Using Medical Ethics to Combat Injustice (Doyle Symposium Proposal)
By: Noreen Sajwani
April 21, 2015
Islam is a monotheistic religion rooted in the Abrahamic tradition and follows the teachings of Allah as revealed through the Prophet Muhammad. As Muslims believe it, the Qur'an is the direct word of Allah and prescribes many of the daily rituals, principles, and practices that guide Muslims on the Straight Path, or sirat-ul-mustaqeem. Within this faith tradition, there is a prominent divide with respect to succession of authority after the Prophet’s death in the eighth century, with Shi'a Islam adopting the belief and practice of imams as spiritual leaders with divine authority and leadership within the Muslim community (Jamali). Specifically, Ismailism is the second largest sub sect in Shi'a Islam that follows the line of Imamat through forty-nine hereditary spiritual leaders and currently follows the guidance of the present-living Imam Shah Karim al-Husseini, given the title of Aga Khan IV. Today, there are over 15 million Ismailis residing in nearly 25 nations across the world.
The work of the Aga Khan in developing communities around the world led to the creation of the Aga Khan Development Network (AKDN), a development organization that follows in line with “Islam’s ethical tradition, [where] religious leaders not only interpret the faith but also have a responsibility to help improve the quality of life in their community and in the societies amongst which they live” (The Aga Khan Development Network). The AKDN achieves this initiative through goals such as alleviating poverty and promoting social and economic equality within the areas it serves. This ideology also promotes an ethical framework crafted and released by the AKDN, which outlines nine ethical principles to help guide and discern decision-making processes in theological as well as professional career discourse (The Institute of Ismaili Studies, 2). Through an in-depth assessment of these ethical values alongside the delivery of medical services, several tools can be utilized to both seek out as well as address the role of medical ethics in our society to promote justice. Specifically in the case of Shi'a Ismailis, a call to engage in dialogue with the Ismaili Muslim community as part of a global society not only enhances our understanding of various faith traditions but also encourages communities like Georgetown to play an active role in seeking out minority groups to discuss shared traditions and values.
Alongside the various ethical principles mentioned in the AKDN ethical framework, three specific values succinctly highlight the ways in which our community can work to overcome the challenges facing Ismaili medical ethics concerns today. These include the ethic of inclusiveness, the ethic of education and research, and the ethic of respect for life and health care (The Institute of Ismaili Studies, 2-4). In the ethic of inclusiveness, an emphasis on every individual patient as a human being brings a sense of commonality among all people, promoting a culture of respect for everyone in all parts of the world. The Qur'an affirms this notion when it states, “Humankind has been created from a single soul, as male and female, as communities and nations, so that people may know one another” (qtd. in The Institute of Ismaili Studies, 2). This ethic reveals a notion of universality among all people, directing the conversation to acknowledge a common thread that binds us all together, interpreted as the soul, in the Islamic tradition. As it states, understanding the limitation of mankind promotes the value of other ethics, such as the ethic of compassion and sharing, wherein individuals can empathize with others based on the shared struggle for transcendence. The framework outlines, “The pious are the socially conscious who recognize in their wealth a right for the indigent and the deprived for whom they help for the sake of God alone” (The Institute of Ismaili Studies, 4). In this way, relating to one’s religious and ethical priorities in delivery of care can be useful for determining the impact Georgetown can have in shaping and sharing underlying ethical values amongst students seeking to be involved in such professions.
Another ethical principle that shapes the way in which we engage in difference to promote equality and social justice involves the ethic of education and research. Within the field of health care, this ethic plays a critical role in managing new forms of information, technology, and medical advances to promote health and well-being while also recognizing human limitations to prolong life, as expressed earlier. It is additionally expressed in the ethic of education and research that learning and seeking to gain knowledge is obligatory to learning more about Allah’s creation (The Institute of Ismaili Studies, 3) as well as utilize the intellect, or akal, to reason, a key characteristic that distinguishes mankind from all other creations (“Introduction”). This is particularly important when applying ethics in the medical world, as proper reasoning and rationalization of every decision must be conducted to adequately treat a human being with the same level of respect and care as other human beings. In application, the ethic of education and research promotes careful consideration and fairness in delivery of medical services, enabling health care professionals to seek a degree of justice for their patients in such circumstances.
An example can be seen when weighing the pros and cons of using a pig’s organs, an animal that is considered haram or forbidden in Islam, to conduct a life-saving surgery for the patient. In such an example case study, Muslim scholars note, “Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient” (Bakari et al. 57). To fully promote a just and ethically sound environment, these considerations should be taken into account alongside guidance of a religious figure, body, or institution that can help families make decisions based on both medically proven evidence, via the ethic of education and research, as well as precedent of adherence to common religious practices in the tradition. Within the Georgetown community, these stakeholders are present on our campus and readily available to all students, through the form of spiritual directors, chaplains, and other staff that work to engage students of different faiths in discussions surrounding ethical dilemmas. As such, it is critical to inform and engage all participants of the driving forces that influence how our community represents and encourages justice within ethical decision making, whether it pertain to the medical field or otherwise.
Finally, the ethic of respect for life and health care integrates the previous two ethics to create a call to action between Ismaili ethics and delivery of healthcare services. This intersectionality is important because each life must be treated fairly and with dignity, particularly in an individual’s most vulnerable state of poor health, when medical illness prohibits one from carrying out activities to his fullest potential. The ethic of respect for life implies that a minority community should not have its religious rights be taken away from them due to a lack of knowledge or understanding about the faith tradition’s practices. With respect to those wishing to become health care professionals, an added ethical duty to serve the needs of the population at hand continues to preside and dictate why Ismaili ethics should be considered. For example, the AKDN ethical framework outlines, “Learning medicine…is a ‘duty of sufficiency’, which is incumbent upon, not every individual, but a sufficient number of people to serve the health needs of a community” (The Institute of Ismaili Studies, 4). In this, it is important to note that this ethic does not advocate for Ismaili Muslims to exclusively learn medicine and serve those in their community, but rather it acknowledges that all people who distinguish themselves to learning about medicine and engaging in the health care system immediately commit to serving the health care needs of the community in which they belong.