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Journal for the Study of Religions and Ideologies, vol. 17, issue 49 (Spring 2018): 46-59.
ISSN: 1583-0039 © SACRI
FOROUZAN AKRAMI
•
ABBAS KARIMI
MAHMOUD ABBASI
•
AKBAR SHAHRIVARI
ADAPTING THE PRINCIPLES OF BIOMEDICAL ETHICS TO ISLAMIC
PRINCIPLES AND VALUES IN THE CONTEXT OF
PUBLIC HEALTH POLICY
Abstract: Public health ethics is a subfield of bioethics that focuses on population health.
This study aims to conform the principles of biomedical ethics to Islamic values in the
context of public health. It culturally helps to optimize health care delivery. The approach
is based on the method of immanent critique. The principle of the common good in Islam
has a rational justification to draw public interests and ward off harms. The rule of “no
harm”, with an emphasis on the preferability of preventing harm to increase benefits, is
consistent with the principle of utility, intending to produce a maximum balance of benefit
over harm in the context of public health. Thus, on the one hand, the government is
obliged to prevent harm and improve public benefits and, on the other hand, as a steward
of health and with reference to the article “limitation of the ownership dominance”, it has
the right to protect public health with the least justifiable harm. Islam attention to human
dignity, individual justice and good will in the rule of goodness implies that Islam, beyond
distributive justice, knows that human flourishing and the cultivation of moral virtues are
a requisite for the realization of social justice. The present study discusses about the
adjustment of the principles of PHE to the principles of the Islamic jurisprudence and, at
the same time, it explains why the optimal PH in Muslim societies requires research in
order to define accurate indicators of benefit and harm based on the teachings of
revelation and reason.
Key words: public health, ethics, common good, utility, justice, Islam
Forouzan Akrami
Shahid Beheshti University of Medical Sciences, Medical Ethics and Law Research
Center, Tehran, Iran.
Email: froozan_akrami@yahoo.com
Abbas Karimi
University of Tehran, Faculty of Law and Political Science, Tehran, Iran.
Email: abkarimi@ut.ac.ir
Mahmoud Abbasi
Shahid Beheshti University of Medical Sciences, Medical Ethics and Law Research
Center, Tehran, Iran
Email: dr.abbasi@sbmu.ac.ir
Akbar Shahrivari
Shahid Beheshti University of Medical Sciences, Medical Ethics and Law Research
Center, Tehran, Iran
Email: shahrivari.akbar@yahoo.com
Forouzan Akrami et al. Adapting the principles of biomedical ethics
Journal for the Study of Religions and Ideologies, vol. 17, issue 49 (Spring 2018) 47
1. Introduction
Public health ethics (PHE) is a new field of bioethics that focuses on
population health. Some public health interventions are counted as a
threat to individual autonomy, privacy and confidentiality. As a political
responsibility, at a minimum, the government commits to protect
population health, which requires collective effort and cannot be achieved
with an individual acting alone. PHE connects overlapping fields of
political, moral and social philosophy. This general philosophy provides a
moral basis and identifies a set of limitations in the laws, policies and
practices of health systems. PHE as a normative discipline can provide a
framework for exploring the fundamental moral values which define the
relationships and duties of personal, governmental and social institutions
in the realm of public health (PH). It can also provide some ways in which
to solve conflicts occurring among moral values (Childress 2015, 5).
Various moral theories can give a different shape to the PHE framework.
For example, in consequentialist theories, policy or action that will result
in the best outcomes is morally right; in utilitarianism – a widely used
theory in health policy, the only value is to maximize the utility (Childress
and Bernheim 2015, 23).
In the Islamic tradition, the laws and principles are derived from a
divine source and are specified in the sharia. Thus, the foundations of
ethics cannot be separated from religion. With the revival of the
revelation-based rational thought, a trans-cultural system can be created
to assist human in the assessment of bioethical problems. This study
intends to adapt the principles of bioethics to the Islamic principles and
values in the context of public health. It thus tries to elucidate if the
application of the principles of PHE is an appropriate system or approach
to be used in a Muslim community. It culturally helps to optimize health
care delivery.
