Medical Examination of the other sex

Medical Examination of the other sex

Since the early battles of the muslim army under the leadership of prophet Muhammad (P.B.U.H.) the medical corps consisted of a group of muslim ladies with special training in therapy and nursing. They were called the “asiyat” or lady healers, whose duty it was to carry the wounded and attend to their treatment. They usually had one or more tents at the margin of the battlefield, probably the prototype of what later became the field hospital. The site of the wound on the body never paused a problem or raised an objection to carrying out their medical duty. It was thus established since the days of Badr and Uhud battle that the general rules governing the concealment of body parts to inspection by others were waived for the purpose of medical treatment, this situation being an exception from the general rule. Some of those lady healers excelled in their work, and one in particular, Nussaiba Bint Kaab, gave away her nursing gear at a critical moment during the battle of Uhud and took up sword and sheild,actually participating in the fighting in defence of the prophet, who later on acknowledged her deed in gratitude. We mention this, by the way, to emphasise the positive role of woman in Islam and the wide spectrum it can cover when necessity arises.

Medical treatment entailing the inspection of the body of the opposite sex is therefore legitimate. Jurists over the ages have acknowledged that religiously concealable body parts of both men and women should be concealed from both men and women, a statute which is waived only for the purpose of medical treatment.

Certain circles emphasise their reserve in the field of Gynaecology and Obstertics in particular. A deeper than cursory look at both medical practice and Islamic jurispru- dence should, however, alleviate their anxieties. In other medical specialities it is quite often the practice to examine normally unexposable body parts. The physician, chest specialist dermatologist, neurologist etc have to examine the body in toto. The surgeon might palpate the breasts to diagnose or exclude cancer. A haemorhoid operation also uncovers the same site of Gynaecologic procedures and yet the cry has not arisen against the male surgical colleague.

A basic truth seems to escape the comprehension of the critics. In medical practice the human body ceases to exhibit its artistic or emotional role as an object of seductive temptation. What a doctor sees in his patient is a system of integrated and interrelated structure and function. He checks it as the mechanic checks a machine, and tries to locate what went wrong and why. Doctors have undergone a process of professionalisation which a nonmedical person might not comprehend but should not deny. Exceptions are rare and are abnormal, and are minimized still by the rules of medical ethics that make the presence of a third party ( eg nurse ) mandatory when a doctor examines a patient of the opposite sex.

Over the ages muslim jurists have always adopted this enlightened opinion; centuries ago they stated legal opinions that remain to the present day a model of broad mindedness, progressiveness and maturity in both Islamic emotion and Islamic mind. In his book ” AI-Mughni” written in the eighth hijri century , Ibn Qudama, an authority in the Hanbali sect wrote: “it is permissible for the man doctor to inspect whatever parts of her body that the medical examination warrants for this is considered a necessity”. AI-Adab Al-Shariyaa written by Ibn Muflih- also of the Hanbali sect relates an interesting account: “Marwathi asked Abu Abdul- lab about a woman who had incurred a fracture and the bone-setter found it necessary to lay his hands on her to manipulate the fracture. The answer was a clear consent since that was a medical necessity. So he went a step further and told that the bone-setter who wanted to apply a splint, wanted to expose her chest and lay his hands over it during the treatment, and again the answer was a straight forward 
permission ” .

The same page in the same book gives the clear statement: ” A man doctor may inspect the religiously coverable parts of a woman’s body that medical examination warrants, as long as none else but a man is available to treat her, even if he has to look at her genital area. The same is true if a man is ill and only a woman doctor is available, she may inspect his body, even the genital parts”. The same was re-iterated by judge Abu Yaala of the Hanbali and Ibn Abdine of the Hanafi sects.

In the modem resurgence of Islam, some hard-liners feel uneasy, and seem to linger too much at phrases like “only if necessary” or “if (\)nly a male doctor is available” and similAr expressions. Recently, a member of parliament in a middle eastern country expressed disquiet at male doctors practising obstetrics, and officially made the plea that only women doctors should conduct deliveries, recruiting the help of the man doctor only when the situation became sufficiently necessary ..”compelling necessity” , to use his own terminol- ogy. Whatever his feelings that formulated his point of view, we do respect them even if we do not concur with them. .but since the claimant based his case on the “teachings of Islam”, we find it inevitable to disagree. A more than cursory study of Islam, and a more serious knowledge about medical practice, should easily alleviate anxieties and cool down that religious emotionalism.

As a matter of fact the general rule in Islam is that the “awra” (part of the body that should not be exposed to others) of a woman is forbidden to be looked at not only by men but by women as well. Even a woman doctor specializ- ing in Gynaecology and Obstetrics would examine and attend her patients not on account of free access but by way of permissible exception on account of the “necessity” status of medical practice.

