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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0312-A CRITIQUE OF THE BIOMEDICAL MODEL FROM AN ISLAMIC PERSPECTIVE

Paper presented at the 4th International Scientific Meeting of the Islamic Medical Association of Malaysia in Conjunction with the 19th Council Meeting of the Federation of Islamic Medical Associations in Shah Alam, Selangor, 4-7th July 2002 by Professor Omar Hasan Kasule, Sr. MB ChB (MUK), MPH, DrPH (Harvard), Deputy Dean for Research, Kulliyah of Medicine, International Islamic University, PO Box 231 Kuantan, MALAYSIA. Fax 609 513 3615. EM: omarkasule@yahoo.com

ABSTRACT

This paper argues that health care based on a holistic medical model is superior to one based solely on the biomedical model. The biomedical model is invasive, costly, materialistic, narrowly focussed, inflexible, and seeks to control and regiment. Its materialism treats health as a commodity. It dehumanizes and demystifies the body by treating it as a ‘machine’, a ‘thing’ or a ‘physico-chemical phenomenon’. It depersonalizes the patient as a case of pathology and not as a human because it is more interested in the disease and not the person. It allows a technical relation to replace a human physician-patient bond. Biomedicine is not holistic because it concentrates only on somatic aspects of disease and equates disease to illness whereas the latter is wider in scope. It limits disease causation to pathological anatomy or patho-physiology and rejects or marginalizes spiritual, cultural, social, and psychological factors. The benefits of biomedicine have been confined to decrease in infant mortality and control of infectious diseases by immunization. In the late 20th and early 21st centuries, the biomedical model has failed to make a major impact on chronic degenerative diseases because it does not have the tools to change life-style and human behavior. Life-style related emerging and re-emerging communicable diseases like HIV and STD are increasing despite sophisticated biomedicine. This poses a challenge to medical policy makers to explain why most resources for health are allocated to curative services based on the biomedical model when its overall effectiveness is questioned. The limitations of the biomedical model cannot be overcome until a serious re-examination of its European philosophical background is undertaken. The major tenets of this philosophy are materialism, secularism, modernism, and post modernism. The paper describes an alternative holistic model of health care delivery based on the tenets of tauhid, universal moral values, purposes of the Law, maqasid al shari’at, and principles of the Law, qawa’id al shari’at. The paper describes the Islamic concepts of life, health, disease and illness, disease treatment and prevention. The paper argues for a health care model involving a holistic approach that emphasizes spiritual and social excellence, behavioral and lifestyle change, environmental amelioration, and primary health care (health promotion, and disease prevention). 

 

1.0 INTRODUCTION

The objective of this paper is to show the superiority of a holistic medical model to one based solely on the biomedical model. It presents a critique of the biomedical model and proposes a holistic Islamic alternative to it. The biomedical model is critiqued based on its basic philosophical assumptions. The paper presents the main concepts of an Islamic holistic model of health care.

 

2.0 CRITIQUE OF THE BIOMEDICAL MODEL

2.1 PHILOSOPHICAL BACKGROUND

Current medical practice is based on the biomedical model. Biomedicine has achieved a lot in prevention and treatment of many diseases but is being challenged by chronic non-communicable diseases and the rising costs of curative medicine. Understanding of the underlying biomedical model is necessary for assessing health policy alternatives. The biomedical model is the culmination of philosophical developments in Europe over the past 500 years that have transformed metaphysical medicine into scientific medicine. The philosophical changes were a materialization of life (empiricism), marginalization of spiritual and other considerations in health (secularism), and physical reductionism (i.e. understanding by breaking up into components).

 

2.2 BASIC CHARACTERISTICS

Biomedicine is materialistic: The materialist background of biomedicine contradicts Islamic concepts. Materialism leads to consideration of health as a commodity that can be bought with money. The materialist background dehumanizes and demystifies the body and treating it like a ‘machine’, a ‘thing’ or a ‘physico-chemical phenomenon’. Besides dehumanization, it depersonalizes the patient who is looked at as a case of pathology and not as a human. It is more interested in the disease and not the person. A technical relation replaces the human physician-patient bond. Patients do not get emotional and psychological satisfaction from encounters with physicians even if their pathological disorders are resolved satisfactorily. Biomedicine relies exclusively on the scientific disease theory which asserts that symptoms reflect specific disease entities and that each disease entity has a unique cause and a unique therapy[i]. It asserts that disease is due to either pathological anatomy[ii] or patho-physiology[iii]. It assumes that causes of disease disturb the equilibrium and the purpose of medicine is to restore equilibrium. Biomedicine does not readily accept other causes of disease outside anatomical and physiological derangements. It therefore bases its diagnosis exclusively on physical assessments[iv]. It does not consider any other ways of defining and diagnosing disease. Definition of abnormality in biomedicine is inadequate since it focuses on biology and ignores culture and psyche. Biomedicine has no fixed criteria for distinguishing the normal from the abnormal in body structure and function. It relies on statistical measures to define the norms. It also considers points of equilibrium as the norm. Despite the claims of scientific objectivity, the biomedical model has not always been able to operate away from subjectivity in practice. Subjectivity cannot be avoided in diagnostic and treatment decisions. Reality depends on the starting point.

