polylog / themes / focus / Ilhan Ilkilic: New Bioethical Problems As a Challenge for Muslims

New Bioethical Problems As a Challenge for Muslims

Summary

New biomedical technologies are used nowadays everywhere in the world, and thus in countries of different cultural and religious backgrounds. Application of the new methods of research and treatment in modern medicine makes new diagnostic and therapeutic interventions possible, but also often raises new complex bioethical problems, which cannot be discussed and judged independently of cultural attitudes. In this article the main positions in Islamic discussions about biomedical applications are discussed; for example, stem cell research, gene diagnostics, gene therapy, in vitro techniques, reproductive and therapeutic cloning and related areas. Moreover, intercultural aspects of these bioethical problems in a value-pluralistic society are dealt with, and lay aspects as well as health literacy are thematized.

1. New Bioethical Questions as a Challenge for the Islamic Image of a Human Being

According to the Islamic image of human being, the human being receives the highest place of God's creatures, and is »God' s vicegerent« (khalīfa) on earth. Since Islam literally means submission of the human being to the will of God, being Muslim is connected with leading a life according to Islamic norms and values (Yazır 1971, 3934). Following the Quran, the human being was created in an ideal form and provided with many gifts from God (cf. Surah 95, 4; Surah 32, 9; Surah 67, 23; and Surah 82, 7-8). Health is counted among the most important gifts of God and is understood as a great blessing.

The understanding of health as God's gift and entrusted blessing is at the same time a starting point for the foundation of a healthy responsibility to oneself. The religious conviction that a person is not the real owner of his body, but rather only its owner in this life, obliges him or her to go about in life lawfully and responsibly. Like extravagant relations with all his belongings, irresponsible behaviour towards the body is not desirable. This responsibility for one's own health, derived from the understanding of God's gift, implies for the Muslim certain options like dietary and hygienic measures for a healthy life, and medical interventions in case of sickness. For the Muslim has to give an account of his relation with his own body in the other world.

A further meaning of health is crystallized in the practical and pragmatic realms. The Islamic faith is very closely bound with a life praxis resulting from this faith. Belief and praxis are an inseparable unity so that God's pleasure as the main goal of the Muslim becomes possible only with habits based on Islamic norms of action. The fulfillment of social and ethical obligations and basic religious duties is of central significance for the development of Muslims. The realization of more of these duties again depends on a healthy bodily and spiritual condition. In this realm health can be considered as a pragmatic means towards a goal, and consequently accorded great value.

This hypothetical ascription of the value of health is, however, not to be understood as valuable only because it serves a goal. There are also other opinions which describe health as valuable because it serves human happiness. This estimation becomes clearer in cases where basic Islamic duties and therapeutic measures come into conflict. Such considerations are to be read in the early main sources of Islam. In some verses of the Quran, conditions are thematized where two goods – namely, health as a human phenomenon promoting well-being, and fasting as a basic religious duty – stand in apparent contradiction to one another. The mercy of God supports health, i.e., minimizing of bodily suffering. The traveler, someone who stays at home, and menstruating and pregnant women are exempted from the duty of fasting, because fasting could burden their bodies. »God desireth for you ease; He desireth not hardship for you.« (Surah 2, 185)

The estimations of health presented here suggest that a healthy condition is desirable and is to be sought after via a worthy lifestyle, but its value is not absolute. Health is not the source of norm and value concepts, but is a blessing among other blessings, and is judged in a conflict of goods by the codex of norms and value concepts. As a consequence, one cannot value life only by »degree of health« or »degree of sickness,« much less can one judge a »life's worth« or the »worthlessness of life.«

New possibilities of technical intervention influence, however, the condition of Muslims with respct to their bodies, and demand the described understanding of health and sickness in many respects. They make possible new forms of action on the human body which cannot simply be understood within the Islamic concept of life and judged uniformly. Stem cell research, which requires the use of embryos, and reproductive and therapeutic cloning raise new questions on the origin of human existence which go beyond the Islamic image of human being and human nature. The Islamic concepts of family and relationship and their meanings for social life are called into question by reproductive cloning. Methods of prenatal diagnosis may allow a pregnant woman to decide on the value of the life of the would-be child. Life-prolonging measures and the definition of coma challenge the classical Muslim definition of death. With the traditional images of human being and faith statements, questions about human identity and borders between individuals, which have arisen with regards to organ transplantation and the decoding of the human genome, cannot be easily answered.

