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Medical Jurisprudence
Third Symposium
on

"The Islamic Vision of Some Medical Practices"
Held from 18-21 April, 1987 A.D.

DISCUSSION

Chairman, Dr. Abdulfattah Shawqi

Brothers and sisters, I declare the first session of the third day open. I'd like to announce some changes in the program: This first session will be on "Plastic Surgery, Medical Concept and Practice" by Dr. Majed Abdul Majed Tahboub, then the Islamic Jurisprudence response to this lecture is "Provisions of Islamic Jurisprudence for Plastic Surgery" by Dr. Muhammad Othman Shabir. As you notice, in the original program handed out to you earlier, all the medical researches are in one session, this session, five researches. However, the secretariat preferred to present the related medical researches and jurisprudence researches together, which may prove more beneficial.

The second session will be, God willing, as scheduled and the topics are: "Menses, Puerperium and Pregnancy, Minimum and Maximum Periods" a juristic study by Dr. Omar Al-Ashqar and a study on "Meaning of Menses, Puerperium and Pregnancy" by Dr. Nabiha Al-Gayyar.

The third session will be on "Hymenorrhaphy". Three speakers will talk on the opic: Dr. Kamal Fahmi Abdulqader, His Eminence Sheikh Ezzuddeen Al-Khateeb Al- Tammimi and Dr. Muhammad Naem Yaseen.

On the fourth session today we'll have "Fate of Fertilized Ova" by Drs. Abdullah Basalamah and Ma'mun Al-Haj Ibrahim. And the last topic "Sexual assault" by Dr. Seddiqa Al-Awadi. Half an hour is assigned to each of Dr. Majed and Dr. Muhammad Othman Shabir. Then we'll have kept nearly another hour for discussions and comments. I hope those who should like to raise points for discussion or to comment would send heir names in good time to be able to listen to as many as possible.

I give the floor now to Dr. Majed Abdulmajeed Tahboub, Head of Plastic Surgery Department at Ibn Sina Hospital to speak on "Plastic Surgery: Medical Concept and Practice".

Presentation of the Research by Dr. Majed Tahboub (Research Section Page No.389).

Chairman Dr. Abdulfattah Shawqi

Thank you Dr. Majed for your valuable brief lecture. We're left now with Prof. Dr. Muhammad Othman Shabir to speak on "Provisions of Islamic Jurisprudence for Plastic Surgery". He has divided the research into three parts: Beautifying hair through artificial lengthening, removal and surgery, the second beautifying body by tattooing and indelible marks and the third part on surgical reconstruction of organs.

The research starts on P. 100 of the hand out you have. I give the floor to Prof. Muhammad Othman Shabir.

Presentation of the Research by Dr. Muhammad Othman Shabir (Research Section Page No.425).

Chairman, Dr. Abdulfattah Shawqi

Thanks to Dr. Muhammad Othman Shabir. Dr. Majed Tahboub has presented his paper concentrating on the scientific and medical aspects as well as the modern scientific spheres of what is known as plastic surgery and clarified that it is constructive, corrective and restorative surgery rather than just cosmetic.

We have also listened to some Sharia opinions on hair cosmetics, body paint and figure cosmetics by means of organ reconstruction. We have, God willing enough time, until 11 :45, to discuss this important modern topic which is very important to all of us Sharia-wise, and medical-wise as well. I give the floor to Dr. Haitham Al- Khayyat.

Dr. Haitham Al- Khayyat

When we speak of the normal creation do we mean the normal creation of the person examined or the normal creation of human beings? if it is the normal creation in general, i.e. if what is done is not going to change the normal creation of human beings, like adding or taking off an organ - deforming or something of the sort, would this be considered altering the creation of Allah? If it is a surgery to repair or reshape a certain organ in a way that would make it harmonious with the normal creation of human beings, would this be altering the creation of Allah? I believe that this is a point which we should decide on in the beginning, because on this we will base the different rulings concerning these surgeries of which some are performed to cure a disease, and these. I believe, are not controversial because the disease is a deviation from the original creation, so all of these surgeries may not be considered in our discussions. The main issue in our discussions is to perform certain plastic surgeries for cosmetic purposes, so if the changes made are within the normal creation of human beings, will they be permissible or not?

