A COMPARATIVE PERSPECTIVE
OF BIO-ETHICS:
CATHOLIC, PROTESTANT, MUSLIM VIEWSUCH, Ibadan, 18 February 1997
by
Joseph Kenny, O.P.
(with the help of Benedict Faneye, O.P.)Two Nigerians passed each other in the Bodija market. They hardly looked at one another, and passed no greeting. Two Nigerians came across each other on a street in Ames, Iowa. Recognizing what country they came from, they beamed, shouted and threw their arms around one another. If Catholics, Protestants and Muslims are conscious how foreign the world of medical ethical thought is from their own religious traditions, they would throw throw their arms around one another and try to share what they have in common.
The underlying attitude in all our religious traditions, when it comes to medical ethics, is respect for the sacredness of life. I will first show how this is reflected in the Old Testament, New Testament, the Qur'ân and Islamic tradition. Then I will look briefly at certain issues that test and manifest the different approaches or methodologies of these religious traditions, and finally analyse and compare these methodologies themselves, looking for possibilites of combining certain perspectives.
Respect for life
The Old Testament
The first chapters of Genesis set the tone that prevails throughout the Old Testament. Man is made in the image and likeness of God (1:27). The drama of Cain killing Abel (chapter 4; cf. Job 16:18) points not only to God's concern for the innocent, but also for the guilty Cain. And Abel's blood crying to God from the earth announces the sacredness of life focused in its primary symbol, blood (Cf. Gen 9:6). Violating the sacredness of life entails the death penalty (Ex 21:12 ff.; Num 35:16 ff.). Shedding the blood of animals in sacrifice was a symbolic expression of the covenant submission and consecration of human life to God (Lev 1; Ex 24), we could say an expression of islâm in the fundamental meaning of the word.
The New Testament
The Old Testament is so emphatic about the sacredness of life that one would think nothing could be added. Yet the New Testament introduces a radically new perspective. The symbolic covenant consecration of human life in the Old Testament gives way to a new covenantal relationship in which human life is really received by God and allowed to share in his own life. This is primarily realized in the incarnation of the Word of God (John 1); it is extended to all humanity who, by faith and sacraments, are made brothers of Christ (Heb 2:11) and members of his body (1 Cor 12:12 ff.).
In a concrete way this relationship of men to God and to one another is manifested in a law of love which is both more emphatic than the Old Testament (Rom 13:8-10; Jn 13:34-35; 15:9-17) and more demanding in its moral applications, as shown in the Semon on the Mount (Mt 5-7).
The Qur'ân and Islamic tradition
Islamic ethics is founded on God's initiative in creating men and guiding them, particularly through prophets. Man's response is meant to be one of submission, or islâm. This is expressed fundamentally by faith in God and his revelation, then by obedience to God's law. Regarding respect for life, we can note particularly the following passages:
Do not kill your children from fear of poverty; we provide for them and you; killing them is a big sin (17:31; 6:151).
Do no kill unlawfully those whose lives God has made sacred, but if someone is killed unjustly we give his representative power [to revenge] but he should not be excessive in killing; he will certainly be helped" (17:33; cf. 6:151, 25:68, 18:74).
It is out of the question for a believer to kill another believer unless in error (6:92).
If two parties of the believers fight, reconcile them. If one side attacks the other, fight the aggressor until he submits to the order of God; if he submits, reconcile the two according to justice and treat them justly (49:9).
We prescribed for them [the Jews] a life for a life, an eye for an eye, a nose for a nose, an ear for an ear, a tooth for a tooth, and that wounds are to be requited in kind; but whoever makes an alms of this right will have atonement for his own [sins] (5:45; cf. 6:178,194; 42:40-41; 22:39; 16:126; 22:60; 2:263; 28:54; 41:34).
Some issues that manifest different approaches
Transfusions/transplants
Although most Christians have no problem with both transfusions and organ transplants, a few groups, like Seventh-Day Adventists, refuse blood transfusions, on the basis of certain Old Testament passages that stress the sacredness of blood. Muslims do not seem to have any practical problem about this, although contact with blood constitutes a ritual impurity requiring ablution before alât, just like contact with excrement.
Abortion and artificial birth control
In the area of propagation of life we find the greatest discrepancies. The Catholic Church and the Southern Baptist Convention are the greatest opponents to abortion and artificial interference with the conception process, stressing chastity in place of condoms and the like. The Catholic Church does consider the dilemma of saving the life of the mother or of the child, and requires the application of very precise principles governing a procedure that has a double effect.