2. The Beginning of Human Life and Its Dignity

The Quran, the holy book of Muslims, describes in a few places the development of the human being in the mother's womb and speaks of a breathing of the soul:

»Thus, He begins the creation of man out of clay; then He causes him to be begotten out of the essence of a humble fluid; and then He forms him in accordance with what he is meant to be, and breathes into him of His spirit: and [thus, O men,] He endows you with hearing, and sight, and feelings as well as minds…« (Surah 32, 7-9)

Another verse describes the human's development in the mother's womb, coming into the world, dying after a certain life-period, and rising again in the other world as components of a continuum with different ontological qualities:

»Verily We created man from a product of wet earth; Then placed him as a drop [nuṭfa] (of seed) in a safe lodging; Then fashioned We the drop a clot ['alaqa], then fashioned We the clot a little lump [muḍġa], then fashioned We the little lump bones, then clothed the bones with flesh, and then produced it as another creation. So blessed be God, the best of Creators! Then lo! After that ye surely die. Then lo! On the Day of Resurrection ye are raised (again).« (Surah 23, 12-16)

The Quran itself does not give any concrete indication as to the exact point in time of the soul's creation. In contrast to this, we find in a Hadith (the sayings of the Prophet Muhammad) the following indication:

»Each one of you collected [as nuṭfa] in the womb of his mother for forty days, and then turns into a clot ['alaqa] for an equal period (of forty days) and turns into a piece of flesh [muḍġa] for similar period (of forty days) and then God sends an angel and orders him to write things, i.e., his provision, his age, and whether he will be of the wretched or the blessed (in the Hereafter). Then the soul is breathed into him.« (Bukhari 1985, 837)

However, there are other Hadiths which describe the embryo as being endowed with a soul at other points in time. Although the Quran does not name the exact time of the creation of soul, some schools of law have formulated the following calculation based on the quoted Hadith: The stages of development mentioned in the verses quoted above lasting until the breathing of the soul – therefore from water drop (nuṭfa) to embryo ('alaqa) to fetus (muḍġa) – are 40 days. On the whole there are 120 days till the time of the creation of soul. If one considers other Hadiths, one derives other moments of time (e.g. 40th or 80th day) for the creation of the soul (cf. Canan 1991, 5-21).

Discussions on the moral status of embryos in Islam first developed around legal sanctions on termination of a pregnancy and the rules of conception. Philosophical questions and discussions, going back to the Aristotelian and Galenic traditions (cf. Musallam 1990, 32-46), developed later than legal discussions, and were not authoritative for Islamic legal judgement. Even if systematic debates on the dignity of the embryo arose only after the establishment of the school of law in the 8th and 9th century, earlier legal judgements on the termination of pregnancy, its cause, and the related measures of sanctions are known to us, going back to the time of Prophet Mohammed (570-632 CE) and the so-called »rightly guided khalifs« (632-661) (cf. Khoury 1981, 8-11).

Breathing of the spirit, i.e., when the embryo or fetus develops a soul, has a certain validity in discussions of the Islamic judicial system (fiqh) about the moral status of an embryo or fetus. Unanimity does not prevail, however, under the Muslim jurists, either about the point of time of the creation of soul or about its normative meaning. Therefore, the judgements of Islamic legal schools strongly differ from one another on human-induced abortion. An abortion before the 120th day of pregnancy is allowed by the Zaidites, some of the Hanafites, and some of the Shafiites. Some Hanafites and Shafiites despise abortions; they are nevertheless allowed if there are valid reasons. Some Malikites prohibit abortions without exception. The official opinion of the Malikites is that abortion is forbidden. The Hanbalites forbid it after 40 days. All legal schools agree that it is forbidden after the breathing of the soul into the fetus, that is, after the fourth month. After this point, an abortion can only be carried out if the life of the pregnant woman is in danger (vgl. Elwan 1967, 439-470; Musallam 1983, 61-88; u.a.).

3. Bioethical Questions

3.1 Stem Cell Research

Since embryonic stem cell research (ES-cells) is related to the death of the embryo, it has been equated by many circles of authorities with abortion. Thus it is not surprising if discussions about stem cell research center on the moment that the soul is breathed into the embryo. On this the Arabic legal expert Isam Ghanem says:

»Embryo Research is … legal under Islamic Jurisprudence provided the foetus is under 120 days old and provided both the mother and husband together consent to such research« (Ghanem 1991, 14).

»The First International Conference on Bioethics in Human Reproduction Research in the Muslim World« in 1991 took issue with the problematic concept of a »pre-embryo« (cf. Jones / Telfer 1995, 32-49) in European discourse and pleaded for research using only embryos which are left over after an in vitro fertilization:

»The excess number of fertilized eggs (pre-embryo) can be preserved by cryopreservation. […] These pre-embryos can be used for research purposes on methods of cryopreservation provided a free and informed consent is obtained from the couple« (Serour / Omran 1992, 30-31; Serour 1997, 171-188)

In this opinion the agreement of the duly married couple, the exclusion of commercial interests and clear, scientifically verifiable, therapeutic goals of research are highlighted (Serour 1997, 176 f.). A similar attitude is also maintained by »The Fiqh Council of North America,« which consists of medical personnel living in the USA, and Muslim jurists and scientists. In their opinion, published in 2001, they plead against using implanted embryos for the purpose of research. 1

These and other arguments are, however, only tenable if one takes the Islamic position which allows abortion without a valid reason until the 40th through the 120th day as a decisive foundation. But those positions which declare abortion as absolutely forbidden – so long as a pregnancy does not endanger the life of the mother – should categorically abandon research on embryonic stem cells. It seems difficult to judge this position, which allows the killing of embryos only if valid reasons are found. Promoters of this position must decide if research on embryos is justified by the possibility of finding forms of therapy for certain diseases. Justifying this is not easy if one considers classical arguments which reflect rather familial and social mores. Since it deals with other intentions and goals of action a casuistic position is afflicted with several methodic problems.

