Supervision and Introduction by
Dr. Abd El-Rahman Abdulla Al-Awadi
Minister of Public Health and of Planning
Chairman of the Islamic Organization for Medical Sciences

Edited by
Dr. K. Al-Mazkur
Dr. A. Al-Saif
Dr. Ahmad Rajaii Al-Gindi
Dr. A. Abu-Ghudda .

Revised by
Prof. Hassan Hathout

RECOMMENDATIONS OF THE
SYMPOSIUM

1. Preamable 2. Confidentiality in the Health Profession 3. Difference between Law and Sharia 4. Sale of Organs

5. Plastic Surgery: Medical Concept and Practice 6. Fate of Fertilized Ova 7. Study On: Menses, Puerperium and Pregnancy: Minimum and Maximum Periods 8. Maximum Pregnancy Period

c. Secret divulgence is originally prohibited and is punishable in ISh ria, professionally and legally.
    d. Secret keeping is emphatically a duty upon members of such pro- 1es ions which would be undermined by secret divulgence, e.g. health Ipro essions, because to them resort those in need of sincere cpunselling an help who should be confident that their secrets are in safe-keeping.
2. Excepted from the obligation of secret keeping are cases where ,ke ping the secret will cause a harm severer to the one entrusting than tha caused by divulgence or where divulgence of secret will achieve a benefit preponderant over the harm caused by withholding. These exceptions are of two categories:

a. Cases where divulgence of secret is deemed obligatory based on the rule of taking the action that causes the lesser harm and the rule of achieving the public benefit which requires bearing the private harm to av rt a public harm if that is deemed necessary . These cases are of two kinds:
                        1) averting an evil detrimental to the community.
                        2) averti.ng an evil detrimental to an individual.
                        b. Cases where divulgence of secret is permissible to:
                        1). achieve a social benefit, or
                        2).   avert a public evil,
    abiding in this by the Sharia intents and priorities for protecting religion life, mind, property and offspring.
    b. Added to these two categories are cases where the one entrusting se rets accepts that his secret be divulged. Divulgence in such cases must be within the limits allowed by him and he has the right to withdraw su h waiver .
    c. Exceptions for cases obligating or permitting secret divulgence sh uld be clearly enumerated in the Law or Health Professions Code and ot er laws with details as to how and to whom divulgence is to be made. Co petent authorities should create the adequate public awareness of su h cases.
   3. A Muslim doctor, who shares in public responsibility as a reformer a ounsellor and a preventar of harm, should try to avoid resorting to divulgence of secrets made known to him through his professional practice, !It though permissible by virtue of cases excepted above, by first assuming i his corrective role to protect those in danger, whether patients or otherwise, by guiding his patient to the straight path assisting him to stand on  his feet again, and the others to avoid the consequent dangers, with a view to psychological rehabilitation and reconciliation of people.

    In so doing a Muslim doctor may employ the method of "pun" through which rights are not wasted and facts are not forged.

Difference between Law and Sharia

    4. The symposium discussed the "Difference between Law and': Sharia' , and from the presented examples of medical practice in the Isla mic countries, it was clear that generally speaking there is hardly any ;i situation that would be embarrassing to the doctor in practice by divergence of law and sharia.

    Adhering to Islamic Sharia is a general duty on all Muslims whether~i members of the health professions or not.

    Therefore, if the positive law is in conflict with the Sharia, then Law :; must be amended in accordance with the Sharia. A Muslim doctor must be, committed to the upright Sharia.
    5. The symposium recommends that curri.cula of health sciences col leges and institutes as well as continuous training include, for medical practitioners, an orientation to the Sharia and Law provisions for their rights, duties, competence and responsibilities in regard to the practice of the health professions.

Sale Of Organs
    In the light of the established Sharia, the opinion of jurists on permissi- bility of organ transplantation under the circumstances and conditions set forth by the Sharia, the symposium discussed "Sale of Organs" andreached the following conclusions:
    6. The best way to obtain organs is through people's compassion for each otrer leading to donation of organs from dead bodies either by will or approval of heirs, as well as from bodies of dead people whose relatives are unknown.
    7. The opinion of the majority is that it is also permissible to obtain rgans by donation from living persons patients provided that sound conditions and controls are followed including causing no harm to the donor or pressuring him to donate his organs.
   8. Sale of organs is prohibited. However, if orgpnst cannot be btained by donation and have to be paid for, then, it is permissible as per pproval of the majority of participants.  It is a prohibition made permissible nly in cases of necessity. Some participants hold the opinion of prohibi ton.
   9. In all cases obtaining organs, especially in critical cases, should ot be left to competition between rich and poor patients; the state should stablish and authority to control it and avoid its perils, managing it accord ing  to a prescribed detailed Law. ( Click for full text of Organ Tranplantation)

Plastic Surgery: Medical Concept and Practice

The symposium discussed "Plastic Surgery" and reached the following conclusions:
    10. Surgeries to treat congenital or aquired deformities to restore normal shape or function of an organ are permissible in the Sharia.
 The majority hold the opinion that this provision is also applicable to t e repair of a fault or improve an ugly appearance that causes a person to suffer physically or psychologically.
    11. Impermissible are the surgeries that would change the normal creation of the body or organ; those meant to disguise criminals to dodge justice; those with fraudulent intentions and those just fulfilling whims.
    12. Surgeries that appeared in certain communities, known as sex change operations, giving in to stray whims are definitely prohibited. H wever, operations to decide and restore the real sex in cases of p eudo-hermaphrodite are permissible.