1.1. Methods
The present study uses the method of immanent critique. Therefore,
it not only attempts to place the research issue in its proper context but it
also examines its epistemic base. This technique has a theoretical-
operational approach that puts the relevant norms in practice (Stahl Titus
2013, 7).
1.2. Foundations
The basis of this study is a common moral language between Islamic
and secular ethics. According to epistemological foundations, the main
foundations of secularism are rationalism, scientism, and humanism
Forouzan Akrami et al. Adapting the principles of biomedical ethics
Journal for the Study of Religions and Ideologies, vol. 17, issue 49 (Spring 2018) 48
(Aderyani and Kiani 2015, 37). Human dignity is an intrinsic quality and
the foundation of the Universal Declaration of Human Rights that explains
the purely secular character of the Universal Declaration (Hughes 2011, 1).
This fundamental value emphasizes that human beings, regardless of their
external features such as color, race, language, social class, religion,
nationality etc., should be respected. God expresses his preference for the
human being over other creatures in the Qur’an as follows: “Indeed, we
have honored the children of Adam and carried forth them on land and
sea and we provided them a variety of good things and preferred them on
many creatures”.
Islam, as a rich scholarly tradition, has its own set of principles that
can be successfully utilized. The principles of Islamic jurisprudence (Uṣul
al fiqh) is a set of principles by means of which Muslim jurists deduce legal
rules from the foundational sources of Islamic law, Qur’an and the hadith
(the sayings of the Islam Prophet). Moreover, the jurists utilize the
consensus of the Muslim scholars for making a decision regarding a
particular issue (Ijma) and analogical reasoning (Qiyas) by Sunni Muslims
or reason (Aql) by Shiite Muslims (Mustafa 2013, 479). Thus, the present
study examines the conformity of the principles and norms of Islamic
jurisprudence with the principles and norms of PHE.
2. Public health as a common good
Generally, health policy-makers think about public health as a public
good and the first consideration is benefit produced in conjunction with
other connected moral considerations including avoidance, prevention
and elimination of harm, and the maximum balance of benefits against the
program burdens (Childress and Bernheim 2015, 9; Abbasi et al. 2017). This
is why we first focus on the issue of the common good.
The objectives and interventions of the public health practice mainly
relate to the ethical principles of beneficence, non-maleficence, and
justice (Childress et al. 2002, 172). Public health is an important public
interest that should be pursued by governments and communities. It is an
intrinsic and instrumental social interest in a community. Therefore,
public health is placed under the broad norm of beneficence (Childress
and Bernheim 2015, 5). The prominent feature of the practice of public
health is its focus on population health, whereas medical ethics focuses on
the principle of respect for autonomy with a liberal basis (Faden and
Shebaya 2016). Daniel Callahan comments on the individual good and the
common good as follows: “Communitarianism, as an alternative ideology
that focused more on the common good and the public interest than on
autonomy, was a neglected approach. But many bioethical issues cannot
reasonably be reduced to questions of individualism and choice only.
Serious ethical analysis must take the social implications seriously and not
Forouzan Akrami et al. Adapting the principles of biomedical ethics
Journal for the Study of Religions and Ideologies, vol. 17, issue 49 (Spring 2018) 49
simply assume that they should be left to the autonomous choices of
individuals” (Callahan 2003, 496).
In the area of policy-making, the discussion of the allocation of
resources focuses on community health and the common good. Thus,
public policies should be based on the common agreement on the good
community, rather than individual rights. We should abandon the liberal
assumptions about the neutrality of the state and the society must be
allowed to implement the fundamental conception of the good.
Biomedical ethics needs to use community-oriented values to implement
social rules and regulations governing health promotion, the use of
genetic knowledge, and the application of modern advances in medical
technology, health care responsibility for future generations and health
care restrictions for the elderly (Beauchamp and Childress 2009, 258). PH,
like any other professional and political institutions, spreads tradition that
requests participants to foster certain virtues in themselves. For the past
several decades, the concept of “structures” in theological ethics, almost
exclusively, has focused on social structures in need of change. Structures
that perpetuate unfair situations and provide systematic disadvantages to
human development were classified as the “structures of sin” and were
targets of social and theological criticism. Public health officials are in an
effort to create new structures such as law, policy, environment etc. that
have a positive impact on the lives of individuals and their communities.
