Theology and Ontology in Medical Ethics

The following is a transcript of a lecture Shaykh Amin Kholwadia delivered, Theological and Ontological Consideration for an Islamic Ethics of Medicine, at a workshop for the Initiative on Islam and Medicine in 2017. The transcriber’s comments are in brackets, and the transcript has been condensed and edited for flow.

I’m going to try and explain the terminologies so it becomes easier for us to explain what we hope to do with bioethics or Islamic bioethics. Theology as the owner: the study of God and what God wants, God’s will, and what God wants us to believe in. That is the Islamic outlook. Ontology is the study of being and existence: the different layers and levels of being, not of God but of creation. God’s existence does not flow into the existence of creation. There is a separation there according to Islamic metaphysics. We have to be clear from the outset that when we are talking ontology and the theory of being in Islam, we are about not God’s being, but about how God has created being in layers.

These metaphysical considerations apply not only to medicine but also to every aspect of a human being’s life. The fundamental question is still: what is God’s will vis-à-vis this situation? If there’s a blood transfusion, what is God’s will? If there’s an issue of pulling the plug, what is God’s will? If there’s an issue of how to pay your debt, what is God’s will?

We’ll use a word that is Qur’anic and easy to use to bring ontology into legal ethics and into medical ethics. The word is ‘amr. The word ‘amr in the Qur’an means God’s command, or God’s order. The Qur’an speaks of two types of orders.

The first is the order of God’s creation: how does God create? The second is the order of God’s law. Both systems or orders use the same word. Without making it too much of a semantic discussion, in Islamic law and any type of ethics, the two orders come together. There’s a synthesis between the order of creation and the order of law.

In order to understand that more effectively and holistically, we must understand ontology. When God’s command comes down, how does it come down, and through which realms? In the Qur’an, Allah ﷻ says ‘All praise is due to God, the Lord of all the worlds’. The Qur’an lays down from the outset that there are many worlds, many spheres, many realms, in the sense that there are realms through which God’s command comes down to the human intellect. The human intellect then processes that command, whereby he investigates whether or not this is good or bad. The process of investigation would either be through revelation or your own intellectual inquiry if revelation has not given you a concrete answer.

The first order in the ontology we find in the Qur’an is the order of the angelic realm. There’s a realm in which angels receive the divine command, and according to the Qur’an they manage that command, and then it comes down to another realm which is somewhat imaginary, and then comes down to the human intellect or whoever is receiving that command. To give you an example: the story of Abraham (peace be upon him) trying to sacrifice his son. The command came from God to Abraham and Abraham read that command, understood it, and acted upon it.

According to the Qur’an, Abraham received the command to sacrifice through a dream, not through direct explicit revelation. Here, you see the Qur’an establishing that the command comes from above, through the Angels, and into a man’s imagination. The man imagines and captures the dream through his imagination, and he will have to, if he is a prophet, fulfill the command.

Abraham, when he sees that he is sacrificing his son, knows what God wants even though that command came in the realm of imagination, not in the realm of this world where there are cogent legal verdicts and statements. He doesn’t flinch, doesn’t say that this dream is subject to interpretation, which is the rule for prophets. Prophets, when they dream, will rarely interpret the dream and invert it. They’ll go with what is seen there in the world of imagination, bring it down here into this concrete reality, and act upon it. This story tells us there is an ontology in which and within which God’s command comes.

It’s up to the legal jurists to find out how and where this command resides. That is further explained by scholars like Shah Wali Allah of Delhi in his famous work Hujjat Allah, where he takes us through the cosmology of ontology, if you can fathom that. We, in Islamic scholarship, wanted to understand being – existence – holistically. We looked into the scripture, the Qur’an, the statements of the Prophet Mohammed ﷺ, the statements of those who are scholars after him, and found that they had already mapped out this wonderful schema and ontology which facilitates for the jurists to come to terms with the command. The Qur’an itself [asks] Muslims to think about all the relevant signs in the horizons and within themselves. This is a Qur’anic injunction that human beings must understand how existence is and understand how Allah’s command comes into existence in different layers and realms.

You might say this is all theoretical – what does it have to do with us? It may not have to do with us, but it has a lot to do with the jurist: how [they will] determine what it is God’s will. For that, we turn to the other type of command, the command of creation.

