Fatwas of Singapore

Science, Medicine and Health

Nazirudin Mohd Nasir (ed.)

Mohd Murat bin Md Aris, Irwan Hadi bin Mohd Shuhaimy, Raihanah Halid, Izal Mustafa Kamar, Faizah Zakaria

Majlis Ugama Islam Singapura (MUIS)

Singapore

All rights reserved. No parts of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the copyright owner.

1

Acknowledgement

The Islamic Religious Council of Singapore (Muis) extends its utmost gratitude to those who have contributed ideas and worked tirelessly, either directly or otherwise, towards the production of this compilation entitled “Fatwas of Singapore Volume 1: Science, Medicine and Health.”

In particular, we would like to thank the Minister for Communications and Information and Minister-in-charge of Muslim Affairs and Minister-in-charge of Cyber Security, Dr Yaacob Ibrahim, and the Chief Executive of Muis, Mr Abdul Razak Maricar, for supporting this project.

Our deepest appreciation is rendered to the Mufti of Singapore, Dr Mohamed Fatris Bakaram, as well as to the Advisor of the Office of the Mufti, Shaikh Syed Isa Bin Mohamed bin Semait, for their counsel and guidance. Our special thanks to Ustaz Mohd Murat bin Md Aris, Muis Senior Director for Education, who contributed the first chapter and offered guidance in the early stages of this project.

Finally, this project would not have been realised without the hard work of the team of researchers, in particular, Ms Faizah Zakaria and officers from the Office of the Mufti, who researched the background and contexts for each fatwa that is presented in this compilation.

Photo Usage

All newspaper clippings featured in this publication have been acquired with permission from the Singapore Press Holdings Limited. Our thanks to the Muis Photographic Library for the photos on Fatwa and the Fatwa Committee. The illustration featured on the cover of this book is a sketch of Singapore’s city skyline by Ms Abi Daker and acquired with permission from the website www.illustratedmaps.info.

2

Note on Transliteration Style

Consonants 

ا : a | ر: r | ع: ‘ | و: w
 ب: b |  ز: z |  غ: gh |  ه: h
ت: t | س: s | ف: f | ء: ’
ث: th | ش: sh | ق: q | ي: y
ج: j | ص: ṣ | ك: k |
ح: ḥ | ض: ḍ | ل: l |
خ: kh | ط: ṭ | م: m |
د: d | ظ: ẓ | ن: n |

Vowels

 Long |  Short |  Doubled |  Diphthongs
 ٰ :  ā | َ    :  a |  يّ ِ  : iyy |   َ وْ : au / aw
و : Ū | ِ    :  i |  وّ  : uww | َ يْ  : ai/ ay
ي : Ī | ُ    :  u |  |

3

Note on Ebook Features

This Ebook is a translation and adaptation of the Malay version of the publication entitled Fatwa-fatwa Singapura Jilid 1: Sains, Perubatan & Kesihatan.

It has been designed to facilitate the study of fatwas and easy cross-referencing within the text of the book. Readers may find the following electronic features useful:

List of fatwas are hyperlinked to the corresponding fatwas in the main text

Endnotes are hyperlinked to the main text within each chapter

Websites mentioned in the endnotes can be accessed by clicking on the links directly

Further background reading and discussion of certain concepts are provided at the end of the book and are linked to the main text. Readers may click on the texts containing such links in order to access these boxes

4

List of Abbreviations

AMD
Advanced Medical Directive

AMLA
Administration of Muslim Law Act

BAC
Bioethics Advisory Committee

BCG
Bacillus of Calmette and Guerin

DNA
Deoxyribonucleic Acid

DVT
Deep Vein Thrombosis

EEG
Electroencephalography

FPPB
Family Planning and Population Board

HOTA
Human Organ Transplant Act

HPV
Human Papilloma Virus

HSA
Health Sciences Authority

IDRC
International Development Research Centre

ISEAS    
Institute of Southeast Asian Studies

IUD
Intra-Uterine Device

IVF
In-Vitro Fertilisation

MKAC
Muslim Kidney Action Committee

MOH
Ministry of Health

MTERA
Medical Therapy, Education and Research Act

MUIS
Majlis Ugama Islam Singapura

NGO
Non-Governmental Organisation

NMEC
National Medical Ethics Committee

NUH
National University Hospital

OIC
Organisation of the Islamic Conference

SGH
Singapore General Hospital

SMA
Singapore Medical Association

TB
Tubercle Bacillus

UNESCO
The United Nations Educational, Scientific, and Cultural Organisation

WHO
World Health Organisation

5

List of Fatwas

1972
Post-Mortem on Cadavers for Research

1973
Donating Organ After Death

1974
Sterilisation

1974
Artificial Insemination

1976
Vasectomy and Sterilisation

1976
Abortion

1976
Intra-Uterine Device (IUD) and Contraceptives

1981
Taking Medication that Contains Alcohol

1983
Test Tube Babies

1984
Ruling on Hymen Reconstruction Surgery

1985
Kidney Donation

1986
Abortion

1987
Family Planning

1988
Using Prohibited Items in Treatment (Through Skin Grafting)

1993
Ruling on Smoking

1994
Advanced Medical Directive

1995
Cornea Transplant

1997
Bone Marrow Transplant

2000
Cloning

2001
Human Stem Cell Research

2001
Kidney Dialysis in Day time Ramadan

2002
Frozen Sperm from a Deceased Husband

2003
Donation and Transplant of the Human Heart

2003
Vaccines Derived from Porcine Sources

2004
Organ Storage and Establishing an Organ Bank

2004
Condition of Witness for Organ Donation Pledge

2006
Fatwa on Smoking

2007
Inclusion of Muslims under the Human Organ Transplant Act (HOTA)

2013
Rotavirus Vaccine

2015
Fatwa on the Drug Heparin

6

Foreword I

بسم الله الرحمن الرحيم

الحمد لله رب العالمين وصلى الله على سيدنا محمد وعلى آله وصحبه
والتابعين ومن تبعهم بإحسان إلى يوم الدين

Muslims today are very fortunate as they are able to refer to, and obtain guidance from, the vast repository of knowledge which has been passed down by scholars (‘ulamā) through their writings and opinions (ijtihād). In every aspect of life, a Muslim is able to receive guidance as outlined by scholars based on their views and in-depth analysis of the main religious textual sources i.e. the Qur’an and Sunnah (Prophetic tradition).

However, with the passing of time, new issues and questions which have not been specifically addressed in Muslim jurisprudence arise. In addition, there are specific questions and issues which individuals and families may encounter. In all these, appropriate solutions and guidance should be sought and offered so as to ensure that Muslims can confidently lead their religious lives. Therein lies the importance of the fatwa institution in guiding the community in overcoming life’s difficulties and challenges.

Throughout Islamic history, the ‘ulamā have devoted their attention to the preservation and development of the fatwa institution. They have produced countless research work and writings, through which they lay the foundations and establish the guidelines which are necessary to ensure that fatwa institutions remain credible.

Amongst the most important approaches that have been employed in achieving this objective is the alignment between the consideration and decision of any mufti or fatwa body, and the concept of public welfare known as maṣlaḥa. Another key instrument which is also central to the fatwa-issuing process is sadd al-dharā’i’, which closes the door that leads to harm or danger. These approaches will lead a mufti to consider the potential consequences of a ruling on individuals, families and societies. A mufti’s role is thus critical in weighing and assessing (muwāzanah) between benefit (maṣlaḥa) and harm (mafsada).

Nonetheless, the fatwa institution may still lose its integrity and relevance if such an evaluation takes place only at the point of fatwa issuance, without a continuous evaluation or review of the effects of any particular fatwa after its issuance. The experience of the Fatwa Committee in Singapore shows that in some circumstances, the outcome of a fatwa on society and individuals after it had been issued could diverge from what the Committee had anticipated. Among the examples is the fatwa on organ transplant. As you may read in this volume, the positions on organ transplant and donation were reviewed several times, the most recent being the inclusion of Muslims under HOTA in 2007.

It is vital that the process of reviewing fatwas such as this is recorded and studied comprehensively so that a legal and ethical framework which defines the standards and fatwa thinking process can be suggested for a wider application in field of iftā’ (fatwa making).

Although Singapore is relatively a small nation and the Muslim community forms a minority, I am of the view that the experience of its fatwa institution can, and should be, offered as a valuable contribution in enriching global discourse on Islamic law and fatwa research. This is especially given Singapore’s position as a nation at the forefront of biotechnological and biomedical research.

Many may not be aware that behind the biomedical industry’s eagerness to explore new areas of development, there have been lively debates on ethics, morality, as well as the value of life-related to the new technologies. This certainly has a considerable impact on the fatwa institution. The establishment of the Bioethics Advisory Committee is a testimony of this, and of Singapore’s commitment to weigh ethical demands amid the industry’s rapid development. The fatwa institution cannot stand idly by in these discussions as these too concern the Muslim community’s religious consciousness and practice.

If the fatwa institution does not keep track of such discussions and developments, it would not be able to comprehend or set relevant guidelines related to it. This will result in a Muslim community that is lacking in guidance, which may consequently affect the community’s participation in potentially-beneficial research that improves the quality of human life in general. At the same time, the fatwa institution must also ensure that it is fully aware of the complexities of the issues discussed, so as not to provide guidance which is based on inadequate knowledge and information. We cannot be an institution that, while not wanting to be an obstacle to development in this industry, ignore the moral and ethical guidelines set by Islamic law.

I humbly call upon fatwa institutions around the world to continue exchanging experiences which will enrich this field of research. This fatwa compilation series is an effort by the Fatwa Committee of Singapore towards that direction. Each analysis of fatwas included in this compilation series aims to describe the context and background behind the formulation of fatwas. It is also an effort that contributes to the ways in which `uruf or local customs and context can be applied as a key principle in the fatwa-making process.

It is my sincere hope that this publication will help readers understand the dynamism of a ruling behind a fatwa. It gives the community an opportunity to appreciate how Islamic legal thought must remain alive and relevant to deal with lived realities.

DR MOHAMED FATRIS BIN BAKARAM,
SOHIBUS SAMAHAH MUFTI,
CHAIRMAN OF THE FATWA COMMITTEE

7

Foreword II

بسم الله الرحمن الرحيم

الحمد لله رب العالمين وصلى الله على سيدنا محمد وعلى آله وصحبه
والتابعين ومن تبعهم بإحسان إلى يوم الدين

While Singapore is a country which practices civil law, our Muslim community requires Islamic laws that encompass the jurisprudential, administrative and general matters for its religious needs.

Following Singapore’s independence, Parliament legislated the Administration of Muslim Law Act (AMLA) in 1966. This paved the way for the advisory role of a central Muslim body which was previously assumed by the Muslim Advisory Board. AMLA was put into effect two years later in 1968, giving birth to the Islamic Religious Council of Singapore (Muis) as a statutory body. In addition, the Shariah Court and Registry of Muslim Marriages were also constituted under the AMLA. With these institutions in place, various efforts to preserve the religious and communal interests of Muslims could be implemented, such as Haj arrangements, halal certification, mosque management, and others.

On matters pertaining to Islamic law, the Muslim community was in need of a statutory body responsible for determining and providing continued guidance. This is not an easy undertaking as it demands a mastery of religious sciences. While the core teachings and doctrines of Islam have already been outlined in sources such as the Holy Qur’an, Prophetic traditions (hadīth) as well as the consensus (ijmā’) of Prophet’s Companions and established scholars, there are numerous new issues which have no clear explanation nor ready answers, thus, needing more in-depth analysis and research in order to resolve them.

This is where the important role of fatwa, which is essentially an act of ijtihād borne out of a rigorous effort to resolve conflicting issues done based on religious sources, come into play. Issuing fatwa not only requires knowing what is taught by religion, but also a refined understanding and knowledge of how to apply it in order to resolve the problems faced by the inquirer as well as society at large.

Alhamdulillah, the Fatwa Committee in Singapore has sought to fulfil this role since its inception. Despite the Committee members not possessing outstanding qualifications nor having access to relevant reference materials in its early days, they demonstrated remarkable diligence and commendable commitment to offer their best during deliberations – a show of their passion and strong sense of religious responsibility.

In line with the changing times and increasing demand from a society that desires more information, this compilation series aims to give a more detailed discussion on the framework and principles of the Sharī’a that were employed in fatwa work by the various committees over the years.

It is hoped that this information will help the Muslim community to better understand the considerations of the Fatwa Committee in resolving various issues. My sincere hope is for this initiative to unite the Muslim community’s spirit in preserving knowledge, as well as contributing to religious life in Singapore. We further aspire for it to open doors to sharing and exchanging information with international fatwa bodies and other Muslim countries.

Muis, as the administrator of religious affairs in Singapore, will continue its efforts to refine and enhance both religious practice and understanding to suit Singapore’s context.

SHAIKH SYED ISA BIN MOHAMED BIN SEMAIT
ADVISOR, OFFICE OF THE MUFTI

8

Editorial Preface

The suitability and adaptability of Islam to changed contexts and environments through the instrument of ijtihād have long been discussed. In essence, those who argue for the renewal of Islamic thought (including its conceptions of law) point to the fact that Islam originated in seventh-century Arabia in an environment far different and unique from contemporary societies. At the same time, Muslim scripture and tradition claim relevance for all time and place with the immutable principles and core set of teachings of Islam. Yet, relevance is not possible without a response and solution to issues and challenges of the day. The principle of ijtihād encourages a reasoned engagement with texts and recognises that a change in environment and context affects the laws of Islam. It therefore prevents the teachings of Islam from being ossified and frozen in time which hinders progress and development. Accordingly, individuals trained in the interpretation of sources are permitted to offer new readings in the substantive matters (furū‘) of religion as part of seeking solutions.

This process, as evidenced in classical Islamic jurisprudence (around the 9th to 14th century CE) in which later jurists built on earlier texts by way of providing new examples and case studies, ensured a continuous stream of growth and dynamism in the Islamic legal tradition. As a contemporary scholar of fiqh explains, such works are

…..less the achievement of a particular author than the shared effort of a whole school of research and interpretation in explaining rules of divine origin. The cooperative nature of this effort may be seen in the multilayered character of its texts, whose primary authors often merely state the ruling of an act, lawful or unlawful, leaving matters of definition, conditions, and scriptural evidence for the commentator to supply, who in turn leaves important details for both writers of marginal notes and for living sheikhs to definitively interpret when teaching the work to their students. [1]

The process is recorded in many resources that discuss Islamic law. For example, the book ʿUmdat al-sālik wa ‘uddat al-nāsik (The reliance of the traveller and tools of the worshipper) authored by the influential 14th century jurist Aḥmad Ibn Naqīb Al-Miṣrī (d. 1368CE), has been the subject of various commentaries. Under the topic of “marriage” (bāb al-nikāḥ), the author explains the conditions of custody of a child, one of which was that if a child is a Muslim, then the person with custody must also be a Muslim. In his rather peculiar commentary on this point, a 20th century jurist Sheikh ‘Abd al-Wakil Durubi extends this condition to day-care service, education and schooling. In the specific context in which values contradictory to Islam were feared to have an impact on young children,  he was of the view that it was prohibited for parents of Muslim children to send them to Christian schools.[2] This view, like many other views on the issue that is set in a particular context, would require a more thorough and comprehensive discussion. Whether a ruling is suitable for particular community or in a particular era, it nonetheless contributes to the development of Islamic law and its intellectual heritage by supplementing new cases and examples. As mentioned by a 20th century Moroccan jurist, Muḥammad ʿAllāl al-Fāsī in his book Maqāṣid al-Sharīʿa al-Islāmiyyah wa Makārimuhā:

The small circle of innovative scholars of jurisprudence, small though their numbers may be, constitutes a guarantee that Islamic jurisprudence will go on progressing to the point at which it becomes linked anew with the objectives of Islamic Law and their supporting evidence, and comes to be applied in Muslim courts and lands. [3]

Although it is a very important instrument of Islamic jurisprudence, ijtihād as interpreted and exercised in classical Islam is probably less adequate as a holistic solution in contemporary times and in modern and secular contexts. For example, scholars often adhere to a specific juristic tradition and tend to adopt the principles of that tradition. This also means they will be more likely to adopt the principles of the tradition without revisiting the core assumptions and ways of interpreting the principles. This practice could hinder a path to reforms required in particular situations as rulings are still bound by the conditions imposed by the classical fiqh legal tradition. An important fact that needs to be considered is that the operative environment of the classical ʿulamā is different from the world today, especially after the emergence of a nation-state system that gives rights and freedom to all citizens in various aspects of life, regardless of their background. Muslim communities today also live in very diverse situations; some as majorities but many others as minorities, and under different types of political and legal systems. The task, therefore, of finding solutions that can truly work, given the complexity of certain issues or problems, as well as its novelty and unprecedentedness warrants a more radical approach towards rethinking former and classical approaches to fatwa making.

In the late 19th and early 20th centuries, Muslim scholars begun addressing this challenge under the broad category of reform in Islamic thought. Some scholars have also looked at the interaction between religion and political systems with a serious implication on the broader conception of the Sharī’a (which covers, among others, fatwas). The crux of the debate is where the line should be drawn between two realms and spheres of influence – religion and the secular. An earlier form of this debate had taken place in classical Islam, when scholars differed as to the source of an Islamic political system; whether obligated by reason or revelation.[4] If the Sharī’a is to dominate in all spheres of Muslim life, would this mean an a priori rejection of all other forms of political and legal order?  In early 20th century Cairo, an Azhari jurist and judge ‘Alī ‘Abd al-Rāziq argued that the Prophet Muhammad’s authority was religious/spiritual and not political. The logical conclusion of his argument is that Islam is ambivalent about political systems and orders and is not prescriptive in this regard. Rather, Islam provides a spiritual and ethical paradigm that seek to help Muslims navigate through various systems which may be foreign to the religion. Such a view inspires much confidence to Muslim communities living in a modern and pluralistic society like Singapore that they can continue to function successfully and contribute to the development of society and the state without compromising religious duties. Yet this opinion requires renewed interpretation and critical undertaking in examining the religious texts, as they form the heritage of Islamic law and support the pillars of religious life for Muslims.

In looking for new solutions, several modalities have been suggested towards finding new approaches. An influential approach promulgated in recent times is to go beyond the written law and look at the higher objectives and intent of law (maqāṣid) and its spirit (ruh al-Sharī’a). This approach has its antecedents in the works of early Muslim scholars, such as the 14th century jurist Ibn al-Qayyim who writes in his famous work Iʿlām al-Muwaqqiʿīn:

Islamic Law is based on wisdom and achieving people’s welfare in this life and the afterlife. Islamic Law is all about justice, mercy, wisdom, and good. Thus, any ruling that replaces justice with injustice, mercy with its opposite, common good with mischief, or wisdom with nonsense, is a ruling that does not belong to Islamic Law, even if it is claimed to be so according to some interpretation. [5]

Ibn Qayyim’s explanation sums up the importance for Islamic law to achieve the purpose of the Sharī’a itself. Widely referred to today by ijtihād maqāṣidi and now internationally adopted by various groups of scholars who issue fatwas in Islamic countries and in Europe, this approach affords greater flexibility in terms of finding new ways at looking at issues and questions. As the scholar ‘Allal al-Fāsī notes, these objectives “[ensure] that people conduct themselves justly, with moral probity and with integrity in thought and action, and that they reform that which needs reform on earth, tap its resources, and plan for the good of all.”[6] This contributes to the critical assessment of the text in light of different contexts. Among other things, it distinguishes between ‘means’ and ‘end’. An example of this concerns the sighting of the (hilāl) moon as the start of the month, in which the visual sighting is a means, like any other legitimate but far more accurate ways (such as astronomical calculations). In this case, the end is to determine the beginning of lunar months with a high degree of accuracy. Here, the purpose and goal of the Sharī’a is the determination of the new month, and the means include precise calculation.[7]

Another contemporary aspect to note is the diversity of Muslim communities worldwide. The issues faced by the Muslim community in Singapore differ, and sometimes, in significant and fundamental ways, from the issues and fatwa evaluations in other parts of the world. For those who live in developed countries and face rapid scientific and technological advances, the considerations on the method of calculation, or generally, the value of scientific knowledge in daily life, will be influenced by the reigning local scientific trends. Further to this, religious questions faced by the Muslim community in Singapore are expected to become more complex. This is not only because of new issues which are not found in religious texts, but because each issue is often multi-dimentional and concerns matters that require specialised knowledge and covers various disciplines, such as science, sociology, humanities, history, politics and others.

In this regard, an important first step is a deep and accurate understanding of the extent of the problem or issue at hand. This requirement cannot be overstated and is not easily achieved, especially in today’s era of specialisation, as each individual has limitations in mastering multiple disciplines. For this reason, although in most Muslim communities today a qualified jurist (mufti) performs this function, in Singapore, a committee of jurists deliberate on such matters in order to tap on collective wisdom. This is not to say that all fatwas are similar in terms of the function they serve. Whilst the majority of fatwas may simply take the form of juristic responsa to a question posed by a questioner (mustafti) with the purpose of helping specific individuals with their religious queries, some others may involve more complex issues that concern the entire community and have implications on public policies. Fatwas in Singapore usually take the form of the latter, as demonstrated in the fatwas published in this volume.

This volume seeks to capture how juristic reasoning and interpretation interacts with the broader factors that surround the issue, which include socio-historical contexts, contemporary needs, and relevant scientific advancements and knowledge. As such, the approach taken here is to discuss fatwas in light of the relevant background and particular contexts. This interaction highlights the flexibility of Islamic law to provide relevant guidelines to society, underlining its dynamic feature. Muis has previously published three fatwa compilations that recorded all fatwas issued by Muis until 1998. However, there is thus far no publication that discusses the broader contexts of these fatwas.

To this end, the Office of Mufti in Muis set up a research team to study the development of fatwas in Singapore. The  team examined records of fatwa meetings in order to identify the background to the fatwa queries. Unlike the text of a fatwa that simply states a ruling and its arguments, the Fatwa Committee discussions as recorded in the minutes of meeting reflect the arguments and considerations expressed by the Fatwa Committee members, as well as any differences of opinion. In addition, the team researched on broader developments relevant to the issue at hand. This could include some historical and socio-religious analysis. In the case of fatwa on organ donation (chapter 3 of this publication), whilst the text of the fatwa itself does not detail the reason and context of the particular issue, a study of the historical development of organ donation through reports in local newspapers and relevant international coverage and the trends and interests in organ donation locally provide a more holistic assessment of the fatwas. This allows readers to better comprehend why certain issues were of a concern to the community, and what the Fatwa Committee’s considerations were in coming up with its decisions.

With these objectives in mind, this publication seeks to be a reference for asatizah, students of Islamic jurisprudence and fatwa, as well as researchers of the socio-history and religious institutions of Islam, and any interested member of the public who wishes to explore the development and management of fatwas in general. The group of researchers and writers hope that by examining the development of fatwa in this book, the reader will be able to appreciate the importance of interpreting religious laws according to contexts, and how this is done without compromising religious principles. In fact, the discussions here seek to provide examples of how contextualisation can be observed if proper attention is given to the purpose and spirit of the Sharī’a and when capabilities to grasp new and complex issues are developed.

FATWAS ON SCIENCE, MEDICINE AND HEALTH

Muis has issued a total of 577 fatwas from the inception of the Fatwa Committee until 2016. These fatwas cover diverse aspects of the religious life of the Singapore Muslim community. This volume is devoted to fatwas related to science, medicine and health.

The old yet pertinent adage that change is a constant rings true in all areas of life, not least in science. Scientific progress and research continue to push boundaries and force us to rethink our religious and ethical positions. This challenge is not peculiar to Muslims, but also applies to other religious traditions, especially those with clear scriptural injunctions and moral guidelines on life’s philosophical questions, such as on human suffering. The march of science, relentless as it may be, often comes face to face with profound ethical questions. Religious communities are, of course, not expected to hinder scientific progress, but this is not to say that one should conveniently move moral boundaries to fit in the conclusions of science and technology. Rather, given a set of principles established in religious texts, how could these principles be read and built upon, with the aim of guiding religious communities to navigate through the unchartered realms of science and ethics.

Whilst an ethical framework inspired by religion does and should not shift much, its principles require continuous reflection. In fact, it is in the application of such principles in new areas and issues that the relevance of these principles are tested. This is an intricate process that involves examining new questions with an open mind. The fatwas in this volume are examples of this process. As is often the case, scholars find their first recourse to established principles to shed guidance on new issues. However, certain matters are simply unprecedented and demand a critical review of classical doctrines and principles. As the Fatwa Committee deliberates and considers the merits and disadvantages of certain propositions, new principles of fatwa begin to emerge. Over time, one could entertain the possibility of a fiqh that is particularised to the context of Singapore. This is one of the purposes of this volume, namely to document and express the thought process behind such fatwas.

To further explain this unique process, the first chapter discusses fatwa management in Singapore and the principles observed by Muis in issuing fatwas. Among these, the Fatwa Committee of Singapore observes the proactive approach and concept of taysīr (simplifying instead of complicating). The chapter also presents a historical background to the establishment of the Fatwa Committee and the collective thinking (jamā’ī) approach as adopted in Singapore.

The second chapter discusses fatwas on family planning and reproductive science. This chapter looks at the use of contraceptives and how this developed historically in Singapore, in the context of the population needs of the country post-independence and the novelty of some approaches in family planning. Questions on permanent forms of contraception (such as sterilisation) and abortion were also asked. In general, the fatwas recognise that this is an area in which both contextual considerations as well as scientific developments affect the way religious rulings are conceived. Some theological principles remain applicable, such as the determination of what constitutes the will of God and the freewill of human beings. The gift of a child remains considered as a divine gift that cannot be annulled by a human act such as abortion. It is only in the instance of established harm to the living, such as imminent danger to the mother bearing the child, that abortion is permitted. As Singapore moved towards more sophisticated reproductive technologies, questions on assisted reproduction such as in-vitro fertilisation (IVF) and sperm banks were also asked.

Organ donation, as discussed in the third chapter, looks at the evolution of Islamic juristic thought in tandem with advancements in therapeutic and biomedical science. In particular, it examines how the ruling on organ donation has changed from prohibition in the first fatwa issued in 1973 to the permissibility of presumed consent in the most recent fatwa issued in 2007. There are two particularly important aspects in this chapter. First is that the fatwas on organ donation incorporate a unique aspect concerning relations between state and religion, as public policy and legislative positions take into account the religious beliefs of the Muslim community as expressed in certain fatwas. Thus, up until the issuance of the fatwa in 2007, Muslims were excluded from the Human Organ Transplant Act (HOTA). Second is that the fatwa deliberations focussed on universal values such as compassion and kindness (as key injunctions in the Qur’an). The increasing plight of those who suffer from organ failure thus shaped the discussions and shifted the discourse away from juridical considerations in classical Islam.

The fourth chapter discusses fatwas on biomedical research, comprising responses by the Fatwa Committee to the consultation papers of the Bioethics Advisory Committee Singapore. The issues presented in this chapter range from the use of human stem cells to cloning and genetic testing. Accordingly, these fatwas enter the domain of bioethical thought, away from discussions on points of Muslim law. In general, the fatwas have been supportive of biomedical research so long as it does not cause a clear harm and can secure the common good for society and humankind.

The fifth and final chapter discusses fatwas on therapeutic science and medication. A key issue is the status of ingredients in medical products, especially in medication (such as tablets) and vaccination. Because this involves consumption, the issue of purity and defilement becomes paramount. In many recent pharmaceutical advancements, the use of porcine sources has increased. Because Islamic law has clear rules on the consumption of pork and derivatives of pig, Muslims have raised questions on the permissibility of medical treatments that use products with porcine elements. The fatwas discuss several classical positions on the subject, but recognise a key difference in the nature of the material that is at the center of the debate. Whilst all classical positions discuss the use of pig or its derivatives in unprocessed forms, modern technology has enabled complex chemical processes that alter the nature of the substance. To what extent, therefore, should classical positions prevail? In this regard, the chapter proposes six principles on medication from the perspective of Islamic law and ethics. These include the avoidance of harm, the specific situation of ḍarura (exceptionalism), and securing good (maṣlaḥa). With particular reference to the nature of pig derivatives in medicine, the fatwas consider two classical concepts with contemporary relevance: istiḥāla and istihlāk. Several other medical- and health-related issues are also discussed, including Advanced Medical Directive (AMD), dialysis and smoking.

This first volume is the first in the fatwa compilation series to be published by Muis. The editorial and writing team hope to be able to publish subsequent volumes on other themes such as theology, acts of worship, and finance and inheritance. These subsequent volumes will adopt a similar approach, but with improvements and refinements based on feedback from readers of this volume. We hope that these efforts receive the blessings of Allah s.w.t. and further enhance the Muslim community’s understanding and practice of Islam, especially in its appreciation of an Islamic intellectual tradition: one that is founded on immutable principles but display courage and audacity to seek new solutions and chart new pathways for a better future.

Ahmad ibn Naqib al-Misri, Reliance of the Traveller, ed. and trans. Nuh Ha Mim Keller (Beltsville, Maryland: Amana Publications, 1994), viii. ↵

Ibid., 552. ↵

Quoted in Al-Raysuni, Ahmad, Imam al-Shatibi’s Theory of the Higher Objectives and Intents of Islamic Law (Kuala Lumpur: Islamic Book Trust, 2006), xviii. ↵

The jurist al-Mawardi discusses this in his influential work al-Ahkam al-Sultaniyya. See p.3-4. ↵

Quoted in Jasser Auda, Maqasid al-Shari’ah as Philosophy of Islamic Law (Kuala Lumpur: Islamic Book Trust, 2010), 186. ↵

Al-Raysuni, Ahmad, Imam al-Shatibi’s Theory of the Higher Objectives and Intents of Islamic Law,  xxiii. ↵

This is an approach accepted by many contemporary scholars such as Faisal Mawlawi and Yusuf al-Qaradawi. See Jasser Auda, Maqasid al-Sharī’a as Philosophy of Islamic Law (Kuala Lumpur: Islamic Book Trust, 2010), 187.   ↵

1

Fatwa Development and Management in Singapore

In the Islamic tradition, the Sharīʿa is a comprehensive law that is relevant for all times and places. This implies a need for the Sharīʿa to provide solutions for every contemporary issue, having the ultimate aim of engendering common good and preventing harm in society. This is achieved through its revealed texts (نصوص), legal principles (أصول), legal maxims (قواعد) and clear parameters (ضوابط).

The Sharīʿa is also guided by a set of higher objectives (maqāṣid al-sharīʿa), which are namely: the preservation of religion, life, intellect, wealth and lineage. These objectives encompass the most essential human necessities (ḍarūriyyāt), complementary needs (ḥājiyyāt) and those that complement the devotion and worship of the servant to his Lord (taḥsīniyyāt). To ensure that the development and application of Islamic law fosters the welfare of humankind, several factors should be considered by a faqīh. As described by the contemporary Muslim scholar, Shaikh Yūsuf al-Qaraḍāwī:

[T]he Islamic law was revealed to realise the well-being (maṣlaḥa) of humanity and to uphold justice amongst them. This should be considered (by a faqīh) when interpreting texts and applying laws. The views of a faqīh when issuing fatwas, educating, writing and developing the law should not be rigid our outdated (jumūd), as time, context, customs and circumstances change. In fact, it is obligatory upon him to consider the comprehensive higher objectives and goals of the Islamic Sharīʿa when ruling on substantive (juzʾī) matters. These are among the enabling factors which would provide space for the human mind to exercise ijtihād and reform when navigating life’s progress and modernity. [1]

The fatwa institution plays a very important role in the growth and development of the Muslim community by offering solutions to the contemporary challenges confronting them. This can be accomplished in accordance with the uṣūl (principles) of the Sharīʿa, derived primarily from the Qur’an and Sunnah.

In this context, the process of issuing fatwas (iftāʾ) becomes a noble and honorable task. However, this task is not devoid of challenges and risks, because a mufti, as stated by Imām al-Shāṭibī, is the heir and successor of the Prophet Muhammad (ﷺ), as well as the interpreter for the commands of Allah SWT.[2] Therefore, a mufti should not issue a ruling unless he is convinced that it is closest to the intent of the Lawgiver (i.e. Allah SWT). Fatwa also represents a process of ijtihād, a manifestation of the dynamism of Islamic jurisprudence and the Sharīʿa that seeks to remain relevant for all times.

This introduction discusses the development and management of the fatwa process in Singapore. As a cosmopolitan state, Singapore is constantly exposed to rapid and dynamic changes, and to the developments in science and technology, particularly in the field of medical science. Issues arising from these developments require guidance from the Fatwa Committee for the Muslim community. This imperative has also shaped and expanded the role of the Fatwa Committee of Muis.

At this juncture, it is only appropriate that we begin with a discussion of the classical principles and fundamentals of the Sharīʿa that continue to form the basis of the process of ijtihād, and the production of a fatwa that is cognisant of context. This includes an overview of Islamic law, its definition, and the roles of fatwas and the mufti.

PART I:  THE FATWA INSTITUTION IN ISLAM

Definition of Fatwa

The word fatwa comes from the root word fa-ta-ya ( فَ-تَ-يَ ) which means “to explain”. Semantically, fatwa also means “informing a point of law from a question; an answer to a question related to an unclear legal point.” [3] The verb aftā means “issuing a ruling by someone knowledgeable, concerning an issue.” [4]

As a terminology of Sharīʿa, it is, as described by a medieval scholar Ibn Hamdān:

الِإخبَارُ بِحُكمِ الله تَعَالَى عَن دَلِيلٍ شَرعِيٍّ

Informing Allah’s law from religious evidences. [5]

It is defined by another scholar al-Alūsī as “clarification of an issue concerning the Sharīʿa law.”[6]

From the definitions above, one can deduce four features that characterise a fatwa:

It is an answer to a question posed by the questioner.

The question is related to a religious issue.

The fatwa is issued by someone with relevant expertise and knowledge.

The fatwa is based on sharʿī evidences and the mufti’s knowledge of the evidences.

The features above distinguish a fatwa from other forms of religious positions and opinions such as taʿlīm, ijtihād and qaḍāʾ. Taʿlīm means teaching and imparting the rules on religious issues and its evidences. It is a general method of relaying rules, in reference to no specific issue. Therefore, taʿlīm does not consider the needs, difficulties or maṣlaḥa that might be faced by particular individuals.

Ijtihād, according to scholars of uṣūl, is an effort by a qualified individual (who has fulfilled the conditions of ijtihād), to develop a legal ruling or a solution to an issue, regardless of whether a question had been posed to him. Ijtihād can be done in matters involving religious issues or otherwise.  A fatwa includes the process of ijtihād, as we will detail in the following paragraphs.

Qaḍāʾ is a ruling made by a person appointed as a judge (qādi) in a particular case. His role is to preside over a legal dispute. A qādi’s decision is final and overrules all contesting opinions (khilāf) but the ruling is applicable only to the parties involved in the case as the judgment (qaḍāʾ) pertains only to the specific circumstances of that case.

The process of issuing a fatwa is important in preserving the continuity of ijtihād and the vitality of the Islamic legal system. The term fatwa and its concomitant functions have existed since the early history of Islam, as recorded in several verses of the Qur’an.

First, al-Nisāʾ verse 127:

وَيَسْتَفْتُونَكَ فِي النِّسَآءِ ۖ  قُلِ اللَّهُ يُفْتِيكُمْ فِيهِنَّ

“They ask your legal instruction concerning women (O Prophet Muhammad), say: “Allah gives you fatwā concerning them.” ( al-Nisā’: 127)

Second, al-Nisāʾ verse 176:

يَسْتَفْتُونَكَ قُلِ اللَّهُ يُفْتِيكُمْ فِي الْكَلَالَةِ

“They ask you for a fatwā (legal verdict). Say “Allah directs (thus) about al-kalālah (those who leave neither descendants as heirs). …” (al-Nisā’:176)

Third, al-Nahl verse 44 tasks the Messenger of Allah (ﷺ) to explain religion (thus issuing fatwas):

وَأَنزَلْنَا إِلَيْكَ الذِّكْرَ لِتُبَيِّنَ لِلنَّاسِ مَا نُزِّلَ إِلَيْهِمْ وَلَعَلَّهُمْ يَتَفَكَّرُونَ

“And We have (also) sent down to you (O Prophet Muhammad) the Dhikir [reminder and the advise (i.e. the Qur’an)], so that you may clear to men what is sent down upon them, and that they may give thought.” ( al-Nahl: 44)

Role of the Mufti and the Process of Issuing a Fatwa

As noted above, a fatwa is, in essence, an explanation of God’s law and how the law applies to human actions as referred to by the texts of the Sharī’a. On this basis, the position of the mufti is of such importance that most scholars describe it as “an interpreter of the meaning of God’s intent.”[7] Others have expressed the role of a mufti as “ a signatory of Allah the All-exalted”.[8] In this matter, Imām al-Shāṭibī states in his writings that:

The Mufti in the society assumes the role of the Prophet (ﷺ). There are numerous evidences for this: one of them is the naqli (textual) evidence of a hadīth that says: “The scholars are the heirs of the prophets, and the prophets do not bequeath dinar nor dirham, but they bequeath knowledge.

This is because a mufti continues to be a point of reference and plays a key role in delivering God’s laws to the community. Imām al-Nawawī mentions a similar concern in his outline of the risks involved in being a mufti:

Know that the act of issuing fatwa is a task of very high risk and danger, a position of great honour with many merits. This is because the Mufti is an inheritor of the Prophets peace and prayers be upon them and [the Mufti] is performing a far ḍ  kifāyah (collective responsibility). However, he [the Mufti] may be subject to error in his views, and this is why they say that a mufti is a signatory of Allah . [9]

The fatwa institution and the mufti command an honorable and noble position in the religion. However, the task of iftāʾ itself is a weighty and challenging responsibility in God’s measure. Such a responsibility must be exercised with the utmost commitment and diligence in order to preserve the tradition of ijtihād, particularly in the following aspects: [10]

First: Performing ijtihād to ensure the authenticity (thubῡtīyyah) of an evidence, its intended meaning (dilālah), and executing istinbāṭ by deriving a ruling from the evidence and mastering qiyās.

Second: Performing ijtihād to understand the question posed by the enquirer (mustaftī) by identifying the issue to be solved, its context and background. [11]

Third: Performing ijtihād to contextualise the application of a ruling derived from religious texts, for the mustaftī’s question, so as to ensure that the fatwa is relevant to resolve the issue.[12] This requires a systematic application of the methodologies of interpreting text developed by classical ‘ulamā, beyond the key sources of jurisprudence such as the Qur’an, Sunnah, Ijmāʿ and Qiyās. This includes concepts in uṣūl fiqh such as istiḥsān, istiṣlāḥ, istiṣḥāb, mazhab ṣaḥāba, sadd al-dharīʿa and others. Ultimately, a fatwa needs to look beyond mere adherence to scriptural analysis and evidential evaluation to take into account the circumstances and needs of the questioner. Therefore, contemporary fiqh methodologies developed by the ‘ulamā should be utilised.

This is based on the principle of moderation which underpins Islamic law itself; law should neither be burdensome nor susceptible to unbridled liberalism to the extent that its meaning and purpose is lost. It is also in line with the Sunnah imparted by the Messenger of Allah (ﷺ).

Therefore, a mufti should be able to provide solutions to issues faced by the people, facilitating them by resorting to concessions permitted by God’s law where applicable. A most pertinent example in this regard is the permissibility of lifting a prohibition in dire circumstances. In times of severe hardship, choosing the easier option is encouraged and preferred, as seen in the following Qur’anic verses:

يُرِيدُ اللَّهُ بِكُمُ الْيُسْرَ وَلَا يُرِيدُ بِكُمُ الْعُسْرَ

“… Allah intends for you ease, and He does not want to make things difficult for you…”( al-Baqara: 185)

And

وَمَا جَعَلَ عَلَيْكُمْ فِي الدِّينِ مِنْ حَرَجٍ

“… and He [Allah] has not laid upon you in religion any hardship.” ( al-Hāj: 78)

The task of interpreting God’s law is an arduous one. Hence, the individual who bears the duty must possess sufficient expertise and knowledge of the Sharīʿa, and, some assert, to the level of a mujtahid. Other scholars stipulate that he must possess expertise in the Qur’anic and hadīth sciences, such as nāsikh and mansūkh, mufaṣṣal and mujmal, ‘ām and khās, and muṭlaq and muqayyad as applied to the Qur’an. In addition, he is required to understand the opinions of the ‘ulamā among the earliest generations, including the companions, the tābiʿīn, classical jurists, as well as to comprehend issues that are agreed upon and those that are disputed (i.e. issues of khilāf) amongst them.

The diverse opinions of the ‘ulamā on the prerequisites of a mufti seek to ensure that those seeking to appoint a mufti – or those assuming the task – do not take it lightly. With the structured higher Islamic learning system today, many countries including Singapore require a recognised advanced degree (or degrees) in Islamic studies as proof of expertise before someone is appointed as mufti. This qualification is deemed adequate because the iftāʾ process in Singapore is a form of iftāʾ  jamāʿī, where the mufti does not issue personal fatwas nor religious guidance. The decision is derived together with members of the official Fatwa Committee, as explained below.

When we study the fatwas collected in this compilation, we will find that some fatwas have evolved. This evolution can be attributed to two things: changes in the context of those particular issues such as time, place, and norms; or changes in the composition of the Fatwa Committee members.

In terms of change in the context of the fatwa, this is based on a legal maxim recognised by the scholars of usūl, “taghayyur al-ahkām bi-taghayyur al-zamān wa al-makān” (rulings will change according to changes in time and localities). As the context of both the question and questioner are important in developing a fatwa, any changes in context may affect the ruling. As the context of both the question and questioner are important in developing a fatwa, any changes in context may affect the ruling. These changes could be caused by variations in the environment, practices, public acceptance, scientific and quantitative evidence, among others.

On the other hand, a shift in opinion due to the changing composition of the Fatwa Committee is an attribute of fatwa jamāʿī. The ‘ulamā in the committee may have different considerations and opinions when deducing a ruling, which is typical in the process of ijtihād. In fact, another legal maxim related to this posits “al-ijtihād la yunqaḍu bi al-ijtihād”, i.e. an opinion is not nullified by another, provided the ijtihād was performed by qualified scholars. What is meant here is that a preceding ijtihād is not wrong or inaccurate because a later ijtihād contradicts it, and those who wish to adopt it are not considered to have done wrong. However, in the context of fatwa, it is the latest fatwa that should be adopted, given that it takes into consideration the latest developments surrounding a given issue.

