband and his family.

-If the children hear it, they will hate the father forever.

-Pushes her to go to Aamils and black magicians who can exploit her in many ways.

-If she is not strong in her Imaan and ilm, it can make her detest and hate the Shariah laws which can take her out of Islam without her even realising it, even if she prays Salah regularly and does all other obligations of Islam.

-Can push her to make arrangements for a plan B in case the husband acts on his threats. This can even open the door to extramarital affairs.

-Causes severe mental tension and distress to her which can cause her psychological disorders.

-Can make her fall prey to feminist propaganda.

-Creates a negative image of the pure Shariah and it's family laws in the society.

Please use your tongue carefully. It can destroy your or someone else's life and Aakhirat even. The Shariah provisions of talaq and polygamy should be used responsibly and in a very thoughtful and serious way. It should not be used as a threat to win arguments. Naudhubillah.

If there are any problems in the marriage, the couple should take proper family counseling from the ulama and Muslim family councillors instead of using such cheap and counterproductive arguments. May Allah give us tawfeeq.

Wednesday, January 24, 2024

Fiqh of Using Medicines containing Gelatine

Use of Gelatine in Medicine
Dr. Mohd Habeeb Haris MD

Gelatine is a protein obtained by partial hydrolysis of animal tissues such as skin, tendon, ligament, bone, cartilage and hooves. The product seems to be of a variety and from the technical standpoint, the raw material must be selected according to the purpose intended. Raw materials intended for medicinal use as well as food production are generally skin and bone of cattle, sheep and pigs. 80% of gelatine in Europe is of porcine origin.

Gelatine is used in the preparation of many pastes, and is the main ingredient in all hard and soft capsules. Gelatine capsules are used as a means to deliver drugs mainly via oral route. Gelatine is also used as a binding agent in some tablets and lozenges.

It is also used in many food products such as ice-cream, jellies, chocolates, sweets, jams, pastries and jellied meats. It acts as a stabilising and smoothing agent in foods. (Muslim Food Guide, 97/98 Edition)

Does gelatine go through istiḥala (complete substance transformation)?

Fatwa of Darul Uloom, Karachi:

Maulana Sarfaraz Muhammad, who wrote this fatwa [which is printed in his book ‘Halal Ghiza Jadid Tibb aur Science’ (pages 37 to 52)], presents a detailed discussion on the definition and standard of istihala, and then goes on to determine that gelatine does go through some chemical change but does not go through a complete change of essence. Rather, the essence is exactly the same and has just been broken down much more. He explains the process is more similar to that of cooking the meat rather than any actual structural change. Many scientific references are quoted to support his statement. Below are a few out of the many quoted:

“Conversion of collagen to gelatine occurs during normal cooking of meat, and this accounts for the gelatinous material that is sometimes evident in meat after heating and cooling….” (Food Chemistry pg. 906, Owen R Fennema)

“The transition of collagen to gelatine outlined above occurs during the cooking and roasting of meat.” (Food Chemistry pg. 546, H.D Blitz, Werner Grosch, Peter Schieberle)

He concludes by saying that since porcine gelatine does not go through a complete change of essence, rather, the essence is exactly the same and has just been broken down into smaller fragments, its use is impermissible. (Darul Ifta of Darul Uloom, Karachi, Fatwa No.: 2/1276; Checked by Mufti Taqi Usmani)

Ruling of International Islamic Fiqh Academy, Jeddah:
Question: What is the ruling on using porcine gelatin transformed into other components in foods, in such a way that it renders laboratory identification impossible?

