The Need for Islamic Ethics in Medicine

Shaykh Mateen A. Khan, MD

As new diseases and treatment modalities arise, health professionals and patients increasingly find themselves facing dilemmas – ranging from birth defects to end-of-life care – that are as much scientific as they are moral. Medicine, as a field, requires a strong ethical directive. However, personal experience and historical references testify to the fact that human intellect alone is often incapable of reaching objective ethical standards or does so in a contradictory manner. More than just outlining the permissible (halāl) and the impermissible (harām), Islam provides the Believer with a worldview and wide-ranging guidance – a guidance not only in our personal lives, but in our professional lives. Not only in our health, but also in our sickness. Similarly, we have come to appreciate in modern Medicine that a holistic approach to patient-care is imperative. We are so much more than biology. With an ethics-based approach, the Muslim health professional can tread a path of greater clarity and purpose.

In Medicine, there is a higher purpose for the student of ethics. Health professionals are honored as agents of Allah as they seek outpatient ease and treatment. The Prophet ﷺ was once asked if there was benefit in Medicine. He replied, “The One who allowed the disease [also] sent the cure.” The cure is from Allah, but its means is the practitioner. Implicitly, in these words, and explicitly in prophetic actions, patients are directed to seek out medical expertise with some Shari`ah rulings predicated on the opinion of a capable medical expert. Their responsibility is to seek out expertise, our responsibility is to serve as the conduit to divine mercy. If we align our intentions properly, we are honored by Allah in this world and benefit ourselves greatly in the Hereafter. The Prophet ﷺ also said, “He who alleviates the suffering of a brother out of the sufferings of the world, Allah would alleviate his suffering from the sufferings of the Day of Resurrection.” This is evidenced in the statements of scholarly greats such as Imam al-Shāfi`ī, who said, “I do not know of any science more noble after the sciences of the permissible and the impermissible than Medicine,” and the great number of Islamic scholar-physicians such as Shaykh Rashīd Ahmad Gangohī. Since then, the two fields have diverged due to the tremendous knowledge required, but both experts of Islamic and medical sciences retain a need to learn Islamic medical ethics.

As health professionals, knowing and understanding Islamic medical ethics fulfills a personal need. It removes the burden, guilt, and anxiety that often accompanies moral decisions dealing with life and death issues. Studies suggest that by practicing Medicine with a clear moral compass “physicians, other healthcare professionals, and healthcare organizations also potentially benefit, but not only because of the satisfaction of conducting themselves in a professionally ethical manner. These groups will benefit by reducing burnout and its personal and professional consequences if attention to health care ethics and values reduces the realities or the perceptions of “incongruence” in these areas between healthcare professionals and the healthcare organizations with which they are associated.”[1]

However, beyond personal contentment, the Muslim health practitioner must also keep the broader good in mind. Indeed, the AMA code of medical ethics concurs, “As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.” An Islamic ethics-based approach to Medicine promises best outcomes spiritually and physically for the individual practitioner, his or her patients, and the community at large. Often, the layperson finds themselves at the mercy of a medical system that is constantly changing, ambiguous or contrary to Islamic morality. Decisions on seemingly impermissible medications to surrogacy can be a great source of anxiety and stress. Increasingly, the Muslim layperson when confronted with such ambiguity or unease in the modern ethical system is looking to their religion for guidance. The characteristic of the All-Wise (Al-Hakīm) means that He has directed us towards our own benefit. Often, the patient will first look to health practitioners for an ethical answer based in religion, and so, it is imperative that we be familiar with the topic. The burden falls upon us to provide initial direction and in complex situations, coordinate a team-approach involving medical and Islamic legal experts.

Every Muslim practitioner should consider it incumbent to learn a certain degree of Islamic medical ethics. Indeed, behind every creation lies the mark of the Creator. He has not left us without guidance. One must only seek it out. Doing so provides ethical direction and beneficial purpose for the health practitioner, patient, and community at-large.

O Allah! The Lord of the people, the Remover of trouble! Heal, for You are the Healer. None brings about healing but You; a healing that will leave behind no ailment.[2]

[1] Mayo Clin Proc. 2011 May; 86(5): 421–424.