Understanding how God creates is a form of profound worship in Islam. God wants us to understand how He creates. We are endorsed by the Quran to find an approach where the process of creation and the process of applying the law come together, synthesized. The jurists in the past have already given us sound evidence of how the two come together.

For instance, in the issue of performing ablution, the Prophet ﷺ has been reported to have said that you should not be extravagant when you are offering ablution even if you are on the banks of a flowing river. The jurists said that one of the wisdoms behind this is that God’s creation, meaning water, is to be seen as a gift and should not be wasted. The command of creation comes into the command of Shari’a.

There are other examples that go into how the early Muslim jurists thought about this, and they thought about it very carefully. Another example that concerns bioethics is the example of an understanding that Qadi Khan, a Hanafi jurist, had about the human fetus. He scanned through various legal verdicts and saw that a Muslim, when gone for Hajj or Umrah, is in a state of ihram where he’s not allowed to harm or hurt any living creature. He says that the jurists said if somebody who is going for the pilgrimage has donned the ihram, if he or she breaks an egg then we see that as a violation. We will see that as an infraction, and a penalty will be levied upon that person who violates that. Jurists with and after him use that to draw an analogy. They said that if there is potential life in an animal’s egg for which you are penalized if you break it during the state of ihram, then there should be some penalty for damaging the fetus in the mother’s womb. They made that connection. What I’m saying is that the only reason they were able to make that connection is because they understood the process of the amr’ of creation and the amr’ of Shari’a. They were able to combine the two and come up with this ingenious way to start the discussion of fetal abortion.

That’s where understanding the ontology and theology comes into play, even in today’s society where we know from our laws that this is unethical. The law stipulates if there’s a need or necessity, then that’s fine, that’s different. But this is the original ruling: that life is sacred and we believe that even the potential life of an egg, if damaged by someone who’s in a state of worship, that life has to be replaced by giving some charity. From that, we have a whole discussion of Islamic law based on it. We see here the Qur’anic injunction to think about the order of creation and to know about the order of law in Sharia. They come together. This is what sparked the dynamic discussion and the prolific writings of classical Muslim scholars.

Theology plays a role in determining what the law is. I’ll expand on that to see how we as Muslims have used this theological consideration to come to terms with God’s will. First, we look at the Qur’an, where many laws came down. For instance, if you make a vow, take an oath, then break the vow, you must pay the penalty. After that discussion, the Qur’an mentions God’s name and attributes – that God indeed is forgiving, clement. The fact that God is speaking about His names and attributes immediately after discussing law tells us there’s a unique relationship between law and theology. Go into the corpus of Islamic law represented by five hundred ayat or so, according to Ghazali – but at least five hundred – and you’ll see that theology, the names of God and His attributes, play a fundamental role in understanding the wisdom and the value of the law that came down as a result of those names traveling through those realms.

Muslim scholars have written on this very extensively. One of the great scholars of British India, Maulana Muhammad Qasim in the 19th century, said that when you study the Qur’an you see that every legal ruling is going to be a manifestation of one of God’s attributes. Now, he is obviously following the likes of Ibn Arabi and other scholars like Shah Wali Allah, but the important point is that when we want to understand God’s law on Earth, we must try to understand God’s names and attributes wherever they are. Without connecting the two, the law becomes very dry. It will remain cogent no doubt. Even in a secular sense, you can make sense of the law, but on a more spiritual and theological level, the study of God Himself was seen as a prerequisite to understand legal philosophy, termed as usul.

The usul al-fiqh, the principles of jurisprudence, have been studied and discussed by the early scholars according to how they saw and understood God’s names and attributes coming down into law. For instance, Ibn Arabi in his famous work Al-Futūḥāt al-Makkiyyah, looks at what Abu Hanifa said regarding God’s command. There’s a category of commandments that are called obligatory, absolutely necessary known as fard. Then he saw there’s another category of laws that are necessary but don’t carry enough weight to be called obligations, so he coined a legal phrase, the term waajib: necessary but not obligatory. He used different words for the difference in their weight. One is fard, the other is waajib – for instance, on the performance of salat al-Eid he says it is waajib and compulsory for us to perform. He didn’t say that it is fard, as he distinguished between the two.

