7. The Four Sources of Sharia. 8. Casuistry as Method – Case-Based Reasoning. 9. The Principles of Islamic Ethics. Appendix I – Jihad: The Sixth Pillar of Islam.

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Cummiskey Chapter II Islamic Medical Ethics and Casuistry – Muhammad 5. The Messenger: The Life of Muhammad 6. The Five Pillars of Islam 7. The Four Sources of Sharia 8. Casuistry as Method Case – Based Reasoning 9. Th e Principles of Islamic Ethics Appendix I – Jihad : The Sixth Pillar of Islam Appendix II – The Sunni – Islam is a major world religion with over one billion Muslims worldwide. Although Islam began in Arabia, eighty percent of Muslims are not Arabs. There are major cultural differences between Muslims in Arabia, Persia, Pakistan, India, Indonesia, Africa, Europe and America. Nonetheless, although Muslims are diverse in many ways, Islam provides a shared way of life that transcends other majo r cultural differences. We will first aim for a basic understanding of the origin of Islam, and the basic elements of the Islamic way of life: the Five Pillars of Islam (the declaration of faith, daily prayer, charity, the yearly fast of Ramadan, and the Hajj, which is a once in a lifetime pilgrimage to Mecca). We will also explore the significance of the Pillars to medical ethics and the nature of Sharia and casuistry as a method of moral reasoning that shapes medical ethics. In addition, the appendixes discuss the nature of Jihad, sometimes called the sixth pillar of Islam, and the important Sunni – larger Islamic tradition. 5 . The Messenger: The Life of Muhammad Islam was founded by the prophet Muhammad and its core theology involves , the was an explicit response to and total rejection of polytheism, tribal ism, and idolatry. The most central el ement of Islam is an unconditional belief in one God. Islam will? Islam is dis tinct from other forms of monotheism in its belief in Muhammad as the last prophet of God. For Muslims, Muhammad is the messenger of God and his life is an example of perfect virtue.

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Chapter II 2 Muhammad was born around 5 70 CE in the Arabian Peninsula. His father die d before his birth and he became an orphan at six years old when his mother also died. He was subsequently raised by his Grandfather a nd then his Uncle Abu Talib. Muhammad also spent much of his youth living with a nomadic Bedouin tribe and tending animal s . It is perhaps in this period that he first developed an ear for the rich tradition of oral history and mythology that sustained the intellectual and spiritual needs of the Bedouin tribes. Although he was an orphan, his family was part of the dominant Q uarish tribe of the city of Mecca . His uncle , Abu Talib, was very influential in the tribe and he cared for Muhhamad and protected him. The Quarish served as the guardians of the holy site of the Kabba in Mecca. The Kabba is said to have been built by t he Biblical Abraham near the place of the sacrifice (where God tested Abraham by asking him to sacrifice his son Isaac) ( 3:97). The Kabba is now the most holy site in Islam , but prior to Muhammad and the rise of Islam, it was a shrine that held ove r 360 idols representing the many gods of the many tribes that visited Mecca. In addition, Mecca was geographically important because it was the site of a spring which served as a shared source of water for travelers. The spring and the city served as a n eutral place of peace where all tribal conflict was set aside. Mecca, as a source of water and peace, became a central resting spot on the trade routes of the Arabian Peninsula. The traders at rest would of course exchange goods, but they would also shar e stories of distant places, different cultures, and different theologies. In addition to the wealth of the economic market, Mecca was also a rich cultural market place of ideas. Mecca was both an economic and cultural oasis. Muhammad thus grew up in a rich and comparatively diverse cultural context. He was well versed in the Bedouin oral tradition but, in the marketplace of Mecca, he also learned a gr eat deal of other cultures, especially the monotheistic traditions of Judaism and Christianity. By t he time he was 25, Muhammad had earned a reputation as an older (40 year old) wealthy business woman named Khadija. He married her and traveled as far as Syria working her trading caravans. During this time we as sume that he was able absorb much of the theology of the Torah and Gospel s that provides the background for the revelations of the . Fifteen years later, in 610 CE, while meditating in the hills outside of Mecca, Muhammad had his first revelation. According to Muhammad, he was visited by the was delivered through him. The is understood to be the direct word of God, from Gabriel. Muhammad is nothing more than the messenger of God. He is in no way divine but is the last of the prophets sent by God to guide mankind on the path of truth and righteousness. The prophets before him, including Adam, Noah, Abraham, Moses, and Jesus, are all also recognized by Islam. Jesus alone is mentioned by name 25 times in the and referred to many more times. Although Muslims accept Jesus as a prophet and extraordinarily special messenger of God, born of the Virgin Mary, and able to cure the sick and r aise the dead, like Muhammad , Jesus is still considered to be a man and distinct from God. In many cases the presupposes familiarity with the stories of the Old Testament and the Christian Gospels, and comments and elaborates on them without repeat ing them. Judaism and Christianity are thus also considered religions of the Book of God, by Muhammad, and the three religions share much of the same history of

