Organ transplantation: contemporary Sunni Muslim legal and ethical perspectives

The problems that organ transplantation poses to the Muslim mind may be summarized as follows: firstly, a Muslim believes that whatever he owns or possesses has been given to him as an amanah (trust) from Allah. Would it not be a breach of trust to give consent for the removal of parts of one's body, while still alive, for transplantation to benefit one's child, sibling or parent? Secondly, the Shari'ah (Islamic Law) emphasizes the sacredness of the human body. Would it not then be an act of aggression against the human body, tantamount to its mutilation, if organs were to be removed after death for the purpose of transplantation? In this paper I attempt to illustrate how the Muslim jurists have tried to resolve the dilemma of Muslims by providing them with certain guidelines based on the original sources of Islam, namely, the Qur'an and the Prophetic tradition. In order to assist the followers of other religious traditions to grasp the gravity of the problem posed by organ transplantation to the Muslim mind, I begin by discussing the opinions of Muslim jurists on the issue of utilization of human parts. Thereafter, I touch upon the resolutions taken by the various Islamic Juridical Academies on the issue in question. Finally, I shed light upon the inclusion of organ donation in a Muslim Will and the enforceable nature of such a will.     

Social Responsibility and the State's Duty to provide Healthcare: An Islamic Ethico‐Legal Perspective

The United Nations Educational, Scientific and Cultural Organization's (UNESCO) Declaration on Bioethics and Human Rights asserts that governments are morally obliged to promote health and to provide access to quality healthcare, essential medicines and adequate nutrition and water to all members of society. According to UNESCO, this obligation is grounded in a moral commitment to promoting fundamental human rights and emerges from the principle of social responsibility. Yet in an era of ethical pluralism and contentions over the universality of human rights conventions, the extent to which the UNESCO Declaration can motivate behaviors and policies rests, at least in part, upon accepting the moral arguments it makes. In this essay I reflect on a state's moral obligation to provide healthcare from the perspective of Islamic moral theology and law. I examine how Islamic ethico‐legal conceptual analogues for human rights and communal responsibility, ?uqūq al‐’ibād and far? al‐kifāyah and other related constructs might be used to advance a moral argument for healthcare provision by the state. Moving from theory to application, I next illustrate how notions of human rights and social responsibility were used by Muslim stakeholders to buttress moral arguments to support American healthcare reform. In this way, the paper advance discourses on a universal bioethics and common morality by bringing into view the concordances and discordances between Islamic ethico‐legal constructs and moral arguments advanced by transnational health policy advocates. It also provides insight into applied Islamic bioethics by demonstrating how Islamic ethico‐legal values might inform the discursive outputs of Muslim organizations.     

Muslim customs surrounding death,bereavement, postmortem examinations,and organ transplants.

Muslims are always buried, never cremated. It is a religious requirement that the body be ritually washed and draped before burial, which should be as soon as possible after death. Those carrying out this duty should be immunised against hepatitis B and be aware of the hazards of AIDS. Muslim women never attend burials and it is rare for funeral directors to be involved. Muslim jurists from the Arab world can justify organ transplantation, but those from the Indian subcontinent are against it. They are united in the belief of the sacredness of the human body and thus deplore postmortem examinations.     