Answer: “It is not permissible to use pig-derived gelatin in foods through the method mentioned above, but it is permissible to use it in medicines if there is no other alternative.” (Resolution No. 225 (9/23), https://iifa-aifi.org/en/6233.html )

Mufti Muhammad bin Adam of Darul Iftaa, Leicester, UK, says:
“If gelatine is derived from pork or an unlawful animal or an animal not Islamically slaughtered, then it is impure and haram. However, if it is derived from a halal source, then there is permissibility in its usage. Most contemporary scholars declare gelatin as unlawful (haram) due to the fact that firstly it is difficult to establish where it’s derived from, and secondly it is mainly derived from pig or haram animal and the change it undergoes is not sufficient for it to be classed as halal. The Islamic Fiqh Academy, Jeddah, Resolution number 23 [1986], considers it as being non-halal.
The ‘chemical change’ that takes place during the manufacture of gelatine is not sufficient to be considered a full transformation (istihala/tabdil al-mahiyya), such as when alcohol transforms into vinegar or when a pig falls into a salt mine and fully turns into salt. Scientifically when meat is cooked, it undergoes structural and chemical change, but remains meat. As such, when pig meat is cooked, it still remains pork and is haram.” (https://daruliftaa.com/food-drink/medicines-with-gelatine/)

However, the Islamic Fiqh Academy, India has a somewhat different view on the issue of gelatine. It decided in the 14th Fiqh Seminar (Hyderabad – A.P) 20-22 June 2004:

“Gelatine is an organic substance, which is a type of protein. It is formed when another protein the Collagen found in the skin and bones of animals undergoes chemical transformation. The substance so obtained takes the form of a different protein, the chemical and medicinal properties of which are absolutely different from that of the Collagen. It is also dissimilar to the Collagen in terms of its colour, smell, taste and other characteristics. In case the substances, which are described as impermissible by Shariah, undergo a complete process of metamorphosis, then the validity of the law does not hold well. The special or basic properties of the substance, by which it has been universally accepted and identified, are the real characteristics and identification of the substance. According to the research undertaken by the scientific experts, Gelatine does not possess the characteristics and properties of the skin and bones of animals, whose Collagen is used to prepare Gelatine. In fact, an altogether new substance is produced which has distinctly different characteristics from its parent substance. Therefore, there is a room for its use.

In view of differences between the jurists as well as the importance of edible substance, the Seminar earnestly appeals to the Muslim businessmen and traders to prepare Gelatine only from permissible animals using the permissible and clean parts of their body, so that there may be no dubiety over the issue of its permissibility and lawfulness.”
(http://www.ifa-india.org/pdfs/pdf-20210602034956.pdf)

Conclusion: Most fuqaha in our times consider gelatine to be an impure substance (if derived from pork or an animal not Islamically slaughtered), holding that the change it undergoes from its original state is not sufficient to be considered essential transformation.

Therefore, most of the scholars have declared gelatine as unlawful (haram) due to the fact that firstly, it is difficult to establish where it’s derived from, and secondly, the change it undergoes is not sufficient for it to be classed lawful (halal).

However, the Hanafi jurists (fuqaha) have given a dispensation in using impure and unlawful substances for medical purposes, provided certain conditions are met.

The classical Hanafi jurist, Imam al-Haskafi (Allah have Mercy on him) says:

“The Scholars differed regarding the usage of haram medication. The apparent opinion in the (Hanafi) school is that it is haram. However it is said that, it will be permissible when the medicine is known to be effective and there is no other alternative, just as there is a dispensation in drinking alcohol for a person dying of thirst, and the fatwa is given on this opinion.” (Durr al-Mukhtar, 1/210)

Conditions for using medicines that have impure and unlawful substances in them:

In view of the above text from one of the fundamental Hanafi reference books, it will be permissible to use medicines that have impure and unlawful substances in them, provided the following conditions are met:

1) It is reasonably known that the medicine will be effective, and is needed to treat the disease;

2) There is no permissible alternative reasonably available;

3) This has been established by an expert Muslim doctor who is at least outwardly upright and god-fearing. (https://daruliftaa.com/food-drink/medicines-with-gelatine/)

Monday, January 22, 2024

Can scientific education save us?

Can scientific education save us from political persecution?

Some people think that Indian Muslims are suffering persecution because we are weak in education and knowledge of science.

However, political problems need mainly political solutions. Education and "science" won't help in the face of fascist political movements, history proves this.

Jews in Germany during the rise of Hitler were quite well educated and had many great scientists including Einstein. That didn't stop Hitler from doing what he did. Those scientists had to flee Germany to save their lives.

