Enhancement Technologies and the Person - an Islamic View
By Shahid Athar, M.D.
Introduction:
Physically and intellectually man is not the same as a million years ago. This "improvement" in the human person has come from within over a period of time and not as a result of any outside biotechnical intervention. So, the question is what is the need now? The fine line between what can be done technically and what should be done morally is the reason for biomedical ethics. What is the nature of man and what is his relationship with his creator and his environment? Whose interest (man, God and environment) are we as scientists and physicians to guard? What are the rights of the unborn and who protects those rights? While seeking medical treatment for infertility and reconstructive surgery for a malformation or genetic manipulation for a genetic disease will be appropriate and recommended, is it appropriate to create a super healthy, super human person with genetic manipulation? If so, then are we embarking on the path of ethnic cleansing of humans of lesser ability and is it appropriate to discriminate? In this paper such questions and concerns are discussed from an Islamic perspective. What is Enhancement technology?
Enhancement Technologies are the science and art of externally applied procedures aimed improving human appearance, behavior, or capacities. They can be classified as physical, intellectual and behavioral. They include manipulation of the immune system (vaccines), age related medical conditions such as BPH, Osteoporosis, Presbyopia, then use of Growth Hormone for short stature children as well as cosmetic surgery. Intellectual manipulation includes use of drugs to improve memory, mental concentration and cognitive ability in senile dementia. Behavior modification by psychotropic drugs to modify aggressive behavior or castration for habitual sex offenders can also be classified in the same category.
The purpose of creation in Islam: Quran describes the purpose of creation. "Blessed is He in whose hand is sovereignty and He is able to do all things, who has created life and death that He may test you which of you is best in conduct and He is mighty and forgiving."
(1). This verse implies that God is a creator and He created us for a purpose. One of the purposes that are described is as a test as to who is best in conduct so that He can make a decision for the life thereafter. What is the position of man in the scheme of God's creation? First we are seen as a trustee of God's own earth. This is described in Quran, "and when the Lord said to the angle, low I am about to place a vice-regent in the earth"
(2). This implied that we would carry the mission of God onto this earth. The trustee will carry the honor of the entity which entrusted him with the task. Therefore, mankind was honored. Quran 1 "we have honored the progeny of Adam"
(3). We also have to remember is the distinction between humans and angels and the moral choices that humans have to face. The angels, in our belief, have no free will and they will follow the commands that they have been ordered. On the other hand, humans will have a choice to believe in God or not to believe in God and to follow His commands or not to follow His commands. Therefore, after knowing this choice, if man decides to believe in God and follow His commands, it is for that reason he becomes "best of the creation"
Human Nature in Islam: There is a physical component of human nature as well as a spiritual and intellectual component. Is it the physical element of man that we give the name to his or her spirit? When Mr. Smith dies, we say this is the body of Mr. Smith, but where is Mr. Smith? Therefore, a man is composed of not only the physical elements which make up his or her body but also intelligence, emotions, intellect and spirituality. God blew into man His own breath and created man in His own image. Therefore, the position of man as an honorable creation is contingent on fulfilling the responsibilities which are given to him.
The Role of Medicine: How do we apply the nature of man to medicine? The great physician of the past, Avicenna also known in the Muslim world as Ibn Sinna, said "medicine is the preservation of health and restoring it when it is lost". Describing the two components of medical practice, one is preventative and the other is reconstructive. On the other hand, another great Muslim physician, Razes, also known as Abu Bakar Al-Razi, said "medicine is the science which keeps and promotes health when it is there and restores it when it is lost". Prophet Mohammad (pbuh) has said that "O, servant of God, seek remedies for that who malady has already created its cure and its remedy." (5) The implication of this is that for every illness there is a possible remedy that we physicians and scientists must work to find a cure, thus, encouraging us to do ongoing research.
