The medical profession has been characterized since its dawn in history by the tremendous responsibilities its practitioners shoulder: extensive knowledge, proper morals, performance dedication, self-denial, and mercy towards all people without discrimination.
Medical ethics draw their essence from Islamic teachings, which call for honesty, sound performance, and God consciousness in every act. They also accommodate what is commonly recognized as noble characteristics and upright traditions, evolved from local heritage and imparted from other cultures, but not contradicting the laws of Islam.
The regulations governing the practice of the medical profession stipulate that the physician must practice his profession for the benefit of the individual and the community within the framework of respecting man’s right to live, safety and dignity. And, he must observe in his practice the upheld customs and traditions of the country.
The physician has certain obligations towards his community, patients and colleagues.
The Honor of the Medical Profession
Islam has made the preservation and welfare of a human being in second place after the preservation of religion: it forbids killing except by rights; it adjudges reprisal; and it prohibits attempts on others’ lives. The Almighty says: “And if anyone saves a life; it (his act) would be as though he has saved the life of all people.”
The medical profession touches on the human soul, man’s health and life, in order to protect it against what may render it impaired or extinct, while it endeavors to safeguard the human mind against what may render it incompetent and ruined. Therefore, it has become one of the noblest and most honorable professions. Al-Shaf`i, the renowned Muslim scholar and jurist, said: “People cannot dispense with two groups of individuals: the scholars for their (the people’s) religion, and the physicians for their (the people’s) bodies.” Since the physician is committed to the task of preserving human life, then he holds a matchless honor and an incomparable standing. If this is his role and this is his standing, then he must maintain a typical, ethical performance that distinguishes him as a practitioner of one of the most respected and honored professions.
Physician’s Personal Qualities
The physician is usually confided in by a patient, his family, his relatives, and by the community at large. This confidence placed in him by the community and relatives requires him to be sincere in his treatment and counseling. He should, above all, seek to please Allah for his efforts.
The physician is entrusted with the souls and the privacy of others. It is a trust he should hold properly. In describing the believers, Allah the Almighty said: “[they are] Those who faithfully observe their trusts and their convents.” Keeping patients’ information in confidence is a sign of honesty.
The physician must be truthful when he speaks, writes or testifies on any issue. He should guard against kinship or friendship ties, or inclinations of greed or fear that may tempt him to give a testimony, report or speech that he knows is contrary to the truth.
The Messenger of Allah, peace and blessings of Allah be upon him, was asked what the worst thing in the sight of Allah was. He said: “Associating partners with Allah and disobeying one’s parents.” The Prophet kept silent for a while and then said, “And so is presenting a false statement, and so is presenting a false statement.” Narrated by Al-Bukhari and Muslim.
Promise-keeping and being punctual in appointments are signs of truthfulness.
Fourth: Compassion and Sympathy
The physician should be sympathetic with his patient’s feelings and feel pity for his sufferings. Apart from dealing with him gently, he must be courteous and kind to him. When talking to him he should not incorporate anything that may render him weak or helpless. He should note the difference in the patient’s psychological condition and administer the proper techniques that would help relieve his fears.
Fifth: Patience and Tolerance
The medical profession is a demanding profession. It entails dealing with people from all walks of life and it requires exercising a lot of patience and tolerance. These are two qualities a physician must equip himself with. The physician must tolerate patients’ manners and must abstain from reciprocating harm by refusing, for example, to treat a patient or diminish his right to be cared for.
The physician should be modest in his practice. He must not be arrogant or disdainful to his patients, no matter what background they come from. Rather, he should show respect to all of those who deal with him – patients and guardians alike. Such modesty will be met with respect from others. Besides, he who acts modestly for the sake of Allah, Allah will raise him in the eyes of others.
Duties of the Physician
The physician, in safeguarding the public’s interest and through the practice of his profession and the available resources at hand, shall spare no effort to contribute his share in serving the community and realizing the following objectives:
- To practice the profession to the highest possible level of knowledge, expertise, truthfulness and honesty. To keep abreast of advances made in his specialization.
- To care for community health through proper health education.
- To contribute in improving the health services that are provided to the community in his place of work or by other health institutions.
