(Photo credit: Hamad bin Khalifa University)
Ahmed J Versi, Doha, Qatar
Muslim religious scholars agree that taking care of children’s overall wellbeing, including their health, is a religious obligation. Early scholars highlighted the parental duty to secure the best possible treatment for one’s child. From the 1990s onward, the ethical questions triggered by modern genetics and genomics have been the subject of intensive Islamic bioethical deliberations.
However, advancements in genetics and genomics have provided great opportunities for improving children’s health and the wellbeing of their families. But genetic testing, whether premarital, pre-implantation, prenatal or newborn, concerns many Muslims who question if the benefits are aligned with their religious beliefs. “Children in Islam are characterized as vulnerable.
They are not Mukallaf – meaning they are not accountable to God for what they are doing – and are considered a vulnerable group entitled to all protections,” explained Dr Mohammed Ghaly, Professor of Islam and Biomedical Ethics, Centre for Islamic Legislation and Ethics, Hamad Bin Khalifa University, Qatar. It’s therefore important to focus on how to make benefit of advanced technologies in genetics without affecting the rights and the best interests of these children. Genetic testing is particularly important in the Gulf region as it faces comparatively higher rates of genetic diseases.
Dr Ghaly said. “This causes difficulties for families, for people around them, married couples, parents, and the national healthcare budget. So, the question is, why not make use of these genetic advancements to minimise suffering? However, there are ethical aspects that need to be addressed that arise from people’s cultural and religious commitments in this region.”
But there are other ethical challenges, like the medical age of consent, abortion, aggressive paediatric treatments and breast-milk banks. I spoke to Dr Ghaly about Islamic ethical issues regarding these challenges during the WISH Summit.
What’s the Islamic ruling on the medical age of consent?
We have classical discussions about this under the term bulugh, adulthood, being of age, and especially, the Hanafi School, they have another important category; they call it tameez, the age of discernment, [which is around] 8 or 9 years old.
Adulthood in Islam is biology, not legal, which is the age [from which] you can procreate, so the woman gets menstruation, or the boy can impregnate a woman, and this means that you become an adult. Whether this will be a nine, twelve, or thirteen-year-old differs from one person to another. Most Muslim countries don’t use this because it’s confusing in a legal setting.
Most Muslim countries use 18 and some use 16, especially when discussing marriage, what age a boy or a girl can decide about their marriage, but in Islam, it’s not one line everyone sticks to.
When you are held accountable, you have freedom because, without freedom, there is no accountability. So you are held accountable in front of God to pray, fast and run your affairs, financial, medical, etc. The Hanafi School and other religious scholars say that from the age of nine, you need to involve the child.
Do they have the mental capacity to discern at age nine?
No, you are still not autonomous. We have a legal guardian, Wali in Arabic, who decides on behalf of the child, but with conditions, the most important of which is that you act in the best interest of the child.
So when the benefit to the child is questionable, an adult can decide but the guardian cannot, like donating an organ. Donating organs may not be harmful to the donor, like kidney donation. However, most religious scholars say the legal guardian cannot do that. But on other issues such as surgeries, genetic interventions etc, the parents can decide if it is in the best interests of the child.
Where is the position of Islamic law on aggressive paediatric treatments, such as the treatment of childhood cancer?
In palliative or intensive care units, we have possible aggressive interventions, not the usual ones, like CPR, DNR resuscitation is a life-sustaining treatment, intensive. And usually, we use them for life-saving measures.
If someone has an accident where the heart or brain stops, we put them on the machine until we can fix it. And then the body regains its structure and the person no longer needs these aggressive treatments.
But in end-of-life care, we have someone who has multi-organ failure where the organ system is collapsing, so, it’s not only a heart or kidney problem, as you’re are trying to fix it here, it goes wrong over here.
The question is, should we go with aggressive treatments in this context? In the report we discussed certain conditions in which it will be possible to stop the treatment because it’s not medical treatment in the strict sense.
In the traditional treatment, I seek medical treatment, go to the hospital for you to restore my health, and then I go home. I go on with my life; you, at the very least, improve my health condition. Here, this treatment is a life-keeping one, not a lifesaving one.
We’re just trying to prolong it as much as possible. Some religious scholars, said, for instance, if a person is diagnosed with brain death, this is death and there is no medical treatment for dead people, so stop everything.
Other scholars say although brain death is not death, we can stop treatment because the patient is dying, and the dying process, called al-ehtedar in Arabic, is also irreversible.
Once a person gets into the process of dying, they will not come back to life. Prolonging the process is not in their best interest because this process is one of the most painful phases in human life. This is not what we do for people who are dear and near to you.
With brain death, the vast majority of, if not the consensus of Muslim scholars, say to stop it. That includes threatening or limiting diseases where there is no treatment and the person is in end-of-life care.
When is abortion allowed under Islamic law and when does a baby have a soul?
The Qur’an speaks of three embryonic developmental stages, nutfah, alaqah, and mudghah, with no duration assigned to each stage.
There is a Hadith that says that each stage takes 40 days. So, 40 times three, 120, and the hadith says after the lapse of the three, an angel is assigned to breathe a soul into the foetus, and it becomes a human.
Some contemporary religious scholars, because of information coming from biomedical scientists, told them: classical religious schools say [life begins at] 120 days. Because they thought before 120 days there is no life.
As a biomedical scientist, I can tell you this is wrong. I can make you hear the heartbeat of the child much earlier than 120 days.
I can show you the organs. The child is moving. There is life, so, the religious scholars said, maybe we need to make a metaphorical interpretation of this, so instead, of 40 plus 40 plus 40, all three (stages) happened in one 40. They pushed it back to 40. This is an over-metaphorical interpretation that does not hold up to any linguistic scrutiny.