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Chapter II 3 prophets and , most importantly , the core monotheism, which is the most essential aspect of Isl am. The relationship between Judaism, Christianity and Islam began as one of commonality and Islamic tolerance of the other earlier monotheistic religion. Christians, Jews, and Muslims were all People of the Book and descended from Abraham. Although the re was tension and conflict from the start with the Jewish tribes and with the Christian Byzantine Empire, it is only after first the Christian crusades and more recently the Palestinian – Israeli c onflict that the seemingly fundamental opposition between th e of his revelation. Muhammad was cautious at first, and his caution was increased when three years passed bef ore his revelations resumed. With time, however, he slowly but steadily shared his experience and revelations with the people of Mecca. Between 610 and 622 CE, his revelations and confidence increased and a small community of followers began to take sha pe. The core of his teaching, however, was hostile to the polytheism and idolatry that constituted the spiritual tradition of Mecca and the Arabian Peninsula. Needless to say, this attack on the traditions and heritage of the people including his own tri be was not popular. Nonetheless, he had the protection of his uncle and his wealthy wife to sustain him. This changed however in 622 CE when both his uncle and wif e died. Muhammad was forced to flee Mecca. Fortunately , however, Muhammad had a reputation for fairness and honesty (he was often called the trustworthy one) , and he was invited to move to the city of Yahtrib and mediate their tribal conflicts. Yahtrib was r enamed Medina, the city of the prophet . With a small community of about 70 followers, Muhammad emigrated to Yathrib /Medina . This migration is called the Hijra and it marks the start of the Islamic calendar and the formation of the Islamic , as followers of the one God , are one People and one Community or Umma. Between 622 CE and 630 CE, Muhammad authority grew and so did the Umma. In a series of conflicts with Mecca, his followers fought with great bravery and conviction in defending the community and the new reli gion of Islam. Their success against the powerful tribes of Mecca impressed the nomadic Bedouin tribes and his followers grew in a rapid and steady fashion until Mecca finally fell and Muhammad returned triumphant in 630. On his return to Mecca, despite having been run out of his own city, he did not seek the blood revenge that was common practice, and instead allowed all to submit to the authority of the Muslim community . Muhammad invited all Meccans to embrace Islam and join the community of believers , but he did not require conversion to Islam . Muhammad did, however, destroy the idols of the Kabba (perhaps, according to some stories, with the exception of Jesus and Mary), and demanded the end of all idolatry and polytheism. Two years later, in 632 CE , Muhammad died. The Umma, however, continued to grow and spread across Arabia and into Egypt and Iraq; driving Byzantium back to Europe and conquering Constantinople; spreading across Persia and India to the east and across North Africa and through Spain in the We st. I n a short 200 years the Islamic empire stretched from India to Spain. The Islamic Empire eventually fell to the Mongols, but with time the Mongols integrated with the Arabian population, and the rulers converted to Islam and indeed led an I slamic revival. With the emergence of the Ottoman Empire, Islam continued its growth and it now spread to Indonesia and through much of Africa.