PART II:  SINGAPORE’S EXPERIENCE IN FATWA MANAGEMENT

Appointment of the Mufti

Official appointment of a mufti in society has been the practice of Muslims for centuries. This is recorded in the book al-Mausū’ah al-Fiqhiyyah under a brief chapter entitled “The Leader and Fatwa Matters” (الِإمَامُ وَشُئُونُ الفَتْوَى). It states that it is the responsibility of the country’s leader to appoint a qualified mufti for each region so he may provide religious guidance for its people. It further explains:

It is the responsibility of a leader to appoint muftis in remote areas should there be a need for such an appointment and when none (of the ‘ulama) are willing to issue fatwas voluntarily. The leader shall not appoint a person (as mufti) unless he is qualified, and he shall give reasonable remuneration and allocation from the provision of baitulmāl for the person carrying out this task. [13]

In Singapore, the appointment of a mufti and the establishment of the Fatwa Committee is formalised through the Administration of Muslim Law Act (AMLA) which came into effect in 1968. Officially, the AMLA forms Chapter 3 of the Statutes of the Republic of Singapore. [14] Before AMLA, Muslims in Singapore obtained fatwas from Singapore’s Chief Kadi,[15] local religious teachers, or looked to fatwas issued by the Mufti of Johor. [16]

In 1999, Muis established a new department called the Office of Mufti to assist the Mufti in religious matters, including in Muis’ public education programmes, research on fatwa matters, and to function as the Secretariat to the Fatwa Committee.

The Fatwa Committee

The task of issuing fatwas and the role of the mufti are increasingly becoming important in a rapidly changing world. As the task requires expertise in addition to a broad understanding of various disciplines, many countries adopt the concept of iftāʾ jamāʿī (collective fatwa) by forming a Fatwa Committee to assist the mufti so that rulings are deliberated upon comprehensively. Members of the Fatwa Committee and the Mufti complement one another in executing the task of issuing fatwas.[17] In Singapore, this Committee consists of:

Mufti as the Chairman

Two qualified members, appointed from among the members of the Muis Council. [18]

Two independent ‘ulamā, who are not from among the members of the Muis Council.

All members in the Committee are formally appointed by the President of the Republic of Singapore on the recommendation of Muis Council and the Minister-in-Charge of Muslim Affairs. Once formalised and approved, the appointment will be notified in the Government Gazette.

Since 1990, the Fatwa Committee has expanded its membership by appointing local religious teachers and ‘ulamā as associate members to participate in the Fatwa Committee deliberations. Beyond enriching the fatwa discussions, the associate membership also serves as a platform for training, exposure, and opportunity for younger religious graduates who may serve the Fatwa Committee in the future.

FATWA COMMITTEE CHART 

The Process of Fatwa Request

The Fatwa Committee generally determines its own procedures, including the frequency of meetings based on its needs.[19] Thus, frequency of its meetings may increase should there be questions which require more in-depth and complex discussions. The quorum of the meeting is fulfilled with the attendance of the Mufti as Chairman, and two other members of the Fatwa Committee – one of whom should not be a member of the Muis Council.

Anyone may pose a question to the Fatwa Committee seeking a fatwa in any religious issue. As set out in AMLA, the Fatwa Committee has the discretion to decide on the necessity of issuing a fatwa.[20] According to the current procedure, the Mufti as Chairman, is mandated by the Fatwa Committee to make such decisions on their behalf. Questions not submitted to the Fatwa Committee will then be answered by the Office of Mufti; such responses are termed as irsyād which refers to guidance and advice and is normally issued in two main forms:

Religious guidelines issued by the Office of Mufti on a particular issue that was not brought to the Fatwa Committee for discussion, because there is already adequate and appropriate guidance from existing works on the matter, or when there is an urgency to have an immediate religious position on a particular issue or;

The question was answered by the Muis Council because the Fatwa Committee was unable to reach a consensus.

Fatwa Jamā ʿī (Collective)[21]

Each fatwa issued by the Fatwa Committee is considered a fatwa jamā’ī (collective) and not fardī (individual). All fatwas issued have to be based on the unanimous decision of the Fatwa Committee. If no consensus is reached on a decision, a fatwa cannot be issued. Instead, the matter will be referred to the Muis Council for discussion, and an ensuring response is considered a religious guidance (irsyād) and not a fatwa.[22]

The process of fatwa-making in Singapore therefore differs from that usually found in the books of classical fiqh, in which any religious answer issued by an ‘alim or a faqīh is considered a fatwa.

Fatwa Discussion Process

The fatwa discussion process is based on the process of ijtihād, in accordance with the tradition established by scholars of uṣūl. It takes as its point of departure the primary sources of Qur’an, Sunnah, Ijmā’, and Qiyās, which is followed by other methodologies such as istiḥsān, istiṣḥāb, mazhab ṣaḥābah, sadd al-dharī’ah, urf and maṣāliḥ mursala. The Fatwa Committee has to ensure the soundness of the processes which it adopts. If there are discrepancies between the evidences, the Fatwa Committee issues a fatwa in favor of the arjaḥ (strongest) opinion while taking into account its implication in the context of Singapore at all times.

The AMLA stipulates that any fatwa issued should first be based upon the Shāfiʿī school of law. [23] However, if the preferred opinion of this school does not address the needs or does not fulfil the welfare and interest (maṣlaḥa) of the community, the opinions of other schools can be considered and adopted. [24] This is in line with the opinion of the scholars of uṣūl on the principles and processes of a fatwa, because the main objective is to achieve well-being and avoid harm for the community.

This approach emphasises the inter-connectedness of the mustaftī, his question, and the fatwa to be issued. It is important for those who issue fatwas to understand its effects on the questioner and other related parties.

The two approaches of ijtihād, namely tarjīḥī intiqāʾī and ibdā’ī inshāʾī, are observed in the discussions. Tarjīḥī intiqāʾī is used to examine the expansive scholarly heritage of the past and present in order to select the arjaḥ (strongest) view as fatwa. This comes after careful deliberation by examining and comparing the strength of each evidence, its positive effect, as well as the uṣūl and maqāṣid of the Sharīʿa. Ibdā’ī inshāʾī is observed in considering issues that have not been addressed in the fiqh tradition, especially for contemporary problems.

In observing ijtihād, the relevant legal maxims of fiqh(qawā’id al-fiqh) is invoked as a reference and guide. For example, Shaikh Yūsuf al-Qaraḍāwī listed in his book Fiqh al-Aqalliyyāt al-Muslimah the basic legal maxims that are critical in the context of a rapidly changing modern world.

These include the review of the definition of ḍarūra in the application of the legal maxim al-ḥājah tunazzal manzilah al-ḍarūra; even as the principles of maqāṣid al-sharīʿa are considered, the scope of ḍarūra is no longer limited to life and death situations alone. For example, in discussing the fatwa on cornea transplant (see chapter 3), quality of life is seriously considered in the definition of ḥāja. Other legal maxims such as al-mashaqqa tajlib al-taisīr (difficulty begets ease) and al-ḍarar yuzāl (harm is eliminated) further strengthen such an argument.

Proactive approach in fatwa discussions

The fatwa institution cannot detach itself from issues which are of concern to Muslims even if some of these issues have yet to occur. In today’s world, rapid developments are the norm in many spheres of life, even more so in science and technology. The fatwa institution is thus required to be proactive in its observations and views, lest it risks being irrelevant because of its inability to provide necessary guidance in a timely manner. Accordingly, the Fatwa Committee gives serious attention to a whole spectrum of emerging issues, such as on biomedical issues and ethics as seen in its submissions to the Bioethics Advisory Committee (BAC). [25]

Facilitativeness of Fatwas

The approach taken by the Fatwa Committee in determining a ruling is to facilitate the questioner and find a workable solution to the issue at hand, but only after considering the strength of its argument and evidences and reaching a consensus. This is to ensure that fatwa solves issues instead of complicating them, and that society will not be burdened with unnecessarily difficult or impractical rulings.

Interview with the Mustaftī

In order to obtain a fuller picture of the question raised, the Fatwa Committee may interview the mustaftī, either as individuals or, if an organisation or a group brings up the issue at hand, representatives of the said organisation or group.

Inclusion of experts in Fatwa discussions

Depending on the case at hand, the Fatwa Committee may invite experts in a particular field such as the life sciences, medicine, and finance, to provide expert information to enable the Fatwa Committee to obtain a more comprehensive understanding of the respective issues. Here, the exchange of knowledge among the members of the Fatwa Committee and these experts is vital to clarify doubts and ascertain facts so that the ensuing fatwa is based upon a robust understanding. Such exchanges may take the form of discussions, presentations, and/or detailed briefings by the experts.

Fatwa and its role in contemporary times

Fatwa becomes more crucial today due to our rapidly changing environment. In an interconnected world, each community is exposed to a variety of new issues that require rigorous religious scrutiny before the most appropriate religious position can be determined. Fatwas, in this case, play an important and significant role in the life of every Muslim, especially for a minority Muslim community in a secular, cosmopolitan, multi-ethnic and multi-religious country. The fatwa-making process is able to provide solutions to these challenges in line with the dynamic and flexible spirit of the Islamic Sharī’a. The fatwa-making process is able to provide solutions to these challenges in line with the dynamic and flexible spirit of the Islamic Sharī’a.

Accordingly, the fatwa institution needs to continuously improve and strengthen. The scholarship and expertise of its members need to be reinforced, and its understanding of current challenges bolstered further through discussions and debates. This includes developing familiarity with various new fields and industries in the traditional domains of the economy, science, medicine, politics, ethics and others. These efforts should go hand in hand with an ongoing training in fiqh and its fundamentals, and contemporary theories on the maqāṣid.

For this purpose, programs that enrich scholarly thinking are continuously organised by the Office of Mufti. Special workshops, many involving international Islamic scholars and thinkers, provide wider perspectives in fatwa-making, and discuss developments in Islamic studies, fiqh and its fundamentals.[26]

Al-Qaraḍāwī, Factors for Expansion and Flexibility in Islamic Shariah, (Dār al-Ṣaḥwah li al-Nashr, first ed., 1985). The following is the Arabic text:“فمن المعلوم أن أحكام الشريعة إنمـا جاءت لتحقيق مصالح العباد، وإقامـة القسط بينهم، وهـذا ما ينبغي مراعاتـه عـند تفسير النصوص وتطبيق الأحكام، فلا يجمد الفقيـه على موقف واحـد دائم يتخذه فـي الفتوى أو التعليم أو التأليف والتقنيـن، وإن تغيَّـر الزمان والمـكان والعـرف والحـال، بـل ينبغـي عليه مراعاة مقاصد الشريعة الكلية وأهدافها العامة عند الحكم في الأمور الجزئية الخاصة. وهكذا تركت هذه العوامل مجتمعة مجالاً واسعاً أمام العقل الإنساني كي يجتهد ويجدد لمواجهة تطور الحياة ومستجداتها.”↵

Al-Shāṭibī, al-Muwāfaqāt fī Usūl al-Aḥkām, vol. 4 (Damascus: Dār al-Fikr, 1922),140.↵

Edward William Lane, Arabic-English Lexicon, vol. 6 (Lahore: Islamic Book Centre, 1982) 2337. First published in English in 1877 by Williams and Norgate, London. ↵

Ibid, 2336. ↵

Ibn Ḥamdān, Ṣifa al-Fatwā wa Adab al-Muftī wa al-Mustaftī (Damascus: Al-Maktab Al-Islāmī, 1960) 4. See also Wizāra al-Awqāf wa al-Shuʾūn al-Islāmiyya, al-Mausūʿa al-Fiqhiyya, Vol. 32 (Egypt: Maṭābiʿ Dār al-Ṣafwa li al-Ṭibāʿa wa al-Nashr wa al-Tauzīʿ, 1995), 12 and ʿAbdullāh Ibn ʿAbd al-Muḥsin al-Turkī, Usūl Madhhab al-Imām Aīmad Dirāsa Usūliyya Muqārana, 725.↵

Al-Ālūsī, Shihābuddīn al-Sayyid Maḥmūd, Rūḥ al-Maʿānī fī Tafsīr al-Qurʾān al-ʿAẓīm wa al-Sabʿ al-Mathānī (Beirut: Dār Iḥyāʾ al-Turāth al-ʿArabī, 1999), 207. ↵

Quote by Imam al-Qarāfī. See al-Mausūʿa al-Fiqhiyya., Vol. 32, 23. ↵

Quote by Imam Ibn al-Qayyim al-Jauziyya. See al-Mausūʿah al-Fiqhiyyah, Vol. 32, 23. ↵

Al-Nawawī, al-Majmuʿ Sharḥ al-Muhadhdhab, Vol. 1, 40. The following is the Arabic text:“اعلم أن الإفتاء عظيم الخطر كبير الموقع كثير الفضل لأن المفتي وارث الأنبياء صلوات الله وسلامه عليهم وقائم بفرض الكفاية لكنه معرض للخطأ ولهذا قالوا المفتي موقع عن الله تعالى.”↵

Al-Mausūʿa al-Fiqhiyya, Vol. 32, 25.↵

This includes understanding the context and environment of the mustaftī. ↵

Meaning solving the problem in accordance with local practices and environment. ↵

Al-Mausūʿa al-Fiqhiyya, Vol. 32, 45. The following is the text in Arabic:“على الإمام نصب المفتين في المناطق المتباعدة إن ظهرت الحاجة ولم يوجد متبرّعون بالفتيا كما تقدّم ، ولا ينصب إلاّ من كان لذلك أهلاً وعليه الكفاية من بيت المال لمن يتفرّغ لذلك.”↵

Administration of Muslim Law Act (Cap 3, 2009 Rev Ed). ↵

The Singapore Chief Kadi was appointed by the Muslim and Hindu Endowment Board which was established in 1906, and later the Muslim Advisory Board set up in 1915. ↵

Syed Isa bin Muhamed bin Semait, “Perkembangan dan Peranan Institusi Fatwa di Singapura [The Development and Role of the Fatwa Institution in Singapore]”, in Mufti dan Fatwa di Negara-negara ASEAN, ed. Abdul Monir Yaacob and Wan Roslili Abd Majid (Kuala Lumpur: Institut Kemajuan Islam Malaysia, 1998) 146. ↵

The Mufti and the Fatwa Committee are supported by the Office of the Mufti as the Fatwa Secretariat. Before the establishment of the Office of the Mufti, each member of the Fatwa Committee was required to conduct individual research on the fatwa. However, after the establishment of the Office of the Mufti, the basic research for each issue is assisted and managed by officers from the Office of the Mufti. The Office of the Mufti is also responsible for helping the Mufti to issue religious guidance and irsyād that does not require a fatwa. ↵

With this condition, the government will ensure the appointment of at least two local ‘ulamā as members of the Muis Supreme Council in each term (three years). ↵

Administration of Muslim Law Act (Cap 3, 2009 Rev Ed) s 31(6) & (7) ↵

Administration of Muslim Law Act (Cap 3, 2009 Rev Ed) s 32(1), (2) & (3). ↵

Although in principle the Fatwa Committee is independent and not influenced by any entity, the Fatwa Committee in certain circumstances takes into account the studies and fatwas issued by other fatwa institutions if they are relevant to Singapore’s context. These institutions include Majmaʿ al-Buhūth al-Islāmīyyah, formed in 1961 under the auspices of al-Azhar, and Majmaʿ al-Fiqh al-Islāmī. which was formed in 1981 under the patronage of the OIC. These research bodies have conducted numerous studies which could be referred to and discussed in order to assist Fatwa Committee deliberations. ↵

For example, the Fatwa Committee did not agree on determining hisab and rukyah for the month of Ramadan in 1980. Eventually the Muis Supreme Council decided that the determination for Ramadan 1980 was to be done by hisab. ↵

Administration of Muslim Law Act (Cap 3, 2009 Rev Ed) s 33. ↵

Please refer to Fatwa Compilation 3, The Transfer of Wakaf (Endowment): Question: Can a wakaf property be sold and the proceeds used for (i) building another wakaf property (ii) constructing a building for the benefit of the Muslim community, such as Madrasah, Islamic Center and the like? Answer: In the event that a wakaf has to be sold for unavoidable reasons, then it can be sold, but it must replaced in kind using the proceeds. If it is not feasible to be replaced in kind, then it may be used for other types of endowments. It is permitted to use the proceeds of a wakaf am (general endowment) to build welfare houses for the Muslim community, or schools, or mosques. However if the wakaf was intended for a particular purpose, then the proceeds should be used for that purpose only. (Fatwa 20 March 1997). The position taken in this fatwa is not the position of Shāfiʿī school of law. ↵

For example, the response of the Fatwa Committee to the recommendations of the Bioethics Advisory Committee on Genetic Testing was decided at a Fatwa Committee meeting on 10 June 2005: The Fatwa Committee has discussed and examined the content of the proposal paper “Ethical, Legal and Social Issues in Genetic Testing and Genetics Research” by the Bioethics Advisory Committee Singapore. Following the discussion, the Fatwa Committee believes that in principle, all 24 recommendations in the paper on genetic testing medical ethics can be accepted because they are consistent with the principles of Islamic law and ʿurf. It is a technical issue that does not impose on the right of an individual, and does not contain elements of coercion. Accordingly, the Fatwa Committee views that genetic testing is permitted. The Fatwa Committee also stresses on some recommendations that might affect religious views, and that they should be further detailed and clarified. These are as follows: Recommendation 3: The Fatwa Committee welcomes this recommendation which stressed that genetic testing should be conducted voluntarily with no element of coercion. Recommendations 14 & 15: These recommendations raise the question on Prenatal Genetic Diagnostic in determining foetal deformities and identifying serious illnesses. Principally, the Fatwa Committee does not object to any individual undergoing Prenatal Genetic Diagnosis. However if the Prenatal Genetic Diagnosis uncovers deformities or serious illnesses on the foetus, the Fatwa Committee recommends Muslims to seek expert religious advice to avoid making decisions that violate the Islamic creed, the sharīʿa, and Islamic ethics. ↵

Among the programs organised were workshops on fatwa thinking with Prof. Mahmud Zuhdi, Prof. Quraish Shihab, and al-Sheikh Dr Amr al-Wirdānī (Director of Fatwa Academy, Egypt) in 2014, and  with the Mufti of Egypt, al-Shaikh Dr Shauqī ʿAllām and Prof. Dr Jasser Auda in early 2015. ↵

2

Family Planning and Reproductive Technology

وَمِنْ آيَاتِهِ أَنْ خَلَقَ لَكُم مِّنْ أَنفُسِكُمْ أَزْوَاجًا لِّتَسْكُنُوا إِلَيْهَا وَجَعَلَ بَيْنَكُم مَّوَدَّةً وَرَحْمَةً ۚ إِنَّ فِي ذَ‌ٰلِكَ لَآيَاتٍ لِّقَوْمٍ يَتَفَكَّرُونَ

“And among His signs is that He created for you partners from among yourselves, that you may find repose in them, and He put between you affection and mercy. Verily, in that are indeed signs for people who reflect.” (al-Rūm: 21)

The family institution is an important aspect of Muslim life. However, the path to building a family unit is not free from challenges. While some couples face difficulties in conceiving, others undertake family planning for a variety of reasons. Technological advances in health sciences have progressed far in providing solutions for both groups. With new techniques come about questions of religious permissibility. In these instances, rulings by the fatwa institution took into account, in addition to religious texts and sources, the society’s socio-economic conditions.

This approach is in line with maqāṣid al-sharīʿa, which, of particular interest here, establishes the protection of lineage and life.[1]Allah SWT states the following:

 وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ وَحَمَلْنَاهُمْ فِي الْبَرِّ وَالْبَحْرِ وَرَزَقْنَاهُم مِّنَ الطَّيِّبَاتِ

وَفَضَّلْنَاهُمْ عَلَىٰ كَثِيرٍ مِّمَّنْ خَلَقْنَا تَفْضِيلًا

“And indeed We have honoured the Children of Adam, and We have carried them on land and sea, and have provided them with at-tayyibāt (lawful good things), and have preferred them to many of those whom We have created with a marked preferment.”
(al-Isrā’: 70)

لَقَدْ خَلَقْنَا الْإِنسَانَ فِي أَحْسَنِ تَقْوِيمٍ

“Verily, We created man in the best stature (mould).” (at-Tīn: 4)

PART I
ISSUES RELATED TO FAMILY PLANNING 

Background

Issues about contraception and reproduction became increasingly prominent as the global population increased rapidly in a post-war baby boom.[2] In Singapore, there were concerns that the economy could not support such demographic growth. Initiatives to discourage procreation in Singapore emerged as early as 1949.[3]

At first, voluntary bodies such as the Family Planning Association of Singapore, a non-governmental organisation (NGO) established in 1949, spearheaded these campaigns. By 1966, the newly independent state had taken over this role[4] by establishing the Family Planning and Population Board (FPPB) to implement a raft of measures designed to limit family size. This board encouraged the use of new medical technologies for sterilisation, contraception and abortion.[5]

The use of contraceptives generated relatively less controversy among the Muslim community in Singapore. A study carried out in 1984 by the Institute of Southeast Asian Studies (ISEAS) and sponsored by the International Development Research Centre (IDRC), Canada, compared the fertility of various ethnic groups. The study found that Malays were the most knowledgeable about the availability of contraceptives among the three major ethnic groups surveyed. [6]  In addition, about 55% of the Malay couples surveyed used some form of contraception.[7]

Among the early contraceptive techniques introduced was the Intra-uterine Device (IUD). When it was first produced, IUDs were particularly controversial in the United States because it prevented the implantation of a fertilised egg in the uterus, which could be construed as a form of abortion.[8] In Singapore, in line with the government’s “Stop at Two” campaign which was first introduced in 1972,[9] the Malay press published several articles between 1971 to 1973 aimed at encouraging small families and the use of devices such as IUD. This generated heightened interest and concern among the Malay-Muslim community on contraceptive use. In 1976, Fatwa Committee was asked about the permissibility of using the IUD.

Fatwa Decision 31/5/1976
RULING ON INTRA-UTERINE DEVICE (IUD) AND CONTRACEPTIVE

Question:

The question asks the Fatwa Committee to explain the rulings on

(a) Intra-Uterine Device (IUD);
(b) Contraceptives.

Answer:

The Committee has examined these matters in depth and after deliberating in accordance with Islamic law, it has ruled that:

(a) Intra-Uterine Device (IUD) –  If it does not pose any harm and used with the husband’s consent, then it is permitted.

(b) Contraceptive –  If it does not pose any harm and used with the husband’s consent, then it is permitted.

The brief fatwa outlines several general conditions for the use of contraceptives. One such condition was that contraceptive devices must be safe for use and not cause any harm or danger. Despite scientific certainty at the time, the Fatwa Committee did not elaborate on the safety aspect, possibly due to the lack of information. The Fatwa Committee focused on two matters: the avoidance of danger and harm and the husband’s consent.

The issue of harm is stressed in the Shari’a based on the hadīth of the Prophet Muhammad (ﷺ):

لا ضرر ولا ضرار
 “Do not inflict harm nor repay harm with another.”
(Narrated by Ibn Mājah and al-Dāral-Quṭni).

According to this ruling, the husband and wife should both be aware of contraceptive use, and ensure that it does not result in harm. This harm includes possible health hazards to users, such as affecting the chances of having a baby in the future. This is further elaborated in the fatwa issued in 1987. 

The 1976 fatwa also stressed that the use of contraceptives requires the consent of the husband, possibly as these devices could be used by the wife without the husband’s knowledge. The rationale for this is that the husband and wife should make decisions on family planning and determining the number of children collectively. This stand is consistent with the decision made by the Islamic Fiqh Academy in 1988.[10]

Sterilization

Sterilization poses religious uncertainty as it differs from other methods of contraception. Tubal ligation was the most common method of sterilization. Initially, sterilization was considered irreversible.

In Singapore, this procedure was legalised in 1970.[11] It was targeted mainly at women, with cash incentives and paid sick leave given to women who chose to undergo this surgery voluntarily. In addition, until 1986, only children whose parents were sterilized before the age of forty were given priority in top primary school registration. Workers in the public sector were not allowed to receive maternity leave for their third child and subsequent children. [12] Sterilisation as a form of birth control was first mooted by Professor BH Sheares from the University of Malaya in 1959.[13] It met with objections from some segments of society especially Christian groups. However, this scheme continued until 1986.

In the early 1970s, there were some discussions in the Malay-Muslim community on the permissibility and safety of taking contraceptive drugs. This followed rumours that claim such medicines had harmful side effects.  A televised forum on family planning chaired by Sha’ari Tadin (then-Parliamentary Secretary in the Ministry of Culture) was held in 1972. Speaking on the forum too were Ustaz Haji Abu Bakar Hashim and Dr. Ghazali Ismail.[14] Muslim community leaders called for individuals to avoid sterilisation unless in life-threatening circumstances, without criticising the policy as a whole.

Fatwa Decision 19/12/1974
RULING ON STERILIZATION

Question:

The question posed is whether sterilization is prohibited or permissible. A woman wants to undergo ligation because she has four children, and if she gives birth to another, she will not be entitled to maternity leave and other educational benefits, and instead will be charged an accouchement fee.

Answer:

Sterilization is prohibited in Islam except in life threatening circumstance, or in cases of emergency.

Fatwa Decision 31/5/1976
RULING ON VASECTOMY AND STERILIZATION

Question:

The question asks the Fatwa Committee to explain the rulings for:

a) Vasectomy
b) Sterilisation

Answer:

The Committee, after examining these matters in depth and in accordance with the Islamic law, ruled as follows:

Vasectomy and Sterilization

According to Islamic law, these are prohibited, except for reasons of emergency.

In both the decision above dated 19 December 1974 and 31 May 1976, the Fatwa Committee issued decisions based on the specific techniques; vasectomy and sterilisation as prohibited, and IUD as permissible.

Family Planning Since the 1980s

A seminar was organised by Darul Arqam Singapore on 27 and 28 June 1987 entitled “Natural Family Planning and Abortion”. Questions on family planning thus resurfaced in 1987 as part of efforts to clarify the religious position on family planning for the Muslim community. This ruling provided more details on the Islamic principles and juristic base in determining the religious position on family planning.

Fatwa Decision 17/6/1987
RULING ON FAMILY PLANNING

Question:

What is Islam’s perspective on family planning?

 Answer:

Islam encourages its followers to marry. For men who could not afford to get married, they are encouraged to fast. Marriage allows mankind to continue his ancestry and to populate the earth. With the birth of children and the strengthening of the family’s foundation, marriage reinforces the spirit of helping amongst the community in their everyday lives.

Rasulullah (ﷺ) forbade Muslims from living celibate lives. Instead, he encouraged the ummah to marry as stated in his hadīth:

تَزَوَّجُوا الْوَدُوْدَ الْوَلُوْدَ فَإِنِّي مُكَاثِرٌ بِكُمُ اْلأُمَمُ يَوْمَ الْقِيَامَة 

“Marry a woman who could bear many children as I would be proud of you on the Day of Judgement for populating the ummah.“

 Rasulullah (ﷺ) also stated that :

اَلنِّكَاحُ سُنَّتِيْ فَمَنْ رَغِبَ عَنْ سُنَّتِيْ فَلَيْسَ مِنِّي 

“ Marriage is my way of life, So he who deviates from my way is not from me (not one of my followers)” Ibn Majah

In recent times, the issues of overpopulation have become a concern for many countries. Some of the concerns of overpopulation are issues such as the division of work, housing, education and other matters which affect the lives of the people.

Islam is a true religion. It is suitable for every place and time as it is a religion which is dynamic and not old-fashioned. It constantly gives “nur” (light) to Muslims who are righteous and provides them with spiritual and physical happiness.

Marriage, especially amongst young adults, is encouraged in many Qur’anic verses and hadīth so as to prevent them from committing adultery (zina) or giving in to their sexual urges. It also protects them from Satan’s distractions. Marriage also provides higher goals in life.

On the issue of family planning, we can find a similar situation in the time of the Prophet. In those days, some of the Prophet’s companions practised family planning with a method called “azal”, which is ejaculation outside of the woman’s womb to prevent pregnancy (coitus interruptus). When this matter was raised to the Prophet, he neither forbade nor encouraged it since the true intention of marriage is to conceive children. From a hadīth, it is understood that adopting the practice of “azal“, with the intention of spacing pregnancies, is permissible. In Surah al-Baqara, verse 233, Allah states:

وَالْوَالِدَاتُ يُرْضِعْنَ أَوْلَادَهُنَّ حَوْلَيْنِ كَامِلَيْنِ ۖ لِمَنْ أَرَادَ أَن يُتِمَّ الرَّضَاعَةَ

“The mothers shall give suck to their children for two whole years, (that is) for those (parents) who desire to complete the suckling term.” (al-Baqara: 233)

This verse signifies that the completion of a child’s suckling could bring about the good health of the child and that the period of suckling could last as long two years.

Jurists are of the following view: “To have sexual relations with a wife who is still suckling her child such that she could become pregnant again is highly discouraged. For fear that the pregnancy would bring about harm unto the health of the suckling child, it is then forbidden.”

From this, we understand that Islam encourages us to protect our babies from physical weaknesses and to care for them such that they become strong and healthy. Proper care of the child could only be ensured by spacing the next pregnancy, with at least two years between them. A hadīth states:

عَنْ عُمَرَ رَضِيَ اللهُ عَنْهُ، قَالَ نَهَى رَسُولُ اللهِ صلى الله عليه وسلم أَنْ نَعْزِلَ عَنِ الْحُرَّةِ إِلاَّ بِإِذْنِهَا² 

 ” Rasulullah (ﷺ) forbids a husband from performing “azal” when ejaculating without the permission of the wife who is a free woman.” Ibn Majah.

“This is because the relations between husband and wife would not be fulfilling and it is cruel towards one of the parties in this relationship. However, with the use of modern contraceptives, the process of “azal” is not necessary.”

From these statements, we can deduce that Islam prioritises quality over quantity. Muslim jurists believe that family planning practices, such as the consumption of pills or other forms of contraceptives, are temporarily permissible so long as these methods do not harm the health of the user. Contraceptives should not render the person barren but allow the person to plan his family with care and order.

Source:
1.Kumpulan Fatwa 1. Muis. First Edition
2 Muḥammad Bin Yazīd Bin Mājah al-Qazwīnī, Sunān Ibn Māja. Vol.1. (Beirut, Dār Al-Iḥyā Al-ʿArabī: 1975). Kitāb Nikāḥ, hadīth number 1928.

This later fatwa provided a more detailed istidlāl in explaining the evidence that permits family planning in Islam. For example, it highlighted the purpose and wisdom of marriage by relating it to the rationale for family planning. This reflects the Fatwa Committee’s emphasis on the intent of Sharī’a by underlining the purpose behind a particular ruling. The safety of contraceptive techniques was no longer touched upon as medical advancements in the 1980s reassuring on the safety of existing contraceptive techniques.

This thus illustrates that the Fatwa Committee kept track of developments in a particular issue so that its guidance remains pertinent to latest findings while being true to the fundamental ethical principle in Islam. Although the approach taken in determining opinions on family planning changed, the principle of protecting both mother and baby from harm remains consistent.

This fatwa also differentiated between temporary and permanent methods of family planning. A different ruling was made on permanent methods of family planning as those methods could cause permanent sterility.

Abortion

Abortion is defined as a procedure to medically remove a foetus from the womb. Abortion was illegal or discouraged in most parts of the world up to the 20th century. However, legal enforcement was uneven and attitudes towards abortion were divided.

Globally, the practice of terminating pregnancies, had existed long before its legalisation. This was mainly done through botanic or chemical abortifacients.[15] Cumin or jintan putih was one of the herbs commonly used by Malays and had an abortifacient effect if used during early stages of pregnancy.[16] In Europe, pennyroyal tea was often used to similar effect. Other herbs used for the same purpose were tansy, savin and opium.[17] In Germany, a tea blend of marjoram, thyme, parsley and lavender was used for the same purpose.[18] Although small amounts of these herbs are not necessarily poisonous, consuming them in large enough quantities or when blended with other herbs to induce abortions could be fatal. For example, in 1994, a young woman in California died after drinking a tea containing pennyroyal extract to induce an abortion.[19] She suffered a seizure when the recommended dose was exceeded.

Surgical methods of abortion such as the use of curettes and vacuum devices developed later, but these methods were not necessarily less dangerous.  Only in 1930 were safer ways to perform abortion developed.  Prior to that, it was still safer to give birth than to have an abortion even in countries like America.[20].

In countries where abortion was illegal, women tended to turn to unregulated abortionists at great risk to their lives. The availability of safe abortion techniques is highly related to society’s views towards abortion itself; whether a woman has the liberty of choosing between continuing with her pregnancy or terminating it.

Proponents of legalised abortions, often known as pro-choice, argue that decriminalising the procedure will offer a safer medicalised option to terminate pregnancies and save the mother’s lives.[21] The flip side of the pro-choice argument comes from a pro-life camp, which asserts that it is paramount to save the unborn life by not offering abortion as an option at all. Abortion remained illegal in many countries for most of the 20th century, largely on the grounds of this argument. However, from the 1960s onwards, many countries started legalising the procedure.[22]  There are some reasons for this shift: the rise of women’s rights movements, better technology to carry out abortions and population pressures from the post-war baby boom.

The decision whether to legalise abortion remains controversial in many societies. One significant area of contention is the question of when human life begins. The decision whether to legalise abortion remains controversial in many societies. One significant area of contention is the question of when human life begins. From a scientific perspective, this question has yet to be satisfactorily resolved. Arguments for a particular position tended to be linked to the development of sub-branches of science itself. From a neurological perspective, life begins at twenty-four to twenty-seven weeks in the womb with the start of discernible activity in the cerebral cortex as measured by an Electroencephalography (EEG).[23]  From an ecological perspective, the start of life is defined when the foetus can sustain itself outside its mother’s womb at around twenty-five weeks.[24] For genetics, life begins at conception as a fertilised egg contains a complete genome for a genetically unique individual.[25]

Although abortion was legalised in 1970 in Singapore, its legality was accompanied by disapproval of the practice among the malay muslim community. Abortion rates were seen as indicators of rising incidence of pre-marital sex, which is a major sin in Islam. In response to increasing abortion rates in the 1990s, several religious leaders in the Muslim community highlighted the importance of not engaging in extra-marital sex through education campaigns and forums, some with the help of the Singapore Planned Parenthood Association.[26] Likewise, church leaders in Singapore also largely disapproved of abortion.[27]

Two fatwa rulings on abortion were issued over a ten-year period, reflecting the corresponding scientific and social developments during this time.

Fatwa Decision 31/5/1976
RULING ON ABORTION

Question:

The Fatwa Committee was asked the ruling on abortion.

Answer:

The Committee has examined the matter in depth, and after deliberation in accordance with Islamic law, decided the following:

Originally, this act is prohibited, but it is allowed (in the following circumstances):

To save the life of the mother;

If the unborn child was conceived out of wedlock (with the condition that it has to be less than 120 days old i.e. before it develops into a foetus).

Fatwa Decision 11/12/1986
ABORTION

Question:

What is the Islamic view on abortion?

Answer:

Scholars agree that abortion after the fourth month is haram, it is in fact is a criminal act. Such an act is similar to killing a living, fully-formed being. Therefore Muslims are prohibited from it unless it is to save the mother’s life.

For abortion before four months, opinions of the ‘ulamā differ. This is because there are disagreements on whether the embryo/foetus is alive. The majority of ‘ulamā view that, based on medical evidence, it is alive; they consequently prohibit its abortion.

Since medical knowledge indicates that a foetus is alive from the point of conception (fertilisation of male and female cells), the Fatwa Committee has decided that abortion is prohibited, no matter the age of the embryo/foetus in the womb.

There is one key difference between the fatwas on abortion issued in 1976 and 1986.  The earlier fatwa allows abortions in cases where the mother’s life is at risk or, in cases of pregnancies outside marriage, for foetuses less than 120 days old. The later fatwa disallows abortion regardless of the age of the foetus unless the mother’s life is in danger, citing medical knowledge that a distinct genome is formed at the point of conception.

The crux of the matter lies in determining at which point life begins in the womb. The crux of the matter lies in determining at which point life begins in the womb. As mentioned in the 1976 fatwa, Muslim jurists differ on terminations of pregnancies less than 120 days long. The root of this difference goes back to determining whether, and at which point, an embryo or foetus holds the same status to that of a living human being, which then prohibits its termination. The sources of Islamic tradition do not clearly specify foetal development and growth. At the time, the technology that could determine this process (known as embryology) was not yet firmly established. The Fatwa Committee relied on Qur’anic verses and hadīth that mention the sanctity of life and the attributes of foetal growth and development. An example is the following Qur’anic verse:

وَلَقَدْ خَلَقْنَا الْإِنسَانَ مِن سُلَالَةٍ مِّن طِينٍ ۝ ثُمَّ جَعَلْنَاهُ نُطْفَةً فِي قَرَارٍ مَّكِينٍ  ۝ ثُمَّ خَلَقْنَا النُّطْفَةَ عَلَقَةً فَخَلَقْنَا الْعَلَقَةَ مُضْغَةً فَخَلَقْنَا الْمُضْغَةَ عِظَامًا فَكَسَوْنَا الْعِظَامَ لَحْمًا ثُمَّ أَنشَأْنَاهُ خَلْقًا آخَرَ ۚ فَتَبَارَكَ اللَّهُ أَحْسَنُ الْخَالِقِينَ

   “And indeed We created man (Adam) out of an extract of clay (water and earth). Thereafter We made him (the offspring of Adam) as a “nutfah” (mixed drops of the male and female sexual discharge and lodged it) in a safe lodging (womb of the woman). Then We made the “nuftah” into a clot (a piece of thick coagulated blood), then We made the clot into a lump of flesh, then We made out of that little lump of flesh bones, then We clothed the bones with flesh, and then We brought it forth as another creation. So blessed is Allah, the Best of creators” ( al-Muʾminūn: 12-14).

The verse above points to several stages of foetal growth in the womb. However, it mentions the attributes of, but not any specific duration for, each stage, nor did it state the markers that differentiate between each stage. The closest evidence that explains these stages is the hadīth reported by ʿAbdullāh Ibn Masʿūd RA which describes the moment when the soul is breathed into the foetus (known as nafkh al-rūḥ).

ِإِنَّ أَحَدَكُمْ يُجْمَعُ خَلْقُهُ فِي بَطْنِ أُمِّهِ أَرْبَعِينَ يَوْمًا نُطْفَةً ، ثُمَّ يَكُونُ عَلَقَةً مِثْلَ ذَلِكَ، ثُمَّ يَكُونُ مُضْغَةً مِثْلَ ذَلِكَ، ثُمَّ يُرْسِلُ اللَّهُ إِلَيْهِ الْمَلَكَ ، فَيَنْفُخُ فِيهِ الرُّوحَ وَيُؤْمَرُ بِأَرْبَعِ كَلِمَاتٍ : بِكَتْبِ رِزْقِهِ وَعَمَلِهِ وَأَجَلِهِ وَشَقِيٌّ أَوْ سَعِيدٌ

“Verily the creation of each one of you is brought together in his mother’s womb for forty days in the form of a drop, then he becomes a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows his soul into him and who is commanded with four matters: to write down his sustenance, his life span, his actions, and whether he will be happy or unhappy (i.e., whether or not he will enter Paradise)” (narrated by al-Bukhārī and Muslim).

Based on this hadith, most ‘ulamā view that the soul is breathed into the foetus after it reaches 120 days. Some others are of the view that all of the stages mentioned above occur in the first 40 days instead of 120 days, and so the soul is present by the 40th day. With the presence of soul, the foetus possesses certain rights that must be protected.

In addition to the above, it should be noted that the 1986 fatwa was published about a year after a large conference of Muslim scholars and scientists in Kuwait debated the issue of when human life begins. The findings were published in a 700-page volume.[28] While no consensus was reached, these findings clarified several major positions. Scientists at the conference generally argued that the zygote becomes human at the moment of conception or when implanted in the uterus because the foetus’ development thereafter is subjective. Religious scholars, on the other hand, were more comfortable with approximating a range of periods – from 40 to 120 days – rather than specifying a particular stage of pregnancy.[29] The fatwa issued in 1986 can thus be seen as in line with the findings of the seminar, and partly as an effort to mirror scientific developments.

PART II
EMERGING ISSUES

Assisted Reproduction and Test Tube Babies

Assisted reproduction underwent several revolutionary changes in the late 20th century. As the field of biological sciences developed, scientists began looking at alternative ways for human reproduction, partially motivated by the need to help infertile couples. These developments presaged experiments in cloning which involved transferring the nucleus from an embryo cell to an egg cell. These egg cells were implanted into a womb using in-vitro fertilisation methods and grew into the complete cloned organisms.

The availability of such techniques opened up new possibilities for solving infertility problems and regenerating diseased cells to cure illnesses. At the same time, they also opened up new ethical issues about the parentage and rights of humans and animals born from such methods. Muslims in Singapore shared those same concerns. The following section focuses on the public discourse and public policies surrounding these ethical issues in Singapore.

Artificial Insemination and Sperm Banks

When it comes to the application of assisted reproduction technology to humans, there was intense discussion of its ramifications among many religious communities in Singapore. In 1960, the Jewish Menorah Club organised a forum on artificial insemination, birth control and euthanasia, with panelists comprising prominent Jewish leaders such as David Marshall – who was also the Chief Minister of Singapore from 1955 to 1956 – and representatives of the Catholic and Anglican churches in Singapore.[30] The discussion produced no clear conclusions – some opposed the procedure while others took a neutral stance.[31] There were also concerns that siblings might not know each other if donor sperm was used during insemination, resulting in unintended incest.[32]

The procedure itself was legalised and made available to the public in Singapore in 1967. In line with the government’s stance towards limiting population growth in the 1970s, the procedure was not particularly encouraged. By 1975, at least 30 known inseminations had been done.[33] A sperm bank – the first in Southeast Asia – was set up in Singapore in 1977.[34] Two types of insemination were available: one using the husband’s sperm and the other using a donor’s sperm. The practice was tightly regulated, not highly encouraged and carried some social stigma; babies born from donor sperm technically had no legal status while doctors often discreetly selected donors with a physical resemblance to the husband.  The sperm bank itself was productive in assisting infertile couples and for research into curbing births.[35]

Fatwa Decision 19/12/1974
ARTIFICIAL INSEMINATION

Question:

What is the ruling on artificial insemination?