BRAIN DEATH IN ISLAMIC ETHICO‐LEGAL DELIBERATION: CHALLENGES FOR APPLIED ISLAMIC BIOETHICS

Since the 1980s, Islamic scholars and medical experts have used the tools of Islamic law to formulate ethico‐legal opinions on brain death. These assessments have varied in their determinations and remain controversial. Some juridical councils such as the Organization of Islamic Conferences' Islamic Fiqh Academy (OIC‐IFA) equate brain death with cardiopulmonary death, while others such as the Islamic Organization of Medical Sciences (IOMS) analogize brain death to an intermediate state between life and death. Still other councils have repudiated the notion entirely. Similarly, the ethico‐legal assessments are not uniform in their acceptance of brain‐stem or whole‐brain criteria for death, and consequently their conceptualizations of, brain death. Within the medical literature, and in the statements of Muslim medical professional societies, brain death has been viewed as sanctioned by Islamic law with experts citing the aforementioned rulings. Furthermore, health policies around organ transplantation and end‐of‐life care within the Muslim world have been crafted with consideration of these representative religious determinations made by transnational, legally‐inclusive, and multidisciplinary councils. The determinations of these councils also have bearing upon Muslim clinicians and patients who encounter the challenges of brain death at the bedside. For those searching for ‘Islamically‐sanctioned’ responses that can inform their practice, both the OIC‐IFA and IOMS verdicts have palpable gaps in their assessments and remain clinically ambiguous. In this paper we analyze these verdicts from the perspective of applied Islamic bioethics and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists.     

Milk banks through the lens of Muslim scholars: one text in two contexts

When Muslims thought of establishing milk banks, religious reservations were raised. These reservations were based on the concept that women's milk creates 'milk kinship' believed to impede marriage in Islamic Law. This type of kinship is, however, a distinctive phenomenon of Arab tradition and relatively unknown in Western cultures. This article is a pioneer study which fathoms out the contemporary discussions of Muslim scholars on this issue. The main focus here is a religious guideline (fatwa) issued in 1983, referred to in this article as 'one text', by the Egyptian scholar Yūsuf al-Qaradāwī who saw no religious problem in establishing or using these banks. After a number of introductory remarks on the 'Western' phenomenon of milk banks and the 'Islamic' phenomenon of 'milk kinship', this article analyses the fatwa of al-Qaradāwī 'one text' and investigates the 'two contexts' in which this fatwa was discussed, namely, the context of the Muslim world and that of Muslim minorities living in the West. The first context led to rejecting the fatwa and refusing to introduce the milk banking system in the Muslim world. The second context led to accepting this system and thus allowing Muslims living in the West to donate and receive milk from these banks. Besides its relevance to specialists in the fields of Islamic studies, anthropology and medical ethics, this article will also be helpful to physicians and nurses who deal with patients of Islamic background.     

An ethical solution to the problem of legal indeterminacy: sharīʿa scholarship at Egypt's al‐Azhar

This article explores the importance of ethical discipline in resolving the ambiguities characteristic of legal interpretation. Drawing on ethnographic fieldwork among religious scholars at Egypt's al‐Azhar, I demonstrate that traditional Muslim educational techniques are structured with the aim of imparting a particular set of dispositions (modelled on those of the Prophet) by enjoining meticulous and constant imitation of the Prophet's personal habits (sunna). By transforming themselves into living replicas of the Prophet, jurists believe that they acquire the ability to mirror his textual interpretations.     

The familiar-strange manifestation of the dead

This article draws on Islamic perspectives that conceive of visions (ru'yā) and nightmares (kābūs) as instances whereby Jamilā, a 13-year-old Syrian refugee girl in Brooklyn, New York, imagines and makes sense of the dead. She uses the Arabic words ma‘rwf (familiar) and gharīb (strange) to describe her dead elderly neighbour, Safiyya, in her visions and nightmares. Jamilā’s familiar-strange experiences imagine the dead both as good (the divine nature of death fundamental to Islamic values) and as evil (the pain and suffering of the departed). These familiar-strange feelings constitute an irresolvable uncertainty about death, shaping an imaginative space for Jamilā to be with Safiyya, who was like a mother to her. The manifestation of the dead consists of dynamic interpretations for the living. This results in a familiar-strange experience granted through the in-between space of what the philosopher Ibn ‘Arabī calls barzakh (‘obstacle’ or ‘separation’), which allows for an understanding of the departed as both blissful and suffering. The vernacular Arabic used by Jamilā in describing her familiar-strange experiences and the Islamic values upheld by her family underscore the importance of knowledge accumulated in the Islamic tradition for understanding the perception of loss and death for an adolescent Syrian refugee.     

WHAT DO ISLAMIC INSTITUTIONAL FATWAS SAY ABOUT MEDICAL AND RESEARCH CONFIDENTIALITY AND BREACH OF CONFIDENTIALITY?