3.2 In Vitro Fertilization and Reproductive Cloning

Progeny, as the foundation for the maintenance of the human race, has a central role in Islamic belief. This value-estimation has resulted in a positive attitude towards modern reproduction techniques and their quick spread through the Islamic world. If pregnancy is not possible through natural means or with the help of other medical measures, in vitro fertilization can be considered. Fertilization with the help of a third person or by technical intrusion outside the mother's womb are judged exactly like natural fertilization. This acceptance by the majority of experts is, however, dependent upon certain conditions: both the egg cells and also the sperm must come from a married couple. The fertilized egg cells should be implanted in the uterus of the wife (cf. Krawietz 1990, 210-221; Diyanet İşleri Başkanlığı 1995, 101-102; Ebrahim 1993, 85-118; Ghanem 1989, 346; Rispler-Chaim 1993, 19-27; et al.).

The qualitative differences between in vitro fertilization and reproductive cloning preclude an equivalent moral judgement of both processes. Thus the ethical arguments accepted for in vitro fertilization lose their meaning when dealing with reproductive cloning. An embryo created by reproductive cloning contains either the father's or the mother's genotype, but in natural reproduction, the embryo instead possesses the genetic code of both of the parents. In a situation such as cloning, it is hardly possible to speak of being a classical father or mother. This kind of reproduction would therefore probably have difficult consequences for the Islamic family structure, and would face enormous social and judicial problems. The relationships among relatives basically define the interactions of Muslim community members. A mixing of family lines would raise social and religio-ethical questions. Likewise, family legal decisions with regard to family punishment and laws would reach an unimaginable proportion. Mohammad Sayyid Tantawi, the Chief Mufti of the Al-Azhar University in Kairo, raises this issue in his argument the descent (nasab). Since cloning would cause confusion in the descent line and thus chaos in social life, it is not uniform with the Sharia (religious law in Islam). Similarly, reproductive cloning was declared forbidden (haram) in the official opinions of the Diyanet İşleri Başkanlığı (Presidium for Religious Matters) of the Turkish Republic. 2

Exceptions to natural reproduction also stand in contradiction to the explicitly mentioned process of God's creation in the Quran. In Surah 49, Verse 13, it is said: »Oh mankind! we created you from a single pair of a male and a female.« Since reproductive cloning excludes the natural origin of a human being by a male and a female component, this process is in opposition to God's creative model. Because of the negative consequenses to human diversity, this process also stands in conflict with the Islamic image of the human being (cf. Sachedina 1998, 233). The Quran describes humanity as having various colours, nations, and languages, and also cites the variety of species in nature as being God-willed. To this is added the following quotation from the Quran:

»And among his signs is the creation of the heavens and the earth and the variations in your languages and your colours. Verily in that are signs for those who know.« (Surah 30, 22)

A further practical problem, which concerns the process of cloning, would strengthen more still an already negative attitude towards cloning: the considation that the cloning of »Dolly« has succeeded only after the 278th attempt. So one must allow that for such attempts egg cells which do not come from the future mother must be used. Since the use of foreign egg cells has already been categorically rejected in the context of IVF, agreement to such a process will not come easily.

Based upon the previously discussed arguments, a general rejection of reproductive cloning in the Islamic world is to be expected. But there are also other voices – although very rare – which proclaim reproductive cloning as ethically legitimate. For those who follow the shiite sheikh al-Harandi, negative consequences in social life or potential for misuse are not sufficient reasons to limit genetic research and the cloning of human beings (cf. Rispler-Chaim 1998, 567-573).

3.3 Therapeutic Cloning

In contrast to reproductive cloning, therapeutic cloning has been discussed very little in the Islamic world until recently. The development of Islam's positive attitude towards theraputic cloning seems secure. In fact, the gain of one person at the cost of the killing of embryos is hardly discussed.

The decision of when an embryo gains a soul is important for an Islamic judgement of therapeutic cloning. If one gains use of the embryonic stem cells on the 3rd or 5th day after fertilization (p.c.), a position which allows the killing of embryos without valid reason until the 40th day will approve of this process. Those who take positions which necessitate a valid reason for the destruction of an embryo must decide whether cell breeding for therapeutic purposes conforms. They also should not lose sight of the experimental character of this process. For those taking positions which categorically reject the killing of an embryo unless the mother's life is in danger, none of these deviations will be acceptable.

It is also possible to bring into the world a cloned child by means of a nucleus transfer, in order to transplant an organ from the clone into the cell's donor. In this situation the cloned person would not profit, but another person would. Situations in which an end-user of cloning is not the cloned person himself raise questions about the consent of the clone. If one also considers the high sensibility of Islam in relation to the importance of the heredity line, which is certainly mixed up by this process, it becomes difficult for Islam to approve.

