Setting the Balance: Fiqh of Health

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Islamic Medicine
Staff member
Setting the Balance: Fiqh of Health
Dr Muhammad Haytham Al Khayat

Setting the balance

This is a discourse in the fiqh of health.

Fiqh, as we all know, is knowledge of practical Islamic rulings as deduced from detailed statements and religious text.

Health, as we define it today, is a state of complete physical, psychological, social and spiritual well-being.

We have in our great reference books on Islamic jurisprudence gems of knowledge in the fiqh of worship (ibadat), fiqh of commercial transactions (muamalat), fiqh of marriage (nikah) and fiqh of prosecution (aqidah); but we have no chapter on the fiqh of health. Its absence is not because it does not exist or is too difficult to find. In fact, it is available everywhere in these reference works. Perhaps it has come to be overlooked because of its immediate availability. It is sometimes said that very close proximity hides an object like a screen.

This book is a modest attempt to bring out this fiqh and to find its threads. I am helped in this by the great change that has occurred in the general concept of health throughout the world. This has led to a general consensus among people responsible for health the whole world over to work together for a single aim, namely, Health for All by the year 2000 and to adopt the primary health care approach in order to achieve it. Muslims, whom God has honored with the task of being the advocates of the message of civilization to mankind, should have been in the forefront of this blessed task. They would be simply advocating principles that they have been reading for centuries. God has described them as being the best community ever produced for mankind. (3:110) This presupposes that they can find the best solutions for the problems of humanity and define the best methods for its advancement. I hope you will agree with me that in the attempt to formulate the fiqh of health, we will find the best way to safeguard and enhance human health.

When we speak of health, we do not restrict ourselves to medicine, as it is commonly understood nowadays, meaning curative medicine. Doctors of former and present times agree that there are two types of medicine: preservation of the health of those who are healthy, and restoration of health to the sick through medication and rehabilitation. A number of hadith have come down to us from the Prophet prescribing certain medicines for certain diseases. Scholars have given these statements due importance, treating them as part of the divine revelations and consequently as part of the religion of Islam. But we find that some of them reflect only what the Arabs at the time had, by experience, found useful. An example of these is the authentic hadith1: "If there is any good [or he might have said ‘cure’] in any of your medication then it will be that in an incision to bleed, or in a drink of honey, or in cauterization, matching the illness [of which one complains]. As for me, I do not like cauterization". Some of these are suitable in a particular environment, considering its climate, temperature and other factors, such as the desert environment of Arabia. They cannot be applied universally, as explained by Imam Ibn Al-Qayyim in Zaad al-ma’ad: "God’s messenger has been sent as a guide to mankind, calling on them to believe in God and follow the way which ensures their admittance to heaven. He has explained to people about God, and clearly pointed out what pleases Him, enjoining people to do it. He has also pointed out to them what incurs God’s displeasure emphasizing that they must refrain from it… … As for medication for physical illnesses, this is complementary to his message. It is meant to serve a different purpose".

What is important in this aspect of medicine, which is the curative aspect, is that the Prophet approved the principle of medical treatment and encouraged us to seek it. In an authentic hadith, he is quoted2 as saying: "Seek medical treatment". In another version of this hadith, he says3: "Yes, servants of God! Seek medical treatment". He raised the hopes of patients, making clear that all diseases may be cured. In an authentic hadith, he says4: "God has not created a disease without creating a cure for it". He also urged doctors to try to identify cures, pursuing the necessary scientific research for this purpose. A hadith5 quotes the Prophet as saying: "Every disease has a cure. If treatment is administered with the right cure, the patient will recover by God’s grace". In a different version6: "God has not created a disease without creating a cure for it, which may be known to some and unknown to others".

Also important in relation to curative medicine is the fact that the Prophet placed the whole issue of the treatment of illnesses in its proper perspective. He was once asked7: "Do our supplication, medication and methods of prevention prevent anything that God has willed?" He replied: "These are also part of God’s will". Thus he has made it clear that one aspect of God’s will may be prevented by another. It is evident that Islam leaves no room for fatalism, even though it may be mistaken for reliance on God. Although disease occurs by God’s will, every Muslim is commanded to try to protect himself against it utilizing methods of prevention which also work by God’s will. In that, as always, they should place their trust in God.

