Medical Ethics in Islamic History

-Dr. Md. Habeeb Haris 

The expression “medical ethics” was not coined until 1803, when Thomas Percival (1740–1804), a physician from Manchester, England, introduced it in his eponymous book Medical Ethics and created one of the first modern codes of medical ethics. 

However, even from the earliest times, the Muslim Physicians gave utmost importance to ethical medical practice. The Muslim health care professionals cannot restrict themselves to just the Western conception of Medical ethics. They need to fulfil the Islamic ethical requirements too to harmonise their professional lives with the wider Islamic worldview. Islamic medical history is full of writings on 'Akhlaq al Tabib' (Etiquettes for Doctors) by many well-known physicians and scholars of Islamic civilisation. Below are mentioned some examples.

1. Abu Bakr Al-Razi: He wrote a special book one thousand years ago under the title Akhlaaq al-tabeeb (Ethics of the physician). It is an epistle addressed to

some of his students. Here are some excerpts:

“A physician should be gentle with people, refrain from talking ill about them in

their absence, and keep their secrets. A person may be afflicted with a

disease which he keeps secret from the closest people to him, such as his

father, mother, and children. He hides it from those close to him and, out of

necessity, reveals it to his doctor. If the physician treats one of a man’s women

folk, girls, or boys, he should cast down his eyes and not look beyond the

afflicted part of the body.” [from WHO document on Islamic code of medical and health ethics https://applications.emro.who.int/docs/em_rc52_7_en.pdf]

"The physician’s duties to the patients: The first of which is to treat the patients kindly, not to be rude or aggressive, but should be soft-spoken, compassionate, and

behave modestly. 
The physician should inspire the patients even those who have no hope for recovery. 
To treat patients equally regardless of their wealth or social status. 
The aim of the physician should not be the money he will get after treatment, but the cure. Doctors should be even keener on treating the poor and needy than the rich and wealthy."

2. Ishaq bin Ali al-Ruhawi: One of the earliest and most thorough books on medical ethics is “Adab al-Tabib” (Practical Ethics of the Physician) by Ishaq ibn Ali al-Ruhawi, a contemporary to Abu Bakr Al-Razi and lived in the second-half of the ninth century C.E. This book was translated to English by Martin Levey in 1967.

A glance at the chapter titles in Adab al-Tabib will reveal how thorough and comprehensive this book is:
1. The loyalty and faith in which a physician must believe, and on the ethics he must follow;
2. Care of the physician’s body;
3. What the physician must avoid and beware of;
4. The directions of the physician to the patients;
5. The behavior of the patient’s visitors;

6. The simple and compound drugs, which a physician must consider;

7. What does a physician ask the patients or others;
8. The necessity for ill and healthy people to have faith in the physician;

9. The agreement that the patient must follow the instructions of the physician;

10. The behavior of the patient with his servants;
11. The behavior of the patient with his visitors;

12. The dignity of the medical profession;

13. The people must respect a physician according to his skills;

14. Peculiar incidents concerning physicians;

15. Medicine must be practiced by those who have a suitable nature and

moral character;
16. Examination of physicians for accreditation;

17. The kings may remove corruption of physicians and guide the people to proper medicine;

18. The necessity of warning against quacks who call themselves physicians;

19. Faulty habits of people, which may hurt them;

20. What a physician must observe during periods of health in order to prepare for periods of illness.
['Islamic medical ethics a thousand years ago' - Saudi Med J 2013; Vol. 34 (7)]

3. Salah Al-deen bin Yusuf: An ophthalmologist from Hama, Syria, seven

centuries ago wrote in his book Noor al-'uyoon wa jami' al-funoon, (a book

of ophthalmology) giving advice to every student of medicine studying under

him:

“You should know that this industry (profession) is a gift from God, the Most Sublime, given to the person who deserves it, as he becomes the intermediary between the

patient and the Most Glorious and Sublime Lord in seeking recovery. When it is achieved through him, he gains the ample respect of people, is glorified by

them, gains renown within his industry, wins confidence in the decisions he

makes, and receives in the Hereafter a reward from the Lord of Creation.

This is because the benefit that is extended to God’s creatures is something great,

particularly when it is a benefit to poor, helpless people. In addition, you acquire a refinement of manners and moral standards, a generous and sympathetic nature.

You should, therefore, put on the gown of purity, virtue, innocence, compassion, and mindfulness of God, the Most Sublime, particularly when you deal with female family members.

You should keep their secrets, cherish proficiency and religiousness, dedicate yourself to your work in science, renounce physical desires, keep company with scholars and learned people, attend to your patients, feel eager to give them proper treatment, and be resourceful in seeking to cure them.
Moreover, if you can assist the weak with your own money, do it.”
[from WHO document on Islamic code of medical and health ethics https://applications.emro.who.int/docs/em_rc52_7_en.pdf]

4. Ali b. Sahl Rabban Al-Tabari: The court physician of Abbasi Caliphs al-Mu'tasim and al-Mutawakkil, described the Islamic code of ethics in his book 'Firdous Al Hikma' ('The paradise of wisdom' - completed in 850 C.E., is the first ever Medical encyclopaedia written, which incorporates all the then available branches of medical science) stressing on good personal characters of the physician, the physician’s obligations towards his patients, community and colleagues.

He stated: 
“The physician should be modest, virtuous and merciful.
He should wear clean clothes, be dignified, and have well-groomed hair and beard. He should select his company to be persons of good reputation.
He should be careful of what he says and should not hesitate to ask forgiveness if he has made an error.
He should be forgiving and never seek revenge.
He should be friendly and a peacemaker.
He should avoid predicting whether a patient will live or die, only Allah knows.
He ought not loose his temper when his patient keeps asking questions, but should answer gently and compassionately.
He should treat alike the rich and the poor, the master and the servant.
God will reward him if he helps the needy.
He should be punctual and reliable.
He should not wrangle about his fees. If the patient is very ill or in an emergency, he should be thankful, no matter how much he is paid.
He should not give drugs to a pregnant woman for an abortion unless necessary for the mother's health.
He should be decent towards women and should not divulge the secrets of his patients.
He should speak no evil of reputable men of the community or be critical of any one's religious belief.
He should speak well of his colleagues.
He should not honor himself by shaming others.” 
(Al-Tabarī, Firdaws al-hikma fī al-tibb, Frankfurt am Main: Institut für Geschichte der Arabisch-Islamischen Wissenschaften, 1996, “Islamic Medicine”, 29.)

In summary, the Muslim health care professionals need to take inspiration from the Islamic conception of Medical ethics and etiquettes formulated by our great predecessors - our Fuqaha and Hukama.  

           
                                                
                    The cover page of al-Tabarī’s book Firdausu’l-Hikmat in Latin letters, published in Berlin in 1928 by M. Z. Siddqi.