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Institutionalization of Bioethical Deliberations

By:
Manfred Sing
Source:
Oxford Islamic Studies Online What is This? Online-only content developed by noted scholars is continuously added to the site, part of our ongoing efforts to expand our coverage of the Islamic world.

Institutionalization of Bioethical Deliberations

The emergence of bioethics as a recognized field of inquiry and practice in both modern medicine and Muslim-majority countries can be traced back to the 1970s and 1980s respectively. Yet it remains difficult to determine the exact, and often contested, beginnings of the term and the field. It seems, therefore, more adequate to understand the emergence and institutionalization of bioethics as a gradual, international, and also rapidly developing process that has responded to different concerns, interests, and challenges resulting from advancements in biotechnology and medicine.

The following remarks are meant to give an overview of the institutionalization of bioethical deliberations in four respects: (a) the emergence of Islamic bioethics as a recognized field of research and practice; (b) the processes of norm finding and decision making, which help to fence in moral uncertainties in Muslim-majority countries and in Western societies with Muslim participation; (c) the broader socio-political contexts of bioethical reasoning; and (d) a final summary.

The Emergence of Islamic Bioethics

Scholars from different professions were involved in the formation of the bioethical field. Originally starting from a critique of human experimentation and ethical abuse in clinical research, philosophers, theologians, and jurists began to examine the ethical dilemmas posed by medical advancements in the 1960s and 1970s in a more general way. With the first edition of Principles of Biomedical Ethics (1979), currently in its seventh edition, the American philosopher Tom L. Beauchamp and the philosopher and theologian James F. Childress aimed to provide a comprehensive framework for the divergent approaches that existed under the name of bioethics, without negating the plurality of possible approaches. Their “principlism” demands a weighing of the four principles: “autonomy,” “beneficence,” “nonmaleficence,” and “justice” for practical moral decision making. In spite of an ongoing debate about the deficits, especially the exclusion of religion or family concerns, these four principles form the core and basis of modern bioethical discussions to this day. They soon came to be taught around the world and were hailed as a cross-cultural, universally valid model (Bouzenita, 2011, p. 53).

At about this time, the Islamic bioethical field started to take shape with the first and second International Conference on Islamic Medicine, held in Kuwait in 1981 and 1982, where several physicians discussed ethical principles and their relation to Islam (Ghaly, 2016, p. 5). Since then, the national ministries of health as well as physicians’ associations in most Muslim-majority countries established committees of “medical ethics.” When the International Bioethics Committee of the UNESCO was created in 1993, representatives of countries with a large Muslim population—Algeria, Morocco, Malaysia, Tunisia, Egypt, Senegal, and Nigeria—were present from the beginning (UNESCO, 2014). In these years individual non-Muslim scholars (Krawietz, 1991; Rispler-Chaim, 1993) and Muslim pioneers, mostly from a medical background (Serour, 1993; Zaki Hasan, 1993), engaged themselves with bioethical issues more systematically. Following international examples, these efforts also resulted in collective works, such as an Islamic code (ʿAwaḍī and Jundī, 2005) and an encyclopedia (Bār et al., 2012) for medical ethics. At a 2013 seminar, held at the Centre of Islamic Legislation and Ethics in Qatar (launched in 2012), the participants summarized nearly thirty years of discussion on the four principles from different Islamic viewpoints and discussed them together with Beauchamp, who defended the principles’ universality (Ghaly, 2016).

Muslim authors have reacted differently to the dominant, secular model of bioethics provided by Beauchamp and Childress. Some have tried to trace the four principles in the Islamic tradition (Aksoy and Elmai, 2002; Aksoy and Tenik, 2002), while others have drawn on terms taken from the Islamic tradition in order to affirm or complement the principles (Sachedina, 2007 and 2009; Chamsi-Pasha and Albar, 2013; Mustafa, 2014)—the inviolability of the human body (ḥurma), the dignity of the human life (karāmah), necessity, public benefit, and interest (ḍarūrah, manfaʿa, maṣlaḥah), the avoidance of harm (ḍarār), the quest for justice (ʿadālah), or the foundational goals of the Sharīʿah (maqāṣid al-sharīʿah). A third group of authors is highly critical of secular medical thinking and bioethics and of Muslim councils that accept, for example, the brain-death criterion. This group believes that the Islamic framework does not support capitalist commodification that turns the human body into a commodity, which is seen as the rationale of modern medicine and its ethical dilemmas (Bouzenita, 2011, pp. 64ff.).

