-Dr. Md. Habeeb Haris (Senior Consultant Radiologist and Alim Graduate)
Islam is not just a collection of beliefs and rituals. It is a perfect Deen which guides humanity in every aspect of individual and collective life - including the Spiritual, Philosophical, Moral, Social, Economic, Cultural and Political aspects. The modern materialistic way of medical practice has taken out God completely from the process of Healing, whereas Muslims are required to put God and His Guidance at the centre of their lives. A Muslim is obligated to follow Islamic guidelines concerning his life in it's totality, including his profession and occupation.
The Quran says:
"O you who have believed, enter into Islam completely [and perfectly] and do not follow the footsteps of Satan. Indeed, he is to you a clear enemy." (2:208)
"It is not fitting for a believer, man or woman, when a matter has been decided by God and His Prophet, to have any option about the decision. If anyone disobeys God and His Apostle, he is indeed on a clearly wrong path." (33:36)
Since Islam gives much importance to the practice of Medicine for the benefit of humanity, it gives many guidelines and regulations regarding it. A Muslim doctor, nurse or health care worker is obligated to learn about those guidelines and follow them in their routine practice. Failure to do so will make him/her answerable before Allah.
Below are given some important Islamic guidelines to be followed in patient care.
There is no place for quackery in Islam.
Mufti Abu Bakar Qasmi writes, "The basic condition for any action to be performed in the Shari'ah is ‘ability and qualification/eligibility’. Any act performed without qualification and eligibility and the required ability is, in any case, unlawful, even though it, by chance, brings a good result.
The Prophet ﷺ said: “Judges are of three kinds: One of them is promised Paradise and the other two are promised Hell. He who is aware of the truth and delivers the judgement accordingly belongs to Paradise. Second judge is the one who knows the truth but gives the verdict wrongly. He will be thrown into Hell. Third judge is he who is unaware of the fact; still, he continues the job of Qaza (judiciary), he is also a man of Hell.” (Abu Dawud: 3573)
Just as the rights of the people are dependent on the office of the Qazi (judge), so is the life and health of the people related to the Medical treatment. That is why ability, eligibility, qualification and appropriate skills are also necessary for the profession of medicine." (Jadeed Tibbi Masail)
The Messenger of Allahﷺ said: Anyone who practises medicine when he is not known as a practitioner will be held responsible. (Abu Dawud: 4586, Nasai: 4830, Ibn Majah: 3466, Mishkaat: 3444 chapter on qisas)
The Messenger of Allah ﷺ said: Any physician who practises medicine when he was not known as a practitioner before that and he harms (the patients) he will be held responsible. (Abu Dawud: 4587)
Hadhrat Omar bin Abdul Azeez (RH) says: “One who undertakes any task without knowledge brings more harm and less benefit.” (Al Ibanah: Hadith No. 570)
Hence it is important to practice in one's own field of qualification in which one has proper training and skills.
This also includes the need for constantly updating one's medical knowledge and skills according to the latest research so that one doesn't prescribe outdated or discarded treatments.
-Acquire the Necessary Knowledge of Fiqh Concerning your Medical Practice:
It is Fardh e Ain (Individually obligatory) on all medical students and practitioners to acquire the knowledge of fiqh concerning medical issues. The Islamic Shariah has defined the limits of permissibility for the ways of cure and medical treatment. But most Muslims, including many who are religious, do not take care to find out if the particular medical treatment is lawful or unlawful. It seems as if the physicians and the patients both have got exemption from the dictates of Shariah. There are some forms of treatment and surgical procedures that are prohibited in Islam. Also some procedures are only conditionally allowed. There are also many shariah guidelines regarding patient interaction, gender rules, handling of cadavers during Anatomical dissection and Autopsy, forms of earnings of doctors, interaction with other colleagues, rules of employment, insurance, commission, etc. Failure to learn about these rules of Shariah will lead one to commit sins.
