Lecture for 4th year medical students on 20th January 2001 by Professor Omar Hasan Kasule Sr.
1.0 THE CONCEPT OF CHANGE OF ALLAH’S
A. Stability of Allah’s creation
B. Beauty and perfection of creation
C. Dissatisfaction with defects
D. Role of shaitan
E. Risk of tampering with fitra
A. Permitted procedures
B. Dishonorable procedures
C. Circumcision procedures
D. Fraudulent and deceptive procedures
3.0 RECONSTRUCTIVE/RESTORATIVE SURGERY
A. Natural malformations
B. Deformities as complications of disease
C. Deformities as complications of treatment
D. Hide identity
E. Sex change
4.0 COSMETIC SURGERY
B. Purposes of the law, maqasid
C. Principles of the law, qawaid
D. Minor cosmetic operations
E. Major cosmetic operations
5.0 GENERAL CONCLUSIONS
1.0 THE CONCEPT OF CHANGE OF ALLAH’S CREATION
A. STABILITY OF ALLAH’S CREATION
The Qur’an has talked about fitra as the creation of Allah that does not change, la tabdiila li khalq
al laah (30:30). It also talked about the stability of Allah’s laws, la tabdiila li sunnat al laah & la tahwiila
li sunnat al laah (35:43, 48:23, 17:77). Interpretation of these verses raises several questions that are pertinent to
reconstructive and cosmetic surgery. Is Allah’s creation stable and unchanging? If it were stable and fixed what then
is the role of humans in building civilization that involves changing fitra by cutting down forests, breeding animals, controlling
rivers, and cultivating the land? Allah’s creation changes daily as we watch humans and other creations grow old and
change and we watch the physical universe undergo changes even without the agency of humans. We can understand from this that
changes are part of Allah’s creation. Allah commanded humans to make changes in the universe as part of human viscegerency,
khilafat al insaan ala al ardh, and human civilization on earth, ‘imarat al ardh. Thus the unchanging
creation mentioned in 30:30 is understood to be constancy of the laws that govern the universe, sunan, as expounded in 35:43,
48:23, and 17:77. Thus changes can be made as long as they follow the laws laid down by Allah. Any changes that do not follow
these laws are repudiated.
B. BEAUTY AND PERFECTION OF CREATION
Allah’s creation is perfect. Allah is the best creator, ahsan al kahliqin (2:138, , 37:125). He perfected everything He made, kamal al khalq (27:88, 32:7, 7:11, 2:138, 23:41, 27:88, 28:77, 31:20, 32:7, 37:125, 40:64, 64:3, 65:11, 95:4).
He made humans in the best image (40:64, 64:3, 95:4). All what Allah created is beautiful and is pleasing to see because it
has esthetic beauty (16:6, 17:7). Inability to appreciate this beauty is a sign of weakness of faith.
C. DISSATISFACTION WITH DEFECTS
Desire to undertake reconstructive or cosmetic surgery arises out of dissatisfaction with defects and the associated
embarrassing appearance; however most of the defects are not part of the primary creation of Allah that is perfect and optimal.
The congenital or acquired defects are in most cases acquired defects either in utero or post-natally and are due to environmental
effects. Even genetic or chromosomal defects may have environmental causes. Thus it is wrong to think that there is a defect
in the primary creation. The defects are due to injuries that according to the principle of injury must be removed, al
dharar yuzaal. Thus technology to remove or correct defects is not opposing or denying Allah’s creation. A serious
issue of aqidat would arise if a human were to be dissatisfied with Allah’s primary creation because it is optimal and
perfect. Humans cannot conceptualize a better creation that they then prefer.
D. ROLE OF SHAITAN
Deliberate effort to change Allah’s primary creation without valid reasons related to isti’imar or
khilafat is due to instigations by shaitan. Shaitan always commands humans to change what Allah created (4:119). In modern
times the role of shaitan in cosmetic surgery is very clear. It induces people to look for eternal youth and beauty. It makes
them feel bad about their natural appearance. The problem is that specific physical features mostly those of northern Europeans
are held out as the standard of beauty and everybody struggles to look like them. In the process people also adopt their cultures,
ways of life with no regard to whether they are goof or bad, useful or harmful.
E. RISK OF TAMPERING WITH FITRA
As we have seen above, Allah gave humans the ability to effect many changes in their bodies, other living things,
and non-living things. These are however not changes of the basic fitra which is perfect and optimal not requiring any change.