- To contribute, whenever possible, in studying health problems in the community, and to propose the relevant proper solutions, for example smoking, drug addiction, road traffic accidents, and infectious diseases.
- To actively participate in medical research and surveys that yield benefit to the community.
- To be committed in cooperating with the authorities entrusted with the task of health, and safeguarding and notifying them of communicable diseases or epidemics.
Duties of the Physician Towards Patients
The physician is expected to fulfill, skillfully and proficiently, the necessary medical service to his patients via the following:
- Being a good listener to a patient’s complaints and understanding his suffering.
- Avoidance of arrogance or contempt towards the patient or dealing with him as an object of ridicule or mockery, whatever his educational or social background may be.
- Respecting the patient’s views and in particular views that touch him personally. This respect should not dissuade the physician from advising the patient on his disease.
- Treating the patient equally without any discrimination on grounds of their difference in social position, rank, or personal feelings towards him.
- Examining the patient gently, observing the “patient undressing code”, and limiting the examination to the necessary parts of the body to reach a proper diagnosis. (Necessity is measured by its extent.)
- Requesting only the needed investigation without adding additional tests not warranted by the patient’s condition.
- Restricting the prescription of medication, or surgically operating on him, to what the patient’s condition warrants.
- Abstaining from any practices that may harm the patient such as the utilization of scientifically unrecognized diagnostic or therapeutic procedures.
- Striving to be open and truthful in advising the patient or his trustee of the illness, its causes, complications, benefits of the diagnostic and therapeutic procedure, and explaining to him clearly the available alternative diagnostic and therapeutic approaches.
- Resorting to his humane judgement in deciding the merit of either telling a terminally ill patient of the whole or partial truth about his prognosis and complications; or only telling patient’s next of kin if he finds it is in the patient’s best interest.
- Exerting utmost care in writing medical reports that serve the right purpose. He should neither exaggerate nor diminish the problem.
- Abstaining from committing infringements of religious rules, such as staying alone with a woman behind closed doors or inspecting the genitalia and such like alone under the pretext of doctor-patient relationship.
- Referring the patient to another physician who can provide specialized treatment, if he is unable to provide it. The physician should not hesitate to refer the patient to another physician if his condition demands so.
- Furnishing the necessary information needed for the treatment of the patient when he refers him to another physician.
- Helping the patient in obtaining the necessary reports and information, should the patient seek the opinion of another physician in respect of his illness.
- Allowing the patient to consult an alternative physician and to have information in his file or a detailed medical report explaining his medical condition.
- Prescribing continuous, quality medical care to patients with terminal or incurable diseases until the last moments in their lives.
- Ensuring that the patient receives the necessary medical care even during his absence, and extending the necessary treatment to the patient in emergency conditions till he is relieved or the care is transferred to another qualified physician.
- Reporting any practice, which conflicts with the law or the ethics of the profession once he becomes certain of its occurrence.
Keeping a Patient’s History Confidential and Protecting it
Islam has commanded to keep secret and not disclose any wrong doing as long as it will not lead to mischief in society. Knowing a patient’s secrets does not entitle the physician to divulge or hint at them in any way that exposes those secrets except in the following situations.
- If disclosure to the patient’s relatives or others is beneficial to the patient’s treatment or to those who come into contact with him, in order to protect them from e.g., infectious diseases or drug addiction. In this case disclosure should be limited to those who may be harmed or should know the patient’s condition.
- If disclosure will benefit society or remove any harm. Disclosure of data can be communicated to the authorities concerned and in instances such as:
- Notification of death resulting from criminal act, or for preventing a possible act of crime.
- Notification of communicable or contagious diseases.
- Refutation of an allegation raised against the physician by the patient or his relatives, smearing his proficiency and the way he practices medicine. Disclosure shall take place only before the authorities concerned.
- Responding to a court order.
- Sufficing educational needs and only within the necessary limits.
The physician must obtain consent from the patient he is treating. Consent may assume the following forms:
- Consent of a patient of legal age (male or female) or his agent – if the patient’s will is passive – shall be obtained prior to any surgical or medical procedure and in accordance with the health authority concerned.
