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Islamic Medicine
Staff member
Sterilization refers usually to a surgical procedure aiming at preventing pregnancy. The common method in woman is the interruption of the continuity of both uterine tubes so that the ascending sperm and the descending ovum can never meet. Sterilization of the male aims at interrupting the continuity of the vas defferens on either side, so that spermatozoa formed by the testicles do not have an egress to the outside and the ejaculate is devoid of spermatozoa; later on the function of producing sperms by the testes is lost, although they continue their hormonal function of producing testosterone, the male hormone responsible for libido and sexual vigour , It does not entail castration, which means removal of the testes (or the ovaries in the female) .

As a surgical procedure, sterilization cannot be described per se as religiously permitted or prohibited, for this would depend on the application rather than the operation, The decision to carry out this operation, however, should not be taken lightly, for although technically easy, the religious implications can be very serious. The gravity of the decision is realized if we remember that the five basic goals of Islamic law are the preservation of self, religion, mind, property and procreation. In the scale of compensations to be paid as ransom for damages resulting in loss of life or of body members and/or functions, the ransom paid for causing loss of the procreative function is equal to that for loss of life.

When performed for a clear medical indication, sterilization is not only permissible but might be mandatory .If an incurable condition of the mother makes a further pregnancy hazardous to her health or life, then she should be offered the option of sterilization, especially if other contraceptive methods are not acceptable, suitable or reliable. Fear of transmission of hereditary disease to the progeny is also a valid indication. This is quite consistent with the Islamic rule of "repelling harm".

The permissibility of contraception is no,t conditioned with a time limit, and sterilization is merely contraception for good. When practised for non-medical indica- tions, however, there is no rule of thumb to be applied. Careful balance has to be made in each indiv.idual case between the pros and cons, but always with full heed to the seriousness of the decision from the religious as well as the human point of view. Permission to sterilization is not absolute, and Islamically the doctor should choose what is best for his or her patient, not what is second best. Certain guidelines should influence the decision making, such as:

( 1) Sterilization should be the outcome of voluntary , enlightened and free consent of both spouses. No government policy should pressure people into sterilization or tempt them to it by attaching money or other incentives. ..for this exploitation of need and poverty is amongst the worst kinds of pressure. Procreation is a basic human right and one of the individual freedoms. The fact that scientific and other agencies in countries where individuality is overemphasized, are seen to encourage an opposite policy of authoritarianism in other countries, the double standard in regard- ing individual rights and freedoms, are, in the long run, conducive of in- justice, bitterness and divisiveness. Expediency should not override principle.

(2) The decision on sterilization should be considered an ultimate decision. Advances in techniques of sterilization and of its reversal do not mean that reversal can be guaranteed. We are aware of practices luring people into sterilization upon the sure promise of reversal if the patient changes her (or his) opinion. This is not honest practice. Besides, the fees of reversal operations should be declared to the patient before and not after, sterilization. As a matter of fact the real impetus for perfecting reversal surgery , that is belated change of opinion, is in itself an admission of a faulty decision on sterilization in the first instance. Few patients in the practice of the gynaecologist are more miserable than women who decided on sterilization and underwent it at a time when they felt quite confident about their decision, and then something happened that made them seek to get pregnant again but without success inspite of repeated surgical attempts, and every gynaecologist must have seen them time and again. Perhaps in-vitro-fertilization may provide an option to address this problem, but is this a really reliable solution? The answer is no, for the success rate of in-vitro-fertilization in terms of a viable pregnancy still revolves around the twenty percent mark. These patients with previously normal fertility are the more miserable because they know that they lost something they already had; they had not been infertile seeking treatment but then they lost their fertility at their own hands and iatrogenically at the hands of their doctors .

With the possibility of loss of children by accidents of fate, or the possibility of the youngish spouse getting divorced or widowed and remar- ried and desirous of getting pregnant in her new family situation, it should be a counsel of wisdom to resort to some form of reversible contraception rather than sterilization as a means of family limitation. The availability of suitable reliable contraception should make sterilization superfluous in the majority of cases.

The situation is perhaps a little more flexible in the elderly patient who has achieved or exceeded her "feasible" family size. The elderly does not have much of an obstetric future to sacrifice anyway, as fertility naturally dwindles with advancing years, with concomitant increased libility to the hazards of high parity for the mother and chromosomal nondisjunction syndromes affecting the fetus. It should be remembered that what we I refer to as' 'feasible' , family size is more socially than medically defined. It might be one or two children for an Indian but six to eight for an Arab, and this is apart from individual family predelictions. During an international conference on contraception a few years ago, a delegate from Egypt pointed out that in his series of sterilization the average patient age was thirty four years and the average number of children was 4.1. Commenting, a French delegate was really hot under the collar as he pounded the table with his fist shouting in an authoritarian way: ' 'This means that we have to be more aggressive, sterilizing more and more women at a younger , and younger age with fewer and fewer children. To me this sounded both amazing and horrifying. From within the captivity of an obsession, medical people sometimes miss the point that their ultimate goal is to end up with happy and not miserable or remorseful clients. At another conference, a colleague from India described how in his set-up the operation of sterilization was carried out by trained paramedical personnel under local anaesthetic, on an ordinary kitchen table, cleaning the instruments between operations with ordinary boiling water, so as to be able to cope with the long queu of women lining outside the room to get the operation performed. At the time when medical liability and the cost of practice insurance in America were soaring up, American colleagues enthusiastically applauded the achievements of the Indian colleague and commended them frantically. Two standards of medical practice seemed to aquire full approval, as long as each was targeted to its respective category of people. To us this is certainly unprofessional, unethical and certainly non-Islamic.

(3) Wholesale sterilization should be avoided, whether to curb population growth or to experiment with new techniques. Individualization is absolutely necessary , and full counsel should be given to every patient (or every couple) individually, without attempt to play down the possible sequelae and implications of sterilization. Consent should be really and honestly informed and free. The choice of the patient should not be binding to the doctor, and when the young patient with low or no parity opts for sterilization then it is the doctor's right to decline if he or she do not feel that this is in the best interests of the patient. Needless to say, if Islamic standards are to be observed, then the doctor should be known to believe in Islam, abide by its regulations and keen to heed its standards.

In a properly Islamic practice, sterilization is an operation that is usually discouraged unless the medical indication is clear or the nonmedical indication carefully appraised. Financial gains should not tempt the doctor to compromise. Nor should the decision be left for junior medical staff eager to gain surgical experience. Mature opinion, preferrably in consultation, should be sought for every case.
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