Maqasid al-Shariah Based Islamic Bioethics: A Comprehensive Approach

A Framework for Examining Bioethical Issues from a Sunni Perspective: Maslaha

All religions should develop convincing responses to emerging bioethical problems stemming from medical and technological advancements. Additionally, believers need to know their faiths' interpretations of bioethical issues to be able to make medical decisions in line with their religious values. Therefore, Islamic bioethics should provide Muslims with conclusive and credible answers regarding newly rising problems in health care by revisiting the religious norms and decrees. However, the diversity in the Islamic denominations, the traditionalist aspect of the Sunni jurisprudence demanding strict compliance with the scriptural texts, the lack of unanimously accepted authority, and the limited number of academic works in Islamic bioethics (at least in English) complicate exploring new standards or rules for new ethical matters. In this view, the present paper aims to delineate two primary Islamic theological schools and propose al-Ghazali's maslaha as a general framework to analyze bioethical issues in the Sunni tradition. Maslaha allows exercising discretion in light of the protection of five fundamental values: religion, life, reason, lineage, and property. Maslaha has the potential to enable Sunni Muslims to appraise contemporary ethical questions, concerns, and dilemmas through an Islamic view and make more autonomous decisions by having religious guidelines.

Applying the Concepts of Benefit and Harm in Malaysian Bioethical Discourse: Analysis of Malaysian Fatwa

Rapid developments in science and technology have resulted in novel discoveries, leading to new questions particularly related to human values and ethics. Every discovery and technology has positive and negative implications and affects human lives either directly or indirectly, involving all walks of life. Bioethical discourse in Malaysia must consider the multiracial and multireligious background of Malaysia and especially the Islamic view as the majority of Malaysians are Muslims and Islam is the religion of the federation. This article discusses several selected bioethical issues in Malaysia by studying the application of maṣlaḥah (the public good) and mafsadah (evil and harms) in Malaysian Islamic rulings (fatwas). This article uses the critical interpretation approach, as this is an ethical, interpretive, textual, and contextual analysis. In a situation when there is a conflict between maṣlaḥah and avoidance of mafsadah, it is preferred to attempt to address both needs. However, if maṣlaḥah and avoidance of mafsadah are mutually exclusive, the decision to choose must be made by weighing (tarjīḥ) and choosing the one which is superior. The maṣlaḥah and mafsadah concepts play vital and significant roles in bioethical discourse to realize human essential interests, namely faith, life, lineage, intellect, and property, thus achieving maqāṣid al-sharī'ah (the ultimate goal of sharia). This concept helps in guiding bioethical discussions, especially in determining the priority between achieving benefits and avoiding harms. The application of this concept will also assist Malaysian authorities in formulating appropriate rulings, especially bioethical issues related to Malaysian Muslims' lives.

Islamic Perspectives on Polygenic Testing and Selection of IVF Embryos (PGT-P) for Optimal Intelligence and Other Non-Disease-Related Socially Desirable Traits

In recent years, the genetic testing and selection of IVF embryos, known as preimplantation genetic testing (PGT), has gained much traction in clinical assisted reproduction for preventing transmission of genetic defects. However, a more recent ethically and morally controversial development in PGT is its possible use in selecting IVF embryos for optimal intelligence quotient (IQ) and other non-disease-related socially desirable traits, such as tallness, fair complexion, athletic ability, and eye and hair colour, based on polygenic risk scores (PRS), in what is referred to as PGT-P. Artificial intelligence (AI) and machine learning-based analysis of big data sets collated from genome sequencing of specific human ethnic populations can be used to estimate an individual embryo's likelihood of developing such multifactorial traits by analysing the combination of specific genetic variants within its genome. Superficially, this technique appears compliant with Islamic principles and ethics. Because there is no modification of the human genome, there is no tampering with Allah's creation (taghyīr khalq Allah). Nevertheless, a more critical analysis based on the five maxims of Islamic jurisprudence (qawa'id fiqhiyyah) that are often utilized in discourses on Islamic bioethics, namely qaṣd (intention), yaqın̄ (certainty), ḍarar (injury), ḍarūra (necessity), and `urf (custom), would instead reveal some major ethical and moral flaws of this new medical technology in the selection of non-disease-related socially desirable traits, and its non-compliance with the spirit and essence of Islamic law (shariah). Muslim scholars, jurists, doctors, and biomedical scientists should debate this further and issue a fatwa on this new medical technology platform.