Dr. Hussain Al Jazaeri

I want to ask a different question: A woman who acquired wrinkles all over her face and she's afraid that her husband might marry a younger woman and her husband doesn't object to her having a face-Iift-would religion object to that? Thank you.

Dr. Ibrahim Al-Sayyad

I'd like to consider for a while two of the Prophetic Hadiths, the first is the one said by Iban Abbas:

"Cursed is the woman who artificially lengthens her (or some- one else's) hair, and the woman who asks for artificially lengthening her hair, the one who plucks hair from her face and the one who gets her hair plucked, the one who tattoos and the one who asks to be tattooed, the women who pluck hair and those who get their hair plucked, and the women who make spaces between their teeth for beautification changing what Allah has created. " And in the end all these were said to have one common trait characterizing them as far as their intentions are concerned: "changing what Allah has created".

Thus, the end of these two Prophetic Hadiths shows the intention behind prohibition, disapproval or damnation -that the human being is created in a way that he doesn't like, though it is the "goodliest mould" and His will is to create this face misshaped either by birth or by a disease. Thus, the point is reshaping this misshape in face to what the normal shape of a human being is and not his own shape.

The creation of human beings in a certain shape is definitely willed by Allah. However, if there's a woman afflicted with what we call total alopecia- all the hair in her head, face, even her eyelashes have fallen; a woman who seeks a permissible life with a husband who can't bear her repulsive appearance, what evil or harm will there be in lengthening the hair of such a woman with the hair deemed permissible or with human hair. It is justifiable and she is not doing it to alter the normal creation of Allah. This is what I seek the opinion of the Jurists about and I would, with a safe conscience, advise a woman afflicted with this disease to lengthen her hair with whatever she wants to use.

H.E. Dr. M.S. Tantawi

In the Name of Allah, the Rahman, the Merciful.
It seems that we're going to spend a long time discussing this issue which Dr. Shabir dealt with at length, Sharia-wise, in his over-40-page research on this issue, a significant study which quotes numerous jurists. In response to the three questions of Dr. Al-Jazaeri, Dr. Al-Khaiyat and Dr.Al-Sayyad, I generally believe that beauty is an appearance prized by Islam and that the Hadiths forbidding certain things may be taken by some people to aim at making plastic surgery repulsive, but I believe that those Hadiths aim at forbidding plastic surgery performed for purposes of deception, fraudulence, boastfulness, bragging or extravagance that would lead to the alteration of the creation of Allah, highly exalted and glorified be He, or similar purposes that sound thinking would not accept. However, if plastic surgery is necessary to avoid the husband's rejection of his wife as in the case of alopecia presented by Dr. Al-Sayyad, or the case presented by Dr. Al-Jazaeri of a woman who wants to become more beautiful for her husband lest he should want to marry another woman since she suffers a condition that needs some plastic surgery; I believe that these are necessities that will make it permissible for a woman to make herself beautiful for the sake of her husband within the accepted limits that wouldn't be considered fraudulence or deception or anything of the sort. However, plastic surgery is generally accepted as long as it is within the reasonable framework of being intended for the sake of the husband and for winning his love which is exhorted by Islam. Therefore, I believe that, generally speaking, plastic surgery in such cases is permissible in the Sharia for maintaining family and matrimonial bonds. May Allah guides us to that which is right.

Dr. Abdullah Basalamah

Allah is beautiful and loves beauty. Certain conditions are aquired by man at later stages of life than at birth, puberty or a short time after it. An unmarried girl might start having a moustache and a beard, so depilating such hair is a sort of treatment, it is not alteration of Allah's creation. Dr. Shabir recommended, among other things, that depilation of hair may be made permissible to married women only, but what about those girls who want to get married and were afflicted with a disease that resulted in a deformity?