Umar bin Al-Khattab [may Allah be pleased with him] said:
"No one should buy/sell in our markets except one who has understanding of the religion." (Tirmidhi: 487)
Sincerity and dedicated service without proper knowledge of Shariah can be counter-productive. Doctors should be in touch with expert, experienced, authentic and pious Ulama to help them in learning the rulings concerning medical practice, medical ethics, and permitted and prohibited forms of earning money. This is how they can protect themselves from unlawful earnings and serve the people in accordance with the injunctions of Shariah. The company of Ulama is also essential for enhancing one’s spirituality and attaining high moral character and balance in one’s life. Distancing oneself from the Ulama is a frequent cause of misguidance and deviation from the correct understanding and practice of the religion.
-Proper Niyyah (Intention):
In order to get the proper mental orientation and acquire spiritual benefits from his clinical work, the doctor should make the niyyah (intention) of treating the sick for the pleasure of Allah and relieving their sickness and pain and also recall the ahadeeth on the rewards for patient care when seeing any patient or at least while going to the clinic/hospital at the beginning of the day and also seek Allah’s help in performing the duty properly.
The Messenger of Allah ﷺ said: "Actions are according to intentions, and everyone will get what he intended." (Bukhari & Muslim)
Imagine how much our approach and behaviour with the patients will change if we start seeing everyone of our patients as an opportunity to earn limitless rewards from Allah and Duas of the Angels instead of seeing them as mere customers or financial opportunities!
Mufti Taqi Usmani writes: "Intention is reflected in action and behaviour: So, intention is what makes the difference. The good intent is reflected in the action. One can claim that his intention is good, but the real intention is observable in one’s own actions. If his intention is to serve humanity, his approach and style of working will be totally different from the one whose intention is only to earn. Such a person will have sympathy in his heart and would feel the pain of others. His interaction with patients with kindness will show what he has in his heart." (‘Al-Balagh’ magazine, February-2019 issue)
-Speak Positively, Give Hope and Cheer up the Patient:
It's the duty of the physician to give hope to the patients and put them at ease by relieving their anxiety. Even if there is bad news to be communicated to the patient or his relatives, it should be done in a very considerate and soft way with wisdom, keeping in mind their emotional state.
The Prophetﷺ said: "If you visit a sick person, then try to put him at ease by giving him hope (of prolonged life), for it does not change anything, but relaxes (and comforts) him." (Ibn Majah & Tirmidhi).
And he ﷺ used to say to the sick, “Do not worry. It (i.e., the sickness) will be a purification (for you), Allah willing." لاَ بَأْسَ طَهُورٌ إِنْ شَاءَ الله (Bukhari).
-Excellence of Character and Morals (Akhlaq) with the Patients, their Relatives and your Colleagues:
This is an important and indispensable quality for all Muslims but definitely is more necessary for the physicians and health workers. One should always greet the patients with a smile. The correct intention teaches a doctor that it is his duty to deal with the patients with patience, good manners, integrity and kindness. His service cannot become worship unless he develops such qualities. A doctor or nurse with a foul mouth and rude/arrogant behaviour cannot earn the trust of his/her patients or their relatives.
The Prophetﷺ said:
“The believers whose faith is most perfect are those who have the best character.” (Ahmad)
"The best amongst you are those who have the best manners and character." (Bukhari: 3559)
“He is not one of us who is not merciful to our young, nor respects our elders…” (Tirmidhi: 1921)
- Avoid speaking on the phone or checking social media accounts during patient consultations. It will irritate the patient and reflect a non-serious attitude, causing the patient to lose confidence in the treatment.
A healthcare practitioner has to tolerate the improper behaviour of his/her patients and excuse the annoyance of patients considering their pain and illness.
Mufti Abu Bakar Qasmi writes, "During his practice, a physician has to face different kinds of people with various temperaments. Some of them will be uneducated or ignorant or impatient or short-tempered. Sometimes they may say harsh words and hurl bad comments at him. Allah has instructed those with great responsibilities and noble professions to show patience and perseverance on such occasions.