A similarly important point in relation to curative medicine is that the Prophet opposed so-called faith healing. He approved medicine that relies on study and experimentation, seeking to relate causes to effects. He spoke against the practices of the pagan Arabs who discarded evident causes and laws of nature in preference for mysterious causes and powers, such as charms, talismans, incomprehensible jabbering and tricks practised by sorcerers and quacks. In a hadith8, he is quoted as saying: "Whoever wears a charm is guilty of associating partners with God". In another version9, he says: "Whoever wears a charm, may God never fulfill his purpose, and whoever wears a talisman, may God never let him enjoy peace of mind".

This is some of the Prophet’s guidance in respect of seeking medical treatment. The other objective of medicine, which is preserving the health of those who are healthy, comes out clearly in his guidance. The rules that relate to health protection are general rules that fit in well with the natural laws that God has put in place to promote the well-being of His creation. God says in the Quran:

Praise the name of your Lord, the Most High, who has created all things and proportioned them. (87:1–2)

O man! What has enticed you from your gracious Lord who has created and well proportioned you, and given you a perfect molding? (82:5–7)

By the soul and Him who has molded it in perfect proportions. (91:7)

To preserve this situation of perfect molding and right proportion is an important objective of Islamic law. The eminent scholar Izz Eddin ibn Abdussalam says in Qawaid al-ahkam fi masaleh al-anam: "Islamic law aims to serve the interests of people and to prevent everything which adversely affects them". He explains this by saying: ‘The achievement of what is beneficent is the pivot round which Islamic law turns: it either prevents what is harmful or enhances what is good. When you hear God say ‘O you who believe’, reflect on what comes after His address. You are bound to find something good which He encourages you to do, or something evil from which He prevents you, or you may find a combination of encouragement and prevention. He has outlined in His book some of the evils and the benefits addressed by His legislation in order to encourage people to keep away from evil and do what is good".

This eminent scholar is right. God says to the Prophet in the Quran:

God knocks truth and falsehood together. As for the scum, it vanishes without trace; what benefits mankind lingers on in the earth. (13:17)

God, then, defines what benefits mankind, in this present life and in the life to come, as the truth which He sent with His messenger.

He says: Mankind, the messenger has come to you with the truth from your Lord. (4:17)

He also says: What has been sent down to you by your Lord is the Truth (13:1) and

Those who are endowed with knowledge believe that what has been revealed to you by your Lord is the Truth (34:6).

Perhaps one of the best discussions of this subject is the one by Imam Najmuddin At-Toofi of the Hanbali school of thought. In his commentary on the Prophet’s pronouncement: "Do not harm yourself or others", Imam At-Toofi says: "It requires the promotion of whatever benefits the individual and the community and the abolition of whatever works against their benefit". He supports his argument with a number of detailed statements from the Quran and the Sunnah. He then presents his method that seeks to make judgments "on the basis of clear text in the Quran and the hadith, as well as the consensus of scholars, with regard to matters of worship, and on the basis of utility in transactions and other matters". He goes on to explain: "We give priority to utility in transactions and similar matters, rather than in worship, because worship is a duty we owe to the Legislator Himself. We are unable to determine what we owe to Him, its quantity, quality, time and place without His direct explanation. Every one of us then knows what he is required to do. The rights of other people are different. They are determined through a legal policy which is established to serve their interests, which are of paramount importance in this regard".

"All scholars, indeed all creeds", as Imam Shatibi says, "are unanimous that the aim of the sharia is to safeguard the five essentials of life, namely: faith, body, offspring, property and mind". These are indeed the essential human rights.

It needs little reflection to conclude that three out of these five essentials, namely, body, offspring and mind, cannot be completely safeguarded without maintaining good health. Good health, however, is only one of a number of important elements that are absolutely necessary for maintaining these essentials. To maintain good health also requires the provision of other developmental needs, such as good food, drink, clothing, shelter, marriage, transport, security, education and income. The Prophet, however, assigns top priority to good health. He instructs us to: "Pray God for forgiveness and sound well-being. No blessing other than faith is better than well-being". The Prophet says: "Wealth is appropriate to a God-fearing person, but good health is better for the God-fearing than wealth". He further says: "He of you who finds himself enjoying good health, secure in his community and has his daily sustenance, is as if he had the whole world at his finger tips".

Therefore, it is no wonder that we find in the Quran, and in the traditions of the Prophet, many statements that help to protect and promote health, preserving the proper, balanced position in which man is created. If we study these statements carefully and apply them properly, as we are required to do, we will find at our disposal a large volume on the fiqh of health. This is based on the fact that the sharî’ah is embodied in clear statements, while the fiqh is the result of careful study of such statements and implementing them.