 

Biomedicine is not holistic. It ignores cultural, social, spiritual, and psychological aspects of illness and concentrates only on somatic aspects. It de-emphasizes overall wellness and welfare and narrowly focuses on pathological anatomy and patho-physiology. Biomedicine has failed to handle psychosomatic disorders that have no obvious anatomical or physiological origin. In its approach to factors of disease it marginalizes environmental medicine[v] and behavioral medicine[vi]. Biomedicine equates illness with disease. Illness is wider and more holistic than disease. Illness is affected by both somatic and non-somatic factors whereas disease is affected by somatic factors alone. The elderly may for example be ill but with no specific disease. In the same way people with serious pathological conditions may not be aware of them or may not be concerned and they feel that they are in good health. Biomedicine fails to distinguish illness from disease because it concerns itself with the body and not the mind. It rejects the body-mind dualism that human traditions have accepted throughout history. It also rejects the dualism of soul and matter that is the unique characteristic of humans.

 

Biomedicine is not flexible. Biomedicine has not been able to respond effectively to the epidemiological shift from acute to chronic disease and the demographic shift from younger to older population distributions. Biomedicine is more applicable to acute than to chronic diseases. It has been very successful in curing acute infectious diseases by use of specific anti-microbial agents. It has not been flexible enough to performed equally well in cure of chronic and degenerative diseases

 

Biomedicine seeks to predict, control, and regiment. Biomedicine is not democratic. It gives all decision-making power to the physician and leaves the patient powerless. It has medicalized human life. It has distorted relations between humans and medicine. Pre-biomedicine humans controlled medicine and used it as they like. Post-biomedicine medicine controls human life and behavior.

 

2.3 PARADIGMATIC CHANGE FROM BIOMEDICAL TO HOLITISTIC MODELS

Need for reform: Many thinkers and physicians are aware of the limitations of the biomedical model. Efforts have been made to correct its deficiencies by adding missing dimensions. A bio-psycho-social model has been proposed to take care of psychological and social aspects. Spiritual aspects have so far not been recognized widely. Radical changes to the biomedical model will only occur if the philosophical background is re-examined. European materialism, secularism, modernism, and post modernism are the dominant philosophical tenets in medicine. No major changes can occur until these are examined critically. Unfortunately Muslim physicians have been very complacent in accepting without challenge most of the European philosophical under-pinning of biomedicine. This is the lizard hole phenomenon that the prophet (PBUH) warned his community about[vii].

 

Three Islamic concepts (tauhid, wasatiyyat, & shumuuliyyat) can form a conceptual basis for reforming the biomedical model to become more holistic. The concept of tauhid motivates looking at the patient, the disease, and the environment as one system that is in equilibrium; thus all factors that are involved with the three elements are considered while making decisions. The concept of wasatiyyat motivates the need for moderation and not doing anything in excess. The concept of shumuuliyyat extends the tauhidi principle by requiring an overall comprehensive bird’s view of the disease and treatment situation. The argument is not that biomedicine is good or bad. The science and technology are good and needed. The problems are the philosophical pre-assumptions that limit medicine to biomedicine and reject other necessary components of medical care.

 

3.0 ISLAMIC CONCEPTS OF HOLISTIC MEDICINE

3.1 CONCEPT OF LIFE

Life is a complex phenomenon with biological, chemical, and spiritual components. Life on earth has a definite time span, ajal[viii]. No human endeavor including the most advanced medical procedures can shorten or extend this time span. The whole purpose of medicine is to exert maximum efforts to improve the quality of remaining life since Allah alone knows the timing of the ajal. Humans do not know ajal, jahl al insaan bi zaman al mawt[ix]. They have no means of foretelling in a certain way the moment of death[x]. They can predict or extrapolate from their empirical observations and experience but this remains at best an approximation. Death occurs immediately when the appointed hour strikes, buluugh al ajal[xi]. The hour of death is fixed, ajal ma’aluum[xii]. It can not be advanced or forwarded[xiii]. Humans naturally want to live for long[xiv]. This may be because they want to enjoy the earth as long as possible or for fear of the unknown after death. Some humans desire a long life to be able to make a maximum contribution to improving themselves and the earth on which they live.  Human life must have some quality. It is not enough to eat and breathe or maintain the vegetative functions only. A human can not live like a plant or an animal. The quality of life can be defined in physical, mental, or spiritual dimensions. The physical criteria are: absence of disease, comfortable environment, and basic necessities. The mental criteria are: calmness, absence of neurosis and anxiety, and purposive life. The spiritual criterion is correct relation with the creator.