Mitochondrial Replacement Therapy: An Islamic Perspective

Mitochondrial replacement technology (MRT) is an emerging and complex bioethical issue. This treatment aims to eliminate maternal inherited mitochondrial DNA (mtDNA) disorders. For Muslims, its introduction affects every aspect of human life, especially the five essential interests of human beings-namely, religion, life, lineage, intellect, and property. Thus, this technology must be assessed using a comprehensive and holistic approach addressing these human essential interests. Consequently, this article analyses and assesses tri-parent baby technology from the perspective of Maqasidic bioethics-that is, Islamic bioethics based on the framework of Maqasid al-Shariah. Using this analysis, this article suggests that tri-parent baby technology should not be permitted for Muslims due to the existence of third-party cell gametes which lead to lineage mixing and due to the uncertain safety of the therapy itself and because the major aim of the technology is to fulfil the affected couples interest to conceive their own genetically healthy child, not to treat and cure mtDNA disorders sufferers.

Islamic Perspectives on Elective Ovarian Tissue Freezing by Single Women for Non-medical or Social Reasons

Non-medical or Social egg freezing (oocyte cryopreservation) is currently a controversial topic in Islam, with contradictory fatwas being issued in different Muslim countries. While Islamic authorities in Egypt permit the procedure, fatwas issued in Malaysia have banned single Muslim women from freezing their unfertilized eggs (vitrified oocytes) to be used later in marriage. The underlying principles of the Malaysian fatwas are that (i) sperm and egg cells produced before marriage, should not be used during marriage to conceive a child; (ii) extraction of mature egg cells from single women being unacceptable; and (iii) fertility preservation in anticipation of late marriage is a conjecture that has not yet occurred. Ovarian tissue freezing can potentially be a more Shariah-compliant alternative to social egg freezing, because once the frozen ovarian cortical tissue sections have been re-transplanted back into the woman, mature egg cells can readily be produced, collected, and fertilized by the husband's sperm only during the period of marriage contract ('akd al-nikāḥ). Unlike accidental mix-ups with frozen eggs, muddling of lineage (nasab) would be automatically avoided in ovarian tissue freezing due to immunological rejection. However, upon critical analysis based on Qawā'id Fiqhiyyah (Islamic Legal Maxims), Maqāṣid-al-Shariah (Higher Objectives of Islamic Law), and Maslaḥah-Mafsadah (benefits versus harmful effects on society), elective ovarian tissue freezing by healthy single women for social reasons would likely be a highly contentious and controversial issue within Muslim communities that may conflict with conservative social-religious norms. This thus needs further debate among Islamic jurists in dialogue with medical doctors and biomedical scientists.

Sunni Islamic perspectives on lab-grown sperm and eggs derived from stem cells - in vitro gametogenesis (IVG)

An exciting development in the field of assisted reproductive technologies is In Vitro Gametogenesis (IVG) that enables production of functional gametes from stem cells in the laboratory. Currently, development of this technology is still at an early stage and has demonstrated to work only in rodents. Upon critically examining the ethical dimensions of various possible IVG applications in human fertility treatment from a Sunni Islamic perspective, together with benefit-harm (maslahah-mafsadah) assessment; it is concluded that utilization of IVG, once its efficacy and safety are guaranteed, could be permissible by strictly adhering to Islamic ethical principles related to marriage, biological/genetic relatedness, sexual intercourse, and moral status of the embryo/fetus versus that of the gamete. As a result, IVG will be acceptable for treating primary infertility, age-related infertility, and preventing genetic diseases. However, it will be unacceptable for application in posthumous reproduction, donor gametes, genetic enhancement, and procreation in same-sex couples.