The changes are undertaken only with two intentions: (a) remove any injury to the basic perfection of Allah’s creation
like surgery to remove a cancer (b) make changes in the universe to fulfill the purposes of khilafat and isti’imar like
agriculture, animal husbandry, and technology. These changes must follow the fixed sunan of Allah otherwise they will cause
destruction. Humans in their development of technology forgot the laws of Allah about balance and equilibrium; the result
is the environmental pollution that we have today and which may threaten the continuation of the human race because its natural
habitat may be completely ruined. It is therefore important that humans do not hasten to tamper with Allah’s creation
for no purpose and without following the sunan.
A. PERMITTED PROCEDURES
Allah made humans in a perfect image. He however also allowed them to enhance their physical appearance by wearing
clothes and using perfumes. The prophet encouraged taking care of hair and beautifying it. Hygienic measures are emphasized.
Water is perhaps the best and most enduring cosmetic in the universe. It is used for washing and ablution. All of these measures
improve our physical appearance but make no changes in the fitra. Humans however in disobedience of the sunan do undertake
other forms of beautification that either change the basic fitra or do not follow the sunan.
B. DISHONORABLE PROCEDURES
The prophet cursed the tattoer, the tattoed, the shortener of teeth, and one whose teeth are shortened (Muslim).
He condemned washm (KS526). He cursed women who widen gaps between their own or others’ teeth for the sake of beauty
changing what Allah has created, la’ana al laahhu al mutafalijaat li al husn (KS286: Bukhari K77 B82; Nisai K48
B20, 27; Ahmad 3:134, 135). He cursed women who pluck eyebrows and those whose eyebrows are plucked, la’ana al llaahu
al munamisaat (KS 294, Abudaud).
C. CIRCUMCISION PROCEDURES
Circumcision is a procedure that involves change of fitra. Male circumcision is obligatory, waajib, or desirable,
mustahabb and is recommended on hygienic grounds. Opinions differ about female circumcision. Some look at it
as an act of nobility, al khitaan mukrimat li al nisaa. Some consider it sunnat or permitted. A few hold the view that
it is obligatory, waajib. Female circumcision is thought to be a preventive measure against zina however there is no scientific
evidence on the effect of circumcision on sexual desire or sexual response. Discussion of circumcision is complicated by the
fact that there is no unanimous agreement on what constitutes female circumcision. There are three operations that are carried
out under the name circumcision. The simplest and the one recommended by the prophet is excision of part of the clitoral foreskin,
kahfdh. Extreme forms of female circumcision involve genital mutilation such as excision of the whole clitoris and
infibulation. Female circumcision is associated with many complications if done in the traditional way. These could be avoided
if physicians in the clean environs of the hospital or clinic carry out circumcision. Immediate complications are pain, hemorrhage,
and infection. Late complications are delayed wound healing, scarring, keloid and scarring, painful intercourse, and difficulty
in childbirth and severe perineal tears.
D. FRAUDULENT and DECEPTIVE PROCEDURES
Wigs and hairpieces are prohibited, al nahyu ‘an muwasalat
al sha’ar (KS293). The prophet cursed the woman who carries out the procedure, wasilat, and the one on whom
the procedure is carried out, mustawsilat (Bukhari from Aishah, Asma bint Abubakr, Ibn Masoud, Ibn ‘Umar, and
AbuHurairah). Bukhari reports 2 instances in which the prophet repeated this prohibition. The first one was a married girl
of the Ansar who fell ill and lost her hair and people wanted to add some strands of hair to her hair (Bukhari Kitaab al Libaas).
The second instance was a mother whose daughter had lost hair due to measles. She asked the prophet for permission to add
a few strands of hair before giving her out in marriage.
Dyeing hair: The prophet told his companions to dye their hair
to be different from Jews and Christians who did not dye their hair, al yahuud wa al nasaara la yasibaghuun fa khaalifuuhum
(KS293), al amr bi sabagh al sha’ar (KS 293). The Prophet prohibited dyeing with black, nahy al khisaab bi
al sawaad (KS293), because that would involve deception about true age. Any other colors can be used; dyeing with yellow
is preferred to dyeing with red (KS294). The prophet mentioned the high reward of having gray hairs, ajr al shayb (KS294).
