ISLAM, BIOETHICS IN

Islam, the last of the Abrahamic religions (literally meaning "submission [to God's will]"), was proclaimed by Muhammad (born ca. 570 c.e.), the prophet of Islam and the founder of Islamic public order in the seventh century c.e. in Arabia. This article will focus on the historical development of Islam, its fundamental teachings, Islamic legal thought, the Islamic theological and ethical tradition, Islamic mysticism, and Islam and modernity. Throughout the article an attempt will be made to relate religious-moral belief to practice, thereby indicating implications of the tradition in molding attitudes toward maintenance and preservation of life, including ways of dealing with suffering, pain, illness, death, and connected issues.

Historical Development

Seventh-century Arabia was socially and politically ripe for the emergence of new leadership. When Muhammad was growing up in Mecca, a city that had become an important center of a flourishing trade between Byzantium and nations on the Indian Ocean, he was aware of the social inequities and injustices that existed in the tribal society dominated by a political oligarchy made up of a few powerful chiefs. Monotheistic traditions like Judaism and Christianity were known to the Arabs; but they had persisted in worshiping their pagan deities, who dwelt in sanctuaries in and around Mecca. The most important shrine in Mecca was the Kaaba, a rectangular building, to which tribes made annual pilgrimage, using the occasion to trade with people who came from all over Arabia.

Religious practices and attitudes before Islam, then, were determined by the tribal aristocracy who also upheld tribal values: "bravery in battle, patience in misfortune, persistence in revenge, protection of the weak, defiance of the strong," generosity, and hospitality as part of their moral code (Watt, p. 20). The growth of Mecca as a commercial center where individuals acted more freely in their own private interest than in the interest of the tribe, had weakened this tribal ethic to the extent that weaker members of a tribe and those who had been marginalized were left without security. Islam emerged in the midst of a serious socioeconomic imbalance between the rich and the poor, between extreme forms of individualism and tribal solidarity.

Muhammad was born into the Hashimite clan of the powerful Quraysh tribe in Mecca. His father died before he was born, and his mother died when he was six years old. In accordance with Arab tribal norms, he was brought up first by his grandfather, then, following the grandfather's death, by his uncle, with whom he traveled on trade missions to Syria. As a young man he was employed by a wealthy Meccan woman, Khadija, as her trade agent. He was twenty-five when he accepted a marriage offer from Khadija, who was fifteen years his senior. When Muhammad received his prophetic call at the age of forty, Khadija was the first person to become muslim ("believer in Islam").

This was the beginning of Islam as a struggle to establish a monotheistic faith and create an ethical public order embodying divine justice and mercy. Meccan leadership resisted Muhammad and persecuted him and his followers, who were drawn mainly from among the poor and disenfranchised. Under unbearable conditions, Muhammad decided to emigrate to Medina, an oasis town in the north, where two warring Arab tribes had invited him to arbitrate their affairs. This emigration in 622 c.e. marks the beginning of the Muslim calendar and the genesis of the first Islamic polity: Muhammad as a statesman instituted a series of reforms to create his community, umma, on the basis of religious affiliation. It also established a distinctive feature of Islamic faith, which does not admit the separation between the religious and temporal spheres of human activity, and has insisted on the ideal unity of civil and moral authority under the divinely ordained legal system, the shari a.

Muhammad died in 632 c.e., having brought the whole of Arabia under the Medina government. However, he had left no explicit instructions regarding succession to his religious-political authority. The early Muslim leaders who succeeded him as caliphs exercised Muhammad's political authority, making political and military decisions that led to the expansion of Muslim domains beyond Arabia. The community leaders were convinced that the Islamic domain, and not necessarily Islamic faith, was to prevail over all other nations. This conviction, in addition to the political need to consolidate the Muslim polity threatened by internal tribal strife, became the driving force behind the early territorial expansion. Within a century Muslim armies had conquered the region from the Nile in North Africa to the Oxus in Central Asia and as far as India. This vast empire required an Islamic legal system for the administration of the highly developed political systems of the conquered Persian and Byzantine regions. Muslim jurists formulated a comprehensive legal code, using the ethical and legal principles set forth in the Qur'an, the collected revelations of Muhammad, and the precedents set by the Prophet and the early community, in addition to the customary law in the conquered regions.