[2] Sahih al-Bukhari 5742

A Sunnah-Minded Approach to Medicine for the Practitioner

Shaykh Mateen A. Khan, MD

Like everything in Islam, the philosophy of practice for a Muslim health practitioner starts with the kalimah. Bear with me on this. The first half of the kalimah explains the reason for our being here. There is no deity other than Allah. As such, there is no creator or sustainer other than Him. We and everyone else exist simply because He willed us to exist. This is not a matter of debate or choice. Rather, it is a reality. The sooner you accept this reality, the sooner you can move forward in life. How should you live so that you’re maximizing your life’s potential? The second half of the kalimah answers this question. Muhammad ﷺ is Allah’s messenger. The way to maximize your life’s potential is to follow the prophetic path as laid out in revelation. When examining the main themes and purposes of revelation, we find one of life’s obligations is the protection and preservation of life itself. The Qur’an states:

وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِ ۛ وَأَحْسِنُوا ۛ إِنَّ اللَّـهَ يُحِبُّ الْمُحْسِنِينَ

Do not throw yourselves into destruction and do good. Indeed, Allah loves those who do good.

Life is precious and calls for good actions as a means of Allah’s love. After examining the primary sources of Islam—the Qur’an, Sunnah, and scholarly consensus, Islamic scholars determined five things to be the purpose of religion (maqāsid al-sharī`ah). From the five maqāsid al-sharī`ah, we find three of them to be directly related to health and of great importance to the health practitioner: preservation of life, mind and mental health, and offspring.1

In numerous narrations, the Prophet ﷺ placed great importance on health.

أَنَّ رَسُولَ اللهِ صلى الله عليه وسلم كَانَ يُكْثِرُ أَنْ يَدْعُوَ‏:‏ اللَّهُمَّ إِنِّي أَسْأَلُكَ الصِّحَّةَ، وَالْعِفَّةَ، وَالأَمَانَةَ، وَحُسْنَ الْخُلُقِ، وَالرِّضَا بِالْقَدَرِ

The Messenger of Allah ﷺ used to supplicate, “Oh Allah, I ask You for health, restraint, trustworthiness, good character, and contentment with the decree.” Al-Adab al-Mufrad

لاَ بَأْسَ بِالْغِنَى لِمَنِ اتَّقَى وَالصِّحَّةُ لِمَنِ اتَّقَى خَيْرٌ مِنَ الْغِنَى وَطِيبُ النَّفْسِ مِنَ النِّعَمِ

“There is nothing wrong with being rich for one who has piety, but good health for one who has piety is better than riches, and being of good cheer is a blessing.” Ibn Mājah

The Sunnah is a reflection and exposition of the Qur’an. As such, it is no surprise to find the Qur’anic command of encouraging the good and prohibiting the evil reflected in the prophetic guidance of preservation of health and prevention of sickness. This applies both to the individual as well as the public.

At the individual level, the prophetic path entails personal hygiene in the form of bathing, cleanliness after using the bathroom, brushing the teeth and tongue, trimming and removing certain hair, trimming the nails, keeping your clothing and personal spaces clean, etc. Any Muslim will immediately realize that there is an overlap between our physical health and worship. All the aforementioned practices, if done with the intent of obeying and emulating the Prophet ﷺ, are credited as acts of divine obedience and worship entailing divine pleasure and reward. Not mentioned above are the obligatory rituals of washing—wuḍu and ghusl—that fall directly into the realm of worship as precursors to prayer and Qur’an recitation. Similarly, preservation and promotion of mental health is found in apparent ritual actions like Allah’s remembrance (al-zikr), Qur’an recitation, and in the prayer (al-ṣalāḥ).2 Although, their primary benefit is spiritual, their health benefits are obvious.

At the public level, the path calls for removal of filth from spaces, prohibition of urinating in areas frequented by people or used by them like water sources, cautious separation of animal vectors from humans, encouraging physical activities like swimming, archery, and horse riding, and making places and times for relaxation. Communicable diseases in the form of outbreaks are regulated using quarantines.3 Although also beneficial on the individual level, prohibition of intoxicants and harmful substances has clear public health benefits in creating a productive, stable, and viable community. Truly, the Muhammadan path is not a path of pointless rituals benefiting neither the Creator nor the creation.