The first of these blessed statements is a unique one that no one other than the Prophet has ever made. This is the highly authentic hadith in which Abdullah ibn Amr quotes the Prophet as saying: "Your body has a [human] right". Fourteen centuries after the establishment of human rights by Islam, the world issued the International Declaration on Human Rights. However, mankind has not yet declared rights for the human body. The human body may rightfully claim from its owner to be fed when hungry, rested when tired, cleaned when it gets dirty, protected against harm and disease, treated when suffering an illness, and not overburdened. This is a rightful claim that imposes a duty on every one of us. It must never be neglected or made subordinate to other rights and claims, including those belonging to God Himself.

One of the most important texts from which we may deduce the fiqh of health is the statement of God in the Quran:

And He enforced the balance. That you exceed not the bounds; but observe the balance strictly; and fall not short thereof. (55:7–9)

This comprehensive statement mentions the balance that God has established in the universe, with its different forces and influences, including man. It draws our attentions to this balance that applies to everything, making clear that any disturbance of the balance, whether by increase or decrease, may lead to terrible consequences.

God says: Mankind! Your transgression will rebound on your own selves (10:23).

The Muslim doctor fully understood this and applied it to health, referring to this dynamic equilibrium as a "state of equilibrium". Ali ibn al-Abbas, who lived one thousand years ago, in his book, Kamil as-sina’ah, gave health a very brief definition: "Health means that the body is in a state of equilibrium" (volume 2, page 3). Ibn Sina, in A.D. 1093 in his famous book Al-Qanoon, expresses the dynamism of this balance, saying: "The state of equilibrium which a human being enjoys has a certain range with an upper and a lower limit". It is, then, like a balance that moves between two extreme limits.

To maintain this health balance in the state of equilibrium, protect it against imbalance, and restore it to its proper position every time it is disturbed, a human being must have a "health potential", so to speak. This is referred to in the hadith, quoting the Prophet as saying: "And store up enough health to draw on during your illness". This health potential may take the form of proper nutrition, or good immunity, or physical fitness that enables a person to cope well with the stress that the body may face. Health potential may also be in the form of mental and personal security and stability that enables people to deal with the mental stress that may beset them. Indeed, the health potential is all these aspects put together.

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What I have discussed so far concerning the fiqh of health is something that we in the World Health Organization consider to be among the great discoveries of the modern era, giving health two important dimensions, namely, health balance and health potential. We refer to the means we take to maintain the health balance as "health protection" while the means that aim to increase health potential are referred to as "health promotion". Within these two dimensions the World Health Organization approved its definition of health just fifty years ago as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This definition reminds us of the Prophet’s statement: "Pray God for well-being. No blessing other than faith is better than well-being". WHO’s definition of health has had a great impact. Previously, doctors used to define health as the absence of disease, just as someone who defines life as the absence of death! The great Western doctors in the first half of this century ignored what the doctors of the Arab Islamic civilization said hundreds of years ago. The Islamic and medical scholar Ibn Rushd defined health in his book Al-kulliyat, some 800 years ago, as: "A state in which an organ performs its normal function or undergoes its normal reaction". In Kamil as-sina’ah, 1000 years ago, Ali ibn al-Abbas stated that health is: "A state of the body in which functions are run in the normal course". In Al-moojaz fi-tibb, Ibn al-Nafees, 700 years ago said: "Health is a state of the body in which functions are normal per se, while disease is the opposite state".

All our medical scholars, then, made health their starting point, while illness was the opposite to it. This is a reflection of their understanding of what God says in the Quran:

Your gracious Lord ... has created and well proportioned you, and given you a perfect molding (82:6–7) Your Lord ... has created all things and well proportioned them. (87:2)

We have created man in a most perfect image. (95:4)

By the individual and Him who has molded it in perfect proportions. (91:7)

A noteworthy feature of the WHO definition is the fact that it speaks of complete well-being not merely well-being. In Arabic, the term used is derived from a root that indicates plenty and high quality. This is indeed the kind of health we would like to prevail: human beings enjoying the best condition, physically, mentally, socially and spiritually.

1. Related by Al-Bukhari and Muslim on the authority of Jaber
2. By Abu Dawood following Usama ibn Shareek
3. Related by Al-Tirmizi
4. Related to Al-Bukhari following Abu Hauraira
5. Related by Muslim and Ahmad following Jaber
6. Related by Ahmad
7. According to Al-Tirmizi following Abu Khizama
8. Related by Ahamad following Oqba ibn Amer
9. Related by Abu Dawood, Al-Nasa'i, Ibn Majah and Al-Hakim
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