The book 'Hitler's Gift: The True Story of the Scientists Expelled By the Nazi Regime' by J.S. Medawar and David Pyke, offers in-depth profiles of the talented Jewish scientists who fled Nazi Germany after Hitler's rise.

Over 2700 German academics, many of them Jewish, had fled Nazi persecution to Great Britain shortly after Hitler came to power in 1933.

David Stollar writes in his online article 'A Way Out of Germany' , "Before the Nazis seized power in the early months of 1933, Germany was at the forefront of science and medicine, and Jewish scientists and physicians, who contributed prominently to that status, seemed secure in their professional careers and, to a large extent, in their personal lives.

As primary targets of Hitler’s onslaught, however, Jews soon found their world and assumptions turned upside down. By April of that year, nearly all were dismissed from academic and civil service positions."

So this idea that "science can save us" is a very dangerous and oversimplistic assessment of the situation. We need to think of politically sound strategies inspired by the Last Revelation, the seerah and our rich history.

Monday, November 27, 2023

Allah’s agent in healing: The missing spirituality in Medical practice

 A Doctor is Allah’s agent in healing: 

-Dr. Md. Habeeb Haris 

Explaining the role of a Doctor, Imam Ghazali (RA) explains,


“A doctor has the ability to get close to Almighty Allah on the basis of his knowledge, and will get reward because of his knowledge, as he is His agent.” (Ihya ul uloom)

This is as mentioned in the Quran, “And when I am ill, it is He who cures me”. (Shoora 26:80).

The Prophet defined the doctor’s role and the mental approach he should have as the seeker of Allah's Shifa saying, “Indeed, Allah has sent down the disease and the cure and he made a cure for every disease. So seek it.” (Abu Dawud)
 
Shaikh Dr Mateen A Khan, a medical practitioner and a contemporary Islamic Scholar, explains this beautifully: "The cure which the doctors seek comes from Allah, but they become the means for it! Although Allah is al-Shāfi, the doctor is the agent through whom He heals. 

In this is the beauty and honor of being a healthcare practitioner. It demands from us a constant connection with Allah. A health practitioner, who loses his or her connection with Allah, has lost his or her connection with the source of treatment and health. It is entirely up to Him if He wishes to guide you towards a cure or to allow you to move away from it. Whereas a healthcare practitioner, who retains this connection, will always benefit not only him or herself but the patient and community."

The following Hadith Qudsi can act as a guide for the Muslim doctors in developing this special spiritual connection with Allah and becoming some one who facilitates 'Shifa' from Allah to the patients, which is a form of His Mercy. 
Abu Hurairah (RA) reported that the Messenger of Allah, , said:

“Allah the Almighty has said: ‘Whosoever acts with enmity towards a closer servant of Mine (wali), I will indeed declare war against him. Nothing endears My servant to Me than doing of what I have made obligatory upon him to do. And My servant continues to draw nearer to Me with supererogatory (nawafil) acts so that I shall love him. When I love him, I shall be his hearing with which he shall hear, his sight with which he shall see, his hands with which he shall hold, and his feet with which he shall walk. And if he asks (something) of Me, I shall surely give it to him, and if he takes refuge in Me, I shall certainly grant him it.'” (Sahih Al-Bukhari)


The Prophet  taught us beautiful short Duas to be read for invoking Allah's Shifa for a patient. These duas re-orient both the doctor as well as the patient towards the real source of cure and establishes a spiritual relationship between them, instead of just a professional or business relationship. This is the beauty of Islamic approach to Medical practice. 

Umm Salama said, "The Messenger of Allah  said, 'When you are with a sick person or dead person, speak well. The angels say 'Amen' to what you say.' (Muslim)

There are many sunnah Duas that can be recited for the benefit of the patients such as:

أَذْهِبِ الْبَأْسَ رَبَّ النَّاسِ وَاشْفِ أَنْتَ الشَّافِي لَا شِفَاءَ إِلَّا شِفَاؤُكَ شِفَاءٌ لَا يُغَادِرُ سَقَمَاً


Take away the hardship, O Lord of mankind, give shifaa, You are the One who cures, there is no shifaa except Your shifaa, a cure that will not leave any sickness. (Bukhari & Muslim).