Differences of opinion on certain critical issues emerged as soon as Muhammad died. The question of succession to Muhammad was one of the major issues that divided the community into the Sunni and the Shia. Those supporting the candidacy of Abu Bakr (d. 634), an elderly associate of the Prophet, as caliph (political successor) formed the majority of the community, who gradually came to be known as the Sunnis; those who acclaimed Ali (d. ca. 660), Muhammad's cousin and son-in-law, as the imam (religious and political leader) designated by the Prophet, formed the minority group, known as the Shia ("partisans").

The dispute had profound implications beyond the political. The ideal nature of prophetic prestige in the community, established both in the Qur'an through persistent admonition to obey the prophet and through the prophet's personal exercise of discretionary power in shaping the public order, meant acknowledgment of an authority whose decisions in all spheres affecting Muslim life would be binding on posterity.

The early years of military victories over the Persians and the Byzantines were followed by the civil wars that broke out in 656 c.e. under Muhammad's third successor, Uthman. The tension occasioned by the existence of political and social injustices in the Muslim polity gave rise to two distinct, and in some ways contradictory, attitudes among Muslims: quietist and activist. The supporters of a quietist posture supported authoritarian politics, which feigned unquestioning and immediate obedience to almost any de facto Muslim authority who publicly promised to uphold Islamic norms. The exponents of an activist posture supported radical politics and taught that under certain circumstances, it was imperative to remove an unjust authority from power. Gradually the quietist and authoritarian stance became associated with the majority of the Sunnite Muslims. The activist and radical stance came to be associated with Shiite Islam.

By the end of the third Islamic century (ninth–tenth c.e.), these two distinct responses to the question of political-religious authority were expounded by the Sunni and Shia schools of thought. Despite the disintegration of the caliphal authority in the thirteenth century c.e., the Muslim community has continued to live in the shadow of the idealized history of early Islam, when the religious and secular authority was united under the divinely guided caliph.

Fundamental Teachings

The two authoritative sources of Islamic teachings are the Qur'an, regarded by Muslims as the book of God, and the sunna, the exemplary conduct of the Prophet. The Qur'an consists of the revelations Muhammad received intermittently from the time of his call as prophet in 610 c.e. until his death in 632. Muslims believe that the Qur'an was directly communicated to the Prophet by God through the archangel Gabriel; accordingly, it is regarded as inerrant and immutably preserved. It has served as the source for ethical and theological doctrines and principles for the public organization. The sunna (meaning "trodden path") has functioned as the elaboration of the Qur'anic revelation, providing details about each and every precept and deed purportedly traced back to the Prophet's own precedent. The narratives that carried such information were designated as hadith. In the ninth century, Muslim scholars developed an elaborate system for the theological and legal classification of these hadith to deduce certain beliefs and practices.

The hadith literature describes the Muslim creed and practice as "the Five Pillars of Islam." The First Pillar is the shahada, the profession of faith: "There is no deity but God, and Muhammad is the messenger of God." Belief in God constitutes the integrity of human existence, individually and as a member of society. The Qur'an speaks about God as the being whose presence is felt in everything that exists; everything that happens is an indicator of the divine. God is the "knower of the Unseen and the Visible; … the All-Merciful, the All-compassionate, … the Sovereign Lord, the All-holy, the Giver of peace, the Keeper of faith, the Allpreserver, the All-mighty, the All-powerful, the Most High" (Qur'an, 59:23). Faith in God results in being safe, well integrated, sound, and at peace.