The Objectives and Sources of the Islamic Laws (Shariah): There are three sources of Islamic jurisprudence, (sharia). One is the glorious Quran which are divine revelations. The second is the traditions of the Prophet in terms of his actions and sayings, also called Sunnah and the third is Ijtihad which includes analogical reasoning, juristic preference, public interest, blocking the means, customary practice and presumption of continuity. It is implied that before we come to Ijtihad or Qiyas, we must consult what is in the Quran and what is in the Sunnah. "It is not befitting a believing man or woman that when God and His messenger have decided an affair for them that they should after that, claim any say in that affair and whosoever is rebellious to God and His messenger, rarely goes astray in error manifest." (6). What is the justification for Ijtihad or Qiyas? One of the companions of the Prophet by the name of Moaz ibn Jabal was asked by the Prophet Mohammad before sending him to Yemen, "on what basis will you judge the cases?" And, he replied "Quran". The Prophet asked and if you can not find the answer in Quran? Then Moaz said "the Sunnah of the messenger of God". The Prophet asked "and if you can not find the answer there either?" Then Moaz said "I will make every attempt in my own opinion to make the right decision". The Prophet was pleased with this answer and said "praise be to God, who has guided the envoy of the messenger of God."
What is Medical Ethics? In my opinion, medical ethics is not all black or white, all right or wrong but it is in the gray areas, choosing a better option over the worse one. The difference between what can be done technically and what should be done morally is the reason for medical ethics. Sometimes we are prompted to do certain things which may not be the best things to do. This could include decisions in our personal lives as well as in medical decisions. This prompting is from the devil who promised to attack humans in order to mislead them. "I will mislead them and I will create in them false desires. I will order them to slit the ears of the cattle and to deface the fair nature created by God". "Whosoever forsaking God, takes Satan as a friend, has indeed suffered a loss that is manifest." (7). Islamic medical ethics uphold the principles of biomedical ethics to include preservation of life, to promote and restore health, to alleviate human suffering, respect patient's autonomy, do medical justice, to tell the truth and to do no harm.
The Rules of Islamic Shariah and Islamic Medical Ethics: On the other hand, the basics of Islamic laws (sharia) are preservation and protection of faith of the individual, his or her life and upholding the sanctity of human life, to serve God his mind and intellect and then to serve God his property and to serve God his or her progeny. The rules of Islamic medical ethics are 1) Necessity overrides prohibition. That is to say if certain things are prohibited in general but at the time of necessity they may become permissible if there is no alternative available.
2) To accept the lesser of the two harms if both harms can not be avoided.
3) Public interest will override individual interests.
4) Harm has to be removed. That is to say that anything which is harmful to the human body becomes not permissible unless it is prescribed by a physician for a reason. In that case, principle #2, to accept the lesser of the two harms would apply (8).
When the Life does begin? In medical ethics, one of the questions which is always asked is "When does life begin"? Is it at the cellular level or at the time of formation of zygote or when the spirit is blown into the fetus at 120 days and the fetus becomes a human person. I feel that the signs of life are that it is a clear and well defined event and if it is not terminated it will continue to grow and it has a genetic core of a mature organisms. Applying this principle, I feel that life begins at inception although the full life is when the fetus becomes viable. If we look into Quran some of the aspects of Embryology which were reviewed 1400 years ago when there was no microscope or the study of anatomy that we have now, we find some interesting revelations. In Quran says "read in the name of thy Lord who has created man from a clot."(96:1-2) Then it says "and indeed we created from quiescence of clay and then replaced him as a small quantity of liquid in a safe lodging, firmly established and we have fashioned this into something which clings and then we made this clot into a chewed lump of flesh and we made this into bones and then covered the bones with flesh and then brought it forth as another creation. So blessed be God, the best to create."(23:12-14). The implication of this Embryology fact that man was created in stages as God designed him to be. The next stage came about ensoulment, (when God's breath was blown into the fetus). Quran says "and breath into him of His spirit (11). Ensoulment occurs at 120 days of intrauterine conception. Although ensoulment occurs later, the embryo is respected from the onset of fertilization and acquires consideration as a human fetus after implantation. Viability of human life begins at implantation. It is for this reason that Islam recognizes the right of the fetus by giving it the right to life, the right for inheritance and the right to penalize assailants. That is to say that a state can not be decided until the fetus is born and if the pregnant woman is assailed by an assailant and the fetus dies or is harmed, then the attacker will be held legally liable to harming the fetus.