Answer:

Artificial insemination is permitted if the wife is the recipient of her husband’s sperm. However, using the sperm of another man other than her husband is forbidden.

This paved the way for many different permutations in parentage and implantation. It was then possible for people to not only have children with men or women who were not their spouses, but a couple also has the option to implant their fertilised egg into the womb of a stranger – often referred to as a surrogate – who would carry the child to term. This challenged traditional definitions of ‘father’ and ‘mother’, with the surrogate mother complicating claims to the child. An example of a negative response to reproductive technology is a newspaper article published in 1978, which reported some religious groups considering the act of bearing a test tube baby as “test tube adultery”. [36]  Furthermore, there were also concerns about the rights of the foetus and child conceived through this method. Some people questioned whether it was right to eliminate a deformed foetus from the in-vitro fertilisation. Other concerns include the possible commercialization of the technology that might exploit the needs of infertile couples by providing such services at a high price.[37] At that time, about 15 to 30 percent of married couples had fertility problems, and this problem increased as the median age a couple first marries rose.[38] In addition, egg donors were in short supply, and their emotions towards the possible birth of a child with their genes are hard to determine and manage.[39]

A debate also ensued in the area of research and the ethical use of embryos in such work. In November 1984, the Ministry of Health in Singapore ordered a temporary halt to research work in this area and formed a committee to discuss these issues. Subsequently, the Singapore Medical Association Committee on In-vitro fertilisation and the Obstetrics and Gynaecology Society of Singapore called for an In-vitro Fertilisation Review Board in Singapore to be formed in order to license and monitor the research in these centres. They strongly supported research on the cryopreservation of embryos and for experiments to be conducted on them.[40]

Muslim religious leaders in Singapore took the view that they should keep up with scientific development, and not impede it or remain ignorant.[41]  The fatwa ruling on this issue, which came out five years after the birth of the first test-tube baby, took into account both concerns by forbidding in-vitro fertilisation involving donors and surrogates but permitting the procedure when used by married couples.

Fatwa Decision 8/3/1983
TEST TUBE BABIES

Question:

What is the Islamic view on test tube babies?

Answer:

The Islamic law on matters related to the test tube babies are as follow:

1) A Muslim donating his sperm to the sperm bank: prohibited.

2) A Muslim man giving his sperm to his wife through the test tube method (internal insemination) if his wife is unable to conceive normally: permitted.

3) A Muslim woman who becomes pregnant from sperm other than her husband’s, which was obtained from the sperm bank because her husband’s sperm is not suitable for conceiving a child: prohibited.

4) A Muslim woman who becomes pregnant with an egg donated by a second woman, which was fertilised by the first woman’s husband’s sperm because her egg is not suitable for conceiving a child: prohibited.

5) The sperm and egg from husband and wife were fertilised externally and then inserted into the womb of the wife, because she could not get pregnant through normal intercourse due to damage to the ovum channels: permitted.

6) For the purposes above, the husband’s sperm can be collected either by ‘azal (coitus interruptus); or from the wife’s vagina, or by masturbation, but these must be observed with a legitimate wife in accordance with Islamic law.

This position was further refined when the Fatwa Committee prohibited the use of banked sperm to conceive a child after the death of the sperm owner. This was in response to a case which took place in Boston, Massachusetts in 2002, when the Social Service Administration refused to recognise a set of twins born by using a man’s frozen sperm after his death as his legal heirs.[42]

Fatwa Decision 25/6/2002
FROZEN SPERM FROM A DECEASED HUSBAND

Question:

The Office of Mufti executive informed the Fatwa Committee about an article titled “Gift of life from the dead wrapped in legal problems” published in The Straits Times on 17 January 2002.  The article discussed the case of a husband of a woman named Lauren Woodwards who died from leukaemia in 1993. Two years after the death of her husband, the woman used her husband’s frozen sperm to get pregnant, and gave birth to a pair of twins. As the issue had already become a reality, the ‘ulamā will be asked to provide religious guidance on the matter. The article is also attached for the benefit of the Fatwa Committee.

Answer:

After deliberation, the Fatwa Committee ruled that inserting a husband’s sperm into the uterus after his death is prohibited. The ‘illah (reasoning) for the prohibition is that the woman in this case is no longer the wife of the deceased. The husband-wife relationship is terminated with the death of one of them. Similar views have been expressed by both past and present jurists. The latest discussion was held by the Islamic Research Academy in Egypt. Among those present at the discussion was The Sheikh Al-Azhar Dr. Muhammad Syed Tantawi, Sheikh Mahmood Hamdi Zaqzuq and the Mufti of Egypt Sheikh Nasr Farid Wasil. The conference issued the following fatwa:

وَضَعَ مَاءُ الزَوْجِ فِي رَحْمِ زَوجَتِهِ بَعْدَ وَفَاتِهِ حَرَامٌ شَرعًا، لِأَنَّهَا لَم تعد زوجة للمتوفى ¹

 “Placing the husband’s sperm in the womb of the wife after his death is forbidden in Islamic law, because she is no longer the wife of the deceased.”

They also issued a fatwa deeming the action as prohibited in religion by stating:

وَهَذَا الفِعلُ مُحَرَّمٌ شَرعًا لِأنَّهً يَتَضَمَّنُ وَضَعَ حَيَوَانَاتُ مُنَوِّيَةُ مِن رَجُلٍ فِي رَحمِ امْرَأَة صَارَت أَجْنَبِيَّة عَنْه وَقَد قَطَعَ المَوْت مَا بَيْنَهُمَا 2

This act is prohibited in Islamic jurisprudence because it is placing the sperm into the uterus of a woman who is foreign to him; the relationship between them was terminated by his death.

Source:
¹ Fatwa issued by Majmaʿ Buḥūth Al-Islāmiyya Egypt, April 2, 2001. See: http://articles.islamweb.net/media/index.php?page=article&lang=A&id=1073

² Ibid.

In essence, artificial and in-vitro insemination drew controversy not because of the technology per se but due to concerns about how such methods impact the creation of a traditional nuclear family with clear lineage. Such techniques could potentially be used to facilitate the mixing of genes of men and women who are not bound by a valid marriage, consequently making parentage ambiguous and impacting inheritance laws. However, given the declining birth rate from the 1990s and the number of couples who were getting married at a later age, artificial insemination technologies also helped to boost the birth rate by assisting married couples with fertility problems. Therefore, Singapore and the Muslim community chose to regulate rather than prohibit the practice.

Conclusion

The progression of fatwas on family planning shows gradual revisions due to new developments and changing contexts. This is common in the process of producing rulings and fatwas, as fatwas are ijtihādī in nature, and muftis and jurists have always taken into account context in order to provide solutions to various issues. This approach also leads to continually evolving religious views.

In the case of family planning and reproduction, the initial approach (before the rapid development of medicine) is to usually prohibit certain actions due to safety concerns and uncertainties as to its efficacy. However, as medical advancements developed, and the safety and effectiveness of these solutions became more established, the fatwa adapts accordingly. The permissibility is tied to stringent requirements in line with the understanding of maqāṣid al-sharīʿa, which includes the preservation of life, and also in line with the higher objective of Islam that honors mankind and secures its welfare and interests.

Please refer to Chapter 4  in respect to scientific and bio-technological research using human tissue. ↵

The world's population is expected to increase in the next century. This will attract global attention on reproductive issues, and impact religious rulings and fatwas. ↵

Yap Mui Teng, “Singapore: Population Policies and Programs” in Warren C. Robinson and John A. Ross, The global family planning revolution: three decades of population policies and programs (World Bank Publications, 2007), 201–219. ↵

Yap Mui Teng, “Singapore: Population Policies and Programs”, (2007), 201. ↵

United Nations Fund, Population Profiles 1: Singapore. United Nations Fund for Population Activities, (1977), (1977), 16-31. ↵

Eddie C.Y Kuo dan Chiew Seen Kong, Ethnicity and Fertility in Singapore, (Singapore:  Institute of Southeast Asian Studies, 1984). ↵

Ibid. ↵

Pam Belluck dan Erik Eckholm, “Religious Groups Equate Some Contraceptives with Abortion.” The New York Times, February 17, 2012. Accessed on 3 March 2015. http://www.nytimes.com/2012/02/17/health/religious-groups-equate-some-contraceptives-with-abortion.html?_r=0. ↵

The "Stop at Two" family planning campaign was introduced in 1972, especially following Singapore’s independence when the birth rate shot up after World War II. For fear of rising costs from uncontrolled birth rate, the campaign was deemed necessary by the government as a nation-building project. Various measures were implemented, with certain policies enforced on 1 August 1973, including; (i) the reduction of income tax relief to cover only the first three children; (ii) an increase in accouchement fees in government hospitals; (iii) exemption from accouchement fees and other charges for the fourth child provided that either the husband or wife undergo sterilisation after the birth; (iv) reducing paid maternity leave from three to two; and (v) lower priority for larger families in the Housing and Development Board (HDB) waiting list. In addition, between 1973 and 1974, the IEC Unit introduced the campaign “Family Life and Population Education” in the primary school curriculum, and distributed publicity materials which reflected the SFPPB campaign slogan “Girl or Boy, Two is Enough” which were printed on the Public Utilities Board (PUB) paper bills, as well as the Postal Department stamps in August and September 1974. The campaign proved successful as the birth rate dropped to 17.7 per 1,000 inhabitants in the following year, which was below the target of 18.0 births. The campaign continued until the late 1980s when the declining birth began to cause concern. The announcement in 1987 by the then-Deputy Prime Minister Goh Chok Tong encouraged parents to have three or more children if they could afford it. In August 2004, Prime Minister Lee Hsien Loong introduced new incentives and financial benefits for every child born to address the declining birth rate. Despite that, Singapore's birth rate remains low at less than 10 births per 1,000 population, with a fertility rate of 1.19 in 2013. See: http://eresources.nlb.gov.sg/history/events/eea3d96d-93aa-455a-ac8a-1564d1b6d215. ↵

The decision to temporarily postpone a pregnancy is permitted if necessary and for reasons accepted by Islamic law, as long as there is agreement between the husband and wife, and the methods used do not cause any harm and do not eliminate any existing pregnancy. This 1976 fatwa preceded the OIC decision by more than a decade. Extracted from Resolution 39, the fifth Daurah of Majmaʿal-Fiqh al-Islāmī, 10-15 December 1988, Kuwait. http://www.fiqhacademy.org.sa/qrarat/5-1.htm↵

Theresa Wong dan Brenda S.A. Yeoh, “Fertility and the Family: An Overview of Pro-natalist Population Policies in Singapore.” Asian Metacenter Research Paper Series 12 (2003). ↵

Yap Mui Teng, “Singapore's Three or More Policy: The First Five Years,” Asia-Pacific Population Journal Vol. 10:4, (1995), 39–52. ↵

“Sterilisation? It’s vile, immoral and degrading,” The Straits Times July 3, 1959. ↵

“Jarang beranak dengan makan pil tak merbahaya,” Berita Harian, July 25, 1972. ↵

John M. Riddle, Contraception and abortion from the ancient world to the Renaissance. (Cambridge: Harvard University Press, 1992) 21-56. ↵

Mohamad Zakaria Mustafa Ali Mohd, Traditional Malay Medicinal Plants. (Kuala Lumpur: Institute Terjemahan Negara Sendirian Berhad, 2010) 139-140. ↵

Ibid. ↵

Kathleen London, “The History of Birth Control,” in The Changing American Family: Historical and Comparative Perspectives, Yale-New Haven Teachers Institute, (1982). ↵

Gordon Young, “Lifestyle on Trial,” Metro, December 14, 1995. Accessed on November 9, 2015 http://www.metroactive.com/papers/metro/12.14.95/pennyroyal-9550.html↵

J. Lewis, and Jon O. Shimabukuro, “Abortion Law Development: A Brief Overview,” Congressional Research Service, January 28, 2001. Accessed on March 3, 2015.http://www.policyalmanac.org/culture/archive/crs_abortion_overview.shtml↵

James A. Holstein and Jaber F. Gubrium, Handbook of Constructionist Research (New York: Guilford Press, 2008). ↵

Britain passed the Abortion Act in 1967. In the United States, Roe vs Wade paved the way for the country's government to allow abortions in 1973. In Japan, abortion has generally been accepted since the late 1940s. See: Marlene LeGates, In Their Time: A History of Feminism in Western Society (London: Routledge, 2001), 363-364. ↵

Kanwaljeet J.S, Anand dan P.R Hickey, “Pain and its effects on the Human Neonate.” in The New England Journal of Medicine, Vol.  317:21, (1987), 1321-1329. The alternative neurology view holds that life begins in the fourth to eighth week with the first signs of brain waves in the brain stem. ↵

Oladele O. Arowolo, Human Rights in Life and Death: Basic Considerations for Development Planning.( Xlibris Publishers, 2010) ↵

Ibid. ↵

“Sex in Islam only for married couples,” The Straits Times., April 18, 1995, 55. ↵

For example, in 1971, a Jesuit priest wrote to The Straits Times criticising a sex education forum for not being honest about the effects of contraceptive use, and for encouraging an unhealthy lifestyle. ↵

The symposium organised by the Islamic Organisation for Medical Sciences was titled “Human Life: Its Beginning and Its End from an Islamic Perspective.” It was the second in a series of symposiums held by the organisation under the theme “Islam and the Contemporary Medical Concerns.” ↵

Mohamed Ghaly (2012) “The Beginning of Human Life: Islamic Bioethical Perspectives.” Zygon: Journal of Religion and Science 47:1, pp. 175-213 ↵

“Mercy Killing - One of the Subjects for Debate,” The Straits Times, April 25, 1960. ↵

“There is point in living even if there is no hope - by Mrs S,” The Singapore Free Press, April 30, 1960. ↵

“Some dangers of artificial insemination.,” The Straits Times, August 25, 1977. ↵

“Demand for test-tube babies likely to increase,” The Straits Times, June 19, 1975. ↵

“Singapore Sperm Bank,” New Nation, July 30, 1977 and “No lack of donors for Sperm Bank” New Nation, August 1, 1977. ↵

The founder of the sperm bank, Professor Christopher Chen, discovered an antigen in sperms that has the potential to be used and developed as a contraceptive in vaccine form. ↵

“Test-tube babies: S’pore can do it but moral issues come first,” The Straits Times, October 8, 1978. ↵

“What about emotions?” The Straits Times, October 8, 1978, 5.  See also “$25000 to have a test tube baby,” Singapore Monitor, March 8, 1983, 6. ↵

“Singapore's other test tube baby pioneer,” Singapore Monitor, August 30, 1983, 6. ↵

“What about emotions?” The Straits Times, October 8, 1978, 5. ↵

"Doctors propose panel for test tube babies," Singapore Monitor, April 21, 1985, 2. See also "Freeze on test-tube baby experiments," Singapore Monitor, November 6, 1984, 4. ↵

See “Kelahiran bayi tabung uji. timbulkan banyak persoalan [Test tube births raise many questions],” Berita Harian, August 12, 1978. ↵

“Kids conceived after Dad’s death are rightful heirs," The Straits Times, January 4, 2002. ↵

3

Organ Donation and Transplantation

 مِنْ أَجْلِ ذَ ‌ٰلِكَ كَتَبْنَا عَلَىٰ بَنِي إِسْرَآئِيلَ أَنَّهُ مَن قَتَلَ نَفْسًا بِغَيْرِ نَفْسٍ أَوْ فَسَادٍ فِي الْأَرْضِ فَكَأَنَّمَا قَتَلَ النَّاسَ جَمِيعًا وَمَنْ أَحْيَاهَا فَكَأَنَّمَا أَحْيَا النَّاسَ جَمِيعًا ۚ وَلَقَدْ جَآءَتْهُمْ رُسُلُنَا بِالْبَيِّنَاتِ ثُمَّ إِنَّ كَثِيرًا مِّنْهُم بَعْدَ ذَ ‌ٰلِكَ فِي الْأَرْضِ لَمُسْرِفُونَ

“Because of that, We ordained for the Children of Israel that if anyone killed a person not in retaliation of murder, or to spread mischief in the land- it would be as if he killed all mankind, and if anyone saved a life, it would be as if he saved the life of all mankind. And indeed, there came to them Our messengers with clear proofs, evidences, and signs, even then after that many of them continued to exceed the limits in the land.”
(al-Māi’dah: 32).

Organ donation has been a controversial issue among the Muslim community in Singapore. It places two main principles in Islam – the importance of maintaining and improving the health and well-being of humans, and the duty to respect the inviolability of the dead – in conflict. This chapter will trace the evolution of the organ transplant fatwa and its formulation, and highlight the debates on the interpretations of Islamic principles vis a vis organ donation, and considerations of the needs of the society and medical advancements. Resolving the Islamic legal position is complex because organ donation is a modern development and there is no direct parallel of this medical procedure in Islamic legal history. The debate thus took into account the various branches of Islamic law, national legislation, as well as ethical and medical viewpoints on the status of the human body.

Background & History of Organ Donation

The idea of healing by substituting a healthy body part for a diseased or absent one, first emerged in the 1600s when early attempts at blood transfusions were made. These attempts were first made on animals and with consequent experiments, more about the circulatory system was discovered gradually such that it could eventually be adapted for humans.  The risks and high failure rate associated with such procedures caused mainstream physicians to shun their use until Karl Landsteiner – a physician and biologist – mitigated such risks through his discovery of blood types in 1901. Subsequently, blood transfusion and banking became widely used in medical science, gaining even more traction due to its necessity during the two World Wars. The concept of medical substitutions was later extended to organs. [1] The first successful organ transplant was carried out on the kidneys of a pair of identical twins in 1954.[2]

Successful transplants of the cornea, lungs, heart and liver quickly followed. Such developments provoked discussion in the Muslim world on two fronts: the permissibility of the act of medical transplants itself and the permissibility of using human bodies for the research necessary to find medical cures. Leaders of the Muslim community in Singapore tackled the latter first but found it difficult to arrive at a conclusion. The first meeting of the Fatwa Committee to discuss the use of human bodies in medical research took place in 1972 and failed to reach a unanimous consensus. In that meeting, majority of the Committee members agreed that the ruling is mubāh (permissible but not obligatory) on the basis that medical research can be beneficial and procedures such as autopsies are necessary. However, two members of the committee abstained.[3]  Another extensive discussion on the issue of the permissibility of organ transplants ensued in 1973. In that meeting, the Committee unanimously concluded upon its impermissibility, regardless of whether the donors pledged their organ voluntarily or unwillingly, and whether the transplant was done on a living or dead donor.[4]  The rationale here was that respect for the sanctity of the body, entrusted to man by God, and the risks in transplant operations supersede potential benefits.

Fatwa Decision 31/7/1973
RULING ON DONATION ORGAN AFTER DEATH

Question:

What is the ruling for a Muslim to donate some of his organs to others after his death?

Answer:

The Fatwa Committee in this meeting unanimously prohibit organ donation, whether the donor is alive or otherwise. The evidences that form this decision according to the hadīth of the Prophet(ﷺ) and the Qur’an are as follows:

Donation when the person is alive is prohibited.

The reasons:

Based on Allah’s statement in Surah al-Baqara, verse 195,

وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِۛوَأَحْسِنُوا

“And do not throw yourselves into destruction and do good.” ( al-Baqara:195)

2. Based on a maxim of fiqh which states that,

 الضَرَرُ لَا يُزَالُ بِالضَرَرِ
 “Harm is not removed by harm.”¹

3. The body and its organs are entrusted by Allah s.w.t. to man. Each one of them will be questioned on the Day of Judgement. Allah states in Surah al-Isrā’, verse 36:

 إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا
“Verily, the hearing, and the sight, and the heart, each of those will be questioned (by Allah)”. ( al-Isrā’: 36)

Donation after death (through a will) is prohibited 

The reasons:

Every body that can be buried should be buried. Allah states in Surah al-Mursalāt, verses 25-26,

  أَلَمْ نَجْعَلِ الْأَرْضَ كِفَاتًا ۝ أَحْيَاءً وَأَمْوَاتًا
“Have we not made the earth a receptacle. For the living and the dead”. (al-Mursalāt: 25-26)

And Allah states in Surah ‘Abasa, verse 21,

 ثُمَّ أَمَاتَهُ فَأَقْبَرَهُ 
”Then He causes him to die and puts him in his grave”. ( ’Abasa: 21)

The sanctity of the human body is assured in its burial. If a particular organ is given to others, it means that it is not buried. Therefore, the whole body could also be given and not buried.

From the hadīth of ‘Aisyah r.a. where Rasulullah (ﷺ) had stated,

كَسْرُ عَظْمِ الْمَيِّتِ كَكَسْرِهِ حَيًّا
“Breaking the bones of a dead is like breaking them while he was alive.”- hadīth narrated by Abū Dawūd.

i) From the book “Al-Majmu’ (New Edition)”, Chapter 5- under the heading “Carrying and burying the dead”.
ii) Muwaṭṭa’ Ibn Mālik

To cut off a body part of the dead is also defined as hurting men and women who are mu’min [believers]. The ruling is harām. Allah states this in his Surah al-Ahzāb, verse 58:

وَالَّذِينَ يُؤْذُونَ الْمُؤْمِنِينَ وَالْمُؤْمِنَاتِ بِغَيْرِ مَا اكْتَسَبُوا فَقَدِ احْتَمَلُوا بُهْتَانًا وَإِثْمًا مُّبِينًا

“And those who hurt believing men and women undeservedly, they bear (on themselves) the crime of slander and plain sin.” ( al-Ahzāb: 58)

Based on the argument that:

الضَرَر لَا يُزَالُ بِالضَّررِ
”Harm is not removed by harm.”²

Since the extraction of an organ from the body of a dead person damages the body, it is deemed a desecration of the body. This is because there is no assurance that the extracted organ provides a benefit that is larger than the magnitude of the desecration. In contrast, the religious obligation of burying and respecting the dead is based upon clear and evident naṣ [text] as well as it being a deed that has been practised by mankind for thousands of years, apart from a small percentage of men.

When it is haram, the deceased’s will be invalidated because Muslims are unable to carry out his will under Islamic law. This is because we have a stronger ordinance– from Allah and His Messenger (ﷺ) – to bury the remains with all its parts intact without exception, and honoring all the body parts as entrusted by God.

Respect for the dead was commonly practiced by the Prophet (ﷺ). The Prophet always stood up in respect of the dead that was carried past him, even it was a kafir [non-believer].

Sayyid Sabiq had quoted in the chapter of Jenazah in “Fiqhus Sunnah” the words of Ibn Hazam, who stated that:

“It is good to stand when a dead is carried past, even if the dead was a kafir.”

Imām al-Bukhārī and Muslim had narrated from Sahl Ibn Hanif, and Qais Ibn Sa‘ad narrated that once when they were seated in front of the Al-Qadisiah area, a body was being carried past and they stood (to respect him). When the people around them said that the body was that of a kafir dhimmi, they replied: “Rasulullah (ﷺ) once stood to respect the body of a deceased person which was being carried past. Then he was told: “It is the body of a Jew.” To which he replied: “Is it still not a life?” Based on this, Islam does not humiliate or disrespect the dead even if the bodies are those of non-Muslims because Allah says:

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ
”And indeed We have honoured the Children of Adam”. (al-Isrā’:70)

Therefore, how do we justify the act of dismembering or cutting up a dead body without reasons acknowledged by the Sharīʿa?

Additionally, the Mufti advised:

Organ donation is not a deed recognized by Sharīʿa for the following reasons:
i) No text or evidence allow such an act as organ donation. Instead there is only evidence of its prohibition.
ii) Based on the hadīth:

 إذَا مَاتَ ابْنُ آدَمَ انْقَطَعَ عَمَلُهُ إلَّا مِنْ ثَلَاثٍ : صَدَقَةٍ جَارِيَةٍ ، أَوْ عِلْمٍ يُنْتَفَعُ بِهِ مِنْ بَعْدِهِ ، أَوْ وَلَدٍ صَالِحٍ يَدْعُو لَهُ
“If the son of Adam dies, his deeds are cut off except for three acts: Lasting charity (i.e. endowment), or beneficial knowledge, or a pious child who prays for him. Narrated by al-Bukhari and Muslim.

This hadīth excludes organ donation as a charity, because it specifically mentions the three things – namely lasting charities, such as endowments or the bequest of wealth if one possesses such wealth – of which only a third of it can be bequested, a pious child, and beneficial knowledge that has been imparted to others.

The Prophet thus encouraged Muslims to seek wealth that would enable them to perform charity, raise their children to be pious individuals who would pray for their parents, and seek useful knowledge to be imparted to others. These are the required services and deeds which have been enjoined upon us. Let us not engage in unworthy matters because God has said:

 وَلَا تَقْفُ مَا لَيْسَ لَكَ بِهِ عِلْمٌ ۚ إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا
“And follow not (O man i.e., say not, or do not or witness not) that of which you have no knowledge. Verily, the hearing, and the sight, and the heart, of each of those one will questioned (by Allah)”. (al-Isrā’: 36)

Religion is Allah’s right, thus when issuing a fatwa or a religious ruling, the pleasure of Allah s.w.t and His Messenger (ﷺ) is sought first before the pleasure of men.

Source:
1 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 210
2 Ibid.

Among the Fatwa Committee’s arguments in the first fatwa on organ donation is the consideration of maṣlaḥa and mafsada, and the extent to which either reaches the rank of certainty and clarity (معتبرة). This discussion needs to be situated in its social context. At the time, organ donation was new, and the Muslim world in general was not ready to accept it. Furthermore, the effectiveness of organ transplantation as a treatment was uncertain. Therefore, the Fatwa Committee was more inclined to take a cautious and careful stand, and decided against it. The Muslim community in Singapore at that time could generally relate to this fatwa although a small segment disagreed with the decision. For example, some of them stressed on the necessity of certain organ transplants.

One of those who expressed disagreement with this fatwa was a Singaporean Muslim intellectual Dr Syed Hussein Alatas who shared his views on the need for cornea transplants in the local Malay paper Berita Harian. The Fatwa Committee responded to his writing, and the debate continued through exchanges on the newspaper forum which lasted for a few weeks. The result was published in a booklet which Alatas authored entitled “Biarkan Buta – (Let (them) be blind)”, in which he argued that the fatwa was based on a literalist interpretation of Islam and was regressive by disallowing procedures that could potentially improve the welfare of the sick and disabled.

There were many factors considered by the Fatwa Committee in arriving at its decision on organ transplant. Although the revealed texts presented as the basis for the prohibition of organ transplant in 1973 highlight the obligation to honor the human body, further reading into the ruling and medical advancements between the 1970s and 1980s showed that they were merely exercising caution in assessing the procedure, which was in its early stages. In addition, the subject was still being debated by other Islamic organisations internationally. In terms of medical development, some types of organ transplants – such as liver and lung – were only successfully conducted in the early 1980s.[5]

The Fatwa Committee took note of international developments in religious discussions of the matter. In January 1985, the Islamic Fiqh Academy (مجلس المجمع الفقهي الإسلامي) under the auspices of the World Muslim League, in its eighth Conference in Makkah, issued a fatwa that allowed organ transplant. The Fatwa Committee examined that decision and debated the issue in a number of meetings between January to November 1985. A new decision repealing the earlier fatwa was issued in December 1985.

Fatwa Decision  3/12/1985
KIDNEY DONATION

Question:

Kidneys are one of the most important organs in the human body and they play a major role in our lives. Kidneys can be afflicted with various life-threatening diseases. Dialysis offers a partial solution for kidney diseases through a process of cleansing the blood. The patient would have to visit the hospital 3 times a week in order to cleanse their blood and the process takes about 5 to 8 hours. This method is inconvenient for the patient in all aspects.

The best solution for the patient is a kidney transplant, which would allow them the opportunity to live life normally. The kidneys would be taken from those who died unnatural deaths or donated by willing parties to the patient. What is the Islamic view on the issue of kidney donation / transplant?

Answer: 

The ‘ulamā have discussed this matter and had agreed upon a fatwa, which allows for a kidney donation/transplant in times of ḍarūra (emergency).¹

Donation when the person is alive is prohibited. 

The reasons:

Based on Allah’s statement in Surah al-Baqara, verse 195,وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِۛوَأَحْسِنُوا
“and do not throw yourselves into destruction and do good.” (al-Baqara:195)

Based on a maxim of fiqh which states,
 الضَّرَرُ لَا يُزَالُ بِالضَّرَرِ
 “Harm is not removed by harm.”²

The body and its organs are entrusted by Allah s.w.t. to man. Each one of them will be questioned on the Day of Judgement. Allah states in Surah al-Isrā’, verse 36:

 إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا
“Verily, the hearing, and the sight, and the heart, each of those will be questioned (by Allah)”. (al-Isrā’: 36)

Donation after death (through a will) is prohibited 

The reasons:

Every body that can be buried should be buried. Allah states in Surah al-Mursalāt, verses 25-26,
أَلَمْ نَجْعَلِ الْأَرْضَ كِفَاتًا ۝ أَحْيَاءً وَأَمْوَاتًا 
“Have we not made the earth a receptacle. For the living and the dead”. (al-Mursalāt: 25-26)

And Allah states in Surah ‘Abasa, verse 21,
 ثُمَّ أَمَاتَهُ فَأَقْبَرَهُ
”Then He causes him to die and puts him in his grave”. (’Abasa:21)

The sanctity of the human body is assured in its burial. If it were permissible to donate a particular organ- meaning that it was not buried along with the rest of the body, it would imply that the whole body could also be donated and not buried.

From the hadīth of ‘Aisyah r.a. where Rasulullah (ﷺ) had stated,

 كَسْرُ عَظْمِ الْمَيِّتِ كَكَسْرِهِ حَيًّا 
“Breaking the bones of a dead is like breaking them while he was alive.”- hadīth narrated by Abū Dawūd.

i) From the book “Al-Majmu’ (New Edition)”, Chapter 5- under the heading “Carrying and burying the dead”.
ii) Muwaṭṭa’ Ibn Mālik

To cut off a body part of the dead is also defined as hurting men and women who are mu’min [believers]. The ruling is haram. Allah states in al-Ahzāb, verse 58:
وَالَّذِينَ يُؤْذُونَ الْمُؤْمِنِينَ وَالْمُؤْمِنَاتِ بِغَيْرِ مَا اكْتَسَبُوا فَقَدِ احْتَمَلُوا بُهْتَانًا وَإِثْمًا مُّبِينًا 
“And those who annoy believing men and women undeservedly, they bear (on themselves) the crime of slander and plain sin.” (al-Ahzāb:58)

Based on the argument that,
الضَرَرُ لَا يُزَالُ بِالضَّرَرِ
 “Harm is not removed by harm”.3

Since the extraction of an organ from the body of a dead person damages the body, it is deemed a desecration of the body. This is because there is no assurance that the extracted organ provides a benefit that is larger than the magnitude of the desecration. In contrast, the religious obligation of burying and respecting the dead is based upon clear and evident naṣ [text] as well as it being a deed that has been practised by mankind for thousands of years, apart from a small percentage of men.

Respect for the dead was commonly practised by the Prophet (ﷺ). The Prophet always stood up in respect of the dead that was carried past him, even if the dead was a kafir (non-believer).

Sayyid Sabiq had quoted in the chapter of Jenazah in “Fiqhus Sunnah” the words of Ibn Hazam, who stated that:

“It is good to stand when a dead is carried past, even if the dead was a kafir.”

Imām al-Bukhārī and Muslim had narrated from Sahl bin Hanif, and Qais bin Sa’ad narrated that once when they were seated in front of the Al-Qadisiah area, a body was being carried past and they stood (to respect him). When the people around them said that the body was that of a kafirdhimmi, they replied: “Rasulullah (ﷺ) once stood to respect the body of a deceased person which was being carried past. Then he was told: “It is the body of a Jew.” To which he replied: “Is it still not a life?”

Based on this, Islam does not humiliate or disrespect the dead even if the bodies are those of non-Muslims because Allah states that:

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ
”And indeed We have honoured the Children of Adam”. (al-Isrā’:70)

Therefore, how do we justify the act of dismembering or cutting up a dead body without reasons acknowledged by the Sharīʿa?

Additionally, the Mufti advised:

Organ donation is not a deed recognized by Sharīʿa for the following reasons:

No texts or evidences allow such an act as a donation. Instead there are only evidences which forbid it.

Based on the hadīth:

إذَا مَاتَ ابْنُ آدَمَ انْقَطَعَ عَمَلُهُ إلَّا مِنْ ثَلَاثٍ : صَدَقَةٍ جَارِيَةٍ ، أَوْ عِلْمٍ يُنْتَفَعُ بِهِ مِنْ بَعْدِهِ ، أَوْ وَلَدٍ صَالِحٍ يَدْعُو لَهُ
“If the son of Adam dies, his deeds are cut off except for three acts: Lasting charity (i.e. endowment), or beneficial knowledge, or a pious child who prays for him.”
– Narrated by al-Bukhārī and Muslim.

This hadīth excludes organ donation as a charity, because it specifically mentions the three things – namely lasting charities, such as endowments or the bequest of wealth if one possesses such wealth, of which only a third of it can be bequested;  a pious child; and beneficial knowledge that was imparted to others.

The Prophet thus advocated Muslims to seek wealth that would enable them to perform charity, raise their children to be pious individuals who would pray for their parents, and seek useful knowledge to be imparted to others. These are the required services and deeds which have been enjoined upon us. Let us not engage in unworthy matters because God has said:

وَلَا تَقْفُ مَا لَيْسَ لَكَ بِهِ عِلْمٌ ۚ إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا 
“And follow not (O man i.e., say not, or do not or witness not) that of which you have no knowledge. Verily, the hearing, and the sight, and the heart, each of those will questioned (by Allah)”. ( al-Isrā’: 36)

IN THE TIMES OF ḌARŪRA

The definition of ḍarūra means that there is a necessity to save lives. Kidney transplants are allowed under conditions of “ḍarūra”. The word “ḍarūra” must be emphasised. This is based on a maxim of fiqh:

الضَرُورِيَّاتُ تُبِيحُ المَحظُورَات
“Neccessity makes the unlawful lawful .”⁴

In Surah al-Baqara, verse 173, Allah states that:

فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلَا عَادٍ فَلَا إِثْمَ عَلَيْهِ ۚ إِنَّ اللَّهَ غَفُورٌ رَّحِيمٌ
”But if one is forced by necessity without willful disobedience nor transgressing due limits, then there is no sin on him. Truly, Allah is Oft-Forgiving, Most Merciful”:( al- Baqara: 173)

If the donor is still alive:

The donor must be a mukallaf.⁵

The donor must be willing and cannot be coerced.

It can be ensured that the operation would normally succeed.

It does not put risks on the donor.

If the organ is taken from someone who has died:

The inheritor has given permission.

The deceased had expressed willingness when he was still alive, verbally or otherwise, to donate his kidneys.

If the person had pledged to donate his kidneys after his death and the plan had been discussed with his inheritors when he was alive. Therefore, if both the donor and the guardians signed an agreement, then it could be concluded that the guardian is agreeable to the donation, so long as his agreement is not withdrawn. To prevent the decay of the kidneys while getting the permission of the guardians, such a transplant is considered as a ḍarūra. Therefore, the permission of the guardian is no longer necessary.

This is based on the following fish maxims:⁶

إِذَا ضَاقَ الأَمْرُ اِتَّسَعَ
“If a problem constricts, then it should expand.”

المَشَقَّةَ تَجْلِبُ التَيْسِيرِ
“Difficulties bring about facilitation.”

الضَرُورَاتُ تُبِيحُ المَحْظُورَاتِ
“Necessity makes the unlawful lawful.”

In general, we have to ensure that kidneys do not become commodified. Kidney donations should also be spontaneous and not kept in “banks”.

Source:
1 Majalla Al-Majmaʿ al-Fiqh al-Islāmī li Muʾtamar al-Fiqh al-ʿAdad al-Rābiʿ,(1988), vol.1,267.
2 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 210
3 Ibid.
4 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 211.
5  A person who is obliged to act in accordance with Allah’s orders and to perform worshipping.
6 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 208.

This 1985 fatwa allows organ transplants in cases of dire emergency, based on the Islamic principle that the preservation and protection of a human life is more important than maintaining the integrity of a human body. It thus marks a shift in the Fatwa Committee’s thinking.  One of the reasons for this shift was the sharp increase in the number of people afflicted with kidney problems requiring organ transplants, almost to a critical level. Such circumstances were considered an emergency. Changes to the Fatwa Committee’s opinion can also be pinned to their increased awareness of the difficulties and suffering faced by patients, which was relayed through various studies to the Fatwa Committee, and its greater exposure to the discussions on the issue by Muslim scholars at the international level.

In the 1980s, organ donation was a relatively new issue for the community, and the discussions persisted until the 1990s among local religious teachers and Muslim organizations. One of the platforms for such discussions was a seminar organized by Jamiyah Singapore. This seminar, which took place from 6-8 May 1994, brought together religious teachers and international religious experts, including those from Brunei and Saudi Arabia. The Mufti of Singapore at the time, Shaikh Syed Isa Bin Mohamed Bin Semait, was one of the five paper presenters. The seminar discussions indirectly contributed to an increased awareness and acceptance by the Muslim community of the need to review the ruling on organ donation. The seminar also demonstrated that it was not a local issue; scholars from other countries recognised the need to provide religious guidelines to help patients who needed organ transplant. The 1990s observed a shift as discussions moved from the question of  permissibility of organ transplants to the types of organs that were permissible for transplantation. The changes in the views of international scholars and the Fatwa Committee contributed to this revision. The need for organ transplants also became more apparent as the demand for donors increased. In consideration of these rulings, the need (ḥājah in usūl al-fiqh) for these organs and the functions they play became the primary consideration of the scholars, as well as the need to alleviate patients’ burden and deliver them from harm. In consideration of these rulings, the need (ḥājah in usūl al-fiqh) for these organs and the functions they play became the primary consideration of the scholars, as well as the need to alleviate patients’ burden and deliver them from harm. The organs that are discussed in the following fatwas pertain to the human cornea and heart.

Fatwa Decision 20/12/1995
CORNEA TRANSPLANT

Question:

What is the Fatwa Committee’s opinion on cornea transplant?

Answer:

Islam is a religion of mercy. The Islamic Sharīʿa was sent by Allah to protect mankind’s affairs – be it in this world or the hereafter. Islam enjoins upon its followers to do things which will bring them benefit, and forbids others which cause them harm. Principally, the Sharīʿa aims to maintain five basic rights of a human being:

(1) Religion
(2) Mind
(3) Life
(4) Generation
(5) Wealth.¹

There are numerous laws and aḥkām introduced by Islam to protect a person in these five aspects – one of which is his life, whereby Islam directs its followers to respect one’s life as well as that of others. Any form of persecution or oppression, let alone killing, is considered a very sinful act in Islam. Thus, in order to maintain social harmony and assure the safety of every individual, a heavy qiṣāṣ punishment is imposed upon those who commit murder. Besides that, Muslims are also forbidden from harming themselves or others. For example, suicide – for whatever reason – is not allowed in Islam.

Allah says:

وَأَنفِقُوا فِي سَبِيلِ اللَّهِ وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِۛوَأَحْسِنُواۛ إِنَّ اللَّهَ يُحِبُّ الْمُحْسِنِينَ
”And spend in the cause of Allah and do not throw yourselves into destruction and do good. Truly, Allah loves those who do good.” (al-Baqara:195)

Based on this, Islam allows a person to seek medical help if he is unwell. This matter has been exhaustively explained by the hadīth – such as the following as conveyed by ‘Abdullāh Ibn Mas’ūd,

‏مَا أَنْزَلَ اللَّهُ دَاءً إِلَّا أَنْزَلَ لَهُ شِفَاءً²
“Allah will not give you a sickness unless He readies for you its cure.” – Ibn Mājah

This permission, however, is bound by the condition that the treatment does not involve any haram products like alcohol, carcasses, poisons and others. This has its basis in a few hadīths, such as the following as conveyed by Ummu Salamah:

إنَّ اللَّهَ لَمْ يَجْعَلْ شِفَاءَكُمْ فِيمَا حَرَّمَ عَلَيْك- لبيهقى وابن حبان
“Allah does not create for you a cure from that which he has forbidden.”– al-Baihaqī & Ibn Hibbān.

The same is conveyed by Abu Hurairah, in another hadīth:

نَهَى رسولُ الله صلى الله عليه وآله وسلم عَنِ الدَوَاءِ الخَبِيثِ ، يَعْنِى السُمّ3
“Rasulullah (ﷺ) forbade (seeking treatment)- through medicine containing poison.”

In a hadith conveyed by Wā’il ibn Hajar al-Ḥaḍramī, Tāriq ibn Suwaid once asked Rasulullah (ﷺ) about the use of alcohol as medicine. Rasulullah replied:

 إِنَّهَا لَيْسَتْ بِدَوَاءٍ وَلَكِنَّهَا دَاءٌ
“Alcohol is not a medicine, but a disease.”⁴

However, this does not mean that Islam is rigid and inflexible. In circumstances where a halal cure for a disease has not yet been discovered, Islam extends leniency in using treatments involving prohibited substances. Rasulullah (ﷺ) himself instructed a number of people to drink camel’s urine because they could not adapt to the Medinan climate.⁵ This is further strengthened by the permissibility of eating carcasses and drinking alcohol in cases of extreme emergency. Such concessions are reflected in Allah’s words:

مَا يُرِيدُ اللَّهُ لِيَجْعَلَ عَلَيْكُم مِّنْ حَرَجٍ وَلَـٰكِن يُرِيدُ لِيُطَهِّرَكُمْ وَلِيُتِمَّ نِعْمَتَهُ عَلَيْكُمْ لَعَلَّكُمْ تَشْكُرُونَ
”Allah does not want to place you in difficulty, but He wants to purify you, and to complete His favour to you that you may be thankful.” (al-Mā’idah: 6)

Cornea transplants have proven to be a reliable treatment for people suffering from blindness. According to the original ruling, cornea transplants from a person who has passed away to a living receiver is not permitted in Islam because Islam requires an individual to be buried whole after his death, together with all his organs. However, there is no alternative treatment available for those suffering from blindness as yet. Blindness is recognized in Islam as a condition which weighs down a person’s life, and therefore from this perspective, cornea transplants are permissible as a form of leniency (رُخْصَة).