Life is the gift of God, and the body is the divine trust given to humankind to enable it to serve God as completely and fully as the wonderful creation of God has made that serving possible. The humble origin of humans is established by the Qur'anic reference to their creation from "dry clay of black mud formed into shape" (15:26). Through the well-proportioned creation of the human body and the perpetual guidance provided to perfect it both spiritually and morally, human beings have been given the trusteeship of their body. On the Day of Resurrection, all parts of the human body will have to account for the actions of the person whose bodily organs they formed. God has set limits on what human beings may do with their own bodies. Suicide, homicide, and torturing one's body in any form are regarded as transgressions.

The Qur'anic affirmation of bodily resurrection has determined many religious-moral decisions regarding cadavers. Dead bodies should be buried reverently, as soon as possible. Islamic law prohibits mutilation of the cadaver and, thus, cremation. Under certain circumstances, in order to determine the cause of death, autopsy is permitted. Postmortem dissection is permitted, for instance, to retrieve a valuable object belonging to another person that might have been swallowed by a deceased person. There was doubt about the use of human cadavers for medical research until fairly recently.

The rulings are now well established in regard to the cadavers of non-Muslims, which do not require any monetary compensation for their mutilation (as required by the shari a for the cadaver of a Muslim). However, if the research for a cure of a disease is dependent on the dissection of a Muslim cadaver, then most Sunni and Shi'ite jurists rule it permissible and, as a precautionary measure, require the payment of compensation to the family of the deceased (Fiqh al-tabib [Islamic Laws for Physicians], pp. 159–180). Some recent rulings from Shi'ite jurists make no distinction between a Muslim and a non-Muslim cadaver, thereby permitting research and use of organs for transplantation (Fiqh al-tabib [Islamic Laws for Physicians]).

The Qur'an affirms reverence for human life in reference to a similar commandment given to other monotheists: "We decreed for the Children of Israel that whosoever killeth a human being for other than manslaughter or corruption in the earth, it shall be as if he had killed all humankind, and whoso saveth the life of one, it shall be as if he saved the life of all humankind" (5:32). This passage has provided modern Muslim jurists with religious documentation to legitimize medical advances in saving human lives. It has also served as an incentive to protect humanity against peril by choosing to save oneself and others from perdition and to serve humanity as service to God.

The corollary of the belief in God's guidance is human accountability to further divine purposes on earth. The purpose of creation is to allow human beings, created with cognition and volition, freely to accept the responsibility of perfecting their existence by working with the laws of nature grasped by the divinely endowed innate disposition (fitra) and by understanding principles of causality that regulate their well-being. The Qur'an emphasizes God's benevolence, all-forgivingness, and mercy. But it also accentuates God's justice, and stresses that humanity should develop moral and spiritual awareness (taqwa) in fulfilling everyday requirements of life.

Human existence is not free of tension and inner stresses caused by rejection of truth (kufr) and impairment of moral consciousness. To help humanity, God sends prophets "to remind" humanity of its covenant with God (Qur'an, 7:172). There have been 124,000 prophets from the beginning of history, of whom five (Noah, Abraham, Moses, Jesus, and Muhammad) are regarded as messengers sent to organize their people on the basis of the guidance revealed by God.

The Second Pillar is daily worship (salat), required five times a day: at dawn, midday, afternoon, evening, and night. These very short prayers entail bowing and prostrations. A Muslim may worship anywhere, preferably in a congregation, facing Mecca. Muslims are required to worship as a community on Fridays at midday and on two major religious holidays, celebrating the end of Ramadan and the completion of the pilgrimage in Mecca. The congregational prayer gives expression to the believer's religious commitment within the community. Women are exempt from the obligation of congregational participation, and the tradition recommends that they worship in the privacy of their homes. However, they have always worshiped at designated areas in the mosque, apart from men. The Qur'an prescribes physical purity for the worshiper through the performance of ablutions, and a full washing after sexual intercourse or a long illness, prior to undertaking worship. Women are required to perform a full washing after the menstrual cycle and childbirth, because blood is regarded as ritually unclean. Islamic law prescribes regular cleansing and physical hygiene as expressions of one's faith.

