Islamic Center of Southern California

The International Islamic Code for Medical and Health Ethics

CHAPTER 2

Medical Behavior and Physician Rights and Duties

The Physician's Duties towards the Patient

Article Two:

A physician should listen carefully to the patient's complaint, sympathizing with him in his suffering, treat him well, and be gentle while examining him. He should avoid any condescending attitude in dealing with the patient or any ridicule or derision of him, regardless of the patient's educational or social level, or religious or racial background. A physician should respect his patient's opinion, particularly in matters that concern the latter personally, but that should not keep the physician from giving the appropriate instructions.

Article Three:

A physician should treat all his patients equally, without any discrimination based on their prestige, their social or moral status, the physician's own feelings towards them, their religious or racial background, their political orientation, or their gender, nationality, or color.

Article Four:

A physician should fear God when dealing with his patients; show respect for their beliefs, religions, and traditions when engaging in the process of examination, diagnosis, and treatment. He should avoid any violations of Islamic law, such as being alone with a member of the opposite sex or looking at the private parts ('awra) of a patient except in as much as the process of examination, diagnosis, and treatment requires; in the presence of a third party; and after obtaining permission from the patient.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "We offered Trust to the Heavens, the Earth, and mountains, but they declined to bear it and were afraid of it, while Man undertook to bear it. He is so unjust and ignorant" (Al-Ahzaab XXXIII: 72).

2. "God commands you to deliver trusts where they are due" (Al-Nisaa IV: 58).

II. In the Prophet's Tradition:

3. In an attributed tradition quoting Abu Sa'eed, "Among the worst people in God's estimate on the Day of Resurrection is a man who tells private things to his wife and she to him, and then he discloses her secret." (Cited by Muslim.) Another version says, "One of the gravest cases of [betraying] trust in God's estimate on the Day of Resurrection is a man who tells private things to his wife and she to him, and then he discloses her secret." (Cited by Muslim, Abu Dawood, and Al-Tirmithi.)

4. In an attributed tradition quoting Jaber, "The confidentiality of meetings should be observed, except in three cases: a meeting where unjustified bloodshed takes place, a meeting where a woman is illicitly violated, and a meeting where property is illegally usurped." (Cited by Muslim.)

Article Five:

A physician should ask only for the tests needed for the patient, without adding any tests not justified by the patient's case. He should base his whole diagnosis and treatment on the best available evidence and data, and refrain from using any unauthorized, unaccepted, or scientifically unrecognized methods of diagnosis or treatment. Moreover, he should ask only for the medications or surgical operations that are called for in the patient's case.

Article Six:

A physician should honestly explain to the patient or anyone representing him the type, causes, and complications of the illness, and of the usefulness of diagnostic and therapeutic procedures. The physician should also explain clearly the proper options of diagnosis and treatment in as much as the patient's physical and psychological condition allows.

Article Seven:

A physician should not hesitate to refer the patient to a doctor specialized in the type of disease the patient has or to a doctor who has more effective equipment whenever the patient's case calls for such a referral, nor to refer him to a doctor whom the patient wishes to consult. It is unacceptable for a physician to delay the referral when it is in the patient's interest. The physician should make the patient's medical record accessible when referring him to another doctor, and to give the patient, without delay, an adequate medical report of his case.

Article Eight:

A patient or a member of his family has the right to invite another efficient doctor for consultation, after the original physician's consent has been obtained. The latter, however, has the right to discontinue his services, without having to give any reason, if the patient or a member of his family insist on consulting another doctor unacceptable to him.

Article Nine:

A physician should never decline or discontinue to treat an emergency patient under any circumstances, unless the patient refuses to follow his instructions or seeks, without the consent of the physician attending him, the services of another doctor. Nor should a physician decline or discontinue to treat a patient, unless the case is not within his field of specialization.

Article Ten:

A physician should continue to give an emergency patient the proper treatment until it is no longer needed or until care for the patient is taken over by another doctor.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "And do good deeds, so that you may succeed" (Al-Haj XXII: 77).

2. "Do not pursue what you have no knowledge of. Hearing, sight, and the heart - man will be accountable for all these" (Al-Israa XVII: 36).

3. "You are the best nation that has been known by Mankind. You enjoin justice and censure evil, and you believe in God" (Aal 'Imraan III: 110).

4. "We offered Trust to the Heavens, the Earth, and mountains . . ." (Al-Ahzaab XXXIII: 72).

II. In the Prophet's Tradition:

1. "Religion is sincerity" (Cited by Muslim).

2. In an attributed tradition quoting Ibn Mas'ood, "Any person who keeps knowledge from his people will be restrained by a bridle of fire." (Cited by Ibn 'Adi).