It’s very important that we realize the point of these practices was not primarily to bring a life of ease in the world. The Prophet’s ﷺ purpose was not to be a master health practitioner nor a public health policy-maker way ahead of his time. Rather, these practices bring spiritual benefits that are less visible to the naked eye and untrained mind. His ﷺ purpose was to show us a path that connects us back to our Creator and allows us to comprehensively see the world with ourselves included—the physical and the meta-physical, the seen and the unseen, the rational and the spiritual.

Let’s continue further with the relationship of treatment and worship as it pertains to us. A man asked the Prophet ﷺ, “Should we not seek treatment?” In answer, he ﷺ turned towards the group before him and called on them as worshipers and servants of Allah by saying:

“O worshipers and servants of Allah (Yā `Ibād Allah)! Seek treatment because Allah has not placed a single ailment without also placing a cure…”4

This command is not obligatory in all situations. Nonetheless, it is a call upon us as worshipers to deal with our illnesses, anxieties, and health problems with a particular mindset. Seek treatment from Allah as a means of closeness to Him rather than just another biological hurdle in life to overcome. It is also an indication to health practitioners to specialize in their respective fields to best help these worshipers. As mentioned above, one of the purposes of the Sharī`ah is preservation of health entailing that when one becomes ill, he or she should seek out a cure. Imam al-Dhahabī wrote, “Medical treatment is Sunnah because the Prophet ﷺ did it and ordered that it be done.”5 I would take this one step further and add that treating an ailment as a trained practitioner is itself a Sunnah as he ﷺ treated people and prescribed medications himself.6 Including an intention to obey and emulate the Prophet ﷺ in this respect can be a source of divine pleasure and reward. The Prophet’s ﷺ command, “Give help to the troubled,”7 and the Qur’anic injunction, “If you help [the deen and people of Allah], He will help you”8 should always echo in our minds.

When we understand this about Islam, we will cease to be surprised by its teachings. Did we expect something less from Allah and His messenger ﷺ? Instead, we will be surprised at how we have practiced for so long without our practice advancing our progress on the prophetic path. Muslim health practitioners will need to be at the forefront of advocating and participating in personal and public health. Not only because they are purveyors of up-to-date, evidence-based health practices, but primarily because they strive to incorporate a philosophy that draws from the unseen (al-ghayb), benefits us spiritually by emulating the Prophet ﷺ, and brings us closer to Allah.

———————

In order of importance, the five are preservation of religion, life, mind, offspring, and property.

Although with weakness in transmission, it has been reported that in the ṣalāḥ, there is a cure. Ibn Mājah 3458

The Prophet ﷺ said, “If you hear of an outbreak of plague in a land, do not enter it; but if the plague breaks out in a place while you are in it, do not leave that place.” Ṣaḥīḥ al-Bukhārī 5728

Sunan al-Tirmidhī 2038

Al-Ṭibb al-Nabawī li al-Dhahabī

Jābir said, “The Prophet ﷺ cauterized Sa`d ibn Mu`ādh from the wound of an arrow.” Abū Dāwūd 3866

Ṣaḥīḥ al-Bukhārī 1445, Sunan Abū Dāwūd 4817, and others

Surah Muḥammad 7

Medication with Unlawful Ingredients

 

Bismihi Ta’ala

Introduction

There are many scenarios in which a Muslim patient may be advised to take medication that is comprised of unlawful substances (“haram medication”).  Is a Muslim allowed to use medication that would be considered unlawful to consume or take benefit of by Islamic law?  If so, in what circumstances?  This article discusses the issue of haram medication and its related rulings based on principles that scholars have derived from the Quran and Sunnah, and provides examples of how these principles can be applied to modern medications and treatments. 