'If you observe patience and fear Allah, then this (observance) is among the matters of firm resolution.' (Quran 3:186)" (Jadeed Tibbi Masail)
The physician should also have patience while taking history and examining the patient. He should give time to the patient to explain about his illness properly. Otherwise he may feel dissatisfied with the doctor and unconfident about his treatment. It will also negatively affect patient compliance with the prescribed treatment.
-Treat Others the Way You Would Like Others to Treat You:
The Prophet ﷺ said: None of you [truly] believes until he loves for his brother that which he loves for himself. (Bukhari, Muslim)
This is a golden rule to follow in dealing with patients and colleagues as it will automatically help one to be his best self in his practice and protect him from double-standards, selfishness and injustice. One should strive to offer the same care and kindness to all the patients as one would give to one's own close relatives.
-Avoid Treatments which have More Harm than Benefit:
The clinician must carefully consider the risk versus benefit before prescribing treatments which can have significant adverse effects on the patient. Harmful, aggressive, overly painful and invasive treatments should be avoided as much as possible.
"The Prophet ﷺ forbade from cures that are Khabith." [Abu 'Eisa said:] Meaning poison (Tirmidhi: 2045)
The Prophet ﷺ said: “There should be neither harming nor reciprocating harm.” (Ibn Majah, Al-Daraqutni and Malik)
-Avoid Prescribing Medicines with Haram ingredients:
Prescribing or using medications containing Haraam ingredients is a serious matter in shariah.
The Prophet ﷺ said: “Allah has sent down the disease and the remedy, and He has created for every disease a remedy, so treat disease but do not treat it with anything that is haraam.” (Abu Dawud: 3874)
Someone asked the Prophet ﷺ permission to take alcohol as a treatment. So the Prophet ﷺ said: "It is certainly not a treatment, rather, it is a disease." (Tirmidhi: 2046)
The Messenger of Allah ﷺ prohibited unclean medicine. (Abu Dawud: 3870)
Conditions for using medicines that have impure and unlawful substances in them:
Mufti Muhammad bin Adam al-Kawthari says: 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/)
Keeping in mind these conditions, the use of vitamin supplements, enzymes, hormones etc., containing gelatine or pork or non halal/non zabiha animal derivatives should be done very carefully.
-Lower the Gaze and Follow Gender and Satr rules:
"Tell the believing men to lower their gaze (from looking at forbidden things), and protect their private parts. That is purer for them. Verily, Allah is All-Aware of what they do. And tell the believing women to lower their gaze (from looking at forbidden things), and protect their private parts (Quran 24:30-31)
The Prophet ﷺ said: A man should not look at the awrah (Satr) of another man and a woman should not look at the awrah of another woman. (Muslim).
“Modesty is part of faith (iman).” (Bukhari & Muslim)
The Prophet ﷺ said: Do not uncover your thigh, and do not look at the thigh of the living and the dead. (Abu Dawud: 4004)
The Prophet ﷺ said regarding the males: "What is between the navel and the knees is awrah (Satr)." (Ahmad, Abu Dawud and al-Daraqutni).
The Prophet ﷺ warned: "If one of you were to be stabbed in the head with an iron needle, this would be better for him than if he were to touch a woman whom it is not permitted for him to touch." (Narrated by Tabarani; it is a sahih hadith).
Abdullah ibn Mas'ud رضي الله عنه went to visit a sick person with some other people. There was a woman in the room and one of the men began to look at her, 'Abdullah said to him, 'It would have been better for you if your eyes had been gouged out.' (Adab al Mufrad of Imam Bukhari)
It’s important to follow the Islamic rules of uncovering of Satr / Awrah of the body, gender interaction and Islamic modesty with the patients and their attendants and other staff. If the Islamic rules of modesty are not followed, one will earn more sin than money through his medical practice and the sin of seeing the impermissible will destroy his spirituality and moral well being.
In cases of necessity, things that are ordinarily forbidden are permitted. The scholars are agreed that it is permissible for a male doctor to look at the site of illness in a woman when necessary, within the limits set by shariah. Similarly, a male doctor may look at the Satr of a sick man. But he should look at the site of the complaint only as much as is necessary (and no more).
