The muslim physician and the ethics of medicine.

Virtuous physicians seem to have become a rarity in modern day medical practice. Many patients and physicians feel that the profession of medicine is not living up to its own standards and expectations. It is the contention of the author that the Muslim physician, guided by the two primary sources of Islamic Law, the Qur'an and the Sunna, will possess the necessary character traits of a good physician. In this article I argue that the Muslim physician who abides by the Qur'an will live a contented life, will be trusted by his/her patients and community, and will be in line with the recently enacted Western principles of medical ethics.

Upon reflecting on the life of Muhammad ﷺ, the Prophet of Islam, people wonder whether such a person can actually exist these days amidst the pluralism and turmoil of a modern life characterized by commercialism, market forces, egoism, dehumanization, and deprofessionalization. Deprofessionalization can be defined as the loss of a special kind of commitment to competence, service, and altruism that has often characterized physicians in the past. These factors are so overwhelming and powerful that they made their way to one of the noblest professions — medicine — to the extent that many physicians these days are accused of being materialistic, heartless, and Machiavellian. What does it take to redeem the old image of the traditional caring physician whose sole objective was to help the patient? Is it true that good character traits and fine dispositions are reserved for prophets? Or are prophets an example (qudwa) to emulate and hence something achievable, even if only to some extent? It is the contention of the author that character traits of the humane and virtuous physician are already embedded in the Qur’an and the Sunna (the tradition of the prophet Muhammad ﷺ). As such, the Muslim physician, guided by these two primary sources of Islamic law, will possess the necessary character traits of a good physician. This, in turn, will lead to a healthy physician-patient relationship and will safeguard the profession of medicine. The true Muslim physician who abides by the Qur’an and the Sunna will live a satisfied life, will be trusted by his/her patients and community and will be in line with the recently enacted Western principles of medical ethics.

In this article, I shall limit my inquiry to the first source of Islamic law, namely the Qur’an, in the hope that it be followed by another article on the character of the Muslim physician and the sunna. In sūrat al-Isrā’, we read:

Verily this Qur’an does guide to that which is most right (or stable), and gives the glad tidings to the believers who work deeds of righteousness, That they shall have a magnificent reward.1

This is the starting point of Islamic medical ethics and of what it means to be a good physician.

Modern medical ethics is witnessing a revival of virtue ethics, which can be traced back to Aristotle. Aristotle believed that a virtuous life is one that is at the same time the best, the most noble, and the most pleasant. According to him, virtue is not innate at birth, but it comes about as a result of habituation. It is a voluntary and purposeful habit that eventually becomes a second nature. Just like Plato, Aristotle felt that character development should begin with childhood education.2

Similarly, the behavior and attitude of a physician are primarily functions of his/her character. The latter is shaped during childhood and adulthood, at home and school, and later on during years of medical training. Herein lies the importance of character education and the significance of medical schools’ admission policies and criteria. High scientific test scores alone should be a necessary but insufficient prerequisite to entrance into medical schools. Furthermore, medical students should not be assured that they will graduate if and only if they meet the scientific requirements of the curriculum. The character development of the student of medicine should be continually assessed to see whether he/she is morally equipped to handle the responsibilities that this profession requires. Such responsibilities are not limited to treating and curing but extend to healing and caring. Therefore, much more important than the Medical College Admission Test (MCAT) and university transcripts is the induction of a method that assesses the character of the potential physician prior to admission and during the medical training years.

This already is beginning to take place at several medical colleges. Numerous medical schools now do evaluate “professionalism” in applicants during interviews. Medical schools that are accredited by the Liaison Committee on Medical Education teach professionalism to medical students. Students must meet a minimum standard on professionalism in order to graduate.3 While this is a very important issue to dwell upon and merits a lengthy discussion, it is outside the scope of this article.