Ahadith that Discuss Haram Medication

There are numerous ahadith that discuss the topic of medicine, and many of these ahadith discuss the use of haram medication.  Some ahadith mention examples of things that are normally prohibited to consume being used as medicine, pointing towards the permissibility of using haram medication:

Anas (r.a.) said, “Some people of `Ukl or `Uraina tribe came to Medina and its climate did not suit them. So the Prophet (ﷺ) ordered them to go to the herd of (Milch) camels and to drink their milk and urine (as a medicine). (Bukhari)

عن أنس بن مالك رضي الله عنه قال: قدم ناس من عُكْلٍ أو عُرَيْنَةَ، فاجتوَوُوا المدينة، فأمرهم النبي -صلى الله عليه وسلم- بلِقَاحٍ، وأن يشربوا من أبوالها وألبانها

Anas (r.a.) states, “The Prophet (ﷺ) allowed Az-Zubair and `Abdur-Rahman to wear silk because they were suffering from an itch.” (Bukhari)

عَنْ أَنَسٍ، قَالَ رَخَّصَ النَّبِيُّ صلى الله عليه وسلم لِلزُّبَيْرِ وَعَبْدِ الرَّحْمَنِ فِي لُبْسِ الْحَرِيرِ لِحِكَّةٍ بِهِمَا‏.‏

‘Urfajah bin As’ad (r.a.) said, “My nose was severed on the Day of Al-Kulab during Jahiliyyah. So I got a nose of silver which caused an infection for me, so the Messenger of Allah (ﷺ) ordered me to get a node made of gold.” (Tirmidhi)

عَنْ عَرْفَجَةَ بْنِ أَسْعَدَ، قَالَ أُصِيبَ أَنْفِي يَوْمَ الْكُلاَبِ فِي الْجَاهِلِيَّةِ فَاتَّخَذْتُ أَنْفًا مِنْ وَرِقٍ فَأَنْتَنَ عَلَىَّ فَأَمَرَنِي رَسُولُ اللَّهِ صلى الله عليه وسلم أَنْ أَتَّخِذَ أَنْفًا مِنْ ذَهَبٍ ‏.

‏Normally, drinking urine is prohibited, just as wearing silk or gold is prohibited for men. Their use for medicinal purposes in the above ahadith indicate that haram medication could be permissible to use. But there there are other ahadith that mention the impermissibility of using haram medication:

Abu ad-Darda (r.a.) said, “The Prophet (ﷺ) said: Allah has sent down both the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically, but use nothing unlawful.” (Abu Dawud)

عَنْ أَبِي الدَّرْدَاءِ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ “‏ إِنَّ اللَّهَ أَنْزَلَ الدَّاءَ وَالدَّوَاءَ وَجَعَلَ لِكُلِّ دَاءٍ دَوَاءً فَتَدَاوَوْا وَلاَ تَدَاوَوْا بِحَرَامٍ ‏

Abu Hurayrah (r.a) said, “The Messenger of Allah (ﷺ) prohibited unclean medicine.” (Abu Dawud)

عَنْ أَبِي هُرَيْرَةَ، قَالَ نَهَى رَسُولُ اللَّهِ صلى الله عليه وسلم عَنِ الدَّوَاءِ الْخَبِيثِ

Tariq ibn Suwayd or Suwayd ibn Tariq (r.a) asked the Prophet (ﷺ) about wine, but he forbade it. He again asked him, but he forbade him. He said to him: Prophet of Allah, it is a medicine. The Prophet (ﷺ) said: No it is a disease.” (Abu Dawud)

عَنْ عَلْقَمَةَ بْنِ وَائِلٍ، عَنْ أَبِيهِ، ذَكَرَ طَارِقَ بْنَ سُوَيْدٍ أَوْ سُوَيْدَ بْنَ طَارِقٍ سَأَلَ النَّبِيَّ صلى الله عليه وسلم عَنِ الْخَمْرِ فَنَهَاهُ ثُمَّ سَأَلَهُ فَنَهَاهُ فَقَالَ لَهُ يَا نَبِيَّ اللَّهِ إِنَّهَا دَوَاءٌ ‏.‏ قَالَ النَّبِيُّ صلى الله عليه وسلم ‏ “‏ لاَ وَلَكِنَّهَا دَاءٌ ‏”‏ ‏.‏

Umm Salamah said, “The Prophet (ﷺ) said: “Verily, Allah has not made your cure in that which he has forbidden for you” (ibn Hibban)