- Woman’s consent:
A woman of legal age may give her consent to have any medical procedure done to her including a surgical procedure. Consent of the husband regarding reproductive issue should be obtained.
- Consent of an incompetent person:
Consent from the legal guardian of a patient who cannot give his consent because he is either unconscious, a minor, or mentally incompetent must be obtained; otherwise, consent must be obtained through government.
- Consent in emergency situations:
If the patient’s life is in imminent danger, the physician may carry out a medical or surgical procedure without waiting to obtain his permission if it is established by him that this procedure will save the patient’s life or remove the hazard, provided that the observed rules are adhered to.
Apology to Patient for not Treating Him
A physician, in non-emergency situations, may abstain from treating a patient for personal or professional reasons provided that such abstinence will not harm the patient’s health and an alternative physician is available.
The Physician and his Professional Colleagues
The relationship of the physician and other members of the medical and paramedical practitioners shall be based on brotherhood, co-operation and mutual respect. The physician must refrain from scoring, belittling or undermining other colleagues’ abilities, scientific, or experience with the aim of luring patients away from his colleagues.
The physician should look upon other physicians and medical colleagues as members of a brotherhood working together for a noble goal. In fact, they are working together with their varied medical specialties for the welfare of community health. Some members of this team work out the preventive aspects of medical practice, while others engage in the active management of diseases, but both contribute to the patients’ wellbeing.
Therefore a physician shall observe the following:
- Good behavior with other colleagues and treating them the way he likes to be treated.
- Refraining from malicious acts against his colleagues, backbiting or following their pitfalls.
- Avoiding direct criticism of his colleagues, especially in the presence of their patients in order to convince the patients to change their physician, or out of sheer envy. Constructive scientific criticism shall be kept strictly within scientific meetings, conferences and periodicals.
- Due efforts shall be paid to aspects of training and educating his medical team.
- Care shall be exercised to benefit them with his experience, knowledge and skills. Moreover, they should be given ample chance to learn and enhance their skills.
Continuing Medical Education
The constant change in medical knowledge makes it incumbent upon the physician to continue learning throughout his life. This is an individual responsibility requiring him to acquaint himself with recent advances made in medicine in general, and those pertinent to his specialty in particular. He should not lose any chance to increase his knowledge because his competence in treating patients is affected by his diligence, literacy or ignorance.
He should realize that learning, in addition to its value when employing it in diagnosis and treatment, is in itself a supplication and a tangible implementation of the Glorious Qur’anic guidance revealed by Allah the Almighty in his saying: “And say, O’ My Lord, increase my knowledge.”
Conducting Research and Studies on Human Subjects
It is not permissible to conduct medical studies on a human subject, honored by Allah the Almighty, unless certain strict conditions are met:
- Conducting such studies should not entail any harm on man’s life, health, or sexual reproduction.
- Informed consent should be obtained from the subject and he must be made fully aware of consequences and the possible harm, if any, that may affect him.
- The subject should be legally competent, i.e. an adult of statutory age and sane in mind. Consent of legal guardian of a legally incompetent person should be obtained.
- It is totally unallowable to resort to pressure, force, or exploitation of one’s need for money or medication when obtaining the consent to carry out a study.
- Permission must be obtained from the designated authority trusted with research and experiments in the institution where he works.
Conducting Research and Experiments on Animals
Islam has commanded kindness to animals. It is reported that the Prophet, peace and blessings of Allah be upon him, said: “A woman is taken to Hell because she locked up a cat: she neither fed it nor left it to eat what sustenance it might find on the ground.”
The Prophet, peace and blessings of Allah upon him, said: “Allah has demanded skillful accomplishment in everything: when you kill, kill skillfully; and when you slaughter, slaughter skillfully; [Should you do it] sharpen your blade and soothe your kill.”
In view of this, conducting experiments on animals should:
- Be validated by a noble objective that contributes to medical advances.
- Not cause any torture to the animal and the pain should be alleviated whenever possible.
- Not to be carried out aimlessly.
- Permission to perform experiments on animals must be obtained from the designated authority in the institution where he works
Dr. Hossam Arafa