3.4 Gene Diagnostics

Gene diagnostics are used in the medical field for various purposes, which must be differentiated in a discussion about the Islamic arguments on these processes. First, genetic research before and after birth are separate. Prenatal research covers prenatal diagnostics via amniocentesis or chorion biopsy, and preimplantation genetic diagnosis. Newborn screening tests, genetic tests, diagnosis of heterozygotism, and pre-symptomatic diagnostics are post-natal tests. Since a detailed discussion of all areas is beyond the context of this paper, only a few basic arguments on gene diagnostics will be dealt with here.

If a prenatal diagnostic serves only to prepare the parents for a child's disease, from an Islamic perspective it is not to be objected against. But if a prenatal diagnostic does not serve this purpose, it is for Islam immediately connected with an abortion. For at the moment there is in most cases no established prenatal therapy for a prenatally-diagnosable genetic disease. However, if one would not consider an abortion on account of a genetic disease like, for example, Down-Syndrome – a position held by a majority of Muslim experts and intellectuals – questions about the meaning and purpose of gene diagnostics are not answered easily.

Osman Bakar, Professor for Islamic Science from Malaysia, is of the view that the desire for a healthy, perfect child is not reconcilable with the Islamic image of man. »Islamic Law cannot accept these known defects as a legitimate basis for abortion unless they are deemed to endanger the very life of the mother« (Bakar 1999, 181). A consideration of the additional risks in this process, like the possiblity of a false diagnosis or that of the damage or death of the embryos during an amniocentesis or chorion biopsy, would strengthen this standpoint. 3

A similarly negative attitude of preimplantation genetic diagnosis is also likely if one recognizes danger to the mother's life as the only legitimate reason for the killing of an embryo. However, if one considers other positions on the human beginning of life or on the creation of the soul, other arguments come into question, some of which have already been dealt with. The positions which have a positive attitude towards preimplantation genetic diagnosis face the burden of proof as to why a genetic disease is a valid reason for destroying a human embryo. But the previously discussed interpretations of sickness make it clear that human life, in the Islamic faith, does not derive its primary value through bodily and mental abilities. As the most noble creature of God, human life has dignity independent of health condition. Therefore positions which judge a life as not worth living because of a genetic disease seem to be irreconcilable with the Islamic image of man.

If one focuses on the point in time of the creation of the soul as the only criterion for the moral status of the embryo, prenatal diagnostics and preimplantation genetic diagnosis could be valued differently. Due to the relatively earlier point of time of intrusion, preimplantation genetic diagnosis can be interpreted as less problematic than prenatal diagnostics. The optimal point of time for Chorion biopsy lies between the 70th and 77th day of pregnancy (10-11th week), for amniocentesis between the 105th and the 120th day (15-17th week of pregnancy), and for fetal blood testing from the 133rd day (from the 19th week) of the pregnancy. The procedures are judged against various theories which set the 40th, 80th or 120th day of pregnancy as the point in time of the creation of soul. However, it must again be noted that it is not the diagnostic process being judged, but the abortion that may be related to it.

Regarding screening of newborns, through which the damage done by some incurable genetic diseases could be minimized via the correct diet or other methods, nothing is to be objected against from an Islamic perspective. Likewise, little is to be objected against regarding genetic testing in order to positively identify a person in legal custody. The possibility of the misuse of the knowledge received through genetic diagnostics – by the state, by life insurance companies, or by employers – is emphasized from an Islamic perspective (cf. Habicht-Erenler 1989; Gabriel 1991, 101-104, et al.). A general consensus prevails in the Islamic world objecting to sex selection through prenatal diagnostics or preimplantation genetic diagnosis (cf. Alfi / Hathout 1981, 416-417).

3.5 Gene Therapy

Gene therapy covers the treatment of a genetic disease by intrusion into the concerned section of the genome. The processes used in gene therapy are at this time marred by various technical problems regarding the efficiency and controllability of the duration of the effects and are still in the experimental stage. An established genetic therapy process can not be spoken of, let alone one which offers clearly proven healing. In any case, it is necessary when making an ethical judgment to differentiate somatic gene therapy from germ line therapy. Somatic gene therapy includes the correction of genetic defects in the body's cells and is limited (at least in intention) to the concerned individual. In contrast, germ line therapy deals with genetic changes which are passed down to the next generations.

From the technical side, somatic gene therapy can be compared in an ethical sense with a new kind of microsurgical operation, or a medical therapy, vaccination or organ transplant (cf. Honnefelder 2000, 69). Interestingly enough, somatic gene therapy has often been compared with organ transplantation or with blood transfusion in Islamic discussion. On this the medical practitioner Hathout says: »It [gene therapy] is the equivalent of organ transplantation at the molecular level …« (Hathout 1990, 100).