Prof. Dr. Hassan Hathout

The research presented is a very rich one, but, with all due respect to all the quotations of jurists listed by Dr. Shabir, it seems that they permitted plastic surgery as a means of treatment from a disease. In our age many diseases have been discovered, thus mental disturbances are now recognized as diseases that were obscure to our predecessors. A woman may have a nose a metre long and 10 metres wide and be satisfied with it and may find some man who likes and praise it, so may Allah bless them; but she, and the people around her, may feel that she is ugly and thus develop a complex that should be treated otherwise she'll shun society or live in the dark damning her bad luck, or may try to deviate or escape.

The Hadith of the Prophet, may the Blessings and Peace of Allah be upon him, is not only connected with alteration of the creation but also conditional upon prejudicing moral standards, but if woman seeks to alleviate ugliness and to increase beauty without prejudicing moral standards. I believe that doing this is a sort of mercy and is rather harmonious with what Allah addressed His Prophet with:

AND WE HAVE NOT SENT THEE EXCEPT AS A MERCY UNTO THE WORLDS.

I will perform these surgeries if I can and I'll never refuse such requests if I can and I believe that this is more of the path and mercy of Allah.

H. E. Sheikh M. M. Al-Salami

In the Name of Allah, the Rahman, the Merciful. I'd like to first, express my deep appreciation of this morning's presentation of Dr. Tahboub's research which was comprehensive and did, in fact, enlighten us in many aspects of which I was not aware, so I learned from it. I'd also like to thank Dr. Shabir for his rich comprehensive study that shows depth in research and great effort, so may Allah bless him for this work. Now to go back to the issue discussed:

Plastic surgery, as Dr. Tahboub said, is new and therefore we can't trace any reference to it in the sayings of ancient Jurists but Dr. Shabir endeavored to deduce the relevant Judgements in accordance with what was said by ancient Jurists who based their opinion on two authentic texts, a Qur'anic one,

AND I WILL COMMAND THEM SO THAT THEY WILL ALTER THE CREATION OF ALLAH,

and a Prophetic Hadith,

"Allah cursed the woman who artificially lengthens her (or someone else's) hair or asks for her hair to be lengthened".

As for the verse, concerning satan's domination over man in such a way that makes man alter the creation of Allah, this is not a Qur'anic ruling but just a deduction from the superficial meaning of the verse; and some thought this is manifest in altering creation in animals, "they will slit the ears of the cattle", so it is connected to making animals suffer in different ways; and some considered that it is to be explained in the light of the prophetic Hadith,

"Allah cursed the woman who artificially lengthens her (or someone else's) hair or asks for her hair to be lengthened".

The Hadith of the Messenger, may the blessings and peace of Allah be upon him, as we listened to it, is clear in parts and is not clear in other parts; the Jurists know very well the meaning of "the one who tattoos" and "the women who make spaces between their teeth for beautification", but the meaning of "the one who plucks hair from the face" is not clear, but it is understood by each one according to his own discretion; for it means pencilling the eyebrows to look beautifully arched, and It also means making the eyebrows thinner so that they'd look like a crescent, suppose some pretty girls were seen one day with eyebrows thinned and eyelashes pencilled, is this included in plucking hair from the face? Possibly. However, I believe that we all agree that among the sharia rules is the one that states the reason why devotional acts of worship are based on enjoined duties, simply because such acts are only acts of worship, i.e. the principle is showing that one acts in obedience, compliance and out of resigning oneself to the will of Allah. Yet, as far as human dealings are concerned, these are based on understanding and on judgements readily admissible to human conception. The issue considered, I believe, is not related to devotional acts of worship nor to enjoined duties; it is a reasonable issue, and therefore, I've found out that the distinguished exegicists especially contemporary ones, sheikh Muhammad Al Taher Ibn Ashour, may Allah bless his soul, in particular; when he commented on this verse,

THEY WILL ALTER THE CREATION OF ALLAH,

and mentioned the Hadith, he reasoned that it only applies to what it states for those things only done by prostitutes at that time while noble, honourable, virtuous women never did (only women who were accused of being irreligious and not adhering to moral codes did those acts). Thus, in order to protect the honour of man and woman and to keep women from degrading to the level of looking like prostitutes, the prophet, may the blessings and peace of Allah be upon him, forbade women to do those acts. When Sheikh Ibn Ashour, may Allah bless his soul, speaks about the wisdom behind forbidding such acts, he says that Kohl changes the colour of eyes and makes them look more beautiful, and Kohl is unanimously agreed to be permissible; and the woman who does physical exercise alters the creation of her body to what is more beautiful and attractive, her figure becomes goodly, her limbs straight - not fatty; can anyone say that women shouldn't exercise to become more attractive?

