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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0203-ETHICS OF HUMAN EXPERIMENTATION: AN ISLAMIC PERSPECTIVE

Paper written for the UAE International Conference on Healthcare Ethics 10-13 March 2002 by Prof Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Deputy Dean, Kulliyah of Medicine, UIA Faculty of Medicine, Kuantan MALAYSIA EM: omarkasule@yahoo.com

ABSTRACT

The Islamic ethical theory on research is based on the 5 purposes of the Law, maqasid al shari’at,under which define the 5 necessities, dharurat, under which human experimentation is allowed: preservation of religion, life, progeny, the mind, and wealth. If any of the 5 necessities, al dharuraat al khamsat, is at risk permission is given to undertake experiments that would otherwise be legally prohibited. Therapeutic research fulfills the purpose of protecting health and life. Infertility research fulfils the purpose of protecting progeny. Psychiatric research fulfills the purpose of protecting the mind. The search for cheaper treatments fulfills the purpose of protecting wealth, hifdh al mal. The 5 principles of the Law (intention, certainty, injury, hardship, and precedent) constitute the Islamic ethical guidelines. Research is judged by its underlying and not expressed intentions. Research is prohibited certainty exists about beneficial existing treatment. Research is allowed if benefit outweighs the risk or if public interest outweighs individual interest. If the risk is equal to the benefit, prevention of a harm has priority over pursuit of a benefit of equal worth. The Law chooses the lesser of the two evils, injury due to disease or risk of experimentation. The principle of custom is used to define standards of good clinical practice as what the majority of reasonable physicians consider as reasonable. Under the doctrine of istishaab, an existing treatment is continued until there is evidence to the contrary. Under the doctrine of istihsaan a physician can ignore results of a new experiment because of some inclination in his mind. Under the doctrine of istislaah preventing a harm has priority over obtaining a benefit. Informed consent by a legally competent research subject is mandatory. Informed consent does not legalize risky non-therapeutic research with no potential benefit. Informed consent is violated in community-based experimentation in which individuals are not consulted. It is illegal to force participation of the weak (prisoners, children, the ignorant, mentally incapacitated, and the poor) in clinical trials. Research on fetal human tissues may encourage abortion. Objection to dissection of cadavers for medical education and post-mortem examination is on the basis of prohibition of mutilation but permission is given where necessity can be established. Use of human bodies in auto crass experiments is an affront to human dignity. Genetic experiments on human organisms, tissues, and cells give rise to many ethical problems. Transformed genes, molecules, and even microorganisms may cause diseases hitherto unknown. They may lead to new forms of environmental pollution. The Law allows research on ageing as long as the aim is not prolongation of life or preventing death because those aspects are under Allah’s control.

Professor Omar Hasan Kasule Sr. March 2003