3. In an attributed tradition quoting Jaber, "The best people are those who give benefit to their folks." (Cited by Al-Qidhaa'i).

4. "A chief is liable to compensation payment."

Article Eleven:

A physician should continue to extend proper care to patients with incurable, terminal, or fatal diseases, and to console them and give them hope to the last minutes of their lives.

Article Twelve:

To the best of his ability and with all the preventive and therapeutic means available to him, whether material or psychological, a physician should relieve the patient's pain and give him the feeling that the physician is eager to give him proper care and attention.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "To you has come a messenger who is one of you. He grieves that you should perish, and he is solicitous over you. He is compassionate and merciful towards believers" (Al-Tawbah IX: 128).

2. "Are you then going, if you are placed in charge, to do evil in the land and sever ties of kinship?" (Muhammad XLVII: 22).

3. "Say, 'Lord, forgive and have mercy; you are the Best of the Merciful'" (Al-Muminoon XXIII: 118).

4. "Say, 'Lord, have mercy on them for they have raised me up when young'" (Al-Israa XVII: 24).

II. In the Prophet's Tradition:

1. In an attributed tradition quoting Al-Ni'maan Ibn Basheer, "In their mutual affection, mercy, and compassion, Muslims are similar to a single body: whenever one of its organs complains, all other organs are mobilized to support it through wakefulness and fever." (Cited by Muslim.)

2. "Answer the person who appeals to you, visit the sick, and relieve sufferers." (Cited by Al-Bukhari and Muslim.) In another, attributed version quoted by Abu Musa: ""Answer the person who appeals to you, visit the sick, and relieve sufferers." (Cited by Al-Bukhari, quoting Abu Musa.)

3. Ibn Maaja quotes Ibn 'Abbaas as saying that the Prophet, blessings and peace be upon him, visited once a sick man. He asked him, "What would you feel like having?" The man said, "I feel like wheat bread." The Prophet said, "If any of you has wheat bread, let him send it to his brother." He added, "If a sick person feels like eating something, let him have it." (Cited by Ibn Maaja).

4. In an attributed tradition quoting Abu Sa'eed, "If you go in to check on a sick person, suggest to him that he still has long to live." (Cited by Al-Tirmithi and Ibn Maaja.)

Article Thirteen:

A physician should see to it that the patient is enlightened as regards his illness and his health in general, as well as to the way to maintain his health and follow proper and effective methods of disease prevention. This should be through face-to-face enlightenment or through the employment of other effective methods when available.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "You are the best nation that has been known by Mankind. You enjoin justice and censure evil, and you believe in God" (Aal 'Imraan III: 110).

2. "We only sent men before you, so ask people with learning if you do not know, with clear signs and with written rules. To you We have revealed a reminding message, so that you may explain to people what has been revealed for them, so that hopefully they would contemplate" (Al-Nahl XVI: 43-44).

3. "Believers, fear God and be among the truthful" (Al-Tawbah IX: 119).

II. In the Prophet's Tradition:

1. In an attributed tradition quoting Tameem Ibn Aws Al-Daari, "Religion is sincerity towards God, His Messenger, and Muslim leaders and masses." (Cited by Muslim.)

2. In an attributed tradition quoting Ibn Mas'ood, "A person keeps telling the truth until he is labeled by God as a truthful person." (Cited by Al-Bukhari and Muslim.)

3. "A Muslim's claim upon a fellow Muslim consists of six points, and if he seeks your advice be sincere with him." (Cited by Muslim, quoting Abu Hurrairah.)

Article Fourteen:

A patient should not be examined or treated without his consent, except in cases when emergency medical intervention is required and informed consent cannot be obtained for any particular reason, or when the disease is communicable or poses a threat to public health or to others, and in accordance with the laws in force. In the case of a patient with full legal competence, his consent can be expressed orally or implicitly. When the patient is a minor, an unconscious adult, or a person who fails to meet one or more of the competence conditions, consent should be given by someone who legally represents him. For surgical operations and for treatment and examinations that have potential side effects, consent should be informed and given in writing.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "We have fastened the fate of every human being around his neck" (Al-Israa XVII: 13).

2. "Then give warning; your task is only to warn. You have no control over them" (Al-Ghashiyah LXXXVIII: 21 - 22).

3. "Do not consume your property among yourselves in vanity, unless it is a trade by your mutual agreement, and do not kill yourselves: God is Merciful to you" (IV: 29).

II. In the Prophet's Tradition:

1. In an attributed tradition quoting 'Itbah Ibn 'Aamer, "Do not force food and drink upon your patients; God, the most glorious and sublime, feeds them and gives them drink." (Cited by Al-Tirmithi, who says it is well-attributed, and Al-Haakem.)