Several theories were offered presenting options to shape the character of the neophyte physician or the student of medicine.4–7 In this article, I focus on the Muslim physician and maintain that if the young physician was well trained on correct Islamic ethics, especially since childhood, he/she will inevitably turn into a virtuous physician who cannot but do the right thing, even when no one is looking. He/she will not need theories of ethics, codes or rules to guide him/her, instead, he/she will do the right thing intuitively, as if it were, to use Aristotelian terms, a second nature. Consequently, the question that arises is whether Islamic ethics, as present in the Qur’an, has what is necessary to solve the modern problem of medical moral lassitude.

Islamic Ethics and the Characteristics of the Muslim

In general, the term “morality” refers to rules of conduct that a person or group holds as reliable in differentiating right from wrong. Simply put, Islam offers such a system and presents a moral order in which good and evil can be evidently distinguished by resorting to human reason. Indeed the Arabic word for ethics is akhlāq (plural of khuluq, which refers to character). The Muslim believer is expected to conduct himself/herself in the best manner possible at all times and places. He/she is advised to take care of his/her physical attributes (cleanliness, health, etc.) as well as personal attributes (honesty, compassion, etc.). Thus, as the verse below indicates, guidelines for right and wrong are presented:

And the soul, and the proportion and order given to it, and its inspiration as to its wrong and its right.8

Humans are asked to control their desires and are given the freedom to choose which path to take following their reason:

Whoever obeys the Messenger, he indeed obeys Allah, and whoever turns back, so We have not sent you as a keeper over them.9

Islamic ethics instructs human beings that, in addition to being virtuous, they must contribute to the moral health of society as a whole:

You are the best of peoples, evolved for mankind, enjoining what is right, forbidding what is wrong and believing in Allah.10

Modern theories of character development often stress the importance of role models. Such role models can be found in persons or in books and in history. In Islamic tradition, the typical role model of moral behavior is found in the Prophet Muhammad ﷺ. His teachings inspire the lives of people with virtue, good manners, and moderation.11 He is the incarnation of the Aristotelian phrominos with his ability to think about practical matters, possession of phronesis, the practical wisdom of choosing the course of action that achieves positive change with as few negative side-effects as possible, and good moral judgment. He is a temperate being who avoids excesses and deficiencies and knows how to accomplish a good and worthwhile life. He strikes the golden mean in the events of daily life: a role model and a teacher. Put simply, he is an inspiration, an exemplar to emulate. In the Qur’an we read:

And surely you have sublime morals.12

One of the verses of the Qur’an that summarizes the character of the Muslim is found in sūrat al-Naḥl:

Surely Allah enjoins justice, kindness and doing of good, to kith and kin, and forbids all that is shameful, evil and oppressive. He exhorts you so that you may be mindful.13

How does all this translate to the character of the physician?

Some Characteristics of the Muslim Physician and the Qur’an

One of the first questions that come to mind is whether the physician (and one of the Arabic words for physician is al-ḥakīm or the wise one) possesses ethics (akhlāq). If the physician does, patients will often feel at ease. A believer and an ethical person will not abuse his/her status or power but will act in all conscience and good will. A virtuous physician will necessarily behave in the right way. He/she will not need to refer to rules and sanctions, rather, the right decisions and actions will ensue from his/her character as does water from a spring, naturally and effortlessly. Indeed, one of the oldest books written about Islamic medical ethics is Adab al-ṭabīb (Conduct of a Physician) by Isḥāq ibn `Alī al-Ruhāwī in the 9th century CE.14,15 The author stated that the true physician is the one who fears God ﷻ, the word fear here encapsulating love and respect.