There is indeed unanimity, including even the ultraradical, that society should have doctors of both sexes, whatever the duties assigned to each of them may be. It does not take much thinking to know that in the preparation of the young man or the young woman to be a doctor, it is imperative for both to inspect the body of the opposite sex. If we delete the male body from the curriculum of female medical students it will not be possible to make lady doctors out of them. ..and similarly it will not be possible to make male doctors if we delete the study of the female body from the curriculum of male students. The nature of medical studies is incompatible with this idea. The making of a doctor starts with the making of the generalist. ..later specialization entails going in depth in a certain discipline with full awareness of relations and interactions with other body functions and systems… otherwise specialization would be reduced to something like peeping through the key hole and shamming a fruitful description of the scene: We would like at this conjunction to reassure many a restless man or woman “ultra-religious” medical student that it is not against religion to pursue medical knowledge as currently presented to them, even if it entails examination of opposite sex, be this in the dissecting room or at the bed side. To prepare doctors of both sexes is a religious duty upon society (Fardh-Kifaya : a duty that some members of society can take over in lieu of the whole). It is the religious dictum that a prerequisite of a religious necessity becomes in itself a “religious necessity”.

And now for a second look at the view that singles out the work of men doctors in gynaecology and obstetrics as a target for assault. We think it would have been more logic if such critics raised the slogan of “male doctors for male patients and female doctors for females”… in all disciplines of medicine, since “exposure” is not confined to the discipline of gynaecology and obstetrics as we already pointed out. Would this be a practical suggestion?

Would it be possible to permit the inspection of the body of the opposite sex only during undergraduate teaching, and after graduation assign doctors to treat patients of their own sex both in general practice as well as in the various medical specialities? Obviously not. Women constitute half the society while women doctors fall too short of constituting half the medical manpower. This appleis in general practice and is even more manifest in the specialities. Some speciali- ties are noticeably shunned by women doctors such as surgery and -we confidently say -gynaecology and obstetrics, which the majority of woman doctors find quite taxing to their faminine nature and to their roles as wives and mothers. Obstetrics in particular is amongst -if not the – most taxing specialities, paying no heed to day or night, incompatible with postponement or temporization, calling for taking serious decisions and promptly executing them at a few moments notice or else mother or baby are jeopardised. Women gynaecologist- obstetricians who attain excellence in this field are only few. .and they certainly pay a sacrifice as ladies, wives and mothers for the sake of their specialist career. Inspired by superficial considerations many persons believe that the natural scope for a woman doctor to specialize in is obstetrics. .both a deeper look and statistics denote the reverse, which to medical practictioners is not surprising at all.

The overzealous would – step back and request that a called to attend a woman – ;necessity” arises and serio parturient or her fetus. which unwillingly -however take amale doctor should only be say in labour -only when us complications threat the then furnishes the recognized ;necessity; old jurists wrote about. It would not upset their religious conscience then to invite the male master specialist who has enough knowledge, experience and skill to deal with the critical situation. But! is this kind of doctor, however , born endowed with all these properties? Can a doctor ever get trained to cope with the difficult without, at the beginning, mastering the easy, then the more and more difficult until experience adds up and more accumen and skill are attained through a gradual and cumulative process of continual education and maturation?! Can a climber reach the top of the mountain without painfully scaling the foot and the side? Since this is the only way to prepare the top man. . and since the preparation of top specialists is a necessity. . and acknowledging that prerequisites of religious necessities become themselves religious “necessities”, the Islamic ruling over this issue is too obvious.

Before concluding, we would like to refer to the occasional woman patient who expresses her desire to be examined by a woman doctor. We believe every effort should be made to satisfy her wish. .not because it is religiously forbidden to be examined by a man, but because we owe it to our patients to respect their personal beliefs and cater for their psychological comfort. If a woman doctor is not available at the time, a later appointment should be arranged. .and if the condition is urgent it should be adequately and convincingly exaplined to her that the urgency of the situation makes it religiously allright to be treated by a male doctor.

As a closing remark, we should like to point out to our readers that this chapter is not a superfluous as it seems to many eyes to be. In the current wave of Islamic revival we have encountered some militants both amongst our medical students and amongst the laity. It is hoped that these pages have successfully revealed Islamic ruling on this topic, alleviated unnecessary anxieties and relieved many a fellow muslim from burdens that God never meant to impose on them. It is a humble guiding contribution lest we subtly drift from the spaciousness of Islam to the tightness of fanaticism.


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