Prayer in Islam is regarded as therapeutic. Besides seeking medical treatment, Muslims are encouraged to seek healing, especially of psychological illnesses, by praying to God. Many illnesses, according to the teachings of the Prophet, are caused by psychological conditions like anxiety, sorrow, fear, loneliness, and so on. Hence, prayer restores the serenity and tranquillity of the soul.

The Third Pillar is the mandatory "alms levy" (zakat). The obligation to share what one possesses with those less fortunate is stressed throughout the Qur'an. The Muslim definition of the virtuous life includes charitable support of widows, wayfarers, orphans, and the needy. Islamic law includes technical regulations about how much zakat is due and upon what property it is to be levied. These legal rulings, which originated before the disintegration of the Islamic public order, do not necessarily prevail in contemporary Muslim nations. Although zakat has for the most part been left to the conscience of Muslims, the obligation to be charitable and contribute to the general welfare of the community continues to be emphasized. In a number of poor Muslim countries this benevolence, provided by wealthy individuals, has underwritten badly needed healthcare for those who cannot afford the rising cost of medical treatment. It has also led to the creation of private charitable foundations that compete with the cumbersome and poorly administered government welfare institutions.

The Fourth Pillar is the fast during the month of Ramadan. Since the Muslim calendar, which has been in use since the seventh century, is lunar, the month of fasting moves throughout the year over a period of time, because the lunar year is shorter than the solar. Ramadan is regarded as the holy month during which the Qur'an was revealed to Muhammad. During the fast, which lasts from dawn to dusk, Muslims are required to refrain not only from eating, smoking, and drinking but also from sexual intercourse and acts leading to sensual behavior. The fasting is meant to alter the pattern of life for a month, and Muslims are required to make necessary adjustments in their normal schedules of work and study. The end of the month is marked by a festival, 'Id al-fitr, after which life returns to normal.

Instituted to cultivate individual spiritual and moral self-control, Ramadan also provides a community experience in which families and friends share both fasting and evening meals in the spirit of thanksgiving. Like prayer, fasting possesses therapeutic value. Prophetic medical tradition prescribes fasting for various kinds of ailments, including psychological problems caused by fear and anxiety. It was regarded as a remedy for excessive sexual drive.

The Fifth Pillar is the pilgrimage, the hajj, which all Muslims are required to undertake once in their lives, provided they have the financial means. The rituals of the pilgrimage at Mecca are a collective commemoration of the sacrifice story of Abraham and of lessons to be derived from it. Its spiritual objective is to inculcate a form of asceticism accompanied by renunciation of worldly desires (sexual intercourse, use of perfumes, and so on) and concern with the hereafter. The experience brings together Muslims of diverse cultures and nationalities to achieve a purity of existence and a communion with God that will exalt the pilgrim for the rest of his or her life.

Islamic Legal Thought

Islamic jurisprudence (fiqh) was developed to determine normative Islamic conduct as detailed in the shari a, the sacred law. The shari a, the divinely ordained blueprint for human conduct, is inherently and essentially religious. The juridical inquiry that led to the shari a code was comprehensive because it necessarily dealt with every case of conscience covering God-human relations, as well as the ethical content of interpersonal relations in every possible sphere of human activity. Most of the legal activity, however, went into settling more formal interpersonal activities that affected the morals of the community. These activities dealt with the obligation of doing good to Muslims and guarding the interests of the community.

Islamic legal theory recognized four sources for judicial decisions: the Qur'an, the sunna, consensus (ijma) of the early community of the Muslims, and analogy (qiyas), a method of reasoning from data furnished by the Qur'an and the sunna in an attempt to estimate the unknown from the known ruling. Al-Shafi'i (d. 820), a rigorous legal thinker, systematically and comprehensively linked the four sources in order to derive the shari a to cover all possible contingencies. The legal precedents and principles provided by the Qur'an and sunna were used to develop an elaborate system of rules of jurisprudence. Human conduct was to be determined in terms of how much legal weight was borne by a particular rule that rendered a given practice obligatory or merely recommended.