As far as possible, the male physicians or technicians should not be assigned to the female patients if female staff (of reasonable competence) are available, particularly if it involves seeing or touching the areas of Satr.
A male and a female should not be together in seclusion (Khalwah) in the hospital too as elsewhere (care should be taken to avoid this specially during night duty or in Operation Theater, etc.)
One should not expose the Satr (minimum concealable part of the body defined in Shariah) of the patient with out a valid need. The doctors should see the portion of the Satr parts of the body only as much as needed. For, it is unlawful to expose these parts and see them in other situations.
Particular care should be taken to assign same sex nurses and other staff for the patients who need exposure and handling of private parts, like inserting urinary catheters, changing diapers, etc.
Also, during the medical procedures and in the Operating Room, the patient's Satr should be exposed to the extent necessary only before the medical staff of same sex who is responsible for preparing the patient for it. Other staff should be called in after properly covering the rest of the body. Those who are not actually performing or assisting in the procedure should not see the exposed body of the patient.
The Satr of a dead body is the same as for living people. It should be respected too.
The lady doctors and other female staff should follow the Shara'i Pardah/Hijab rules in their dress and behaviour. Their hospital and OT dress should be in such a way that it covers their Satr fully. Their scrubbing and dressing area should be separate from male areas. Unnecessary interaction with male staff should be avoided.
The managements of Muslim owned hospitals/clinics have a responsibility to apply and encourage these rules in their setups and educate and sensitise the staff to these rules.
For detailed explanation of Satr rules see:
https://seekersguidance.org/answers/hanafi-fiqh/a-detailed-exposition-of-the-fiqh-of-covering-ones-nakedness-awra/
-Explain the Muslim Patient if the Disease or Treatment Impacts his Acts of Worship:
Explain the modifications needed in Ghusl, Wudhu, Tayammum, Salah, Fasting, etc., due to the medical need.
Do not make exemptions or modifications unless really required. To be able to properly advise the patient, doctors need to learn the relevant Fiqh.
Mufti Abu Bakar Qasmi writes, "It is compulsory for a Muslim Physician to know the instructions and commandments regarding various acts of worship and the relaxations given for the sick. Since, sometimes, people suffering from illness ask the doctors some rulings concerning acts of worship which relate to health or illness. The lack of knowledge may cause the physician and the patient both to commit the things prohibited by Shariah." (Jadeed Tibbi Masail)
-Respect the Patient’s Appointment Time and Refrain from Making Them Wait for a Long Time:
Every effort should be made to have proper, well organised appointment schedules for the patients and not to inconvenience them by making them wait for a long time for consultations, tests and procedures.
-Duas while Visiting the Sick and Dua for the Sick:
The Messenger of Allah ﷺ said, 'When you are with a sick person or dead person, speak well. The angels say 'Ameen' to what you say.' (Muslim)
There are many Sunnah Duas that can be read 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)
A Muslim physician should seek Allah’s help while providing treatment to the patient and start his work with ‘Bismillah’ (in the name of Allah), because nothing happens without Allah’s Will. This will infuse his heart with satisfaction and peace and he will find that Allah is helping him in his work instead of solely relying upon his own experience and skill. This will also increase his certainty and trust in Allah (Yaqeen and Tawakkul).
The doctor should maintain the quality of humility and should be grateful to Allah that He has selected him for this noble profession and remind himself that it's only Allah Who cures the patient. It does not suit a physician to be over confident on his own capability, skill, experience and knowledge. If one relies only on himself, Allah will deprive him of His blessings and help, leaving him alone with no Divine help and guidance, making him incapable of achieving much. Reading the Duas regularly during one's clinical work will help correct one's orientation too and avoid the feelings of arrogance from developing in one's heart.
-Ask the Muslim Patient to Pray for You:
The Prophet ﷺ said: "If you enter upon a sick person, then ask him to supplicate for you, for his supplication is like the supplications of the angels." (Ibn Majah).
The beautiful spiritual relationship that Islam establishes between the doctor and the patient is based on mutual well-wishing, sincere concern and care. In this, the doctor prays for the health of the patient and also requests the patient to pray for him! Can such a doctor ever exploit or harm the patient or even treat him carelessly?