With regard to the cultural translatability of the four principles, a general critique is that in their search for bioethical principles Muslim authors have until now mainly referred to authors of secular orientation writing in English, while generally neglecting approaches developed by representatives of other religious traditions (Atighetchi, 2007, p. 23).

Whereas the term “bioethics” has gained wide currency for an ever growing number of ethical problems in the life sciences in the US and Western countries since the early 1970s, a definite equivalent for “bioethics” in Arabic or in the languages of other Muslim-majority countries is missing. Thus, the respective moral quandaries in Islamic contexts have been mainly addressed as part of “medical ethics” (Ar. akhlāqīyāt ṭibbīya) or “the ethics of the medical profession” (akhlāqīyāt mihnat al-ṭibb) and as a problem of Islamic norm finding, a variation of the question of what it means to act as a good Muslim. Since the mid-1990s a growing number of Arabic publications has also started to use the loan translation “biological ethics” (akhlāqīyāt biyūlūjīya). The absence of a singular equivalent for “bioethics,” the debate on the cultural translatability of the four principles, and the predominant recourse to principles taken from Islamic law (Sharīʿah) hint at the fact that the establishment of Islamic bioethics as an independent discipline with its own epistemology is still under way or a contested issue, to say the least. Atighetchi (2007, p. 19) observes that “the majority of scientific contributions on Muslim bioethics deal with individual issues,” while “a reflection on the epistemology of bioethics seems disregarded.” As a majority of non-Muslims and Muslims writing on biomedical issues focuses on fatwā-literature and touches only superficially on the underlying ethical deliberations, Sachedina (2008, p. 241) criticizes that “what has been circulating as ‘Islamic bioethics’ has little to say about ethics as a discipline that endeavours to understand the moral reasoning behind ethical decisions.”

On the practical level new reproductive technologies like contraception, abortion, and in vitro fertilization (1978) greatly affected state programs of family planning and population control in Muslim-majority countries since the 1960s. In the same vein, biotechnological and genetic breakthroughs have gradually spread to Muslim-majority countries and opened the door to new medical possibilities, but also enhanced moral and legal uncertainties. A far-reaching impact had been the 1968 Harvard Medical School’s ad hoc definition of brain death as “clinical death” and irreversible coma, which became the pivotal term in questions of life support and organ transplantation from corpses. Transplantation possibilities rapidly improved in the twentieth century, after the first successful transplants of cornea (1905), kidney (1954), heart (1967), liver (1967), heart and lung (1968), and bone marrow (1968). At first Muslim patients were sent to Europe and the United States in order to receive organs, then some local centers started to perform transplantations with the help of European and US physicians, using organs from living and dead donors, often coming from abroad, partly provided by Eurotransplant, partly stemming from dubious sources. Finally, local centers were able to perform transplantations from local donors and corpses on their own (Atighetchi, 2007, p. 183). The first kidney transplants in Iran in 1968 and in Egypt in 1976, the first heart transplant in Saudi Arabia in 1988, the first bone marrow transplant in Egypt in 1989, and the first liver transplant in Egypt in 1992 exemplify the spread and the availability of these new technologies.

