SHIFA

It is a breach of a doctor’s duties that he prescribes medicine produced by a certain pharmaceutical company on the basis of the offers he receives from that company, regardless of how beneficial this medicine may be to patients.

This is a form of cheating, which is defined in the Shari’ah as deceiving someone by presenting him/her something whose specifications are different from the specifications he/she needs. The Prophet (Sallallahu ‘alayhi wassalam) is reported to have said;

“He who cheats us is not one of us [is not a faithful Muslim].”[Tirmizi]

A doctor’s primary role is to diagnose the patient’s condition and then to honestly prescribe the medicine he considers being effective in treating the disease.

The issue raised in this question is an example of the moral decline that dominates the world today. The principal duty of a doctor is to prescribe to his patients the medicine that he considers to be most beneficial in treating their cases. He is not to be affected by the incentives which pharmaceutical companies offer him in order to prescribe the medicine they produce.

If a doctor prescribes a certain medicine because he receives incentives from the company producing that medicine, while knowing that there is another kind that is cheaper and more beneficial, then he is violating the dictates of honesty. He and the company that deals with him share in the sin implied in such an act.

What is called a “present” given by a certain pharmaceutical company to a doctor so that he prescribes its medicinal products is no more than a bribe. This is because it incites the doctor to prescribe medicine to his patients, not on the basis of the cheapest price, (which is more beneficial to them) but on the basis of the benefits he will obtain from the company. If it wasn’t for such presents, the doctor may have prescribed the medicine needed by the patient at an affordable cost.

The Prophet (Sallallahu ‘alayhi wassalam) said:

“Religion is to be faithful… to Almighty Allah, His Book, His Messenger, the rulers of the Muslims, and to common Muslims.” (Reported by Sahih Muslim)

The actions of many pharmaceutical companies as raised in the question are contradictory to the faithfulness Muslims are required to have towards one another according to the above mentioned hadith. When a certain pharmaceutical company gives incentives to doctors to prescribe its products to patients, it seeks to achieve marketing benefits at the expense of the patients who could otherwise use other cheaper medicines having the same effect
A doctor may accept a present from a pharmaceutical company when there is an actual bond [friendship, for example] between the doctor and the owner of the company. In such a case there should be no pressure on the doctor to prescribe the medicine produced by the company to treat his patients.

Likewise, exaggerating in describing the benefits and effects of products in any way is also a kind of cheating that is unlawful in Islam. The Prophet (Sallallahu ‘alayhi wassalam) said, “He who cheats us is not one of us [is not a faithful Muslim].”

To be on the safe side, marketing companies and their representatives are to describe their products without exaggeration. If they fail to do so, they may be guilty of committing doubtful things, so they should beware.

May Allah Ta’ala guide all of us to the straight path, and guide us to that which pleases Him.

Traditions of the Prophet (Sallallaahu ‘alaiyhi Wasallam) in seeking remedy:
Islam considers disease as a natural phenomenon and a type of tribulation that expiates the sins of the believers. Not only the patient who suffers in dignity will be rewarded in the hereafter, but also his family who bear with him the ordeal (trial). Even the visitors of such a person will get their reward from Allah.

The prophet Muhammad (Sallallaahu ‘alaiyhi Wasallam) himself sought remedy when he was ill, ordered his family, companions and Muslims at large, to seek the appropriate remedy for their ailments. He said: "Never does Allah Ta'ala send a disease without sending its cure." (Sahih Bukhari).

Jabir ibn Abdullah Al-Ansari (Radiyallahu ‘anhu) said: the Prophet Mohammad (Sallallaahu ‘alaiyhi Wasallam) said:" For each ailment there is a cure and medicament. If the proper medicine is used, the disease will be cured by the will of Allah.'' (Sahih Muslim)

Abdullah ibn Mas'ud (Radiyallahu ‘anhu), another companion of the Prophet Muhammad (Sallallaahu ‘alaiyhi Wasallam) narrated that the he said: There is no disease that Allah sent without sending for it a cure. Some will know that cure, while others will not.''(Al Mustadrak Hakim)

Usamah bin Shareek (Radiyallahu ‘anhu) said: The Bedouin Arabs came to the Prophet (Sallallaahu ‘alaiyhi Wasallam) and asked: Should we seek remedy? He replied: O servants of Allah seek remedy for Allah in his Glory did not put a disease without putting for it its cure, except one ailment. They asked: which aliment? He said: Old age. (Sunan Tirmizi and Abu Dawood)

Jabir ibn Abdullah Al_Ansari (Radiyallahu ‘anhu) said: The prophet (Sallallaahu ‘alaiyhi Wasallam) visited his maternal cousin Sa'ad ibn Abi Waqaas and found him ill (after emancipation of Makkah). He put his hand on Sa'ad chest and said: Call for Al Harith ibn Kaldah, the brother of Thaqif (a tribe living in Taif near Makkah), for he is a man who practices medicine.'' (Sunan Abu Dawood)

The Prophet Mohammad (Sallallaahu ‘alaiyhi Wasallam), not only sought remedy for himself, his family and companions, but also he used and advised certain medicines e.g. black cumin (black seed, Nigella sativa), Aloe Vera, Senna, Henna (Lawsonia inermis), Hijama (blood letting and cupping) and using honey for many ailments.