Protecting confidentiality is an essential value in all human relationships, no less in medical practice and research.(1) Doctor-patient and researcher-participant relationships are built on trust and on the understanding those patients' secrets will not be disclosed.(2) However, this confidentiality can be breached in some situations where it is necessary to meet a strong conflicting duty.(3) Confidentiality, in a general sense, has received much interest in Islamic resources including the Qur'an, Sunnah and juristic writings. However, medical and research confidentiality have not been explored deeply. There are few fatwas about the issue, despite an increased effort by both individuals and Islamic medical organizations to use these institutional fatwas in their research. Infringements on confidentiality make up a significant portion of institutional fatwas, yet they have never been thoroughly investigated. Moreover, the efforts of organizations and authors in this regard still require further exploration, especially on the issue of research confidentiality. In this article, we explore medical and research confidentiality and potential conflicts with this practice as a result of fatwas released by international, regional, and national Islamic Sunni juristic councils. We discuss how these fatwas affect research and publication by Muslim doctors, researchers, and Islamic medical organizations. We argue that more specialized fatwas are needed to clarify Islamic juristic views about medical and research confidentiality, especially the circumstances in which infringements on this confidentiality are justified.     

On the Islamic authority of the Indonesian state: responsibility,suspicion, and acts of compliance

This article examines how the Indonesian state's efforts to style itself as an Islamic authority have influenced the behaviour of its Muslim citizens. I present cases in which Muslims in Indonesia's Riau Islands comply with Islamic state directives in order to transfer responsibility for their actions to the state, showing how such a mode of practice can support Islamic governmentality, bolster nationalism, and constrain civic activism. Interestingly, compliance may occur even when citizens harbour deep misgivings towards a directive, leading me to query whether suspicion is necessarily inimical to authority. I conclude that a pronouncement's Islamic authority hinges on how Muslims relate to their suspicions regarding it, and that, for Riau Islanders, suspicion's urgency has been tempered by cultural models of personhood, individual subjectivity, and the moral murk of post‐Suharto Indonesia.     

‘This is a gathering of lovers’: Islamic self-help and affective pedagogies in contemporary Singapore

In Singapore, the proliferation of Islamic classes drawing from self-help rhetoric, popular culture, the Qur'an, and Hadith allude to the increased appeal of affective pedagogies to Muslim youth. Taught by Singaporean Al-Azhar University graduates, the classes predominantly attracted university-educated, minoritized Malay Muslim women. Through the use of affective pedagogies, the teachers reframed Islamic piety to foreground three forms of love: self, divine, and romantic. Extending scholarship on racialized affect, this article interrogates the ways in which the teachers’ affective pedagogies mediated young women's anxieties within a neoliberalizing context, and the latter's negotiations of their newly acquired religious knowledge as they contended with quotidian precarities. While anthropology's foregrounding of lived materialities complicates some of the theoretical presuppositions of affect theory, the latter expands our understanding of piety projects as not merely concerned with ethical self-discipline, but entangled with broader racialization processes – especially for minoritized subjects whose capacity to transform becomes constitutive of a will to improve. By placing anthropological theory on Islamic piety in a dialogical tension with affect theory, I highlight the forms of affective religious sentiments that circulate through difference and negation, and are integral to particular sites of minoritized Muslim subject formation.     

Balancing agency,gender and race: how do Muslim female teenagers in Quebec negotiate the social meanings embedded in the hijab?

In the past decade, the hijab has increasingly come to be regarded in the West as an unambiguous symbol of female oppression. Such an orientalist framework rests upon a feminist rhetoric using gender equality as a vehicle for the racialization of Muslims. Correlatively, from the 1970s onwards, conservative Islamist movements have converted the hijab into a natural(ized) symbol of cultural resistance to Western imperialism. In this context, what room is left to Muslim women's agency in the production of the social meanings embedded in veil wearing? I explore this issue by presenting the findings of an interview-based research with veiled and non-veiled high school Muslim female teens in Montreal (Quebec). I show that, although these teenagers have much leeway to bypass and subvert the dominant framings of veil wearing, one should not overestimate their capacity to disrupt the dominant gendered religious framework through which this practice is socially construed.     