For instance, if it is deemed that by risking one's life, one may be able to save another person from impending death, then the law permits not only donation but also sale of a needed body part or an organ after a careful risk-benefit analysis. Vital organs like eyes are excepted in this ruling. Likewise, it had to be decided whether an obligatory act, because of its social relevance and the degree of applicability of a given rule or precedent, was to be enforced by penalties in the courts or left to God's judgment in the hereafter.

In family law, the rights of women, children, and other dependents were protected against the male head of the family, who, on the average, was stronger than a woman and more independent, being free of pregnancy and having to care for children. Islamic marital rules encouraged individual responsibility by strengthening the nuclear family. Shari a protected the prerogative of the male because he was required to support the household; the woman was protected primarily by her family. Muslim jurists gave the husband one-sided divorce privileges because for a woman to divorce a man would mean to unsettle her husband's economic investment. Under these rules a husband could divorce a wife almost at will; a wife who wished to leave her husband had to show good reason.

The main legal check upon the man in divorce was essentially financial and a matter of contract between equal parties that included a provision about the bridal gift. Part of the gift, which might be substantial, was paid at the time of marriage; if a husband divorced his wife without special reason, he had to pay her the rest. The equality of women in the shari a carried with it an important financial independence. The Muslim woman could own property that could not be touched by any male relative, including her husband, who was required to support her from his own funds. Moreover, she had a personal status that might allow her to go into business on her own. However, this potential female independence was curbed primarily by cultural means, keeping marriages within the extended family, so that property would not leave the family through women marrying out.

Muslim jurists, although tending to give the male an extensive prerogative, presupposed a considerable social role for women. The Qur'anic injunction to propriety was stretched by means of the sunna to impose seclusion. The veil was presented simply in terms of personal modesty; the female apartments, in terms of family privacy. It was not intended to become a form of social distinction, as it did with upper-class women living in rigorous segregation. Among the latter it became a mark of a woman of a quality that she was secluded from all men but those in her own family.

Segregation of the sexes as required by the shari a has led to untold problems in the teaching and practice of medicine today. The problems cover such areas as closely examining and touching the reproductive organs (male-female, female-male, male-male, and female-female); looking at photographs of naked persons for studying physiology and anatomy; taking the pulse and other vital signs of patients of opposite sex. While the classical decisions were prohibitive in all these cases, the majority of the modern Muslim jurists have casuistically accommodated the need to carry out necessary medical training, research, and treatment.

In the patriarchal family structure, and not necessarily in the shari a, women were assigned a subordinate role in the household and community. Through certain cultural practices women's reproductive capacity was controlled. In some parts of the Muslim world women are subjected to traditional practices that are often harmful to their well-being and that of their children. One of the controversial and persistent practices is female circumcision (khafd or khifad), without which it is believed that girls cannot attain the status of womanhood. Islamic views on female circumcision are ambiguous. While Islam does not condone the practice, neither does it forbid it. The operation was performed long before the rise of Islam. It is not a practice in many Muslim countries, including Saudi Arabia, Tunisia, Iran, and Turkey. There is nothing in the Qur'an that justifies female circumcision, especially its most severe form, infibulation. The Prophet opposed the custom as found among pre-Islamic Arabs, since he considered it harmful to women's sexual well-being. Yet the official juridical position among the majority of Sunni jurists is that female circumcision is sanctioned by the sunna. However, the shari a does not regard it as obligatory. It is merely a recommended act.

As Islamic jurisprudence became highly technical, disputes about method and judicial opinions crystallized into legal schools designated by the names of prominent jurists. The legal school that followed the Iraqi tradition was called Hanafi, after Abu Hanifa (d. 767), the great imam (teacher) in Iraq. Those who adhered to the rulings of Malik ibn Anas(d. 795), in Arabia and elsewhere, were known as Malikis. Al-Shafi'i founded a legal school in Egypt whose influence spread widely to other regions of the Muslim world. Another school was associated with Ahmad ibn Hanbal (d. 855), who compiled a work on hadith reports that became the source for juridical decisions of those who followed him. Shiites developed their own legal school, whose leading authority was the imam Ja'far al-Sadiq (d. 765).