This issue is subject to the fiqh maxim⁶(المَشَقَّةُ تَجْلِبُ التَّيْسِيرِ): A burden, or difficulty draws simplicity. This means that in certain circumstances where a person suffers, Islam facilitates alleviation by repealing the impermissibility of certain deeds. Rasulullah (ﷺ) allowed some of his companions to wear silk despite it being ḥarām for Muslim men. This exception was given because they suffered from a skin disease which required that they only wear silk. In a similar situation, those who cannot tolerate cold weather are allowed to perform tayammum in place of wu ḍ u` and ghusl.

Additionally, the concession given for the cornea transplants in Islam parallels the fiqh maxim ⁷(الْحَاجَةُ تَنْزِلُ مَنْزِلَةَ الضَّرُورَةِ) “necessity may take the form of exigency.” In other words, where there is a need that must be fulfilled lest harm ensues, it becomes equal and similar in ruling to a situation of emergency which nullifies its prohibition. However, this comes under several conditions:

First: The need to be fulfilled must be something critical, lest it causes harm or difficulty to the individual.

Second: The above difficulty must not be unique, but general that may afflict average individuals should they find themselves in a similar situation.

Third: The need must be the only solution to release the individual from the burden or difficulty. If there are other solutions available which are halal in Islam, then the need do not qualify for concession.

Fourth: The degree of concession is similar to that in an emergency situation – only enough to alleviate the emergency.⁸

Since a cornea transplant fulfils all the four conditions stated above, it is deemed permissible until an alternative treatment becomes available. When this happens, it ceases to be an ‘emergency’. Cornea transplant is similar to kidney transplant in its process, whereby the person from whom the cornea is transplanted, as well as his next-of-kin, must have given prior permission in his lifetime to have his cornea removed after his death.

This concession is in accordance with a hadīth related by Ibnu ‘Abbās:

إنَّ اللَّهَ شَرَعَ الدِّينَ فَجَعَلَهُ سَهْلًا سَمْحًا وَاسِعًا وَلَمْ يَجْعَلْهُ ضَيِّقًا

 “Verily Allah has ordained this religion and made it easy and forgiving, and He did not make it difficult.”

However, the concession given to cornea transplantation does not mean that it is mandatory. In Islam, seeking treatment to cure a certain disease is mubāḥ and not wājib. Therefore, a Muslim has a choice: to seek a cure for his illness, or to endure the pain that Allah is testing him with so that he may be rewarded. This is based on a hadīth related by ‘Abdullah ibn ‘Abbās:

 أَلَا أُرِيكَ امْرَأَةً مِنْ أَهْلِ الْجَنَّةِ؟ قُلْتُ بَلَى! قَالَ: هَذِهِ الْمَرْأَةُ السَّوْدَاءُ أَتَتْ النَّبِيَّ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ فَقَالَتْ: إِنِّي أُصْرَعُ وَإِنِّي أَتَكَشَّفُ فَادْعُ اللَّهَ لِي. قَالَ: إِنْ شِئْتِ صَبَرْتِ وَلَكِ الْجَنَّةُ، وَإِنْ شِئْتِ دَعَوْتُ اللَّهَ أَنْ يُعَافِيَكِ” فَقَالَتْ: أَصْبِرُ، فَقَالَتْ: إِنِّي أَتَكَشَّفُ فَادْعُ اللَّهَ لِي أَنْ لَا أَتَكَشَّفَ، فَدَعَا لَهَا⁹
“Do you want to see an occupant of Paradise? I said: Please do so. He said: This black woman once approached Rasulullah (ﷺ) and asked: I am suffering from fits, and I often unknowingly flip the cloth which is covering me when I have an attack, so please pray to Allah for me. Rasulullah replied: “If you wish to be patient then your reward is Heaven, but if you would like to be cured than I will pray to Allah to cure you.” The woman then said: “If that is the case, then I will be patient. But I often embarrass myself when my clothes are flipped and tossed, therefore pray to Allah for me that it will not happen again.” Rasulullah (ﷺ) then prayed for her.”

Therefore, no matter how burdened a person is by a certain illness, he is required to trust his affairs to Allah and be patient. He must have full conviction that the illness is a test from Allah and that he must go through it bravely, accepting what Allah has given him. This is so that in the case that his effort to cure the illness fails, he will not sigh and be disappointed. In a hadīth related by Suhaib bin Sinān, Rasulullah (ﷺ) said:

عَجَبًا لِأَمْرِ الْمُؤْمِنِ إِنَّ أَمْرَهُ كُلَّهُ خَيْرٌ وَلَيْسَ ذَاكَ لِأَحَدٍ إِلَّا لِلْمُؤْمِنِ إِنْ أَصَابَتْهُ سَرَّاءُ شَكَرَ فَكَانَ خَيْرًا لَهُ وَإِنْ أَصَابَتْهُ ضَرَّاءُ صَبَرَ فَكَانَ خَيْرًا لَهُ

 “A believer’s condition is special, and this is characteristic of only he who believes. When he is in a good situation he will be thankful, and this is good for him. When he is in bad situation he will be patient, and this is good for him too.”

With this, the Fatwa Committee concluded that cornea transplantation is permissible in order to remove harm.

Source:
1 Wahba al-Zuḥailī. Usūl al-Fiqh al-Islāmī (Dār al-Fikr: 1986), Vol.2, 1017.
2 Muḥammad Bin Yazīd Bin Mājah al-Qazwīnī, Sunan Ibn Mājah, Kitāb al-Tib, vol. 2, hadīthno. 3438.
3 Ibid., hadīth no.3459.
4 Full text hadīth:
‏ أن ‏ ‏سويد بن طارق ‏سأل رسول الله ‏‏صلى الله عليه وسلم ‏عن الخمر فنهاه عنها أن يصنعها فقال إنها دواء فقال رسول الله‏ ‏صلى الله عليه وسلم ‏ ‏إنها ليست دواء ولكنها داء
ʿAbdullāh bin ʿAbd al-Rahmān Al-Dārimī. Sunan Al-Dārimī , Kitāb al-Ashriba, Hadith no.2140. (Arab Saudi: Dār al-Mughnī Li al-Nashr Wa al-Tauzīʿ : 2000), Juz 2.
5 full text hadīth:
أن ناساً اجتوو في المدينة، فأمرهم النبي (صلي الله عليه وسلم) أن يلحقوا براعية – يعني الإبل – فيشربوا من البانها وأبوالها، فلحقوا براعيه، فشربوا من ألبانها وأبوالها حتى صلحت ابدانهم، فقتلوا الراعي وساقوا الإبل، فبلغ النبي (صلى الله عليه وسلم) فبعث في طلبهم، فجىء بهم، فقطع أيديهم وأرجلهم وسمر أعينهم
Aḥmad Bin Alī Bin Ḥajar al-ʿAsqalānī, Fatḥ Al-Bārī bi Sharḥi Saḥīḥ al-Bukhārī, Kitāb Al-Tib, hadīth no.5686. (Cairo: Dār al-Hadīth, 1998), Vol.10.
6 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 194.
7 Ibid., 218.
8 Wahba al-Zuḥailī. Naẓariyya al-Ḍarūra al-SharʿiyyaMuqārana Maʿa al-Qānun al-Waḍʿī. 4th.ed, (Beirut: Muassasah al-Risālah, 1985), 275.
9 Aḥmad Bin Alī Bin Ḥajar al-ʿAsqalānī, Fatḥ Al-Bārī bi Sharḥi Ṣaḥīḥ al-Bukhārī, Kitāb al-Marḍā, hadīth no. 5652, Vol.10

The above fatwa on cornea donation is a marked change in Muslim law, as the permissibility of cornea donation was no longer limited to emergencies and life and death situations. Hājiyyāt (such as improving a patient’s eyesight) was given the same level of consideration as a ḍarūra, in line with the the maxim (الحاجة تنزل منزلة الضرورة) “Necessity may take the form of exigency”. It also considers the maqāṣid and places emphasis on the importance of prioritizing and balancing between the two types of harms; i.e. leaving the patient blind or using donated corneas from a deceased person without violating the sanctity of the deceased’s body. The fatwa above also demonstrates the Fatwa Committee’s inclination to ease the suffering of patients and improve their quality of life. Additionally, the Fatwa Committee’s decision can also be seen as a contribution towards solving public policy issues – in this instance finding a solution for those in need of organ transplant from third parties.

The Fatwa Committee had also stressed that organ transplant is a form of treatment that is accepted by religion, and not a procedure that violates the sanctity of the deceased. Such a paradigm shift is important in the development of religious rulings in Singapore, particularly in the realm of organ donations. This is because treatments using donated organs have increasingly become more successful, and the technology has been expanded to treat chronic diseases including those caused by organ failure. This fatwa thus started a new chapter in the Fatwa Committee’s assessment of subsequent issues on organ transplants.

From another standpoint, the 1973 fatwa did not distinguish between the transplant of regenerative and non-regenerative organs. Regenerative forms such as blood donation and transfusions were generally not included under the prohibition as the discourse was restricted to transplantation of non-regenerative organs. These were also not raised in public discourse. However, in 1997, a fatwa was issued on the permissibility of transplantation of bone marrow on the grounds that bone marrow is regenerative and replaces itself in about four weeks. Because of its regenerative nature, it was not likely to inflict permanent damage on a donor or leave him handicapped whilst still alive, unlike organ transplants.

Moreover, bone marrow transplant is effective in treating leukaemia (blood cancer). In the treatment of blood cancer patients, a healthy donor with the suitable bone marrow may donate it to a patient in need. The Fatwa Committee ruled as follows:

Fatwa Decision 7/4/1997
BONE MARROW TRANSPLANT

Question:

What is the Islamic position (hukum) on bone marrow transplants?

Answer:

An Islamic position (hukum) is determined by Allah swt, through the Qur’an or Sunnah Rasulullah (ﷺ).  Rasulullah (ﷺ) explains the ruling, and we as Muslims are asked to accept and abide by them as in God’s words:

وَمَا آتَاكُمُ الرَّسُولُ فَخُذُوهُ وَمَا نَهَاكُمْ عَنْهُ فَانتَهُواۚ

”And whatsoever the Messenger (Muhammad  ﷺ) gives you, take it; and whatsoever he forbids you, abstain (from it). And fear Allah; verily, Allah is severe in punishment.”
al-Hashr:7.

It has been acknowledged that leukemia is a type of cancer which causes the bone marrow to stop functioning. Those who have the illness will suffer due to the lack of blood (anemia). He will regularly have fever, as well as bleed and contract other diseases easily. This illness (leukemia) is complicated and cannot be cured. Of late, it has been discovered that leukemia patients can be treated via a bone marrow transplant from another person who has similar tissues as that of the patient.

The Fatwa Committee notes that bone marrow has an important function in a person’s body. It produces blood cells for the body, including the white blood cells which help a person’s body to resist or fight other diseases contracted by the red blood cells. Meanwhile, the function of the red blood cells is to transport oxygen and deposit unwanted substances from the body’s organs and tissues which can cause blood clot.

The bone marrow transplant is done by piercing a needle into the patient’s posterior, and inserting it into the person’s body. Medical experts have also clarified that the donor’s health will not be adversely affected and that his bone marrow will regrow within a few days. They also affirm that the process of transplanting the bone marrow is not difficult and in fact easy and safe. The risk is small, and most donors can move freely after resting for only a few days. The donor’s health will also not be affected in the future.

Bone marrrow transplants were not known in the past. It was not mentioned by the jurists because the treatment is a modern innovation as a result of medical research. It is Allah who teaches mankind what they do not know.

Blood has a critical function in a person’s body. Therefore, what is the religion’s perspective on the benefit of transfusing blood from one person to another?

The international ‘ulamās have debated this issue numerous times. They concluded that it is permissible to do so under certain conditions¹

First: It is an urgent need.
Second: It can be confirmed by a Muslim doctor, or a non-Muslim one (according to Malikī school of law) that the blood will help the recipient and will not cause harm to the donor.
Third: There should not be any form of buying and selling in the process, as selling of human blood is forbidden in Islam.

When it can be confirmed that the bone marrow transplant will not bring harm to the donor and can really help the patient, then the Islamic position in this matter is that it is permissible.

 Source:
1 Majallah Majmaʿ al-Fiqh al-Islāmī Daurah al-Thāniah Li Mu’tamar Majmaʿ al-Fiqh al-Islāmī ʿAdad al-Rābiʿ, 2nd.ed,. (1986), Vol.1, 135.

This fatwa first acknowledges the benefits of a bone marrow transplant. Unlike other organs of the body that could be donated such as the heart, liver, kidney and cornea, bone marrow can regenerate in a short time. Therefore, there is no hindrance to the donation of bone marrow as it will be replaced naturally. However, there are ethical principles that should be observed to ensure the welfare and safety of both donor and patient.

In consideration of this, bone marrow donation is permitted only when there are urgent medical needs pertaining to the patient and his quality of life. To ensure that this requirement is met, the recommendation for transplant must come from physicians. The Fatwa Committee also took into consideration that Singapore is a multi-religious country. In view of the fact that there are non-Muslim medical professionals, the Committee adopted the view of Malikī school of law and stated that consenting physicians need not be Muslims. It further added that bone marrow donation is only permitted if no trade is involved. This stance is similar to that outlined by international ethics bodies in assessing issues pertaining to clinical science. This stipulation is necessary to prevent injustice and the exploitation of the underprivileged in organ trading practices.

With rapid advances in clinical science, other forms of transplantation followed suit, one of which was heart transplantation. It has proven to achieve a good success rate and has been accepted as a viable treatment for heart patients. The Ministry of Health consulted the Fatwa Committee regarding heart transplants as part of its proposal to amend HOTA and to include in the Act organs such as liver, heart, and cornea that can be harvested from a cadaveric donor. The fatwa issued in 2003 on heart transplants also relied on the principles of needs to allow emergency medical procedures to be performed.

Fatwa Decision 7/10/2003
DONATION AND TRANSPLANT ON THE HUMAN HEART

The Fatwa Committee notes that under the proposed amendments to the Human Organ Transplant Act (HOTA), Muslims are excluded as per the current arrangement.

After deliberation, the Fatwa Committee is of the view that on the issue of heart donation and transplant, the Shari’a viewpoint that the remains of a Muslim must be buried properly is crucial. This is based on God’s words in Surah ‘Abasa:

ثُمَّ أَمَاتَهُ فَأَقْبَرَهُ
”Then He causes him to die and puts him in his grave”. (al-’Abasa:21)

However, the donation of a human heart is permissible on the basis of emergency or urgent need. This is based on the legal maxim:¹

الضَرُورِيَّات تُبِيحُ المحظُورَات
 Necessity makes the unlawful lawful.

Nonetheless, the level of emergency that allows for human organ donation or transplant must be restricted in accordance with the extent of the necessity. This is based on another legal maxim:

ما أُبِيح للضرورة يقدَّر بقدرها
What is allowed due to emergency, is limited only to its rightful measure.

As heart transplant is also categorised as an emergency to save lives, the Fatwa Committee views that the ruling is the same as kidney donation and transplant, in that it is permitted.

Source:
¹ Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 211.

As part of the proposed amendments to HOTA, the Fatwa Committee was also asked the Muslim view on establishing an organ bank for the storage of corneas, which the Committee consented to. Among the organs included in HOTA, only corneas are allowed to be stored for a brief period of not more than two weeks as transplants cannot be done immediately in some cases and may be postponed for medical or logistical reasons. In discussing the issue, the Fatwa Committee considered the need for banking, as well as the benefits and advantages that can be achieved. These were weighed against the harm and hardship that it may result in.

Fatwa Decision 2/3/2004
ORGAN STORAGE AND ESTABLISHING AN ORGAN BANK

Question:

The Ministry of Health explained that the organs included in HOTA are kidney, heart, liver and cornea. Among these organs, only the cornea can be stored for a period of up to two weeks for the purpose of transplantations, or frozen for longer periods of time for therapeutic purposes.

Cornea storage for transplantation is sometimes necessary because of the lack of suitable recipients, or because the corneal transplant surgery had to be postponed due to medical or logistical reasons. What are the views of the Fatwa Committee in this matter?

Answer:

The Fatwa Committee ruled that, in principle, cornea storage is not allowed. However, if there are necessities as highlighted by the Ministry of Health, then there are religious provisions that may allow the storage of corneas.

Human Organ Transplant Act (HOTA)

HOTA was introduced in Singapore in 1987. At that time, the Muslim community was excluded from the scheme based on a 1985 fatwa that requires expressed consent from the donor during his lifetime. This consent must be witnessed by two of the donor’s next-of-kin. These conditions did not correspond with the way HOTA was implemented, which allowed for organ transplant on the basis of presumed consent. This meant that every citizen over the age of 21 years is automatically considered as an organ donor unless they opt out of the scheme. Although Muslims were not included under HOTA, Muslims could still pledge their organs by means of a voluntary pledge (i.e. opt-in) under another act called the Medical Therapy, Education and Research Act (MTERA).

MTERA was introduced in 1972 but proved insufficient to fulfilling the demand for kidney transplants at the time. For instance, between 1970 and 1978, only 22 kidney transplants were successfully performed. The government then introduced an opt-out system. The impact of this change was significant. Between 1987 and 2004, 222 patients received kidney transplants under HOTA.[6]

HOTA was amended in 2004 to include the transplant of liver, heart and cornea, alongside kidney.[7] This amendment also included changes to the cause of death as a condition for an organ to be transplanted, whereby it was no longer limited to deaths caused by accidents, but included deaths from other causes. Nonetheless, the requirement that a donor must be from among those whom doctors have declared as brain dead was maintained.

Religious communities had raised concerns about the permissibility of transplants. In Christian circles, there was also a debate on whether the gift of organ donation violates biblical teachings of resurrection of the whole body and prohibition of self-mutilation, even if the act of donating an organ itself is consistent with the Christian values of humanitarianism and love for one’s neighbour.[8] However, no church prohibited donating or receiving organs, and the public discourse about the procedure in Singapore was generally supportive.[9]Muslims were thus the only community excluded from HOTA because of a clear religious injunction which the Fatwa Committee relied upon in its fatwa of 1985.

As mentioned above, the number of Singapore donors pledging their organs before HOTA was implemented was relatively low. After HOTA, studies noted that although there was no change in the number of suitable donors, the number of successful transplants increased among non-Muslims.[10] For kidneys, the number of successful transplants increased to 16% per year in 1990. [11] By virtue of their exclusion, Muslims were placed on a lower priority for receiving donated organs. The burden faced by kidney patients is very taxing; the cost of weekly kidney dialysis is exorbitant while many lose their jobs because of the need for dialysis treatment.[12] Although they could opt in, relatively few Muslims signed up for the scheme. In the decade between 1997 and 2007, the number of Muslims as a percentage of the total number of patients on dialysis jumped from 15% to 25%.[13]  Muslim kidney patients who required dialysis thus represented a large percentage of the general Muslim population.

Number of patients in waiting list (as of 15 March 2007)

| Kidney | Liver | Heart | Cornea | Total | Percentage
Malay/ Muslim | 115 | 2 | 0 | 1 | 118 | 20.80%
Total | 541 | 17 | 1 | 7 | 566 | 100%

The move to amend HOTA to include Muslims had substantial support from the Muslim grassroots. It was first facilitated by the 1985 fatwa which allowed kidney transplants for medical emergencies. [14] This was followed by the fatwa that permitted the donation of all types of organs covered under HOTA. However, the opt-in rate was still low despite many public education campaigns. This prompted Muis to review the 1985 fatwa which required a Muslim donor’s pledge to be consented to by two of his next-of-kin. A fatwa issued in 2004 removed this condition; donors no longer needed to nominate their next-of-kin as witnesses.

Fatwa Decision 26/6/2004
CONDITION OF WITNESS FOR ORGAN DONATION PLEGDE

Question:

Must anyone wishing to pledge an organ obtain the signature of his next-of-kin on the pledge form?

Answer:

The Fatwa Committee has reviewed the requirement of obtaining the consent of one’s next-of-kin in organ donation in six of its meetings held between January to June 2004. As result of these discussions, the Fatwa Committee decided that if someone had, during his lifetime, pledged to donate his organs, then the next-of-kin must respect the pledge and execute it, as long as the pledge falls within the limits of Islamic law. If the deceased has not made a pledge, then the matter is decided by the next-of-kin.

This means that, if someone wants to make a pledge to donate his organs — kidneys, heart, liver and corneas — he is not required to get his kin’s signature on the pledge form. What he needs is to obtain his signature of any two adult male Muslim witnesses to sign the pledge form.

After the fatwa was issued in 2004, the number of organ pledgers remained low, and the chances for patients to receive organs remained slim. Patients and their families suffer from various afflictions while awaiting their turn, including financial hardship that affects their daily lives, as well as worsening health conditions. In such circumstances, the mafsada (distress) and the difficulties experienced by patients must be relieved through appropriate solutions in Islam.

Among the measures through which this could be achieved is to assess the potential benefits from including Muslims in HOTA as this could boost the number of organ pledgers. HOTA functions on the basis of presumed consent, whilst respecting the individual choice to exclude oneself from the organ donation system. Even though participation in HOTA is not compulsory, it facilitates those who wish to become donors.

As the presumed consent system was still new, especially to the Muslim community, the Fatwa Committee studied it in great detail and discussed the concept of presumed donor’s consent.

Fatwa Decision 17/7/2007
THE INCLUSION OF MUSLIMS UNDER THE HUMAN ORGAN TRANSPLANT ACT (HOTA)

Question:

What is the opinion of the Fatwa Committee on the participation of the Singapore Muslim community in the Human Organ Transplant Act (HOTA)?

Answer:

1.         After considering carefully the latest updates on the issue of Muslims and organ donation in Singapore, as presented by the Office of the Mufti, which included:

Latest developments provided by the Muslim Kidney Action Committee (MKAC), included in the presentation by the Office of the Mufti, on the problems and sufferings of Muslim kidney patients in Singapore, and the outcomes of public awareness campaigns on the importance of rendering help to kidney patients by becoming organ pledgers, and the current number of Muslim pledgers, and whether this number can help alleviate the problems of the kidney patients in the future, and

Latest developments provided by the Ministry of Health, included in the presentation by the Office of the Mufti, on the process of transplantation and the statistics and status of Muslim kidney patients, as compared to other patients in Singapore, and the benefits for the Muslim community from their inclusion in the Human Organ Transplant Act (HOTA),

2.         The Fatwa Committee takes the position that it is permissible for Muslims to be included in the Human Organ Transplant Act (HOTA) for the following reasons:

The general consensus of Muslim jurists is that organ transplant and donation by the deceased is permissible in Islam. Among the reasons quoted by jurists are:

Islam calls for the seeking of cure and treatment for illnesses, and the most effective treatment for those who suffer from organ failure, currently, is by receiving a new organ in place of the failed one.

The objectives (maqāṣid) of the Sharī’a clearly state the importance of protecting and saving human lives. This is mentioned in the Holy Qur’an:

وَمَنْ أَحْيَاهَا فَكَأَنَّمَا أَحْيَا النَّاسَ جَمِيعًا  
“…and whoever saves one life, then it is as though he has saved the whole of humanity.”
(al-Māidah : 32)

The Sharī’a is built upon values such as care and compassion. The shariah thus calls for mankind to help one another, and to contribute in alleviating human suffering and pain, such as the suffering of kidney patients.

Donating one’s organs is an act of jāriyah (continuous charitable deed) in which the rewards accrue even after one’s death.¹

The current pledging system for Muslims (through the opt-in in MTERA) is not helping kidney patients overcome their medical condition. Although a fatwa was issued in 2004 to simplify the process of making a pledge [by lifting the condition that a pledge must be witnessed by two family members (waris)], the number of pledgers is still very low. Whilst waiting for organ donors, patients and their family members suffer in many ways, including having to go through financial and emotional distresses. Thus, the mafsadah (harm) and maḍ arrah (difficulties) that these patients encounter must be alleviated in an appropriate manner. This is in accordance with numerous legal maxims² in Islamic jurisprudence, such as:

إِذَا ضَاقَ الأَمْرُ اِتَّسَعَ 
 “If a problem grows acute, then it shall be relieved”

المَشَقَّةُ تَجْلِبُ التَّيْسِيرِ
 “Difficulty calls for facilitation”

To safeguard public interest and welfare (maṣlaḥa ), leaders of the community (waliyyul-amr) should decide for the community what is in their best interest. This is in line with the legal maxim³:

تَصَرَُفُ الإِمَامَ مَنُوطُ بِالمَصْلَحَةِ
“The actions of an Imam (leader) is driven by the interest of the community.”

The presumed consent or opt-out system in HOTA is a method of obtaining early consent from the donor. The donor is given the option to object and not give consent during his/her lifetime. He or she can do so by opting-out from HOTA. As such, there is no conflict with the requirement in Islamic law of consent to be made during the person’s lifetime for organ donation, as agreed upon by majority of Muslim jurists.

Muslims stand to gain from inclusion in HOTA.⁴ Upon inclusion, the Muslim community will have the same opportunity as other communities in receiving transplants. Due to the waitlist system, Muslims who are not pledgers are disadvantaged, as they are not placed in the priority list for available transplants.

Without inclusion in HOTA, the plight of kidney patients and those suffering from organ failure will remain. They will also need to bear the high cost of dialysis treatment.⁵

3.     The Fatwa Committee puts forth the following recommendations, alongside the position that Muslims can be included in HOTA:

The relevant authorities should ensure a transparent and fair system of choosing recipients for available organs.

The relevant authorities should ensure an extensive public education on organ donation and HOTA. Each individual Muslim should receive information on how HOTA will affect them, together with a clear explanation on the opt-out scheme.

The relevant authorities must also ensure that the community has the option to be excluded from HOTA, either by excluding all organs, or only selected ones.⁶

The relevant authorities should seek the opinion of the Fatwa Committee on prospective amendments to the HOTA which will affect Muslims.

The Muslim community must be given a clear explanation on the hukum (ruling) and need for organ donation. This can be done through public education before and after the fatwa has been issued.

Source:
1 Yūsuf al-Qaraḍāwī, Fatāwā Muʿāṣara, 532 dan 537.
2 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 208.
3 Ibid., 278.
4 Muslim kidney patients (21% of all patients) are proportionately higher than the Muslim population in Singapore (14-15%).
5 According to MOH, every patient needs to spend around $40,000 annually in medical expenses. Dialysis does not cure patients, and the survival rate of those undergoing dialysis treatment after 5 years is 65% compared to 91% of those who receive kidney transplants.
6 “HOTA only covers the kidney, heart, liver and cornea. All other organs from HOTA donors will be subjected to the provisions of the MTERA”. Ministry of Health. Manual on Organ Donation and Transplant. (2005).

The proposition to include Muslims in HOTA started emerging in public forums and newspapers in the early 2000s.[15] A few years before the HOTA amendment was proposed in 2007, the Ministry of Health (MOH) in Singapore held public discussions with members of the Muslim community to clarify the process of organ donation and dispel misconceptions surrounding it.[16] When the Singapore Parliament passed the amendment to include Muslims in 2008, many measures were taken to ensure that the Muslim community were adequately informed of this change. This included letters sent to every Muslim household, attached with informational pamphlets on the legal application of HOTA and the religious opinions on organ donations and transplants in Islam.  Opt-out forms were also included in the mailers for those who wished to opt out. However, since 2008 not many Muslims have chosen to opt out. This reflected the support and progressive religious thinking of the Muslim community who were receptive to the fatwa issued by the Fatwa Committee. Public education efforts to raise awareness on organ failure appeared successful, and the Muslim community agreed with the need to help patients regardless of race or religion. As a result of the amendment to include Muslims under HOTA, the number of successful transplants among the Malay Muslim community almost doubled in 2008 compared to the preceding year, making up 19% of of all organ transplants in Singapore.[17]

Analysis of the Fatwas on Organ Donation

The Consideration of Maṣlaḥa and Mafsada

The Fatwa Committee in its 1976 fatwa prohibited organ donation on the grounds of uncertainty as to whether “the benefit from the organ is commensurate with what was inflicted on the body.” As organ transplant technology was still new at the time, and the outcome of organ donation was yet unclear, the Fatwa Committee’s decision was therefore expected. The Fatwa Committee, in consideration of the ruling, not only looked at the principles of uṣūl al-fiqh but also took into account the degree of maṣlaḥa and mafsada. As the maṣlaḥa could not be determined, while its mafsada remained certain, the Fatwa Committee took a more cautious stance and decided not to permit it.

Considerations of maṣlaḥa and mafsada also formed the basis of the Fatwa Committee’s subsequent fatwas on organ transplant. After more than 30 years, organ transplant technology showed rapid advancements and transplants were carried out successfully and effectively. Concurrently, the issues faced by organ failure patients also became more varied. The Fatwa Committee thus decided not only on the permissibility of kidney, cornea, heart and liver donations, but that Muslims could be included in the “opt-out” system (on the basis of presumed consent).[18]

Gradual Application of the Maxim ‘Constrictions Demand Relief’ 

In the development of fatwa in organ donation, various Fatwa Committee sittings applied the following Islamic legal maxims:

إِذَا ضَاقَ الأَمْرُ اِتَّسَعَ [19]
“If a matter becomes constricting, it demands relief”

المَشَقَّةُ تَجْلِبُ التَّيْسِيرِ[20]
“Hardship begets facility.”

Both these principles offered latitude for the easing of hardship. However, the Fatwa Committee took a cautious approach, and the process of permitting organ donation was observed in gradual stages according to the needs of each era. This was based on the maxim:

[21]ما أُبِيح للضرورة يقدَّر بقدرها
Which means: “What is allowed due to emergency, is limited in accordance with it.“

Among the basic principles that the Fatwa Committee used since the beginning of its discussions on organ donation is that each organ is entrusted by Allah SWT and each individual will be accountable for them. On this premise, an organ is not a right that can be transferred freely without an urgent need.[22] The Fatwa Committee also referred to the prohibition of actions that might hurt or violate the sanctity of the dead. This principle was maintained in the fatwas of 1973, 1976 and 1985. [23]  This phased approach was not free of criticism. Dr Syed Hussein Alatas objected to the prohibition of cornea donation as evinced in his article in the local newspaper and his booklet “Biarkan Buta – (Let (him) be blind)”. However, the Fatwa Committee only allowed cornea donation some 20 years later. This phased approach is illustrated in the following diagram depicting the development of fatwas issued on organ donations, before the eventual fatwa permitting Muslims to be included in HOTA in 2007.

The three decades taken by different Fatwa Committees demonstrate how the fatwa institution in Singapore did not review its positions except with extreme caution and thoughtful consideration. At all times, the fatwa institution assessed the context and evolving needs of the community, and examined the implications of its rulings on every issue.

Stewardship versus Ownership of the Human Body and Soul

In a press statement made in 1973 on organ donation, [24] Mufti Shaikh Isa Semait emphasised a Qur’anic concept that the human body is held in trust for which one would be accountable to Allah SWT. The physical body and the soul are regarded as a single entity that cannot be distinguished. The former is therefore considered to be a blessing and a gift by God, over which man does not bear full ownership, nor can he do unto it as he pleases, because man is regarded only as the trustee of God. This trusteeship has a deeper implication: his freedom to do as he wills towards his body is limited.[25] Because of this, Islam forbids suicide, as well as other actions that could bring harm or cause adverse effects on the health and well-being of the body.[26] This prohibition also includes inserting or removing something from a dead body, such as organ harvesting, so as to protect the sanctity of the dead.

Nevertheless, the approach of maqāṣid al-sharīʿa which forms the basis of Islamic ethics permits operating on the dead when the need arises, such as in determining the cause of death, resolving inheritance issues, or saving the life of another. In classical fiqh works, scholars permitted surgery to be performed on a deceased pregnant woman if there is a high probability that the baby in the womb could be saved.[27] Thus, the idea that humans are only trustees and not absolute owners of the body is still subject to other considerations as provided for in religious texts. Included in this consideration is the issue of organ donation either during lifetime or after death. As such, the donation of critical organs (which cannot regenerate, or whose removal may threaten the life of the owner, or that may affect one’s physical form or functionality – such as eyes or ears) during one’s lifetime is forbidden based on the Qur’anic principle mentioned above.[28] But if there is a need to preserve the life of another human being by taking organs from the dead, then it is permitted based on the legal maxim that allows choosing the lesser of two harms (إذا تعارض مفسدتان روعي أعظمهما ضررا بارتكاب أخفهما)[29] in order to preserve the maqāṣid al-sharīʿa of protecting the life of a living person.

Brain Death from an Islamic Viewpoint

In the consideration of fatwas related to organ donation after death, one of the ethical and legal issues brought up was whether brain death – the cessation of brain stem function- can be accepted as a criterion for determining death.

There are many verses in the Qur’an that mention death, but none that clearly explicates the criteria for death, particularly from a clinical standpoint. This issue is very significant in medical science, especially in determining the time of death for various reasons, such as surgery. The criteria for determining death from a religious standpoint is therefore a new and complex matter, and has to be determined through means of ijtihād.[30]The criteria for determining death from a religious standpoint is therefore a new and complex matter, and has to be determined through means of ijtihād. Following this, jurists have expressed various ethical and jurisprudential opinions.

In debating the criteria for death, the relationship between body and soul is vital. There are two theories regarding this relationship. The first theory states that the nature of true human existence lies in the soul, while the body is simply an instrument that serves the soul’s existence. This means that the soul does not merge with the body to form a single entity. Instead the soul is the source of life for the body. Here, the soul is regarded like a master who commandeers and controls the body. Imām al-Ghazalī was of the view that the soul is the essence of God’s creation (al-laṭīfa al-rabbāniyya) that affords people the ability to think and learn. The soul – according to him – is synonymous with the terms heart (qalb), self (nafs), and intellect (‘aql). It is able to think and feel for itself without having to merge with the body. According to this view, the body is just an instrument that manifests what the soul thinks and demands. Death therefore occurs when the soul leaves the body, even though the body has not stopped functioning.[31]

Another theory states that the soul is an attribute inserted into the foetus by God. This means that body and soul merge into one, and only then is personhood realised. Death occurs when the soul starts to leave the body, and the body begins to stop functioning.[32]

In the texts of Islamic law, the permanent cessation of breathing is sufficient to determine a person’s death. This is different from brain death, which is determined by the absence of reaction to external stimuli or internal needs; the cessation of body movement and breathing for at least an hour under the supervision of medical experts, as well as the absence of physical responses which are attributed to brain activity.[33]

Jurists discuss two types of life that may provide guidance in determining the criteria for physical and neurological death: stable life (mustaqarr) and unstable life (ghayr mustaqarr).[34] The Hanbali and Shafi’i schools of law see a difference between the two, whereas the Maliki school holds the view that there is absolutely no difference. Those who distinguish between these two types place several key criteria, including the cessation of breathing and heart activity for a specified period; if it functions only for a certain time and then stops permanently, then it is regarded as unstable life, marking the beginning of death.[35]

However, some scholars view that such criteria is still incapable of determining the occurrence of death. This is because movement, pulse and respiration can still occur even after death. Such criteria are more appropriate as a guide for the general public. Medical experts with a more complex understanding of the human body should have a more robust criteria beyond mere external indicators. For example, physical movements may still occur in those who have died, due to the presence of certain chemicals and reactions caused by internal organs. [36]

Clinically, brain death is defined as a permanent and total loss of brain function, including the brain stem.[37] When the brain permanently ceases to function, all bodily organs will also stop. According to medical experts, when a person is brain dead, the process of death has already begun because a person will no longer be able to return to life.[38] It is only through modern medical technology that a heart which has experienced momentary failure is able to continue circulating blood to the vital organs despite the brain dead patient not responding to any external and internal stimuli. In Singapore, the Ministry of Health (MOH) has very strict conditions in the determination of death, including the administration of seven specific clinical tests. Due to the stringent criteria, brain death is accepted by state law as legal death. Contemporary scholars have also ruled that brain death is legal death.[39] This is in line with traditional Islamic interpretations of the relationship between the body and soul discussed above, in which the cessation of bodily functions indicate that the soul has separated from the body, which is evident in brain death.

The legal maxim “the actions of a leader are driven by the interests of the community” (taṣarruf al-imām ʿalā al-raʿiyya manūṭun bi al-maṣlaḥa)

The 2007 fatwa did not only permit Muslims to donate organs such as cornea, liver, heart and kidney, but also included the Singapore Muslim community in the HOTA opt-out system. This legislation was enacted with the aim of increasing the number of organ donors.

Islamic law also recognizes the paramount importance of the interests and welfare of the community and nation, in matters of public administration. The philosophy is not foreign to Islam, as it was practiced by the Prophet Muhammad (ﷺ). On this basis, jurists assert that state policies and programs will be void if they do not benefit the populace, whether in this world or the hereafter.[40] Such considerations are in accordance with the following principle in Islamic governance:

[41]تَصَرُّفُ الإِمَام مَنُوطٌ بِالمَصلحة
“The actions of a leader are driven by interests [of the community]”

The notion of public interest (maṣlaḥa) in Islamic jurisprudence falls within the categorisation of ḍarūriyyāt al-khams, which is the prioritization of religion, life, intellect, lineage and property. All that can cause distress and burden to the community must be denounced or prevented. In addition, there are several key principles recognized by Islam in state administration such as:

karāma insāniyya (human dignity),

ʿadāla (justice),

musāwā (equality),

ḥurriyya (freedom),

wafāʾ bi al-ʿahd (fulfilling covenant),

muʿāmala bi al-mithl (reciprocity of treatment),

tasāmuḥ (compromise),

taʿāwun (cooperation),

manʿu al-fasād (prevention of harm).[42]

This maxim is tied to the scholars’ practice of accepting maṣlaḥa as a principle in producing religious rulings and fatwas. Imam Mālik, in particular, employed maṣlaḥa mursala[43] as a foundation in Islamic law. This view was shared by the likes of Imām al-Shāfiʿī (d.204H), Imām al-Ḥaramain al-Juwaynī (d.438H) and Imām Aḥmad ibn Ḥanbal (d. 241H).[44]

Conclusion

This chapter on organ donation has outlined the evolution and development of the Fatwa Committee rulings over a period of three decades. Apart from explaining scholarly opinions on organ donation, this chapter also shows how medical advancements, awareness of patient needs, and public readiness to accept organs harvested from a dead person contributed to the Fatwa Committee’s decisions. Discussion and analysis of the organ donation fatwas also indicate how fatwas interacted with national legislation and public policy, thus creating a confident Muslim society in a secular country that does not have to compromise its religious principles.

At the same time, the Fatwa Committee’s decisions also took into account the ethical dimensions in organ donation. This includes accepting brain death as true death, which has allowed the harvesting of vital organs. The Fatwa Committee also solved the dilemma between protecting life and preserving the sanctity of the deceased, by following priorities according to maqāṣid al-sharīʿa. All these demonstrate the confidence and competence of local Muslim thinkers and scholars in producing a much needed religious leadership to guide the community through contemporary and emerging challenges.