عن أم سلمة، أن النبي صلى الله عليه وسلم قال: ” إن الله لم يجعل شفاءكم فيما حرم عليكم

The above ahadith seem to point towards different rulings regarding the use of haram medications.  Based on this, some scholars state that it is impermissible to use haram medication, while others state that it is permissible in certain situations.  In addition to these ahadith, the scholars have also applied the following verse of the Quran to the use of haram medication:

إِنَّمَا حَرَّمَ عَلَيْكُمُ الْمَيْتَةَ وَالدَّمَ وَلَحْمَ الْخِنزِيرِ وَمَا أُهِلَّ بِهِ لِغَيْرِ اللّهِ فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلاَ عَادٍ فَلا إِثْمَ عَلَيْهِ إِنَّ اللّهَ غَفُورٌ رَّحِيم

“He has only prohibited for you carrion, blood, the flesh of swine and that upon which a name of someone other than “Allah” has been invoked. Then, whoever is compelled by necessity, neither seeking pleasure nor transgressing, there is no sin on him. Verily, Allah is Most-Forgiving, Very-Merciful” (Surah al-Baqarah, 173)

This verse of the Quran explains that in situations of necessity, a person would not be sinful for consuming that which is normally prohibited.  Scholars of tafsir explain that this pertains to cases of extreme hunger or thirst, when there is a danger to one’s life. In this case, he may consume that which is unlawful to the extent of the need, and only to that extent.  Scholars have further explained that using haram medicine, either externally or internally, can fall under this category and can be used when necessity exists.  Just as with thirst and hunger, this would apply when one’s life would be in danger without its use as medicine, and a lawful alternative is not available.  And just as with haram food in the case of extreme hunger, it should only be used to the extent of the need[1].

Rulings Pertaining to the Use of Haram Medication

Scholars that consider the use of haram medications to be permissible in certain situations explain that the ahadith that indicate the impermissibility of using haram medication refer to cases in which a halal alternative is available.  In addition, they can refer to cases in which there is doubt that the haram medication is a cure for the illness[2].  

For example, scholars explain that the hadith mentioned above, “verily, Allah has not made your cure in that which he has made forbidden for you”, pertains to cases in which the haram medicine is not actually a cure for the illness. As for things in which there is a cure, then there is no harm in it, i.e. it would not be forbidden for you in that case.  This is similar to the case of drinking alcohol for the thirsty person, as it is considered permissible for him to drink the alcohol out of necessity (to the extent needed for survival).[3]

This hadith can also pertain to using haram medicine when one is aware of a halal alternative, because in that case one could suffice with that which is permissible.  However, when there is no alternative cure from halal medicine, it can be said that the impermissibility of using the haram medicine has been removed by the presence of necessity. So therefore, one would not actually be seeking a cure with something that is haram, because the previously haram medicine would actually be permissible in such a situation[4]

Based on this understanding, the ahadith that indicate the permissibility of using haram medication refer to cases in which a halal alternative is not available, and in which there is no doubt that the haram medication is a cure for the illness.  If these conditions have been met, then the use of the haram medication would be permissible.  Amongst Hanafi scholars, this is the relied upon opinion, and the fatwa has been given on this ruling[5]

Regarding the condition of having no doubt that the medication is a cure for the particular illness, this does not mean that the medication has to be effective 100% of the time.  It means that there is no doubt that the haram medication is an appropriate treatment for the illness, and can be expected to bring a cure.  For example, a doctor may prescribe an antibiotic for a bacterial infection, but there is a chance that the bacteria that is causing the infection is resistant to the antibiotic, and therefore the infection would not be cured by that antibiotic.  Similarly, a doctor may prescribe a medication for the treatment of hypertension, but the patient’s blood pressure may remain elevated in certain cases.  In both examples, there was no doubt that the medication that was prescribed was an appropriate treatment for the illness. If  the medication was haram but no halal alternative was available, it would still have been considered permissible for the patient to use. 