If such is the case, and many of the fundamentals of beautification are based on physical exercise, then we should stop here and consider: how do we permit women to exercise in order to become more beautiful and attractive and when they want to achieve the same aim through surgery we say that it is impermissible? This issue needs to be reconsidered.

I'd like to point out two things that I was astonished to hear from two men whom I really respect and hold in esteem, what I mean is being so hasty to say that with a safe conscience I'll advise any woman whose hair has fallen to lengthen her hair or that I'll perform those surgeries if I can;

AND IT IS NOT FOR A BELIEVING MAN OR A BELIEVING WOMAN, WHEN ALLAH AND HIS APOSTLE HAVE DECREED AN AFFAIR, THA T THEY SHOULD HA VE ANY CHOICE OF THEIR OWN.

A challenge like this is not a challenge to us jurists, it's a challenge to legislation; we ought to be patient and wait until we reach an opinion that satisfies all of us, and whatever is the opinion we reach, we follow

To go back to my friend Dr. Shabir as he says in the conclusion of the third issue that the doctor should be sure of the success of the operation. As far as we know, a doctor, no matter how clever, intelligent, experienced or knowledgeable he might be, can never be sure of the success of any surgery whatsoever; he'd say, for example that the percentage of success is 90% or that the greater possibility is success, and that is how he'd be sure, he'd be almost sure not absolutely sure. To conclude, I'm convinced that alteration of the creation of Allah applies to what is meant to have a detrimental effect on the community by means of evil fraudulence in the sense that someone who commits a crime goes to a surgeon and asks him to change his face so that he wouldn't be recognized. This happened in the after match of World War II and many of the Nazis managed to escape unrecognized thanks to such surgeries. Ever since then and till now and as the time goes on such surgeries that hide criminals and delude Justice will keep operating.

Second, plastic surgery that involves a woman deceiving a man who's asking her hand for marriage, a surgery whose effect will not last for long and after a while the husband will see the original real face, this is evil, it involves deception and fraudulence. I believe that the woman should live with her husband in mutual trust and undergoes surgery if mutually accepted and desired. We shouldn't be hasty so as to say that it's prohibited from the very beginning. I admire the opinion of Malik, when he was asked about a case and he found that forbidding is the more likely, he didn't say. "It's prohibited" but used to say, "I disapprove of it". Therefore, his followers, after him, followed his path, showing the disapproval intended, is it for maintaining high opinion of someone or for rendering something impermissible. I believe that plastic surgery is permitted as long as performing it does not harm other people. I believe that there isn't a clearcut impermissibility for it.

Dr. M. A. Al-Ashqar

Thank you Sheikh Salami for this valuable explanation and may I add that fraudulence may not be traced, at a later time, in the woman or man who had the surgery in person, but it may appear in the children as a hereditary disease passed on from one of the parents. Therefore, if the husband knew that this woman had a certain disease or deformity; but he married her free of such defect not knowing that it will appear in his children, he probably wouldn't have married her. I hope this issue will be taken into consideration.

Sheikh M. M. Al-Salami

What His Eminence said is probable, but probabilities in Islamic Sharia are of two types: possible probabilities which are to be considered when a jurist is examining a certain case, and improbable possibilities which should not be considered by the jurist at all, otherwise matters would get complicated. If we take the improbable possibilities into consideration I'm going to say that it is impermissible for me to leave this place lest I have a car accident. The possibility that I crash my car into another car and get killed is a valid possibility and so is the heredity issue - it is not definite, nor does it approach any degree of certainty, it is a probable possibility. I don't think that if a woman has some plastic surgery in her face to make it look more beautiful, she will be harming me, or that her children will have the same defect. Second, the children don't inherit hereditary diseases from the parents only, but such traits are carried through out a long line of descent.