For more information on how successful blood transfusion helps organ transplant, see Susan E Lederer, Flesh and Blood: Organ Transplantation and Blood Transfusions in 20th Century America (Oxford University Press: 2008). ↵

Hakim Nadey, Living Related Transplantation (World Scientific: 2010), 39. ↵

Recorded in the Fatwa Committee Meeting held on 29-08-1972. ↵

Recorded in the Fatwa Committee Meeting held on 31-07-1973. ↵

C. J. E. Watson and J. H. Dark, “Organ transplantation: historical perspective and current practice” in BritishJournal of Anaesthesia, (2012), Vol. 108. ↵

National Library Board Singapore.  http://eresources.nlb.gov.sg/infopedia/articles/SIP_1401_2009-01-08.html (2008). ↵

http://statutes.agc.gov.sg/ ↵

Bobby A. Howard, “What the Bible Says about Organ Transplants”, in Journal of Christian Nursing, Vol. 15:4, (2005). ↵

See “Donate Kidney Calls to Church Members” The Straits Times, 8 September, 1975; “Confused by Priest” The Straits Times, 12 July, 1986 and “Last week’s focus: Do other countries have laws like HOTA?” The Straits Times, 23 July, 2003. ↵

See Low H. C. et al “Impact of New Legislation on Presumed Consent on Organ Donation on Liver Transplant in Singapore,” in Transplantation. Vol. 82:9. (2006). ↵

Inaugural Workshop of the Singapore Renal Registry, 39. ↵

Statistics for the unemployment rate and subsidy cost of dialysis treatment can be found in Woo Keng Thye and Grace SL Lee (eds), First report of the Singapore Renal Registry 1997, Singapore Renal Registry (1998). ↵

See Choong Hui Lin (ed), Seventh Report of the Singapore Renal Registry 2007/2008, Singapore Health Promotion Board (2008); and Woo Keng Thye and Grace SL Lee (eds), First report of the Singapore Renal Registry 1997, Singapore Renal Registry (1998). ↵

Please refer to the Fatwa Committee's second fatwa on organ transplant dated 3rd December 1985 ↵

See “Peserta forum syor Muslim disertakan dalam HOTA [Forum participant suggests Muslims to be included in HOTA],” Berita Harian, 18 February 2003; “Ramai Muslim tak keberatan diserta dalam HOTA [Many Muslim do not mind being included in HOTA]”, Berita Harian, 9 January, 2004, and “Masyarakat alu-alu rancangan pemerintah pinda HOTA [Community welcomes government plan to amend HOTA]”, Berita Harian, 21 August, 2007. ↵

“Alami: Muis akan sokong MOH perjelas tentang derma organ dan HOTA [Alami: Muis supports MOH explaining organ donation and HOTA]”, Berita Harian, 21 August, 2007. ↵

See “More Muslims receive transplants,” Today, 11 February, 2009. ↵

The opt-out scheme is subject under HOTA, where every Singaporean included in the system is treated as prospective donors unless they choose to exclude themselves. ↵

Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya.208. ↵

Ibid. 194. ↵

Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 212. ↵

This is based on a press statement by the Mufti on the first organ donation fatwa issued by the Fatwa Committee. “Derma organ ḥarām: Fatwa Mufti [Organ donation prohibited: Mufti’s fatwa]”, Berita Harian, 2 August, 1973, 1. ↵

The fatwa permitting cornea donation was decided by the Fatwa Committee on 20 December 1995. ↵

“Derma organ haram: Fatwa Mufti [Organ donation prohibited: Mufti’s fatwa]”, Berita Harian, 2 August, 1973, 1. ↵

Abdulaziz A. Sachedina. Islamic Biomedical Ethics: Principles and Application. (Oxford, Oxford University Press: 2009). 175-176. ↵

This is based on verse 195 in Surah al-Baqara: “And spend in the way of Allah and do not throw [yourselves] with your [own] hands into destruction [by refraining]. And do good; indeed, Allah loves the doers of good.” ↵

ʿIzz al-Dīn ʿAbd al-ʿAzīz bin ʿAbd al-Salām, Qawāʿid al-Aḥkām fī Maṣāliḥ al-Anām. Vol. 1. (Cairo, Dār al-Sharq: 1968). 97; Jād al-ḤaqqʿAlī, “Naql al-Aʿḍāʾ Min Insān Ilā Ākhar,” in Majalla al-Azhar, No. 10, (1983), 1375-1384. ↵

Ibn ʿĀbidīn, Ḥāshiya Ibn ʿĀbidīn. Vol. 5. (Beirut, Dār al-Fikr; 1992). 58. ↵

Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 217 ↵

Sachedina, Islamic Biomedical Ethics: Principles and Application, 149. ↵

Abu Hamid Muhammad Al-Ghazālī, The Remembrance of Death and The Afterlife. Translation, note and introduction by Timothy J. Winter. (Cambridge, Islamic Texts Society: 1989),122-123. ↵

Al-Rāzī, Tafsīr al-Kabīr, Vol. 21, 45. ↵

Sachedina, Islamic Biomedical Ethics: Principles and Application, 158-163. ↵

ʿAbd al-Raḥmān al-Jazīrī, al-Fiqh ʿalāal-Madhāhib al-Arbaʿa. Vol. 2. (Beirut: Dār al-Kutub al-ʿIlmiyya, Second ed.: 2003). 23-24. ↵

Ibid, 23. ↵

Sachedina, Islamic Biomedical Ethics: Principles and Application, 154-155 ↵

More information on HOTA is available on the Ministry of Health website at https://crms.moh.gov.sg/FAQ.aspx↵

Ministry of Health. Among the description of brain death is: “A person who is brain dead is truly and unequivocally dead and will never wake up nor regain consciousness again. Brain death occurs when there is total and irreversible cessation of all functions of the brain in a person. When a person is declared brain dead, he will not be able to breathe on his own and will need to be artificially supported by a ventilator. Once the ventilator is switched off, the person’s heart will cease to beat as his brain has already stopped functioning.” Ibid. ↵

The Islamic Fiqh Academy in its 10th Conference in Mecca on 17 October 1987 ruled that “Patients on life support, if it was verified by three doctors that he is brain dead and could not recover, then it is permitted to disconnect the life support even though the heart and respiratory systems are still functioning with the help of the paired device.” ↵

Aḥmad bin Muḥammad al-Zarqāʾ, Sharḥ al-Qawāʿid al-Fiqḥiyya. (Damascus, Dār al-Qalam: 1989). 309. ↵

Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. Vol 1. 278. ↵

ʿAbd al-Karīm ʿUthmān, al-Niẓām al-Siyāsīfīal-Islām. (Beirut, Dār al-Irsyād: 1968),138. ↵

A benefit that is not explicitly supported or opposed by religious texts, is intended by the Shariah to be preserved. ↵

Tājʿ al-Dīn ʿAlī bin ʿAbd al-Kāfī al-Subkī, Al-Ibhāj fī Sharḥ al-Minhāj: ʿAlā Minhāj al-Wuṣūl ilā ʿIlm al-Uṣūl (Beirut, Dār al-Kutub al-ʿIlmiyya: 1984), Vol. 3,178.   ↵

4

Science and Biomedical Research Using Human Tissue

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ وَحَمَلْنَاهُمْ فِي الْبَرِّ وَالْبَحْرِ وَرَزَقْنَاهُم مِّنَ الطَّيِّبَاتِ وَفَضَّلْنَاهُمْ عَلَىٰ كَثِيرٍ مِّمَّنْ خَلَقْنَا تَفْضِيلًا

“And indeed We have honoured the Children of Adam, and We have carried them on land and sea, and have provided them with at-tayyibāt (lawful good things), and have preferred them to many of those whom We have created with a marked preferment.”(al-Isrā’:70)

Biomedical research using human tissues and stem cells has grown rapidly over the past few decades. The procurement and use of such tissues and cells have caused some controversy globally. The most recent instance was the nationwide protests in the United States against Planned Parenthood for allegedly selling tissues from aborted babies. Such controversies and dubious practices highlight the need for regulation of the biomedical research industry.

With regard to the supervision and monitoring of biomedical research in Singapore, the Ministry of Health has required all government sectors and hospitals to establish ethics committees since 1998.  Each committee reviews the pharmaceutical trials, procedures and other clinical studies involving human subjects.[1] At the national level, the National Medical Ethics Committee was formed primarily to issue guidelines on research involving human subjects. However, this legal infrastructure proved inadequate as advances in biomedical research brought many new issues to the table. In December 2000, the Singapore Cabinet appointed the Bioethics Advisory Committee (BAC) to examine the ethical, legal and social issues that could result from developing biomedical research in Singapore. The establishment of the BAC is very important and timely for Singapore as the country moved towards creating a thriving biomedical industry as part of Singapore’s economic planning. Members of the BAC are appointed for two-year terms. The Committee comprises legal experts, scientists, religious leaders, and academics from various disciplines.[2] Before submitting its findings, the BAC consults various organisations, including religious organizations such as Muis.  A large number of the questions submitted to Muis have been discussed by the Fatwa Committee in which they ascertained their religious positions and the results of these have been returned to the BAC. Since 2002, the Fatwa Committee has published eight reports outlining their policy recommendations for issues such as stem cell research, genetic testing, human-animal hybrid research, donation of human eggs and the use of personal information in biomedical research.[3]

Prior to the consultation by the BAC, the Fatwa Committee received requests for fatwas on issues related to scientific research involving human bodies, tissues and cells as early as the 1970s, such as the issue of post-mortem on cadavers for the purpose of forensic and medical research. Although this was not a cutting-edge procedure compared to today’s scientific research, the fundamentals of the ruling nonetheless outlined the main principles for future concerns in similar issues.

Fatwa Decision 29/8/1972
PERFORMING POST-MOTERM ON CADAVERS FOR RESEARCH

Question:

Is it permissible to perform post-mortem on Muslim cadavers for medical research?

Answer:

The Fatwa Committee could not reach a unanimous decision on whether the bodies of deceased Muslims can be used for medical research.

The Chairman is of the view that this is allowed only in cases of emergency, with the condition that the researcher is an actual medical student who is required to dissect the human body as part of his medical training, and not any lay person who is not undergoing training for medical studies.

The evidence for the opinion is as follows:
Islam commands its followers to seek treatment when ill. The Messenger of Allah (ﷺ) himself sought treatment and instructed his household and companions to seek treatment when ill. The Messenger of Allah (ﷺ) said in a hadīth, which means:

“Seek treatment because Allah does not place a disease, except that there is a treatment.”

And he also said:

“Allah does not bring down a disease, except that there is a treatment. Some know the treatment (how to treat) and some do not.”

Therefore the learning and teaching of medical treatment, is masyrū‘ (permitted by religion) based on evidence from the hadīth and the actions of the Prophet, in addition to evidence from the Qur’an that allows the breaking of fast for the sick so that they may seek treatment and avoid matters that may bring further harm.

Clearly, learning medicine and its related knowledge is beneficial and is thus considered fardu kifayah, which makes it obligatory on some Muslims. Otherwise, everyone would be in sin if it were totally neglected. The same goes for other sciences and disciplines that are needed by the community; there must be Muslims from the ummah who fulfil the fardu kifayah.

Post-mortem and surgery are essential lessons in medical science and should be adequately studied both on theoretical and practical levels so that the student can appropriately and successfully fulfil his task upon completion.

With the aforementioned evidence, it is clear that learning surgery is compulsory (fardu kifayah) upon every community. The same goes for teaching and making full use of the knowledge gained in service of humanity. It is also a fundamental maxim that it is (as-shāri‘) who makes the law – when a matter is compulsory, then its components are also compulsory. For example, when Allah made prayer obligatory, it is obligatory for the one who performs it that his body is also in a state of cleanliness.

Since some Muslims are obligated to learn medicine and serve as doctors, Islam also requires that they study surgery to become surgeons. It is clear therefore that to do so, they need to learn how to dissect. Now, the other issue is the question of the sanctity of the human body, and whether it would be considered an abuse if it is dissected.

A person who does not comprehend this will definitely object to it. But by considering the Islamic legal maxims, we will find that the objective of Islamic law is to “maintain goodness and avoid harm.” That which leads to good is pursued, and that which leads to harm is avoided and strictly prohibited by the religion.

When weighing the benefit of surgery or dissection in medical research in comparison to that which brings benefit as a result of the study– such as upholding truth, helping the wrongly accused from capital charges, convicting a murderer – we will find that research involving surgery and dissection is more beneficial. Some conditions have to be adhered to before such procedures are carried out: mainly that it is allowed only due to ḍarūra (exigency). The procedure must also be done by Muslim doctors in a Muslim country, and not simply conducted by anyone.

In discussing the issue above, the Fatwa Committee weighed between the two forms of potential harm (mafsada): the mafsada if Muslims were prohibited from performing dissections on a cadaver for the purpose of studying medicine and surgery, thus being deprived of the knowledge of treating sickness, and the mafsada of dissecting a human body.

Based on the maxim “jalb al-maṣālih muqaddam ʿalā dafʿal-mafsada” (drawing benefit takes precedence over avoiding harm), the Fatwa Committee assesed the benefits that can be gained from the procedure and weighed it against the necessity of avoidance of harm.

The Fatwa Committee opined that examining diseases through surgery could save many lives. It should also be noted that in the opinion of the Fatwa Committee, a post-mortem does not encroach on the sanctity of the deceased. However, the Fatwa Committee cautioned that the procedure should be carried out only on the basis of necessity, in order to avoid any exploitation that can give rise to other ethical issues, such as the sale and trafficking of cadavers. By allowing the operation to be performed on the deceased, the fatwa is similar in its objective to the 1985 fatwa on organ donation on the basis that transplantation can be performed due to exigencies.

When analysed from a contemporary perspective, it can be said that the fatwa reflects a conservative stance. For example, it places a condition that the surgery should be performed only by Muslim doctors in Muslim countries. Such a position was not all too surprising, given several reasons. Among them is that the fatwa was issued in the early years of the formation of the Fatwa Committee and less than a decade since its inception. It therefore shows a preference towards adopting a cautious approach and decisions issued were guided by the opinions of scholars from Islamic countries, particularly the Middle East. This approach changed in subsequent years. For example, the religion of the health provider no longer became a condition in subsequent fatwas related to medical issues such as organ donation.

Human Stem Cell Research

Research involving human tissue not only focused on the cause of diseases, but also on improvements on current health services and explorations in new forms of treatment and research. Among the findings that have paved the way for other forms of research is the use of stem cells in treatment and reproduction of other cells. This secondary area of research is not free from ethical questions either. This is because one of the sources of stem cells – in fact, the one with the greatest pluripotentiality – is from embryos less than five days old. This breakthrough has generated numerous discussions on whether it should be done, and whether the potential benefits outweigh the harm that may arise.

Stem cells are unspecialised cells which are able to renew and reproduce themselves. Under certain conditions, they could also differentiate into specialised cells for specific functions. There are three common types of stem cells, each of which come from three different sources; (1) Embryonic stem cells which come from early human embryos created from in-vitro fertilization; (2) Adult stem cells which are found in certain adult tissues such as the bone marrow and the brain; and (3) Embryonic germ cells which come from developing or cadaveric fetuses.

Sources of human stem cells

Name | Acronym | Source | Pluripotentiality*
Embryonic stem cell | ES | Embryo aged less than 5 days (blastocysts) | High pluripotentiality
Embryonic germ cell | EG | Aborted foetus in the first trimester | Undetermined pluripotentiality
Adult stem cell | AS | Tissue taken from adult human (blood, bone marrow, cord blood, liver, brain) | Low capability pluripotentiality

*Pluripotentiality: the ability to generate into other types of cells[4]

There is great scientific interest in these cells because they could potentially be used to generate specialised cells to replace tissues and organs, treat injuries as well as ameliorate currently incurable conditions such as muscular degeneration, Alzheimer’s disease, multiple sclerosis and spinal cord injuries. Embryonic stem cells, in particular, have the greatest potential. The incidence rates for such medical conditions in Singapore are expected to increase in the future. For example, the rate for dementia is projected to increase from 0.16% in 2005 to 1.09% in 2050.[5] These conditions will become even more prevalent as Singapore’s population ages. Therefore, there is great interest in promoting research that could help combat these diseases.

Prior to the formation of the BAC, there was no comprehensive legal framework in Singapore governing research on human embryos,[6] apart from guidelines for private healthcare institutions embarking on stem cell research. Soon after it was formed, the BAC discussed stem cell research under their Human Stem Cell Research subcommittee. This Committee studied the practices of other countries and developed some recommendations. In November 2001, they conducted a series of consultation sessions in which their findings were shared, and views from 39 professional and religious bodies, including Muis, were sought. This was followed by a number of dialogue sessions. The Fatwa Committee studied their findings as well as the views of contemporary scholars on related technological developments.

Fatwa Decision 22/11/2001
HUMAN STEM CELL RESEARCH

Question:

The Bioethics Advisory Committee (BAC) is of the view that it accepts the use of embryos created from in-vitro fertilisation, which are less than 14 days old, for the purpose of serious research involving stem cells for the benefit of mankind.

Based on scientific research, human embryos, which are less than 14 days old, have no pain or sentience since only at the 14th day does a primitive streak appear and develop into the nervous system. The Fatwa (Legal) Committee was requested to give a fatwa on this issue.

Answer:

Muis had organised a talk on 8 Sep 2001 on Stem Cells and Genome, which was delivered by Assoc Prof Tusqa Too Heng Poon.  The talk was attended by the Muis Council and the Fatwa Committee.

Based on the explanation and research on the issue, the Fatwa Committee is of the view that Islam welcomes academic research on human genome, genetic engineering and other related fields.  However, such research must be utilised for the benefit of mankind in areas like the treatment of illnesses.  The research has to be within the boundaries of principles in Islamic Jurisprudence, which include:

  لا ضرر ولا ضرار
“There should not be any harm and nothing should be done to cause harm”

The principle means:-

Do not cause harm to one self and to others.

Do not do something that will benefit one self but will harm or cause difficulty to others.

 الضرر يزال
“Harm should be avoided”

The principle means:-

Harm, when is sure to occur, should be avoided whether before or after it occurs.

POSITION OF EMBRYO IN ISLAMIC LAW

What is Islam’s view on the fertilisation of an embryo within or outside the womb?

The Fatwa Committee is of the view that Islam does not place any judgement on an embryo which is not fully formed.  An embryo is only considered as a human life after it is 4 months old as, in Islam, it is believed that a soul is introduced into the embryo when it is four months old.  This is the view of most jurists based on the hadīth (tradition) narrated by Abdullah bin Mas‘ūd:

‏إن أحدكم يجمع خلقه في بطن أمه أربعين يوما ثم يكون في ذلك ‏ ‏علقة ‏ ‏مثل ذلك ثم يكون في ذلك ‏ ‏مضغة ‏ ‏مثل ذلك ثم يرسل الملك فينفخ فيه الروح ويؤمر بأربع كلمات بكتب رزقه وأجله وعمله وشقي أو سعيد

 “Verily the creation of each one of you is brought together in his mother’s belly for forty days in the form of seed, then he is a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows the breath of life into him and who is commanded about four matters: to write down his means of livelihood, his life span, his actions, and whether miserable or fortunate…” -narrated by Bukhari and Muslim.

Thus, an embryo below four months, whether within or outside the womb, is considered a living thing undergoing the growth process.  However, it is not yet considered as the beginning of human life with the presence of a soul.

Past and present jurists have given a similar view.  Among them is Dr Muhammad Sulaiman Al-Asyqar who is of the view that no judgement will be pronounced or placed on an embryo which is not formed or is not in a woman’s womb:  He explains:

 Islamic law does not place any form of judgment on an embryo which is not formed.  Verily, I have indeed explained in detail my opinion during my forum discussion on birth.  In that forum, a decision had been made that Islamic law does not place any judgment on a woman’s fertilised egg except after it is in the womb. There is no judgment on it before it is in the womb.

A similar opinion was also given by the Darul Ifta’ of Saudi Arabia, where, for as long as there is no soul in an embryo, the sperm and the egg are judged to be living things adapting to their specific conditions.  They are considered as components of the fertilization process. They have not reached the stage of a complete human being.  The following is the text from the fatwa of Darul Ifta’:

 If it is destined that the sperm and a woman’s egg do not die, both will live adapting to their respective conditions as they were created. With Allah’s will and predestination, both will fuse.  At that point, an embryo will be formed.  The embryo will live according to its growth and development following the defined stages.  When a soul is introduced, a human life will be created based on the will of Allah, who is the Subtle one and the All-Knowing.

In relation to this, the Fatwa Committee rules that the opinion of the BAC to use stem cells from embryos below 14 days old for the purpose of research that will benefit mankind is allowed in Islam. This is with the condition that is is not misused for the purpose of human reproductive cloning, which would result in the contamination of progeny and loss of human dignity.

In the Fatwa Committee’s view, this issue needs to be addressed from both religious and legal aspects. The Fatwa Committee needs to answer related ethical questions, such as whether a stem cell attains the status of personhood, which requires it to be protected like a complete human being, and thus not to be used for research purposes. This is then related to whether such research is permitted in Islam, and the prerequisite guidelines and ethical limitations that should be observed.

Status of Personhood

The status of a foetus whether it is considered a full person is an issue that has still not been conclusively resolved from the Islamic viewpoint. The status of a foetus whether it is considered a full person is an issue that has still not been conclusively resolved from the Islamic viewpoint. Apart from references in the Qur’an and hadīth to the various stages of embryology, there are no clear criteria in the Muslim sources that determine when the foetus should be considered a human being and is endowed with the same rights as a newborn.[7] While the ‘ulamā do not dispute the biological development of life and the sanctity and dignity of the foetus, they disagree on the stage at which a foetus cannot be tampered with, or have its existence threatened (which is discussed through the concept of dhimma ṣāliha).[8] Therefore, differences of opinion exist on moments of fertilisation, the insertion of the soul, the possibility of life, and the rights of personhood which is granted only to newborns whose life is definite outside the womb.

By way of definition, a foetus is confined (istijān) in the mother’s womb until birth,[9] and thus does not have the personhood status that results in the full protection of human rights. This view is expressed in the Ḥanafī school of law. This changes after the foetus is born when it begins to acquire related rights such as protection of life, lineage, inheritance and others.[10] This also forms the basis for the Ḥanafī view that if the foetus endangers the life of the mother (whose existence is definite), it can be aborted no matter how late the stage it is in.[11] However, such an understanding of the human foetus could and have resulted in abuses, such as abortions which are not due to any medical emergency, or done to avoid poverty as evident in population control measures.[12]

In its response to the ethical dimension of the foetus’ personhood, the Fatwa Committee differentiates between two types of foetuses; a foetus that was fertilised and developed inside the mother’s womb, and a foetus that was fertilised outside the mother’s womb and remained externally, i.e. not implanted in the mother’s womb.

In a fatwa ruling on aborting a foetus that is inside the mother’s womb, the Fatwa Committee recognised that this foetus is accorded the status of personhood as early as the moment of conception. Therefore, abortion is not allowed no matter how early, except in medical emergencies when the mother’s life is in danger if she continues with the pregnancy. Although the Fatwa Committee interpreted the hadīth (which describes the stages of foetal development) narrated by ʿAbdullāh ibn Masʿūd above that the status of personhood is granted on the one hundred and twentieth day, it is more disposed to the interpretation that personhood could occur within one month.[13] This preference takes into consideration the sanctity of life that has been bestowed on a fertilised embryo and the fact that the stages of human development have already begun from the moment of conception. Meanwhile, the egg and sperm that are fertilised in-vitro and implanted into the womb at a later stage would remain, in essence, as separated cells without any element of soul nor personhood. This means that it is not subject to the ordinary rights of protection.

Despite the Fatwa Committee’s opinion above on embryos fertilised externally, it should also be noted that the Fatwa Committee, on ethical considerations, has set a limit of 14 days for the manipulation of stem cell for research. This is because studies have shown that embryos have the potential to sense pain due to the onset of nerve pulses after 14 days. In this case, it is clear that the Fatwa Committee takes into account scientific developments in establishing the criteria for determining the status of personhood. In addition, the Fatwa Committee also stressed that the use of stem cells is limited to research that benefit mankind. It also placed ethical conditions that stem cells cannot be abused, whether for human cloning, contaminating lineage, or whatever may cause harm to mankind, in reference to the maxim which prohibits the removal of harm with another type of harm, which forms a core principle in Islamic ethics.

The BAC had also received feedback through its consultations on the issue of the personhood of embryos. It had outlined three main views on the subject of stem cell research. One camp treats embryos as mere cells and do not object to any form of research on them. A second camp accepts that a human embryo is more than a collection of cells and should be accorded some protection and respect but is uncertain about how this should be done. A third camp accords the human embryo with the status of a person and considers the creation and destruction of an embryo for research purposes wrong and unethical.

The final recommendation by the BAC adopts a moderate view that such embryos hold a special status, one that is different from the rights of a living person. Pursuant to this, they recommended the use of stem cells in research under stringent conditions. They also published a set of recommendations related to research involving human tissue in general in 2002. Their recommendations include the following:

Enforcing informed consent on donors of human tissue, allowing only the use of tissues which had been gifted for this research and not to accept or give any form of payment,

Allowing the donor to decide how the tissue can be used,

Restricting institutions which carry out each research and safeguarding the personal information of donors to licensed statutory bodies,

Initiating professional and public dialogue on the matter.[14]

A subsequent publication in 2004 refined the recommendations in the 2002 report. In particular, it sought to monitor future research by suggesting that all proposed research programs should be reviewed by an independent board licensed by the Health Sciences Authority (HSA).

Cloning

The question of the permissibility of cloning was also studied by the BAC. Cloning is a process where a genetically identical copy of an animal or human being is produced. With the advent of in-vitro fertilization, concerns arose that the technology could potentially be applied in a socially undesirable way. This includes choosing a baby’s gender and skewing the population sex balance, “designing” babies with desired intelligence and physical traits, and hiring wombs to carry and birth such babies in an attempt to create a “super-race.” [15]

The fears were not about the sanctity of traditional nuclear families but the act of genetically tinkering and ‘creating’ new human beings. In other words, with the success of in-vitro fertilisation, many felt that cloning would not be far behind. This proved to be true, as in-vitro methods paved the way for the transfer of nuclei of humans and animal cells, a key step that enabled cloning.

Therapeutic Cloning

Therapeutic cloning is a related technology that does not involve the creation of a genetically identical human or animal. Instead, it uses the somatic cell nuclear transfer process to create new cells that are genetically identical to donor cells. This means that these new cells could be used to treat diseases. Unlike transplanted donor cells, the body is unlikely to reject these new cells as they are genetically identical.  Therapeutic cloning is thus more likely to succeed than stem cell transplants. Furthermore, cells created from cloning have the added advantage of being pluripotent, which means that it could give rise to all cells in the body except the embryo.

However, therapeutic cloning also gave rise to some ethical problems. For example, this process involves many attempts to create a viable egg as the egg with an infused somatic nucleus often has poor stability. At the same time, the embryo created through this method is usually destroyed after stem cells are extracted. For groups that consider an embryo as a human life and has rights to life and dignity, the destruction of the embryo is unacceptable. For groups that consider an embryo as a human life and has rights to life and dignity, the destruction of the embryo is unacceptable.

At both international and local levels, these issues were a matter of some concern. The United Nations Education, Scientific and Cultural Organization (UNESCO) issued several guidelines in 2001 for countries that wish to develop research in this area. It recommends that any country that permits research involving the use of embryos should also come up with a regulatory framework and construct controls to prevent the unethical use of embryos. However, UNESCO stopped short of specifying the controls and standards that it considers to be ethical since it was mindful of the diversity of opinions on this matter.[16]

As part of its consultation process on the issue of cloning, the BAC sought the views of Muis on the various types of cloning. In determining the ruling, the Fatwa Committee studied the risks and wide-ranging impact of such scientific technologies. This includes the potential benefit of allowing it for therapeutic use as it could lead to other advancements in patient care such as growing replacement organs and conceiving twins. In determining the Muslim law regarding cloning, the Fatwa Committee’s consideration needs to carefully balance between the potential benefits and possible harm at both individual and community levels. It is similar to allowing controversial procedures such as stem cell research on the basis that it has the potential to bring great benefits in the future.

Fatwa Decision 15/2/2000
CLONING

Question:

What is the opinion of the Fatwa Committee on cloning, especially on the matters related to the issues below:

a. The process of determining the sex of the child.
b. The process of creating identical twins.
c. The process of giving birth to twins using DNA from only the father or mother, without the DNA of the spouse, although the child is implanted in the mother’s womb.
d. The process of producing human organs for the purpose of

Medical research and

Replacing the organs of needy patients

Answer:

After deliberating and examining the content of the lecture on cloning that was previously organised by Muis, the Fatwa Committee is made aware of several forms of genetic cloning that can be conducted to produce babies that have the same characteristics, or for medical purposes. The Fatwa Committee is of the opinion that the fiqh ruling on them varies according to the different intents and processes taken. As described in the question above, cloning could be carried out for the following purposes:

First: Cloning for the purpose of determining the gender of the child.

This form of cloning is contradictory to religious ethics from two perspectives:

i. The knowledge of the womb is a matter for Allah. None on God’s creation knows it. Allah says in surah ar-Ra’d:

اللَّهُ يَعْلَمُ مَا تَحْمِلُ كُلُّ أُنثَىٰ وَمَا تَغِيضُ الْأَرْحَامُ وَمَا تَزْدَادُ ۖوَكُلُّ شَيْءٍ عِندَهُ بِمِقْدَارٍ
“Allah knows what every female bears and by how much the wombs fall short (of their time or number) or exceed. Everything with Him is in (due) proportion”. (ar- Ra‘d: 8)

ii. Any claim that humans have the power to determine the gender of the foetus is considered to be interfering with the affairs of Allah the Omniscient and the All-Wise; His Wisdom has determined everything for the foetus. In fact, this is one of the evidence for the existence of Allah and His power. Allah says in surah as-Shūrā:

 لِّلَّهِ مُلْكُ السَّمَاوَاتِ وَالْأَرْضِ ۚ يَخْلُقُ مَا يَشَاءُ ۚ يَهَبُ لِمَن يَشَاءُ إِنَاثًا وَيَهَبُ لِمَن يَشَاءُ الذُّكُورَ

“To Allah belongs the kingdom of the heavens and the earth. He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills” (as-Shūrā: 49)

However, as the contemporary scholar Shaikh Yūsuf al-Qaraḍāwī: mentioned in the first volume of his book “Fatawa Mu’asharah”, we can interpret Allah’s knowledge of the womb as ‘tafsili’ (detailed) knowledge which covers the particulars of the womb, such as whether the foetus will live or die, be bright or dull, weak or strong, happy or suffering, and so on. Whereas man is only able to know whether the foetus is male or female.

If we consider this interpretation, then gender selection of the foetus is not excluded from the will of Allah because man is only carrying out His will. The Fatwa Committee is of the opinion that gender selection through this process is allowed only in an emergency because the process is merely an attempt to satisfy the human desire that is included in Allah’s will; man proposes, Allah disposes. The process is allowed only if there is no syubhah (uncertainty) in the Sharīʿa. It is, therefore, better and safer in this case to refrain from engaging in such a selection and follow Allah’s will and predestination.

Second: Cloning for the purpose of fulfilling the desire to have identical twins. This process is done by splitting the embryonic cells into two (for twins), four (for quadruplets), eight (for octuplets), and so on. Then the embryo is implanted into the mother’s womb to be born as identical twins. The Committee believes that in principle, this process is allowed because it does not contaminate the lineage. In this case, man proposes, God disposes.

Third: Cloning for the purpose of giving birth to a baby, by using only the DNA of the father or the mother, and not the combination of both (as it would have been by fertilising the father’s sperm with the mother’s egg). Each egg that undergoes fertilisation contains 46 chromosomes, 23 from the father and 23 from the mother. This cloning process, therefore, aims to produce children that inherit 100% of the DNA of the father or the mother. This is done by removing the DNA (46 chromosomes) from the fertile egg. Then they are replaced with 46 new chromosomal DNA extracted from the mother (if the couple wants their child to inherit her mother’s genes). This new DNA is inherited through the mother from the grandparents of the new egg. The egg – with the new maternal DNA – is inserted back into the mother’s womb. When born, the child will be 100% similar to the mother as the genes were inherited totally from the mother. This can also be conducted on virgin women, or in other words, she can get pregnant without marrying or without husband-wife intercourse.

The Fatwa Committee is of the opinion that this cloning process involves elements of syubhah (uncertainty) because the baby’s genes are not the result of the genes of both the mother and father, but instead comes from the mother only, which in turn was inherited from the baby’s grandparents. Regarding lineage, the baby is a syubhah because she/he is like the mother’s twin. As Muslims are commanded to avoid syubhah, this form of cloning is prohibited for Muslims. It is especially prohibited on women who are not married.

Fourth: Cloning for the purpose of producing organs of the human body, either for the purpose of medical research or replacing damaged organs. Although scientists are still in the early research and experimental stages, it may be a reality in the future. If the project is successful, a person suffering from heart or kidney disease will not face problems in obtaining replacement organs as it can be produced from his DNA. Moreover, since these organs originate from his DNA, it will not face transplant rejection. The Fatwa Committee is of the opinion that this form of cloning is permissible because it brings benefit without violating any religious rules. However, it should be noted that this cannot be done for commercial reasons.

The Fatwa Committee would also like to note that the Muslim community should not be confused and worry if there is a conflict between Allah’s law, the Islamic faith, and scientific discoveries. Indeed, all knowledge comes from Allah and it is exposed to man for their benefit, to be used for good – or as guidance – and not to be abused for harm. Discoveries such as these should further strengthen our faith because it reinforces the verses of the Qur’an on Allah’s creations, such as the creations of Prophet Adam and Prophet Jesus (peace be upon them).

Fatwa Analysis

In its position issued above, the Fatwa Committee has prohibited cloning for gender selection except in an emergency, as well as the production of a clone of either parent, especially for unmarried women. The Fatwa Committee highlighted that technological innovation should not affect Muslim faith in Allah s.w.t since knowledge itself comes form Him, the All-knowing. The Fatwa Committee also considered the ethical concerns of each type of cloning, distinguishing the forms and purposes of different type of cloning techniques. Such specificity shows that the Fatwa Committee understands the differences between the processes which lead to a more meaningful deliberation.[17] In evaluating and developing appropriate answers to the questions above, the Fatwa Committee relied on a number of principles, (1) maqāṣid al-sharīʿa, (2) fiqh al-ma’āl, and (3) fiqh iftirāḍī.

For example, the Fatwa Committee’s decision to prohibit the third type of cloning using DNA from only the mother underscores the need to preserve the maqāṣid al-sharīʿa in protecting lineage. By stating that a baby created solely from the mother’s DNA is “syubhah because she/he is like the mother’s twin”, the Fatwa Committee also implied that for the pregnancy to be valid in Sharīʿa, the foetus must be formed from two types of genes; man and woman. This ultimately ensures that the traditional family – the union between a husband and wife – remains preserved in Islam. For this reason too, the Fatwa Committee prohibited such procedures if it were conducted on an unmarried woman. This symbolises the principles of fiqh al-ma’āl by considering the long-term social impact should the third type of cloning be allowed.[18] At the same time, the Fatwa Committee also considered the future potential of this procedure by utilising the concept of fiqh taqdīrī (also known as fiqh al-tawaqquʿ and fiqh iftirāḍī).[19]a concept more commonly used by scholars in the Ḥanafī school of thought.[20] This is apparent from the text of the fatwa: “Although scientists are still at the early experimental stages, it may be a reality in the future.”

The Underlying Principles on the Permissibility of Therapeutic Cloning

The Fatwa Committee’s decision to prohibit the cloning of a complete human means that cloning parts of the human body for therapeutic purposes is excluded from the general prohibition, and by extension, can be permitted. However, it is safeguarded by certain conditions. For example, it should only be used for the person whose cells it originates from. This is to fulfill its main objective of minimising rejection of donated organs by replacing it with a cloned organ that is fully compatible. In addition, the Fatwa Committee placed a clear prohibition on the the trade of cloned body parts. This is intended to guard against potential abuse, such as the exploitation of the poor, and the commodification of human cells and tissue by those who are deemed to have attractive physical features.

Based on the concept of qiyās al-aulā,[21]it could be surmised from this decision that cloning body parts and attaching them to form a complete human being is also prohibited, all the more cloning multiple people would be so. This clearly runs contrary to maqāṣid al-sharīʿa that preserves clear lineage, familial ties, and human dignity.

Between Playing God and Preserving God-Granted Knowledge

The issue of cloning is also intricately linked to the Islamic theological creed. For example, the Fatwa Committee questioned whether man is playing God through the act of cloning. This concern is not unique to Islam. In their discourse on religious ethics, Christian thinkers view cloning with suspicion and great caution. They often emphasise their concern that cloning is akin to playing God, especially in imitating the process of human creation and manipulating human stem cells and the nucleus.[22] In the first part of the aforementioned fatwa, the Fatwa Committee recognises that cloning to select gender is seen as a violation of ethics on human creation as outlined in the Qur’an. From this ethical viewpoint, what takes place in the womb is the affair of Allah s.w.t and no creature has knowledge of it. Thus, any claims of human having the power to dictate the sex of the foetus is considered to be interfering in God’s affairs. In elaborating this, the Fatwa Committee quoted the view of the contemporary Muslim jurist Shaikh Yūsuf al-Qaradāwī that God’s knowledge of the womb is tafsīlī (i.e. detailed) that covers the fate of the foetus, whether it will survive, and various other attributes such as its intelligence, happiness or suffering, whereas man could only have access to the gender of the foetus with scientific progress. On this basis, the Fatwa Committee allows gender selection of the foetus with the condition that it should be free from any syubhah and ambiguity. On this basis, the Fatwa Committee allows gender selection of the foetus with the condition that it should be free from any syubhah and ambiguity. The Fatwa Committee however, stated that it is “better and safer in this case to refrain from engaging in such practice and to follow Allah’s will and predestination.”

The Fatwa Committee did not directly address the question of man playing God, but opined instead that these are dubious matters that are best avoided. Nonetheless, it did not expound on the concept of syubhah in this instance. For example, does the syubhah here prohibits cloning? The cautious approach adopted by the Fatwa Committee serves as an indication that they are more inclined to prohibit cloning, or allow it only in extreme necessity and in controlled conditions. However, this view is unlike that expressed by the former Mufti of Egypt Dr. Naṣr Farīd Wāsil who disapproves of cloning and believes that the government should protect its citizens from its dangers.[23] The Fatwa Committee also did not address the implications of allowing gender selection. For example, couples or individuals could end up selecting preferred attributes that changes the genome, further resulting in the creation of a “super race.” Although the Fatwa Committee took steps in including ethical considerations and restrictions, there is still room to further develop these ethical considerations.

Following its opinion that cloning for gender selection is not in conflict with religious ethics, the Fatwa Committee then allowed the manipulation of cells fertilised outside the womb, which are then split into multiple cells, and later developed into a foetus in the womb. The two processes are similar to genetic engineering; by cloning and creating life from human or animal DNA for the purpose of having progeny.

Genetic Testing

Genetic testing is a contentious issue because the technology enables individuals to find out whether their genes predispose them towards certain medical conditions. Examples of genetically inherited conditions include blood disorder thalassemia, Down Syndrome, Alzheimer’s disease and dementia. A major breakthrough occurred in the new millennium with the Human Genome Project, which mapped the sequence of human genomes for the first time.[24] By 2005, the technology had progressed enough for successful testing of embryos to determine if it was free of gene mutations linked to Alzheimer’s and to screen for gender even before the embryo is implanted into a mother’s womb.[25] Do-it-yourself medical testing kits also became available over the Internet, promising to reveal an individual’s ideal diet, how to exercise and which diseases they are likely to have.[26]

The repercussions of genetic testing go beyond individual patients. With advancements in technology, sections of the public became concerned that public knowledge of their genetic make-up might result in discriminatory practices by employers or insurers. A survey among the British public in 1998 indicated that 51 per cent were unwilling to take a genetic test and less than 20 per cent was willing to share their genetic information with insurers.[27] These worries are not unfounded. As early as 1983, a few companies in the United States used genetic testing to determine who are more susceptible to occupational diseases. Some 59 more companies expressed an interest in doing so.[28] However, the United States Equal Employment Opportunity Commission (EEOC) later took some employers to court for carrying out genetic testing on their workers.[29] British life insurers are allowed to charge higher premiums or refuse cover to those born with genes that could lead to serious illnesses later in life.[30] While an individual could choose not to be tested, he could not withhold the results if he was tested. The United Kingdom was the first country in the world to do so, with the Netherlands, Norway and France objecting to such a move.[31] These debates around the world highlighted the potential impact of genetic testing on the general public.

In Singapore, the BAC recommended that genetic testing be done only with informed consent from the patients and that it should be followed with a post-test counselling.[32] Parents are only allowed to screen their unborn babies for serious genetic diseases such as thalassemia, preferably so that preventive treatment could be carried out. Genetic testing to choose the gender of a baby is not permitted.[33] Employers and insurers should not be allowed access to the data without the consent of the patient himself. Public feedback indicated that Singaporeans, in general, agree with the BAC’s proposals. Click here for future issues in Bioethics.

Conclusion

Based on the decisions of the Fatwa Committee on scientific research and the biomedical use of human tissues, some principles in Islamic legal and ethical thought can be outlined:

Necessity dictates that any research in this area contribute to the preservation of maqāṣid al-sharīʿa, and brings people closer to it, instead of away from it.

The maṣlaḥa that may be achieved from any research in this area outweighs any harm and prevents the occurrence of greater harm.

The need to apply the concept of fiqh iftirāḍī on an informed but hypothetical basis and latest research trends, and not to wait until the research has begun before issuing religious and ethical guidelines.

The need to preserve the knowledge granted by Allah s.w.t. together with ethical guidelines. Although caution is necessary so that research does not violate ethical limits, it should not necessarily hamper efforts to develop further research. Researchers need to strike a balance between the potential of ideas for scientific discovery and the risk of harm to nature and human beings.

The determination of full personhood. In this matter, the Fatwa Committee distinguishes between an embryo fertilised in the womb and one that is fertilised externally. In the former, the foetus is granted the position of full personhood from the moment of fertilisation, and thus its growth cannot be tampered with, unless the mother faces harm. On the other hand, if an embryo is fertilised outside the womb and was not implanted in the mother’s womb, the Fatwa Committee allows it to be manipulated solely for human medical purposes, provided that it does not exceed 14 days.

The principles above should continue to be reviewed and improved as research and biomedical science develop, especially in places such as Singapore with its emphasis on such research activities. This means that the religious leadership and jurists have to continue develop a framework that is suitable to guide further research from religious and ethical aspects. The guidelines and positions should not only contribute to the development of religious thought, but also inform conversations on global ethics.