These social structures are formed by individual characteristics and
virtues as fundamental value units that make a person's habits and form
them (Rozier 2016, 39).
3. The common good “Maslaha” from the perspective of Islam
The term “maslaha” in Arabic means “attention to promote benefit
and remove harm” and the word “al-mursala” means to be free. The two
words together, Maslaha al-mursala (considerations of public interest),
mean the pursuit of the good of the people, without any reference to the
revelation texts. The implication of this concept is that the common good
is so obvious that it does not require any revelatory text for credit
verification. In addition, from the perspective of the legislator, since the
purpose of good is recognizable by reason, it also seeks God's approval.
Generally there is concomitance between revelation and reason about the
“common good” (Sachedina 2011, 48 ). The Islamic ethical system is of
divine origin, and the importance of legal ordering is derived from it.
Yassar Mustafa has quoted Ghazali’s sayings about ‘best interests’: “…its
meaning is protecting the purposes of Revelation. There are five purposes
of Revelation for mankind: (1) their religion, (2) their lives, (3) their
lineage, (4) their minds and (5) their property. Everything that promotes
the preservation of these five purposes is beneficial and everything which
damages them is a source of corruption” (Mustafa 2013, 480).
Forouzan Akrami et al. Adapting the principles of biomedical ethics
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According to the verse “indeed, God commands to justice and
goodness” and the hadith of the Islam’s Prophet, harm shall not be
inflicted nor reciprocated (la-darar wa la-dirar), it can be said that the rules
of goodness “ihsan” and no harm are two general rules that flow from the
principle of “maslaha” (Sachedina 2011, 47), while the rule of goodness also
covers harm exorcising. The concept of “ihsan” is primarily associated
with intention. One who does what is good, based on good will
(benevolence), is called a “Muhsin”. (Mohaghegh, Damad 2016, 148). That is
why the principle of the common good and the rule of goodness in Islam
have more far-reaching concepts than the principle of beneficence in
bioethics. The two juristic rules of “istislah” (preventing harm and
promoting benefits in the public sphere) and “istihsan” (priority of two
equally valid judgments) are implications of the public intrest (Sachedina
2011, 46). When the rule of “istihsan” (choosing one of the two possible
solutions of a case) is evoked to justify a legal-ethical decision, the
rationale for the decision is based on considerations of the common good.
Thus, the common good functions as a criterion for legislation, while the
individual good functions as the context for derivative rulings (Sachedina,
2011 57).
4. The “utility principle” in the area of public health
The “utility principle” has had different interpretations in the past
few centuries and philosophers like Jeremy Bentham and John Stuart Mill,
provided the following normative terms: “the greatest good for the
greatest number” which provides a way to determine right and wrong, or
justified and unjustified policies and conducted actions, with determining
whether they “can provide the greatest good” (Beauchamp and Childress
2013, Childress 2015, 27). In recent years, in order to better isolate the
impact of the explanations about the production of the pure balance of
good over bad consequences, the label consequentialism is preferable to
utilitarian. Following the beneficence principle, the principle of utility can
be understood as the principle of producing the maximal balance of
benefits over harms or the maximum net benefits of health (Childress
2015, 22). Regarding some general moral considerations, the principle of
utility does not commit us to utilitarianism as a general framework. This
because from the perspective of utilitarianism, generating utility is
considered a fundamental principle that all moral norms are divided from
or a maxim that cancels other moral norms (Mill 2006, 269).
Risk Reduction may be considered a benefit and different
interventions in the light of their effectiveness in reducing complications
and death are evaluated. Utility-based justifications for public health
interventions is conducted often using cost-effectiveness analysis (Index
of quality adjusted life year-QALY). Risk assessment shows the likelihood
Forouzan Akrami et al. Adapting the principles of biomedical ethics
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of negative consequences, particularly harmful effects and seeks to
determine whether the estimated risk is acceptable or it can be reduced.
