Ethical Questions
ISLAM AND BIOETHICS Beyond Abortion and Euthanasia
Jonathan E. Brockopp
ABSTRACT
Muslim theologians, jurists, and healthcare workers have been address- ing the challenges of modern biotechnology for years. Major textbooks on religion and bioethics cover Islam in one or two articles, offering only a general introduction to these important discussions. The five articles in this issue of the Journal of Religious Ethics, originating from a conference at Pennsylvania State University, are unusual in the specificity of their topics - brain death, feeding tubes, sex selection, spiritual counseling, and organ transplantation - and in their engagement with complex discussions in the Muslim and non-Muslim worlds. In this essay, I introduce the five articles and consider two larger implications: the changing definition of the human person in light of biotechnological advances and the continuing importance of religious traditions, especially Islam, in legitimizing ethical responses to these advances.
KEYWORDS: death, personhood, exceptionalism, legitimate authority, Mus- lim ethicists
In the field OF religious bioethics, abortion and euthanasia take up a disproportionate amount of discussion, public debate, and legislation. In the midst of these debates, researchers and healthcare professionals are facing new and disturbing ethical dilemmas, many caused or exacerbated by technological innovations. The five articles in this focus issue are devoted to some of these cutting-edge issues, the ethical problems they engender, and the ways that Muslims are responding. These articles were selected from twenty-four papers presented at a conference on "Islam and Bioethics: Concerns, Challenges and Re- sponses" held at Pennsylvania State University, March 27-28, 2006. (1)
(1) The conference was co-sponsored by the Rock Ethics Institute, the College of Liberal Arts, the Department of History, and the Institute for the Arts and Humanities at the Pennsylvania State University. Conference proceedings were recorded and may be viewed at http://rockethics.psu.edu/islam_bioethics/program.htm. JRE 36.1:3-12. © 2008 Journal of Religious Ethics, Inc. This content downloaded from 199.73.44.216 on Sun, 23 Apr 2017 18:55:20 UTC All use subject to http://about.jstor.org/terms 4 Journal of Religious Ethics
More than fifty scholars, physicians, and researchers from ten different countries engaged in a broad, interdisciplinary discussion of key bioeth- ical issues facing Muslims and the Muslim world. The conference was a continuation of two previous efforts: a volume on Islamic Ethics of Life: Abortion, War, and Euthanasia (Brockopp, ed. 2003) and the "In- ternational Conference on Medical Law and Ethics in Islam" held at the University of Haifa, Israel, in March 2001. (2) Although those earlier ef- forts helped to foster important new research, two substantial points of criticism were raised. First, it is evident that Western knowledge of ethical decision making among Muslims is based on limited information (Krawietz 1997) and that scholars are only just beginning to appreciate the wide-ranging implications of an ethical system in which cases and case-based reasoning play a significant role (Reinhart 2003). Second, scholarship on ethics in Europe and North America often does not con- nect with ongoing scholarship in the Muslim world and vice versa. As a result, ethicists on both sides underestimate the complexity of the others' positions while at the same time missing many points of possible conver- gence (Brockopp 2002). The articles in this focus issue respond directly to these points of criticism, bringing new Muslim voices to the discussion and demonstrating a keen awareness of connections between Muslim and non-Muslim ethicists. In aggregate, they transcend in-house, parochial debates and offer clear evidence of how religions can respond to modern bioethical concerns.