Fate of Fertilized Ova

13. The ideal situation is to have no surplus of fertilized ova. This can  achieved if scientists continue research to find a way to preserve unfertilized ova capable of normal fertilization when required.  The symposium recommends that scientists expose to fertilization only the number of ova th t will be introduced.  If that was followed we would not be left with surplus fertilized ova.
    Nevertheless, if there is a surplus, the majority hold the opinion that fertilized ova are not made inviolable by the Sharia at all, and are not re- spected until they are embedded in the uterine wall, and therefore, it is not prohibited to destroy them. Some, however, hold the opninion that a fetil- ized ovum is the first phase of the human being honoured by Allah. When choosing between destroying fertilized ova, using them for purposses of scientific research or leaving them to die naturally, the last option seems to be the least prohibited since it does not involve positive aggression on life.
    14. It was unanimously approved to emphasize the fifth recom- mendation of the symposium on "Reproduction in Islam" regarding the prohibition of implanting a woman's fertilized ova into another woman's uterus. Adequate precautions must be taken to prevent the use of fertilized ova in such an illegitimate pregnancy. And also to emphasize the fourth recommendation of the same symposium regarding warning against experiments aiming at changing the normal creation of Allah or using science for purposes of evil, wickedness or sabotage, and the symposium recommends that controls of the Sharia be made as a guarantee against such practices.

Study On: Menses, Puerperium and Pregnancy:
Minimum and Maximum Periods

In the light of medical and Sharia studies presented, the participants reached the following conclusions:
    15. Minimum and Maximum Menstrual Period and Cycle: Doctors agreed with a Fiqh opinion which says that the minimum period of men- struation is a drop of blood, while the maximum differs from one woman to another .
    Bleeding between menstrual periods is medically considered abnormal and is attributed to many pathological causes. There is no clear-cut demarcation between normal menstrual bleeding and that effected by a disease, for there is an allowance of one, two or three days to regular men- strual periods, taking into consideration other pathological symptoms like excessive bleeding and other symptoms as well as results of clinical and laboratory examinations.
    The symposium recommends that Muslim doctors give more importance to differentiation between menstruation and other bleeding occuring between menstrual periods, as well as deciding on the maximum period of menstruation by conducting necessary researches. As for the menstrual cycle (which is the menstrual period and the purity period following until the next menstruation occurs): If the cycle is normal (i.e. the ovary secretes ani ovum), for most women the cycle is 28 days, the minimum is approximately 3 weeks while the maximum is unlimited.
    16. IMinimum Pregnancy Period: It happens that the uterus elpels pregnancy at any of its stages; this is called abortion if the fetus is nonviable and is called delivery if the fetus is viable, and the new horn is premature if pr gnancy period is less than 37 weeks.
    The demarcation between abortion and delivery used to be 28 weeks but with he progress of medicine which improved the chances of survival for youn er fetuses, the demarcation is lowered to 24 weeks which con- forms to the Sharia provision that considers the minimum period of pregnancy ntil delivery to be six months.
                      
17. Maximum Pregnancy Period
Doctors decided that pregnancy grows from the time of fertilization until birth deRending on the placenta for nourishment and that originally the period of pregnancy is approximately 280 days, starting count from the first day of the last normal menstruation period.
    If delivery is delayed the placenta will still serve the fetus efficiently for two more weeks then it will start suffering starvation to the extent that the percentage of fetal death during the 43rd and 44th weeks is high; the fetus rarely estapes death when it stays in the uterus for 45 weeks.
    However, just to include the rare and the abnormal case the period is extended two more weeks to become 330 days, though it has not been known yet that a placenta was as durable as this.
    (The Law, to be more on the safe side and depending on some Fiqh opinions besides the scientific opinion, extended the maximum pregnancy period even more to make it one year).
    18.  M imimum and Maximum Period of Puerperium: The Medical opinidn resented in the symposium agreed with some of the Fiqh opinions that consider puerperium to be what is discharged from the woman afterdel.ivery or abortion until the site where the placenta was attached in the u~eri e cavity heals.  It starts as blood then it turns to a yellowish dischargle until it stops, and its minimum period is not determined but its normal maxi um period is six weeks, and if it stays longer than this it is considered p thological like intermenstrual bleeding; it could be caused by placenta remnants, in the uterus or atony of uterus that leads to failing to stop bleeding, or other causes that need to be diagnosed and treated accordingly. When puerperium is over, it may be followed by menstruation or a short or long period or purity.