Or one can say seven times:
أَسْأَلُ اللَّهَ الْعَظِيمَ رَبَّ الْعَرْشِ الْعَظِيمِ أَنْ يَشْفِيَكَ

 
“I ask Allah the Exalted, the Lord of the Great Throne, to heal you.” (Tirmidhi)


Indeed a spiritually oriented doctor is a Wali of Allah in this aspect. Ignoring this vital spiritual dimension of treatment will limit one's clinical effectiveness, inspite of all of one's medical qualifications and skills. 

Spiritual benefits and opportunities for Doctors:


Allah says, "And if anyone saved a life, it would be as if he saved the life of the whole mankind." (Quran, 5:35)

 From this we can just imagine the almost unlimited spiritual rewards from Allah for the doctors.

 The Prophet said, “He who alleviates the suffering of a brother out of the sufferings of the world, Allah would alleviate his suffering from the sufferings of the Day of Resurrection.” (Sahih Muslim)
So relieving patient's pain and suffering will relieve the doctor from sufferings of Aakhirah.
 

Angels' Dua of forgiveness for the doctor:
Ali (RA) reported that the Prophet  said: 

“When a Muslim visits his sick brother in the morning, seventy thousand angels make dua for his forgiveness till the  evening. And when he visits him in the evening, seventy thousand  angels make dua for his forgiveness till the morning, and he will be granted  a garden for it in Jannah.” (Tirmidhi, Abu  Dawud)

Allah's Nearness and Pleasure for a doctor:

In a Hadith qudsi it is related that Allah will say to a person, ‘Son of Adam, I was ill and you did not visit Me.' He will say, 'O Lord, how could I visit You when You are the Lord of the universe?' He will say, 'Do you not know that My slave so-and-so was ill. If you had visited him you would have found Me with him." (Muslim)


All this spiritual benefit, forgiveness & getting nearness of Allah is for a single visit to a patient. What would it be for continual treatment and care!

Approaching patients with this mindset in our daily practice will give us a better understanding of our elevated role and make all our efforts a form of worship.

Medical Practice as a means of Tazkiya of Ruh and Qalb (Spiritual purification):

The doctor who knows that he is just an agent of Allah in treating the sick will never become arrogant or over-confident as he knows he is just a catalyst. Also he will never be depressed when his treatment fails when Allah's permission for cure doesn't come. 

The doctor sees human suffering, helplessness and death so closely that it can become a source of softening of his heart, opening his eyes to the temporary nature of Dunya and it's enjoyment and create a concern for Aakhirah. This indeed is a powerful way of Tazkiya of his Heart and soul. The human sympathy that the medical practice demands helps in overcoming selfishness and individualistic approach to life.

Approaching patients with this mindset in our daily practice will give us a better understanding of our elevated role and make all our efforts a form of worship.

Status of Medical science in Islam

Status of Medical science in Islam:

The importance of medical science in Islam can be understood by the fact that almost every book of Hadith like Sahih Bukhari, Muslim, etc. contain separate chapters named 'Book of Medicine' with dozens of ahadeeth.

lmam Ghazali RA said,
“Medical profession is one of the most important collective duties (fard kifayah).”


 Imam Shafi’ee RA said,
“Indeed, knowledge is of two types: knowledge of the religion and knowledge of the world. The knowledge of religion is of fiqh and the knowledge of the world is of medicine.”

(Adab Ash-Shafi’ee 1/244)

Al-Rabīʿ reported that al-Shāfīʿī said: “I don't know any knowledge more precious than medical science after the knowledge of ḥalāl and ḥaram, and Muslims lost one third knowledge of it and handed over to the Ahl al-Kitāb (ie: Christians and Jews).”