2. In an attributed tradition quoting Haneefah Al-Raqqaash, "It is only by his free consent that a Muslim's property can be touched." (Cited by Abu Dawood.)

3. In an attributed tradition quoting Abu Bakr, "The blood, property, and honor of each of you are inviolable by the rest of you." (Cited by Al-Bukhari and Muslim.)

Article Fifteen:

A physician is entrusted to investigate the health care programs suitable for the patient's case. He should ascertain the usefulness of a course of treatment before choosing it and applying it to the patient. He should follow the patient's case until he fully recovers, if the disease is curable. When a patient asks for an ineffectual course of treatment, the physician should convince him that it is useless.

Article Sixteen:

Taking into consideration the stipulation of Article Four, a physician should make sure to observe the following while examining a patient:

a. He should make a record of the patient's condition and of personal and family medical history before beginning to diagnose and treat the case.

b. He should be careful and efficient in, and give sufficient time to, the examination and diagnosis process.

c. Prescriptions should be made in writing and should be clear, with dosages and method of administration specified. The patient or his family members, as the case requires, should be made aware of the importance of following the method of treatment prescribed by the physician and of the serious potential side effects of the medical or surgical treatment.

d. Side effects resulting from medical or surgical treatment should be monitored and treated promptly when possible.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "To you has come a messenger who is one of you. He grieves that you should perish, and he is solicitous over you. He is compassionate and merciful towards believers" (Al-Tawbah IX: 128).

2. "Are you then going, if you are placed in charge, to do evil in the land and sever ties of kinship?" (Muhammad XLVII: 22-24).

3. "Say, 'Lord, forgive and have mercy; you are the Best of the Merciful'" (Al-Muminoon XXIII: 118).

4. "Say, 'Lord, have mercy on them for they have raised me up when young'" (Al-Israa XVII: 24).

II. In the Prophet's Tradition:

1. "In their mutual affection, mercy, and compassion, Muslims are similar to a single body: whenever one of its organs complains, all other organs are mobilized to support it through wakefulness and fever." (Cited by Muslim.)

4. In an attributed tradition quoting Abu Sa'eed, "If you go in to check on a sick person, suggest to him that he still has long to live." (Cited by Al-Tirmithi and Ibn Maaja.)

Article Seventeen:

A physician should make sure that surgical operations are performed under the following conditions:

1. The physician who performs an operation should have the specialization and medical experience that qualify him to do the required type of surgery.

2. The surgical operation should be performed at a therapeutic institution or health establishment which is sufficiently equipped for the performance of such a surgery.

3. Proper laboratory and radiology tests should be made to confirm that surgical intervention is necessary and appropriate as a treatment for the patient and to make certain that the patient's health condition allows the surgery to be performed.

4. The surgeon attending the patient has the obligation of performing the surgery himself. He may be helped by a resident at the hospital or some other surgeon, with no need for the patient's consent. The surgeon may also authorize an assistant of his to perform certain procedures of the surgery, provided that they are done under the surgeon's supervision and with his help, and that he bears the legal responsibility for them.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

2. "God commands you to deliver trusts where they are due" (Al-Nisaa IV: 58).

II. In the Prophet's Tradition:

1. "When a person who is unknown to have medical experience practices medicine, he is accountable."

2. "The blood, property, and honor of each of you are inviolable by the rest of you."

3. "Injustice leads to layers of darkness on the Day of Resurrection."

Article Eighteen:

A patient should be made aware of his heath condition and of available treatment alternatives, if he can grasp this information. A physician should not force a treatment on a patient without his consent, nor force him to sign, unwillingly, data in his medical file.

Article Nineteen:

A physician should gently, honestly, and wisely and without undue exaggeration explain to the patient the consequences of declining to follow a treatment and the resulting complications. The physician should also take the patient's admission if the latter declines to follow the treatment, and when he refuses to give it, a statement signed by the physician and a member of the nursing staff should be added to the patient's medical file, in order to clear the physician from any responsibility.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

1. "We have fastened the fate of every human being around his neck" (Al-Israa XVII: 13).

2. "Then give warning; your task is only to warn. You have no control over them" (Al-Ghashiyah LXXXVIII: 21 - 22).

3. "Do not do not consume your property among yourselves in vanity, unless it is a trade by your mutual agreement, and do not kill yourselves: God is Merciful to you" (IV: 29).

II. In the Prophet's Tradition:

2. In an attributed tradition quoting Haneefah Al-Raqqaash, "It is only by his free consent that a Muslim's property can be touched." (Cited by Abu Dawood.)