Islamic view of infertility: It is human nature to be fertile and have children to continue the work with which the parents would like their name to continue. Quran says that "wealth and progeny are allurements for the life of this world" (12). This means that the two things families look for are to have a secure financial future and children. One of the prayers of believers described in Quran is "O, Lord, grant us spouses and offspring who will be the comfort of our eyes." Seeking cure for infertility is appropriate and all assisted reproductive technologies are permitted in Islam if the semen donor, ovum source and the incubator (uterus) are from the legally married husband and wife during the span of their marriage. (13). This is so because we honor the sanctity of marriage. Although a child can be born without marriage, Islamically the aim is to have a child with a mother and father who are legally married to each other. Surrogacy and frozen sperm after the death of the husband is not permitted.
Prenatal Diagnosis and Gender Selection: Do we have the right to prevent congenital malformation and protect the well being of children? Prophet Muhammad has said "select your spouse carefully in the interest of your offspring because your lineage is a crucial issue." But, it implies that there should be premarital genetic counseling so that people with certain diseases do not intermarry in order to protect their offspring. Also in the hadith is mentioned, "do not marry your close relative because you will get weak offspring. For example, if both parents are related as cousins, and both have Type I diabetes or hemophilia, there will be 100% transmission of that genetic possibility. It also says that if you have weakened your descendants, you should marry strangers (those who do not have certain disease traits). Is it appropriate to do gender selection? In many countries, including third world countries, this happens. Female fetuses are discarded or aborted. Gender selection is only up to God. Quran says "He creates what He wills and plans. He bestows children, male or female according to His will and plans or he bestows both male and female and leaves them whom He wills. (14) What is the significance of lineage in a family? Islam stresses the centrality of the family unit. Blood relatives who have a special status with legal matters and those related by womb have prior rights against each other. Inheritance laws and certain restrictions on marriage are dependent on proper identification of lineage. Quran says "He has established the relationship of lineage and marriage."(15)
Human Cloning: Thus, every person has the right to be legitimate child of his or her parent. Quran says "out of your spouses He created children and grandchildren and provided you out of His bounty". When it comes to human cloning, we feel that the genetic research directed to alter or delete a diseased gene is permissible. However, the use of fetal tissue and the use of fetal issue of spontaneous abortion and miscarriage is permissible but just to conceive in order to get fetal tissue and then discard the fetus is not. Fetal harvesting is not allowed. Human cloning is not permitted in Islam on the basis of the sanctity of marriage, the question of lineage and every human is created in his own unique nature. The use of donor sperm, ova and fertilized eggs or embryos is unlawful. This may akin to some degree in the form of adultery when sperm outside the marriage is introduced into the uterus of the woman. Quran says "and God has made for you mates and companions of your own nature and made for you out of them your sons, daughters and grandchildren".(16). In 1998, the Fiqh council of Islamic World League made the following resolutions: 1) It reaffirmed the previous resolution banning human cloning. 2) It permitted genetic engineering to prevent or cure diseases or minimize their harm, provided it does not harm otherwise during the process and it suggested that genetic engineering should not be applied to achieve evil or hostile ends of anything that is prohibited by sharia. It concluded by saying that genetic engineering should not be used in tampering with the possibility of human beings and their individual responsibilities or interfering with the structure of human genome under the pretext of enhancing the human race. Finally, it is not allowed to conduct the research treatment of diagnosis of an individuals genome unless a vigorous prior assessment of the potential risks and benefits pertaining to such an operation have been made and informed consent of the person involved is obtained and the results are kept strictly confidential and provision of the sharia regarding the rights and dignity of man are observed. It also concluded that it is not permissible to use human embryos as a source of organs and tissues except if certain conditions are satisfied, that is organs and tissues obtained from spontaneous aborted fetuses or legally aborted fetuses. If the fetus is delivered viable, save its life but if it dies, organs and tissue can be obtained from the cadaver according to this resolution of the Fiqh academy.