قَالَ صَالِحُ بنُ مُحَمَّدٍ جَزَرَةُ: سَمِعْتُ الرَّبِيْعَ، سَمِعْتُ الشَّافِعِيَّ يَقُوْلُ: لاَ أَعْلَمُ عِلْماً بَعْدَ الحَلاَلِ وَالحَرَامِ، أَنْبَلَ مِنَ الطِّبِّ، إِلاَّ أَنَّ أَهْلَ الكِتَابِ قَدْ غَلَبُوْنَا عَلَيْهِ.


Ḥarmalah said: al-Shāfīʿī was so distressful about it that Muslims lost the knowledge of medical science and used to say Muslims lost one third knowledge of it and handed over to al-Yahūd wa ʿl-Naṣṣārá (ie: the Jews and Christians).

قَالَ حَرْمَلَةُ: كَانَ الشَّافِعِيُّ يَتَلَهَّفُ عَلَى مَا ضَيَّعَ المُسْلِمُوْنَ مِنَ الطِّبِّ، وَيَقُوْلُ: ضَيَّعُوا ثُلُثَ العِلْمِ، وَوَكَلُوهُ إِلَى اليَهُوْدِ وَالنَّصَارَى. 

(Siyar Aʿlām al-Nubalāʾ, 10/57 of Imam al-Ḏahabī ) 



Importance of Health in Islam:

Islamic scholars have identified the Shariah’s objectives [Maqasid al-Shariah] as preserving religion, life, intellect, lineage and wealth. So the preservation of life and health is the second objective of Shariah next only to Deen.

According to Imam Al-Ghazali: “A proper understanding and implementation of religion, from the standpoint of both knowledge and worship, can only be arrived at through physical health and life preservation”.  (Al-iqtisad fi al-i'tiqad)

Our bodies belong to Allah, who has entrusted us with their care. As such, we aren’t completely free to treat our bodies however we wish. Rather, we must act in accordance with the instructions of its owner — Allah.

The Prophet said:

“Your body has a right over you”. (Sahih al-Bukhari, 5199)

"Two favors that many of the people squander are health and free time." (Sahih al-Bukhari 6412, Ibn Majah 4170 and Tirmidhi 2304)

“A strong believer is better than a weak believer.” (Muslim)

“Indeed the first of what will be asked about on the Day of Judgment – meaning the slave (of Allah) being questioned about the favors – is that it will be said to him: ‘Did We not make your body healthy, and give you of cool water to drink?’” (Tirmidhi 3358)

"Whosoever begins the day feeling secure, having good health; and possessing food for his day is as though he possessed the whole world." (Tirmidhi)

'There is no harm in wealth for someone who has Taqwa, but good health for the person who has Taqwa is even better than wealth. Cheerfulness is a blessing.'" (Ibn Majah 2141, Adab al Mufrad of Imam Bukhari, grade Sahih)

“Make the best use of five things before the onset of five others: your life before your death, your health before your illness, your free time before being busy, your youth before your old age and your wealth before you end up in poverty” (Hakim and Baihaqi)

As Muslims, we are supposed to take care of our bodies by preserving our physical and mental health.
Several Islamic practices involve health-promoting actions, among them making Ghusl, Wudhu, using a miswak to clean our teeth, rules of consuming only halal and Tayyib things, moderation in eating, fasting, male circumcision, etc.

Other injunctions are in part meant to preserve health (e.g., the prohibition of intoxicants and illicit sexual behavior) and promote mental health via prayer, supplication and submission to God: “Verily, with the remembrance of God do hearts find peace” (Quran, 13:28).

At the community level, the Prophet    called for removal of filth from spaces, prohibition of urinating in areas frequented by people or used by them like water sources, cautious separation of animal vectors from humans, encouraging physical activities like swimming, archery, and horse riding, and making places and times for relaxation. Communicable diseases in the form of outbreaks are regulated using quarantines. He also suggested many medicines for various common diseases.
Truly, Islam is not a religion of pointless rituals benefiting neither the Creator nor the creation.


 Spreading health awareness among Muslims patients and doctors by the use of these Islamic teachings is likely to carry a strong influence on their behaviours.

Islamic approach to diseases:

Even if we follow all health guidelines, we may still get sick because God ordains all diseases. However, these are not necessarily punishments. 