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Chapter II 4 From its roots in Arabia, Islam is now a global religion of more than one billion believers. Indeed today, l ess than twenty percent of Muslims are Arabs. The reasons for its overwhelming success are a complex combination of military conquest and voluntary conversion. We leave aside this fascinating historical narrative and now return to our main interest in Is lamic ethics in particular. 1 6 . The Five Pillars of Islam Islam is a way of life and the core of this way of life is captured by the Five Pillars of Islam which encapsulate the basic responsibilities of a Muslim. They are: 1. declaration of faith in God an d his messenger Muhammad 2. daily prayer 3. a commitment to charity 4. once a year Ramadan fast 5. once in a lifetime Hajj pilgrimage to Mecca The Declaration of Faith (or Shahada) is deceptively simple, for it is far absolute oneness and unity of God. In the time o f Muhammad, the declaration of faith is a repudiation of polytheism with its tribal go ds and idols. Monotheism is a unifying force: i f there is one God, we are people of one God and thus part of a human community that is prior to and superior to tribal al legiances. Islam is supposed to transcend all mmitment to the authority of , first , the Koran as the direct revelation of the word of the one God, and , second , it recognizes the special status life. If one lives in the footsteps of Muhammad , one lives in a way clearly favored by God. This is the theological basis of the authority of the – ic sayings of Muhammad and the use of his life as a model of ethical beha vior. The and Hadith, as we see below, are the source of Islamic law and ethics (the Sharia). The central it y of an attitude of submission to God is clearly an important difference from western secular ethics focused on autonomy. For a Muslim, on ultimately in the hands of God. As we shall see, however, submission to God does not imply a fatalistic or passive attitude. The second pillar of Islam is Prayer (or Salat) . A Muslim is supposed to pray five times a day. The favored times are dawn, noon, midday, sunset, evening. The first prayed toward Jerusalem but Muhammad switched the d irection of prayer to Mecca after the flight to Medina in 622.) Although it is preferable to worship together in a mosque, a Muslim may pray almost anywhere, such as in fields, offices, factories, 1 For more information on the life of Muhammad and the bas ic elements of Islamic thought, see Malise Ruthven Islam: A Very Short Introduction (Oxford 1997). Also see the Empire of Faith video series and www.Islam101.com .

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Chapter II 5 is a familiar part of life, and reinforces the common experience of the Islamic community (the Umma) who all face Mecca together and pray together . Of course, p raying in the West and in non – Muslim communities may be more c hallenging. If for some good reason one cannot pray in the ritualized prescribed matter on a particular occasion, the you are safe, you shall commemorate God as He taugh 2:239). Prayer is a deep commitment and deeply cleansing; it keeps once close to God, The corridor of a hospital in particular is not the best place for kn eeling in devout prayer. But many hospitals in the west do not have prayer rooms. Praying in a chapel often comes with its own set of problems — forbidden pictures and statues of living beings, pews facing in the opposite direction of Mecca, and worshipp ers wearing shoes on the floor where Muslims kneel to pray. To alleviate these problems and welcome Muslim patients and families, hospitals can easily provide a prayer room , with pra yer rugs for 10 to 15 people . Ideally the prayer room will include a spe cial niche in/on the prayer room wall, which indicates the direction of Mecca and displays Islamic sayings and symbols. In addition, if necessary, a conference room can be reserved for the larger Friday afternoon prayers. The third pillar of Islam is Char ity (or Zakat) . A donation of 2.5% of capital assets is supposed to be given to the Muslim community. In addition, sadaqa – h, translated as charity should be done in secr et and not done for public praise. A Muslim should live a simple life and not one of lavish material excess. Indeed, an attitude of Charity should principle of beneficence and compassion in clinical medical ethics. Indeed, the Indeed pr inciples of justice and charity are widely help by Muslims to require the community to provide universal access to at least basic health care services. The fourth pillar of Islam is Fasting (Sawm) during the month of Ramadan. The Fast involves abstaining from food, drink, and sexual relations during daylight hours, for the month of Ramadan. Each night the fast is broken , and it is traditional for individuals to gather together each night with others for a shared celebratory dinner. Fasting is supposed to teach self – restraint and instill an appreciation of the simple needs of food and water. Importantly, one is not required to fast if it would be imprudent or unwise. For reasons of health, or other good reasons, one may break the fast, but one should mak e it up day for day at some later date if possible. The medical indicated taking of drugs, even IV drugs, does not break the fast, but IV nutrition and hydration does break the fast. Nonetheless, one should break the fast if doing so is medically indicat ed. The fifth pillar of Islam is the The Hajj is a once in a lifetime obligation only for those who are physically and financially able to do so. Over two million people go to Mecca each year from every corn er of the globe. The yearly experience of people from all over the world coming together in Mecca are exchanged from the far corners of the Muslim world. The Hajj b rings the people of Islam together just as it brought the Arab people and traders from afar together in the