What about Stem Cell Therapy? The following decisions were made by the Fiqh council: First, it is permissible to obtain stem cells to be grown and used for therapy for permissible scientific research if its source is legitimate. For example: 1) adults if they give permission without inflicting harm on them. 2) Children, providing that their guardians allow it for a legal benefit and without inflicting harm on the children. Doctors in Islamic jurisprudence council in December 2003, concluded that it is forbidden to use stem cells from illegal sources, i.e. fetal harvesting to conceive with the intention to use stem cells then discard or abort the fetus. In Islam, all actions are to be judged according to the intention. For example, charity has to be given from a legally earned source and not by stolen money. In terms of stem cell therapy, the placenta or umbilical cord blood with the parent's permission can be used if the fetus is spontaneously aborted or when aborted for therapeutic reasons permitted by sharia. Finally, left over zygote remnants from vitro fertilization if donated by parents, when it is ascertained that they will to not be used in illegal pregnancy.
What about therapeutic cloning? The cloning of animals or plants for therapeutic purpose is permissible. Cloning human cells for therapeutic purpose is permissible provided the human cells are treated with dignity and with the informed consent of parties involved. However, creating whole human embryos for the soul purpose of using them for cloning is not permitted. Dr. Yusuf Qardawi ,the great contemporary Islamic scholar, has been on the record saying "If it has possible through research to clone organs such as hearts, livers, kidneys or other which may benefit those who are in dire need of them then it is permitted by religion and the researcher or the scientist will receive rewards from God. This is because the research will give benefit to humanity without loss to others or infringing upon others. Therapeutic cloning is therefore permissible and encouraged. In fact, in some circumstances, it may become mandatory to enhance the research in accordance with the need and mass research capability.
Two cases for discussion:
1. A 40 year old woman, unmarried, lawyer had multiple facial surgeries after an auto accident leading to facial scarring due to skin grafts. She now wishes to return to her law practice and social life. She considers a whole face transplant which may change her ethnic facial features. Is it a medically necessary procedure? Is it appropriate to change her God given ethnic features? Will she be satisfied with her new look? Discussion: The Islamic permissibility is based on;
a. The advice of the Prophet to seek cure
b. Take lesser of the two harms i.e. to keep the disfigured face or risk the operation
c. Necessity over rides the prohibition ( to change the ethnic God given features)
2. An experiment is under way to alter the genetic composition in order to change the destined behavior and memory. The researcher to experiment on boys ages 6-12 with parent's permission with predicted excessive aggressive and antisocial personality to subdue aggressiveness and augment docility. Will Islam allow such experiment to change the destined behavior? Discussion: The Islamic permissibility or non-permissibility should be based on
a. The saying of the Prophet that "All actions will be judged according to intention. What is the intent here?
b. One can change the behavior but not the destiny
c. The public interest overrides the individual interest. Thus if the intent is to safe the public from future harms by an individual, it may be permitted.
Presented on September 9 at the 13th Thomas A. Pitts Memorial lecture on Bioethics held at the Medical University of South Carolina. Dr. Athar is a past president and chair, medical ethics of the Islamic Medical Association of North America (
www.imana.org ). He can be reached at his email
[email protected] . References:
(All translations of Holy Quran are by Yusuf Ali Amana corp.)
1. Quran 67:1-2
2. Quran 2:30
3. Quran 17:70
4. Quran 98:7
5. Saying of the Holy Prophet Muhammad (compiled by Bukhari)
6. Quran 33:36
7. Quran 4:119
8. Medical Ethics Position paper published by The Islamic Medical Association of North America
9. Quran 96: 1-2
10. Quran 23: 12-14
11. Quran 32:9
12. Quran 18:46
13. Fadel HE , JIMA
14. Quran 42: 29-50
15. Quran 25:54
16. Quran 6:72
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