Another example of the spread of modern life sciences is the foundation of the Centre of Arab Genomic Studies in Dubai in 2003. It initiated the Catalogue for Transmission Genetics in Arabs (CTGA) database, a pilot project, supported by the international Human Genome Organization (HUGO), which was founded in 1988 and was also involved in the human genome project (1990–2003). Delegates from different countries discussed the ethical implications of the database in its second Pan-Arab meeting in 2007. The CTGA database has until now documented more than one thousand genetic disorders on country and disease levels among Arabs, against the background of 6,500 worldwide known and unevenly distributed inherited disorders (Tadmouri, 2012; Obeid and Tadmouri, 2012, p. 90). According to the researchers, the data indicate “a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity” (Tadmouri et al., 2009, p. 1), as “many Arab countries display some of the highest rates of consanguine marriages in the world, and specifically first cousin marriages which may reach 25–30% of all marriages” (ibid.). The data further show that “congenital malformations are the second leading cause for infant mortality in the countries of the Gulf Cooperation Council” (Tadmouri, 2012, p. 23). Tadmouri admits that, in spite of successful counselling in some affected families, people in general “are reluctant to refer to a genetic counsellor” because they often assume that counsellors would advise them on personal issues, such as the choice of a marriage partner. While this “misconception” even existed among healthcare providers, he proposes as a useful strategy to “integrate genetic counselling into the procedure of routine prenatal care, so that it may be better accepted by the population” (ibid.).

Issues like family planning and organ transplantation already triggered debates among Muslim religious scholars in the 1950s and 1960s (Hamdy, 2016; Keller, 2010, pp. 161ff.). The growing application of new biotechnologies not only intensified these debates, but also created new problems, such as the question of distributive justice, since new technologies are not equally available for everybody. The spread of technologies, which have ramifications for people’s understanding of life, death, and family, further increased the need of national legislation and regulation. Against this background, the discussion of Islamic principles and bioethical dilemmas developed in already existing religious councils or in national parliaments as well as in newly established multiprofessional committees or research institutes of national and transnational character. The discussions in these different settings often bore different results.

In Saudi Arabia, for example, the majority of the Committee of Senior ʿUlamāʾ approved in Resolution no. 99 (1982) that organs could be harvested from a corpse or a living donor for the benefit of Muslims. In Iran the parliament voted against a bill legalizing explantation from a cerebrally dead donor in 1993 and upheld this position until 2000, although the Ayatollahs Khomeini and Khamenei had already authorized explantation from corpses in 1989 and 1992. In Egypt, parliament was unable to agree upon an transplant law before 2010 in spite of several attempts over three decades. In this period, without a law regulating transplant and criminalizing organ trade, Egypt became a centre for organ trafficking in the Middle East, while its cadaveric procurement program was suspended and its pioneering efforts in kidney transplantation damaged (Atighetchi, 2007, pp. 183–191; Egyptian Initiative for Personal Rights, 2010). The transnational Fiqh Academies of the Muslim World League (MWL) and the Organization of Islamic Cooperation (OIC) also dealt with the questions of brain death and organ transplantation in the mid-1980s. While the MWL—an international committee of Muslim scholars—only approved of organ transplantations from living donors (1985) and did not accept brain death as the only criterion for death (1987), the multiprofessional OIC committee both accepted brain death (1986) and cadaveric organ transplantation (1988) by majority vote. By referring to the decisions taken by both the MWL and the OIC, the Central Counsel of Muslims in Germany (Zentralrat der Muslime in Deutschland), speaking for the Muslims in Germany, consented to a new transplantation law in Germany, enacted in 1997, which also included cadaveric organ procurement (Elyas, 1995).

The debates and decisions on medical subjects bear witness of the fact that there is no monolithic Islamic view on bioethical issues, but rather a variety of different, partly overlapping, partly conflicting positions both within and between Sunnī and Shiite scholars, scholars in the humanities, physicians, and scientists.

Processes of Norm Finding and Decision Making

The existence of divergent and even contradictory religious opinions (fatāwā) regarding bioethical questions has attracted the attention of both Muslim and non-Muslim observers since these opinions appear as an additional challenge that begs for an explanation. Some argue that contradictory judgments expose the incompatibility of Islam with modernity, in this case with the life sciences. They argue either that broadly defined, classical notions taken from the Qurʾān, ḥadīth, and Sharīʿah are incapable of coming to terms with new bioethical challenges and predispose misunderstanding between religious scholars and physicians (Eich, 2005) or that the advancements of secular biomedicine should or could not be applied to Muslim societies because they lead to Westernization (Hamdy, 2013). An opposing view understands Sharīʿah principles as a culturally defined framework fully equipped to find solutions for bioethical challenges. In this respect, observers have also traced back the divergent application, or rather manipulation, of Islamic notions to “conservative” and “progressive” scholars’ different receptiveness of technical progress, with the former’s “anachronism” versus the latter’s “pragmatism” (Moosa, 1999). A further argument in this debate is that contradictory bioethical fatāwā approve of the casuistic nature of Islamic law (Eich, 2005).

