ISLAM AND BIOETHICS

Muslim theologians, jurists, and healthcare workers have been addressing the challenges of modern biotechnology for years. Major textbooks on religion and bioethics cover Islam in one or two articles, offering only a general introduction to these important discussions. The five articles in this issue of the Journal of Religious Ethics, originating from a conference at Pennsylvania State University, are unusual in the specificity of their topics—brain death, feeding tubes, sex selection, spiritual counseling, and organ transplantation—and in their engagement with complex discussions in the Muslim and non‐Muslim worlds. In this essay, I introduce the five articles and consider two larger implications: the changing definition of the human person in light of biotechnological advances and the continuing importance of religious traditions, especially Islam, in legitimizing ethical responses to these advances.     

CONTEMPORARY MUFTIS BETWEEN BIOETHICS AND SOCIAL REALITY

Selecting the sex of a fetus has been a desire of parents in many different cultures. Modern Muslim religious scholars have identified advantages and disadvantages of this practice, permitting it in certain cases while forbidding it in others. In general, they do not appear to desire that selection of sex become a common practice, yet they are willing to allow it for personal reasons. This case‐by‐case approach exemplifies a key aspect of Muslim ethical discourse. After an overview of justifications for fetal sex selection in different cultures, I turn to a discussion of authoritative Islamic sources. I then analyze the reasoning of several modern authorities who deal with the issue. In the absence of a clear religious text on the subject, scholars seem inclined to legitimize sex selection, and in so doing they appear strongly influenced by social attitudes.     

The Spirituality of Human Consciousness: A Catholic Evaluation of Some Current Neuro-Scientific Interpretations

Catholic theology??s traditional understanding of the spiritual nature of the human person begins with the idea of a rational soul and human mind that is made manifest in free will??the spiritual experience of the act of consciousness and cause of all human arts. The rationale for this religion-based idea of personhood is key to understanding ethical dilemmas posed by modern research that applies a more empirical methodology in its interpretations about the cause of human consciousness. Applications of these beliefs about the body/soul composite to the theory of evolution and to discoveries in neuroscience, paleoanthropology, as well as to recent animal intelligence studies, can be interpreted from this religious and philosophical perspective, which argues for the human soul as the unifying cause of the person??s unique abilities. Free will and consciousness are at the nexus of the mutual influence of body and soul upon one another in the traditional Catholic view, that argues for a spiritual dimension to personality that is on a par with the physical metabolic processes at play. Therapies that affect consciousness are ethically problematic, because of their implications for free will and human dignity. Studies of resilience, as an example, argue for the greater, albeit limited, role of the soul??s conscious choices in healing as opposed to metabolic or physical changes to the brain alone.     

COLLECTIVE RELIGIO‐SCIENTIFIC DISCUSSIONS ON ISLAM AND HIV/AIDS: I. BIOMEDICAL SCIENTISTS

During the 1990s, biomedical scientists and Muslim religious scholars collaborated to construe Islamic responses for the ethical questions raised by the AIDS pandemic. This is the first of a two‐part study examining this collective legal reasoning (ijtihād jamā‘ī). The main thesis is that the role of the biomedical scientists is not limited to presenting scientific information. They engaged in the human rights discourse pertinent to people living with HIV/AIDS, gave an account of the preventive strategy adopted by the World Health Organization, and offered an (Islamic) virtue‐based preventive model. Finally, these scientists tried to draft a number of Islamic legal rulings (a?kām), usually seen in Islamic jurisprudence as the exclusive business of Muslim religious scholars. This multilayered role played by the scientists reflects intriguing developments in the Islamic religio‐ethical discourse in general and in the field of Islamic jurisprudence in particular.     

AN ISLAMIC APPRAISAL OF MINDING THE GAP

The neglect of psycho‐spiritual needs of patients as they traverse the modern healthcare system has been a featured theme in medical literature over the past decade. This literature, which often highlights in‐patient palliative care, as well as acute and critical care settings, influences practice guidelines and protocols of doctors and nurses. In this essay, I review some of the pertinent issues raised in the literature and examine the validity of placing an ethical perspective on this issue. I also compare Islamic theocentric perspectives with secular, non‐theistic perspectives on restoring psycho‐spiritual care for patients. I then develop a framework for pastoral intervention based on aspects of the Islamic tradition and elaborate this framework by addressing clinical contexts and cases. The essay is an exposition based upon a review of the modern medical literature, an analysis of some of the traditional Islamic written sources, and the observations of the investigator, a practicing physician and an American Muslim.     