Pfeilgift aus Südwest‐Afrika (Damaraland)

Much current anti-consumerist and anti-globalisation discourseidentifies boycotting as an immensely powerful force. Religious and secular activists alike promote consumer boycotts as a type of practised resistance that promises to break US economic, military and culturalhegemony. Obviously, consumers' supportis essential for the success of such boycotts, and I argue that insufficient anthropological attention has been paid to the micro-sociallogics of modern forms of boycotting. This article examines the political and cultural effects of the Islamic opposition's call to boycott US goods in Malaysia in the wake of 9/11. I shall show how this issue evokes a wide range of contestations and paradoxesin the everydaylives of suburban Malay Muslim middle-class families. Most of all, the boycott confronts divergent Malay middle-class groups with the problem of how to translate intentionality into practice.     

THE ONGOING CHARITY OF ORGAN DONATION. CONTEMPORARY ENGLISH SUNNI FATWAS ON ORGAN DONATION AND BLOOD TRANSFUSION

Background: Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject. Method: We analysed 70 English Sunni e‐fatwas and subjected them to an in‐depth text analysis in order to reveal the key concepts in the Islamic ethical framework regarding organ donation and blood transfusion. Results: All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation. Conclusion: Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity.     

‘Don't be so serious’: ethical play,Islam, and the transcendent

Modes of play and playfulness are central to ethics, yet have not been as rigorously considered by anthropologists as have more earnest forms of ethical life. In this article, I argue that attention to play reframes recent anthropological debates about ethical transcendence and immanence. I do so through a consideration of the Islamic discourse of ‘calculation’ (ḥisāb), an idiom by which Muslims articulate their hoped-for state in the hereafter through the imagery of a divine accounting of good and bad deeds. Drawing on ethnography from the Indonesian province of Aceh, I show how ḥisāb cultivates forms of epistemological play through which Muslims explore the inscrutability of transcendence. Such play reveals the socially and theologically emergent qualities of transcendent truths and values, suggesting hidden affinities between transcendent stances and more immanent forms of ethical life.     

'Representing' British Muslims: the strategic dimension to identity construction

This article explores how Muslim identity is constructed in different ways by two groups of political activists in Britain. At the heart of our investigation is an interest in how these different definitions of Muslim identity are organized to promote different forms of political action. We pay particular attention to how these groups employ the same Islamic concept, da'wah (the injunction to invite people to Islam), and show that it only gains meaning when invoked and deployed in the context of practical argumentation. That is, the meaning of such concepts is not a fixed given but highly contingent upon the contrasting strategic concerns of those claiming to represent the community. While these points have a general applicability, they are particularly important in the analysis of Muslim political activity. For too long, the ahistorical essentialist assumptions of 'Orientalism' have obscured the fundamentally contested and strategically constructed nature of Muslim identity.     

Looking for Myself: Current Multisensory Input Alters Self-Face Recognition

How do I know the person I see in the mirror is really me? Is it because I know the person simply looks like me, or is it because the mirror reflection moves when I move, and I see it being touched when I feel touch myself? Studies of face-recognition suggest that visual recognition of stored visual features inform self-face recognition. In contrast, body-recognition studies conclude that multisensory integration is the main cue to selfhood. The present study investigates for the first time the specific contribution of current multisensory input for self-face recognition. Participants were stroked on their face while they were looking at a morphed face being touched in synchrony or asynchrony. Before and after the visuo-tactile stimulation participants performed a self-recognition task. The results show that multisensory signals have a significant effect on self-face recognition. Synchronous tactile stimulation while watching another person''s face being similarly touched produced a bias in recognizing one''s own face, in the direction of the other person included in the representation of one''s own face. Multisensory integration can update cognitive representations of one''s body, such as the sense of ownership. The present study extends this converging evidence by showing that the correlation of synchronous multisensory signals also updates the representation of one''s face. The face is a key feature of our identity, but at the same time is a source of rich multisensory experiences used to maintain or update self-representations.     