Because of the inherent nature of public health practice to reduce
morbidity and mortality outcomes, and promote health, the adoption of
an intervention depends on the balance of benefits and possible risks in
that context. Different types of burdens come from PH activities. Most
burdens fall in three major categories: risks to freedom and individual
autonomy; risks to privacy and confidentiality, especially in data
collection activities; and risks for justice, when public health experts
suggest interventions only for certain groups. We are morally obligated to
minimize the burdens identified and this implies it is necessary to
determine whether the program can be modified through minimizing the
burdens while the benefits of the program are not reduced to a large
extent, or whether there are alternative strategies or interventions (Kass
2001, 1779-80). A variety of physical and psychological harms can be
expected following a PH intervention. For example, if forcible quarantine
is necessary in order to control a contagious disease, it should be
accompanied with psychological support for the people. Social values and
the public perception of the risk rooted in the culture and religion of the
society form an important part of the context of public health and are
involved in the implementation of ethical principles in various
communities. For example, people fear the risks associated with accidental
HIV infection more than other comparable risks, such as accidental
infection with hepatitis B, because of the stigma associated with HIV
infection.
Autonomy at least means freedom from both the interference of the
others and the insufficient perception, because these two are significant
barriers of any informed and free selection. In medical ethics, autonomy is
used for the critique of utilitarianism and paternalism (Beauchamp and
Childress 2013, 107). For respecting individual autonomy, valid data about
the benefits and potential harms of intervention should be tailored to the
needs of different levels of awareness and access. Six justificatory
conditions of effectiveness, necessity, minimal infringement of autonomy,
proportionality, impartiality and public justification have been provided
for the prominence of norms in conflicting conditions of selecting PH
interventions. If there are two interventions to solve a public health
problem, assuming that the benefits will not decrease significantly, we are
morally obligated to choose an approach that is less threatening to other
moral claims such as autonomy, privacy, opportunity, and justice
(Childress and Bernheim 2015, 8).
In public health programs where obtaining informed consent is not
possible, such as Tab water fluoridation, a democratic decision-making
process with the participation of affected groups and individuals for a fair
decision-making procedure (procedural justice) has been recommended.
In a democratically legitimate public decision process, people's
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participation in public health thinking is necessary. Prompt public health
decisions are usually located in communities with specific conditions.
Hence, transparency and accountability have to provide rational reasons
and justifications for mandatory interventions such as quarantine to
ensure that people can accept and support such actions (Kass 2001, 1781).
Regarding the criticisms that have been considered for QALY as an
indicator of benefit, Erik Nord believes that whenever ethical questions
arise in health care, the preferences of the public should be referred
directly. In his opinion, people should directly ask what should be given to
the public. This is because the answer of the public usually makes a real
difference to the results of the analysis of benefit and cost effectiveness,
because the public considers the factors such as severe disability and vital
technologies more seriously (Nord 1999, 2). The well-being theory
emphasizes the limitations of theories of justice to resolve priority issues
and also the need to integrate social values in such decisions in ways that
it does not provide formal analyses. The methodologic review of the cost-
value analysis and also some claims based on procedural solutions to solve
the prioritization problem, using the disability adjusted life years-DALYs
or QALYs, show that the democratic theoretical contribution is a general
approach for any discussion on the allocation of priorities that emphasizes
the need for reasonable accountability in decision-making processes
affecting public matters (Powers and Faden 2006, 279).