The majority opinion, adopted by fiqh [Islamic jurisprudence] councils, is 120 days. Before 120, we have the potential for human life but no life yet. It becomes a life after the breathing of the soul, which happens after 120 days. How did we know this? It’s not science. That’s metaphysics. This is what the revelation told us as revealed by God to the Prophet. The One who created us told us this happens.
After 120 days, only one (abortion) excuse can be accepted, the life of the mother is endangered, and then we give priority to her. Can we abort a child before 120 days? Yes, but the question is under what condition.
There should be a religiously valid reason, athrun shar’i. What is the athrun shar’i? Religious scholars disagree; the majority accept life-limiting medical conditions, so within a matter of days or a matter of weeks of birth, the child will die.
Or a disabling disease, the child will live with permanent disabilities, can’t breathe, difficulty for the family, etc. The parents wanted it, signed it, and three physicians confirmed the medical condition. Many religious scholars say “yes, you can”.
It doesn’t matter the name of the condition, as long as it’s applicable, they will say to you, “Okay, this disease is a religiously valid excuse.” I would say it’s much more than this. It’s not only the medical condition. [It’s] the country where you are living, the healthcare service available in the country, and the genetic history of the family, with this specific genetic condition.
These things will be decided and the longer the pregnancy is, the more it’s developmental. So, the longer it is, the more difficult it should be. So, after day one, it’s something. After day 20, it’s something else. The further you go, the closer you approach the borderline.
What if the foetus has Down syndrome?
After 120 days, the medical condition cannot be an excuse. In the past, we did not have genetics. We did not know if there was anything wrong with the baby during pregnancy.
It was unseen. Now we can, and that’s why we have the question. In the past, religious scholars were much more permissive because they thought before breathing the soul, there is no life. Now we know this is not the case.
Is the use of milk banks in Muslim countries allowed considering the complications of milk kinship in Islamic law?
With the Muslim world and discussions about milk banks, there are several issues. The first one is that we have the concept of milk kinship, which you hardly have in any other culture. The woman’s milk creates kinship between her, her family, and the child that she’s breastfeeding. So, the child becomes part of the family. She is the mother, her husband is milk father, and the children are milk brother and sister so you cannot get married.
The second thing is that the family knows who the milk mother is. Milk banks were introduced in the West for a specific reason, not only for medical but also for cultural development.
The woman who starts working doesn’t have time to breastfeed. There was an idea that breastfeeding affects the slim figure and stuff like that, so they said it was better to give formula milk. Milk banks started with the concept of protecting the privacy of the donors. So, they remain anonymous.
They give it even if they get compensation. We consider them donors because it’s a good charitable act.
The discussion started in the 1980s. Some Muslim physicians living in the US and Europe asked Muslim religious scholars. We have this model in the West.
What do you think about doing it in the Muslim world? We are aware of the milk kinship. Muslim scholars were divided. A minority of them, including the scholar who recently died, Shaykh Al-Qaradawi, said milk banking is something and breastfeeding is something else. Only breastfeeding creates milk kinship. But milk banking has nothing to do with breastfeeding; it’s a service that you give to people.
The people who receive milk from those banks are not related to these women, and they have several arguments. But the majority remained by the standpoint if the conditions of breastfeeding are fulfilled by how the milk is given to the baby, then there is milk kinship. Even if you call it milk banking, it doesn’t matter.
…Because breastfeeding is physical contact?
Yes, this is one argument the scholars mentioned. It’s a bottle when it’s in the milk bank and it’s processed, etc. But, a minority said it’s not. The majority said milk banking is equal to breastfeeding. Any milk bank in the Muslim world must fulfil the conditions of breastfeeding.
So, every woman’s identity should be disclosed as should the amount of donated milk and the children who receive the milk, and they should know each other. And you must keep this data for a long period so it can always be checked.
This doesn’t work in the business model of milk banking, so we never had milk banks until Prolacta, an international company specialising in milk banking. They read my article about milk banking, and contacted me. They said, “We’re an international company. We want to get into the market in the Middle East and don’t understand what the problem is.”
They had an international conference in the US. I listened to their discussions and visited the company, saw how milk banking works. And then I told them, “You have three options. One option is to say that we will have a milk bank as it stands, endorsed, and we base ourselves on the minority of the religious scholars who said it’s okay in Islam.”
But I said, “I don’t think this option will work for you, because we want to have clients. As a client, you tell me some scholars say it’s possible, others say it’s not. I will not use your service because of this doubt. This is about lineage and incest. These people can get married to each other. And that’s impossible.” So I said, “Don’t use this strategy.”
The other strategy is that you use milk banking, and you change the model so that you will not create kinship, according to everyone. Even those who say breastfeeding is the same as milk banking because not only breastfeeding creates milk kinship. If the child gets one feeding session, or two feeding sessions, this woman will not be the mother. Many religious scholars say five feeding sessions are the threshold.
What’s a one-feeding session?
The feeding session we call the radha, means the baby takes the breast when it is hungry, and then stops when it is full.
This is one session. We repeat this five times.
You either minimise the number of donors or reveal their identities. When you reveal the identity, it will be easier because you will have only one woman and one child. You will let them know about each other, and that’s it. You have a problem with this, then you will maximise the number of donors. It will not be possible for one child to get five feeding sessions from one donor.
They said we could mix the milk of 300 donors, making it practically impossible that there will be milk kinship according to any religious scholar. This is the one they used in Dubai.
More reports and interviews from the WISH summit will be published in the next issue of The Muslim News.
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