Imam Bukhari (R) compiled 118 authentic hadiths i.e. sayings and acts of the Prophet Mohammad (Sallallaahu ‘alaiyhi Wasallam) in a chapter of his compilation called "Book of Medicine."

Imam Muslim wrote a similar number of hadiths regarding medicine and seeking remedy. In fact, every book of hadith contains a fairly large number of hadiths regarding Medicine.

Some authors wrote individual books on what they termed "Tibbi Nabawi" (Prophetic Medicine). The earliest one is that of Imam Ali Rizza who wrote a treatise in preventive medicine called "The Golden Message" written in 200 AH.

The second was Abdul Malik ibn Habib Al Albiri Alandalusi (Rahmatullahi ‘alayhi) (died in 238H/851G). The most well known is Tibbi Nabawi of Ibn Al Qayim (Rahmatullahi ‘alayhi) which has been widely circulated and in the modern era and published in many editions with comments. It has been translated to many languages including English. The other well-known book is Tibbi Nabawi of Imam Az-Zahabi (Rahmatullahi ‘alayhi), which was published in several editions. There are more than 20 books labelled Tibbi Nabawi; many of them are still in manuscripts.

Conversely, there are also certain hadiths of Muhammad (Sallallaahu ‘alaiyhi Wasallam), which encourage reliance upon Allah Ta'ala and abstaining from remedy. They are:

a) "There are 70,000 of my people who will enter paradise without being questioned; they are the ones who do not seek remedy by ruqia (incantations), the ones who don't believe in omens, the ones who do not cauterize themselves (for remedy); and they completely resign their matter to their Lord.''(Tirmizi Shareef)

b) An African lady once complained to the Prophet (Sallallaahu ‘alaiyhi Wasallam) that she suffers from convulsions do to which parts of her body become exposed. She asked him to pray for her to get cured. He said: "if you persevere and be patient you will enter paradise". She said: "I will be patient but I don't want to become exposed (i.e. naked); he said: "I will pray for you that you might not become exposed"

She continually suffered from attacks but never became exposed after that incident. (Sahih Bukhari)

The status of seeking remedy in Islamic Jurisprudence:
There are basically three outcomes of remedies which will affect the ruling of the medication in each instance:

1. The first type is where the medication is certain and guaranteed to be effective.
2. The second type is where the medication has a high probability of effectiveness.
3. The third type is where there is a presumption and presupposition that the medication will be effective.

First Types: Obligatory
It will be incumbent to utilize such types of remedies or requisites for human life wherein recovery is certain. The Jurists present the examples of food and / or water for starving and thirsty patients. In such cases, it is certain that by drinking water or eating food, the patient who was dying of thirst or starving of hunger will save his life. In such a situation, not partaking of the food or water will not be considered as Tawakul (trust in Allah); hence it will be Haram to refrain from the food and water when there is a possibility of the death of the patient.

Second Type: Encouraged / Discretionary
In regards to such medication or treatment wherein there is no absolute surety of effectiveness but there exists a good possibility of its efficacy, it will be preferable for the majority of people to utilize it. Utilizing this type of medication will not negate one's resignation to the will of Allah. However, for the elite and pious ascetics, it will be preferable to abstain from using it.

Third Type: Abstention Preferred
In regards to such treatment wherein there is mere conjecture and presumption in its effectiveness such as cauterization and incantation; it will be a precondition of Tawakul to refrain from utilizing it. This is based upon the Hadith of Rasulullah (Sallallaahu ‘alaiyhi Wasallam) "There will be 70,000 people of my Ummah who will enter paradise without reckoning. He was asked who they will be. He replied by saying they will be the ones who do not seek remedy by means of Ruqia (incantations), the ones who don't believe in omens, the ones who do not cauterize themselves (for remedy); and they completely resign their matter to their Lord.''

In all cases, whether one utilizes the medication or not and whether he is cured or not, he should maintain the conviction that Allah Ta'ala decrees what He wills and what He decrees will come to pass. If Allah wills, the medication will produce a positive effect through His decree. If Allah wills, the medication will fail to produce any effect. The medication does not have any intrinsic and inherent effect without the decree of Allah.

First of all, it is noteworthy that every human being is bound to feel ill sometime and somehow. A Muslim does not feel panic when afflicted with any sickness because his belief in the mercy of Allah is great, so is his faith in destiny and his awareness of the importance of enjoining forbearance and patience. All these elements give him strength to stand fast and endure his ordeal. However, he is supposed to seek treatment in response to the Prophet's Muhammad (Sallallaahu ‘alayhi wassalam) order to seek medical treatment. Here appears the significance of medicine in Islam and the great role played by doctors.