Legislative Enforcement of Nonconsensual Determination of Neurological (Brain) Death in Muslim Patients: A Violation of Religious Rights

Death is defined in the Quran with a single criterion of irreversible separation of the ruh (soul) from the body. The Quran is a revelation from God to man, and the primary source of Islamic knowledge. The secular concept of death by neurological criteria, or brain death, is at odds with the Quranic definition of death. The validity of this secular concept has been contested scientifically and philosophically. To legitimize brain death for the purpose of organ donation and transplantation in Muslim communities, Chamsi-Pasha and Albar (concurring with the US President’s Council on Bioethics) have argued that irreversible loss of capacity for consciousness and breathing (apneic coma) in brain death defines true death in accordance with Islamic sources. They have postulated that the absence of nafs (personhood) and nafas (breath) in apneic coma constitutes true death because of departure of the soul (ruh) from the body. They have also asserted that general anesthesia is routine in brain death before surgical procurement. Their argument is open to criticism because: (1) the ruh is described as the essence of life, whereas the nafs and nafas are merely human attributes; (2) unlike true death, the ruh is still present even with absent nafs and nafas in apneic coma; and (3) the routine use of general anesthesia indicates the potential harm to brain-dead donors from surgical procurement. Postmortem general anesthesia is not required for autopsy. Therefore, the conclusion must be that legislative enforcement of nonconsensual determination of neurological (brain) death and termination of life-support and medical treatment violates the religious rights of observant Muslims.     

THE DUTY TO FEED IN CASES OF ADVANCED DEMENTIA

Cases of dementia present us with difficult ethical dilemmas as we strive to care for those unable to care for themselves. In this article, I review the relevant Islamic texts on caring for the ill, alleviating suffering, and feeding the hungry—all in light of the modern clinical environment. I find that the ethical appropriateness of tube feeding at the end of life is not as clear‐cut as it may seem. My analysis, however, suggests that Muslim scholars ought to favor insertion of a feeding tube in patients who can no longer respond to assisted feeding. Nonetheless, several important issues require further clarification in this clinically important but neglected area of ethical inquiry.     

Translating Neuroethics: Reflections from Muslim Ethics

Muslim ethics is cautiously engaging developments in neuroscience. In their encounters with developments in neuroscience such as brain death and functional magnetic resonance imaging procedures, Muslim ethicists might be on the cusp of spirited debates. Science and religion perform different kinds of work and ought not to be conflated. Cultural translation is central to negotiating the complex life worlds of religious communities, Muslims included. Cultural translation involves lived encounters with modernity and its byproduct, modern science. Serious ethical debate requires more than just a mere instrumental encounter with science. A robust Muslim approach to neuroethics might require an emulsion of religion and neuroscience, thought and body, and body and soul. Yet one must anticipate that Muslim debates in neuroethics will be inflected with Muslim values, symbols and the discrete faith perspectives of this tradition with meanings that are specific to people who share this worldview and their concerns.     

CREATED FOR EVERLASTING LIFE: CAN THEISTIC EVOLUTION PROVIDE AN ADEQUATE CHRISTIAN ACCOUNT OF HUMAN NATURE?

Christians who affirm standard science and the biblical doctrine of creation often endorse theistic evolution as the best approach to human origins. But theistic evolution is ambiguous. Some versions are naturalistic (NTE)—God created humans entirely by evolution—and some are supernaturalistic (STE)—God supernaturally augmented evolution. This article claims that NTE is inadequate as an account of human origins because its theological naturalism and emergent physicalist ontology of the soul or person conflict with the Christian doctrine that God created humans for everlasting life. Both the traditional Christian account of the afterlife and its modern Christian alternatives involve God's supernatural action and a separation (dualism) of person and body at death. STE can combine with several philosophical accounts of the body‐soul relation to provide an adequate Christian account of original human nature.     

Muslims and Meat‐Eating

Religious thinking, including among Muslims, connects food and sex, as well as women and animals; both food practices and gender norms are significant for communal identity and boundary construction. Female bodies (properly covered) and animal bodies (properly slaughtered) serve as potent signifiers of Muslim identity, as patriarchal thought sustains the hierarchical cosmologies that affirm male dominance in family and society and allow humans to view animals as legitimately subject to human violence. I argue that Muslims in the industrialized West—especially those concerned with gender justice—ought to be vegetarians and that feminist ethics provides underutilized resources for Muslim thinking about ethics generally and food ethics in particular. Much contemporary Muslim thought about meat is at least as concerned with demonstrating the primacy of “Islamic” identity as with general questions about the formation of virtuous subjects and the development of good societies. This defensive concern with religious authenticity poses a stumbling block to richer thinking. Engagement with non‐Islamic (though not “un‐Islamic”) ethics provides a model for productive dialogue and engagement among parties who disagree about basic presumptions but agree on desirable outcomes, including the development of individuals' ethical sensibilities and the construction of societies conducive to human flourishing.     