Newer approaches call these views into question and rather argue for the similarity of secular and religious approaches to bioethical quandaries (Sing, 2008). In spite of different sources, legal traditions, and semantic contexts, both secular and religious ethical systems struggle with the same threefold process: identifying grounds for judgment, organizing consensus among sources and experts, and building up legitimate authority for decision making. As ethical dilemmas withstand clear-cut solutions in every tradition, the argument that they might tell us something definite about the nature of Islamic law and decision making is dubious. Apart from this, Jonsen (1995), one of the pioneers of bioethical reasoning, has made the case for casuistry as an open-minded approach and a complement to the four principles, which he finds especially useful for dealing with bioethical questions. Therefore, the classical Islamic concept of the scholarly difference on a certain issue (ikhtilāf) appears to be an appropriate way for looking at the question of why different Muslim scholars deal differently with ethical dilemmas. Sachedina (2008 and 2009), pleading for a further inquiry into the normative reasoning that undergirds legal rulings, underlines the difference between ethical and legal forms of deliberation and decision making and argues that bioethics has to move intellectually from case to norm and from norm to case, leaving open the possibility of revision and further research.

On the one hand, the question of what constitutes an Islamic way of bioethical reasoning and decision making certainly is a contested one, since the singular muftī and fatwā have lost their importance and states tend to mandate multiprofessional committees to find tenable solutions for moral quandaries. On the other hand, unanimity—even within the same professional tradition—is the exception. Not only conservative religious scholars challenge the applicability of modern biomedicine, but also an active minority in the medical professions is skeptical (Hamdy, 2013 and 2016). As Padela et al. (2011) have shown, medical advisors of religious scholars tend to transgress the boundaries of their field of expertise and speak like shuyūkh or “co-muftīs” to convey their ideas about bioethical problems.

French sociologist Pierre Bourdieu (1997, pp. 114–117) has argued that constructing legitimate authority becomes more delicate as the circuits of legitimatization grow larger, so that arbitrariness is always somehow inscribed into laws, when nearly inexpressible concerns are cast into juridical forms. From this point of view, one can argue that it seems more important for the norm-finding to be seen as Islamically correct than for the decision to be resolved in one way or another. In practice religious scholars, multiprofessional committees, and national or transnational institutions have to organize a consensus, when facing moral quandaries in order to fence uncertainties in. In this process, experts draw on divergent textual material, professional traditions, terms, and contexts, they balance different viewpoints, and decide rather by majority vote than by the unchallenged authority of textual interpretation, philosophical insight, or medical expertise. The construction of consensus and legitimacy in bioethical questions should therefore not be understood as a permanent solution, but as an open-ended discursive process, in which decision making can be seen as a form of un/doing uncertainties.

Apart from this, national legislation cannot solve fundamental ethical dilemmas, but only fence them in, which often leads to new dilemmas. The lack of a thorough regulation of certain bioethical technologies limits medical possibilities and creates black markets and organ trafficking (Budiani and Shibly, 2008), while the allowance creates the problem of distributive justice and the question of how to mobilize popular participation in these technologies. Irrespective of national legislation, the moral question of whether Muslims should take part in the new possibilities of modern medicine is always relegated to the individual level. In case of national prohibition, for example, Muslims who can afford it can travel abroad to receive a special medical treatment, while in case of national allowance, they have to make up their mind to benefit from technologies they might view with unease. Thus, the juridical, religious, and moral guidance in these questions by experts does not take decision making off individual Muslims’ shoulders; rather, in view of the ongoing proliferation of new technological possibilities, they are forced to take a positive or negative decision, as soon as they are affected individually.