Islam considers sickness as a test from Allah and a means to remove the sins, earn rewards, a means for spiritual growth, to enter paradise and to increase in ranks with Allah (however, all this is with the condition of Sabr on the sickness).

We believe that disease is part of destiny. Yet this is not the same as fatalism. We are instructed to take precautions as well as seek cure. And when a disease afflicts us, our belief in the hereafter enables us to bear the pain and suffering related to the disease or other calamities more readily.


Allah says,
“We will certainly test you with a touch of fear and famine and loss of property, life, and crops. Give good news to those who patiently endure…” (2:155)

The Prophet  said,
“Do not curse the fever for it expiates the sins of the children of Adam just as furnace removes the impurities of iron”. (Muslim)

“When Allah desires good for someone, He afflicts him.” (Bukhari)

 Aisha RA said, "I did not see anyone more severely ill than the Messenger of Allah." (Bukhari)

'Ata' b. Abi Rabih said: Ibn Abbas said to me: May I show you a woman of Paradise? I said: Yes. He said: Here is this dark complexioned woman. She came to Allah’s Prophet  and said: I am suffering from falling sickness and I become naked; supplicate Allah for me, whereupon he (the Prophet) said: Show Sabr (endurance/patience) as you can do and there would be Paradise for you and, if you desire, I supplicate Allah that He may cure you. She said: I am prepared to show Sabr (but the unbearable trouble is) that I become naked, so supplicate Allah that He should not let me become naked, so he supplicated for her. (Muslim)

Aim of medicine:


Our classical Islamic Scholars have described the comprehensive aim of medicinal treatment. The great Faqih and Usuli Imam Al Izz ibn Abdulsalam (RA) said in his famous book on Qawaid e Fiqhiyya,
“The aim of medicine is to preserve health, restore it when it is lost, remove ailment or reduce its effects.

To reach that goal it may be essential to accept lesser harm, in order to ward off the greater one, or lose a certain benefit to procure a greater one”.

 -“Al-Qawa’id al-Kubra” By Imam Al Izz ibn Abdulsalam

Wednesday, November 22, 2023

Causes of Decline in Scientific advancements in the Islamic civilisation:

Causes of Decline in Scientific advancements in the Islamic civilisation:

Dr. Muzaffar Iqbal

[Currently, Dr. Iqbal is the President of Center for Islamic Sciences, Canada. He has worked as Director (Scientific Information) COMSTECH, the Ministerial Standing Committee on Scientific and Technological Cooperation of the OIC (Organization of Islamic Cooperation) and has written many books on the topic of Islam and science].

For understanding the reasons for decline, we must make an attempt to look at the state of the Muslim world in minute details at the dawn of the fifteenth century—a time when Ibn al-Shatir was actively employed in the Jami' Mosque of Damascus and Ulugh Beg was conducting the most advanced astronomical observations and theoretical research. The following section is a small beginning toward this important task. Thus, delimiting the question allows us to focus on the period of three hundred years, between the fifteenth and the seventeenth century. This is the most crucial period for understanding the causes of decline of the Islamic scientific tradition. 


To begin with, let us note that, unlike the popular perception that constructs a tale based on supposed lack of material resources, geopolitical developments related to internal conflicts, and political instability, the actual historical data of this period does not support any of these “causes”.

On the contrary, this data shows that this period was actually a time of great prosperity and of three stable and internally cohesive empires: the Ottoman (689-1343/1290-1924), the Indian Timuri Empire (933- 1274/1526-1857),“ and the Safavi (907-1135/1501-1722). 


By the dawn of the fifteenth century, the Ottoman, the Indian Timuri (Mughal), and the Safavi empires had emerged through a historical realignment of the Muslim world following the sacking of Baghdad. 


General Features of the New Empires

Built on the ruins of the ‘Abbasid Empire, through a century and a half of conflicts, confrontations, and realignments, these three empires inherited the Islamic scientific tradition in a broken form in the sense that major centers of learning, libraries, and patrons had been uprooted. The large- scale devastation that accompanied the Mongol invasion and the subsequent strife had a deep impact on the social fabric of the society. It created new ruling elites, new centers of power, and new interests. Baghdad was no longer the social, intellectual and economic capital of the Muslim world; instead, there arose other cities to claim the honor: Tabriz, Delhi, Isfahan (after 1599), and Istanbul (after 1453).