EMBRYONIC PERSONHOOD,HUMAN NATURE,AND RATIONAL ENSOULMENT

This essay briefly describes a few of the problems associated with using personhood language to defend the right to life of the pre‐implantation embryo. Arguing that an immaterial soul explains the personal identity of an embryo is problematic for many people because there is no apparent spiritual activity in the unborn. While some scholars argue that the embryo has the potential to act as an adult person and thus should be protected from harm, others contend that potentiality alone is insufficient reason to ascribe special moral worth to the embryo in utero. For Thomas Aquinas, the soul is not only the life‐principle that organizes the human body, but it is also that by which the human being thinks and wills. By making suitable corrections to Aristotle's hylomorphic depiction of the soul–body relation, I suggest that a rational soul must be present from the moment of conception and that it is at the service of the (embryonic) person. What is of critical importance here is to accept that a human being is present from the moment of conception, something the vast majority of embryologists maintain, notwithstanding the inveiglement of those who state that the pre‐implantation blastocyst is simply a disorganized clump of cells.     

CHRISTIAN AND BUDDHIST PERSPECTIVES ON NEURO PSYCHOLOGY AND THE HUMAN PERSON: PNEUMA AND PRATITYASAMUTPADA

Abstract. Recent discussions of the mind‐brain and the soul‐body problems have been both advanced and complexified by the cognitive sciences. I focus explicitly here on emergence, supervenience, and nonreductive physicalist theories of human personhood in light of recent advances in the Christian‐Buddhist dialogue. While traditional self and no‐self views pitted Christianity versus Buddhism versus science, I show how the nonreductive physicalist proposal regarding human personhood emerging from the neuroscientific enterprise both contributes to and is enriched by the Christian concept of pneuma (spirit) and the Buddhist concept of pratityasamutpada (codependent origination).     

Divine simplicity

According to a doctrine widely held by most medieval philosophers and theologians, whether in the Muslim or Christian world, there are no metaphysical distinctions in God whatsoever. As a result of the compendious theorizing that has been done on this issue, the doctrine, usually called the doctrine of divine simplicity, has been bestowed a prominent status in both Islamic and Christian philosophical theology. In Islamic philosophy some well-known philosophers, such as Ibn Sina (980–1037) and Mulla Sadra (1571–1640), developed this doctrine through a metaphysical approach. In this paper, considering the historical order, I shall first concentrate on Ibn Sina’s view. Then I shall turn to the theory of divine simplicity of Thomas Aquinas (1225?–1274), as the most developed and comprehensive version of the medieval theories in Christian world. Finally, I will return to Islamic philosophy and explore the more complicated and mature account of the doctrine as it was introduced by Mulla Sadra according to his own philosophical principles.     

The degree of certainty in brain death: probability in clinical and Islamic legal discourse

The University of Michigan conference “Where Religion, Policy, and Bioethics Meet: An Interdisciplinary Conference on Islamic Bioethics and End-of-Life Care” in April 2011 addressed the issue of brain death as the prototype for a discourse that would reflect the emergence of Islamic bioethics as a formal field of study. In considering the issue of brain death, various Muslim legal experts have raised concerns over the lack of certainty in the scientific criteria as applied to the definition and diagnosis of brain death by the medical community. In contrast, the medical community at large has not required absolute certainty in its process, but has sought to eliminate doubt through cumulative diagnostic modalities and supportive scientific evidence. This has recently become a principal model, with increased interest in data analysis and evidence-based medicine with the intent to analyze and ultimately improve outcomes. Islamic law has also long employed a systematic methodology with the goal of eliminating doubt from rulings regarding the question of certainty. While ample criticism of the scientific criteria of brain death (Harvard criteria) by traditional legal sources now exists, an analysis of the legal process in assessing brain death, geared toward informing the clinician’s perspective on the issue, is lacking. In this article, we explore the role of certainty in the diagnostic modalities used to establish diagnoses of brain death in current medical practice. We further examine the Islamic jurisprudential approach vis-à-vis the concept of certainty (yaqīn). Finally, we contrast the two at times divergent philosophies and consider what each perspective may contribute to the global discourse on brain death, understanding that the interdependence that exists between the theological, juridical, ethical, and medical/scientific fields necessitates an open discussion and active collaboration between all parties. We hope that this article serves to continue the discourse that was successfully begun by this initial interdisciplinary endeavor at the University of Michigan.     