Discussions about somatic gene therapy do not concern the genetic character of the process, but its efficiency and controllability. A false integration of transferred DNA can have oncogene effects and result in negative outcomes. With the insertion of viral vectors, the danger of the onset of competent virus replication cannot be fully excluded (cf. Rispler-Chaim 1998, 568). Skepticism and reservations against this type of attempts intensified after 18-year-old Jesse Gelsinger, who suffered from an inherited lever sickness, died while undergoing gene therapy in the United States.

If in judging such processes one has in the foreground of his mind the Islamic principle »adding no damage has higher priority as doing good«, (Sachedina 1998, 240) then a precise estimation of the consequences and dangers which may result is necessary. Imperfect knowledge of the effects resulting from these processes and previous negative outcomes makes a good estimation of risk impossible. Undoubtedly, the experimental character of these healing attempts strengthens negative opinions. Furthermore, the principles of clinical human experimentation, like medical indication, consideration of alternatives, consent of patients, and the right to stop therapy, among others, are to be considered.

Skepticism and reservations concerning somatic gene therapy are, however, based only on the present phase. If a therapy method is established and successfully applied, there is no reason to reject it. The same position, however, does not apply for germ line therapy from an Islamic perspective. In spite of the already mentioned considerations, germ line therapy is not acceptable because of its therapeutic uncertainty, its use of embryos, and above all, its incalculable effect on future generations. Basically, even therapies with eugenic goals, which serve the improvement of certain characteristics (enhancement), are to be rejected (cf. Yaman 1998, 26).

4. Muslims in a Value-Pluralistic Society

From the perspective of intercultural philosophy, the availability of various cultural attitudes towards bioethical themes in a society is certainly an interesting phenomenon. This image of the globalization in which we find ourselves is not an academic creation of fantasy, but a day-to-day reality (cf. Engelhardt 1982, 64-78). About fifteen million Muslims live in the EU countries at the moment, and many of them have citizenship in these countries. This reality, which is characterized by the existence of various value concepts in a society, raises new, complicated questions about the bioethics at different levels (cf. Ilkilic 2002). The universal validity of moral arguments on these bioethical questions can be discussed in the philosophical realm. Questions of whether moral norms are cultural variants and whether »good« means the same in all cultures are classical problems of ethics and are not the subject of this paper. Dealt with much more here are the social and individual dimensions of a value-pluralistic society.

Regarding bioethical conflicts in a value-pluralistic society, Hans-Martin Sass asks, »Is there a bio-ethics which can oblige all people in the same way and could trust in the same way all people?« (Sass 2003, 1). He is convinced that in bioethical discussions there are other models of explanation and self-discovery besides a manichaen (destructive) struggle between cultures. Instead of the model »Clash of Civilizations,« he pleads for communication and cooperation between cultures, which offers a methodical and more conceptually flexible and optimal understanding of present cultural and ethical conflicts and confrontations (cf. Sass 2003, 1-3).

How can successful communication and cooperation between cultures relating to bioethical themes be achieved? How can bioethical conflicts, in all their multidimensionality, be made understandable for the common man? How can men in the process of forming opinions relating to cultural identity be encouraged and supported? How can citizen participation in the socio-political process of decisions regarding bioethics be realized? The following suggestions, formulated in the context of a few theses, are not a final answer to these questions, but are unavoidable first steps for a value-pluralistic society.

5. Formation of Opinions and Participation of the Common Man

It is understood that the formation of opinions and participation in discourse about the bioethical issuse surrounding stem cell research and reproductive and therapeutic cloning presupposes corresponding scientific knowledge. Only then can a decision be made and competence supposed. Recent scientific studies prove, however, that there is a great information deficit when it comes to human genetics and new bio-technical processes (cf. Ilkilic / Düwell / Graumann 2002). Social, linguistic and cultural barriers also hamper the quality of information possible. Therefore, poor information should be improved by measures including the dissemination of simplified brochures and information materials, discussion of these arguments on radio and TV programs, and introduction of content-rich Internet sites, among others (cf. Ilkilic / Ince / Pergoulam-Ernst 2004; and Schröder 2003).

An effective information politics in a value-pluralistic society should take into account cultural aspects.

It is not enough to translate printed information materials into the language of a minority. Even if they are didactically and linguistically well-done, the translations should take into account additional cultural-religious aspects. Positions must be neutrally presented. These materials should provide the necessary information for the formation of a decision and not prejudice the readers beforehand.

Cultural bridges between the common man and experts must be built.

Printed materials can only begin to provide information and cannot replace interactive discussion and individual counsel. Through educational seminars a bridge can be built between commoners and experts, and questions can be answered concretely. A telephone hotline or – for the younger generation – an Internet portal can likewise encourage interactive dialogue. Thus the scientific and intercultural competence of experts can be harnessed.

Intercultural and inter-religious forums of discussions on bioethics can promote inter-religious dialogue and folk understanding.