(2) Many of the proceedings from that conference were published in a special issue of Medicine and Law (2002). This content downloaded from 199.73.44.216 on Sun, 23 Apr 2017 18:55:20 UTC All use subject to http://about.jstor.org/terms
As I argue below, interdisciplinary work is essential if we are to grasp the full range of Muslim bioethical discussions, yet this work is demand- ing and difficult. The very category of "Islamic bioethics" is contested, and not everyone agrees on how Muslim attitudes toward bioethical dilem- mas are to be characterized. For example, at the Penn State conference, a division developed between those who granted primary authority to principles derived from pre-modern texts (theologians, jurists, and histo-
rians) and those who depended on "lived experience" of the modern world (physicians, anthropologists, and sociologists). The former group viewed bioethics as a set of prescriptive norms that set the bar for ideal, ortho- dox behavior. The others saw these ideals in constant flux, as pragmatic considerations force the occasional violation of norms or their complete suspension. The nature of norm-production in the modern Islamic world further complicates the problem. As a discursive tradition, Islamic law has al- ways depended on the debate among legal scholars (fuqaha', sing, faqih) to determine correct action in specific cases. Ideally, these scholars un- dergo years of training at institutions such as al-Azhar in Cairo, after Islam and Bioethics 5 which they may give fatwas - answers to legal questions.(3) Today, how- ever, Azhar-trained scholars must compete with popular preachers and ideologues who also speak in the name of Islam and sometimes even issue "fatwas "(4) Furthermore, as I discuss below, major Muslim states have cre- ated transnational organizations (for example, the Organization of the Islamic Conference) to come up with consensus rulings on major issues.
(3) I speak here largely of Sunni Islam, in which these scholars are called muftis and their opinions are authoritative but not binding. Shiites generally attach themselves to a par- ticular authority, called a mujtahid, and are bound to follow fatwas from these authorities. Since there are multiple mujtahids, the process is still discursive but less open to influence from non-traditional scholars. (4) See, for example, the wide range of authorities cited by Vardit Rispler-Chaim in this issue. See also the writings of Osama bin Laden (2005), who uses aspects of the traditional fatwa form despite a lack of formal training. This content downloaded from 199.73.44.216 on Sun, 23 Apr 2017 18:55:20 UTC All use subject to http://about.jstor.org/terms
These organizations have an important legitimizing effect, yet they also are subject to debate and dissent (Eich 2008). Norm-production, there- fore, depends on cogency of argument, clarity of precedent, and the power to make one's voice heard. The productive tension between these two groups of scholars is at the heart of an edited volume of papers derived from the Penn State conference (Brockopp and Eich 2008). For this focus issue of the Journal of Religious Ethics, however, I have selected five longer articles that explicitly bridge this divide. Each of these authors is keenly aware of the need to balance authority from the classical sources with experience of the clinical environment. In so doing, they take significant risks and offer some provocative solutions. Much of mainstream bioethics ignores or excludes religious perspec- tives, but these authors argue for the continued relevance of Muslim views in the face of technological advance. For example, Omar Haque plumbs old, pre-modern theological debates to respond to the implica- tions of new advances in brain research; he then explores the implications of a naturalist notion of personhood for Islamic ethics. Likewise, Shabbir Alibhai finds that Qur'anic injunctions offer significant guidance, even in the face of conflicting science on the artificial feeding of patients suffering from advanced dementia. In both cases, technological innovations of re- cent decades - brain scans and feeding tubes - challenge, but do not ob- viate, fundamental religious tenets. In fact, as science probes the limits of human life, religious guidance seems all the more essential. These two articles also call into question the very definition of the human person and the care owed that person. Most Muslim authorities, modern and pre-modern, consider the human person to be a combina- tion of matter and spirit. Picking up on Qur'anic language (Q. 39:42 and 56:83), the ologians defined death as the moment when the material body and the immaterial soul separate, only to be reunited on Judgment Day. This separation is by its nature not visible to most human beings, and so the mystery of death is left in God's hands (Brockopp 2002, 234). This du- alism was based on the best science of the pre-modern era, but it created as many theological problems as it solved.