ON THE VERY IDEA OF CRITERIA FOR PERSONHOOD

I examine the familiar criterial view of personhood, according to which the possession of personal properties such as self‐consciousness, emotionality, sentience, and so forth is necessary and sufficient for the status of a person. I argue that this view confuses criteria for personhood with parts of an ideal of personhood. In normal cases, we have already identified a creature as a person before we start looking for it to manifest the personal properties, indeed this pre‐identification is part of what makes it possible for us to see and interpret the creature as a person in the first place. This pre‐identification is typically based on biological features. Except in some interesting special or science‐fiction cases, some of which I discuss, it is human animals that we identify as persons.     

DISABILITY,IMPAIRMENT, AND SOME MEDIEVAL ACCOUNTS OF THE INCARNATION: SUGGESTIONS FOR A THEOLOGY OF PERSONHOOD

Drawing on insights from the medieval theologians Duns Scotus and Hervaeus Natalis, I argue that medieval views of the incarnation require that there is a sense in which the divine person depends on his human nature for his human personhood, and thus that the paradigmatic pattern of human personhood is in some way dependent existence. I relate this to a modern distinction between impairment and disability to show that impairment—understood as dependence—is normative for human personhood. I try to show how medieval theories of the resurrection of the body can provide, within this context, plausible accounts of what it might be for human persons to be redeemed.     

Major themes in the Arabic political literature of Islamic revivalism, 1970–1985: The Islamic system of government (al‐nizam al‐islami), shūra democracy and the implementation of the Sharica as opposed to secularism (cilmaniyya)

The analysis of the political literature of Islamic revivalism belongs to the pertinent issues of Muslim‐Christian dialogue. This article is an inquiry into the major themes of this literature published in Arabic. The historical context of the writings of political Islam is the failure of the secular nation‐state in the world of Islam to cope with the processes of modernization and development. The political Islamic response to this failure is the revival of the dream of reconstructing the Islamic state along the model of Medina on the eve of the rise of Islam. The analysis of the intellectual reconstruction of the early Islamic state as an expression of divine order, which ought to replace the secular state, reveals that this construction is imbued with projections of modern times into the Islamic past. Thus the alleged Islamic government of nizam islami/Islamic system as a modern issue is an outgrowth of political Islam. In this sense, the notion that Islam is a din wa‐dawla/ divine order of the state cannot be found in classical Islamic sources. Part one of this two‐part article comes to the conclusion that political Islam is a burden for modern Islam and an obstacle to the accommodation of the needs of the Muslim people to the modern age; it is not a promising future prospect in the present situation of crisis.     

Defining Death for Persons and Human Organisms

This paper discusses how alternative concepts of personhood affect the definition of death. I argue that parties in the debate over the definition of death have employed different concepts of personhood, and thus have been talking past each other by proposing definitions of death for different kinds of things. In particular, I show how critics of the consciousness-related, neurological formation of death have relied on concepts of personhood that would be rejected by proponents of that formulation. These critics rest on treating persons as qualitative specifications of human organisms (Bernat, Culver, and Gert) or as identical to human organisms (Capron, Seifert, and Shewmon). Since advocates of the consciousness-related, neurological formulation of death are not committed to either of these views of personhood, these critics commit the fallacy of attacking a straw man. I then clarify the substantive concept of personhood (Boethius, Strawson, and Wiggins) that may be invoked in the consciousness-related, neurological formulation of death, and argue that, on this view and contra Bernat, Culver, and Gert, persons have always been the kind of thing that can literally die. I conclude by suggesting that the discussion of defining death needs to focus on which approach to personhood makes the most sense metaphysically and morally.     

MYSTICISM AS MORALITY

Sufism—spiritual practice, intellectual discipline, literary tradition, and social institution—has played an integral role in the moral formation of Muslim society. Its aspiration toward a universal kindness to all creatures beyond the requirements of Islamic law has added a distinctly hypernomian dimension to the moral vision of Islam, as evidenced in a wide range of Sufi literature. The universal perspective of Sufism, fully rooted in Islamic revelation, yields a lived (and not just studied) ethics with the potential to view and embrace all creatures through a single ethical vision, regardless of religious or other affiliation. This side of Islam, both acknowledging and surpassing the outlook of the legal heritage, offers important insight into understanding the nature of Muslim society as both Islamic and meta‐Islamic in religious orientation. Sufism, still significant in today's Islamic world, thus offers important material for locating Islam as part of an international order with principles and standards that resonate deeply with the moral vision of Islam itself.