 

Each human has an inalienable right to life from Allah, haqq al hayaat. This life cannot be taken away or impaired by any human being except in cases of judicial execution after due process of the law. Life is sacred and its sanctity, hurmat al nafs, is guaranteed by the Qur’an[xv]. The life of each single individual whatever be his or her age, social status or state of health is important and is as equally important as the life of any other human[xvi]. Protection of life, ‘ismat al hayaat/hifdh al nafs, is the second most important purpose of the shari’at coming second only to the protection of the ddiin. Legal compensation for bodily damage or homicide is replacement of lost earnings and not paying for the value of life. The compensation is a legal provision to provide sustenance to surviving relatives in case of death. It also provides sustenance to persons whose organ was severed and who therefore cannot work to support themselves. Every life is as important as any other life. Destroying the life of one person is equivalent to destroying the life of all humans[xvii].

 

3.2 CONCEPT OF HEALTH

The prophet said that good health, sihhat, and ‘afiyat are two bounties that many people do not enjoy[xviii]. Few people are healthy in all their organs and at all times. Health is a positive state of being and not just absence of disease. The traditional view of health looked at it as the absence of disease. Before the development of scientific medicine, few diseases were curable. With increasing ability to cure disease we find that people may not be in optimal health and well being even if all physical ailments were eradicated. This has led to the realization that good health is an independent entity that can be defined and handled independent of disease. Stated in other words, individuals who are disease-free may not be healthy. The components of good health are spiritual health, sihhat ruuhiyyat; physical health, sihhat al jasad / raahat jasadiyyat; psychological and mental, sihhat nafsiyyat / raahat nafsiyat, and social health. Spiritual health is maintaining correct relations with the creator that in turn orders relations with other humans and with the environment. Health in the biological sense is maintaining physiological function in the optimal situation. Psychological health is being aware of and at peace with the self as well as the social environment around. Health in the social sense means harmonious functioning in the social milieu involving give and take relations. The various components of health are inter-related and closely inter-dependent such that a problem in one can easily lead to disequilibria in others. Islam looks at health in a holistic sense. If any part of the body is sick the whole body is sick, mathal al jasad al waahid idha ishtaka minhu ‘udhuwun tadaa’a lahu saairu al jasad bi al sahar wa al humma. If a member of a family is sick the rest of the family are affected emotionally and psychologically. Any sickness in the community will sooner or later have some negative impact on all the members. The holistic outlook also means that all aspects of physical, emotional, psychological, and spiritual health are considered together. A person who is spiritually sick will sooner or later also become physically sick. The reverse is also true unless the iman is very strong.

 

Health is relative and subjective. It varies by age, place, norms, gender, and state of iman or tawakkul. A physical state that is healthy in an elderly person may not be so in a younger one. The conventions and norms, ‘aadat, of what is good health vary from place to place and even in the same place may vary from era to era. The subjective feeling of good health varies among individuals and groups of people. Those with strong iman and trust in Allah, tawakkul, may feel subjectively healthier than those who do not have these attributes. Health is often assessed subjectively using terms such as ‘good health’, ‘healthy’, ‘poor health’ and ‘unhealthy’. There are measurable statistical indicators of good health that are useful for a group of persons since they describe the average or the range of the normal. The health status of a community is usually measured by morbidity, mortality, and disability. For the individual, the assessment of health is very individualized and cannot be summarized as indices or statistical measures. The indices of health are limited in that they indicate only the final state of health and do not take into account the intermediate stages. They also cannot measure the intangible spiritual and mental components of good health. The best index would be one that includes both spiritual and physical parameters. Such an Islamic index has not yet been constructed to our knowledge. This index would also include criteria that reflect relations with Allah, with the self, with other humans, and with the environment.