In centuries-old books of Islamic law, scholars have mentioned various examples of haram medicine including wine, urine, blood, carrion and a woman’s breast milk.  Some other medications were considered to be disliked (makruh), such as donkey’s milk, donkey’s meat, cow’s urine, horse’s meat, and pigeon droppings.[6]   Based on the principles discussed above, the scholars have explained that the haram medications in these examples would only be permissible to use when for a Muslim patient when he is sure that the haram medication is a cure for his disease and there is no halal alternative.  The scholars mention that if an experienced doctor tells him to take this medication, then it satisfies the condition of having certainty that a cure lies in the medication[7].

The haram medications mentioned in these texts may be centuries-old, but modern medicine often uses medications and treatments from similar prohibited sources.  For example, medications may be derived from animals (carrion), pigs, human blood, human body parts, and alcohol.  Therefore, the same principles that were applied to the haram medications mentioned in these texts can be applied to the many haram medications and treatments that exist today.   Some examples follow:

Medications in Capsule Form

Doctors may prescribe medication that is contained in a capsule. Capsules commonly contain gelatin, which scholars consider impermissible to consume unless it is from halal sources (such as fish or halal animals).  Based on this, most medications in capsule form would be considered haram consume. Therefore, based on the principles discussed above, when a Muslim patient is prescribed a medication in capsule form, the following needs to be considered:

  • Is he certain that this medicine can provide a cure? 
  • Is there a halal alternative available?

If he has been prescribed the medication by a trained and experienced doctor, then we can consider the first condition to have been met.  However, regarding the second condition, he may need to ask his doctor if there are alternative treatments that do not come in capsule form.  If the doctor advises that there are alternatives, then it would not be permissible for the patient to consume the capsule if it is from haram sources (such as animal-derived gelatin).

One common scenario would be the use of antibiotics to treat an infection.  For example, a patient with a throat infection may be prescribed the antibiotic clindamycin, which comes in capsule form[8].  However, in most cases the same infection can be treated with an antibiotic that comes in tablet form, such as amoxicillin-clavulanate.   There are exceptions, such as cases in which the bacteria causing the infection is known to be resistant to a particular type of antibiotic.  Therefore, although the patient cannot decide to switch the antibiotic on his own, it is necessary for him to inform the doctor that he needs to avoid medications in capsule form unless there is no acceptable alternative. 

For some medications, both capsule and tablet forms exist.  The commonly used antibiotic doxycycline is an example of this[9].  The capsule form contains gelatin, so if the tablet form is equally effective for treating a particular infection, then it would not be permissible for the Muslim patient to use the capsule form. On the other hand, certain medications in capsule form, such as some extended-release medications, may act differently in their tablet forms, so it is necessary for the Muslim patient to be aware of this and to discuss treatment options with his doctor prior to taking the capsule.  

If a Muslim ends up consuming the capsule medication when a halal alternative in tablet form was available, then this would not satisfy the requirements mentioned above for being allowed to consume a medication with a haram ingredient (the gelatin in the capsule in this case). 

Meningitis Vaccines with Pork Ingredients

The administration of meningitis vaccines are required in numerous situations, including for those who plan to perform hajj or umrah.  Most formulations of this vaccine contain pork-derived ingredients.  Vaccines would not even fall under the discussion of the use of haram medications discussed above, because they are not a cure for a disease, but rather a tool to prevent future infection.  As mentioned above, a Muslim may use a medication that contains a haram ingredient when he is certain that it contains a cure for a disease, and no halal alternative is available.  In this case, he is not infected by meningitis, so no cure is even needed. Therefore, if the vaccine contains a haram ingredient, then it cannot be used unless necessary.

Vaccines such as those used for preventing meningitis may be necessary in certain cases due to legal requirements, such as travel or when a student is living in a college dormitory in the USA.  In these situations, scholars may state that it is permissible to use the vaccines with haram ingredients if no halal alternatives are available, so a Muslim who is required to receive such a vaccine should inquire about its permissibility from a scholar.  But if a halal alternative does exist, then the haram vaccine would no longer be necessary to use. For example, in the case of meningitis vaccines, one of the more recent formulations, manufactured under the brand-name Menveo, does not contain pork derived ingredients[10].  Therefore, a Muslim who is required to receive a meningitis vaccine should discuss the availability of non-porcine vaccines such as this one.  If the pork-free alternative is available for his use, then it would not be permissible to use the vaccines that contain pork.