5. The principle of utility from the perspective of Islam
The rule of “no harm” (la-darar) in the Islamic law is among the
governing rules and it has veto power over other laws and rules. This rule
covers the non-maleficence principle in bioethics and it has strong
rational reasons in addition to legal documentation. The principle of “no
harm” is dominant in the relations between people, in social moralities, as
an important barrier to harmful interventions. Avoiding probable risks,
based on the principle of “preference to avoid harm to improve the
benefit”, jurists support the patient's right to avoid harm (Mohaghegh
Damad M 2004, 150). Both from the standpoint of the rational and of
tradition, which implies the respect for no harm to oneself or others, it
has been concluded that only a certain harm is not the target, but if the
harm is the suspicion, it must be avoided. Of course, for the notable harms,
such as corruption or destruction of the body, this is important to the
extent of a rule called “necessity of prevention of possible harm”, which
means a rational rule has been created. According to this rule, it can be
generally said that harm is not legitimate in Islam and the illegitimacy of
harm encompasses both legislative and implementation phases (Safaee
and Abbasi 2016, 235). In other words, the avoidance of harm has priority
over the pursuit of a benefit of equal or lesser worth. Another maxim in
this category (Darura or necessity) also states that harm may not be
Forouzan Akrami et al. Adapting the principles of biomedical ethics
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removed by a similar harm, and in case of coincidence of two harms, then
a ‘lesser of two evils’ approach should be considered to prevent greater
harm (Mustafa 2013, 481). This can be applied where the public good takes
priority over the individual good. For example, individual autonomy can
be infringed in case of necessity of the vaccination to prevent the
imminent epidemic of an infectious disease. From what was said, the
consistency of the principle of utility in public health with the rule of “no
harm” can be inferred.
Islam greatly emphasizes the personal autonomy and responsibility
that contribute to the strength of the social system. According to the
domination rule, human beings have no right to dominate or control other
people unless guardianship intervenes as a proof, such as a father’s
guardianship of his young children. This rule, in addition to the religious
reason, has a rational reason and the legitimacy of governments derives
from the fact that people have the right to choose (Mansoor 1998, 91).
Thus, on the one hand, the government is obliged to promote public
health and to prevent harm to improve public benefits and, on the other
hand, as a steward of health and with reference to the article “limitation
of the ownership dominance”, it has the right to protect public health
with the least justifiable harm.
6. Justice
Justice has been defined as ‘giving everyone his or her due’ (Have
2006, 101). In public health, the principle of justice including distributive
justice for a fair distribution of benefits and burdens, equal access and the
reduction of inequalities in health outcomes, and also procedural justice in
the form of the participation of all affected parties in decision-making
processes have a central role. (Kass 2001, 1780; Childress et al. 2002, 171;
Childress and Bernheim 2015, 5; Marckmann et al. 2015, 4). John Rawls
believes that justice will be achieved through the correct distribution of
goods and responsibilities in social cooperation and this is linked to the
structure of society and its constituent entities. This is because social
institutions determine the access to resources and the rules for
determining merits and achieving the political power and capital
accumulation. Thus, justice is the elimination of unreasonable privileges
creating actual balance among the conflicting demands of people
predicted in the structure of a social institution (Rawls 1999, 5).
A liberal theory of justice focuses on individual freedoms, along with
one’s duty to respect the freedom of others and the duty of the
government to protect the rights and freedoms of citizens. This often
means that the “minimal state” is able to prevent or punish breaches of
personal boundaries, including individual property rights. In this view,
health care is not a right but people can voluntarily contribute to the
distribution of health care in a community. In the perspective of
Forouzan Akrami et al. Adapting the principles of biomedical ethics
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utilitarianism, justice is seen as a set of policies or rules that produce the
maximum net benefit, involving the correlation of the rights and duties
not as an independent decision but rather deriving from benefit. Health
care and public health can be valuable at least partly involved in the
production of the net social benefit (Childress 2015, 27). Nevertheless,
utilitarian justice principles are relative but if their inclusion range is
precisely specified, utilitarianism, as a consequence-based doctrine, will
play a major role in health policy-making (Beauchamp and Childress 2013,
361). Communitarian theories of justice arise from several philosophical
views that do not necessarily take into consideration the importance of
individual rights such as freedom. Their perception of health care and just
health rather depends on the perception of the community of the good of
health, in conjunction with other primary goods (Childress 2015, 27).