As Haque points out, scientists today with their knowledge of "biochemical signaling cascades, molecular interactions, neural networks, and feedback loops" no longer need a soul to explain personality and memory. The question he levels is one that all religious adherents must answer: now that we understand something of the mysteries of life and death, should we not update our theology? Haque continues by pointing out that the argument is not merely aca- demic; thousands die every year for want of organ transplants in the Islamic world, in part because of resistance to defining brain death as death. However, if we agree with Haque that the soul is equivalent to person- ality, which in turn is located in the brain, then how are we to respond to patients suffering from dementia? These patients, often in advanced stages of Alzheimer's or other degenerative diseases, no longer recognize relatives and lose the ability to feed themselves. They may not even feel hunger. With the loss of personality and memory, they could be said to have lost their souls: the essence of what makes them unique. Are they still persons, due every bit of care granted others? Or do we need a new, more limited category of being? The very fact that we must face these questions is a sign of our times. The abilities to inflict death at enormous distances and to grant life to the gravely injured are unique markers of our age. We can now do to our- selves and to each other what previous generations have only dreamed of, including determining the genetic features of our offspring. As Vardit Rispler-Chaim points out, couples in most societies have tried to influ- ence the sex of their children for centuries, sometimes by quite color- ful means. Now, however, the procedures are far less colorful and far more effective, leading some countries to ban sex selection altogether. Rispler-Chaim outlines a fascinating discussion among Muslim schol- ars, with some opposing fetal sex selection and others allowing it. Both sides, however, express deep concern that the core of Islamic society - the family - be maintained, and that broad issues of social good be taken into account. They also seem quite ready to distinguish between rules that ought to be generally applied and specific family circumstances that might call for an exception. This attention to specific circumstances leads to a form of exception- alism that is, in effect, a respect for privacy. Although Islamic rituals emphasize the importance of community, Islamic theology promotes in- dividual, not communal, salvation. Scholars, therefore, can offer advice to persons in need of guidance, but in private matters such as raising a and family, the state does not usually intervene.(5) Rispler-Chaim refers ex- plicitly to muftis who give allowances to individual couples despite their own general rulings. This respect for individual circumstances is also visible in Alibhai's article. From his perspective, one might say that the duty to feed holds prima facie but that this general rule should not pre- vent specifics - such as the possible economic burden of such feeding on the immediate family - from being taken into account. Observers of Islamic societies who depend primarily on textual sources can miss this exceptionalism, leading to an impression of Islamic ethics as rule-bound legalism, yet this flexibility and respect for individual choice seem to be widely found (Bowen 2003, 70-71; Brockopp 2003, 186; and Alshech 2004). This balance between general rules and individual circumstances in- forms Faiz Khan's entire article as he outlines an ethics of care derived from the Qur'an, hadith literature, and the wisdom of spiritual masters. This ethics of care presumes the possibility of a spiritual interaction between physician and patient, one that transcends religious bound- aries.
(5) There are important exceptions to this general observation, such as when the Egyptian state declared female genital marking (or mutilation) to be illegal; as a result, the ritual did not stop but moved from the sterile hospital to the private home. Also, the moving of illness and care from the home to the public hospital environment can lead to significant ethical dilemmas for patients and their families (Brockopp 2002, 240-41). This content downloaded from 199.73.44.216 on Sun, 23 Apr 2017 18:55:20 UTC All use subject to http://about.jstor.org/terms
In a world where Sunnis and Shiites fight to the death in Iraq and al-Qaeda threatens to "kill Americans everywhere," Khan's reading of Islamic sources forms a useful corrective, one that is far more typical of the world's 1.2 billion Muslims. Furthermore, his wide-ranging dis- cussion is not limited to the physician-patient relationship. Rather, it is a larger argument about the ethics of interpersonal relationships in a technological world. Citing extensive literature on the importance of spiritual attitudes in the healing process, Khan argues that the physi- cian must address the "psycho-spiritual" concerns of a patient. Although sensitive to the limitations of the hospital environment, he gives concrete examples of how physicians and patients can build a more human, more spiritual relationship. In so doing, Khan expresses a willingness to take risks - to cross boundaries - that is all too rare in medical practice to- day. He also effectively explains the intolerance for religious viewpoints within biomedicine and at the same time demonstrates the need for those viewpoints. All these authors, Alibhai, Haque, Rispler-Chaim, and Khan, depend on Islamic sources and in many cases offer normative ethical judgments for