3. In an attributed tradition quoting Abu Bakr, "The blood, property, and honor of each of you are inviolable by the rest of you." (Cited by Al-Bukhari and Muslim.)

Article Twenty:

When a patient is referred to one of the institutions in which the physician holds shares, the following should be observed:

a. The establishment should offer outstanding services that are not inferior to others in type or quality.

b. Referral to the establishment should be warranted by the incapability to deal with the patient's condition. The patient should not stay in the establishment he is referred to longer than necessary.

c. The physician should inform the patient that he, the physician, has a financial interest in the establishment to which he is referring the patient. In all cases the patient should be given the freedom of choice.

Supporting Islamic Legal Evidence:

The rules of the Islamic Jurisprudence (Fiqh) include the following:

1. A lesser evil is given precedence [in being tolerated] over a more general one.

2. Prevention of harm has precedence over the acquisition of benefits.

3. Intention is the criterion of actions.

Article Twenty-One:

A patient should be checked out of the health establishment where he is receiving treatment only if his health condition allows that or he expresses his desire to leave although he is made aware of the consequences of his departure. In the latter case, a written statement should be obtained from the patient or, when he is not fully competent, from a family member of the first, second, third, or fourth degree of kinship and should be included in the patient's medical file.

Supporting Islamic Legal Evidence:

I. In the Glorious Quran:

2. "God commands you to deliver trusts where they are due" (Al-Nisaa IV: 58).

3. "Let no scribe decline to write as taught by God; therefore, let him write" (Al-Baqarah II: 282).

II. In the Prophet's Tradition:

1. "When a person who is unknown to have medical experience practices medicine, he is accountable."

2. "The blood, property, and honor of each of you are inviolable by the rest of you."

3. "Injustice leads to layers of darkness on the Day of Resurrection."

Article Twenty-Two:

A physician should cooperate with the other members of the medical team involved in providing care to the patient, and he should make available to them, whenever he is asked to do so, what information he has of the patient's condition and of the method of treatment he, the physician, has been using.

Article Twenty-Three:

A physician should give to his patient an advance notice of any travel or absence plans he has and should tell him how to act when the physicians is absent. Under all circumstances, a suitable physician should be available in the absence of the doctor in charge of the patient to guarantee that the latter continues to receive treatment.

Article Twenty-Four:

If invited to examine a patient being treated by a colleague, a physician should observe the following rules:

a. Even if there are no clear justifications, he should answer the invitation for consultation if it comes from the attending doctor. The consulted physician should disclose his findings to his colleague, rather than to the patient himself.

b. The consulted physician should reassure the patient, reduce his anxiety, and use his own discretion in determining what the patient should know and what should be reserved to the attending physician.

c. He should guard against any word or suggestion that implies any discredit or disparagement of the attending doctor or any underestimation of the latter's efforts in treating the patient. This should be particularly observed when the consulted physician's point of view differs from that of the attending doctor.

d. If the patient desires to terminate the service of the original physician, the latter has to be informed of that decision.

e. The attending doctor has the right to consult another colleague in the same field of specialization after the first consulted doctor has given his opinion and made his recommendations.

Article Twenty-Five:

When a physician is commissioned to extend health care to individuals with limited freedom, he should abide by the following:

a. He should provide them with the same type and level of health care available to persons with no freedom restrictions.

b. He should not, actively or indirectly, perform anything that amounts to collaboration in torture procedures or other forms of cruel or inhuman treatment, or to complicity in, enticement of, or keeping silent about such acts.

c. He should never use his professional knowledge or skills to help in the interrogation of people with restricted freedom in a way that is hazardous to their physical or psychological condition. Nor should he participate in any restricting procedure against them.

d. If he notices that a restricted person has been or is being subjected to torture or abuse, he should report it to the proper authorities.

Article Twenty-Six:

Physicians who attend minors, should explain to these patients, each to the extent of his comprehension skill, the nature of the medical procedures or interventions applied.

Article Twenty-Seven:

When treating a child patient, a physician should defend his patient's interest if the family or relatives of the child fail to appreciate the case fully or if they fail to carry out their duty towards the child.

Article Twenty-Eight:

A physician attending a patient who takes any addictive material should deal with his patient seriously, carefully, and confidentially. He should endeavor to apply the best treatment procedures to his patient, whether in special institutions or at his own office if treatment equipment is available. In doing so, the physicians should observe the laws in force.

Supporting Islamic Legal Evidence:

All this can be covered, as far as Islamic Law is concerned, by the above-cited rules of Islamic Jurisprudence (Fiqh) and legal purposes. Islamic Center of Southern California