"Genetic Testing: How (not) to play God," The New Paper, April 2001, 6. ↵

The details of the Committee can be obtained in the preface of each bioethics committee report. The report is available online at: http://www.bioethics-singapore.org/index/publications/reports.html. ↵

Ibid. ↵

Ariff Bongso, “Human Embryonic Stem Cells – Science & Ethics”, in Ethical, Legal and Social Issues in Human Stem Cell Research, Reproductive and Therapeutic Cloning, Bioethics Advisory Committee Singapore (2002). ↵

“Dementia in the Asia Pacific Region: Statistical Appendix,” for Asia Pacific Members of Alzheimer's Disease International, Access Economics PTY (2006), 24. Accessed on November 11, 2015. http://www.scribd.com/doc/118025112/About-Dementia-Statistics-AsiaPacificEpidemicSept06-Statistical-Appendix#scribd↵

Human embryo refers to the first eight weeks after fertilisation, after which it is described as a foetus. Stanley J Ulijaszek et al, The Cambridge Encyclopedia of Human Growth and Development (Cambridge: Cambridge University Press, 1998), 161. ↵

Abdulaziz Sachedina, Islamic Biomedical Ethics Principles and Application (Oxford: Oxford University Press, 2009), 125. ↵

In the chapter “Crime against foetus”, ʿAbd al-Rahmān al-Jazīrī, “Kitāb al-Ḥudūd,” in Kitāb al-Fiqh ʿalā al-Madhāhib al-Arbaʿa (Beirut: Dār al-Kutub al-ʿArabia, 1972), Vol. 5, 372-75, explains the detailed rulings and legal comparison of the status of the foetus and acts that could be deemed as crime against it. ↵

This is as defined in Lisān al-ʿArab and other dictionaries such as al-Ṭāhir ʾAhmad al-Zāwī, Mukhtār al-Qāmūs: Murattab ʿalā Ṭarīqāt Mukhtār wa al-Ṣiḥḥa wa al-Misbāḥ al-Munīr (Riyadh, Saudi Arabia: Dar Alam al-Kutub, 1998); and al-Muʿjam al-Wajīz Majmaʿ al-Lugha al-ʿArabiyya (Cairo: al-Majma’, 1980). ↵

Muhammad Amīn Ibn ʿĀbidīn, Hāshia al-Radd al-Mukhtār fī al-Sharḥ al-Tanwīr al-Abṣār fī al-Fiqh al-Mazhab al-Imām Abī Ḥanīfa al-Nuʿmān (Cairo: Maṭbaʿa Muṣṭafā al-Bābī al-Halabī, 1966), Vol. 6, 587; Zain al-Dīn Ibn Nujaym, al-Baḥr al-Rāʾiq: Sharḥ Kanz al-Daqāʾiq (Cairo: al- Maṭbaʿa al-ʿIlmiyya, 1983),vol. 8 839. ↵

Al-Mausūʿa al-Fiqhiyya al-Islāmiyya (Cairo: al-Majlis al-Aʿlā li Shuʾūn al-Islāmiyya, 1953) Vol. 3, 159-179. ↵

Al-Mausūʿa al-Fiqhiyya al-Islāmiyya Vol. 3, 159-179. Also see the declaration made in the International Conference on Population and Development (ICPD), September 5-13, 1994, Cairo, Egypt. ↵

Ṣaḥīḥ Muslim, no. 2643 (Cairo: Dār Ihyāʾ al-Kutub al-ʿArabia, 1955), 2036. ↵

The report and recommendation can be found online at http://www.bioethics-singapore.org/index/publications/reports/173-human-tissue-research.html↵

See “Sambutan girang-bimbang terhadap kemunculan bayi tabung uji pertama [Celebration and worry over the first test tube baby],” Berita Harian, August 1978; “Cubaan Hitler cipta generasi terbaik [Hitler’s attempt to create the best generation],” Berita Harian, October 1978 and “2800 bayi lahir di bawah ujian Hitler cipta bangsa terbaik [2800 babies born in Hitler’s experiment to create the best race],” Berita Harian, October 1978. ↵

Alexander McCall Smith dan Michel Revel, “The Use of Embryonic Stem Cells in Therapeutic Research,” United Nations Education, Scientific and Cultural Organization (UNESCO), (2001). ↵

Sachedina, Islamic Biomedical Ethics, 203. ↵

The term fiqh al-maʾāl was known or used by classical ulama such as Imam al-Shāṭibī (d. 790H) in his treatise al-Muwāfaqāt with the phrase Iʿtibār al-maʾāl  or al-naẓar fī maʾālāt al-afʿāl. The word fiqh means understanding, thinking and analysing, and is a perfect match for the word al-Maʾāl which means result or something that will arise in the future. Therefore, a mujtahid must understand, think, and analyse a matter that has long-term consequences, and whether they bring goodness (maṣlaḥa) or harm (mafsada). ↵

For further details on the concepts of fiqh iftirāḍī or fiqh tawaqquʿ, see transcript of discussion with Shaikh Abdullah bin Bayyah at http://www.aljazeera.net/programs/religionandlife/2009/4/14/%D9%81%D9 % 82% D9% 87-% D8% A7% D9% 84% D8% AA% D9% 88% D9% 82% D8% B9 (accessed on 15 September 2015) ↵

See: http://www.ahlalhdeeth.com/vb/showthread.php?t=36943 for a discussion on the opinions surrounding cases of fiqh iftirāḍī. ↵

Qiyās Aulā is a qiyās in which its reason necessitates the existence of a dependent (mulḥaq) ruling, and is conditional on a stronger ruling based on the original case (mulḥaq bih). For example, the comparison between physically harming one’s parents and saying “ugh” to them, as mentioned in the Qur’an: وَقَضَىٰ رَبُّكَ أَلَّا تَعْبُدُوا إِلَّا إِيَّاهُ وَبِالْوَالِدَيْنِ إِحْسَانًا ۚ إِمَّا يَبْلُغَنَّ عِندَكَ الْكِبَرَ أَحَدُهُمَا أَوْ كِلَاهُمَا فَلَا تَقُل لَّهُمَا أُفٍّ وَلَا تَنْهَرْهُمَا وَقُل لَّهُمَا قَوْلًا كَرِيمًا “And your Lord has commanded that you shall not serve (any) but Him, and goodness to your parents. If either or both of them reach old age with you, say not to them (so much as) "Ugh" nor chide them, and speak to them a generous word.” (surah al-ʾIsrāʾ:23) ↵

Eugene C. Newman, “Biblical Reasoning against Human Cloning,” in Chalcedon Foundation, accessed on 8 September 2015, http://chalcedon.edu/research/articles/biblical-reasoning-against-human-cloning-part-i/↵

Istinsākh Bayna al-Islām wa al-Masīḥiyya (Beirut: Dār al-Fikr al-Lubnānī, 1999), 305. ↵

“Genome Mapped,” Today, April 2003, 3 ; “Genome Map 60 days away,” The Straits Times, March 2000, 8. ↵

“Allow genetic tests for serious cases,” The Straits Times, April 2005, 2. ↵

“Do-it-yourself kit? It's not that simple,” The Straits Times, April 2005, 4. ↵

“Insurance: British 'no' to genetic testing,” The Straits Times, July 1998, 3. ↵

“Genetic testing on workers,” The Business Times, May 1983, 5. ↵

“Genetic testing lands employer in court,” The Straits Times, February 2001, 9. ↵

“British life insurers can use genetic tests,” The Straits Times, October 2000, 6. ↵

“British life insurers,” The Straits Times, October 2000. ↵

“Panel sets out guidelines for genetic testing,” The Business Times, April 2005, 9. ↵

“Allow genetic tests for serious cases,” The Straits Times,April 2005, 2. ↵

5

Medicine, Health and Treatment

عَنْ أُسَامَةَ بْنِ شريكٍ، قَالَ أَتَيْتُ النَّبِيَّ صلى الله عليه وسلم وَأَصْحَابُهُ كَأَنَّمَا عَلَى رُءؤسِهِمُ الطَّيْرُ فَسَلَّمْتُ ثُمَّ قَعَدْتُ فَجَاءَ الأَعْرَابُ مِنْ هَا هُنَا وَهَا هُنَا فَقَالُوا يَا رَسُولَ اللَّهِ أَنَتَدَاوَى فَقَالَ

 ‏ ” تَدَاوَوْا فَإِنَّ اللَّهَ عَزَّ وَجَلَّ لَمْ يَضَعْ دَاءً إِلاَّ وَضَعَ لَهُ دَوَاءً غَيْرَ دَاءٍ وَاحِدٍ الْهَرَمُ “‏ ‏           

Usāma Ibn Sharīk narrated the following:

I came to the Prophet (ﷺ) and his companions were sitting as if they had birds on their heads. I said my greetings of salam and sat. The bedouins then came from all over, and they started asking the Prophet: Oh Messenger of Allah, should we seek medical treatment (if we are unwell)? He replied: “Seek medical treatment, for Allah has not made a disease without providing a cure, with the exception of one illness, which is old age.”

The physical body is entrusted by Allah to mankind and is a valuable gift that should be treasured. As such, Islam places great importance on health. One who is healthy does not only have a sound mind; good health helps a Muslim to perform duties and perfect worship. However, should a Muslim fall sick, whether due to negligence or other unavoidable factors, effort should be made to seek treatment for the illness.  This hadīth provides the basis for seeking treatment and medication:

إنَّ اللهَ أنْزَلَ الدَّاءَ والدَّواءَ ، وَجَعَلَ لكلِّ داءٍ دواءً ، فَتَداوَوْا ، ولا تَتَداوَوْا بالحَرَام

“Verily Allah has sent down illnesses and cures. And He has made (available) a cure for every illness. So seek treatment, but do not treat with what is prohibited.”[1]

This hadīth is a reminder that we must have proper understanding of how to seek treatment whilst observing the guidelines of treatment.

Taking medication and following a proper diet can relieve, treat, or even prevent diseases, in addition to improving one’s health. There are many available methods that serve as preventive measures or treatments of diseases, such as traditional herbs and modern medicine. Modern medicine typically uses drugs derived from scientific research to treat ailments. It also involves the use of vaccines to fight against pathogens or to protect the body from diseases. The production of these drugs often involves naturally-occurring chemicals and ingredients from animal sources.

As the awareness of health issues increase and Muslims are exposed to information on drug and vaccine production, an increase in questions on the permissibility of consuming medication containing alcohol or cells, fats or protein from non-halal sources, can be expected.

Islamic Principles on Medication

There are some key principles pertaining to medical ingredients as specified by Islamic law: (1) the concept of istiḥāla and istihlāk (2) the concept of emergency (ḍarūra) (3) preventing harm through treatment, and (4) the concept of maṣlaḥa. 

First: Istiḥāla and Istihlāk

The Fatwa Committee considers the principles of istiḥāla and istihlāk in relation to medication that are mixed with, or originated from, impure (najis) sources, thus undergoing the process of change or microfiltration until the impurity is changed or dissolved.  A more detailed explanation will follow in the discussions on related fatwas.

Second: The concept of emergency (ḍarūra) in seeking treatment

Emergency (ḍarūra) here means a situation in which the life or property of a person is exposed to harm.[2] A situation can be considered an emergency when a medication that has a prohibited substance(s) or a medical procedure is needed if

the main objective is the preservation of life, health and/or the physical body; and/or

in a situation where it is the only available medication or treatment suitable for the patient.

The basis for this state of emergency has to be established by medical experts before such a dispensation (rukhṣa) can apply.

Among the fiqh maxims observed in emergencies (ḍarūra) are:

A. Difficulties bring about ease. (المشقة تجلب التيسير)
This legal maxim allows for a difficulty to be resolved by way of flexibility in dire situations. The basis of this is the Qur’anic verse:

 يُرِيدُ اللَّهُ بِكُمُ الْيُسْرَ وَلَا يُرِيدُ بِكُمُ الْعُسْرَ
“Allah intends for you ease and does not intend for you hardship.”
(al-Baqara: 185)

This means that when difficulties arise in the observance of a ruling by the masses, a dispensation (rukhṣa) from the ruling can be considered. However, this is contingent upon the presence of harm. This principle, in turn, is related to the following legal maxim:

B. What is allowed during hardship, will be voided when it (the hardship) is removed. (ما جاز لعذر يبطل بزواله)

As mentioned above, all efforts to medicate from permissible substances must be exhausted. For example, where there are medications that do not contain prohibited substances in the future, such an emergency no longer exists and exceptions that have allowed for their use will be removed.

C. Emergency is limited to its rightful extent. (الضرورات تقدر بقدرها)

This maxim denotes that resorting to something prohibited (haram) is allowed up to the extent of what is required to remove the emergency. An example is a treatment for a disease, or to prevent it from worsening. However, this treatment cannot contain non-essential supplements or additives. This method reflects how Islam allows for facilitations to problems but within certain established parameters.

In Islamic jurisprudence, there are fixed rules known as ʿazīma, and concessionary rules known as rukhṣa. Muslims must abide by the rulings of ʿazīma as long as there is no concession allowing for dispensation (rukhṣa), such as the permissibility of breaking fast in Ramadan for those who are unwell. Among the reasons for dispensations include emergency, travelling, sickness and being placed under duress.

An emergency situation that warrants dispensation (rukhṣa) is specific. Dr Wahba Al-Zuhailī defines it as:

Emergencies occur to someone in dangerous situations, or in severe difficulties, or when there is a risk of injury or illness to life, limb, dignity, intellect, or property, and everything connected to it. In such a situation, it is permitted to resort to the prohibited, or to abandon or delay the compulsory in order to resist harm from occurring, while adhering to considerations within the boundaries of Islamic law.[3]

Similarly, Shaikh Yūsuf al-Qaraḍāwī in his al-Ḥalāl wa al-Ḥarām fi al-Islām, stresses that Muslims should not make light of the concessions given by the Lawgiver by using necessity as an excuse for not observing religious duties.[4]

Third: The Principle of Preventing Harm through Treatment

Another important principle in seeking treatment is that it should not cause harm or danger. This is based on the maxim that prohibits the removal of harm by inflicting a different type of harm based on a hadīth: “Do not harm or (reciprocate) harm” – Narrated by Ibn Mājah.[5] Imām al-Shāṭibī commented that although the status of the hadīth is weak (considered an uncertain hadīth i.e. ẓannī), its principle is certain (qaṭʿī) because harm and malice are known prohibitions in Islamic law.

Therefore, any medicine or treatment taken by a Muslim must be determined safe, not harmful nor poisonous, and does not endanger the patient’s health or those around him. This also forms the basis of seeking treatment from an illness. If there is a way to reduce pain, Sharīʿa encourages treatment, although it is not an obligation (as will be discussed later in the fatwa on Advanced Medical Directive).

Other maxims related to ḍarar (harm) are:

A. Harm cannot be removed by harm (الضرر لا يزال بالضرر) [6]
B. Harm is repelled according to one’s ability. (الضرر يدفع بقدر إمكان)
C. A more severe harm (ḍarar) can be removed by inflicting a less severe one. (الضرر أشد يزال بالضرر أخف)

This means that for a patient who has the option of either to undergo surgery (which is not without pain nor possible complications that may arise from the procedure) or to refuse the procedure and persevere with the illness, this maxim serves as a guide for him to choose the lesser of the two pains.

Fourth: Observing Maṣlaḥa

Classical jurists such as  Imām Mālik, Imām al-Shāfiʿī (d. 204H), Imām al-Ḥaramain al-Juwaynī (d. 438H) and  Imām Aḥmad Ibn Ḥanbal (d. 241H) accepted maṣlaḥa as a key doctrine and principle in Islamic legal thought. Whilst the guidelines developed by the classical scholars on the precedence of maṣlaḥa against harm are useful, ultimately one needs to assess every particular situation and balance between benefit and harm in his or her own unique circumstances. Whilst the guidelines developed by the classical scholars on the precedence of maṣlaḥa against harm are useful, ultimately one needs to assess every particular situation and balance between benefit and harm in his or her own unique circumstances. In the domain of jurisprudence, this is known as fiqh al-muwāzana. By taking into account both maṣlaḥa and mafsada, one must determine which maintains the maqāṣid al-sharīʿa. In relation to the topic at hand, undergoing a surgical procedure and providing treatment are considered essential to ensure that the live-preserving objectives of Sharīʿa are fulfilled. This is in accordance with a legal maxim that states “Any harm [or danger] should be eliminated”.

In his explanation of this maxim, Imām al-ʿIzz Ibn ʿAbd al-Salām divided maṣlaḥa into four:[7]

Permitted maṣlaḥa
An example of this is maintaining a healthy diet for someone who is in good health.

Compulsory maṣlaḥa due to critical benefits
An example of this is consuming prohibited food in order to preserve life.

Recommended maṣlaḥa due to additional benefits
An example of this is researching on supplements that can improve health of consumers.

Disputed maṣlaḥa, yet the maṣlaḥa outweighs the mafsada.
An example of this is praying in a state of impurity (without even performing tayammum) due to unavoidable circumstances and situations, as the priority is to conduct one’s prayer.

It must also be noted that maṣlaḥa does not necessarily include only matters that bring benefit. Jurists have categorised maṣlaḥa into several types: (1) maṣlaḥa muʿtabara (2) maṣlaḥa mursala and (3) maṣlaḥa mulghā.

1) Maṣlaḥa Muʿtabara (recognised good) refers to maṣlaḥa that has been clearly stated in the Qur’an and Sunnah, as a reason or purpose to be achieved with particular rulings. An example is maintaining individual honor and dignity by prohibiting adultery, or the prohibition of spreading allegation of adultery charges without any evidence.

2)Maṣlaḥa Mursala (unattested good) is a maṣlaḥa not explicitly mentioned but that needs to be achieved and maintained, and there is no specific scriptural basis for rejecting it. It can be understood as a maṣlaḥa that embodies the understanding of the purpose and spirit of Islam which must be preserved. Jurists have placed some conditions for maṣlaḥa mursala which include:

The maṣlaḥa to be achieved must be definitive (ḥaqīqiyya) and not uncertain.

The maṣlaḥa to be achieved must benefit the community in general (kulliyya) and not limited to individuals or certain groups.

The maṣlaḥa to be achieved must not contradict one of the religious principles or values determined by religious evidences or ijmāʿ.[8]

3) Maṣlaḥa Mulghā (annulled good) refers to benefits which are clearly prohibited in the Qur’an or Sunnah.[9] An example of this is the prohibition of usury (ribā). Even if it might benefit certain parties, its maṣlaḥa is rejected by Sharīʿa in the verse:

وَأَحَلَّ اللَّهُ الْبَيْعَ وَحَرَّمَ الرِّبَا
“And Allah has permitted trade and has forbidden usury.”
(al-Baqara: 275)

Therefore, the maṣlaḥa one intends to secure from cosmetic surgeries might be deemed as maṣlaḥa that is mulghā (annulled), for two reasons:

It inflicts pain and harm on one’s limbs without valid reason, and this is prohibited by the religion

Such procedures differ from medical surgeries whose purpose is to maintain the health of the human body, which is considered one of the maṣlaḥa muʿtabara (recognised good).

The Status of Impurities (Najis) in Medication

The status of najis elements used in medication is a debated issue among jurists. For medicines containing alcohol, there are two main issues, namely (1) the status of najis, and (2) the prohibition against consuming intoxicants. For other najis substances, the discussions concern various other concepts as explained later in the relevant fatwas.

Alcohol in Medicine

Shaikh Yūsuf al-Qaraḍāwī explains in his book al-Ḥalāl wa al-Ḥarām fi al-Islām that Islam prohibits the consumption of alcohol in medicine as it might lead to addiction while its potential as a treatment is uncertain. His opinion was based on the opinion of Ibn Masʿūd that “Allah s.w.t. did not make a cure from what is forbidden.”[10] However, he made some exceptions in necessity, that is if there are no alternatives available.[11]

Some ‘ulamā consider intoxicating drinks such as liquor (khamr) as najis. As such, it cannot be used externally. The reason for the prohibition of intoxicants is found in the following verse:

يَاأَيُّهَا الَّذِينَ آمَنُوا إِنَّمَا الْخَمْرُ وَالْمَيْسِرُ والأَنصَابُ والأَزْلامُ رِجْسٌ مِنْ عَمَلِ الشَّيْطَانِ فَاجْتَنِبُوهُ لَعَلَّكُمْ تُفْلِحُونَ
Oh you who have believed, indeed, intoxicants, gambling, idol [worshiping], and divining arrows are but defilement from the work of Satan, so avoid it that you may be successful.” (al-Māʾidah: 90).

The second reason for this prohibition is the hadīth of the Prophet Muhammad (ﷺ) as narrated by Ibn ‘Umar r.a.:

كل مسكر خمر وكل خمر حرام[12]
All that intoxicates is khamr, and all khamr is prohibited.”

As liquor (khamr) contains alcohol, this causes intoxication. However, alcohol as a substance is a product of a chemical reaction. There are several types of alcohol. The alcohol contained in liquor is known as ethyl alcohol. It is formed by the fermentation of sugar and yeast, and can be produced from either organic ingredients or through a synthetic process. Ethyl alcohol, among the other types of alcohol, is found in medication.[13]

Therefore, when discussing medication containing alcohol, one should distinguish between synthetic alcohol and alcoholic drinks known as khamr, because both have been used in the production of medication. If a medicine contains the second type, i.e. khamr, it is considered impure (najis) and is prohibited based on the hadīth above. However, if it contains synthetically-produced alcohol, then it is not deemed as najis.

Alcohol has many medical uses. For centuries, alcohol was the main component of European pharmaceutical products. Roger Bacon, an English philosopher in the 13th century and also a medical writer, wrote that among the benefits of alcohol is that it helps to protect the stomach from acid. Some pre-modern theories argued that consuming gin could ward off a plague.[14] Islamic history itself has revealed some examples of the use of alcohol to treat patients, such as those carried out by the physician al-Zahrāwī.

Early American explorers, who found it difficult to get hold of clean water sources and relied on water filtration methods, often used alcohol and opium for medical purposes.[15]In modern times, there are various views on the use of alcohol in medicine. In 18th and 19th century Europe and America, organisations promoting moderate alcohol use tried to change public opinion on using alcohol for medical purposes.[16] In 1917, the American Medical Association adopted a resolution declaring that alcohol and other stimulants are not necessary in the treatment of diseases.[17] This was later followed by a ban on alcohol across the United States in the 1920s and 1930s. However, to this day, alcohol remains an essential ingredient in medication, especially in cough medication.[18]

Fatwa Decision 29/7/1981
TAKING MEDICATION THAT CONTAINS ALCOHOL

Question:

What is the ruling on taking medications containing alcohol?

Answer:

Taking medication containing alcohol is allowed only if there are no other drugs that can replace it. This is like treating an illness by taking medicines containing najis substances [which is allowed], and not like taking liquor only [which is not allowed, as it intoxicates without healing].

The basis for allowing the consumption of medication from najis substances is a hadīth narrated by Al-Bukhārī: From ’Abu Qilabah from Anas, he said: “There are some people of ‘Ukl and Urainah, who came to visit Medina. The Prophet (ﷺ) sent some of his companions to give them camels full of milk, so that they drink its urine (for treatment) and as well as its milk…” until the end of the hadīth.

There is another hadīth narrated by Abu Dardā’ which diverges from the hadīth used in the fatwa above, which prohibits treatment with najis substances. How can we then reconcile these two hadīths?

Among the factors that may cause a medicine to become prohibited are as follows:

It contains substances from non-halal animals or animals not slaughtered according to Islamic law

It contains substances deemed as najis

It contains substances from human origin

As earlier explained, for medicines containing alcohol, two questions arise: whether alcohol is najisnajis, and whether consuming liquor is prohibited.

In the hadīth narrated by Anas r.a. in Jāmiʿ al-Tirmīdhī, in which the Prophet explained that Allah s.w.t. did not create treatment from prohibited substances, a possible meaning, as offered by Shaikh Al-Mubārakfūrī, is that the hadīth forbids using prohibited substances for medication when there are other halal options (ikhtiyār) for treatment. Where such options are unavailable, then it is considered a necessity in which the use of prohibited substances is permitted.[19] This is consistent with the injunction in Surah al-Anʿām:

وَمَا لَكُمْ أَلَّا تَأْكُلُوا مِمَّا ذُكِرَ اسْمُ اللَّهِ عَلَيْهِ وَقَدْ فَصَّلَ لَكُم مَّا حَرَّمَ عَلَيْكُمْ إِلَّا مَا اضْطُرِرْتُمْ إِلَيْهِ ۗ وَإِنَّ كَثِيرًا لَّيُضِلُّونَ بِأَهْوَائِهِم بِغَيْرِ عِلْمٍ ۗ إِنَّ رَبَّكَ هُوَ أَعْلَمُ بِالْمُعْتَدِينَ
“And why should you not eat of that upon which the name of Allah has been mentioned while He has explained in detail to you what He has forbidden you, except which you are compelled to consume. And indeed many do lead [others] astray through their [own] inclinations without knowledge. Indeed, your Lord – He is most knowing of the transgressors.” (al-An’ām: 119)

This principle is also further illustrated in the case of using pig skin grafting as discussed next.

Surgery

One way to treat skin damage is through surgery. Unlike vaccinations or drugs, some people regard skin grafting as a cosmetic procedure rather than a life-saving medical procedure. This is inaccurate as human skin is the body’s largest organ and performs many important functions. It protects the body, regulates body temperature, and produces protein and Vitamin D.[20]

The outer layer of the skin (epidermis) forms a waterproof coating while the inner layer (dermis) contains nerve endings, glands and hair follicles. The subcutaneous layer contains fat and protects the body from heat and cold.[21] Healthy skin helps to heal internal trauma such as in some medical conditions and in cases of burns.[22] The procedure involves taking healthy skin from areas of the body that are not damaged, to be grafted onto the injured skin. This method also reduces the problem of DNA incompatibility and promotes faster recovery.

In Singapore, this procedure has been used since the 1930s to help victims of acid attacks and burns.[23] A special burns unit offering skin grafts and plastic surgery was established at the Singapore General Hospital (SGH) in 1959.[24] As early as 1963, doctors planned to set up a human tissue bank for skin grafts, followed by the launch of a ‘skin farm’ in SGH in 1991.[25] Although research was conducted on the possibility of developing artificial skin, skin grafting remains the most viable treatment until now.[26] From attempting to develop artificial skin, the ‘skin farm’ now aims to grow healthy skin. This is done by taking small pieces of skin from a patient’s body before it is grafted so that the skin can be used to treat those suffering from serious skin injuries.[27] Within 3 years of its opening, at least seven patients with severe burns have benefited from this technology.[28]

There are also situations where patients suffer an injury so severe that no skin on the patient’s body was deemed suitable to be grown. In this situation, animal skin was used as an alternative skin source. It was found that there are many similarities between human skin and pig skin; both contain 95% collagen and 2% elastic fibers in the external cells.[29] Furthermore, pig skin is also used to treat heart defects, specifically to patch a hole in the heart.

A question related to this procedure was posed to the Fatwa Committee in 1988. In the fatwa, the use of pig skin was allowed if no other alternative source is found. This method also carries a higher risk as compared to grafting the skin of the patient unto himself, as the human body tends to reject foreign objects from other species.[30] However, the ruling took into consideration the harm that a patient faces from his current injuries, as well as the harm that a patient might face should he be deprived of the surgery.

Fatwa Decision  15/11/1988
USING PROHIBITED (HARAM) ITEMS (PIG SKIN) IN TREATMENT (THROUGH SKIN GRAFTING)

Question:

My niece is suffering from a congenital heart defect (hole in the heart) and according to the doctors, the hole must be sealed using pig skin. What would the ruling be if a Muslim uses pig skin as a treatment to an illness and what would be the impact on his responsibilities as a Muslim as defined in the Sharīʿa?

Answer:

There are several things which have been specified as haram by Allah s.w.t. to protect mankind from their ill effects and as a safeguard for the well-being of mankind.  These items include alcohol, carcasses, pork and several others. Allah explains in detail in surah al-Māʾidah verse 90:

يَاأَيُّهَا الَّذِينَ آمَنُوا إِنَّمَا الْخَمْرُ وَالْمَيْسِرُ والأَنصَابُ والأَزْلامُ رِجْسٌ مِنْ عَمَلِ الشَّيْطَانِ فَاجْتَنِبُوهُ لَعَلَّكُمْ تُفْلِحُونَ

 “O you who believe! Intoxicants and gambling, idol [worshiping], and (divination of) arrows, are defilement from Satan’s handiwork; so avoid it that you may be successful.”

In surah al-An‘am verse 145, Allah explains:

ُقُلْ لا أَجِدُ فِي مَا أُوحِيَ إِلَيَّ مُحَرَّمًا عَلَى طَاعِمٍ يَطْعَمُهُ إِلا أَنْ يَكُونَ مَيْتَةً أَوْ دَمًا مَسْفُوحًا أَوْ لَحْمَ خِنزِيرٍ فَإِنَّهُ رِجْسٌ أَوْ فِسْقًا أُهِلَّ لِغَيْرِ اللَّهِ بِهِ فَمَنْ اضْطُرَّ غَيْرَ بَاغٍ وَلا عَادٍ فَإِنَّ رَبَّكَ غَفُورٌ رَحِيمٌ

Say: ‘I find nothing in what has been revealed to me that forbids any one to eat of any food except the dead, running blood, and the flesh of swine for these are unclean and that which has been hallowed in its slaughter to other than Allah. But whoever is constrained to eat of any of these, not intending to sin or transgress, then your Lord is Forgiving, the Most Merciful.

The last statement in this verse implies that in a critical situation where there exists no other alternatives, such actions can be forgiven, as Allah has stated in surah al-Baqarah verse 173:

إِنَّمَا حَرَّمَ عَلَيْكُمْ الْمَيْتَةَ وَالدَّمَ وَلَحْمَ الْخِنزِيرِ وَمَا أُهِلَّ بِهِ لِغَيْرِ اللَّهِ فَمَنْ اضْطُرَّ غَيْرَ بَاغٍ وَلا عَادٍ فلا إِثْمَ عَلَيْهِ إِنَّ اللَّهَ غَفُورٌ رَحِيم

“He has only forbidden you dead meat, and blood and the flesh of swine and that on which any other name has been invoked besides that of Allah. But if one is forced by necessity without willful disobedience, nor transgressing due limits – then is he guiltless. For Allah is Oft-Forgiving, Most Merciful.”

This verse implies that whilst in normal situations these items will remain haram, there are exceptions to the rule in extreme situations where there exists no other recourse to save a life or to protect one’s health and prevent an illness than to consume these prohibited items. In such situations, their consumption is allowed.

In a situation of extreme thirst where there exists no water or other alternative liquid save alcohol, Islamic law permits the consumption of the alcohol with the intent of saving a life. The same goes for the consumption of items that are haram or najis for medicinal purposes. Islamic scholars have unanimously agreed that it is allowed to use haram or impure items for medicinal purposes to remove a life-threatening illness. [1] The scholars have, however, attached two conditions to this. Firstly, the relevant doctors must be trustworthy and honest with a credible background and experience in the profession. Secondly, it must be ascertained that no other alternative forms of treatment are available so that it cannot be said that the medication with haram components was intentionally taken.

As the illness suffered by your niece is considered critical and as the doctor has determined that there are no alternative treatments that can be used other than utilising pig skin for grafting, the treatment is thus allowed and there is no sin for doing so. There are also no restrictions placed upon the person in fulfilling his ibadah such as the prayer, etc.

Source:
1. Wahba al-Zuhailī, Fiqh Perundangan Islam (Malaysia: Dewan Bahasa dan Pustaka, 1995), Vol. 3, 593.

The fatwa above explained the concept of overriding necessity (ḍarūra) with more detail and scriptural evidence. The issue raised by the questioner was that the procedure involves using pig skin – which is categorised as ‘major impurity’– to permanently patch the heart. Hence, the question is not only whether the procedure is permissible, but relates as well to the acts of worship performed by the patient after undergoing skin-grafting.

By undergoing the surgery, the patient is putting himself in a situation considered religiously as impure. To understand the answer provided in the fatwa ruling, the classification of ‘needs’ and ‘emergencies’ must be scrutinised. Carrying or implanting a non-halal substance for medical reasons – as in the case mentioned above – should not be compared to someone using and wearing something prohibited (haram)as detailed in the following hadīth narrated by Muslim:

عن أبى هريرة رضى الله عنه قال  قال رسول الله صلى الله عليه وسلم: إِنَّ اللَّه تعلى طَيِّبٌ لاَ يَقْبَلُ إِلَّا  طَيِّبًا وَإِنَّ اللَّه أَمَرَالْمُؤْمِنِينَ بِمَا أَمَرَبِهِ الْمُرْسَلِينَ فَقَالَ تَعَالَى:  يَـأَيُّهَا الرُّسُلُ كُلُوا مِن الطَّيِّبَاتِ وَاعْمَلُوا صَالِحًا، وَقَال تعالى: يَأَيُّهَا الَّذِ ينَ آمَنُوا كُلُوا مِنْ طَيِّبَاتِ مَارَزَقْنَاكُمْ. ثُمَّ ذَكَرَ الرَّجُلُ يُطِيلُ السَّفَرَ أَشْعَثَ أَغْبَرَ يَمُدُّ يَدَيْهِ إِلَى السَّمَاءِ: يَارَبُّ يَارَبُّ وَمَطْعَمُهُ حَرَامٌ وَمَشْرَبُهُ حَرَامٌ وَمَلْبَسُهُ حَرَامٌ وَغُذِىَ بِالْحَرَامِ فَأَنَّى يُسْتَجَابُ لَهُ.

Abu Hurairah r.a. related that the Messenger of Allah (ﷺ) said: “Allah is Pure and, therefore, accepts only that which is pure. Allah has commanded the believers as what He has commanded upon His Messengers by saying: ‘O Messengers! Eat of the good things, and do good deeds.’ And He said: ‘O you who believe! Eat of the lawful things that We have provided you.” Then the Prophet (ﷺ) mentioned about a person who travels for a long period of time, his hair is dishevelled and covered with dust. He lifts his hand towards the sky and makes the supplication: ‘My Lord! My Lord!’ But his food is unlawful, his drink is unlawful, his clothes are unlawful and his nourishment is unlawful, how can, then, his supplication be accepted?”

It must therefore be noted that the meaning conveyed in this hadīth differs from the issue being discussed at hand. First, nutrition and clothing must be halal, pure and free from doubt (shubhah).[31] As such, it not only refers to prohibited physical substances, but also to how the food and clothing were obtained, that is, whether they were obtained through forbidden or doubtful means. Secondly, the hadīth considers food and clothing as part of a person’s property. There is clearly a difference between clothes and items used as a treatment or as an implant in the body. Therefore, a patient undergoing this treatment should not worry about the validity of his worship, or that he might be categorised among those whose prayers are not accepted due to the presence of prohibited substances in his body. The reason for this is that these substances were not arbitrarily added, but only used for treatment, based on necessity and dire need.

Apart from drugs or surgical treatments, there are also other preventive measures made available through vaccination. As a vaccine enters the bloodstream, the issue of whether its ingredients are halal become important. The Fatwa Committee issued fatwas on two types of vaccinations with questionable ingredients, namely the Meningitis and Rotavirus vaccines.

Vaccines

The use of enzymes and bacteria derived from animals in vaccines originated from the invention of world’s first vaccine by Edward Jenner, who invented the smallpox vaccine where inoculation is done using cowpox matter.[32] Later, many human drugs and vaccines used cow, monkey or swine enzymes in the production process. This could be done directly where the enzymes become part of the vaccine itself (as in the case of the smallpox vaccine) or indirectly where the enzymes help to cultivate the necessary ingredients but is not inherently present in the vaccine (for example, the Rotavirus vaccine).  Such enzymes were initially thought to be non-pathogenic, although some new research have shown otherwise.[33]

History of Vaccine Use

In Southeast Asia, vaccination largely came through programs implemented by colonial powers. Vaccination was a key component of the Dutch Ethical Policy program in the then Dutch East Indies from 1901 while the British-made smallpox vaccination was compulsory in Malaya in 1891.[34] Such attempts by colonial powers to improve public health were not necessarily well received and village headmen often had to help to round up their constituents to receive the vaccination shots. Early opposition to such programs was not due to the content of the vaccine but suspicion of the procedure itself and the colonial authorities’ intrusion into the bodies of their colonial subjects.[35] Much later, in the new millennia, controversial studies emerged suggesting a possible link between vaccinations and childhood autism.[36] Although these findings were highly contested, it catalysed opposition to vaccines for children.[37] Furthermore, some conservative religious groups in the United States oppose mandatory vaccinations for sexually transmitted diseases like human papilloma virus (HPV) although they support vaccination on the whole.[38] Muslims generally do not oppose vaccination on religious grounds. Sometimes, ostensibly religious reasons lead communities to decline vaccination but this reflects personal beliefs rather than theological rules.[39]

Vaccination Programmes in Singapore

In Singapore, there is currently a vaccination program in place to inoculate children called the National Childhood Vaccination Program which started in the 1980s. Introduced in stages, it currently vaccinates children against tuberculosis, hepatitis B, pneumococcal, diphtheria, tetanus, poliovirus, measles, mumps, rubella and pertussis.[40] These vaccinations were done at scheduled years during childhood and carried out in primary schools. Vaccination against measles and diphtheria are compulsory by law while the rest are optional. Before the advent of vaccines, disease prevention generally focused on ensuring the cleanliness of public and private spaces to minimise infectious contact.[41] Letters to the press prior to 1947 about the dangers of infectious disease also stressed the importance of controlling the environment such as controlling milk supply rather than prevention through medical intervention.[42]

The benefits of a vaccination program can be seen through the example of tuberculosis immunisation. In 1908, French scientists Albert Calmette and Camille Guerin discovered a tuberculosis vaccine in 1908 and named it ‘bacillus of Calmette and Guerin’, better known by its acronym BCG.[43] The vaccine’s success rate in countries such as Denmark and Russia was very high but doubts arose about its safety when 73 babies in Germany died after being given the vaccine in 1930. It was later found that that culture was contaminated with a highly virulent strain of tuberculosis.[44] Medical authorities for Singapore started examining the feasibility of adopting the vaccine for Singapore in 1947, years after the safety concerns had died down. At the time, the high incidence of tuberculosis was a source of major concern in Malaya and Singapore. The Sultan of Johore had died of the disease in 1895[45] and it was one of the top two causes of death in 1910.[46] The situation abated slightly before the war years but the rate appeared to spike during the Japanese Occupation and tuberculosis was the number one killer in Singapore in 1950.[47] The cost of tuberculosis relief that year exceeded $20000 per month.[48]

The introduction of mass BCG vaccinations in Singapore was received well by the public. The take-up rate for tuberculosis vaccination in Singapore was even higher than that in Britain itself in 1949.[49] By 1969, the disease was on a decline[50] and the number of deaths from T.B only numbered about 450 in 1975.[51] Besides vaccination, improved housing and sanitation also helped the situation.[52] Today, the disease is virtually eradicated here although there was a slight rise in recent years.[53]

The Fatwa Committee issued fatwas on two types of vaccinations with questionable ingredients from the perspective of Islamic law, namely the Meningitis and Rotavirus vaccines. Among Muslims in Singapore, opposition to vaccines because of how they were produced seemed to first arise only in 2002, following a high-profile case in Malaysia. By this time, communities here are largely in favour of vaccination as a means of fighting disease and have supported compulsory vaccination programs. However, in that year, a Malaysian doctor went to the press to point out that the vaccine used for meningitis had “bovine and porcine” elements used during its production.[54] This became a major issue as the Saudi Arabian government had mandated meningitis vaccinations for pilgrims entering the country for the Haj in that same year.[55] Therefore, Haj-bound pilgrims could not avoid it. The Saudi government’s decision was due to concern about the rising number of meningitis cases.

This led to an unintended consequence: a rise in the demand for the vaccine worldwide and closer scrutiny of its ingredients. There were actually two types of meningitis vaccines available: one made from vegetable-based fat (Mercevex) and the other from animal-based fat (Menomune). Government hospitals and clinics in Malaysia generally used a quadrivalent vaccine known as ACYW-135 based on Mercevex while some private clinics in Malaysia opted to vaccinate using the Menomune form when higher worldwide demand reduced stocks of Mercevex.[56] Given the medical need for such a vaccination and the fact that the fats were transformed into a chemical form, the Malaysian Medical Society opined that the Menomune vaccine was halal.[57] This was disputed by Malaysia’s religious authorities later that year when they ruled only the Mercevex version is halal.[58]

This debate in Malaysia, extensively reported in Malay-language newspapers here, appeared to lead to a greater sensitivity to the contents of vaccines. In 2003 and 2013, the Singapore Health Sciences Authority (HSA) asked Muis to rule whether using vaccines derived from small quantities of porcine elements is permissible before rolling out the vaccines to the public.  This seemed to be a pre-emptive move to prevent an uproar similar to what happened in Malaysia. The Meningitis vaccination requirement remains a point of contention: as late as 2010, Indonesia was still protesting the requirement because many available vaccines used porcine enzymes.[59] However, as long as the need for vaccine remains, the ruling outlined in fatwas is still relevant and applicable.

Fatwa Decision 21/10/2003

VACCINES DERIVED FROM PORCINE SOURCES

Question:

What is the ruling on vaccines derived from porcine sources?

Answer:

The Fatwa Committee views that, in principle, treatments with substances containing impurities (najis), namely pork, is allowed in an emergency (ḍarūra) if there are no other drugs that can replace it.

This fatwa, in particular, refers to vaccinations that contain prohibited ingredients, which are deemed permissible only with the condition that there are no other available alternatives that fulfils the same function. This fatwa also applies in cases where halal-certified vaccines run out, and re-stocking would take time. In particular, this fatwa continues to provide guidance for haj and umrah pilgrims, or individual Muslims who need to travel to countries that require vaccination. This is so that they can use whatever available vaccine, without having to wait for halal vaccines to become available in Singapore.

In 2013, the HSA asked the Fatwa Committee about another vaccine called the Rotavirus vaccine, which also contained religiously-prohibited ingredients. Before the development of the Rotavirus vaccine in 1984, rotavirus had killed approximately one million children a year by causing acute diarrhea[60] although no deaths from the virus has ever occurred in Singapore.[61] HAS posed the question in order to respond to queries and to address concerns by Malay-Muslim patients and parents, rather than instituting compulsory enforcement of it. In addition, the Rotavirus vaccine is not among the vaccines recommended by the World Health Organization that is compulsory for children in Singapore.

Fatwa Decision 28/2/2013
THE ROTAVIRUS VACCINE

Question:

What is the ruling for the Rotavirus Vaccine on babies?

Answer:

The Fatwa Committee has received a question from the Health Science Authority (HSA) on the Rotavirus vaccine.
Rotavirus infection can cause vomiting, dehydration, fever, and in some cases, death. At present, the Rotavirus vaccine remains the best way to tackle the disease. Information received from the HSA states that at one stage of manufacturing, enzymes from pig pancreas (trypsin) was used to separate and transfer the cells of the vaccine

Islamic Principles on Medicine and Treatment

Islam strongly encourages each individual to seek treatment for diseases. This is because the preservation of life is among the main objectives of the Sharīʿa (maqāṣid sharīʿa), and seeking treatment fulfills this purpose. There are many hadīths in which the Prophet (ﷺ) encouraged his people to seek cure.

From Usāma bin Sharik, an Arab Bedouin once asked the Prophet (ﷺ):
ياَ رسول الله أَلَا نَتَدَاوَى؟ قال: (تَدَاوَوْا، فَإِنَّ اللهَ لَم يَضَعْ دَاءً إِلاَّ وَضَعَ لَهُ شِفاءً أَو قَالَ دَوَاءً إِلاَّ دَاءً واحداً) قالوا: يا رسول الله وما هو؟ قال: الهرم

“O Rasulullah, do we need to seek treatment? The Prophet  said: ‘Seek treatment, because Alllah does not place a disease, except that He placed a cure for it, except one (of which there is no cure).’ They asked: And what is it? The Prophet said: ‘Old age.’”

Taking vaccines serves as a preventive treatment from diseases. A person who wants to prevent himself from contracting a particular disease can be vaccinated before he is infected. Preventive treatment is also highly recommended in Islam. It was narrated from the Prophet (ﷺ):

مَنْ تَصَبَّحَ بِسَبْعِ تَمَرَاتٍ عَجْوَةٍ لَمْ يَضُرَّهُ ذَلِكَ الْيَوْمَ سَمٌّ وَلَا سِحْرٌ

“He who eats seven Ajwah dates every morning, will not be harmed by poison and magic on that day.” -Muttafaq Alaihi

Elements of Najis in Medication

In principle, Islamic law prohibits seeking treatment from najis or prohibited sources. However, when there are no halal alternatives and the patient’s life depends on the medication, the Sharīʿa allows for medication with that which is najis or prohibited. Allah s.w.t. says:

 وَقَدْ فَصَّلَ لَكُم مَّا حَرَّمَ عَلَيْكُمْ إِلَّا مَا اضْطُرِرْتُمْ إِلَيْهِ

“… and He has explained in detail to you what He has forbidden upon you, except that to which you are compelled.” (al-An’am: 119)

Fatwa Committee Decision

After examining the manufacturing process of the vaccine, the Fatwa Committee found that a solution which contains enzymes from pig pancreas (trypsin) was used to transfer the developed vaccine cells to other instruments. Based on the information received from the HSA, the trypsin solution – for now – is the safest way to ensure that the transfer of cells reach the desired amount. The solution is not used in subsequent processes. The vaccine cells also go through repeated filtration and purification processes to ensure that the final product is free from the trypsin solution.