The Lesser of Two Evils: Application of Maslahah-Mafsadah Criteria in Islamic Ethical-Legal Assessment of Genetically Modified Mosquitoes in Malaysia

The release of over 6,000 genetically modified mosquitoes (GMM) into uninhabited Malaysian forests in 2010 was a frantic step on the part of the Malaysian government to combat the spread of dengue fever. The field trial was designed to control and reduce the dengue vector by producing offspring that die in the early developmental stage, thus decreasing the local Aedes aegypti population below the dengue transmission threshold. However, the GMM trials were discontinued in Malaysia despite being technologically feasible. The lack of systematic studies in terms of cost-benefit analysis, questionable research efficacy and safety-related concerns might have contributed to the termination of the field trial. Hence, this research aims to evaluate the feasibility of GMM release in Malaysia by using a holistic approach based on an Islamic ethical-legal assessment under the maslahah-mafsadah (benefit-risk) concept. Three main strategies based on the maslahah-mafsadah concept approach have been applied: 1) an evidence-based approach, 2) an impact-based approach and, 3) a priority approach. The analysis concluded that GMM could be categorised as zanniyyah (probable). GMM is a promising alternative for dengue control, but many issues must be addressed before its widespread adoption.

Justification for requiring disclosure of diagnoses and prognoses to dying patients in saudi medical settings: a Maqasid Al-Shariah-based Islamic bioethics approach

Background

In Saudi clinical settings, benevolent family care that reflects strongly held sociocultural values is commonly used to justify overriding respect for patient autonomy. Because the welfare of individuals is commonly regarded as inseparable from the welfare of their family as a whole, these values are widely believed to obligate the family to protect the welfare of its members by, for example, giving the family authority over what healthcare practitioners disclose to patients about their diagnoses and prognoses and preventing them from making informed decisions about their healthcare.

Discussion

Family dominance over the healthcare decisions of competent patients is ethically problematic when the family prevent healthcare practitioners from disclosing diagnoses and prognoses to patients who have the capacity to consent and make decisions in their own best interests. Thus, the author holds that sociocultural values ought to be respected only when they do not prevent competent patients from knowing their diagnoses and prognoses or prevent them from making their own decisions.

Conclusion

Healthcare practitioners should not allow patients’ families to control what can or cannot be disclosed to competent patients. This is particularly important when patients are approaching death so that they may address their material and spiritual wishes—among other needs—as they prepare for death. Justification for this position is drawn from the Maqasid Al-Shariah-based Islamic bioethics approach, from which it is possible to argue that the harm of withholding diagnoses and prognoses from patients who are imminently dying outweighs the potential benefits.

Is social egg freezing (oocyte cryopreservation) for single women permissible in Islam? A perspective from Singapore

Elective egg freezing (oocyte cryopreservation) for fertility preservation - commonly referred to as social egg freezing or non-medical egg freezing, will be permitted in Singapore from 2023. There is a need for clear religious directives on social egg freezing for the minority Muslim population in Singapore, due to conflicting Fatwas on this medical procedure that were issued in different Islamic countries, in particular Egypt and Malaysia. Although social egg freezing would be beneficial for the fertility preservation of many single Muslim women who are unable to start a family due to various personal circumstances, there are also various potential risks and harms of this medical procedure at the individual and societal level. Hence, based on Maqasid Al-Shariah, by which preventing harm takes precedence over securing benefit in medical treatment (Tadawi), it is posited that social egg freezing should be classified as Makruh, which is permissible but discouraged in Islam.