 

Keeping the body in good health is a responsibility, amanat. Muslims must keep their bodies physically fit to be able to undertake the functions of viscegerancy, istikhlaf, and civilization, isti’mar. Poor health not only deprives society of the contributions of an individual but also creates a burden for others. Neglect of one's health is a sin. It is a religious obligation, fardh, for the sick to seek treatment. It is also obligatory to undertake disease-preventing measures such as dietary regulation, general and oral hygiene, avoiding violence, avoiding diseases of the qalb that precede mental illness, or in general avoiding anything that impairs good health. Good health is a gift from Allah, ni’mat al sihhat[xix].

 

The concept of community health was not recognized widely until the last quarter century. It is however a very old concept found in the Qur'an. The Qur'an has told us about many communities in the past as lessons for us[xx]. Good, al balad al taib[xxi] and safe, al balad al amiin[xxii] are adjectives that the Qur'an has used about some communities. Some of them were blessed and lived in peace and plenty[xxiii]. Makka was described as a city of peace and general welfare[xxiv]. The Qur'an also told of communities that were victims of collapse, khiraab[xxv], those that were punished by famine[xxvi], or those that were destroyed by Allah, ihlaak[xxvii]. The physical destruction was due to moral deviations like transgression, dhulm[xxviii], and corruption, fasaad[xxix]. No community is destroyed or is punished until it receives a warning from Allah[xxx].

 

3.3 CONCEPTS OF ILLNESS and DISEASE

Health is a condition in which all of the body functions are integrated and are being maintained within the limits of optimal design. A distinction must be made between disease as a pathological manifestation and illness that is a subjective feeling. Disease is divergence from the normal, Gaussian mean, but not all deviation is disease because of the reserve capacity and ability of the body to adjust to variations. The demarcation between pathology and normal physiological variation can be fine. The definition of disease is very relative. A high blood pressure in an elderly person does not have the same implication as the same level in a younger person. Temperature levels have different interpretations in neonatal and adult infections. Adolescent behavior that may be normal would be considered illness in adults. There are changes in the body that should be accepted as normal processes of ageing and not as diseases. There is a space-time variation in definition and perception of disease depending on the culture, beliefs, attitudes, and prevalence of diseases. In localities where the burden of major diseases is high, some minor ailments may be ignored whereas in other places they are taken as serious diseases. There are diseases that may be associated with social status. One socio-economic group may perceive them as serious whereas another one does not. Some diseases become reclassified with changing public opinion and perceptions. New diseases continue to be defined due to changes in the causative agents, host factors, or new scientific knowledge. Today's disease entities may be redefined and re-classified in the future. Definition of disease considers several dimensions that may operate singly or in combination: moral or spiritual, biological or pathological, psychosocial, or normative statistical.

 

Overall disease is a state of dis-equilibrium, khuruuj al badan ‘an al i’itidaal. Loss of spiritual equilibrium is a disease in itself and soon leads to physical disease. Appreciation of this fundamental principle distinguishes a believing from a non-believing physician. Most diseases involve disturbances in the equilibrium of the normal body physiology. These biological disturbances may be within the range of normal physiological variation or may be clearly pathological. The psychosocial dimension of disease is associated with loss of equilibrium and may precede or follow physical disturbances. The normative or statistical dimension of disease is the most confusing. Sometimes people are branded ill because they fall at the extreme end of the health-illness spectrum as measured biochemically or physically. In the final analysis it is the perception of disease by the victim, the family or the health care givers that defines disease. The underlying pathology need not correspond with the victim’s disease complaint; perception operates in between.

 

Diseases may also be classified by cause as diseases of the heart, amradh al qalb[xxxi], and diseases of the body, amradh al badan. Diseases of the heart include: lahw[xxxii], ghaflat[xxxiii], ghill[xxxiv], ghaidh[xxxv], kibr[xxxvi], and nifaq[xxxvii]. These diseases of the heart lead directly or indirectly to somatic diseases. There is a relation between diseases of the heart, amradh al qalb, and diseases of the body, amradh al badan. The mental and spiritual disease of kufr leads to a lot of human cruelty like genocide because of lack of moral restraint. Diseases of the heart such as jealousy lead to violence and even death. Failure of appetite control leads to obesity and other attendant diseases. Addiction to alcohol leads to many physical and mental derangements. Loss of sexual self-control leads to promiscuity and sexually transmitted diseases. Protein energy malnutrition of the poor manifests social injustice in the community. Lack of spiritual equilibrium leads to inability to handle normal stresses of life. This is often followed by addiction to alcohol and psychoactive substances. Physical diseases may cause so much depression and loss of hope that they lead to diseases of the heart.

 

3.4 NATURE OF DISEASE

Disease is both reaction and adjustment. A patho-physiological disturbance is normally a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including their symptoms and signs are a reaction to the injury and an attempt to re-adjust.