Islam sets the foundations for behaving well and possessing the requisite character traits to becoming a fine person and, by extension, a physician with good moral fiber, since one cannot be virtuous only in part. In other words, a physician cannot be a virtuous parent, child, or spouse yet an immoral physician. It is the entire person who is either good or not. Patients all over the world expect a certain kind of treatment from their physicians precisely because of the nature of the goals of medicine. As stated by Pellegrino and Thomassma, “the ends of medicine are ultimately the restoration or improvement of health and, more proximately, to heal, that is, to cure illness and disease, or, when this is not possible, to care for and help the patient to live with residual pain, discomfort, or disability.”16 To be able to do this in good faith, even when no one is looking, the physician will have to be a certain kind of physician, whom patients expect to be humble, kind, compassionate, trustworthy, and honest, to respect confidentiality, and to have the interest of the patient in mind, to mention but a few character traits.17–9 A physician is not someone who treats the patient as if he/she were a disease, a mass of tissues, or a number. The true Muslim physician cannot but be a good physician precisely because moral obligations in Islam as set by the Qur’an make him/her a certain kind of being who will not favor one patient over the other but treat all patients equally and who will restrain and curtail his desires if they go contrary to reason and morality. Allah ﷻ says:

If you judge, judge in equity between them. For Allah loves those Who judge in equity.20

And for such as had entertained the fear of standing before their Lord’s (tribunal) and had restrained (their) soul from lower desires. Their abode will be the Garden.21

Thus, the physician will not abuse his/her status just for monetary gain, will avoid wrongdoing, and will not mislead his/her patients because God ﷻ does not love the liars and wrongdoers:

Contend not on behalf of such as betray their own souls; for Allah loves not one given to perfidy and sin.22

And cover not Truth with falsehood, nor conceal the Truth when you know (what it is).23

A humble one, he/she learns to curtail his/her arrogance precisely because haughtiness is condemned by the holy book, which clearly states that Allah ﷻ does not love the highhanded person: Rather, Allah ﷻ loves those who do good and humble themselves: The health-care practitioner will not lie to his/her patient and abuse his/her power:

Undoubtedly Allah knows what they conceal. And what they reveal. Verily He loves not the arrogant.24

Swell not your cheek (for pride) at men. Nor walk in insolence through the earth: For Allah loves not any arrogant boaster.25

But those who believe and work righteousness and humble themselves before their Lord, they will be companions of the Garden, to dwell therein forever!26

They seek to hide themselves from the people, but they cannot hide from Allah, while He is with them when they plot by night, in words that He cannot approve: and Allah does compass round All that they do.27

Nor will he/she waste any resources hastily and unnecessarily:

O Children of Adam! Wear your beautiful apparel at every time and place of prayer: eat and drink: But waste not by excess, For [Allah] loves not the wasters.28

Nor will he/she be tempted to forge medical records:

And he who brings the truth and he who confirms (and supports) it — such are the men who do right.29

In addition, the physician is not supposed to make fun of his/her patients or call them names, which some justify nowadays as a means to let out stress:

O ye who believe! Let not some men among you laugh at others: It may be that the (latter) are better than the (former).30

Another focal term in the life of the Muslim is taqwā (best translated as piety). Indeed, in his farewell sermon, the Prophet ﷺ has said that there is no difference between people except in taqwā.31 Taqwā requires a continuous form of self-examination and it is that which differentiates the believer from the nonbeliever and the righteous from the pretentious. Most important, it is the basis of deeds. Ultimately, we are told, when all is over and this ephemeral life is finished, what matters to humans is the work they have done and the deeds they have left behind.

The character traits depicted above in the Qur’an and exemplified by the Messenger Muhammad ﷺ are not supernatural but rather human traits par excellence. They are traits that any Muslim physician can, and indeed should, have if he/she decides to follow the dictates of the Qu’ran and the example of the Prophet ﷺ. Indeed, the professionalism being taught and evaluated in contemporary medical schools and residency training programs reflects the conduct of the Prophet Muhammad ﷺ. Perhaps the best way to end this article is with a ḥadīth reported by Imam al-Tirmidhi according to whom the Prophet ﷺ once said:

The believers whose faith is most perfect are those who have the best character.32

Still, one might be tempted to ask whether this is too much to ask of the Muslim physician in the 21st century, a century marked by Machiavellism, greed, corruption, and power. Put differently, can the Muslim physician stand against the tide and be the kind of person the Qur’an expects? My question is whether a Muslim can afford to be otherwise.