For the purpose of our study, the following new factors are important.

1. After the Mongol invasion, when the dust finally settled and the new empires emerged as stable entities, the Islamic scientific tradition did not find a new home (or homes) where it could re-establish itself in a manner that would not create a break with what had gone before. This is because most of the old centers of scientific research had been destroyed, patterns of social life were disrupted and numerous libraries had been plundered.



2. A new political situation arose: For the first time in Islamic history, there appeared three powerful empires with adjacent borders, two of which fought one another for supremacy and control of the areas that were previously held under one empire. This was not the same as the small-scale disputes at the borders of the ‘Abbasid Empire or even claims to authority within the empire. The Ottomans, often together with Ozbegs, opposed the Safavids on religious, economic, political and territorial grounds, and though the Indian Timuris remained out of this long-term conflict, they were often courted by the other two for help. 


3. The Safavids not only chose the Shi‘i interpretation of Islam as their official creed, they also established their institutions, legal system, and social organization on this basis. This created parallel, and often conflicting, claims to loyalty and patronage. This division had a deep impact on the pace of scientific research.



4. In all three empires, there arose ‘model emperors’, who ruled for long periods, greatly expanded their empires, laid the foundation of stable bureaucracies and administrative structures and vastly increased the revenues of the state through efficient use of resources, but placed little priority in science.



5. Out of the three empires, the Indian Timuri empire had a uniquely new historical situation: a large non-Muslim population, which outnumbered the Muslims. This gave birth to a tension in the social fabric of the society and often rulers were pre-occupied with wars, rebellions and conflicts.

6. When new centers of intellectual activity emerged in any stable form, the interest of rulers and patrons had changed from patronizing science to building impressive monuments of architectural splendor and to supporting other forms of artistic expression; all civilizations take this route when large amounts of wealth are accumulated in the hands of few institutions or individuals. Thus in all three empires, the greatest amount of energy and resources were devoted to architectural and artistic expressions, rather than natural sciences. Hence we see the emergence of monumental buildings, great poetry and paintings in all three empires. 


7. In the Safavi Empire, the Islamic philosophical tradition re­ established itself through a new synthesis that combined elements of falsafa and Ishraqi mysticism that recast the vision of Philosophia in Sufi terms. But this renewed interest in philosophy was not accompanied by an interest in natural sciences to any significant degree. 


8. Although both the Indian Timuri and the Ottoman empires were Sunni, none could claim the universalistic nature of the caliphal authority that was held by the ‘Abbasids. 


9. Because there existed, more or less, permanent borders between the three empires, the free flow of people, goods and ideas was not like it used to be. Of the three empires, the Safavi held the greatest share of the traditional centers of Islamic scholarship, followed by the Ottomans in their Arab domains. But these old centers of intellectual scholarship were not revitalized in the new empires, which had their own intellectual centers.



10. The position of Arabic, as the universal language of discourse, did not remain the same in the new realignment. Although it was still accepted as the language of scholarship in large areas, Persian emerged as an important second language; Turkish and various Indo-Muslim languages also drew attention. This produced a restrictive impact of its own. Great scholars came to India from the other empires but the Indian scholars rarely left India, except when they went to settle in Hijaz, which became the conduit for the spread of their works and ideas. Consequently, books written in India reached the Ottomans via Hijaz but the books written by the Ottomans were practically unknown in India. 


What does all of this suggest? Certainly not a case of a civilization having come to its lowest ebb. The least one can gather from this data is that there existed, during these three centuries, a set of unique circumstances common to all three empires. The most striking facets of this set is neither the paucity of wealth, nor weakening of intellectual vigor, but an unusual interest in artistic expression: great mosques decorated with wonderful calligraphic designs and artwork, lavish palaces, vast public squares suitable for polo and troop movement, miniature paintings which show rich details and poetry.