An organized social exchange of views can be achieved through intercultural and interreligious forums of discussion about bioethical themes. Likewise, they contribute to a mutual understanding between those who believe and think differently from one another and create a space for understanding and tolerance (cf. Kreß 2004). If one is convinced as to the importance of social discourse and participation in it, one should be ready to take part. The development of one's own opinion and participation in such discussions necessitate a few ground rules on the function and goals of these discussions, which can not be expected without the readiness and willingness of the participants. Everyone should come ready to engage in dialogue, which necessitates respect for the thoughts of others and interest in other points of view. Finally, the point of such forums is not to dictate one's opinion, but to learn from one another, to explain one's own position and to reflect critically on it.

In England, Switzerland, Denmark and Germany, some citizens' conferences on bioethical themes have been organized with the goal of encouraging public participation in bioethics and bio-medicine. At a gene diagnostics seminar in Dresden in 2001, and at a stem cell research conference in Berlin in 2004, the citizen participants were chosen at random. The participants discussed bioethical themes, experts from various areas answered questions, and a citizens' statement was formulated. In these generally very positively regarded conferences, culture-specific aspects were not considered. However, they serve as a model for further intercultural and inter-religious forums of discussion and citizens' conferences.

A secular, constitutional state should guarantee the freedom of religion and create space for the free development of individual religiousness.

Heiner Bielefeldt says the following on the secular constitutional State:

»Much more the secular constitutional State has its meaning in the human rights to freedom of religion. […] The best defense of the secular constitutional state consists in taking earnestly the freedom of religion as a mandate and possibly to bring consequently to realization. Like all human rights, even the freedom of religion aims as equality.« (Bielefeldt 2002, 73)

This equality implies the possibility of Muslims joining in the formation of a society together. Participation in discussions on the ethical problems of new scientific technologies and in the corresponding processes of decision-making are components of this cooperation.

6. Lay Perspective and Health Literacy

What does a practicing Muslim, as a lay person, do if he feels overwhelmed by a bioethical matter and needs advice? In such a situation a religious edict (fatwa), which concretizes Muslim value concepts into practicable actions, can help him. The fatwas help Muslims make decisions which are highly pleasing to God. In Muslim countries, the Mufti (Muslim jurist) is responsible for such cases. After one has communicated to the Mufti the question to be answered in oral and written form, the Mufti answers the question immediately or – when necessary – only after he has made himself acquainted with the issue. The Mufti, in his judgment, should take into account to which law school the client belongs, and also his individual situation. In the Muslim countries there are, in addition to privately working Muftis, official Muftis. Because in European countries official Mufti-offices are rare, Muslims often search for the prayer leader in the nearby Mosque (Imam), or a qualified, trustworthy person, and present their questions.

A Mufti tries to communicate the probable will of God in his verdict, using his theological competence. But this opinion, though derived from the highest knowledge and conscience of its author, has no absolute claim and thus can be fallible. Also, various personal interpretations of the Muftis can result in different judgments. Therefore, it is not rare to find, between different law schools but also within the same law school, various decisions on the same issue. This plurality of opinion goes back to inner Islamic dynamics and the lack of a hierarchy like that of the Catholic Church, where a religious council's decisions are absolutely binding. This gives an individual more space, on one hand, for making decisions of conscience, and thus gives him flexibility in action. On the other hand, however, the situation makes it difficult for him to make a decision without intensive, individual discussion. For an individual Muslim, the responsible definition of a position can take a »health literacy« as its foundation (cf. Ilkilic 2004; and Hartmann 2003).

Health literacy is based upon an individual's responsibility in health matters to knowledge of new scientific findings and also one's own preferences; from them, a personal attitude towards health and sickness emerges. Health literacy cannot be reduced to simply agreeing to courses of action suggested by a medical practitioner based upon the latest scientific knowledge and medical theories. Literacy implies the ability to interpret information given by experts, also taking into consideration individual value concepts and cultural impacts, when making a decision.

Therefore citizens must be able to discuss with one another, both in health and in sickness, the question, »What do health and sickness mean to me?« Health literacy impacts not only one's own health, but that of society, both in a medical sense (for example, regarding behaviours to prevent the spread of diseases like AIDS, Hepatitis, and SARS) and also in an economic sense (financial consequences on the community as a whole).

Health literacy has both a present and a future meaning. Leading a healthy life, with its related hygienic and dietary measures, impacts the current condition of health, and also the body's future condition. The future of health literacy constitutes much more than individual discussions about medico-technical interventions and their consequences. It also involves questions about intensive, life-sustaining measures, pain therapy, artificial feeding, organ removal, and criteria for braindeath. Power of attorney makes it possible for people incapable of decision-making to be treated according to their values. This »testament of patients« demands that citizens must discuss situations which have not yet occured (cf. Sass / Kielstein 2003).

The future of health literacy also includes the formation of opinions on stem cell research and reproductive and therapeutic cloning and their bioethical consequences. Knowledge of medical technologies and the moral questions concerning them is indispensable when determining a position on stem cell research which uses embryos. People must add their own thoughts and judgments to this. This process will be connected with difficult questions of conscience, cultural impacts, individual value concepts, and images of humanity and life (cf. Ilkilic 2005).

