Ethical Controversies in Abortion - an Islamic Perspective
By Shahid Athar, MD, FACP, FACE
Abortion remains a controversial issue, both from religious and secular perspectives. The purpose of this article is to examine the current controversies in ethical aspects of abortion, to include the definition of life, viability of the fetus, concept of Soul or (ruh), the rights of the fetus, mother and father. I will also be examining aspects of conception, including against the will of the mother in cases of rape, incest and war crimes. I will discuss the role of Muslim physicians in these situations.
A warm up case:
A 26 year old woman has had 2 miscarriages. A third pregnancy results in CD 19 deficiency, a fatal condition without any doubt. Bone marrow transplantation is done twice at a cost of $200,000 but the child dies at 8 months. She is now 4 weeks pregnant again and now the question is should she consider
A) abortion
B) amniocentesis first and then abortion if it is positive for the same abnormalities or
C) continue the pregnancy. Most of the physicians who responded to this question chose B for amniocentesis and then abortion if it is positive. However, a small number did opt for A or C.
To recapitulate the goals of Islamic shariah or Islamic laws are
A) protection of life,
B) protection of mind,
C) protection of private ownership and
D) freedom of religion. The principles of Islamic medicine are
A) sanctity of human life as Quran says (5:32) "If anyone who has saved one life, it is as if he has saved the life of all mankind".
B) Seeking cure : from the saying of the Prophet Mohammad "Seek cure, as God has created no disease without a cure except old age".
The rules of Islamic medical ethics are:
1) necessity overrides the prohibition. This means that whatever is prohibited can become permissible in times of need.
An example can be taken that though pork is prohibited for us for consumption but if there is no food available of any sort, in order to save life, taking pork would be permitted as dying of starvation would be suicide which is not acceptable.
2) Accept the lesser of the two harms if both harms can not be avoided.
When a difficult but life saving operation has to be performed , it is possible that the patient may die during that operation, but since there is a greater chance for the patient surviving the operation, the lesser harm, or taking the danger of the operation will be acceptable.
3) Public interest overrides individual interest, i.e. what is good for society is more important that what is good for an individual.
4) Harm has to be avoided at every cost.
An example of this would be cigarette smoking is not mentioned in Quran but since it is an act which causes harm to the body, it becomes prohibited as we are not supposed to harm our bodies.
One of the questions in medical ethics in terms of abortion is , "When does life begin?" The pro-choice movement does not consider the fetus as a living being but as an entity growing inside the mother's body like a vestigial organ. The question "When does life begin?" can be answered:
1) Inception itself is a clear and much defined event in biology.
2) The fetus has signs of growth and the growth will continue unless it is terminated.
3) The genetic code of a fetus is as of a natural organism. Therefore, most ethicists of a religious back ground, believe that life begins at inception.
In the hadith of the 40s, it is mentioned that at 40 days a Nutufa is formed which is a blood clot and at the next 40 days another stage is reached which is called Alaqa and in the next 40days a 3rd stage of development of the fetus which is called Mudagha. Then, the angel is ordered to write the sustenance life span, deed and whether the child's life is happiness or misery and then he blows the spirit into him. In another version, he asks "My Lord ! Is this a male or female?" which means that the gender is decided at that time. There seems to be some controversy about this hadith as some believe it is a weak narration and others believe that life begins at 120 days when the ruh or spirit is blown .
Now, let us examine what happens to the fetus at 3 months. The fetus wakes and sleeps, it digests and has bowel movements and he can breath amniotic fluid, swallow, can make a fist, has fingers and his vital organs are functioning. This is at 90 days. So, from a biological point the fetus is alive at this time, showing all signs of development.
Quran is very clear about infanticide being prohibited. In (17:31) we read "kill not your children for the fear of want, for we shall provide for them as well as for you. The killing of them is a great sin." In (60:12) we read, "The pledge of the believing woman is that they should not kill their children."
Rights of the fetus in Islam
Islam considers the fetus as a living being by giving him his rights. Those rights of the fetus are 1) the right to live, which means if a pregnant woman is condemned to death, the sentence can not be executed until she delivers. 2) The right for inheritance. After the husband's death, if the wife is pregnant then the estate can not be distributed until she delivers. 3) The right to penalize the assailant. If the fetus is injured or dies if the mother is attacked, then the assailant will be penalized or give compensation for the fetal injury. Thus, in Islam, the fetus is considered as a living person.
Opinion of Muslim jurists on abortion
Now, let us consider some opinions of Muslim jurists. Dr. Yousuf Al-Qardawi says "Abortion after the ensoulment of the fetus, is forbidden and is a crime against a living and viable being.
In the Maliki school, abortion is not permitted even during the first 40 days of conception.
However, the Hanafi school says abortion is only permitted to save the life of a nursing infant.