Normally, Muslims accepted one of the legal schools prevalent in their region. Most Sunnites follow Hanafi or Shafi'i; the Shiites follow the Ja'fari school. In the absence of an organized church and ordained clergy in Islam, determination of valid religious praxis was left to the qualified scholar of religious law. Hence, there emerged a living tradition, with different interpretations of the Qur'anic laws and prophetic traditions, giving rise to different schools of the shari a.

The scope of shari a, understood as the norm of the Muslim community as a community, was defined by two essential areas of human life: acts of worship, both public and private, connected with the pillars of faith; and acts of public order that ensure individual justice. The shari a reflected Muslim endeavors to ensure that Islam pervaded the whole of life. However, many areas of human existence, including the ethical problems connected with the medical treatment of ailments, received little systematic attention in the classical formulations of the legal thought.

Islamic Theological and Ethical Tradition

In the first half of the eighth century, the debates about qualified leadership, the existence of injustices in the community, and the appropriate response to redress the situation, formed the rudiments of the earliest systematic theology of the group called Mu tazilites. Before them, some Muslim thinkers had developed theological arguments, including a doctrine of God and human responsibility, in defense of the Islamic revelation and the prophethood of Muhammad when these were challenged by other monotheists. The Mu tazilites undertook to show that there was nothing repugnant to reason in the Islamic revelation. Their theological system was worked out under five headings: (1) belief in God's unity, which rejected anything that smacked of anthropomorphism; (2) the justice of God, which denied any ascriptions of injustice to God's judgment of human beings, with the consequence that humans alone were responsible for all their acts, and thus punishable for their evil ones; (3) the impending judgment, which underscored the importance of daily righteousness and rejected laxity in matters of faith; (4) the middle position of the Muslim sinner, who, because of disobeying God's commandments was neither condemned to Hell nor rewarded with Paradise but was regarded as reformable; and (5) the duty to command the good and forbid the evil in order to ensure an ethical social order.

In defining God's creation and governance of the world, these early Muslim theologians sought to demonstrate the primacy of revelation. At the same time, their theology reflected Hellenic influences. From the ninth century on, translations of the full Greek philosophic and scientific heritage became available in Arabic. The result was the development of a technical vocabulary and a pattern of syntax that enriched theological terminology.

The Ash arites, reacting to Mu tazilite rationalism, limited speculative theology to a defense of the doctrines given in the hadith reports, which were regarded as more reliable than abstract reason in deducing individual doctrines. The Ash arites emphasized the absolute will and power of God, and denied nature and humankind any decisive role. What humans perceive as causation, they believed, is actually God's habitual behavior. In their response to the Mu tazilite view on the objective nature of good and evil, and in their effort to maintain the effectiveness of a God, at once omnipotent and omnibenevolent, who could and did intervene in human affairs, they maintained that good and evil are what God decrees them to be. Accordingly, they cannot be known from nature but must be discovered in the sources of revelation, like the Qur'an and the Prophet's example. There are no inherently unchanging essences and natural laws that self-subsistent reason can discern. God transcends the order of nature. Hence, the notion of free will is incompatible with the divine transcendence, which determines all actions directly.

Ash arite theological views remained dominant well into modern times, and had a profound effect upon scientific (and particularly medical) theory and practice among the Sunnites. The attitude of resignation, a by-product of belief in predestination, is summed up in the Sunni creedal confession: "What reaches you could not possibly have missed you; and what misses you could not possibly have reached you" (Fiqh akbar, art. 3, in Wensinck, p. 103). This belief in overpowering destiny was bound to have negative implications for some Sunni Muslims encountering adversities caused by illness and other forms of suffering. The Shiite theological and ethical doctrines were based on the Mu'tazilite thesis about the justice of God and the objective nature of moral values.