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Chapter II 6 time of Muhammad. The importance of the Hajj cannot be overestimated and for persons facing terminal illness, the Hajj maybe an important final act that completes their life. An important characteristic of each the Five Pillars of Islam is the degree of flexibility and pragmatism that is built into them: One is to pray five times a day, but if one cannot the important thing is to keep God before one contribute economically to the commun ity , but the duty of charity is a personal commitment and we each must determine how to make charity an important part of our lives. Fasting is required, unl ess it would be a real burden, undu e hardship , or medically risky . The point of fasting is to learn self – restraint and appreciating the condition of those who need food; it is not for simple self denial and suffering. On Ramadan, the shall fast a similar number of days later on. God desires your well – being, not your discomfort 2:185, emphasis added) Similarly, the Hajj is something that one should do, if one has the ability and means . Although certain Islamic traditions a re more austere and uncompromising, it is an important characteristic of Islamic ethics that it has a significant deg ree of pragmatism at its very core. 2 7 . The Four Sources of Sharia The Five Pillars of Islam are considered the defining and essential asp ects of Islamic Muhammad is his messenger commits oneself to as revealed in th e , and through the example provided by the life of Muhammad . The first pillar of Islam thus includes all of Islamic law and ethics, called The Sharia. at work here is that of the moral la w in the broadest possible sense. Sharia means both Law and the Path. Similarly, the word for Islamic jurisprudence, Fiqh, means both Jurisprudence and Insight. God f or man, and it is thus much more than law in the civil and political sense of the term. The Sharia is in fact more specific about family law (which governs marriage, divorce, and inheritance) than it is about criminal and civil law in more general terms. 3 The Sharia is based on four sources: 1. The — the prophetic recitation from Allah (through the Angel Gabriel) to Muhammad 2. The Sunna and Hadith — stories of the life and sayings of Muhammad 3. The Consensus of Scholars — including the classical c ommentaries on the meaning of the below) 2 For more on the Five Pillars of Islam, see Ruth ven p. 143 – 148; and see http://www.islamicity.com/mosque/pillars.shtml For an excellent discussion of the Islamic way of life, see Suzanne Haneef What Everyone Should Know about Islam and Mus lims ; especially pp. 63 – and pp. 93 – to be a Muslim 3 For a comprehensive account of the Shari a and the different schools of interpretation, see Michael Cook Commanding the Right and Forbidding the Wrong in Islamic Thought (Cambridge University Press, 2000).

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Chapter II 8 their reasoning to apply the timeless Islamic principles in creative ways to the evolving problems of human lif e. 4 W ith each new si tuation, new knowledge, and new technology, we get novel problems and questions. Of course, t his is especially the case in biomedical ethics . Since the and Hadith provide some clear cases of required actions, permissible conduct, and prohibition, we can use these examples as a basis for analogies to guide us in thinking about new situations. When a consensus forms on an issue or case , then this additional example provides the basis for a new an a l o gy to help u s resolve a novel moral problem or question. The fourth source of Sharia is this type of analogical reasoning from clear cases to new cases. Moral reasoning that is based on analogical reasoning is called casuistry . For example, the states that man should not use fire as a punishment, for it is the punishment of God, and thi s has been interpreted by many to exclude the firing of cities in times of war. On this basis, many argue that the use of nuclear weapons to incinerate cities is clearly analogous to burning cities , and th us the first use of nuclear weapons is also forbidden. The , however, also says that one should arm and prepare oneself for war so as to deter aggressors. And, additionally, the also states that one need not continue to restrain oneself, from otherwise forbidden means of wagin g war, when the enemy has not shown similar restraint. On the basis of these three different passages, many Islamic scholars conclude that the first use of nuclear weapons is forbidden, but nuclear deterrence and nuclear retaliation (in response to anothe use of nuclear weapons) may be permissible. An opinion on a moral question , like the permissibility of nuclear weapons, or on other matters of theology, is called a Fatwa . A fatwa is simply an opinion on a particular issue or question that is based on the four Sharia sources. Anyone who has seriously studied the Sharia may issue a fatwa, but the weight, the significance and influence, of a particular fatwa will depend both on the quality of the reasoning, and also on the reputation an d authority of the person issuing it. On new issues, there are likely to be competing opinions based on different sources, or on different interpretations of the significance of ic passages and Hadith . There are also differe nt traditions of interpretation that lead to different conclusions . Over time, if a consensus develops as to the best opinion, then this becomes part of the settled Sharia itself — and a source of future ana logies. In other instances, different Sharia sources may equally justify distinct and competing opinions and thus there may be a plurality of shared but distinct opinions on an issue. When distinct subsets of the larger Islamic community hold di fferent opinions on an issue, each of these opinions is entitled to respect . Consequently, the consensus would state that the matter remains undetermined and each opinion maybe equally valid. In these unresolved cases, many believe that i ndividual Muslims can then follow the opinion they believe to be most compelling. that continue to play an influential role in defining the Sharia. They are the Hanafi, the Maliki, the Shafi, and the Hanabali, and are named after their founders. The Hanafi School was originally founded in Iraq, as the favored school of the Abbasid r ulers, by Abu Hanifa ( d. 767). This school of thought is now especially 4 See Tariq Ramadan, Radical Reform: Islamic Ethics and Liberation (Oxford, 2009); In the Footsteps of the Prophet: Lessons from the Life of Muhammad (Oxford , 2007)