Chairman, Dr. Abdulfattah shawqi

There is a written question... What is the attitude of Sharia towards a Muslim doctor who knows and witnesses a female patient having surgical operation for the purpose of changing sex, and what is the attitude of Sharia towards the Muslim doctor who carries out such an operation, and what should the Muslim doctor, who knows the case of this patient, do? Should I such a surgeon disclose her secret or keep silent about it, and should a I surgeon earn a living out of conducting sex change operations? The floor is now given to Dr. Abdulrazzaq Al-Samera'i.

Dr. Abdulrazzaq Al Samera'i

A person is sometimes born having a congenital opening in the eyelid, and there is, also, the case of sagging eyelid in old age; would it be deemed a change of what Allah has created if such things are amended through surgical operations? There is also another thing; a person is, sometimes, born with a large spot in or beneath the eyelid, which blemishes his features and appearance. Will it be change of what Allah has created if this spot is removed by surgical operation?

Dr. Muhammad sulaiman Al-Ashqar

Dr. Muhammad Sayed Tantawi is kindly requested to give the answer if he so wishes.

Dr. Muhammad Saved Tantawi

The answer for the question raised by Dr. Al-Samera'i is that there is no inadmissibility, neither in the Sharia nor rationally, to performing such surgical operation for a child, for this is a necessary thing and there is nothing wrong with it. As for the first question, which was about change of a male to female or a female to male, I in fact, cannot give an opinion on such a question promptly unless I am cognizant of some of the surrounding conditions and reasons which justify such a course of action. Some of my brother jurists may have a clearer idea in this concern. But as for me, It happened that when a similar case with all concomitant conditions was submitted to me in Egypt, I said. "This is permissible in case it is necessary", for no one knows better than medical people whether there is a necessity or not?

Dr. Muhammad Al Ashqar

Thank you Dr. Muhammad Sayed Tantawi. Sheikh Ezzuddeen Al- Khateeb is, now, kindly requested to give the answer.

Chairman, Dr. Abdulfattah Shawqi

I beg to draw your attention that the subject of sex change will be discussed in the next session, and in order to keep to what we have already agreed upon no interruption will be allowed. Mr. Omar Al-Ashqar, please come up.

Dr. Omar Al-Ashqar

What Dr. Haitham brought forward is, I think, the pivot of this research, and therefore it is necessary to exhaustively explain the reason for this prohibition which is about changing of what Allah, has created. There are cases the causes of which can be determined and known so judgement can be given, other cases are inapplicable and others fall in between and therefore need to be reviewed. The Messenger of Allah (PBUH),

"Has forbidden haughtiness (or pride) and said that a proud person with even the weight of a mustard seed of pride in his heart shall not enter paradise".

A man said:

"O Messenger of Allah, a person would love that his dress and shoes are fine, whereupon the Messenger of Allah, told him that was not pride".

This may, in fact, be thought as a kind of pride, whereas it is actually not so. Therefore the Messenger, explained to the man that such a feeling was not pride. So, the creation of Allah is but His own. Therefore, just as any person should not intrude upon or imitate certain qualities and acts of Him, such as by painting and sculpturing figures as well as being proud, so he should possess some qualities such as mercy and pity. This is the main causative factor in the subject.

There is no doubt that change of shape of the face, as the doctor said, by say, removing and fixing bones as well as sex change by diminishing or enlarging breasts is change of what Allah, has created. But it part of a person's body is damaged in a fire or an accident and is restored to normal shape, this is never an act of changing what Allah has created. There remains a moot question; it is controversial as whether there is change of what Allah has created or not, that is in the case of existence of an extra finger or a harelip, would it be change of creation of Allah if these things were surgically amended? Viewpoints may differ on this issue. However, I can say that there, are certain things which definitely constitute change of what Allah has created, and there are other things which categorically do not represent change of creation of Allah and there is a third group that is debatable as far as change of creation of Allah is concerned.

As regards the point kindly made by Dr. Hassan, I say if we gave free rein to such a matter what would be the consequences? I think it is not permissible to change sex, but what if a person is dejected because he feels that his present sex does not suit him or her? This is similar to the issue of blemished nose or face. This means that it is not possible for us to set a limit for these matters... and we can't draw the line.