Most Protestant churches or individuals, although opposed to indiscriminate abortion, are swayed by hard-luck cases, such as rape or danger to the mother's life to justify abortion and the use of contraceptive devices.
For Islam, the Qur'ânic condemnation of killing children is generally understood as applying to abortion as well. The following is a typical statement:
The physician has no right to terminate any human life under his care. This also applies to the unborn baby, since clear evidence indicates that human life starts at the time of conception. Consequently, the physician has no right to terminate the life of the unborn baby unless it constitutes a definite threat to the mother's life. (1)
Muslims also are commonly opposed to contraception, on the basis of the adîth condemnation of coitus interruptus, (2) but, with the same imprecision that allows abortion in exceptional cases, some Muslims are yielding to Planned Parenthood propaganda to support artificial contraception.
Euthanasia
It seems that the only religious people to support euthanasia under limited circumstances is the liberal wing of Protestants, along with a few Catholics rebelling against Church teaching.
The foundation of ethical positions in these religious traditions
Catholicism
The Natural Law tradition has provided the framework with which the Catholic Church has approached issues or problems in the bioethics field. This Natural Law theory provides a very strong meta-ethical basis for the Catholic biomedical ethics. This theory can be explained as meaning that there is a natural end to things following their own individual nature. Besides this role of the Natural Law theory in Roman Catholic biomedical ethics, there is also the teaching authority of the Church known as the Magisterium. This teaching authority is based on both Scripture and Tradition, reason and revelation. The entire Catholic Church recognizes this authority as divinely inspired. Besides this theory of authority, there is also a theory of knowledge, one which identifies God as the one source of all things and also the one point of reference. This provides a unified source of reference in time of disputes. This is also a source of dissension as the history of the Catholic Church has proved to us within the last 30 years. (3)
Protestantism
Protestantism simply rejects outright the "legalism" and the "authoritarianism" of the Catholic position on biomedical ethics. As Luther rejected the authority of the Papacy, so some Protestant opinions have rejected the notion that either the physician or the priest should have an authority over patients. This means that each person, or each patient, should have the freedom to be the sole decision-maker as to what happens with him/her. One of the people in this school is Joseph Fletcher.
Protestant thought is not as systematic and organized as Catholic tradition with regard to a theory of authority or a theory of knowledge. Protestantism rejects the Natural Law doctrine in its approach to medical ethics. However, there is still a conservative position within the Protestant circle, and this is well represented by Paul Ramsey. (4)
Paul Ramsey presents the ethic of covenant fidelity. For him, ethics is a matter of series of covenant relationships, and fidelity is important in these relationships. An example of his covenant fidelity is respect for individual autonomy. Another example of the covenant fidelity is equity, a principle of justice.
This conservative position of Paul Ramsey makes him very close to some Catholic religious ethicists such as André Hellegers (founder and first director of Kennedy Institute of Ethics, Wash, D.C.).
Islam
Before considering Islamic medical ethics, we should examine the question sometimes raised whether Islam is in favour of medicine at all. The reason for this question is the fatalism of many adherents, particularly the uneducated, who prefer either prayer, talismans or traditional medicine.
Yet, in the 12th and 13th centuries, when philosophy and the human sciences were under attack by the Muslim theologians, medicine was always respected and allowed to flourish. For centuries Ibn-Sînâ's medical treatises were the basic medical texts in both the Islamic world and Europe. Much of what passes for traditional medicine in northern Nigeria is really from Ibn-Sînâ, excerpts of whose works still circulate. Apart from this, Muslims have entered the modern medical field with full force and are taking the lead in many areas, so that the question of Islamic medical ethics is very relevant.
The fundamental characteristic of Islamic ethics is that revelation only, and not natural law or any human legislation, determines what is right and wrong. Anything short of this position is taken as tantamount to idolatry, since it is placing another authority alongside that of God.
Therefore Muslims will first search the Qur'ân and the adîth to find any pronouncements regarding medical ethics. Since both of these are very scanty about medical questions, Muslim jurists are forced to resort to the principles of analogy (qiyâs) to come to a conclusion on contemporary questions; such conclusions have authority only on the basis of another principle, that of consensus. But, since consensus is not easy to obtain or to determine, Muslims are mostly left with private opinions and common traditional practice to guide them in many ethical decisions.