The Fatwa Committee also notes that the elements derived from pig enzymes in the trypsin solution is very small (0.001%). Based on the concept of istihlāk, the Fatwa Committee views that the miniscule amount of najis element was mixed with large amount of pure elements. The trypsin solution is thus regarded as pure because it goes through the dissolution process by being added to other pure ingredients. The dissolution process by addition is known in Islamic jurisprudence as istihlāk bi al- Mukāthara.

In addition, the official information obtained by the Fatwa Committee from the HSA also indicates that ingredients derived from pig enzymes (trypsin solution) are not contained in the rotavirus vaccine. This enzyme is in fact used as a tool to transfer the vaccine cells, and these cells will be cleansed several times. These processes show that the pork enzyme is not contained in the vaccine. The resultant vaccine also undergoes filtering, cleansing and purifying processes repeatedly until no element of the pig enzyme is left in the final product. Based on these considerations, the Fatwa Committee is of the opinion that the Rotavirus vaccine is halal and pure, as there are no elements of najis in it.

Concepts of Istiḥāla and Istihlāk

In contrast to the 2003 fatwa, the focus of the fatwa on Rotavirus above was not to address the dire need for such vaccine, but to shed more light on the ingredients and contents of the vaccine itself. As part of the research which the Committee conducted, the technical information that was provided by the health authorities was closely studied, especially the manufacturing process of the vaccine.

The Committee learnt that the impure substance (najis) was dissolved as a result of several levels of filtration and purification of the vaccine. Hence the istihlāk (decomposition) method was applied for the content of the vaccination to be considered pure and halal. The issue of whether taking an immunisation is a necessity which reaches the level of an emergency no longer arises, because it is already classified as pure through the process of istihlāk al-tām (full decomposition). The issue of whether taking an immunisation is a necessity which reaches the level of an emergency no longer arises, because it is already classified as pure through the process of istihlāk al-tām (full decomposition). Thus, even in non-emergency situations, such vaccination can be used.

The concept of istihlāk is further refined in another fatwa ruling on the drug heparin (see fatwa below) which contains a prohibited substance in its production. Heparin is an anticoagulant. It is not a vaccine but a medication given to patients suffering from cardiovascular diseases and only in critical condition. The key ingredient in heparin that dilutes blood is glycosaminoglycan. The base material in processing heparin is taken directly from animal sources, usually from bovine liver or pig intestines. [62]Bovine heparin was withdrawn from the market due to worries that it could be contaminated with bovine spongiform encephalopathy (mad cow disease).

Just like the fatwa ruling on the Rotavirus vaccine, a detailed study was carried out on heparin, including obtaining clinical information from medical experts on the production process of the drug and its use in treatment. Two main points that the Fatwa Committee considered in their discussions were (1) the level of necessity and emergency which requires urgent administration of the medication, and (2) its production process.

For the first consideration, the administration of the drug is used in an emergency situation to avoid blood from clotting. This will save lives and prevent harm on a patient suffering from heart or kidney diseases.

Although such dire circumstances call for the administration of heparin, the Fatwa Committee considered other aspects in its deliberations, specifically on the non-halal ingredient in the product, as there are several types of heparin drugs available in the market. While animal enzymes were used as a starting material in heparin production, the drug is later mixed with other ingredients. This differed from the Rotavirus vaccine in which the impure elements were only used in the early stages as a method to transfer the vaccine cells, and not as one of the key ingredient, after which, the vaccine is filtered until no traces of the impure substance is left in the final product.

Clinical tests on heparin conclude that most types do not have any trace of animal cells in the final product, although a small number of samples still contain a small residue of animal content. The fatwa ruled that the drugs have been through the process of istihlāk bi al-Mukāthara (dilution), which means that the impure content had dissolved despite being present in the early stages of production. From this ruling, there is a noticeable development in fatwa thinking, specifically in relation to the use of impure substances in medicines. The fatwa takes into consideration the needs of patients, in addition to the level of scrutiny, in both the manufacturing process and in the end product. This development in fatwa thinking is important, as the pharmaceuticals market is expected to grow rapidly as medical research becomes increasingly diversified.

Fatwa Decision 27/10/2015
FATWA ON DRUG HEPARIN

Background

The Fatwa Committee received a question from the Health Sciences Authority (HSA) and the National University Hospital (NUH) Heart Centre on 23 July 2015 on using heparin for treating Muslim patients. The Fatwa Committee was informed that heparin is a drug used to reduce or prevent blood clots. It is commonly used for patients undergoing treatments such as dialysis, heart surgery and blood transfusion. The drug is also effective in preventing complications that might occur after heart attacks.¹

Among the main ingredients of heparin is a substance that prevents blood coagulation. This ingredient is glycosaminoglycan. The information shared with the Fatwa Committee shows that glycosaminoglycan is derived from pig enzymes and is taken directly from pig intestines. The question posed to the Fatwa Committee is whether the use of heparin is allowed on Muslim patients, as all heparin drugs in Singapore contain ingredient derived from pig enzymes.²

Source of Heparin

There are essentially two main sources for producing heparin. It can be derived from either animal enzymes or synthetic chemicals.³

Heparin produced from animal enzymes is either derived from the liver of bovines, or from the inner surface of pig intestines. However, due to the mad cow virus that spread around the 1990s, companies which produce heparin no longer source it from bovine enzymes. To ensure patient safety, heparin is produced only from pig intestines.

Seeking Treatment with Pure Substance

Islam commands its followers to seek treatment with elements that are pure, and to avoid the prohibited and unclean. In a hadīth narrated by ’Abū al-Dardā’, the Prophet (ﷺ) said:

إِنَّ اللَّهَ أَنْزَلَ الدَّاءَ وَالدَّوَاءَ ، وَجَعَلَ لِكُلِّ دَاءٍ دَوَاءً ، فَتَدَاوَوْا وَلَا تَدَاوَوْا بِحَرَامٍ

“Verily Allah has sent down illnesses and cures. And He has made (available) a cure for every illness. So seek treatment, but do not treat with what is prohibited.” (Hadīth narrated by Abū Dāud)

Imām al-Bukhārī also narrated in his ṣ ahīh from Ibn Mas‘ūd as follows:

إنَّ اللَّهَ لَمْ يَجْعَلْ شِفَاءَ أُمَّتِي فِيمَا حَرَّمَ عَلَيْهَا
 “Allah does not make a cure for my people from what He made forbidden on them.” Narrated by al-Bukhārī

In the 2013 fatwa on Rotavirus vaccine, the Fatwa Committee stated that the Sharīʿa principally prohibits someone from seeking treatment from najis or prohibited sources. However, when no other halal alternatives are available, and the patient’s life depends on the treatment, then the Sharīʿa allows treatment with substances that are najis or prohibited

Drug Production and Najis Element

The information shared with the Fatwa Committee stated that heparin is derived from pig intestines in various stages of extraction,⁴ so that the resulting heparin is safe for medical use. At the same time, heparin is also mixed with other substances such as liquid sodium.

Several laboratory tests on the drug found no traces of porcine DNA in low-concentration heparin. However high-concentration heparin was found to contain very low traces of porcine DNA.

The Fatwa Committee is of the opinion that the process of istihlak⁵ has occurred on low-concentration heparin. Since the product has undergone a dilution process through which other pure ingredients are added to it, it no longer contains any trace of porcine DNA. As such, it is considered pure and permitted to be used as a treatment.

As for high-concentration heparin with traces of najis, the Fatwa Committee examined a number of Sharīʿa texts to determine its ruling. For example, in a hadīthnarrated by Imām al-Bukhārī, the Prophet (ﷺ) himself prescribed camel urine as a remedy for illness. The hadīth states: “That a group of eight people from `Ukl came to the Prophet (ﷺ) and pledged allegiance to him. But the climate of Medina made them fall sick, so they complained to the Messenger of Allah (ﷺ) and he said to them: “Why don’t you go with our herdsman to his camel, and get its milk and urine…” (Hadīth narrated by al-Bukhārī and Muslim).

In addition to the hadīth above, the Prophet (ﷺ) also allowed the use of non-najis yet originally prohibited elements as treatment. For example, Prophet (ﷺ) allowed ‘Abd Raḥ mān Ibn ‘Auf and al-Zubair al-‘Awām r.a. to wear silk due to a disease they were suffering from, which provides the analogy for using najis in emergencies.⁶ The Prophet (ﷺ) also permitted Arfajah ibn Asad r.a. to put on a nose made of gold because of necessity.⁷

The Fatwa Committee believes these evidences demonstrate that if there is a need,⁸ then high-concentration heparin is allowed as treatment for certain patients.

Decision

Based on the evidences and arguments set out above, the Fatwa Committee views that low-concentration heparin derived from pig enzymes is permitted, as it has gone through a process of istihlāk which completely eliminates all traces of najis. As for high-concentration heparin, the Fatwa Committee also views that it is permitted when certain patients require it, in order to avoid danger and harm. This is based on the verse of the Qur’an:

وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِ وَأَحْسِنُوا إِنَّ اللَّهَ يُحِبُّ الْمُحْسِنِينَ
 “Do not throw [yourselves] with your [own] hands into destruction. And do good; indeed, Allah loves the doers of good.” (al-Baqara:195)

Source:
1 Some other health complications that can be managed and prevented through heparin includes DVT and pulmonary embolism.
2 Some porcine-sourced heparin brands commonly used in Singapore are Clexane, Tinzoparin and Fraxiparin.
³ Synthetically-produced heparin does not contain animal enzymes. However, it is not safe for some patients, especially those suffering from chronic kidney disease.
⁴ Heparin production involves several stages to remove an essence from pig intestines, and later processed to remove heparin from the essence, before finally filtered to isolate heparin from other elements.
⁵Istihlāk: The term istihlāk is derived from the Arabic phrase (هلك) which means: destoyed. Therefore, istihlāk refers to a process of destruction. In this context, it refers to the destruction or elimination of najis substances. There are several processes for eliminating najis, a common example given by fuqahā’ is by mixing a drop of liquor to large quantities of water (istihlāk bi al-Mukathāra). Istihlāk means mixing a small amount of prohibited or najis substance with a large amount of pure and halal substance, until the characteristics of the prohibited substances (such as its colour, odor and taste) are eliminated. This transforms the characteristics of najis, therefore changing the najis status of the substance according to Sharīʿa. See: az-Zuhaily, Qa ḍā yā al-Mu‘a ṣ ira, Damascus:Dar al-Fikr, 1428H/2007, p.72.
⁶ Narrated by al-Bukhārī and Muslim.
⁷ Narrated by al-Tirmīdhī, Abu Dāwud and al-Nasā’ī.
⁸ Based on information provided by the health officer, high-concentration heparin is needed by certain patients immediately after surgery, in which physicians need to make sure there is no blood clotting. Low-concentration heparin was found to be inadequate to meet these needs.

Issues of Modesty (aurat) in Seeking Treatment

Apart from discussions on the halal status of ingredients in medicines, other issues that were discussed by the Fatwa Committee on health matters include aurat (modesty) between patients and those who treat them. A fatwa issued in 1984 concerns surgery to restore a part of female genitalia. Although revealing the aurat is prohibited, the text of the fatwa explains that there are other equally important considerations, such as the purpose of a surgery and its level of emergency.

The hymen and virginity is regarded as important in many societies. From the religious standpoint, it is vital to protect the genitalia from illegal sexual intercourse, known as zina. It is one of the basic laws of Sharīʿa to safeguard the dignity of Muslims and preserve lineage. This is based on the verse in surah al-Muʾminūn:

وَالَّذِينَ هُمْ لِفُرُوجِهِمْ حَافِظُونَ ۝  إِلَّا عَلَىٰ أَزْوَاجِهِمْ أَوْ مَا مَلَكَتْ أَيْمَانُهُمْ فَإِنَّهُمْ غَيْرُ مَلُومِينَ ۝ فَمَنِ ابْتَغَىٰ وَرَاءَ ذَ‌ٰلِكَ فَأُولَـٰئِكَ هُمُ الْعَادُونَ
“And they who guard their private parts; except from their wives or those their right hands posses, for indeed, they will not be blamed. But whoever seeks beyond that, then those are the transgressors.” (al-Mu’minūn: 5-7)

Generally, the physical aspect of virginity is being emphasised through the good structure of the hymen. This has led to social stigma against many prospective brides and their families, who are embarrassed by torn hymen although this could have been caused by natural and non-illicit causes. So much so, that in some societies, bleeding during intercourse is taken as an important proof of virginity.[63]

Hymen surgery is known by various names, such as hymen repair, hymen reconstruction, hymenoplasty or devirgination.[64] In most cases, these are aesthetic surgeries to repair or recreate the hymen, which is what the fatwa below refers to. If there is confirmation from a qualified medical expert that such a procedure is required, only then is the surgery deemed as an emergency. Otherwise, hymen surgery is not permitted.

The position of the Fatwa Committee on hymen restoration also shows how, despite customs and social norms being a basis of Islamic law, they can – at times – also be modified by Islamic law. This is especially so if the custom is not consistently practised or if it is impractical and can lead to harm. As such the fatwa states that it is not a religious obligation to restore the hymen to prove virginity, especially since there is no medical urgency. This signals that the practice of proving virginity through the hymen should not persist, not only because it can lead to suspicion among newlyweds, but also because it can have a negative effect on the couple’s relationship and their families. This is one example when a fatwa may subtly change the norms and customs of society.

Fatwa Decision 23/8/1984
RULING ON HYMEN RECONSTRUCTION SURGERY

Question:

Can a woman go for hymen reconstruction surgery?

Answer:¹

Ustaz Ahmad Sonhadji views that the ruling on the matter may be based on the following hadīths:

إِنَّمَا الأَعْمَالُ بِالنِّيَّاتِ 
 “Verily, actions depend upon intentions.” N arrated by al-Bukhārī

إِذَا لَمْ تَسْتَحِ فَاصْنَع مَا شِئْتَ
“If you do not feel shame, then do as you please.” N arrated by al-Bukhārī

Because this action involves elements of deception, and also the exposure of aurat without any needs recognised by the Sharīʿa, it is thus deemed prohibited.

The doctors who perform the surgery is also involved in enjoining the prohibited, because it is unlawful to get involved in anything forbidden.

Source:
¹ Even though this is based on the opinion of Ustaz Ahmad Sonhadji, it obtained the agreement and consensus of other Fatwa Committee members and therefore became a fatwa. This is because each fatwa has to be issued on a collective agreement and based on a unanimous decision by the Fatwa Committee members. If no consensus is reached, then a fatwa cannot be issued.

A consequential rule to this fatwa is that since the purpose of hymen restoration is not religiously accepted, the woman is not allowed to expose her aurat to foreign (i.e. non-mahram) men for the surgery. However, in situations where a life is endangered or where a medical need establishes itself, it is not prohibited for a person to seek treatment from a non-mahram doctor or nurse of the opposite gender.[65] This exception is clear from the Islamic principle that acknowledges the “needs recognised by the Sharīʿa”, which is a condition clearly stated in the fatwa above. This is especially as hospitals or treatment centres, in addition to administering medical needs, do not necessarily have enough staff of the same gender to attend to any particular patient.

When weighing the harm of exposing one’s aurat to a non-mahram for treatment, and the harm of avoiding treatment that may make a condition life-threatening, then the preservation of life is prioritised. This is interpreted from the fiqh maxim that deals with the weighing of different types of harm as mentioned above.

Euthanasia and Advanced Medical Directives (AMD)

Active euthanasia is prohibited by law in Singapore but the choice on whether to prolong or curtail treatment that could artificially support life remained at a patient’s and his family’s discretion. Accordingly, apart from the discussing the need for treatment, the Fatwa Committee had also looked into the issue of whether a Muslim could choose to avoid treatment. This issue revolves around the Advanced Medical Directive (AMD) bill proposed by the government.[66]

The law allowing AMD in Singapore was introduced in late 1995.[67] It was initially proposed as a ‘living will’ but was later passed as First Directive.[68] The AMD is a bill in which a patient declares to the doctor that he does not wish to subscribe to life-prolonging treatments, especially for critical illnesses with little or no chance of recovery. It was approved after the National Medical Ethics Committee (NMEC), a body appointed to study the matter for a year, published its 21-page report. The NMEC had consulted various groups and religious representatives in Singapore. In these discussions, it received the feedback from more than twenty religious and professional groups. Fourteen of the groups supported the recommendation to adopt the proposed legislation, while seven others disagreed.[69] The NMEC concluded that in order to pass the bill, doubts surrounding the intention of the patient should be clarified before he is in a coma and unable to communicate.[70]

In Singapore, the directive can only be done by those who are of sound mind, aged 21 years and above. Two witnesses, including the doctor treating the patient, must be present when the order is signed. The witnesses must also be honest and not be beneficiaries (i.e. do not stand to gain any benefits upon the patient’s death).

The availability of such directives is necessitated by rapid technological advances that prolong life without actually treating the patient. One example would be the use of a ventilator, which takes over the body’s natural respiratory system.[71] The AMD is different from euthanasia; patients invoke the AMD to withdraw from prolonged treatment while euthanasia accelerates a patient’s death. Also, the AMD is legally allowed in Singapore while euthanasia is not.

There are many groups, especially religious bodies, that continue to have concerns about the AMD. Even some Members of Parliament were concerned that if the law was passed, it might cause patients to give up and stop their treatment.[72] Groups that opposed the AMD include the Catholic Medical Association, the National Council of Churches and the Family Council. Some fear that the bill will pave the way for allowing euthanasia as AMD is considered as a form of “passive euthanasia”.[73] The bill was finally passed in December 1995 after it was debated in Parliament.[74] It should also be noted that the law does not make the AMD compulsory.

Although the debate often focuses on legislative issues, some groups view that the recommendation to allow the living will is associated with economic motives. Hospital costs have increased since the 1980s, and caring for patients with respiratory support equipment require substantial financial resources.[75] For example, the National Council of Churches of Singapore, in voicing their opinion on the bill, stated that they are aware that the recommendation for the AMD was first voiced in Parliament in the debate on the affordability of health care. However, the NMEC Chairman, Dr. Chew Chin Hin, clarified that the AMD is not motivated by economic motives, and stressed that cost is not a determining factor in making a diagnosis on a patient, whether he is suffering from terminal illness or not.[76]

Among the Malay-Muslim community, there were great efforts to publicise the fatwa permitting the AMD in 1994. This fatwa was issued by the Fatwa Committee before the bill was passed. There were also at least three articles published in the Malay newspaper that explained the position of the Fatwa Committee. Among others, it stated that the AMD is allowed but not compulsory. The explanation also pointed out that if a patient wants to persevere and face death naturally without relying on breathing apparatus, he should be allowed to do so.[77] In other Muslim countries, the principles of these rulings were discussed by the Islamic Fiqh Academy in Mecca in 1987.

As the law does not make the AMD obligatory, not many Singaporeans took up this option. Only 650 people made the AMD in 1999, most of whom were in good health.[78] Ten years after the law was introduced, this number increased to 2,645. Furthermore, with the improvement of hospice care in Singapore, many people do not see the need to make the “Will of Life”.[79] This trend changed when the case of Terri Schiavo received worldwide coverage. A year after the Schiavo case, the number of those who made the AMD in Singapore rose sharply; 1,328 people signed up in that year, bringing the total number of Singaporeans who registered for the AMD to almost 4,000 people in 2006.[80]click here to see the case of Terri Schiavo.

Health Minister at the time, Mr Khaw Boon Wan, announced that the government would focus on providing more information on living wills to the public over the next five years in order to facilitate their decision-making.[81] This effort included encouraging doctors to discuss the option more openly with their patients so that they have a more thorough understanding on the AMD. The government will also create a portal for patients to write their AMDs online.[82]

Fatwa Decision 20/9/1994
ADVANCED MEDICAL DIRECTIVE

Question:

The National Medical Ethics Committee (NMEC) proposed a law whereby each Singaporean is given the right to make advance medical directive in their own will.

The law will allow the patient to give instructions and allow a doctor to stop treatment should the patient has no more chance to live. The law will also allow an individual who is above 21 years of age and is mentally stable to draft a will anytime.

The will can only be executed when an individual is so ill that he ‘has no chance to live or the only chance of survival is via a life-support system’. What is the Committee’s opinion on this matter?

Answer:

The Committee is of the opinion that if a person has made a conscious decision not to be attached to a life-support system when he is terminally ill – then the Islamic position is that this is permissible. It can be considered that he has chosen to be patient and allow himself to die naturally because he is confident that one will eventually die when his time has come.

This is allowed because the majority of Islamic scholars have agreed that the Islamic position on seeking medical help is not compulsory although Islam highly encourages it. This is based on a hadīth narrated by Bukhārī which tells the story of a woman who has fallen ill and asked Prophet Muhammad (ﷺ) to pray for her. The Prophet then told her:

إن شئت صبرت ولك الجنة، وإن شئت دعوت الله أن يعافيك”  فقالت : أصبر
“If you are patient, the reward that awaits you is heaven. Or if you would rather I pray to Allah for your recovery.” The women then replied: “In that case then I would want to be patient.”¹

Furthermore, a life-support system serves to act as a human body’s organ, not to alleviate the illness of the patient, especially when the patient is terminally ill. However, we are thankful that in NMEC’s proposal, normal treatment will still be carried out for the patient.

Medical ethics stipulates that all possible efforts to cure, including the use of a life-support system to continue the life of a patient, should be observed.  The Fatwa Commitee is of the opinion that the life-support system can be detached from the patient only if the patient is in a coma and the machine serves no other functions for him. However, this is applicable only under the following conditions:

If three doctors certify that the patient has no more hope to live. When a differing opinion arises, then the matter should be brought to the attention of an independent committee of experts as suggested by NMEC.

The same matter has been debated by the Islamic Fiqh Academy in its convention in Mecca on 17 October 1987, whereby three decisions were made:

It is permissible to detach the life-support system from the patient, even though his heart is still functioning with the help of the machine, if three doctors certify that he is brain-dead and the condition is irreversible.²

As mentioned in the proposal papers of NMEC, euthanasia or “mercy killing” is illegal in Singapore, as much as it is also prohibited in Islam.

As the advance medical directive is a new initiative, we also suggest that NMEC ensures that there is no abuse. We also support the fact that the directive is only effective if it is made willingly or by choice.

Source:
1 Fatḥ al-Bārī Bi al-Syarḥ ṣaḥīḥ al-Bukhārī. 5220. addition:
‏ألا أريك امرأة من أهل الجنة قلت بلى قال هذه ‏ ‏المرأةالسوداء ‏ ‏أتت النبي ‏ ‏صلى الله عليه وسلم ‏ ‏فقالت إني أصرع وإني أتكشف فادعالله لي قال ‏ ‏إن شئت صبرت ولك الجنة وإن شئت دعوت الله أن يعافيك فقالت أصبرفقالت إني أتكشف فادع الله لي أن لا أتكشف فدعا لها
http://hadith.al-islam.com/Display/Display.asp?Doc=0&Rec=8448
2 Refer to Majallah Al-Majma‘ al-Fiqh al-Islāmīy Li Muktamar al-Fiqh al-Islāmīy al-‘Adad al-Thalith. 1987. Vol.2, 767.

Seeking Treatment in Islam

In deliberating the AMD issue and whether a medical treatment should persist, the focus is on the Islamic principle of preserving life. Islam gives great emphasis on the protection of life, as evident in the verses of the Qur’an and hadīths of the Prophet (ﷺ). In the surah al-Isrā’, Allah s.w.t. mentions the elevated status of humankind:

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ وَحَمَلْنَاهُمْ فِي الْبَرِّ وَالْبَحْرِ وَرَزَقْنَاهُم مِّنَ الطَّيِّبَاتِ وَفَضَّلْنَاهُمْ عَلَىٰ كَثِيرٍ مِّمَّنْ خَلَقْنَا تَفْضِيلًا

 “And We have certainly honoured the children of Adam and carried them on the land and sea and provided for them of the good things and preferred them over much of what We have created, with [definite] preference.” (al-Isrāʾ: 70)

There are also restrictions against hurting oneself and engaging in acts that put someone in danger. This is based on the following verse:

وَأَنفِقُوا فِي سَبِيلِ اللَّهِ وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِ ۛوَأَحْسِنُوا ۛ إِنَّ اللَّهَ يُحِبُّ الْمُحْسِنِينَ

 “And spend in the way of Allah and do not throw [yourselves] with your [own] hands into destruction. And do good; indeed, Allah loves the doers of good.” (al-Baqara: 195)

Islam recognises the preservation of life and the well-being of the physical body. This is based on the following verse:

 وَلَا تَقْتُلُوا أَنفُسَكُمْ ۚ إِنَّ اللَّهَ كَانَ بِكُمْ رَحِيمًا
“And do not kill yourselves [or one another]. Indeed, Allah is to you ever Merciful.”  (an-Nisā’:29)

The ruling also includes the prohibition against suicide. This is due to the dignity of human life, and the right of Allah s.w.t. – who commands its protection – that supersedes a human’s right to end his/her own life.

Here, the main consideration in deciding whether AMD is permissible is whether it is mandatory to seek treatment from a religious viewpoint. The religious opinion in seeking treatment for a Muslim patient suffering from terminal illness – with no hope of recovery – is guided by the dominant view among jurists that it is not mandatory. The religious opinion in seeking treatment for a Muslim patient suffering from terminal illness – with no hope of recovery – is guided by the dominant view among jurists that it is not mandatory.

The basis for this is found in a hadīth of Ibn ‘Abbās mentioned in the fatwa. The woman mentioned in the narration was reported to have been suffering from ṣarāʿ or epilepsy. As its cure was unknown at the time, this would be analogous to someone suffering from a terminal illness. This interpretation is also a form of conciluation (al-jam’u) between this hadith and others that encourage seeking treatment, such as that narrated by Bukhārī and Muslim:

ما ورد عن النبيِّ صلى الله عليه وسلم حين قال :  ما أنزلَ اللهُ مِنْ داءٍ إلا أنزلَ لَهُ شِفاءً
Verily Allah has not sent down an illness, except that (He also) sends down a cure for it.

The hadīth emphasises that Allah s.w.t. makes a cure available for any diseases, and encourages Muslims to seek treatment. Yet, this must be accompanied by the understanding that medical development occurs in stages, and the ability of the human mind to know is limited, as mentioned in surah al-Isrā’:

وَمَا أُوتِيتُم مِّنَ الْعِلْمِ إِلَّا قَلِيلًا
“And humankind have not been given of knowledge except a little.” ( al-Isrā’:85)

Therefore, the fatwa ruled that euthanasia – be it by a patient deliberately committing an action such as taking poison, or asking someone else to commit an action leading to his death – is prohibited. This prohibition includes actions committed by the patient himself, or by a doctor with or without the patient’s request.

Meanwhile, the living will or the Advanced Medical Directive is not the same as euthanasia, as the patient chooses not to seek treatment in a situation that recovery is unlikely, and instead chooses to surrender completely to the will of Allah s.w.t. Various fatwas on the use of modern treatment to prolong a patient’s life were also issued by other fatwa bodies much after that issued in Singapore.

The Dār al-Iftāʾ in Egypt issued a fatwa on 3 January 2006, which states that:
It is permitted, with the advice of a physician, to disconnect the medical ventilator from a patient who has no hope of recovery, when the machine is used to prolong his life without treating his health. However if the machine is used for other purposes, such as removing fluid to help the patient’s breathing, then it is not allowed (to disconnect the machine).[83]

The Jordanian Fatwa Council issued a fatwa on 11 October 2006, which states:
The Council believes that there is no Sharīʿa prohibition for not using a medical ventilator or dialysis machine, if a group of physicians believe that it has no benefit (medically) to be gained from its use. This is provided that the decision is made by three physicians, at the very least, who are competent, fair, and credible. This is based on the principle that the use of these devices do not bring benefits in removing the disease, and that the death of a person cannot be delayed or accelerated.[84]

The National Fatwa Council of Malaysia issued a fatwa during its session held in December 2011 on the removal of the medical ventilator. The Council decided:
[I]n cases where physicians have decided that a patient has no hope of recovery and is allowed to be sent home, then stopping the main treatment and only continuing with palliative treatment is allowed in Islam, as it does not fall within the prohibited practice of euthanasia or mercy killing. However if the treatment/life support system is used for other purposes such as removing fluid to facilitate breathing, then disconnecting/stopping it is not allowed.[85]

While permitting the removal of the life support system, the additional condition in this fatwa – that the device should not be used for other purposes that aid the patient – is similar to the Egyptian Dār al-Iftāʾ fatwa.

The Permanent Committee for Islamic Research and Fatwa in Saudi Arabia also ruled on the use of resuscitation equipment during cardiac arrest, or when the heart stops, in patients suffering from diseases with no hope of recovery. The Committee decided the following:
It is permitted to use resuscitation equipment if the patient could recover. However, if the patient’s heart can only function when using the equipment, and ceases to function without it, then it is better not to use it because the patient is actually lifeless.[86]

Kidney Dialysis

Apart from issues concerning the permissibility of medical treatments, there are also questions on the effects of a treatment on acts of worship. This relates to kidney dialysis and its effects on fasting.

Fatwa Decision 13/2/2001
KIDNEY DIALYSIS IN DAY TIME RAMADAN

Question:

On 7 December 2000, Berita Harian published a Saudi Arabian fatwa that says kidney dialysis nullifies fasting in Ramadan. The reason given was that dialysis removes impurities in blood, and after cleaning and mixing it with chemicals and nutrition, the blood is then pumped back into the patient. What is the opinion of the Fatwa Committee on this matter?

Answer:

After its deliberation, the Fatwa Committee noted that dialysis is a process that removes impurities in blood and replaces it with cleansed blood into the patient’s body through the kidney dialysis machine.

Before dialysis, kidney patients will usually feel weak and frail. This treatment will steadily improve the health of kidney patients for several days until they undergo another dialysis treatment.

The Fatwa Committee also considered the use of injection needle in the month of Ramadan among the contemporary issues not discussed in detail by ‘ulama of the past. Evaluated from the medical standpoint, the injection needle which is inserted into a patient is divided into two types:

Injection that contains no nutrition, and

Injection that contains nutrition

An injection into the bloodstream that contains no nutrition does not invalidate the fast, because these injections do not contain nourishment that reaches the stomach.

However, for injections that contains nutrition, there is a difference of opinion (khilāf) among the ‘ulamā:

The injection invalidates the fast

The injection does not invalidate the fast

Those who hold the view that the injection breaks the fast reasoned that nutrition directly goes into the bloodstream.

Those who hold the opposing view – that the injection does not break the fast – argued that fasting is invalidated by putting something into the body through its open orifices, such as the mouth, ears, and nose, which then reaches the stomach and causes a person to feel full. They viewed that these injections merely entered the bloodstream and do not directly reach the stomach.

Having examined the different views of the ‘ulamā and their arguments, the Fatwa Committee is of the opinion that injections containing nutrition in the month of Ramadan do not invalidate the fast. However, as a precautionary measure (الِاحْتِيَاط) especially for kidney patients, dialysis should be delayed until after sunset. If it cannot be delayed, and the patient still intends to fast, then his fast is not invalidated by the dialysis as long as it does not cause harm. If the dialysis is harmful because of the fast, then breaking the fast or not fasting is better than enduring harm.

In considering this ruling, the Fatwa Committee consulted the opinion of jurists on the types of injections that break a fast. This study also required an accurate understanding of the dialysis process and its effects. In selecting the strongest opinion given the circumstances of the problem (tarjih), the Fatwa Committee adopted the view that accommodates the needs of a patient who cannot undergo dialysis at night. The Fatwa Committee also took into consideration patients who cannot suspend treatment throughout Ramadan. At the same time, the fatwa also contains advice and guidance for Muslim patients: that if fasting during dialysis causes harm, then harm should be removed, and therefore the patient should not fast.

Smoking

Smoking is defined as the practice of inhaling smoke obtained from burning a stimulant or hallucinogen. It has been a common practice since ancient times, as seen in temple carvings and old manuscripts from ancient Egypt, Greece, Babylon, India, China and the Peruvian Andes which depict people smoking. Often associated with religious ritual in the past in civilizations such as the Maya, the Aztecs and the Chinese, smoking probably originated from the burning of incense, later adopted for pleasure. Hallucinogens were  also used to achieve trances or to contact the spirit world. Their central role in the ancient Aztec religion is symbolized by the goddess Cihuacoahuatl whose body was made of tobacco.[87]

There are many different substances and methods of smoking. The most common today is tobacco but prior to the 19th century, many people from various parts of the world smoked opium and cannabis legally. These substances were also considered to have medicinal properties as they dulled pain. The ancient Chinese, for instance, used cannabis as a panacea for rheumatic pain, intestinal complication and malaria, while Assyrians used it in treatments for impotence and kidney stones.[88]

Opium was widely used in Asia up to the twentieth century, particularly among the poor, although it had an adverse health effect. Both cannabis and opium are illegal in many countries today, partly because these substances caused many social and economic problems. This leaves tobacco as a legal and most widely used substance being used today.

The main active ingredient in tobacco is nicotine. Its genus, nicotiana, most likely originated from South America and was named after Jean Nicot, the consul of the King of France in the 17th century who brought the plant over to Europe.[89] French scientists later developed methods of extracting pure nicotine from the tobacco plant and experimented to find out its properties.[90] Early scientific investigation of its properties showed that pure nicotine was highly toxic and would be lethal if ingested even in small amount. However, diluted nicotine could be incorporated into products like snuff, chew, cigar and later, cigarettes where inhalation of the smoke produced when burned has comparatively less severe physiological impact. Click here for further reading on tobacco and culture.

  Science and health risks of smoking

The twentieth century – which had seen the rise of widespread smoking in the form of cigarettes – also generated scientific interest and research on this practice. Such research, however, were sometimes commissioned by the big tobacco companies themselves and this compromised the integrity of their results. For example, up to the 1940s, doctors in the United States routinely appeared in cigarette advertisements attesting to the safety of these products.[91] However, in the 1940s, scientists began seeing a link between cancer and the use of nicotine. By 1959, Alan Rodgman, a scientist working in a research laboratory of R.J Reynolds – a huge tobacco company – reported that cigarette smoke contains polycyclic aromatic hydrocarbons that can cause cancer.[92]  In response, the tobacco companies also funded research aimed at reducing the amount of carcinogens in their products and sought to suppress public knowledge of these health concerns, each competitively advertising that their products were safer.

However, more and more research emerged showing the adverse effect smoking had on health. The tide against smoking turned with the discovery that passive smoke can cause lung cancer, thus putting non-smokers at risk.[93] This meant that the issue went beyond personal choice but impacted public health. Furthermore, there emerged more scientific evidence about the addictive nature of nicotine.[94] Prolonged nicotine consumption could change the circuitry of the brain and nervous system to make it dependent on this product.[95] This element of addiction called to question the idea that smokers could stop any time they wanted to, and highlighted the similarity of cigarettes to banned substances such as opium and cannabis. Such information became public knowledge in a series of highly public trials of cigarette companies, particularly from the mid-1990s.[96]

Today, there is much greater regulation on smoking. Cigarettes are still freely available in countries around the world but many countries now mandate that cigarette packages carry a health advisory and ban smoking from certain public places such as restaurants in order to reduce public exposure to passive smoke.

Smoking in Singapore

In Singapore, efforts to stamp out smoking paralleled global trends. Opium and cannabis are banned. From 1950, when there was a record number of opium seizures from smugglers caught trying to bring the substance into the country,[97] Singapore generally enforced a tight ban on these drugs. Cigarettes are legal, both in the past and today. Public disapproval of the practice became evident fairly early, with letters decrying smoking appearing in the Singapore press as early as 1950, when the deleterious health effect of smoking was only beginning to be publicized.[98] However, the key message then was to smoke in moderation, with some doctors claiming “ten cigarettes a day are without any ill effect for an average adult.” [99]

Since then, there was a gradual movement to ban smoking in public places. It was first banned in buses, cinemas and theatres in 1970. This was followed by a ban on smoking in public indoor locations such as malls in 1977. Smoking was also banned from mass rapid transit (MRT) trains since its inception in 1987 due to fears of fire.

The space for smokers was further restricted in 2005 when cigarettes were banned in bus interchanges and bus stops, as well as public toilets and swimming complexes. This extended to coffeeshops, hawker centres, entertainment nightspots, night clubs (except in pre-defined smoking areas), children’s playgrounds, exercise areas, markets, ferry terminals and jetties, offices and lift lobbies when bans were imposed successively from 2006 to 2009.

Smokers also found their freedom to smoke in their own neighbourhoods curtailed when the ban was extended to linkways, corridors, stairwells and multi-purpose halls in 2013, although this proved difficult to enforce especially during wakes and funerals. Those found flouting these rules faced a minimum fine of $200. In addition, cigarette packs in Singapore carried mandatory health warnings and, from 2004, graphic pictures of diseased organs.[100]

The discourse in the media about smoking highlighted deep divisions among proponents of the freedom to smoke and those who wished to see smoking banned completely. With the institution of each successive regulation or restriction, letters protesting such a move or reports of business owners unhappy with these rules appeared in the local press. Nightspot owners in particular found these rules onerous and bad for their business. On the other side, many non-smokers in Singapore supported the bans, to the extent that some groups set up an online Tobacco-Free Singapore campaign in 2010, which sought to prevent the sale of tobacco to millennials and thus, stamp out the practice completely.

Among Malay Muslims, this issue was also equally divisive. Some Muslims sought advice about it from a religious perspective through the Malay press, and the general response to these questions throughout the 1970s and 1980s was that smoking was not haram or forbidden although it is makruh or practice that was highly disapproved of and better to abstain from. If the habit resulted in fatal disease, continuing the habit could also be haram. Such a stance was not agreed on by all schools of Muslim thought.

In 1993, Pertapis, a Muslim charitable organization in Singapore, issued a stand stating that the smoking was haram according to the Shafi’i school of law. This meant that the act of smoking is considered as sinful as that of consuming pork or liquor.[101] This hardline stance caught the attention of the English press and led to more debate about the Islamic ruling on smoking. Some Muslims pointed out that the accepted rule on smoking here was that it was makruh, and that even religious leaders in the Malay Muslim community smoke regularly. Haji Abu Bakar Hashim, then-president of Singapore Religious Teachers Association (Pergas) and President of Sharīʿa Court tended to side with the Muis stand but emphasized that the ruling depended on situation and could be haram for habitual smokers who endangered their health but makruh for social smokers.[102] There were also calls in the Malay press for clarification and a unified stand on the issue.[103]

Globally, there also exist similar disputes about this issue in the Muslim world. In 1995, Malaysia’s opposition Islamic party Parti Islam SeMalaysia (PAS) also issued a similarly hardline opinion against smoking. In 1994,Shaikh Yūsuf al-Qaraḍāwī opined that it was haram to smoke if it can be proven that smoking slowly kills.[104] Mosques in Singapore also began to enforce informal bans on the practice in their compounds. There were suggestions mooted to create a smoking zone in mosques, however, this was not implemented as the existence of such a zone could be interpreted as condoning the practice.[105]

Although a common consensus is lacking about precisely how strongly Islam discouraged smoking, there was a general agreement that the practice was bad for health, in accordance with all the emerging scientific evidences. When the Singapore government tightened the bans on public smoking, there were a few renewed calls by Muslims for a fatwa to ban the practice.[106] However, education appeared to be the method of choice for Malay Muslims to tackle the problem, with regular campaigns against smoking as well as celebrities and leaders setting the example by publicly giving up smoking.[107]

Fatwa Deliberations Regarding Smoking

Fatwa Decision 13/9/1993
RULING ON SMOKING

Question:

The Fatwa Committee has been asked to explain the ruling on smoking. The issue was raised after a news article appeared in The New Paper, in which Pertapis was reported to have said that smoking is prohibited. The report also mentioned that smoking is a sin, similar to other sinful acts such as eating pork and drinking alcohol.

Answer:

After discussion, the meeting agreed with the opinion that generally, smoking is discouraged (makruh). If smoking is verified to cause harm to an individual, then it is prohibited for him. Also as there are evidences on the harm of smoking, then it should be avoided, in line with the Islamic legal maxim meaning “avoiding harm is prioritised over obtaining benefit”.

Fatwa Decision 20/4/2006
FATWA ON SMOKING

Question:
What is the opinion of the Fatwa Committee on smoking?

Answer:
Fatwa Committee agrees that smoking is prohibited because the harm on the smoker and the people around him is clear and definite.

In deliberating the ruling on smoking, the principle of rejecting harm is observed. There is also a gradual and incremental approach in the fatwa positions (described as al-tadarruj fī al-taṭbīq al-Ḥukm), as the fatwa on smoking changed from makruh to being forbidden. In the period between the two fatwas, the content of cigarettes did not change. The only difference is the medical and scientific information available on the dangers of smoking, studies that proved the negative effects of smoking, as well as tighter regulations. Greater awareness on the danger of smoking can be cited as a reason why it was ruled as forbidden.

This goes back to the aforementioned incremental or gradual application of Islamic law (tadarruj) in the ruling, which was an approach taken by Prophet Muhammad (ﷺ) and his companions in the history of Islamic law. An example is the prohibition of liquor at the time of Prophet Muhammad (ﷺ). The first revelation in this context proclaims its sinfulness despite recognising there are benefits associated with it. However, there was no explicit prohibition on liquor in this verse of the surah al-Baqara:

  ۗيَسْأَلُونَكَ عَنِ الْخَمْرِ وَالْمَيْسِرِ ۖ قُلْ فِيهِمَا إِثْمٌ كَبِيرٌ وَمَنَافِعُ لِلنَّاسِ وَإِثْمُهُمَا أَكْبَرُ مِن نَّفْعِهِمَا
“They ask you about wine and gambling. Say, “In them is great sin and [yet, some] benefit for people. But their sin is greater than their benefit…” (al-Baqara:219)

It was reported that liquor was still consumed after the revelation of this verse until a companion of the Prophet led a Maghrib prayer and recited the verses of the Qur’an in the wrong order. Following this, the following verse in surah al-Nisā’ was revealed:

يَا أَيُّهَا الَّذِينَ آمَنُوا لَا تَقْرَبُوا الصَّلَاةَ وَأَنتُمْ سُكَارَىٰ حَتَّىٰ تَعْلَمُوا مَا تَقُولُونَ
“O you who have believed, do not approach prayer while you are intoxicated until you know what you are saying.” (an-Nisā’:43)

Later, a clear pronouncement that completely prohibited liquor was revealed in the surah al-Māʾida:

يَا أَيُّهَا الَّذِينَ آمَنُوا إِنَّمَا الْخَمْرُ وَالْمَيْسِرُ وَالْأَنصَابُ وَالْأَزْلَامُ رِجْسٌ مِّنْ عَمَلِ الشَّيْطَانِ فَاجْتَنِبُوهُ لَعَلَّكُمْ تُفْلِحُونَ
“O you who have believed, indeed, intoxicants, gambling, [sacrificing on] stone altars [to other than Allah], and divining arrows are but defilement from the work of Satan, so avoid it that you may be successful.”  (al-Mā’ida:90)

Conclusion

In conclusion, the main deciding factors for the use of prohibited substances in medication are: key ingredients, production process of these ingredients, benefits and effects of the medicine, and the availability of alternatives. The same considerations are applied for medication containing ingredients from alcohol and animals, as have been previously elaborated.