The difference between decision making on a national and legal level versus a personal and moral level plays an important role in discussions on bioethical issues in a secular environment, where Muslims form only a minority. Muslim councils in Western societies have often approved of national legislation concerning controversial issues like cadaveric organ procurement as long as these laws rest on “informed consent”—like in the above-mentioned German case. The rationale behind this is that Muslim councils in a minority position do not oppose a legislative process they cannot really halt, while at the same time ensuring that individual Muslims or their relatives have the right to decide on their own whether they want to undergo a certain biomedical treatment.

The Socio-political Context of Bioethical Reasoning

Biomedical technologies have ramifications on people’s understanding of life, death, personhood, kinship, and family “that can be viewed as either deeply unsettling, profoundly liberating, or more commonly, some patchwork of both” (Inhorn, 2008, p. 255). As these technologies are not received in a social, cultural, and moral vacuum, the different regulations in Muslim-majority countries show that “Islamic bioethics” today forms an umbrella term for deliberations, whose meaning is negotiated through a plurality of opinions, local constellations, national projects, and international standards. Therefore, questions of bioethical practices and legitimacy cannot be isolated from their broader socio-political context. Discussions by Muslims on healthcare issues in Western societies, in which Muslims form a minority, further add to the complexity of these renegotiations of what Islamic bioethics and Muslim identity mean (Padela, 2015). As moral reasoning permanently has to weigh the particular and the universal against each other, Islamic bioethical deliberations can either look at Muslims as a distinct group with specific cultural experiences and normative sources or at the universal impact of biomedical technology on people’s lives in the world of science and medicine. In a clinical encounter the question often arises how Muslim patients, grappling with issues of illness and healing, can be treated in a culturally sensitive manner and whether they should be seen as patients with particular or ordinary desires, when they resist a special biomedical treatment or accept it pragmatically.

In view of this constellation, bioethical deliberations have moved beyond the narrow framework of juridical opinions and embraced the broader structural conditions in Muslim-majority and Western societies. Since asymmetries are also inscribed into clinical encounters and healthcare systems, bioethics also deals with the issues of access to standard medical treatment, the privatization of healthcare systems, the availability of certain techniques, or the lack of reciprocity in organ donation. For example, rich people, who can afford to buy organs, do not feel compelled to donate their own organs; poor people will not donate their organs because they cannot afford a transplantation. When selling kidneys is legalized under certain circumstances, such as in Iran, organ donation reflects a strong social bias. As most vendors come from the lower classes, eighty percent sell their kidney for economic reasons and fifty-one percent despise the (rich) recipients of their organs (Ghods, 2002; al-Khader, 2002). Without financial incentives, organ donations from living donors mostly happen between relatives, with a clear bias toward female donors and male recipients. All over Muslim-majority countries in which cadaveric organ procurement is allowed a rather low turnout rate has been reported; families often do not agree because of emotional or religious reasons or a general skepticism—in spite of religious authorities taking sides for donation in these countries (Atighetchi, 2007, pp. 183–197).

Therefore, Muslim popular skepticism cannot be simply explained by traditional or religious worldviews, by “backwardness” or “superstition,” as some physicians want to have it (Hamdy, 2016, p. 4). The reluctance to agree to certain medical practices also has to do with wider concerns about the fairness, access, and justice in the medical spheres and can change with the socio-political conditions (Hamdy, 2013 and 2016). In Egypt, for example, ophthalmologists secretly practiced cornea grafting from the early 1960s without patient and family consent; the doctors found it impractical—and even unnecessary within a strongly paternalistic medical context—to approach family members to gain their consent because they judged them a priori as reluctant. In the 1990s the eye banks, which were established with Saudi and US help in the 1980s, were forced to shut down, after reports on “eye theft” and a black market for kidneys and liver lobes had become public. In popular understanding, these cases represented not only corruption and mismanagement, but also the mistreatment of the most vulnerable members of society, the dead, and contributed to suspicion about end-of-life care in hospitals. However, in the revolutionary turmoil of 2011, people’s attitude toward cornea donation suddenly changed because many activists suffered eye injuries through tear gas, rubber bullets, or shrapnel. Eye injuries became a symbol of the sacrifices “living martyrs” endured for the revolution and their country. In 2012 protesters and physicians started a widely supported campaign to obtain people’s consent to put their dead bodies to medical use. Although this movement could, in the end, not realize its goal of providing restorative operations for those blinded during the uprisings, it serves as a correction of the view that it is “ignorance” or “incorrect religion,” which prevents people from consenting to organ donation (Hamdy, 2016).