Muslims to consider, yet they are also well aware of similar discus- sions among secular ethicists and ethicists from other faith traditions. None of these issues is unique to Islam, so one might well wonder whether the focus on Muslim sources and experience is a bit artificial. The final article addresses just this question by suggesting that there is no fun- damental distinction between Islamic ethics and the ethical systems of the West but that we can only appreciate these structural similarities through the process of comparison. Manfred Sing argues that Islamic and Western ethical systems both struggle with the same threefold process: identifying grounds for judg- ment, organizing consensus among sources and experts, and finding le- gitimate authority. Both systems are, in effect, open-ended discursive processes that promote an illusion of permanence and absolutism to ground what is a responsive, malleable framework. With his focus on the construction of legitimate authority, Sing points out that it is more important for the process of ethical decision making to be seen as Islam- ically correct than for the decision to be resolved in one way or another. This goes to the heart of the matter as to why "Islamic law" is a poor translation for Sharia. With law, we expect legislation, codification, and enforcement. However, Sharia does not live within these strictures. It is rather the intent of the person to follow God, and in this case to de- termine an answer in the most legitimate way, that is at stake (Powers 2005). Therefore, no particular solution may, in advance, be declared un- Islamic, not even the rejection of body-mind dualism in the case of Omar Haque's article. The problem turns, rather, on whether the inquiry is le- gitimized through Islamic or non-Islamic authorities. Haque's explicit intention to discover possible Islamic responses to modern brain theory places him squarely within the same tradition as Ibn Sina and al-Ghazali and quite far from the purely instrumentalist use of religion discussed by Faiz Khan. By pointing out that the structural features of Islamic ethics are, in their essential components, no different than Western ethical discourse, Sing is claiming that the comparative project can provide us insights to bring back to our own traditions. When looking at another tradition, it may be easier to see patterns of legitimization and authority that are also present in our own. Conversely, it is helpful to see claims to absolute authority - whether described as the "framers' intent" regarding the U.S. Constitution or the "literal" meaning of the Bible - as simply one position within a discursive tradition. To these overall observations, I would add another: the difference between the Islamic tradition as perceived by the Western ethicist and the tradition's self-image. Muslim ethicists, in general, are far more aware of Western ethical tra- ditions than vice versa, and they must struggle with the common percep- tion of Islamic law as a system without flexibility or nuance. Sing refers to this aspect of Islamic discourse explicitly when he discusses the role of dissent (ikhtilaf) in Islamic ethics. As he points out, the process of achiev- ing consensus on ethical matters in Muslim societies always included the recording, and honoring, of minority opinions. Vardit Rispler-Chaim finds that this process is still very much alive in the diverse debates over fetal sex selection, and Omar Haque builds his own theory of personhood on a minority opinion from the pre-modern era. This feature is no less than an ability to live with ambiguity, and it may seem odd to those who are more comfortable with the principle-driven ethics common in many U.S. and European circles.(6) From a Muslim theological perspective, how- ever, this process also highlights the limited nature of human abilities, because ultimately it is God who determines whether an act is right or wrong, not human reason. In a world of constant change, such a tolerance of ambiguity could put Muslim ethicists in a better position to adapt to scientific discoveries. The comparison of Islamic and Western bioethical discourses is, how- ever, a difficult and in some ways problematic task. Although it serves as a beneficial heuristic method for challenging our presumptions, it could result in a counterproductive reductionism. Sing, for example, is most concerned with the pronouncements of national and international ethical councils, such as the Muslim World League (Mecca) and the Or- ganization of the Islamic Conference ( Jeddah), as well as the theory of Islamic law. Although these councils take physicians' opinions into ac- count, they remain driven by the authority structures of Islamic law. As Sing himself points out, however, "jurisprudence [alone] cannot solve fun- damental ethical dilemmas"; its solutions are always contingent, balanc- ing the various demands of the moment without necessarily considering the implications of new technological and medical advances. This is why those interested in Muslim bioethics must move beyond the framework of jurisprudence to embrace other authoritative structures in Muslim societies. The other four articles demonstrate that juristic institutions form only one element in the decision-making process of Muslim ethicists. Alibhai, for example, looks to the opinions of major jurists, the Qur'an, and the Sunna for guidance but also considers scientific and sociolog- ical data in forming his conclusions. The personal needs of the indi- vidual couples, as well as larger societal concerns, seem to strongly influence Rispler-Chaim's authorities.