It is also important to note that preserving life is one of the objectives of the Islamic Sharīʿa (maqāṣid al-sharīʿa) which needs to be observed at all times. In circumstances that can result in great harm, this principle should take precedence. This must be also be seen together with the Islamic teaching that encourages the seeking of treatment.

Hadīth narrated by Abū Dāwūd, 4: 217; al-Shawkānī, Nayl al-Awṭār, 9: 93. ↵

In the chapter on Organ Transplant and Donation, the concept of emergency (ḍarūra) was discussed in a narrow scope, i.e. treatment through organ transplants. This chapter meanwhile discusses the concept in more general terms. ↵

Waḥba Al-Zuhailī, Naẓariyya al-Ḍarūra al-Sharīʿa (Beirut: Muassasah Risalah, 1979), 73. ↵

Al-Qaraḍāwī, The Lawful and the Prohibited In Islam, 46. ↵

Hadīth narrated by Ibn Mājah, Kitāb al-Aḥkām, Bab Man Banā Fī Haqqihi, No. 2332. ↵

Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, (Dar as-salam, 1998), Vol. 1, 214. ↵

Al-ʿIzz Ibn ʿAbd al-Salām, Qawāʿid al-Ahkām fī Masālih al-Anām, Vol. 1, 84. ↵

Kamali, Principles of Islamic Jurisprudence, 344-347. ↵

Ibid. ↵

Yūsuf al-Qaraḍāwī, The Lawful and the Prohibited in Islam (Malaysia: Islamic Book Trust, 2013), 75. ↵

Ibid. ↵

Ṣaḥīḥ Muslim, No. 2003. ↵

USDA, (2015) "Organic Production/Organic Food: Information Access Tools," Alternative Farming Systems Information Center. United States Department of Agriculture National Agricultural Library. Available online at http://www.nal.usda.gov/afsic/pubs/ofp.ofp.shtml. Accessed 23 July 2015. ↵

"Alcohol therapy: medicinal drinking through the ages," BBC News. Accessed on 23 July, 2015, http://www.bbc.com/news/health-25712005↵

Caroline J. Acker and Sarah W. Tracy (eds.), Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800-2000 (Amherst, Mass.: University of Massachusetts Press, 2004), 3-5. ↵

Ibid. ↵

"Alcohol as Medicine." Malayan Saturday Post, June 1925, 17. ↵

Singapore health authorities do not provide a list of medicines that contain alcohol. The US Food and Drug Administration has a list of which can be found at http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm. Retrieved on July 24, 2015. ↵

Refer to Tuḥfa al-Aḥwāzi Sharh Jāmiʿ al-Tirmīdhī, 244. ↵

Gottschlich M.M., “Fat-Soluble Vitamins and Wound Healing”, in Molnar, J.A. ed. Nutrition and Wound Healing, (Boca Raton: CRC Press; 2007), 156. ↵

Kathi C. Madison,"Barrier Function of the Skin: "La Raison d'Etre of the Epidermis," Journal of Investigative Dermatology, (2003) 231-238. A brief explanation on skin functions can also be found in the following article: "Only skin-deep," The Straits Times, November 2004, 7. ↵

“Covers dead, burnt skin,” The New Paper, October 2000. ↵

See “Malay Disfigured for Life,” The Straits Times, January 1934; “Farzana’s boyfriend was once burnt too,” The Straits Times, November 2000; “SGH discharges Bali blast victims”, Today, October 2003.  ↵

"Burns Unit opens at General Hospital," The Straits Times, February 1959, 4 and "Unique skin farm set up in SGH to grow grafts for burn victims," The Straits Times, March 1991, 3. ↵

"Doctors plan a 'human tissues' bank," The Straits Times, February 1963, 11. ↵

See “Developing Natural Skin,” The Straits Times, January 1982 and “Aussies Claim Skin Success,” The Straits Times, June 1990 which explained several alternatives to the regular grafting treatment. ↵

"Skin can be grown at 'farm' and grafted onto burn patients," The Straits Times, February 1992, 19. ↵

"Life-saving skin farm," The Straits Times, February 1994, 15. ↵

Heinrich W, Lange PM, Stirtz T, Iancu C, Heidemann E. Isolation and characterization of the large cyanogen bromide peptides from the alpha1- and alpha2-chains of pig skin collagen. FEBS Letters, 1971;16(1):63–67. ↵

"The Soul Barrier," The Singapore Free Press, December 1960, 4. There is also extensive scientific research on organ transplant rejection. ↵

Al-Nawawi, Sahih Muslim, (Cairo: Dar al-Salam, 1996), Kitāb al-Zakāh, hadīth No. 1015. ↵

Derrick Baxby, “Edward Jenner’s Inquiry: A Bicentenary Analysis,” Vaccine, 17:4, (1999) pp. 301-7. See also Ian Bailey, “Edward Jenner (1749-1823); naturalist, scientist, country doctor, benefactor to mankind.” Journal of Medical Biography 4:1, (1996), pp. 63-70 ↵

See for instance, Tuija Kekarainen, Laura Martinez-Guino and Joaquin Segales, “Swine Torque teno virus detection in pig commercial vaccines, enzymes for laboratory use and human drugs containing components of porcine origin.” Journal of General Virology, 90:3, (2008), pp. 648-53. ↵

For the history of vaccination in British Malaya, see Lenore Manderson, Sickness and the State: Health and Illness in Colonial Malaya, 1870-1940, Cambridge University Press (2002). ↵

For more about indigenous resistance to vaccination in British colonies, see Atsuko Naono, “Inoculators, the Indigenous Obstacle to Vaccination in Colonial Burma” Journal of Burma Studies,Vol. 14, (2010), pp. 91-114 and David Arnold (1993), Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth Century India, (Berkeley, CA: University of California Press), ↵

See Hileman, Bette, “Vaccines and Autism”, Chemical and Engineering News, 82:8, 2004 and Jan Poling, “Vaccines and Autism Revisited” The New England Journal of Medicine, 359:6, 2008. ↵

See Michael S.W Lee, Mike Male, “Against Medical Advice: The Anti-Consumption of Vaccines” The Journal of Consumer Marketing, 28:7, pp. 484-490. ↵

Sprigg P “Pro-family, pro vaccines but keep it voluntary”, Washington Post, 15 July 2006. ↵

John D. Grabenstein, “What World Religions Teach, Applied to Vaccines and Immune Globulins” Vaccine, 31:6, 2013. ↵

Details about the program and schedule for vaccination can be found at Health Promotion Board (2013) "Immunization for Primary School." Health Promotion Board Singapore. Available online at http://www.hpb.gov.sg/HOPPortal/health-article/630. Accessed on July 20, 2015. ↵

For more information see Manderson (2002), Sickness and the State. ↵

See among others, "Communication of Disease," Eastern Daily Mail and Straits Morning Advertiser. 18 April 1906, p. 2; "Sanitation of Singapore," The Straits Times, 12 June 1907; "Milk Supply Scandals," The Straits Times, 15 September 1908, p. 7. ↵

"BCG - Tuberculosis Defence," The Straits Times, 8 April 1947, p. 6 ↵

Ibid. ↵

"The Sultan of Johore," Mid-Day Herald, 2 July 1895, p. 2. and "Details on the death of the Sultan of Johore," The Straits Times, 2 July 1895. ↵

"Tuberculous Disease," The Singapore Free Press and Mercantile Advertiser, 15 July 1910, p. 8. ↵

"T.B still No. 1 killer in Singapore." The Straits Times, 17 January 1950, p. 4 ↵

"T.B relief bill 000 a month," The Straits Times, 14 January 1950 ↵

"S'pore leads Britain in BCG work," The Straits Times, 9 January 1950, p. 3. ↵

"Many infectious TB cases still in Singapore," The Straits Times, 21 January 1969, p. 6. ↵

"Better housing tends TB a beating," The Straits Times, 17 March 1975, p. 5. ↵

Ibid. ↵

"T.B cases on the rise here." Today, 23 March 2009, p. 4. ↵

‘Suntikan vaksin sebelum kerjakan haji didakwa kandungi lemak babi’ Berita Harian, 16 June 2002. ↵

Ibid. ↵

‘Vaksin Jemaah Haji, unmrah disahkan halal’, Berita Harian, 23 June 2002 ↵

‘Ubat pelali dari lemak babi dibenarkan’ Berita Harian, 14 October 2002. ↵

‘Fatwa: Hanya suntikan vaksin ACYW 135 yang dibolehkan untuk jemaah’ Berita Harian, 1 December 2002. ↵

“Indonesian clerics ask Saudi to drop Hajj vaccine” Al-Arabiya news. (online). Available: http://www.alarabiya.net/articles/2009/06/08/75297.html. Accessed 20 May 2015. ↵

‘New vaccine can fight virus that causes diarrhea deaths’, The Straits Times, 12 November 1984 and ‘Rotavirus punca utama cirit birit serius di kalangan kanak-kanak’, Berita Harian, 30 March 2003 ↵

‘No ordinary diarrhea’ The Straits Times, 25 June 2009 ↵

Robert J. Lindhart, et al, “Production and Chemical Processing of Low Molecular Weight Heparin” in Seminars in Thrombosis and Hemostasis (1999), Vol. 25, 5-16. ↵

See Ruzy Suliza Hashim, “Meniti duri dan ranjau: Pembikinan gender dan seksualiti dalam konteks dunia Melayu [Exploring a thorny issue: The creation of gender and sexuality in the Malay world]”, Sari, (2006), Vol. 24,15-34. ↵

Ahmadi A., “Ethical issues in hymenoplasty: Views from Tehran's physicians”, J Med Ethics, (2014), Vol.  40, 429–430  ↵

Among the fatwa bodies issuing similar view is Dar al-Ifta, Egypt in 2008. http://www.dar-alifta.org/ViewFatwa.aspx?ID=366&LangID=5&MuftiType=2 . Accessed on 26 October 2016. ↵

More information can be obtained from https://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/advance_medical_directiveact.html. ↵

“Living wills law to be introduced later this year,” The Straits Times, July 1995. ↵

“Wasiat Hayat tukar jadi Arahan Awal, [Living will changed to Advance Medical Directive]” Berita Harian, December 1994. ↵

“Living wills law to be introduced later this year,” The Straits Times, July 1995. ↵

“Law needed to clarify doubts,” The Straits Times, July 1995. Also see “When a patient is dying and unable to speak, family members get very emotional. It is difficult to make the decision not to take heroic measures. A directive will help them,” The New Paper, 28. ↵

Singapore follows the life-sustaining treatment policy of the United States Uniform Rights of the Terminally Ill Act. See “Living wills law to be introduced later this year,” The Straits Times, July 1995. ↵

“MP fears seriously ill may lose hope and see easy way out,” The Straits Times, August 1995. ↵

“Clearing the air on advance medical directives,” The Straits Times, June 1997. ↵

“Advanced directive Bill up for scrutiny,” The Straits Times, December 1995. ↵

“Health - focus shifts from cost to ethics,” The Straits Times, March 1995. ↵

“Clearing the air on advance medical directives,” The Straits Times, June 1997. ↵

See “Harus sebab mudahkan pesakit nazak temui ajal [Permitted because it enables terminal patient to die],” Berita Harian, September 1994. “Fatwa kaitan wasiat hayat [Fatwa on living will],” Berita Harian, September 1994. “Wasiat Hayat tukar jadi Arahan Awal [Living will changed to Advance Medical Directive],” Berita Harian, September 1994. ↵

“The Advanced Medical Directive,” The New Paper, February 1999. ↵

“Quality Hospice Care,” The Straits Times, April 1999 and “Dying patients can turn to hospice care,” The Straits Times, April  2001. ↵

“Nearly 4000 had signed living wills,” The Straits Times, March  2006. ↵

“MOH to focus on living wills for the next five years,” The Straits Times, October 2006. ↵

“Living Wills to be made easier,” The Straits Times, October 2008, 35. ↵

http://www.dar-alifta.org/ViewFatwa.aspx?ID=405&LangID=1 ↵

http://www.aliftaa.jo.Decision.aspx?DecisionID=119 ↵

http://www.e-fatwa.gov.my/fatwa-kebangsaan/hukum-eutanasia-atau-mercy-killing     ↵

Fatāwā al-lajna al-dāima, al-majmū‘a al-ūlā, 25: 71-78, Fatwa no. 8926. ↵

Francis Robiscek, "Ritual Smoking in Central America," in Smoke: A Global History of Smoking, ed. Sander Gilman and Zhou Xun (London: Reaktion Books, 2004), 33-35. ↵

Antonio Waldo Zuardi, "History of cannabis as a medicine: a review,"Rev Bras Psiquiatr 2nd ed., (2006), Vol. 28,153-157. ↵

Allan Brandt, The Cigarette Century (New York: Basic Books, 2007), 20. ↵

Hewitt Grenville Fletcher Jr. "The History of Nicotine," in Journal of Chemical Education (1941), 303-307. ↵

Brandt, The Cigarette Century, 201. ↵

Ralph Nader, "Perspective on the Tobacco Settlement: Marlboro Man Still in the Saddle," Los Angeles Times, November 1998. ↵

Joaquin Barnoya dan Stanton A. Glantz "Cardiovascular effect of secondhand smoke nearly as large as smoking," in Circulation (2005), Vol. 111,2684-2598 and P. Brennan, P.A Buffler et al. "Secondhand smoke exposure in adulthood and risk of lung cancer among never smokers: a pooled analysis of two large studies," in International Journal of Cancer, (2004), Vol. 109,125-131. ↵

Neal L. Benowitz, "Pharmacologic aspects of cigarette smoking and nicotine addiction," The New England Journal of Medicine (1988), 1318-1330. ↵

Ibid., 1319-20. ↵

Brandt, "The trials of Big Tobacco," in The Cigarette Century, (2007), 401- 445. ↵

"Record number of opium seizures in Singapore," The Straits Times, October 1950, 9 and "Opium runner hard hit", The Singapore Free Press, June 1950, 7. ↵

"The smokers," The Straits Times, May 1950, 9. ↵

"Warning to the Lovers of Lady Nicotine," The Singapore Free Press, February 1950, 2. ↵

Information on smoking policies in Singapore can be obtained from the Ministry of Environment and Water Resources (Singapore) “Public Health Policies: Smoking Ban.” Government of Singapore. http://mewr.gov.sg. Accessed on 4 September 2015. See also “Going smoke free: a step forward,” National Environment Agency of Singapore (2014). http://www.nea.gov.sg. Accessed on 4 September 2015. ↵

“Smoking sinful for Muslims,” The New Paper, September 1993, 12. ↵

Ibid. ↵

“Benarkah rokok haram [Is smoking really haram]?” Berita Harian, September 1993, 7. See also “Merokok: Hukum masih dikaburi asap [Smoking: Ruling still clouded by smoke].” Berita Harian, November 1993. ↵

“Ulama: Merokok bahaya [Ulama: Smoking is dangerous],” Berita Harian, November 1994. ↵

“Akan datang: sudut khas bagi perokok di masjid [Coming soon: Smokers’ corner in mosques]?” Berita Harian, April 2000, 6 and “Saran dibatal ura-ura [Suggestion to cancel proposal],” Berita Harian, April 2000, 27 and “Patut susahkan bukan mudahkan [Should make it harder not easier],” Berita Harian, May 2000, 7. ↵

“Syor haram merokok [Recommend to prohibit smoking],” Berita Harian, July 13, 2001, 16. ↵

“Tidak wajar biarkan Muis saja tangani isu [Not right to let MuiS tackle issue alone],” Berita Harian, August 2006, 35 and “Kesedaran harus dipupuk melalui didikan Islamiah [Awareness should be fostered through Islamic education],” Berita Harian, October 2006, 26 dan “Apabila Imam setuju berhenti merokok [When Imam agrees to quit smoking],” Berita Harian, June 2007. ↵

1

Further Notes on Chapter 1

Ibn al-Qayyim

“The principles and fundamentals of the Shariah concerning the injunctions and the good of humankind in this life and the next are all based on justice, mercy, the good of human and wisdom. Every situation in which justice succumbs to tyranny, mercy to cruelty, goodness to corruption, wisdom to foolishness, has nothing in common with the Shariah.“¹

Source:
1 Ibn al-Qayyim al-Jawziyyah, I‘lām al-Muwaqqi‘īn vol. 3 (Riyadh, Makkah: Maktabah Nazar Mustafa al-Baz, 1996), 797.

Imām al-Shāṭibī

When explicating the role of a mufti as a religious leader whose fatwa becomes a guide for the people’s benefit, Imām al-Shāṭibī states:

“The competent mufti, of the highest authority, is one who leads people towards a natural balance, appropriate for the laity. He does not lead them to extremism, nor does he lean with them towards the excess of unbridled liberalism.”

Source:
1 Al-Shātibi, al-Muwāfaqāt fi Usūl al-Aḥkām, vol. 4, 149.

Contemporary Fiqh

 Fiqh al-muwāzanāt (understanding balance)

Fiqh al-awlawīyāt (understanding priorities)

Fiqh al-wāqiʿ (understanding contexts and realities)

Fiqh al-sunan (understanding fitrah – cause and effect)

Fiqh al-ikhtilāf (understanding etiquettes of disagreements)

Fiqh al-naṣ (understanding scriptural texts)

Imām al-Shāfiʿī

Imam Muḥammad Ibn ʿIdrīs al-Shāfiʿī, was born in Gaza, Palestine in the year 105H. He studied under the tutelage of scholars in Mecca, Medīna, Yemen, Kufa, Baṣra and Egypt. Among his teachers were the Mufti of Mecca Muslim Ibn Khālid al-Zanjī, Imam Abū Yūsuf, and Imam Mālik Ibn Anas. He wrote and published many books, including al-Risāla which discusses the science of Islamic jurisprudence. He passed on in Egypt in the year 204H. 1

Source:
1 Zulkifli Mohd al-Bakri, Istilah-istilah fiqah dan usul: Empat Mazhab (Selangor: Jabatan Kemajuan Islam Malaysia: 2010), 361-362.

Qawā’id Fiqh

Qawā’id fiqh are Islamic legal maxims that have been outlined by the classical ‘ulamā to solve fiqh issues. The five general Islamic legal maxims are:

Al-Umūr bi Maqāṣidihā

Al-Yaqīn la Yuzālu bi al-Shakk

Al-Masyaqqa Tajlibu al-Taisīr

Al-Ḍarar Yuzāl

Al-ʿĀdah Muhakkamah

AMLA

Sections 30 to 33 of AMLA¹ provided for the appointment of the State Mufti, his jurisdiction, the Fatwa Committee, the fatwa procedure, and the observance of the main mazhab (school of law). Based on this Act, the Mufti is officially appointed by the President of the Republic of Singapore and his appointment is notified in the Government Gazette. The Mufti is also an ex-officio member of the MUIS² Council and remains a member of the Council until his retirement.³ The key roles of the Mufti of Singapore include:

To chair the Fatwa Committee as stated in Sections 30-33 (AMLA).

To advise the MUIS Council or other MUIS committees on religious affairs.

To act with the President and Secretary of MUIS for immediate decisions in urgent matters.

To declare the beginning of Ramadan, Shawwal and Dzulhijjah.

To prepare the Islamic calendar (Hijri) and prayer times for Singapore.

To announce the annual rate of zakat fitrah.

To be responsible for the production of Friday and also ‘Eid sermons prepared by MUIS.

To interview and approve the appointment of imams for all mosques in Singapore.

To be the religious advisor in certain matters that might arise at such time.

Source:
1 Please refer: The Statutes of The Republic of Singapore, ‘Administration of Muslim Law Act (Chapter 3) – Revised Edition (October 31, 2009).
2 Stands for Majlis Ugama Islam Singapura or Islamic Religious Council of Singapore
3 In August 1968, the Islamic Religious Council of Singapore started operation and subsequently, the first Mufti of the Republic of Singapore was appointed.

 FATWA COMMITTEE CHART 

2

Further Notes on Chapter 2

Tubal Ligation

Tubal ligation is the most common method of sterilization. It involves severing and tying a woman’s fallopian tubes to prevent eggs from being fertilized by sperm.¹ A similar procedure for men is a vasectomy, where a male’s testes are severed and tied.2 Although there have been accounts of sterilization being performed as far back as the 19th century in Europe, it was only in the 1960s – with the invention of the laparoscope – that surgery methods progressed far enough to allow consistently safe outcomes.³

Source:
 Rochelle N. Shain and Harold D. Dickson, “Characteristics of women most affected by the option of reversibility,” in Social Science and Medicine, Vol. 16 (1983), 1067-1077.
2 George Watts, “Vasectomy for Sterilization,” in The British Medical Journal 2, (1969), 119.
3 “Wanita kini boleh dimandulkan dalam masa lima minit saja,” Berita Harian, March 12, 1972.

Dilation and currettage

Dilation and curettage is a method where the cervix is dilated and a curette – a metal rod with a handle on one end and a sharp loop on the other – is used to scrape out the tissue in the uterus.¹ The danger in such a procedure was that it could perforate the uterine or cause infection.² This method is now uncommon in abortion. The more common technique today is vacuum or suction aspiration. This method was pioneered in 1958 in China.³ It involves inserting a sterile cannula connected to a pump into the vagina. The pump creates a vacuum that is used to empty uterine contents.⁴ It is safer than using a current, but there is still a risk of excessive blood loss or perforation of the uterine.5

Source:

1P.G. Stubblefield, “Midtrimester abortion by curettage procedures: an overview,” in Jane Hodgson (ed.) Abortion and Sterilization: Medical and Social Aspects. (New York: Grune & Stratton, 1981) 277-281.
2 Angelo B. Hooker, Marike Lemmers, Andreas L. Thurkrow, Brent C. Opmeer, Hans A.M. Brölmann, Ben W. Mol and Judith A.F. Huirne, “Systematics review and meta-analysis of intrauterine adhesions after manual vacuum aspiration for early pregnancy failure,” Fertility and Sterility vol. 85:6, (2013).
3 Yuantai Wu and Xianzhen Wu, “A report of 300 cases using vacuum aspiration for termination of pregnancy,” Chinese Journal of Obstretics and Gynaecology, vol. 336, (1958), 447-449.
4 Forrest Greenslade, Janie Benson, Judith Winkler, Victoria Henderson and Ann Leonard, “Summary of clinical and programmatic experience with manual vacuum aspiration,” Advances in Abortion Care, vol. 3:2, (1993).
5 Vanessa K. Dalton, Natalie A. Saunders, Lisa H. Harris, Jennifer A. Williams and Dan I. Lebovic, “Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure,” Fertility and Sterility, vol. 85:6, (2006).

Artificial Insemination of Animals

Artificial insemination of animals had been carried out decades before the technology was applied to humans. In Singapore, early cases dated back at least to 1938 when artificially inseminated cows were born in the Singapore Dairy Farm.1 This was not particularly controversial and indeed considered advantageous to the livestock industry as pedigree cows often did not breed well in Singapore’s tropical climate. Artificial insemination also helped owners of pedigreed dogs in Malaya produce puppies when their movements were restricted by anti-rabies regulations in the end of 1940s.² Singapore, in fact, developed artificial techniques for reproducing animals to the extent that by 1968, super guppies were bred here for export.³

Source:
1“Test-Tube Births in Singapore,” The Straits Times, March 27, 1938.
2 “Test-tube Puppies born in Ipoh,” The Straits Times, March 9, 1948.
3 “Singapore to breed super-guppies for export market,” The Straits Times, July 17, 1968.

Test Tube Baby

Within the Muslim community in Singapore, there was little interest in artificial insemination until the birth of the first “test tube baby.” The baby, Samuel Lee Jian Wei, was born in 1983 at the Kandang Kerbau Hospital.¹ The local papers covered the event quite extensively, touting his high technology birth.² The interest in this particular baby could be attributed to a paradigm shift in reproductive technology. Before in-vitro fertilization, artificial insemination births refer only to conceptions done through injecting sperm into the vagina in order to increase gamete density at the site of fertilization so as to improve chances of conception.³ Test-tube babies born through in-vitro fertilization, on the other hand, took the process a step further by extracting the egg from the mother and sperm from the father for fertilization outside the womb. Samuel was the first test-tube baby conceived in this fashion and this was done five years after the first test-tube baby in the world – Louise Joy Brown – was born on 25 July 1978.4  Both babies grew up to be healthy, high-functioning adults.

Source:
1“First Singapore test tube baby due today,” Singapore Monitor, May 19, 1983, 1.
2 “Computerised cradle that rocks by itself a hit with test-tube baby,” August 14, 1983.
3 Willem Ombelet and Johan van Rohays, History of Human Artificial Insemination in Facts, Views and Visions in Obgyn, Vol.1 (2010).
4 “Born in test tube, raised in success,” The Straits Times, July 26, 2003, 1.

3

Further Notes on Chapter 3

The Evolution of HOTA

Number of Muslim Organ Donors

Source: Report by Integrated Health Services Division, Ministry of Health.

4

Further Notes on Chapter 4

Dolly The Sheep

From a scientific perspective, cloning is the process of creating genetically identical offspring by using an adult somatic cell through the technique of nuclear transfer.¹ This differs from in-vitro fertilization because cloning need not use human egg and sperm but made reproduction with any cell possible. The first animal to be cloned using this method was a sheep called Dolly in 1996. It only survived 6 years, less than her life expectancy of 12 years.2 Some scientists hypothesized that Dolly died early because she was cloned from a six-year old sheep and was born with that genetic age, as evidenced by her shorter telomeres.³ This indicated that the process itself was risky and might result in abnormalities. Since Dolly’s birth, other animals such as pigs, deer, horses, sheep and bulls have been cloned with mixed success. For each cloning success, there had been hundreds of failed attempts.⁴ However, research into the possible use of this technique continues in many different directions such as cloning new organs to replace diseased ones and reviving dead humans or extinct species with frozen tissue. To date, there has been no consistent success in these efforts.⁵ The most visible application of the technology in human life is the formation of clinics that allow parents to choose the gender of their baby for a fee but even that practice is not always successful.⁶ Practically speaking, the application of cloning technology has thus far been speculative.

Source:
1 Wilmut, I,  Schrieke A.E, McWhir J., Kind A.J et al, “Viable Offspring Derived from fetal and adult mammalian cells.” In Nature, 385, (1997), pp 810-13
2 ‘Tech and Science’ The Straits Times, 18 February 2003.
3 Shiels P.G, Kind A.J, Campbell K.H et al. “Analysis of telomere lengths in cloned sheep.” Nature 339, (1999), pp. 316-7.
4 David Shukman, ‘China cloning on an industrial scale’ BBC News Science and Environment, 14 February 2014.
5 ‘Not time yet for therapeutic cloning: Experts’ The Straits Times, 25 June 2002.
6 ‘Gender Selection: An Empty Promise’, The New Paper, 16 May 2004.

Therapeutic Cloning, Reproduction and Stem Cell Research

The BAC explained that any research done  should be based on the guiding principles of being “just and sustainable.”¹ Therefore, it recommended that research is permitted but regulated in Singapore. It suggests that stem cells should only be derived from cadaveric foetuses subject to the informed consent of the tissue donor. While this was still unacceptable to groups who were against abortion, the BAC maintained an intermediate position in that it asserted that the human embryo had a special status but not equal to that of a living child.² A year later, it took the view that therapeutic cloning of embryos as a source of embryonic stem cells should be legalized, which boosted stem cell research in the country.³

This supportive stance towards research attracted experts such as Professor Alan Coleman who had helped to clone Dolly the sheep. He moved to Singapore in 2002 to carry out more research here.⁴ Millions of dollars were also spent funding research in stem cells.5 Such a decision is and remains highly controversial both locally and internationally. Some religious groups such as the Catholic Church remained strongly opposed to therapeutic cloning using embryos.

At the international level, the United Nations called on member states to avoid using somatic cell nuclear transfer, a stance that was shared by the Council of Europe’s Convention on Human Rights and Biomedicine.⁶ The World Health Organization took the opposite stand.⁷ Outside Europe, no international treaty on stem cell research has been signed and ratified since many Asian countries such as Japan and China are generally positive about the technology and related research. It has also been reported that China had already cloned hundreds of embryos.⁸ It remains to be seen whether a consensus on the issue can be reached in the future.

Source:
1 Bioethics Advisory Committee (2001). Ethical, Legal and Social Issues in Human Stem Cell Research, Reproductive and Therapeutic Cloning. Bioethics Advisory Committee (Singapore). Available online at http://www.bioethics-singapore.org/index/publications/reports/86-reports/174-stem-cell-research.html. Accessed on Aug 8, 2015.
2 Ibid.
3 ‘Cloning can wait until moral issues clear up’ The Straits Times, 5 July 2002
4 ‘Goodbye Dolly, Hello Molly’ The Business Times 13 September 2002.
5 ‘70m stem-cell funding may see cure for diabetes’ The Straits Times, 14 September 2002.
6  ‘Convention for the Protection of Human Rights and Dignity of Human Beings with Regard to the Application of Biology and Medicine,’ Signed in Oviedo (2010) (Text online). Available at: http://conventions.coe.int/Treaty/EN/Treaties/Html/164.htm. Accessed 18 May 2015.
7 See Roberto Adamo, “The Oviedo Convention: A European Legal Framework at the Intersection of Human Rights and Health Law” Journal of International Biotechnology Law 2:4, 134.
8 ‘China has cloned 30 human embryos’ The Straits Times, 16 July 2002

Fiqh Iftirāḍī

A contemporary scholar of Muslim law, Dr. Kamal Imam, stated that fiqh iftirāḍī is the process of theorising future issues according to the foundations of sharīʿa and its sources in order to determine the rulings for these issues. This is so that the Muslim community is not caught unprepared to address new developments, as well as advancements in science and life where rulings have yet to be decided. He argues that the hypothetical process assumes the occurrence of an issue and establishes its ruling, which is an integral part of contemporary fiqh that should be developed.¹

Source:
Muhammad Kamal Imam, “al-Tafkīr al-Fiqhī fī al-Madhāhib wa al-Mauqif min al-Fiqh al-Iftirāḍī: Murājaʿa Naqdiyya”. Working paper delivered at the 8th Seminar on the Development of fiqh with the theme of fiqh and the Future: Principles of Maqāṣid and al-Fiqh al-Iftirāḍī, Oman April 6-9, 2014.

Genetic Testing and Genetics Research.

The BAC published its recommendations titled “Ethical, Legal and Social Issues in Genetic Testing and Genetics Research.” These recommendations were discussed by the Fatwa Committee, who agreed in principle to the recommendations put forth as they are congruent with Islamic principles, especially the principle of ʿUrf. These are evident from the proposed guidelines, which seek to ensure that it is an individual choice and that there is no coercion in the matter. The Fatwa Committee also gave greater emphasis in its discussion on some of the recommendations that have direct impact on Islamic practice and creed.¹

Source:
1 Refer “Bioethical code proposed,” Today, April 2005. For full article see, “Genetic Testing and Genetic Research,” Bioethics Advisory Committee Singapore (2005), accessed on 30 July 2015. http://www.bioethics-singapore.org/index/publications/reports.html

Future Issues in Bioethics

An area of scientific development that will require more attention by the Fatwa Committee is the combination of human-animal cells for the production of research cells, known as human-chimera hybrids. A chimera is an organism that has cells from another organism, which may or may not be from a different species. Technically, these hybrids and chimeras already exist in our society as animal parts have been used on humans medically for decades in operations, such as in skin grafting and heart transplants. However, with the advent of stem cell research, scientists became interested in developing ‘cytoplasmic hybrid embryos’ in order to extract stem cells for future research.¹ These hybrids are created by moving a human nucleus into an animal egg, in which the nucleus has been taken out, whereas an ‘animal chimera’ is produced by transplanting human stem cells into an animal body to study the biology of these stem cells.

The main ethical issue is that such research opens up the possibility of producing humans with animal characteristics or vice versa if these embryos are allowed to mature. This process blurs the boundaries between humans and animals, leading to a bigger question of the moral rights of each species. This was among the reasons that have caused many countries to hesitate in allowing this type of research. In addition, some people object to the idea of “playing God” by creating hybrid species not found in nature while others find the process cruel to animals.²

Scientists managed to forge ahead in countries like China where they successfully created cytoplasmic embryos from combining human cells with rabbit eggs³ while scientists in Britain succeeded in generating stem cells from a fertilized cow egg and a human nucleus in 2008. These developments marked milestones in the field.⁴Cytoplasmic embryos have the advantage of patient-specific or disease-specific stem cells derivation.⁵ Britain became one of the first countries to approve of creating cytoplasmic embryos when the Human Fertilisation and Embryology Authority approved applications by two universities that sought to do so.⁶ This move was followed by legal approval: lawmakers in Britain rejected a legislative amendment to ban such research in May 2008,⁷ even though the move was protested by pro-life groups and the Vatican. Other countries such as Australia, India, New Zealand and the United States circumvented controversy by setting up strict restrictions on such research.

In Singapore, the BAC reached out to the public for their opinions on the research through the public forum REACH.⁸ They released a consultation paper in January 2008 and held a discussion forum as well as an e-consultation paper. About 64 responses were collected in total and they indicated that animal rights groups and religious groups tended to find such research disturbing.⁹ The BAC eventually concluded that human-animal research should be subject to the same regulations as pertains to the use of animals in research. The breeding of human-animal hybrids are strictly prohibited.¹⁰

Source:
1 “Fact sheet: Cybrids,” The Straits Times, 21 May 2008, p. 20.
2 Bioethics Advisory Committee, (2010) “Human-Animal Combinations in Stem-Cell Research,” Bioethics Advisory Committee, Singapore, pp. 16-20. Available online at http://www.bioethics-singapore.org/images/uploadfile/54403%20PMHAC%20Report%20.pdf.  Accessed on 23 July 2015.
3 Chen Y et al. (2003). “Embryonic stem cells generated by nuclear transfer of human somatic nuclei into rabbit oocytes.” Cell Research, 13, pp. 251-263.
4 ‘New Breed of Cow-boys,’ The Straits Times, 13 April 2008, 30.
5 Ibid.
6 ‘First human-animal embryos for Britain,’ The Straits Times, 3 April 2008, 16.
7 ‘Britain rejects human-animal embryo ban,’ The Straits Times, 21 May 2008, 20.
8 “Time to discuss grey areas.” Today, 3 April 2008, p. 10.
9 Bioethics Advisory Committee (2010)”Annex D: Summary of Responses from REACH Online Discussion Forum and e-Consultation.”Bioethics Advisory Committee Singapore. Available online at http://www.bioethics-singapore.org/index/publications/reports/86-reports/167-human-animal-combinations-in-stem-cell-research.html. Accessed 30 July 2015.
10 Bioethics Advisory Committee, (2010) “Human-Animal Combinations in Stem-Cell Research,” pp. 21-22.

5

Further Notes on Chapter 5

Istiḥāla & Istihlāk

Definition of istiḥāla: This refers to the transformation of impurities (najis) into purities. For example, changes in the essence and characteristics of faeces, liquor, and pork in processes such as combustion, fermentation, filtration, or by mixing impurities with a purity such as the mixing of pork with salt until it turns into salt.

Definition of istihlāk: This refers to changes that occur when mixing large quantities of a purity with small quantities of an impurity. It results in the impurity dissolving in the purity, thereby eliminating its original essence and characteristics. For example, pouring a drop of liquor in a large pool of water diminishes liquor’s form and characteristics. Jurists consider istihlāk as a form of istiḥāla.

ʿAzīma & Rukhṣa

ʿAzīma is the original rule prescribed by God. For example, drinking liquor is prohibited, as is taking drugs containing alcohol.

Rukhṣa is an exception in certain situations for the reasons mentioned by theSharīʿa.¹

Source:
1. Hashim Kamali, Principles of Islamic Jurisprudence (Selangor: Pelanduk Publication, 1989), 429-430.

Al-ʿIzz Ibn ’Abd al-Salām

Imām Abū Muhammad ʿIzz al-Dīn ʿAbd al-ʿAzīz Ibn ʿAbd  al-Salām Ibn Abī al-Qāsim al-Silmī al-Dimashqī al-Shāfiʿī is a faqih, i.e. expert in the principles of Islamic jurisprudence, the Arabic language, and Qur’anic exegesis. He was born in Damascus in 577/8H. He read from many scholars and attained the level of a mujtahid. He served as a khatib in the Damascus Mosque, as well as presided as judge in Egypt. He died in Cairo, Egypt in 660H. He wrote many books, the most renowned of which is Qawāʿid al-Ahkām fī Maṣāliḥ al-Anʿām which gathered and analysed the rules of Mazhab  al-Shāfiʿī.¹

Source:
1.Muhammad ʿIzz al-Dīn ʿAbd al-ʿAzīz Ibn ‘Abd al-Salām Al-Silmī, Qawāid al-Ahkām fī Maṣaliḥ al-Anām, ed. ʿAbd al-Laṭīf  Hasan ʿAbd al-Rahmān (Beirut: Dar al-Kutub al-Ilmiyyah, 1999), 3-4

Al-Zahrāwi

A Muslim physician born in Cordova in 930CE. He was a well-known surgeon in al-Andalus. He pioneered a technique to stop bleeding from the skull using wax and alcohol during cranial surgery in the middle ages. He also used alcohol in sewing torn skin.

Euthanasia

Euthanasia is usually categorised into two types: passive and active. Passive euthanasia is defined as letting someone die. “Letting” is the key word in this definition, and it includes stopping or indirectly treating a patient to prolong his life, such as providing a breathing tube, or feeding him through a tube. Active euthanasia involves an act that causes the death of a patient without his involvement. Euthanasia is also divided into voluntary and involuntary, referring to whether the act was done at the request of the patient or not, and whether the patient has the ability to give consent.¹

Source:
1 Fecio Jennifer MacDougall & Martha Gorman, Euthanasia: A Reference Handbook, (California: ABC-CLIO, 2008), 32

The Terri Schiavo Case

Schiavo was involved in an accident and became vegetative as her brain activities ceased. Her condition caused a conflict between her parents and her husband. The latter wanted to stop her life support equipment, but Schiavo’s parents disagreed and wanted their daughter to continue to live (on life support). The case ended with a victory for her husband. Schiavo died a few days after her life support equipment was stopped. As Schiavo did not make an AMD or living will, it became difficult for her family members to choose who among them should decide on her behalf. The result is a long and bitter family struggle, as seen in the case.

Tobacco and Culture

In the early twentieth century, companies producing tobacco products started mass marketing them in the United States and many other parts of the world. By 1929, for example, Lucky Strike – a major cigarette company – spent more than US$ 7 million in advertising.1 With this extended advertising, a culture of coolness associated with smoking began to develop. The most emblem of this gendered cultural association is that of the macho “Marlboro Man.”2 Many films in both Western and local cinema prior to 1970 also had main characters who smoked heavily. Therefore, both cigarettes and its attendant culture had a global reach.

Source:

1 Brandt (2007), The Cigarette Century, p.201.

2 Katie Connolly (2011). “Six Ads that Changes the Way You Think.” BBC News. Available online at http://www.bbc.com/news/world-us-canada-1196364. Accessed Sep 4, 2015

6

Glossary

ʿĀm: General. Ilmu al-‘amma is general religious knowledge that is expected of every Muslim of sound mind to know, such as the obligation to perform the five daily prayers.

ʿĀzīma: Original and unmodified rule.

Dalil: Evidence.

Ḍarūriyyāt: Essential needs in life to ensure the spiritual and material well-being of humankind.

Dilāla: Meaning, implication.

Fatwa: An explanation to a specific question on Muslim law.

Faqīh: Jurist.

Ḥājiyyāt: Basic needs in life that can relieve hardship and difficulty, and facilitate the normal functioning of life.

Iftāʾ: Act of issuing a legal opinion (fatwa).

Ijtihād: Utmost effort expended by a jurist in formulating a religious ruling which is unclear from the primary sources.

Istidlāl: Reasoning.

Istiḥsān: To deem something as good; juristic preference and consideration for public interests and justice based on an independent interpretation.

Istinbāt: Process of deriving certain rules or meanings from a text.

Khāṣ: Specific. A word or a text which conveys a specific meaning.

Mafsada: Harm.

Mansūkh: A ruling which has been abrogated by later religious injunctions or rulings.

Maṣlaha: Public good or interest.

Mufaṣṣal: Detailed. That which is clear in its meaning and its purposes are established from explicit texts or interpretation.

Mujmal: Vague. Terms and texts which are ambiguous and may contain more than one meaning.

Mujtahid: Qualified jurist with a mastery of the sciences of the Quran, Sunnah, Qiyas (analogy) and various other fields.

Muqayyad: Conditional and qualified.

Mustaftī: One who requests for a religious ruling (fatwa).

Muṭlaq: Unspecified and unqualified. It differs from ʿām, as the latter comprises all to which it applies, whereas the former can apply to any one of a multitude, but not all.

Mazhab al-Ṣaḥāba: The opinion of the companions of the Prophet Muhammad regarding a religious ruling.

Nāsikh: That which abrogates a religious injunction or ruling.

Qiyās: Deductive analogy. Process of taking an established ruling from Islamic law and applying it to a new case, in virtue of the fact that the new case shares the same operative  causes (‘illah) for which the original ruling was applied.

Rukhṣa: Concession or concessionary rule, modified due to presence of mitigating factors.

Sadd dharīʿa: Blocking the means to an expected harm or danger, or opening the means to an expected beneficience; where the end posesses the likelihood or unlikelihood of materialising should the means be unblocked or left unopened.

Taḥsīniyyāt: Optional needs in life which are of less importance than ḍarūriyyāt and ḥājiyyāt, which function to enhance and complete their fulfillment; taḥsīniyyāt includes things such as commendable customs, rules of ettiqutte and moral standards.

Tadarruj: Gradual approach in establishing religious rulings to ensure that they are implemented in an effective and comprehensive manner.

‘Urf: Customs and norms of a particular society which are collectively practised and accepted by people of sound nature.