That is based on a theological consideration. Ibn Arabi puts it together in a very beautiful, eloquent way. He says, and if I put it correctly, in his book Al-Futūḥāt al-Makkiyyah, that Abu Hanifa was such a brilliant scholar that he differentiated between what God says himself as an obligation and what God made an obligation through the tongue of His Messenger. What He made an obligation through the tongue of His messenger is going to be lower in rank than what He made an obligation through His own tongue, meaning the Qur’an. Ibn Arabi appreciates the theological consideration in the legal philosophy of Abu Hanifa.

Those of you who know Ibn Arabi, he’s a mystic, a Sufi, but as much as he’s esoteric he appreciates the value of bringing this esoteric evaluation into law, or legal concrete rulings made by people before him. He goes on further to say that God’s law is translated in the opinions of jurists. [A jurist] brings down the law as a reflection of God’s will. This is a theological consideration that scholars in the past have been able to determine so that today we see how Islamic law, in its totality, can be applied to any new situation that occurs in the Muslim community.

Scholars believe that they do not need to legislate afresh. We discover the law. We uncover God’s will. We don’t initiate God’s will. That is very critical in terms of theology, because when you’re going to criticize there are two camps. In one camp, you’re criticizing people for playing God, i.e. these anarchists in secular society who feel they can do anything they want because they can, and in the other camp you have people who are theologians trying to say that they understand God’s will more than anybody else. My consideration here is that when you bring theology and ontology into law, then you come to the table and have a meaningful conversation with each other in such a way that you’re not going to be rude to each other. This is why understanding the discipline, the ethics of having a meaningful discussion, and the adab of having a difference of opinion, becomes so necessary in trying to determine Islamic ethical values in medicine.

We will not be able to determine God’s will overnight. It’s not humanly possible. It’s not something, as I call it, a drive-through service: that you pick up the phone and you ask a jurist or theologian, “What is God’s Word in this?” You may want to take a step back and say, “Wait a minute, let me think about this because I have to process all of these considerations before I come to terms with a ruling.”

Finally, we must applaud Dr. Aasim [Padela] and his tremendous work for initiating such a project, we are indebted to him, alhamdulillah. We are trying to develop a common language for Muslim bioethics. This is where our work really is: trying to develop a common language helps us understand each other, not only correctly and accurately, but more practically. If a medical doctor and scholar are using different sets of vocabulary and they’re not on the same page, then you’ll have a short fuse. You’ll be measuring one distance in kilometers and the other distance in miles and you’ll get the Space Shuttle blown up, basically…

What I’m proposing is that we get language right. We must have a common language within which we are able to communicate effectively for the sake of understanding bioethics. That takes time and resources. It also takes a lot of patience, which is the essence of healing. We have to heal ourselves in this quest to become experts in bioethics, which is what we’re trying to do here, and at Darul Qasim we have a group of scholars who do this kind of work on a regular basis.

As we see God Almighty creating at different levels, in different worlds, in different realms, we also see the descending of God’s revelation. The Qur’an uses the words nazal, anzal and tanzil. It came down onto the Prophet’s mind and the Prophet’s heart ﷺ, then disseminated into the intellect of those who received that instruction and revelation from him. Then it came down to us today 1400 years later, where we are still trying to determine for every new case what is God’s will.

The role of the mujtahid, the one who’s engaged in intellectual discretion and intellectual research, is to first be close enough to God himself that he knows that he’s not going to distort what God’s will is in the name of something else, which is where perhaps the theory of utilitarianism takes a hit. You have to be principled and organized in trying to determine what is God’s will. You would lean towards conservatism initially, until you find evidence that this is allowed or okay, and that is the mandate that we have had from our scholars in the past: make sure you do not distort God’s will by claiming that this is necessary for the community without verifying whether or not God wants it. In order to determine God’s will, we need a structure and a process. That is legal theory and the bulk of jurisprudence that we have inherited from the past and that should prompt us forward, not backwards.

The value of tradition is to understand how they solved problems. The value of tradition is not mimicking. Mimicking is easy. The value of tradition is to understand which tools they used in order to come up with solutions that occur for problems that are problems nowadays. They didn’t have the same problems then, but at least we can be on the same page as far as methodology, structure, and procedure. If you have a table of six different jurists here, they will give me six different opinions. That’s okay.

The value of tradition is this: this is who they were, they were always thinking forward so that Muslims and other people in the world could live better. And that’s the point of bioethics.