All of these features are common in all three empires and many great architectural works still stand to testify to an age rich in expression of beauty, splendor and wealth. 


Writing toward the end of the fourteenth century, Ibn Khaldun (733- 809/1332-1406) was conscious that a new level of civilization might be on the horizon in the Muslim world—a level of civilization which only comes when sedentary culture has reached a certain degree of stability and prosperity. The new political and social circumstances of the three empires show exactly that kind of flowering.


“It is true,” wrote Ibn Khaldun, “that the old cities, such as Baghdad, al-Basrah, and al-Kufah, which were the [original] centers of scholarship, are in ruin. However, Allah has replaced them with even greater cities. Science has been transplanted in the non­ Arab ‘Iraq of Khurasan, to Transoxania in the East, in Cairo and the adjacent regions in the West . [Ibn Khaldun, Muqadamah, tr. by Rosenthal, Franz (1967), Princeton University Press, Princeton, p. 341. ]



Compared to the austerity of the Prophetic times, these empires seem to be driven by an internal desire to express and display the accumulated cultural riches of a civilization that had turned its focus and attention to a this worldliness with a concentration never before seen in the Islamic civilization, not even in the fabulous times of Harun al-Rashid.

The high culture of the Ottomans, Safavids, and the Timuri Indians displays such a florescence of arts that no other time in the Muslim history is comparable to it. The cultivation of Turkish language by the Ottomans, that of Persian by the Safavids and the Timuri Indians produced rich poetry and imaginative prose works which speak of this worldly splendor in an exalting language that is almost alien to the Islamic emphasis on moderation. And though individuals like Katib Qelebi (called HajjI Khallfah, 1015- 1068/1606-57), an encyclopaedist who was at home with a broad range of Arabic, Farsi and Ottoman texts as well as aware of new developments in geography and astronomy in the West, did make their appearance, they were rare in a culture of pleasure, almost bordering on decadence.

It is in this pleasure-seeking high culture of this age, that the real causes of decline are to be found.

The courts at Delhi, Istanbul and Isfahan, now captive of their extravagant routines and almost alienated from the realities of the vast empires they controlled, the courtiers and the elite families who contributed so much to the decadence and absolutism of the courts and the concentration of wealth in fewer and fewer hands are the indicators of a civilization at the brink of disastrous ruin. 



The Islamic scientific tradition became a caricature of its past glory in these three centuries and those who had cultivated it, were replaced by those who preferred to seek pleasure in the finite realm of the senses, rather than the splendors of the spirit.



When this interlude of three centuries came to its close, and the high culture and the decadent practices felt threatened by the approach of foreign armies at their doorsteps, it was already too late. The West had achieved a decisive edge over the Muslim world through remarkable advancements in science which were quickly translated into technologies which produced superior weapons, enhanced industrial production and, most of all, a vast reservoir of energy which sought to expand their frontiers, both physically as well as intellectually.



The future historians of Islam must divert their attention to these three centuries in order to understand the causes of decline and the withering of the Islamic scientific tradition. Those who have sought “internal causes” in the very foundations of Islam have misled these efforts for too long and with disastrous results. It is time for a total new orientation and a new search. 


One should also not forget the impact of the timing of certain inventions in Europe. One of the most important and fateful aspects of the new developments was a rapid shrinking of the globe. Science produced skills, tools and techniques. Technology produced weapons and means of transportation; all synchronized with a time when wars could still be fought in distant lands and victories could still be held for long time without endangering global repercussions. It was a time when victories and defeats were still isolated and localized affairs. It was also a time when the Muslim world was so divided that one part of it could not come to rescue the other part. This global dimension of the impact of modern science, this rapid shrinking of the planet, passed through that phase and then came to a new phase in the post World War II era. The timing of events was a major factor in deciding the fate of the Islamic scientific tradition and thus of the relationship between Islam and science. 


It is also important to mention that before it faded from the Muslim lands, a large part of the Islamic scientific tradition had been transmitted to Europe.

-Adapted from his book 'Islam and science' page 166 to 170.