Positive sciences, especially medicine and astronomy, emerged from the rationalism of Muslim theologians influenced by translations of the works on these subjects from Greek into Arabic. Nature studies in Islamic civilization were pursued by intellectuals who contributed to the Mu tazilite and Shiite rational theology. Human nature was studied in order to deduce rational principles that could help direct human life to create an ideal society. Ethics and politics were regarded as rational knowledge necessary to harmonize human existence in the universe.

At the practical level, medicine involved the training necessary to apply techniques that demonstrated tact and insight in the treatment of patients. Medical practice was based on a tradition of clinical observation, which became the source for encyclopedic works like the Canon (al-Qanun) of Avicenna (d. 1037). Since dissection of human cadavers was impossible because of the prohibition in Islamic law against mutilation of the dead and the requirement of immediate burial, physicians treated their patients partly on the basis of their knowledge of anatomy and partly by relying on their understanding of the rationality and harmony of the cosmos. Diagnosis and prognosis were also based on their insights about psychological and environmental factors. Despite the disapproval of some orthodox Muslims, who rejected Greek medicine as not provided for in the Prophetic medical tradition, many of these Greek-influenced philosopher-physicians came to be known as the hakim (wise). Prophetic medicine (al-tibb al-nabawi) was believed to have arisen to counter the authority of Greek-based medical tradition by positing the notion that certainty in knowledge, including medicine, depended upon revealed sources. However, although seemingly based on the Qur'an and statements attributed to the Prophet, Prophetic medicine actually was the remnant of the medicine customarily practiced among the Arabs in the pre-Islamic age.

Islamic Mysticism

In the early days of the Islamic empire under the Umayyads (eighth century), the mysticism that began as an ascetic reaction to growing worldliness in the Muslim community became institutionalized. Sufism, as Islamic mysticism came to be known, aimed to interiorize the formally undertaken ritual acts, and emphasized rigorous self-assessment and self-discipline for the achievement of spiritual and moral perfection. In its early form Sufism was mainly a form of ascetic piety that involved ridding oneself of any dependence on satisfying one's desires, in order to devote oneself entirely to God. Mystical practices developed by the Sufi masters comprised a moral process to gain the relative personal clarity that comes at moments of retreat and reflection. A further dimension of this reflection was to cultivate an ability to face reality about oneself and to love any being capable of needing love. The mystic experienced more intense levels of awareness, which could take ecstatic forms, including ecstatic love of God.

This aspect of Sufism brought the mystics into direct conflict with orthodox Muslims. Sufi teaching that a symbolic and spiritual fulfillment of religious duties was as good as the actual rites was seen by orthodox Muslims as a kind of antinomian behavior within the community that considered literal adherence to the requirements of law as the valid form of religiosity. In general, Sufis increasingly tended to minimize religious differences among various faiths and cultivated humanism based on universalistic spiritual and moral qualities.

By the eleventh century the Sufi masters had developed a new form of religious orientation that brought about the acceptance of Sufism in many parts of the Islamic world. Near the end of the twelfth century, several formal Sufi brotherhoods or orders (tariqa), in which women also participated, were organized. Each order taught a pattern of invocation and meditation that used devotional practices to organize a group of novices under a master. Special controls of breath and bodily posture accompanied invocative words or syllables to make possible more intense concentration. The orthodox, who had been suspicious of early elitist Sufism, were now persuaded to accept the Sufism of the masses and to try to discipline it. The ultimate approval of Sufism as a genuine form of Islamic piety was facilitated by Abu Hamid al-Ghazali (d. 1111), who taught Islamic law and theology in Baghdad. His writings in connection with his personal spiritual crisis at the height of his professional success demonstrated that Sufism could be a powerful discipline for curing doubt and experiencing truth.