This is in complete contrast to the mere commercial relationship it has been reduced to by the materialistic corporate healthcare industry today.
-Spiritual Counselling and Dawah to Patients:
A health care provider is generally trusted by the patients and his family and his/her words can have an impact on them. They should use this opportunity to explain the spiritual aspects of illness and seeking cure according to the Islamic teachings and cure their spiritual diseases along with physical diseases and bring the patient closer to Allah. There is a need to spiritualise the process of medical treatment and approach it as a way of holistic Healing. The patients learn their approach to disease and treatment from the doctors' words, behaviour and approach. If doctors ignore God in all this, then the patients too will adopt a soul-less, materialistic and mechanical approach to their treatment, ignoring the need for spirituality and invoking God for their healing. And this has an impact on the wider society too. The way the society views disease and the process of cure has to be brought in line with the Islamic Aqeeda and Spirituality.
-Avoidance of Trivialities and Pettiness:
Hadhrat Umar Farooq (RA) used to say, “We used to leave out ninety percent of lawful things because of the fear of falling into unlawful things.” (Ihya Al-Ulum of Imam Ghazali: 95/2)
Shaikh Dr. Rafaqat Rasheed says, "It's not appropriate for a healthcare practitioner to indulge in affairs that are religiously repugnant or socially reprehensible, like backbiting, tale-bearing, talking too much, arguing, laughing too much, or saying socially unacceptable words - especially while performing his/her duties.
It’s preferable to refrain from all such acts that are against decency or reflect a non-serious attitude, though they may not be religiously prohibited, such as chewing gum while working, untidy appearance, wearing strange and socially unacceptable clothes, indecency, undignified behaviour."
Similarly, one should avoid talking too loudly, watching social media clips, listening to music, frequent texting, unnecessary frequent or long phone calls in the hospital.
-Community Health Education:
Consider public health through health education that is suitable for the practitioner’s area of influence, to endorse or contribute to the preventive programs, and the protection of the environment. Recognize that the community and environment are important factors in the health of individuals by helping the community to deal with the social and environmental determinants of diseases.
-Adhere to the Medical Ethics:
The Muslim physicians cannot restrict themselves to just the Western Medical ethics. They need to fulfil the Islamic ethical requirements too to harmonise their professional lives with the wider Islamic worldview.
The Islamic Medical Ethics consist of responsibilities:
1. Towards Patients
2. Towards the Community
3. Towards Professional Colleagues
4. Towards Him/Herself
5. Towards God- by following the Religious Rulings
Ethical practise not only benefits the patients, it benefits the medical practitioners and hospitals too.
Studies suggest that by practicing Medicine with a clear moral compass physicians and other healthcare professionals also potentially benefit, because of the increased professional job satisfaction and reduced physician burnout.
The Mayo Clinic Proceedings published an article with the title, "Ethics and Values in Clinical Practice: Whom Do They Help?" It says in conclusion:
"The title of this article asked who benefits from an ethical and values orientation in health care. Patients clearly do. Physicians, other health care professionals, and health care organisations also potentially benefit, but not only because of the satisfaction of conducting themselves in a professionally ethical manner. These groups will benefit by reducing burnout and its personal and professional consequences if attention to health care ethics and values reduces the realities or the perceptions of “incongruence” in these areas between health care professionals and the health care organisations with which they are associated."
(Mayo Clin Proc. 2011 May; 86(5): 421–424.)
-Serving the Deen and Providing Intellectual Leadership to the Community:
The Medical professionals are considered among the intellectual elite of the community, so their responsibilities to the community and Deen extend beyond the Medical profession. They may use their intellectual abilities to acquire a deeper knowledge and understanding of Islam from reliable scholars and educate the other educated Muslims and youth in Islamic values and ideology.
They can provide leadership to the community in various fields. They can help in defending Islam from the various ideological attacks in the present times.
May Allah grant us the strength, patience, awareness and dedication to adhere to the Shariah guidelines at all times of our career. Aameen.
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