Communitarians emphasize community obligations towards the
individuals and the duty of individuals in society. They believe that an
emphasis on community and common good is also evident in the policies
of health care allocation. Egalitarian theories have a history as old
religious traditions and believe that all human beings should be treated
equally because they are created equal and have equal moral status
(Beauchamp and Childress 2013, 256), which makes the foundations of
human rights. The right to health requires governments not only to
respect individual human rights, but also to protect people from harm and
to satisfy the community health needs (Annas and Mariner 2016, 129). No
dominant egalitarian theory has included a distributive principle of equal
sharing of all primary goods to everyone. The quality of dominant
egalitarian theories is to identify basic equalities that allow some
inequalities and many of them recognize the probable legitimacy of a two-
layer system, with the least favorable layer of health care (based on the
deliberative democratic process) (Beauchamp and Childress 2013, 273).
John Rawls' theory of Justice is the most important temperate egalitarian
theory which has challenged liberalism, utilitarianism and communita-
rianism. From among those who have been influenced by John Rawls,
Norman Daniels argues on the concept of “fair equality of opportunity”, in
which justice has to remove or reduce the barriers which prevent fair
equality of opportunity for people, such as health as moral importance, to
pursue a variety of objectives and programs of individual life, depending
on the talents and skills of people (Daniels 2008, 47).
Since the beginning of the 21st century, some innovative ideas have
been debating on justice in bioethics. Although this literature has been
formed in response to Rawls's egalitarian theory, in terms of foundation it
is not exactly like Rawls's theory. This literature is mainly influenced by
the moral theory of Aristotle, in particular the role and importance of
human flourishing states that rely on moral virtue and excellence. The
approach starts from the assumption that the opportunity to achieve good
performance and well-being are ethical principles and the freedom to
Forouzan Akrami et al. Adapting the principles of biomedical ethics
Journal for the Study of Religions and Ideologies, vol. 17, issue 49 (Spring 2018) 55
achieve such cases is analyzed in the language of “capability”. The quality
of life depends on what people are able to do, and a good life is a life in
which people maintain their original capabilities. This theory holds that
the minimum level of social justice requires “main capabilities for all
citizens”(Beauchamp and Childress 2013, 259). The capability theory
focuses on the pre-condition of capabilities for well-being, whereas some
new theories have focused on well-being. In other words, freedom,
capabilities and empowering education and their resources are considered
a well-being equipment. Regarding bioethics in public health and health
policy-making, Powers and Faden have provided a non-distributive justice
theory that complements the distributive justice but it is beyond it. In
their point of view, questions about the important inequalities are
understandable only by examining the social determinants that interact
with human well-being (Powers and Faden 2006, 37; Powers, Faden, and
Saghai 2012, 8; Beauchamp and Childress 2013, 260). According to the well-
being theory, the job of justice is to ensure an adequate level of six
fundamental dimensions of human well-being, including health,
reasoning, self-determination, attachment, personal security and respect
for all (Powers and Faden 2006, 25; Beauchamp and Childress 2013, 261).
Therefore, according to recent theories of justice, the most important
topic discussed in public health is not the set of restrictions on freedom
and the autonomy of individuals, but also the promotion of their
autonomy. In other words, autonomy is a central value in a just society in
which better conditions are provided in order to facilitate the possibility
to make right decisions (Buchanan 2015, 409).
7. The principle of justice in Islam
Justice in Islam is one of the basic principles, and this has been
stressed in the Qur’an and the Hadith. From the perspective of Islam,
justice is one of the inherent characteristics of rational dignity and every
human, with a sound mind, and who is against moral vices, will always
tend toward it. The human will and freedom of choice are the basis of
legitimization of the rules and responsibility in Islam, without which
individual and social justice is unreasonable (Sobhani Tabrizi Gh 2000, 4-
23). Distributive justice is most evident in the concept of maslah al-
mursala, that is common good. Thus, the ultimate goal of the sharia is the
establishment of justice along with the preservation of the best interests
of people. Individual justice accounts for a moral virtue in each individual,
as a result of control and balance of internal tempers of humans and this is
the underpinning pillar for social justice. History is a good evidence of the
vanguard of Islam in the fight against injustice and for the establishment
of social justice. Commands such as paying “khums and zakat” and also
giving parts of the asset to poor people (infagh) are the instances of
distributive justice and fairness in Islam. Justice in Islam is the basis of
Forouzan Akrami et al. Adapting the principles of biomedical ethics
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jurisprudence, law and legislation. The most famous and most
comprehensive definition of justice among the veterans and jurists
“granting the right to their owners” shows that justice and the right are
intertwined and justice is the implementation of the right. The principle
of justice does not put alongside other rules but it is in fact a meta-
juridical principle. There are also many other important legal rules, such
as the “no-harm” rule as a strategy to achieve justice (Motahari Morteza
2011).