By this it means that abortion would be permitted if the mother has an infant who is nursing and he is dependant on mothers milk and she has become pregnant and then in order to save the life of the nursing infant, and there was no formula milk available, it would have been permissible to abort the child.
On the other hand, the Shafi school says " abortion is a crime both before and after 120 days.
However, the seriousness of the crime is more after 120 days. Imam Ghazali belonged to this school as well as Dr. Hassan Hathout.
The 4th view is that of Hambali school which says " if a pregnant woman drinks a medicine which causes her to abort, she must give the blood wit. That means this is the most serious crime and equal to committing murder.
So, the question may be asked "When is abortion permitted?" According to Dr. Buti, an Islamic scholar, abortion may be permitted before the 4th month of pregnancy in the following cases: 1) If the mother's life is in danger as a result of the pregnancy such as worsening of heart failure in congenital heart disease, 2) If the pregnancy itself causes a disease such as toxemia of the pregnancy. 3) If the new pregnancy causes severe depletion of milk and the existing infant is dependant on the mother's milk. For the question is when abortion may be permitted there is another opinion by scholar Shiekh Nizam Mangera is that abortion can be permitted before 120 days in the following situations
1) Rape
2)
Incest 3) Fetal deformity such as anencephaly and
4) sex with a mentally retarded woman.
In Message International in January 1994 issue, Dr. AM Darsh was asked this question: "Is abortion allowed for a Muslim woman raped by soldiers in the war, such as in Bosnia, if they became pregnant. His response was "Rape is a crime and so is abortion. One crime can not be replaced by committing another crime and most Muslim women, even if abortion was offered during such situations, decided to continue with the pregnancy.
There is another case where a widow with 6 children but no income ( no financial means to support any of the children) is now pregnant with the 7th child. This case came from India. Her 6 children are between age 2-12 and she is 8 weeks pregnant. Her employed husband died suddenly in an accident leaving her with no financial support. She seeks your advice regarding the termination of this 7th pregnancy. We took the opinion of Muslim physicians on this case . 55% said no to abortion, 22% said yes to abortion and 23% said that they were not sure.
The final case I received was via E-mail. This man wrote " my wife is 19 weeks pregnant. We have found that the fetus has large polycystic kidneys and no amniotic fluid around it. All specialists have told us that the kidneys are not functioning and because of the lack of amniotic fluid, the lungs will not develop. The doctors suggest that the pregnancy should be terminated. Otherwise, it may also endanger my wife's life. What is your advice?" We asked Muslim physicians' opinions on this case and 45% said yes to abortion, 22% said no to abortion and 33% again had no opinion. We told the family about the difficulty in arriving at this decision, that all life is sacred, even of an infant with congenital deformity. We told them to make a decision after consulting with each other and the family. They sent us an E-mail saying "thank you very much for your advice. We have decided not to terminate the pregnancy. We found peace and comfort of mind in not intervening in Allah's process of life and death. Please pray that Allah makes this test easy for us."
Concluding Remarks:
One can not make this decision i.e. to abort or not without pondering over all aspects and especially in relation to Quran., Sunnah and opinion of Muslim Jurists first. "It is not befitting for the believers, men or women, to have an option in the matter when Allah and his messengers have decided their affairs for them. Those who disobey Allah and his messengers shall fall into manifest error." ( Quran 33:36). I end this article with a couplet from my friend and mentor Dr. Hassan Hathout , the Islamic ethicist, scholar and poet. "For the wind that blows the sail is the mind
The faith in the heart is the compass to guide
What is the eyesight if heart is blind.
Lo, we all look so good, but what is inside?
Who is right and who is wrong,
Only God will decide."
Dr. Shahid Athar is the former chair Medical Ethics of Islamic Medical Association of North America . His web page is www.islam-usa.com and e mail sathar3624@aol.com
Selected Readings:
1) The Holy Quran: Yusuf Ali translation (Amana corp.)
2) Sahih Al -Bukhari English translation (M.M. Khan)
3) Hassan Hathout, Islamic Perspectives in OB/GYN-1996
4) Hassan Hathout, "Reading the Muslim Mind"- ATP 1994
5) Hassan Hathout " Shall I stand before God "- ATP 2004
6) Shahid Athar, "Islamic Perspectives in Medicine"-ATP-1993
7) Shahid Athar, "Health Concerns for Believers"- KAZI -1995
8) Islamic Code of Medical Ethics- by International organization of Islamic Medicine- Kuwait 1982
9) AFM Ebrahim, Abortion, Birth Control and Surrogate Parenting-ATP 1993
10) AFM Ebrahim , Biomedical issues in Islamic Perspective -Open Press 1993
11) Fazlur Rahman " Health and Medicine- Islamic traditions"- New York 1987
12) AMA Code of Medical Ethics- 1987
13) Tom Peters."Playing God" Routledge 1997
14) FIMA Yearbook 2002 by Federation of Islamic Medical Associations
15) FIMA Yearbook 2003, published by FIMA
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