 

Disease as a bounty: In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. Falling ill may be Allah’s way of forcing the person to take a desired rest or care for the body before it can deteriorate further. Death from some diseases was said by the Prophet to be martyrdom, shahaadat. The pain due to disease is a reminder of the punishment and suffering that the evildoers will suffer from in hell. Disease can be an opportunity for personal redemption by expiation/atonement for previous sins, al maradh kaffaarat ‘an ba’adhi al dhunuubi[xxxviii]. Disease may enable a person return to the due equilibrium in life. Falling sick may at times be Allah’s blessing in disguise that a person is incapacitated and thus is prevented from pursuits that could prove more dangerous for him. While a person is sick and is not busy with the routines of life he may have time to reflect and remember Allah. Disease is a trial: The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness[xxxix]. Patience with chronic disease/disability is associated with high reward. The prophet (PBUH) talked about rewards for epileptics[xl] and the blind[xli]. Patience in the face of severe illness is a reason for entering paradise, jannat.

 

Disease as punishment: Some diseases are due to disobedience. Acts of disobedience may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship. The prophet taught that when communities commit inequities, Allah sends them diseases unknown in their ancestors. Many of the diseases of industrialized societies are related to lifestyle and may be Allah’s punishment for various transgressions.

 

Causality in disease: According to the Islamic perspective every phenomenon in life has an immediate cause, sabab, that humans can search for and find. However behind all these causes is the power and majesty of Allah who alone is the source of all causes, musabbib al asbaab. When all the factors that produce a certain pathological condition exist, we say that there is a sufficient cause of disease. However humans can never know for sure that there is a sufficient cause because Allah’s divine will, qadar, is involved. There are many cases when all the humanly known factors of a disease exist but the disease does not occur. This is because of the unknown factor attributable to Allah alone. There are empirical factors that must operate for a certain pathological condition to occur. These are referred to as necessary causes. For example the tubercle bacillus is a necessary cause for the disease of tuberculosis. Humans must know the necessary causes of diseases. Denying their existence is denying the cardinal principle of sunan Allah fi al kawn and is akin to superstitious belief.

 

Multi-factorial causality of disease: Human diseases, like the human organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act in sequence, knowledge of only one may be sufficient to interrupt the causal pathway.

 

Pre-determination, qadar, in disease: The causation, progression, and resolution of disease are in the hands of Allah and are part of qadar. It is Allah’s pre-determination that a person falls sick. Humans try to understand disease processes in order to reverse them. This is not contradicting or opposing Allah’s will. All what a physician does is with Allah’s permission and is therefore part of pre-determination. Treatment and prevention of disease are not against qadar but are subsumed under the principle that qadar can reverse another qadar, radd al qadar bi al qadar. In the end all cure is from Allah and not the human[xlii].

 

3.5 DETERMINANTS OF DISEASE

Environmental causes of disease: heat, cold, radiation, water, smoke, and high altitude can lead to patho-physiological disturbances and disease. Extreme heat can cause heat stroke and dehydration. Water kills drowning people, gharaq[xliii].

 

Contagion, ‘adwah, from the microbiological environment is part of Allah’s plan especially in fulfilling the food chain. It is part of the balance of the eco-system. This does not however mean that such diseases should be left alone. There has been some confusion about hadiths of the prophet dealing with infection and contagiousness of disease. The Prophet was speaking about different diseases on different occasions. Some were contagious while others were not. Even with one disease like leprosy there are contagious and non-contagious forms[xliv]. 

 

Other determinants of disease are malnutrition, genetic anomalies, immunological anomalies, neoplastic and degenerative change. Islamically speaking we cannot say that there was a genetic or chromosomal mistake. It is all part of Allah’s grand design. The Qur’an teaches that degeneration occurs with aging[xlv].

 

3.6 CONCEPTS OF TREATMENT and CURE OF DISEASE

Every disease has a treatment. The prophet Muhammad (PBUH) said in an authentic hadith that Allah did not reveal any disease, bau, without also revealing its cure, dawaa[xlvi]. Humans are encouraged to seek treatment, al hatthu ‘ala al dawaa[xlvii]. The Qur’an described cure, shifa[xlviii]. The Qur’an is itself a cure[xlix]. Honey is described in the Qur’an as a cure[l]. Some people may know the cure and others may ignore it but it nevertheless exists. The Qur’an described disease in prophet Ayyub (PBUH) and its eventual cure[li]. The Qur’an described how Isa cured chronic diseases[lii]. Humans try, but it is Allah who cures, Allah huwa al shaafi[liii]. Humans should not be arrogant by attributing cure to themselves and not Allah. In the same way humans cannot refuse to take measures to cure disease claiming that Allah will take care of it. It is true that Allah cures but in some cases that cure operates through the agency of humans. Sometimes the measures that humans take to cure a disease may not be sufficient on their own to alleviate the condition; it is Allah’s divine intervention and mercy that brings about the complete cure. Disease treatment is part of qadar[liv]. Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadar. The principle that applies here is reversal of qadar by another qadar , rad al qadr bi al qadr.