In the article on Islamic medical ethics cited above, the authors adopt a series of stances, reflecting the Oath of the Muslim Physician, adopted by the Islamic Medical Association in 1977. Each rule is based on a Qur'ânic text, as the following exemplify:
The professional requirement of a physician is to acquire and maintain proper knowledge:
Verily, those who fear God among His servants are those who have knowledge (35:28).
The physician may not terminate the life of a patient or of the unborn baby:
Whoever kills a human being in lieu of another human being nor because of mischief on earth, it is as if he has killed all mankind, and whoever saves the life of a human being, it is as if he has saved the life of all mankind (5:32).
The physician has no right to recommend or administer any harmful material to his patients:
And he makes for thme good things lawful, and bad things forbidden (7:157).
The physician must render the needed help regardless of the financial ability or ethnic origin of the patient:
And they feed, for the love of God, the indigent, the orphan and the captive, saying "We feed you for the sake of God alone; no reward do we desire from you, nor thanks" (76:8-9).
The physician must protect the patient's confidentiality:
Those who faithfully keep their trusts and covenants... (23:8).
It is advisable that the physician examine patients of the opposite sex in the presence of a third person whenever feasible:
Say to the believing men that they should lower their gaze and guard their modesty; that will make for greater purity for them, for God is well acquainted with all that they do. And say to the believing women that they should lower their gaze and guard their modesty (24:30-31}
The physician must not criticize another physician in the presence of patients or health personnel:
O you who believe, let not some men among you make fun of others; it may be that they are better than them; nor let some women make fun of others; it may be that they are better than them; do not defame, nor be sarcastic to each other, nor call each other by offensive nicknames (49:11)
This presentation of Islamic ethics shows both the overt and the underlying methodology of the authors. The overt method is to derive each rule from a Qur'ânic text. Yet the conclusions go beyond the immediate meaning of the texts cited. We cannot accuse the authors of eisegesis, or reading meaning into the Qur'ân that is not there. Rather, the underlying method of the authors is to take these texts as they have been understood in an evolving consensus over the centuries.
This evolution has mainly been based on an intra-Islamic dialectic, but has not been closed to outside thought. Muslim ethicists have guarded authentic values and have not been afraid to defy the politically correct thinking of the secular establishment on many ethical issues. Yet in issues of common agreement they do not hesitate to utilize the vocabulary of ethical norms prevalent outside Islam.
Conclusion
I think each religious tradition reviewed above has its specific contribution to bioethics, and a judicious synthesis of the three could produce a working consensus and guidelines for a pluralistic society.
Islam is to be commended for its uncompromising fidelity to divine commands to respect life. Protestantism is to be commended for its sensitivity to the concrete human situation and the variables of each case. Catholicism is to be commended for its investigation of bioethical problems both with consideration of revelation and with a deep philosophical analysis that provides principles for making practical decisions.
1. Abdul Rahman, C. Amine, and Ahmed Elkadi, Islamic Code of Medical Professional Ethics, presented to the First International Conference on Islamic Medicine Celebrating the Advent of the Fifteenth Century Hijri (Kuwait: Ministry of Health, 1981), printed in Cross cultural perspectives in medical ethics: readings (Kuwait), p. 120-125.
2. Bukhârî, Sahîh, Kitâb an-nikâh, Bâb al-`azl (62:97).
3. Some of the more important Papal and other Roman documents on bioethics are:
—Congregation for the Doctrine of the Faith, Declaration on Procured Abortion (1974}
—Congregation for the Doctrine of the Faith, Declaration on Euthanasia (1980}
—Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in its origin and on the Dignity of Procreation: Replies to Certain Questions of the Day (Donum Vitae), 1987.
—Pope Paul VI, Encyclical Letter, On the Regulation of Birth (Humanae Vitae), 1968.
—Pope John Paul II, Apostolic Letter, On the Christian Meaning of Human Suffering (Salvifici Doloris), 1984.
Besides, Charles E. Curran's "Roman Catholicism", in the Encyclopedia of Bioethics, Second Edition. Edited by Warren T. Reich (New York: Macmillan, Vol. 4, 1995), pp. 2321-2331, is a very good detailed summary of the Catholic position on bioethics.4. Paul Ramsey, The Patient as Person (New Haven: Yale University Press, 1970). For other Protestant postions see Allen Verhey, "Protestantism", in the Encyclopedia of Bioethics, Second Edition, Edited by Warren T. Reich (New York: Macmillan, Vol.4, 1995), pp. 2117-2126.