Thus, biomedical questions are not only ethical or medical questions; actors also use them to address the shortcomings of a healthcare system or formulate outright socio-political demands. Hamdy (2013) reports about a small group of Egyptian doctors’ campaigning against brain death and renders their argument that “the cost of such expensive, technologically advanced interventions could be better channelled into preventative health measure, like cleaning up the water and land that had predisposed Egyptians to renal and liver failure in the first place” (ibid, p. 151). On a similar note, different ideological-political camps engaged in a public debate in 2007 on whether nurses should be allowed to wear the niqāb in Egyptian hospitals. Thus, state and non-state actors renegotiated Egyptian national and religious identity by drawing on this question. While for some the argument that the nurses should adhere to the global standards of their profession was equal to “Westernization,” for others the relatively recent spread of the niqāb in Egypt represented “Wahhabization” (Eich and Bentlage, 2011, p. 232).

That bioethical discussions lend themselves to socio-critical concerns has also to do with the fact that the institutionalization of biomedicine has gone hand in hand with the centralization of modern state power and the co-optation of religious authority in most Muslim-majority countries during the twentieth century. Criticism of modern medicine can therefore not only be read as an expression of a “culture gap” between science and religion, but also as a comment on the modern state project and its discontents. Against this background, the institutionalization of bioethical deliberations can further be understood either as a way to mitigate the asymmetries and distortions in the modernization process or as a way to strengthen state-led modernization and dissipate critique thereof. More generally, the transnational quest for an Islamic bioethics can also be seen as a way of inscribing Islam into global debates and modern science, thus underlining, at the same time, its contemporaneity and particularity.

Summary and Prospects

In practice, the continuous institutionalization of Islamic bioethics is visible in both a growing amount of literature and an increasing number of experts and committees that deal with ethical and social questions in medicine and the life sciences in recent years. Muslim and non-Muslim practitioners in the field like to claim that the growing attention for these issues has already turned Islamic bioethics into a separate discipline, “a field in its own right” (Clarke et al., 2015, p. 266). For example, Clarke et al. state that Islamic bioethics should not be seen as a mere subfield of Islamic studies, but as “a paradigmatic and revealing instance of the present transformations in Islamic religious authority under globalised modernity” (p. 277). Yet, as Islamic bioethical deliberations obviously form a conglomeration of different methodological and theoretical approaches, it seems also justified to see Islamic bioethics as a multidimensional inquiry cutting across different disciplines, such as Islamic studies, philosophy, law studies, medicine, genetics, political studies, sociology, and anthropology. From this viewpoint, the establishment of Islamic bioethics as an institutionalized field of practice, research, reflection, and teaching remains a continuing challenge. To meet its multifaceted requirements, the practitioners, researchers, and teachers in the field should go well beyond the fatwā literature and pay additional attention to ethical concerns and their socio-political implications, thus avoiding treating “biopower” and “biopolitics” (Foucault, 2003; Agamben, 1998; Lemke, 2011) as restricted to medical ethics only. Building on an already existing development, future researchers of Islamic bioethics are required to broaden their focus, geographically by going beyond the Arabic-speaking world, thematically by examining issues beyond the traditional focus on medical interventions and technological innovation, and sociologically by including secular stakeholders, such as legal institutions, medical associations, and governments (Schreiber et al., 2013). On the one hand, they might dig deeper into the foundational sources of Islamic ethics, the moral principles and rules that undergird Islamic legal theory, its casuistry, processual reasoning, and practical application. On the other hand, they are also obliged to reflect more on the dialectics between particular and universal, leave behind stable binaries (religion vs. secularity, religion vs. medicine, Islam vs. modernity), and turn to a situational, contextual, comparative, and processual understanding of ethical practices and reasoning. They could, for example, more systematically engage with the dynamics of the de- and revaluation of Sharīʿah principles, the de- and reconstruction of authority, the de/legitimatization of state or international policies, and the moral economy of resistance and pragmatics in bioethical discussions. With this in mind, the future study of Islamic bioethical deliberations holds the prospect of more profound, systematic, and critical research that can give the field more depth and coherence, without denying its diversity.