 

3.7 CURATIVE MEDICINE, TIBB ‘ILAJI

Curative medicine may be invasive or non-invasive. Where possible non-invasive approaches are preferred because invasive disease treatment whatever its nature involves some element of risk to the patient. A non-invasive approach that aims at helping or assisting the body to fight the disease is the best. Many physicians forget the tremendous potential that the body has to take care of itself and cure disease with the help of Allah. Medical treatment in most cases should be supportive to the body’s natural healing processes.

 

Among spiritual approaches to disease management is use of dua from the Qur’an[lv]  and hadith as ruqiy. Dua was reported to have been used for madness, dua min al junoon [lvi] and for fever[lvii]. The formulas for ruqy reported from the prophet, al ruqiy al mathuur, consist of the following chapters of the Qur’an: al fatihat, al falaq, al naas, ayat al kursi, and the various supplications reported from the prophet, dua ma’athurat. The Qur’an is the best medicine[lviii]. Dua is medicine[lix]. Asking for protection from Allah, isti’adhat, is medicine. A strong iman and trust in Allah, tawakkul, play a role in the cure of diseases. Salat is a cure[lx]. The spiritual approach to cure is mediated through the physical processes. Psychosomatic processes affect the immune functions and other metabolic functions of the body. A believer who is spiritually calm will have positive psychosomatic experiences because he or she will be psychologically healthy and at ease. Faith can change the very perception of disease symptoms. Pain is for example subjective. A believing person who trusts in Allah may feel less pain from an injury than a non-believer with the same injury.

 

Among physical approaches to disease management are: diet, natural agents (chemical, animal and plant products), manufactured chemical agents, surgery, jiraaha, and physical treatment e.g. heat. All therapeutic agents and procedures are allowed unless they contravene a specific provision of the law. This provides a wide scope for the practice of medicine. Bad medicine is forbidden[lxi]. Bad medicine causes more harm than benefit. While seeking treatment, the moral teachings of Islam must be respected. The end never justifies the means. Haraam material is not allowed as medicine except in special circumstances where the legal principle of necessity, dharuurat, applies. Alcohol is for example not an accepted cure for any disease; it is actually itself a disease. The side effects of medication must be considered alongside the benefits. Harmful treatments are not allowed in situations in which the cure is worse than the disease. Choice of what treatment modality to use should involve a careful weighing of benefits and possible harm or injury. It is a principal of Islamic Law to give priority to preventing harm over accruing a benefit.

 

 

1.8 CONCEPT OF PREVENTION:

Preventive medicine is a pro-active measure: The Qur’an has used the concept of wiqaayat in many situations to refer to taking preventive action against entering hell-fire, wiqaayat min al naar[lxii], against punishment, wiqaayat min al’ adhaab[lxiii], against evil, wiqaayat min al sharr[lxiv], against greed, wiqaayat min al shuhhu[lxv], against bad acts, wiqaayat min al sayi’at[lxvi], against injury/harm, wiqaayat min al adha[lxvii], against jealousy, wiqaayat min al hasad, against oppressive rulers, wiqaayat min al taghoot[lxviii], against annoyance, wiqaayat min al adha[lxix], and against heat, wiqaayat min al harr[lxx]. Prevention is therefore one of the fixed laws of Allah in the universe, sunan llah fi al kawn. Its application to medicine therefore becomes most obvious. Disease could be prevented before occurrence or could be treated after occurrence. The concept of prevention, wiqaayat, does not involve claiming to know the future or the unseen, ghaib, or even trying to reverse qadar. The human using limited human knowledge attempts to extrapolate from the present situation and anticipates certain disease conditions for which preventive measures can be taken. Only Allah knows for sure whether the diseases will occur or not. The human uses knowledge of risk factors for particular diseases established empirically to predict disease risk. Preventive action usually involves alleviation or reversal of those risk factors.