8. Fairness (not the ‘split-half’)
Equality and negation of discrimination are the most important
meanings of the social dimension of justice. Equality is a precondition of
justice, but the order of justice is not equality only. However, in Islamic
jurisprudence, if there is a financial dispute and there is no preference for
one of the parties involved, in order to remove suspicion, the sentence is
for dividing the asset between the parties, in two halves. Some lawyers
have defined justice as a vague feeling of fairness that arises in the
application of legal norms by persons. Sometimes fairness means to divide
equally, but if it is to complete the law, it means to give rights on the basis
of merit of individuals, not only on the basis of equality (Asghari 2009,
174).
In the Islamic attitude, social justice does not only include
distributive justice but it also has a broader sense. The analysis of the
general policies of the politico-moral philosophy of Iran health system as
an Islamic country suggests egalitarianism as the dominant theory
(Akrami et al. 2017, 1). But it should be noted that the foundation of social
justice consists of divine justice, on the one hand, and of human nature,
reason and freedom, on the other hand. As noted above, because of the
inherent dignity, the human has the right to live honorably in society and
no one has the right to produce a risk for his/her life or property. Islam,
with a deep understanding of the human in addition to inherent dignity,
has also given him a valuable dignity which the human being acquires
through the knowledge, self-purification and proximity to God: “Indeed,
the most honorable of you with Allah is the most pious of you”. This kind
of dignity is an adventitious prosperity acquired as a result of fulfillment
of the inherent talents. Thus, it can be concluded that the religion of Islam
is for human flourishing and the fostering of moral virtues necessary not
only for individual justice, but also for social justice. This is possible by
providing Islamic and healthy social structures meant to shape these
behaviors.
Forouzan Akrami et al. Adapting the principles of biomedical ethics
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9. Conclusions
The present study outlines the connection between the principles of
PHE and the principles of the Islamic jurisprudence. The principle of the
common good has a rational justification in Islam meant to draw public
interests and to remove harm. The rule of “no-harm”, with an emphasis
on the preference for preventing harm in order to increase benefit, is
consistent with the principle of utility meant to produce the maximum
balance of benefit over harm in the context of PH. Therefore, on the one
hand, in PH, the government, due to its responsibility to prevent disease
and death and to promote health, has the duty to prevent harm and to
promote PH. On the other hand, as a steward of PH and with reference to
the article “limitation of the ownership dominance”, it has the right to
protect PH with the minimizing justifiable harm.
The right to health and public use of biotechnology advances are the
rights of all human beings and implementing it is the instance of true
distributive justice in Islam, with special attention to disabled persons and
the poor. Islam’s attention to make people conscious of their rights and
duties and of acquired dignity, as a result of the fulfillment of inherent
talents, suggests that Islam, beyond distributive justice, knows that the
cultivation of moral virtues and human flourishing are a requisite for the
realization of social justice. In Islamic philosophy, human excellence is
considered to the extent that good will in addition to the concept of
individual justice can be deduced from the concept of the rule of goodness.
Applying the principles of PHE is an appropriate approach to be used in a
Muslim community in order to optimize health care delivery. At the same
time, the optimal PH in Muslim societies requires research in order to
define the accurate indicators of benefit and harm based on the teachings
of revelation and reason.
Acknowledgment: This study is part of the Ph.D. Thesis in Bioethics. This is to thank the
Shahid Beheshti University of Medical Sciences for funding this research.
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