7. Prospect

The concept of a »multicultural society« hints at the side-by-side existence of cultures within a society, where »pluralistic society« goes a step further, implying not only the existence of cultures, but their presence in society and in its decisions. The development and integration of different cultural value concepts as an elementary characteristic of a pluralistic society raises various questions regarding bioethics in academic, social and individual realms. A proper social discourse in a value-pluralistic society about bioethical issues like stem cell research and reproductive and therapeutic cloning presupposes communication and cooperation between cultures, which may be realized and established through certain measures. For an understanding of different positions and for an individual's responsible determination regarding them, the concept of »health literacy« can function as a foundation.

Translation from the German by Anand Amaladass.

polylog: Forum for Intercultural Philosophy 6 (2005).
Online: http://them.polylog.org/6/fii-en.htm
ISSN 1616-2943
Source:

Satya Nilayam: Chennai Journal for Intercultural Philosophy 7 (2005), 72-92.
© 2005 Author & polylog e.V.

Bibliography

Omar Alfi / Maher Hathout (1981): »When the Female Infant, Buried Alive, is Questioned for what Crime was She Killed? – In the 20th Century« In: Bulletin of Islamic Medicine 1 (Kuwait), 416-417.

Osman Bakar (1999): The History and Philosophy of Islamic Science. Cambridge.

Heiner Bielefeldt (2002): »Muslime im säkularen Rechtsstaat – vom Recht der Muslime zur Mitgestaltung der Gesellschaft«. In: Thomas Hartmann / Margret Krannich (Hg.): Muslime im säkularen Rechtsstaat. Berlin.

Muhammad ibn Ismail al-Bukhari (1985): The Translations of the Meanings of Sahih al-Bukhari. Trans. by Muhammad M. Khan. Vol. 8. Bairut.

Ibrahim Canan (trans.) (1991): Kütüb-i Sitte. Vol. 14. Ankara, 5-21.

Diyanet İşleri Başkanlığı (ed.) (1995): Fetvalar. Ankara.

Abul Fadl Mohsin Ebrahim (1993): Biomedical Issues, Islamic Perspective. Rev. Ed. Kuala Lumpur.

Omaia Elwan (1967): »Empfängnisregelung und Abtreibung im Islam«. In: Eduard Wahl et al. (Hg.): Rechtsvergleichung und Rechtsvereinheitlichung. Heidelberg, 439-470.

H. Tristram Engelhardt Jr. (1982): »Bioethics in Pluralist Societies«. In: Perspectives in Biology and Medicine 26.1, 64-78.

Hans Werner Gabriel (1991): »Arbeitsschutz und genetische Analyse«. In: Hans-Martin Sass (Hg.): Genomanalyse und Gentherapie. Berlin, 101-104.

Isam Ghanem (1989): »The Response of Islamic Jurisprudence to Ectopic Pregnancies, Frozen Embryo Implantation and Euthanasia«. In: Arab Law Quarterly 4, 345-349.

Isam Ghanem (1991): »Embryo Research: An Islamic Response«. In: Medicine, Science and the Law 32.1, 14.

Susanne Habicht-Erenler (Hg.) (1989): Genom-Analyse an Arbeitnehmern: Schutz oder Auslese?. Rehburg-Loccum.

Fritz Hartmann (2003): Patienten als Gehilfen ihrer Ärzte. Bochum (Medizinethische Materialien 145).

Hassan Hathout (1990): »The Ethics of Genetic Engineering: An Islamic Viewpoint«. In: Journal of the Islamic Medical Association of North America 22.3, 99-101.

Ludger Honnefelder (2000): »Gentherapie«. In: Wilhelm Korff (Hg.): Lexikon der Bioethik. Bd. 2. Gütersloh, 68-71.

Ilhan Ilkilic (2002): Der muslimische Patient. Medizinethische Aspekte des muslimischen Krankheitsverständnisses in einer wertpluralen Gesellschaft. Münster – London.

Ilhan Ilkilic (2004): Gesundheitsverständnis und Gesundheitsmündigkeit in der islamischen Tradition. 2. Aufl. Bochum (Medizinethische Materialien 152).

Ilhan Ilkilic (2005): Begegnung und Umgang mit muslimischen Patienten. Eine Handreichung für die Gesundheitsberufe. 4. Aufl. Bochum (Medizinethische Materialien 160).

Ilhan Ilkilic / Marcus Düwell / Sigrid Graumann: Information und Aufklärung über Chancen und Risiken der Humangenetik und neuer gen- und biotechnischer Verfahren. Abschlussbericht. Tübingen 2002.

Ilhan Ilkilic / Irfan Ince / Azra Pergoulam-Ernst (2005): E-Health, Kultur und Gesundheitsmündigkeit. Recherche, Analyse und Evaluation der Internetseiten über Gesundheitsinformationen für muslimische Laien und ihre Bedeutung für Gesundheitsmündigkeit. 2. Aufl. Bochum (Medizinethische Materialien 158).

»Islamic Code of Medical Ethics«. In: Bulletin of Islamic Medicine. Vol. 1, 2nd. ed. Kuwait 1981.