 

Three levels of prevention: The concept of prevention can be understood at three levels. Primary prevention aims at making sure the disease does not occur at all. Secondary prevention aims at limiting the impact of the disease once it has occurred; this is usually by attempting to detect the disease early and instituting necessary treatment. Tertiary prevention aims at mitigating the long-term sequels and complications of a disease. Prevention also involves avoiding any act that can hurt good health or destroy life, halaak[lxxi]. There are activities that promote good health and are part of preventive medicine because they put the body in the best possible status to be able to fight and overcome any disease that occurs. Examples of such activities are: physical exercise, rest and recreation, diet, dhikr llah, happy marriage and good family life.


[i]  This assertion is seriously challenged by chronic diseases

[ii]  Disease is due to anatomical anomaly

[iii]  Disease is due to deranged physiological or biochemical function

[iv]  Clinical examination for signs, medical imaging, and medical chemistry

[v]  Environmental medicine asserts that disease is related to the physical and social environments

[vi] behavioral medicine is based on the doctrine of mind-body dualism asserts that immune, endocrine, and nervous systems are inter-related)

[vii] The Prophet (PBUH) warned that Muslims in later times would follow the Yahuud and Nasaara like lizards follow one another running into their holes. He said ‘Latatiba’anna sunan man kaana qablakum shibran bi shibri wa dhiraa’an bi dhiraa’in hatta law dakhaluu juhra dhabbi lataba’atumuuhum. Qulna ya rasul al llaah al yahuud wa al nasaara! Qaala faman?

[viii] Qur’an 6:2, 6:128, 11:3, 13:38

[ix] Qur’an 31:34

[x]  Qur’an 31:34

[xi]  Qur’an 63:11

[xii]  Qur’an 35:45

[xiii]  Qur’an 15:4, 16:61, 71:4, 63:10-11

[xiv]  Qur’an 2:96

[xv]  Qur’an 2:84-85, 4:29, 5:32, 6:151, 17:33, 18:74, 25:68

[xvi]  Qur’an 5:32

[xvii]  Qur’an 2 5:32

[xviii]  Bukhari K81 B1, Tirmidhi K24 B1, Ibn Majah K37 B15, Darimi K20 B2

[xix] Bukhari K81 B1, Tirmidhi K34 B1, Ibn Majah K37 B15, Darimi K20 B2

[xx]  Qur’an 11:100

[xxi]  Qur’an 7:58, 34:15

[xxii]  Qur’an 95:3

[xxiii]  Qur’an 2:58, 7:96, 7:161, 16:112

[xxiv]  Qur’an 2:126, 14:35

[xxv] Qur’an 2:259, 27:34

[xxvi]  Qur’an 7:94-95, 16:112, 65:8-9

[xxvii] Qur’an 6:131, 7:4, 7:96-98, 11:102, 11:117, 1:4, 17:16, 17:58, 18:59, 21:95, 22:45, 22:48, 25:40, 26:208, 27:56-58, 28:58-59, 29:31, 29;34, 46:27, 47:13

[xxviii] Qur’an 4:57, 11:102, 18:59, 21:11, 22:45, 22:48, 28:59

[xxix] Qur’an 6:123, 7:82, 7:88, 7:96, 17:16, 18:77, 21:74, 27:56, 28:58, 34:34, 43:23

[xxx]  Qur’an 6:92, 6:131, 12:109, 25:51, 26:208, 28:59, 34:34, 36:13, 42:7, 34:23