Bioethical insights from the Fiqh Council of North America's recent ruling on medical cannabis

There is growing momentum to legalize medical cannabis across the United States. Positive public attitudes and permissive policies are based on growing anecdotal experiences and medical evidence that enumerate the health benefits of cannabis. Against this backdrop, Muslim stakeholders are (re)-evaluating their stance on the issue for Muslim patients who may benefit from such novel treatments, Muslim physicians who could incorporate the provision of cannabis into practices, and Muslim entrepreneurs who may seek to engage with the pharmaceutical and business aspects of the growing industry. Given this renewed interest, the Fiqh Council of North America (FCNA), a deliberative body comprised of Islamic jurists and medical consultants, examined the medical as well as religious evidence surrounding medical cannabis in order to furnish Muslim Americans with religious guidance. In 2018, they resolved that, while the use of intoxicating substances is proscribed by Islamic law, medical cannabis was permissible for Muslims to use with the following stipulations: Non-psychoactive preparations of cannabis are permitted to treat illnesses for which therapeutic effects of cannabis are certain, and psychoactive preparations are contingently permissible in cases of dire necessity. In this paper we first discuss the deliberative process and ethico-legal rationale brought to bear in furnishing the ruling, and then proceed to critically examine its conceptual gaps, practical limitations, and future implications. Clarifying the nuances around the religious permissibility of medical cannabis is important for Muslim patients and providers whose attitudes and behaviors may be informed by the ruling, as well for stakeholder groups within pharmaceutical and health policy circles who aim to address the needs of the global Muslim community that may stand to benefit from advances in medical cannabis research and therapeutics.

A Critique of Contemporary Islamic Bioethics

Last year marked a decade since the publication of the book "Islamic Biomedical Ethics" by religious studies professor Abdulaziz Sachedina in which he called for a critical and rigorous analytical approach to the ethical inquiry of biomedical issues from an Islamic perspective. Since the publication of this landmark work, some authors have continued to call into question the ways in which Islam as a religious tradition is engaged with in the secular bioethics literature. This paper describes common argumentative issues with current Islamic bioethics scholarship and offers general pearls and strategies to facilitate better engagement with religious approaches to bioethical issues.

Honouring Wishes of Patients: An Islamic View on the Implementation of the Advance Medical Directive in Malaysia

An Advance Medical Directive (AMD) is a document in which competent patients express their wishes regarding their preferred choice of future medical plans in the event they become incompetent. AMD is important in relation to the patient's right to refuse treatment. However, they must also consider cultural and religious values of different communities. In Islam, there are several concerns that need to be addressed, namely the validity of the AMD according to Islamic jurisprudence and patients' right to end-of-life decision-making. To address these concerns, this article refers to multiple sources of Islamic jurisprudence, such as the Quran, the tradition of Prophet Muhammad and the works of Islamic scholars related to this topic. Based on the findings, Islam does not forbid the use of AMD as a method to honour patients' wishes in their end-of-life care. Islamic jurisprudence emphasises on the importance of seeking patients' consent before carrying out any medical procedures. However, several conditions need to be given due attention, such as: i) a patient's cognitive capacity during the process of drawing up an AMD; ii) the professional views of medical experts; iii) the involvement of family members in end-of-life care and iv) the limitations of a patient's decision-making in creating an AMD.

Using the Maqāṣid al-Sharī'ah to Furnish an Islamic Bioethics: Conceptual and Practical Issues

The field of Islamic bioethics is currently in development as thinkers delineate its normative content, ethical scope and research methods. Some scholars have offered Islamic bioethical frameworks based on the maqāṣid al-Sharī'ah, the higher objectives of Islamic law, to help advance the field. Accordingly, a recent JBI paper by Ibrahim and colleagues describes a method for using the maqāṣid al-Sharī'ah to provide moral end-goals and deliberative mechanisms for an Islamic bioethics. Herein I highlight critical conceptual and practical gaps in the model with the hopes of fostering greater discussion about how maqāṣid al-Sharī'ah frameworks may fit within Islamic bioethics deliberation.