It is offensive to change gray hair, karahiyat taghyiir al shaib (KS294). Plucking out the gray hairs is forbidden,
nahyu natf al shayb (KS294). It is clear from the above that any procedures that aim at making a person appear younger
that what he is are a form of deception and are forbidden.
Hymenal reconstruction: A bride who has had previous sexual experience
and has her hymen reconstructed so that her husband may be deceived into thinking that he is marrying a virgin.
There are other forms of beautification. Increasing body weight and changing body shape by dieting is common and
was practiced by women at the time of the prophet without objection. Golden teeth were used.
3.0 RECONSTRUCTIVE/RESTORATIVE SURGERY
A. NATURAL MALFORMATIONS
Malformations may be congenital or acquired. The distinction is not important because many of the congenital malformations
are due to environmental factors operating in utero. Examples of natural malformations: extra digit on the hand or foot, drooping
eyelid, excessive facial hair for a woman, beard or moustache for a woman, and moles. The purposes of surgery on malformations
are: (a) restoration of the normal appearance to relieve psychological pressure & embarrassment(b) restore function. These purposes do not involve change of fitra but restoration of fitra to its state
before the injury.
B. DEFORMITIES AS COMPLICATIONS OF DISEASE
Diseases may leave ugly sequelae such as scars of deformations. The purposes of surgery in such cases are: (a)
relieve pain and embarrassment (b) restore function. These do not change fitra but are a return to the normal.
Breast reconstruction following mastectomy
C. DEFORMITIES AS COMPLICATIONS OF TREATMENT
Treatment of breast cancer by radical mastectomy is followed by deformations that can be corrected by breast reconstruction
surgery. No change of fitra is involved here. The procedure is an attempt to restore normal fitra.
D. HIDE IDENTITY
A witness who helped the authorities arrest and prosecute dangerous criminals may fear for his life and resort
to facial surgery so that he cannot be detected. This situation involves deliberate change of fitra but with a noble purpose.
E. SEX CHANGE
A pseudohermaphrodite has a genetic gender of male or female but the external sexual organs are indeterminate or
may look like those of the opposite gender. A surgical operation to reveal the true gender is not change of fitra but an attempt
to restore fitra altered by hormonal or chromosomal damage. Sex change operations have another objective of trying to preserve
or restore the reproductive function.
4.0 COSMETIC SURGERY
For purposes of our discussion, cosmetic surgery includes extra-ordinary surgical procedures for the sole purpose
of enhancing beauty with no medical or surgical indication. Examples of cosmetic surgery: straightening a crooked nose. We
will review these using the purposes of the Law and the principles of the Law.
B. PURPOSES OF THE LAW, maqasid al shariat
Cosmetic surgery fulfils the purpose of preserving progeny, hifdh al nasl, if carried out for beautification
in order to improve chances of finding a husband or wife and fulfill the obligations of marriage and procreation. Cosmetic
surgery, like any other form of intervention, carries a risk thus violating the purpose of preservation of life. Most procedures
of cosmetic surgery are very expensive and they violate the purpose of preserving wealth, hifdh al maal. The strongest
criticism of cosmetic surgery by Muslims today is that it violates the principle of preservation of religion, hifdh al
ddiin. Most people carry out cosmetic surgery to look like blonde north Europeans with aquiline noses, small lips, straight
faces, and pale skin. This is being held and accepted as the standard of human body with the implied assumption that other
human forms are ugly. A true believer knows that all humans and all other creations created by Allah are beautiful each in
its own way. Denial of this is a denial of the creator and hence denial of religion.
C. PRINCIPLES OF THE LAW, qawaid al shariat
Under the principle of motive, qasd, it is the motivation for an action that is considered and not outside
appearances. We therefore have to look at each individual case of cosmetic surgery and judge it based on the intention. As
mentioned above a simple cosmetic surgery operation may lead to the noble purpose of marriage. We however must consider the
benefits of cosmetic surgery against its harm under the principle of injury, qa’idat al dharar. The Law gives
priority to prevention of injury over accruing a benefit. The principle of hardship, qa’idat al mashaqqat, can not be
applied to cosmetic surgery because there is no life-threatening situation necessity, dharuurat, to justify putting aside
normal prohibitions. Pursuit of beauty in not necessary for life and good health. Beauty is in any case a nebulous intangible
entity that is very subjective.