Islamic medical ethics a thousand years ago.

F several centuries, the world, and particularly Europe has benefited from the great contributions brought about by Muslim physicians in the field of medicine. These contributions were not only based on technical skills but also on the role of eminent Muslim physicians in establishing medical ethics. Many prominent physicians of the Islamic civilization involved themselves with professional ethics; among them were al-Ruhawi, and al-Razi (Rhazes). Both wrote the earliest and most thorough books on medical ethics over a thousand years ago.1,2 Islamic medical ethics refers to Islamic guidance on ethical or moral issues relating to medical and scientific fields, in particular, those dealing with human life. Islamic bioethics is an extension of Shari’ah (Islamic law), which is itself based on 2 foundations: The Qur’an (the holy book of all Muslims) and the Sunna (the aspects of Islamic law based on the Prophet Muhammad’s words or acts). The fundamental basis of Islamic bioethics is that all rulings and actions must fall in accordance with Islamic law (Shari’ah).3 The Quran and sayings of the Prophet established morality and mode of conduct of physicians and surgeons. The Prophet Muhammad gave many rules regarding seeking remedy, and the importance of consent. The Islamic jurisprudents required from the practitioner to be competent and obtain licensed to practice. He also should get the consent of the patient or his guardian if he is not competent, otherwise he would be liable.3 Abdul Malik ibn Habib Al-Andalusi (d238 H/853 cc)4 in his book “Tibbi Nabawi” stressed that the physician should be competent, licensed, and should obtain the consent of the patient, otherwise he would be liable. Ibn Al Qayim in his book “Tibbi Nabawi”5 made comprehensive details pertaining to human behavior and ethics, and stressed that the physician should be well trained, alert, and keen on getting his job carried out in the best way. The principles of bioethics in the Western world were developed and outlined in 1979 by 2 American philosophers and bioethicists, Beauchamp and Childress in their book “Principles of Biomedical Ethics”.6 The concept of bioethical principles has since been regarded as a purely “Western” innovation, which is absent in the Islamic health care system. These bioethical principles: autonomy, beneficence, non-maleficence, and justice have been legitimized by Muslims jurists as falling into the sphere of Islamic law, and have also been supported by Qur’anic verses. There are, however, many differences in the details, especially regarding autonomy.3 Both Al-Ruhawi, and Al-Razi (Rhazes) built their knowledge upon themes from the Hellenistic medical tradition and incorporated it with Islamic traditions. In fact, one of the earliest and most thorough books on medical ethics is entitled “Adab al-Tabib” (Practical Ethics of the Physician) by Ishaq ibn Ali al-Ruhawi, a Christian who probably embraced Islam.7 Al-Ruhawi was a contemporary to Abu Bakr Al-Razi and lived in the second-half of the ninth century A.D. This book was translated to English by Martin Levey in 1967 (Transactions of the American Philosophical Society).1 Al-Razi has also written a book fully devoted to medical ethics called “Akhlaq al-Tabib” (Medical Ethics).2 To establish such opinions in a well organized book over a thousand years ago is quite significant. Besides, these ideas still maintain their validities nowadays and are laid down in several ethical codes of medicine. Although Al-Ruhawi quoted Aristotle, Socrates, Galen, and Hippocrates to support these ideals, he used Islamic traditions, as well, to further support his points.7