(6) Alternatively, as Sing might suggest, it may serve as a basis for questioning the sup- posed permanence of principles; they may, in fact, be more contingent than we might like to admit. See, for example, Bretzke 2006.
Haque and Khan both draw on Sufi and philosophical trends within the broader Islamic tradition to balance what they see as limitations in Sharia discourse. This variety of argumentation is important, and students of religious ethics must be on guard against inscribing a legalism upon a tradition that is itself pluriform. Finally, it is worth pointing out that religious ethics as a subject risks its own legitimacy in a field dominated by scientific discourse. With its easy, unreflective appeals to nature and the natural, religious discourse can seem quaint. Part of what made the recent conference at Penn State unique was that physicians and religious scholars made the attempt to talk to one another. However, as Faiz Khan points out, when religion is discussed at all in the realm of mainstream bioethics, it is often seen as a psychological crutch upon which many patients lean. Outside of the clinic, many scientists (and members of the public) see religion as an irrational brake on scientific advances, such as stem cell research or gene therapy. The observation is not without reason, yet these five articles challenge such a reduction of religion to the role of conservatism. Particularly use- ful here is Sing's observations of the ways that Muslim bioethics have been perceived: (1) that Islamic discourse is compatible with modern bioethics but dominated by irrational conservatives, (2) that Islam is fundamentally incompatible with modern bioethics, and (3) that they are compatible but must be treated sui generis. Sing rejects each of these, arguing that these tensions are productive elements of the process of legitimization. Alibhai's, Khan's, and Rispler-Chaim's sources all seem convinced that there is wisdom enough in the rich Islamic tradition to address new technological advances. In contrast, Haque seems to think there is a genuine crisis looming, fearing that Islam - and by extension other religious traditions - is on the edge of irrelevance. Whether Haque is correct or not, his article demonstrates the depth of the problem; religions can keep the word "soul," but science has stripped it of the rich content given it by pre-modern theologians.(7)
(7) Although Haque does his best to laud the marvelous complexity of the brain, the time for phrases such as "selling your brain to the devil" or loving someone "heart and brain" has not yet come. This content downloaded from 199.73.44.216 on Sun, 23 Apr 2017 18:55:20 UTC All use subject to http://about.jstor.org/terms
However, this is only one example in which the shifting ground of science destabilizes ethical discourse. For example, recent advances in stem cell research may mean that ethicists no longer have to ponder whether a blastocyte is a human being and therefore has an inviolable right to life. Likewise, the "morning after" pill seems to obviate some ethical concerns resulting from unprotected sex. In both these cases, technological "work arounds" were developed before intense ethical debates had been resolved. It need not be the case that bioethicists must also be physicians or technicians, but it is clear that we must develop sufficient expertise to read the sci- entific literature and engage in technical discussions. Turning the tables, it seems equally important to welcome physicians, such as Alibhai, Haque, and Khan, to engage in normative theological speculation. Indeed, this is a role that physicians such as Ibn Sina and Maimonides have traditionally enjoyed in Muslim societies. To use Sing's framework, bioethicists seek legitimization and consensus, and these are only possible if we include those willing to bring three interconnected discourses to bear: the technical language of the clinic, the authority of Muslim texts and persons, and the ethicists' precision and clarity of argu- ment. Whatever our own backgrounds, we can all agree that the issues of sex selection, feeding people with dementia, harvesting organs, and car- ing for the ill need more discussion. In reading these five articles, there can be no doubt that these and other challenges of modern biomedicine deeply engage Muslims; now we all must respond to those challenges lest the technical specifications of our devices define our very humanity.
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