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  • Hamdy, Sherine. “All Eyes on Egypt: Islam and the Medical Use of Dead Bodies Amidst Cairo’s Political Unrest.” Medical Anthropology 36, no. 3 (2016): 220–235. Shows how changing political circumstances influence the people’s acceptance of cornea transplantation.
  • Hamdy, Sherine. “Not quite dead: why Egyptian doctors refuse the diagnosis of death by neurological criteria.” Theoretical Medicine and Bioethics 34, no. 2 (2013): 147–160. Discusses the reasons for patient mistrust and physicians’ unease with the brain death concept.
  • Inhorn, Marcia C. “Conclusion.” In Muslim Medical Ethics: From Theory to Practice, edited by Jonathan E. Brockopp and Thomas Eich, pp. 252–255. Columbia: University of South Carolina Press, 2008. Evaluates achievements and shortcomings of academic studies in Islamic bioethics.
  • Jonsen, Albert R. “Casuistry: An Alternative or Complement to Principles?” Kennedy Institute of Ethics Journal 5, no. 3 (1995): 237–251. Proposes casuistry as a useful tool of resolving moral problems by focusing on the circumstances of particular cases instead of applying ethical theories and principles.
  • Keller, Martin. Islamische Rechtsmeinungen zu medizinischen Eingriffen an den Grenzen des Lebens. Ein Beitrag zur kulturübergreifenden Bioethik. Würzburg, Germany: Ergon, 2010. Analyzes different fatāwā on a variety of bioethical problems and compares their legal-moral reasoning with the arguments in Western bioethical discussions.
  • Khader, A. A. al-. “The Iranian Transplant Programme: Comment from an Islamic Perspective.” Nephrology Dialysis Transplantation 17 (2002): 213–215.
  • Krawietz, Birgit. Die Ḥurma: Schariatrechtlicher Schutz vor Eingriffen in die körperliche Unversehrtheit nach arabischen Fatwas des 20. Jahrhunderts. Berlin: Dunker und Humblot, 1991. Discusses the Islamic concept ḥurma as an equivalent to the inviolability of the human body.
  • Lawrence, Dana J. “The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate.” Journal of Chiropractic Humanities 14 (2007): 34–40. Discusses the central role of the four principles in bioethics.
  • Lemke, Thomas. Biopolitics: An Advanced Introduction. New York: New York University Press, 2011. Gives an overview over Foucault’s and Agamben’s theories, discusses “life” as the basis and object of politics, also treats “bioeconomy,” and offers a key to the analytics of biopolitics.
  • Moosa, Ebrahim. “Languages of Change in Islamic Law: Redefining Death in Modernity.” Islamic Studies 38, no. 3 (1999): 305–342. Explains different fatāwā by the different attitudes of conservative and progressive religious scholars.
  • Mustafa, Yassar. “Islam and the Four Principles of Medical Ethics.” Journal of Medical Ethics 40, no. 7 (2014): 479–483. Investigates how the four principles are rooted in Islamic medical ethics, thus aiming at a culturally sensitive health care delivery.
  • Obeid, Tasneem, and Ghazi Omar Tadmouri. “Initial Results of a Pilot Arab Human Variome Project.” In Genetic Disorders in the Arab World: Qatar, edited by Ghazi Omar Tadmouri, Mahmoud Taleb Al Ali, and Najib Al Khaja, pp. 74–101. Dubai: Centre for Arab Genomic Studies, 2012. Presents the initial results from two attempts to document human genome variations at country and disease levels (Qatar and Beta-Thalassemia).
  • Padela, Aasim I. “Muslim Perspectives on the American Healthcare System: The Discursive Framing of ‘Islamic’ Bioethical Discourse.” Die Welt des Islams 55 (2015): 413–447. Analyzes the ambiguities in positions taken by different American Muslim organizations and scholars with regard to healthcare reform and Obamacare.