As for the role of a Muslim doctor, we'd like to cite the following:

The Muslim doctor shares with the Muslim patient the two main characteristics: the faith in Allah and destiny, and the conviction that there is a cure for every disease. But the doctor must have something more; he is supposed to know, or at least try to know, the proper diagnosis and the proper cure. He must be aware of the mission entrusted to him in his capacity as the agent of healing.

Being an agent, he believes that the act of healing is not entirely his, but it depends on Allah's will. It seems that doctors are more aware than others of the Divine power and Allah's will. They meet every day with cases where destiny plays the major pan and they encounter the most unexpected results. Our Prophet (Sallallahu ‘alayhi wassalam) said,

"For each disease there is a cure; and when the treatment is given, the disease is cured by the Will of Allah." (Reported by Ahmad and Muslim)

The art of healing, which is called the medical profession in modern language, has been highly respected all through the ages. For a long period in human history this was closely correlated with religious leadership and quite often confluent with magic and miracles. Since the advent of Islam 1400 years ago, medicine has become a science subject to human intelligence and discovery. Nevertheless, the medical doctor has persistently captured the appreciation and respect of his contemporaries, especially as medicine was usually associated with other philosophical and social knowledge.

In fact, this close marriage between philosophy and medicine distinguished the medical history of Islam. The gist here is that doctor's prognosis included the spiritual, psychological and social sides of the patient over and above the pathological aspects. In an Islamic state, all Muslim doctors in course of their every day practice, and when dealing with Muslim patients in particular, should keep this traditional prognostic attitude in mind.

But what is it that makes a Muslim doctor different from other non- Muslim doctors? From the technological and scientific points of view, all doctors fall in one category. However, when it comes to practice, the Muslim doctor finds himself bound by particular professional ethics plus his Islamic directives issuing from his belief. In fact, the Muslim doctor—i.e., a doctor who tries to live his Islam by following its teachings all through—is expected to behave differently in some occasions and to meet greater responsibilities than other non-Muslim doctors.

1. The Public Responsibility:

A Muslim doctor is supposed to belong to a Muslim community where there are some common causes, common feelings, and mutual solidarity.

Almighty Allah also says:

(Believers are brothers.) (Al-Hujurat 49: 10)

(And hold fast all of you together to the Rope of Allah, and be not divided among yourselves: and remember Allah's favour on you, for you were enemies and He joined your hearts together, so that by His Grace you became brother...) (Al `Imran 3: 103)

The implication here is that the Muslim doctor is a member in a Muslim community where the same body of the individual is crucial for its survival and development. The doctor has a big say and great weight in influencing his patients and in righteously guiding their orientation. Besides, he should be actively involved in propagating true Islam among Muslims and non- Muslims. Almost all Christian missionaries depend on medical doctors when approaching alien masses, taking advantage of the humanistic service doctors render to poor diseased people. The best missionary service to be rendered by a medical doctor is to behave all the time in accordance with his Islamic teachings, to declare his conviction, and to feel proud of it. Then he serves a good model that would convince others and gain their hearts.

2. Faith and healing:

By accepting the fact that Allah is the Healer and that the doctor is only an agent, both patients irrespective of their creeds and their doctors, fight their battle of treatment with less agony and tension. We think it is an established fact that such spiritual conviction would improve the psychological state of the patient and boost his morale, and thus help him overcome his physical weakness and sickness. There are many examples where faith played a miraculous part in the process of healing. A Muslim doctor must make faith the backbone of his entire healing procedure.

3. Reprehensible, Prohibited and Permissible Acts:

More than any other professional, the Muslim medical doctor is confronted more frequently with questions regarding the Islamic legitimacy of his activities. There are almost daily controversial problematic issues on which he is supposed to decide: e.g. birth control, abortions, opposite sex hormonal injections, trans-sexual operations, brain operations affecting human personality, plastic surgery, extra-uterine conception, and so forth. The Muslim doctor should not be guided in such issues merely by the law of the country in which he is residing (which may be non-Muslim). He must also find the Islamic answer and rather adopt it as much as he can. To find the answer is not an easy matter, especially if the doctor himself has no reasonably solid background in the field of Islamic teachings. Yet, to gain such knowledge is very simple and would not consume much time as generally presumed.

In general, every Muslim must have a preliminary knowledge of what is reprehensible and what is prohibited. One has to admit that our early education as individuals is very deficient in this regard. But this does not justify our ignorance of the essentials of our religion and our indifference towards its injunctions. There is no difficulty nowadays to obtain a few reference books about our Shari’ah and to find out the answers to most, if not all, our medical queries. The importance of Islamic knowledge becomes conspicuous when the subject of the issue is purely technical and thus lies beyond the reach of the normal religious scholar. Besides, there are many secondary questions that arise in the course of dealing with patients where the personal judgment of the doctor is the only arbiter. There, as always, the doctor needs a criterion on which he can build his code of behavior and the ethics of his medical procedure.

To conclude, the role of the Muslim doctor is briefly to put his profession in service of the pure religion Al-Islam. To this end, he must know both: medicine and Islam.

Note that some articles taken from different sources- Adapted and edited by

Mohammad Ashhad Bin Saeed (Ghufirallahuma)

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