A number of Sufi masters served as analysts for younger Sufis, helping them to understand their psychic states and making sense of their place in the universe. In the premodern Islamic world, where medical treatment was not generally available to an average person, some prominent Sufis practiced traditional medicine based on the theory of the four humors that kept the body functioning. Herb remedies were used to treat ailments caused by imbalance in the four qualities of the body (hot and cold, moist and dry), which led to an imbalance of the humors. Other Sufis treated physical and psychic disorders through the writing of talismans and amulets. Talismans, some using sections of the Qur'an, and exorcism are used in treating mental disorders even today in rural areas of the Islamic world.

Islam and Modernity

The modern age brought Islam and Muslims face to face with intellectual as well as political challenges both from within and from without. From within, Muslims faced the deterioration of Islamic religious life caused by centuries of stagnation and petrification of doctrines and beliefs. From without, the hegemony of the West since the mid-nineteenth century resulted in alien domination of Muslim societies. Since that time, Muslims have endeavored to strike a balance between the divine promise of earthly success to Muslims and their tenuous contemporary situation by introducing internal reforms to prevent further degeneration of Islamic life, and by resisting any form of domination of Muslim societies by the Western powers.

Islamic fundamentalism in modern times stems from the acute awareness among Muslims of a conflict between the religion that promises worldly as well as eternal prosperity to its followers, on the one hand, and the historical development of the Muslim world, which points to the breach of a divine promise, on the other. Muslim leaders call for a return to the original teachings of Islam in the Qur'an and the Prophet's exemplary life. To regain the power and prestige of early Islam, they propose fashioning the modern nation-state on ideals derived from the practices of the original Muslim community. Muslim brotherhoods throughout the Islamic world have joined forces to implement strictly religious reform in a modern society, requiring adherence to the restrictive traditional social-cultural norms. Resistance to modern secular ideologies and their implications has posed a greater challenge to the Muslim leadership. It has meant providing an Islamic alternative to intentionally imported or externally imposed sociopolitical systems. Such an alternative entails creative interpretation of religious ideas and symbols. Thus far, the traditional Muslim leadership has not succeeded in providing such an alternative as the only viable solution to the multifarious problems faced by the Muslim societies.

A case in point is provided by enormous problems that have arisen with the technological advancement in medicine. Muslim jurists are faced with a crisis because, by its own standards, Islamic jurisprudence has ceased to progress toward some further stage of development. The methods of inquiry and the forms of argument have disclosed inadequacies to furnish solutions to concrete problems faced by the community. Hence, important questions connected with the role of female physicians and patients in a male-dominated profession; conflict between rigorous religious observance and medical education; state policy toward family planning; and social and cultural factors that affect women's health adversely are among numerous pressing issues that remain to be authoritatively resolved.

The judicial decisions issued so far in various Muslim countries, where conferences on bioethics have been held in the last three decades, are mostly in the form of supposition or opinion, and lack the intellectual rigor to become part of state-sponsored health policy.

The greatest challenge to Muslim leadership, both religious and political, remains that of correcting the social and political injustices endured by the common people, who encounter a modern, materialist world over which they have minimal control.

Muslims living as a minority outside the geographical sphere of Islam face the challenge of integration and assimilation in the non-Muslim social universe. Muslim communities belonging to various ethnocultural groups in the West, including North America, are engaged in working out socially interactive strategies that will enable them to establish their identity as Western Muslims. African-American Muslims in North America have reminded the immigrant Muslims of the difficult process of integrating ethnic-cultural and religious identities in modern secular society. African-American Muslims, having been part of American society for a long time, have emerged with a rare ability to combine the most relevant and applicable facets of the modern American social universe and their adopted religion, Islam.

abdulaziz sachedina (1995)

SEE ALSO: Abortion, Religious Traditions: Islamic Perspectives; African Religions; Authority in Religious Traditions; Christianity, Bioethics in; Eugenics and Religious Law; Hinduism, Bioethics in; Judaism, Bioethics in; Medical Ethics, History of: Near and Middle East; Population Ethics, Religious Traditions: Islamic Perspectives; Sikhism, Bioethics in; Women, Historical and Cross-Cultural Perspectives

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