The Body as Gift,Resource or Commodity? Heidegger and the Ethics of Organ Transplantation

Three metaphors appear to guide contemporary thinking about organ transplantation. Although the gift is the sanctioned metaphor for donating organs, the underlying perspective from the side of the state, authorities and the medical establishment often seems to be that the body shall rather be understood as a resource. The acute scarcity of organs, which generates a desperate demand in relation to a group of potential suppliers who are desperate to an equal extent, leads easily to the gift’s becoming, in reality, not only a resource, but also a commodity. In this paper, the claim is made that a successful explication of the gift metaphor in the case of organ transplantation and a complementary defence of the ethical primacy of the giving of organs need to be grounded in a philosophical anthropology which considers the implications of embodiment in a different and more substantial way than is generally the case in contemporary bioethics. I show that Heidegger’s phenomenology offers such an alternative, with the help of which we can understand why body parts could and, indeed, under certain circumstances, should be given to others in need, but yet are neither resources nor properties to be sold. The phenomenological exploration in question is tied to fundamental questions about what kind of relationship we have to our own bodies, as well as about what kind of relationship we have to each other as human beings sharing the same being-in-the-world as embodied creatures.     

La filiation et l'aide médicale à la procréation

Kinship following artificial insemination by unknown donor defines the child's mother and father as unknown. Although it could have been possible to construct this kinship on the model of adoption, the model adopted was that of blood and organ donation, which completely erases the donor's identity so that the recipient can take complete possession of the donated substance. But is gamete donation the same thing? Gamete donation concerns procreation and the parents' sexuality. Would it be possible to no longer consider the parents' sexuality to be exclusively reproductive sexuality allowing recognition of the progenitors alongside the mother and father?     

The Untold Sacrifice: The Monotony and Incompleteness of Self-Sacrifice in Northeast Brazil

There is no such thing as an accidental sacrifice. Sacrifice is always pre-meditated, and if not entirely goal-oriented, at the very least inherently meaningful as a process in itself. This paper is about how we might begin to understand sacrifices that do not conform to these rules. It concerns the question: does sacrifice exist outside of its (often) dramatic, self-conscious elaboration? Within the Brazilian Catholic tradition everyday life – ideally characterised by monotonous, undramatic, acts of self-giving – is ‘true sacrifice’. For ordinary Catholics, the challenge is not how to self-sacrifice, but how to make one's mundane life of self-sacrifice visible whilst keeping one's gift of suffering ‘free’. In this paper I describe, ethnographically, the work entailed as one of ‘revelation’ and use the problems thrown up to reflect upon both the limits and advantages of Western philosophical versus anthropological understandings of Christian sacrificial practices to date.     

Cutaneous and Bone Marrow Histoplasmosis After 18 Years of Renal Allograft Transplant

The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to evaluation, developed a nodule after followed by ulceration upon her posterior right leg and a second one upon her left leg 3 months and 2 months before her hospitalisation, respectively. The biopsy of lesion revealed the presence of Histoplasma spp. Bone marrow aspiration was performed and also revealed the same organism. She had initially received itraconazole without improvement of lesions, while a new lesion appeared on her left arm. Healing of all lesions could be observed after 40 days of liposomal amphotericin B when she was submitted to skin grafts on the legs and a surgical treatment on the arms, and the myelosuppression improved simultaneously. Histoplasmosis seems to be very uncommon among patients who underwent to organ solid transplantation. Most cases occur within 12–18 months after transplantation, although unusual cases have been presented many years post-transplant. There are cases reported in the literature, occurring from 84 days to 18 years after organ transplantation, but without cutaneous involvement. Our patient developed lesions on limbs and myelosuppression after 18 years of chronic immunosuppression medication. This case suggests that besides cutaneous histoplasmosis is an uncommon infection following iatrogenic immunosuppression and even rarer over a long period after the transplantation. Clinicians who care SOT recipient patients must bear in mind histoplasmosis infection as differential diagnosis in any case of cutaneous injury with prolonged fever and try to use as many tools as possible to make the diagnosis, once this disease presents a good prognosis if it is diagnosed and treated promptly.