[xxxi] Qur’an 2:10, 5:52, 8:49, 22:53, 24:50, 33:12, 33:60, 47:20, 74:31

[xxxii]  Qur’an 21:3

[xxxiii] Qur’an 58 18:28

[xxxiv] Qur’an 58 7:43, 15:47, 59:10

[xxxv]  Qur’an 3:118-119

[xxxvi] Qur’an 40:35, 40:56

[xxxvii]  Qur’an 2:8-10, 2:2-4, 3:167, 5:41, 9:8, 9:64, 9:75-77, 48:11

[xxxviii] Bukhari K75 B1, Bukhari K75 B2, Bukhari K75 B3, Bukhari K75 B13, Bukhari K75 B14, Bukhari K75 B16, Muslim K45 H45, Muslim K45 H46, Muslim K45 H47, Muslim K45 H48, Muslim K45 H49, Muslim K45 H50, Muslim K45 H51, Muslim K45 H52, Muslim K45 H53, Abudaud K20 B1, Tirmidhi K8 B1, Ibn Majah K31 B18, Darimi K20 B56, Darimi K20 B57, Muwatta K50 H6, Muwatta K50 H8, Ibn Sa’ad J2 Q2 p11-13, Zaid H346, Ahmad 1:11, Ahmad 1:172, Ahmad 1:173, Ahmad 1:180, Ahmad 1:185, Ahmad 1:195, Ahmad 1:196, Ahmad 1:201, Ahmad 1:381, Ahmad 1:441, Ahmad 1:455, Ahmad 2: 194, Ahmad 2:198, Ahmad 2:203, Ahmad 2:205, Ahmad 2:248, Ahmad 2:287, Ahmad 2:303, Ahmad 2:335, Ahmad 2:388, Ahmad 2:402, Ahmad 2:450, Ahmad 2:500, Ahmad 3: 4, Ahmad 3:18, Ahmad 3:23, Ahmad 3:24, Ahmad 3:38, Ahmad 3:48, Ahmad 3:61, Ahmad 3:81, Ahmad 3:238, Ahmad 3:258, Ahmad 3:316, Ahmad 3:346, Ahmad 3:386, Ahmad 3:400, Ahmad 4:56, Ahmad 4:70, Ahmad 4:123, Ahmad 5:198, Ahmad 5:199, Ahmad 5:316, Ahmad 5:329, Ahmad 5:330, Ahmad 5:412, Ahmad 6:39, Ahmad 6:42, Ahmad 6:53, Ahmad 6:88, Ahmad 6:113, Ahmad 6:120, Ahmad 6:157, Ahmad 6:159, Ahmad 6:167, Ahmad 6:173, Ahmad 6:175, Ahmad 6:203, Ahmad 6:215, Ahmad 6:218, Ahmad 6:247, Ahmad 6:254, Ahmad 6:257, Ahmad 6:261, Ahmad 6:278, Ahmad 6:279, Ahmad 6:309, Ahmad 6:448, Tayalisi H227, Tayalisi H370, Tayalisi H1380, Tayalisi H1447, Tayalisi H1584, Tayalisi H1773, MB1949

[xxxix] Mukhtasar Bukhari 1948, MB1951

[xl] Mukhtasar Bukhari 1954

[xli]  Mukhtasar Bukhari 1955

[xlii] Qur’an 26:80

[xliii]  Qur’an 2:50, 7:64, 7:136, 8:54, 10:73, 10:90, 11:35, 11:43, 17:6, 17:103, 21:77, 23:27, 25:37, 26:66, 26:120, 29:40, 37:82, 43:55, 44:24, 71:25

[xliv]  Ibn al Qayim: At Tibb al Nabawi.

[xlv] Qur’an 36:68

[xlvi] Mukhtasar Bukhari B1962, Bukhari K76 B1, Muslim K39 H69, Abudaud K27 B1, Abudaud K27 B10, Tirmidhi K26 B2, Ibn Majah K31 B1, Zaid H987

[xlvii] Mukhtasar Bukhari 1962, Tirmidhi K26 B2, Ibn Majah K31 B1, Ibn Majah K31 B23, Muwatta K50 H12, Ahmad 4:278

[xlviii] Qur’an 3:49, 5:110, 9:14, 10:57, 10:69, 17:82, 26:80, 41:44

[xlix] Qur’an 17:82

[l] Qur’an 16:69

[li]  Qur’an 21:83-84, 38:41-44

[lii] Qur’an 3:49, 5:11

[liii] Qur’an 21:83-84, 26:80, 38:41-42

[liv] Tirmidhi K26 B21, Tirmidhi K30 B12, Ibn Majah K31 B23, Ahmad 3:421, Ahmad 5:371

[lv] Qur’an 17:82

[lvi] Ahmad 1:302

[lvii] Tirmidhi K45 B36, Tirmidhi K45 B111, Tirmidhi K45 B118, Zaid H349, Zaid H350

[lviii] Ibn Majah K31 B28, Ibn Majah K31 B41

[lix] Ahmad 2:446

[lx] Ibn Majah K31 B10, Ahmad 2:390, Ahmad 2:403

[lxi] Tirmidhi K26 B7, Ibn Majah K31 B11, Ahmad 2:305, Ahmad 2:446, Ahmad 2:478

[lxii] Tirmidhi K45 B 66:6

[lxiii] Qur’an 2:201, 3:16, 3:191, 3:34, 13:37, 40:7, 40:9, 40:21, 44:56, 52:18, 52:27, 70:11

[lxiv] Qur’an 86:11

[lxv]  Qur’an 59:9, 64:16

[lxvi]  Qur’an 40:9, 40:45

[lxvii] Qur’an 16:81

[lxviii] Qur’an 3:28

[lxix] Qur’an 16:81

[lxx] Qur’an 16:81

[lxxi] Qur’an 4:176, 67:28

Professor Omar Hasan Kasule sr. December 2003