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Chapter II 9 influential in Western Asia, except Arabia, including Turkey, lower Egypt, Pakistan, and South Asia. It is the most liberal tradition. The Maliki School was also known as the Medinia n School because it grew out of the particular Sharia interpretation, the practice of Islamic Law, in the city of the Prophet, Medina. Its champion was Malik ibn Anas ( d. 795) who collected the traditions upon which he, as a practicing judge at Medina, ba sed his decisions into a corpus called al – Muwatta now especially influential in Upper Egypt, North and West Africa. The Shafi School was founded by al – Shafi’i ( d. in Egypt 820), who was a disciple of Malik. Al – that is based on the four sources (explained above) by emphasizing the central role of analogical reasoning. This school of thought is now especially influential in Egypt, Indonesia an d Southeast Asia. The Hanabali School was originally founded in Baghdad by Ahmad ibn Hanbal ( d. 855). This school was a conservative reaction and response to the emergence of more rationalist Islamic movements. (Islamic rationalism will be discussed below .) This school of thought is now especially influential in the Arabian Peninsula. The now influential conservative and fundamentalist Wahhabi tradition in Saudi Arabia is a contemporary descendant of the classical Hanabali School. The Hanabali are espec ially deferential to the classical tradition of that emerged in the first three centuries, and especially resistant to new or novel (individual interpretation) close d in the third Muslim century. To clarify, these are schools of thought; that is, traditions of interpretation which emphasize particular commentaries and collections of Hadith, the opinions of particular classical scholars, and the scholars that have foll owed them and further developed the particular tradition of interpretation. In addition, although each of these Schools is more influential in some regions than in others, in general, there is a mutual respect and reciprocity between the different school s. Specifically, each School may itself form a consensus on an issue, and this consensus within the particular School is then recognized as an acceptable alternative opinion by the other Schools. The exception here is the Hanabali/Wahhabi School of inter pretation, which tends to be significantly more intolerant of the other Schools, and more insistent on the orthodoxy of its particular (more conservative) interpretation of Sharia. In short, the Sharia relies heavily on already established consensus on ma ny issues, but there is also a range of acceptable positions officially represented in the distinct Schools of thought. We have focused on the four sources of Sharia. Equally important, however, is the core objectives of Islamic Sharia: the protection of the Islamic community, the inner strengthening of faith, and the protection of life, family, and property . In difficult cases and moral dilemmas, the fundamental core and objectives of the Sharia takes center stage. This brings us to the final two fundam ental, although secondary, principles of Islamic Sharia) that deal directly with moral dilemmas. The principle of necessity states that necessity makes permissible the prohibited, and the principle of lesser evil states that when forced to choose between u ndesirable outcomes always choose the lesser evil . As the –