  • Padela, Aasim I., Hasan Shanawani, and Ahsan Arozullah. “Medical Experts & Religious Scholars Deliberating over Brain Death: Gaps in the Applied Islamic Bioethics Discourse.” The Muslim World 101, no. 1 (2011), 53–72. Offers a taxonomy of experts and organizations that must work together when undertaking applied Islamic bioethical deliberations and analyzes their discussion process.
  • Piarulli, Amanda. “Forming Bioethics.” Momentum 1, no. 1 (2012). repository.upenn.edu/Momentum/vol1/iss1/16. Discusses the historical formation of the bioethical field and the role of the four principles in it.
  • Rispler-Chaim, Vardit. Islamic Medical Ethics in the Twentieth Century. Leiden, Netherlands: Brill, 1993. Analyzes fatāwā by religious scholars on different bioethical issues.
  • Sachedina, Abdulaziz. “Defining the Pedagogical Parameters of Islamic Bioethics.” In Muslim Medical Ethics: From Theory to Practice, edited by Jonathan E. Brockopp and Thomas Eich, pp. 241–251. Columbia: University of South Carolina Press, 2008. Discusses the question of how Islamic bioethics should be taught at university.
  • Sachedina, Abdulaziz. Islamic Biomedical Ethics: Principles and Application. New York: Oxford University Press, 2009. Argues that distinct Islamic principles can serve as sources for Muslim biomedical ethics and engage in dialogue with both secular and other religiously oriented bioethics in the context of universal medical practice and research.
  • Sachedina, Abulaziz. “The Search for Islamic Bioethics Principles.” In Principles of Health Care Ethics, 2d ed., edited by Richard E. Ashcroft et al., pp. 117–125. Hoboken, N.J.: John Wiley & Sons, 2007. Discusses the four principles in light of traditional Islamic ethical reasoning and jurisprudence and identifies Islamic principles as well as the way in which they can be applied to modern Islamic bioethical reasoning.
  • Schreiber, Jenny, Thomas Eich, and Morgan Clare: Conference Proceedings of the International Conference: Health Related Issues and Islamic Normativity. Halle, Germany: Universitäts- und Landesbibliothek Sachen-Anhalt, 2013. nbn-resolving.de/urn:nbn:de:gbv:3:5-81356.
  • Serour, Gamal. “Islam and the Four Principles.” In Principles of Health Care Ethics edited by R. Gillon and A. Lloyd, pp. 75–91. New York: John Wiley & Sons, 1993.
  • Sing, Manfred. “Sacred Law Reconsidered: the Similarity of Bioethical Debates in Islamic Contexts and Western Societies.” Journal of Religious Ethics 36 (2008): 97–121. Draws a comparison between bioethical debates in Islamic and secular contexts.
  • Tadmouri, Ghazi Omar. “Genetic Disorders in Arabs.” In Genetic Disorders in the Arab World: Qatar, edited by Ghazi Omar Tadmouri, Mahmoud Taleb Al Ali, and Najib Al Khaja, pp. 10–29. Dubai: Centre for Arab Genomic Studies, 2012. Gives a historical, demographical, and genetic overview on the “Arab” population as well as on the distribution of genetic disorders and the screening programs in different Arab countries.
  • Tadmouri, Ghazi Omar, et al. “Consanguinity and Reproductive Health among Arabs.” Reproductive Health 6, no. 17 (2009): 1–9. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/ 1742-4755-6-17. Extracts data from the CTGA database and discusses the relation between genetic disorders and the practice of endogamy.
  • UNESCO. “Compositions Anterieures du Comite International De Bioethique de L’UNESCO (CIB) / Previous Compositions of the International Bioethics Committee of UNESCO (IBC).” 8 April 2014. unesdoc.unesco.org/images/0022/002274/227453M.pdf.
  • Zaki Hasan, K. “Islam and the Four Principles: A Pakistani View.” In Principles of Health Care Ethics, edited by R. Gillon and A. Lloyd, pp. 93–104. New York: John Wiley & Sons, 1993.
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