D. Gareth Jones / Barbara Telfer (1995): »Before I was an Embryo, I was a Pre-Embryo: Or was I?«. In: Bioethics 9, 32-49.

Hayrettin Karaman (1997): »Genetik Kopyalama«. In: Yeni Şafak, 9. März 1997, 2.

Adel Theodor Khoury (1981): Abtreibung im Islam. Köln (CIBEDO-Dokumentation 11).

Birgit Krawietz (1990): Die Hurma. Schariatrechtlicher Schutz vor Eingriffen in die körperliche Unversehrtheit nach arabischen Fatwas des 20. Jahrhunderts. Diss. Berlin.

Hartmut Kreß (2004): »Religionsfreiheit und Toleranz als Leitbild: Kulturelle Grundlagen – sozial- und rechtsethische Problemstellungen«. In: Hartmut Kreß (Hg.): Religionsfreiheit als Leitbild. Staatskirchenrecht in Deutschland und Europa im Prozess der Reform. Münster 2004, 21-58 (Ethik Interdisziplinär 5).

Basim F. Musallam (1983):. Sex and Society in Islam. Birth Control before the Nineteenth Century. Cambridge 1983.

Basim Musallam (1990): »The Human Embryo in Arabic Scientific and Religious Thought«. In: G.R. Dunstan (ed.): The Human Embryo: Aristotle and the Arabic and European Traditions. Exeter.

Vardit Rispler-Chaim (1993): Islamic Medical Ethics in the Twentieth Century. Leiden 1993.

Vardit Rispler-Chaim (1998): »Genetic Engineering in Contemporary Islamic Thought«. In: Science in Context 11.3/4, 567-573.

Abdulaziz Sachedina (1998): »Human Clones: An Islamic View«. In: Glenn McGee (ed.): The Human Cloning Debate. Albany, CA, 231-244.

Hans-Martin Sass (2003): Menschliche Ethik im Streit der Kulturen. 2. Aufl. Bochum (Medizinethische Materialien 132).

Hans-Martin Sass / Rita Kielstein (2003): Patientenverfügung und Betreuungsvollmacht. 2. Aufl. Münster.

Peter Schröder (2003): Vom Sprechzimmer ins Internetcafé: Medizinische Informationen und ärztliche Beratung im 21. Jahrhundert. 2. Aufl. Bochum (Medizinethische Materialien 137).

Gamal I. Serour (1997): »Islamic Developments in Bioethics«. In: B. Andrew Lustig et al. (ed.): Bioethics Yearbook. Vol. 5: Theological Developments in Bioethics: 1992–1994. Dordrecht 1997, 171-188.

Gamal I. Serour / Abdal-Rahim Omran (eds.) (1992): Ethical Guidelines for Human Reproduction Research in the Muslim World. Cairo.

Ahmet Yaman (1998): »Klonlama ya da Genetik Kopyalamaya İslâm Hukuku açısından bir yaklaşım«. In: Diyanet İlmi Dergi 34.8, 21-41.

E. Hamdi Yazır (1971): Hak Dini Kur'an Dili. Bd. 6. Istanbul, 3934.

Notes

Due to the importance of the descent (nasab) in Islamic legal doctrine surrogacy as well as embryo adoption are refused. This legal position underlines even more that opinion.

Official answer to my question on 8th August 2002. For a more detailed foundation of the position of Diyanet İşleri Başkanlığı see the contributions by Yaman (1998) and Karaman (1997).

»All respective methods run a certain risk of abort. This is up to 1% in the case of amniocentesis, and up to 3% in the case of chorion biopsy.« (Propping 2000, 251)

Author

Ilhan Ilkilic (*1967 in Kepsut, Turkey) is collaborator of the project »Public Health Genetics« at the Institute for History, Theory und Ethics of Medicine at Johannes Gutenberg University Mainz (Germany). He studied Medicine, Philosophy, Islamic Studies and Orientalist Philology in Istanbul (Turkey), Bochum and Tübingen (both Germany). In 1990, he finished his doctorate in Medicine at the University of Istanbul; in 2001, he received his PhD in Philosophy by the Ruhr University Bochum. His areas of specialization are social and ethical concerns of »public health genetics«, health ethics, health literacy and autonomy of the patient, Islamic and intercultural bioethics and concerns of »e-health.« Among his publications are Der muslimische Patient. Medizinethische Aspekte des muslimischen Krankheitsverständnisses in einer wertpluralen Gesellschaft (2001), and Begegnung und Umgang mit muslimischen Patienten (2003).

Dr. Ilhan Ilkilic
Johannes Gutenberg University Mainz
Institute for History, Theory und Ethics of Medicine
Am Pulverturm 13
D-55131 Mainz
Germany
Fax +49 (6131) 393 66 82

ilkilic@uni-mainz.de

http://www.uni-mainz.de/FB/Medizin/Medhist/institut/mitarbeiter/ilhan_ilkilic.php


	themes	literature	agenda	archive	anthology	calendar	links	profile

Ilhan Ilkilic