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Chapter II 10 and so in circumstances where there are serious consequences to life, health, or well – being particular prohibitions t hat would block life – saving action or cause serious harm do not apply. Of course, applying the principles of necessity and the lesser evil requires judgment and is highly context and situation specific. One must consider the significance and point of the prohibition as opposed to the beneficial consequences of an infringement, and decide if the prohibition is waived in that particular context. These principles inevitably play a significant role in matters of life and death, and they are thus central prin ciples of Islamic medical ethics. 8 . Casuistry as Method As a general model of reasoning, casuistry starts from a consensus on particular cases, and then moves, by means of analogy, from the clear and settled cases to more difficult or novel cases. Th e art of casuistry requires an intimate understanding of the particular case to be decided and its analogies and disanalogies with clear settled cases. The method of casuistry is typically thought to emphasize the particular case over more abstract princi ples. It is also said to involve an inductive model of moral reasoning that treats the particular case as prior to general moral principles. Moral principles are thus supposed to be derived from the particular cases. 5 Because of its reliance on analog y from settled c ases (in the , the Hadith, and earlier consensus ) , Islamic ethics is often considered a particularly clear example of casuistry. Sharia interpretation, however, also presupposes basic principles of justice, toleration, compassion, an d of the fundamental value of human life. Furthermore, in examining difficult moral issues, as we shall see, the process of ic interpretation cannot simply focus narrowly on particular verses. It must instead look for the underlying principles that make the most overall sense of the as a whole. What then is the proper place of principles in a form of reasoning that is supposed to be rooted in particular cases? Although Islamic ethics and jurisprudence relies heavily on particular cases, t here is an alternative interpretation of the role of settled cases in moral reasoning, which perhaps more accurately reflects the structure of Islamic jurisprudence. First, it is important to notice that the settled cases, that provide the starting point for moral reasoning, always include underlying principles that systematize cases together into a line of reasoning. Any set of cases is unified explicitly or implicitly by judgments of relevance that allow one to reason from one case to the next. All case – based reasoning presupposes a principled basis for selecting apt analogies (from competing ways of seeing the case and thus from competing analogies). Second, this makes clear that interpreting cases is itself always theory – laden. There is no morally ne utral description of a particular case. The features of the case are selected and noted based on considerations of moral relevance, and these principles of moral relevance are the means by which the case is generalized and shown to be relevant to novel an d more complex cases. The actual process of moral deliberation, and Sharia reasoning, is not so much inductive or deductive as it is a process of seeking coherence and consistency. By thinking about concrete cases in all their specificity, we are able t o better and more 5 Add references here

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Chapter II 11 accurately specify the demands of our principles and also see more clearly how to balance competing principles The details of specific cases are important not because they are methodologically prior to principles but because previously se ttled cases provide paradigmatic models for balancing and specifying principles. 9. The Principles of Islamic Ethics as revealed by the and the example of the proph et. At the core of the Muslim way of life are the five pillars of Islam (the Declaration of Faith, Prayer, Charity, the Ramadan Fast, and the Hajj Pilgrimage). The Sharia, Islamic law and ethics, is deeply rooted in the and the Hadith which recoun t the sayings and the life of Muhammad. From these initial sources , a consensus of scholars has forme d on many fundamental issues. N ew ethical questions and problems are addressed by a process of analogical reasoning from cases that is itself guided by ba sic principles. Devotion, dereference, and submission to the Will of God is the essence of Islam , but human reason and judgment is our only tool for understanding and interpreting the Divine Will as revealed to Muhammad. The inescapable tension between f aithful submission to the and the Hadith and rational reason – governed interpretation is the definitive and fundamental feature of the distinctively Islamic approach to moral problems. In brief, the principles of Islamic normative ethics include: Su bmission to the Divine Will through the , Hadith, and reasoning; not Individual Autonomy Non – malificence – Beneficence, Charity and Compassion Justice and Equity Focus o n Responsibilities; not rights Family Autonomy; not individualism In chapters that follow, we will explore the application of these principles to a range of particular issues including clinical medical ethics & the patient – physician relationship (sect 33), the concept of death & organ transplantation (sect 38), assisted dying & euthanasia (sect 49), and abortio n & reproductive ethics (sect TBD ). In exploring these concrete problems and moral dilemmas, the contours and character of Islamic ethics will take on ever sha r per shape and specificity.

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