Mouthwash Containing Alcohol

The consumption of khamr (alcohol derived from grapes or dates) is considered haram , even in miniscule amounts[11].  However, even for other types of alcohol such as ethanol, it is considered haram to consume drinks that are intoxicating.  As stated above, alcohol can be used in medicine when certain conditions are met, such as being advised to use that medicine by a doctor when no alternative exists. 

For dental health, people often purchase mouthwash, and many formulations contain alcohol.  Some may contain miniscule amounts of synthetic alcohol and are not intoxicating, and are therefore considered permissible to use by scholars.  However, others contain large amounts of ethanol, up to 26.9%, more than 5 times the ethanol concentration in beer.  Consumption of even a small amount of such a mouthwash could cause intoxication.[12].  Therefore, this would be classified as a medication that is haram to use. 

If a Muslim buys mouthwash over-the-counter at his own direction just for freshening his breath or cleaning his teeth without being instructed to do so by a doctor or dentist, then it would not be permissible to use a mouthwash that could be intoxicating.  Many alcohol-free alternatives would be available for him to purchase.  On the other hand, if for example this Muslim has an oral or dental disease and was prescribed a mouthwash that contains alcohol, then the same conditions discussed above would need to be met for him to be allowed to use it.  Is its use necessary for the cure of his disease? Is there a halal alternative available?  Does it contain a potentially intoxicating level of alcohol? Prior to using this mouthwash that has been prescribed, he should discuss this with the prescribing doctor or dentist.  If there are halal alternatives available for the treatment of his condition, then this mouthwash would not be considered permissible to use as medicine if it is potentially intoxicating. 

Blood Transfusions

According to the shariah, blood is considered to be impure once it exits the body. Therefore, scholars consider it to be in the same category as other types of impure substances in being considered impermissible to use for medicinal purposes[13].   Just as with other types of haram medication, blood transfusions can only be used when a doctor states that there is a cure in it, and no permissible alternative is available.  Examples include cases of severe anemia with a dangerously low hemoglobin level and rapid blood loss due to bleeding[14].  However, in many cases, alternative treatments that do not require blood transfusion can be used, such as iron supplementation in cases of iron deficiency, and medications that stimulate blood cell production in the bone marrow, such as epoetin alfa[15].  Therefore, when a blood transfusion is being considered for a Muslim patient, it would not be considered permissible if the prescribing doctor could expect a cure from one of these alternative treatments.   As in the examples mentioned above, the Muslim patient should ask his doctor if other effective treatments are available before proceeding with the transfusion.

A Further Point of Research

It should be noted that certain materials undergo a complete chemical metamorphosis during the manufacturing process of modern medications.  Scholars explain that when this occurs, the material would be lawful to consume even if it was originally from an haram source, due to the complete transformation that has occurred[16].  Therefore, this could make some medications that contain ingredients sourced from haram sources halal to consume.  However, this requires research into the manufacturing process of the particular medication and cannot be assumed to occur without verification and investigation.   Most contemporary scholars do not consider the examples of gelatin and porcine vaccines mentioned above to fall under this category. 

Conclusion

According to the shariah, haram medication can only be used when certain conditions are met.  A Muslim patient can only use haram medication, both internally or externally, when instructed to do so by an experienced doctor (thereby making him certain that a cure can be expected from the medication), and when an alternative halal medication is not available.  Therefore, Muslim patients need to be aware that haram materials need to be avoided in medications just as haram ingredients need to avoided in food.  It is advised that they seek treatment from an experienced Muslim doctor who is aware of these issues when possible, and if it is not possible, then they must discuss the availability of halal treatment options prior to taking any haram medication. 

And Allah knows best

Mufti Adil Farooki, MD


[1] Maariful Quran, English Translation by Prof. Muhammad Hasan Askari & Prof. Muhammad Shamim (1/436)

[2]  البحر الرائق شرح كنز الدقائق ومنحة الخالق وتكملة الطوري (1/ 122)

[3] البحر الرائق شرح كنز الدقائق ومنحة الخالق وتكملة الطوري (1/ 122)

[4]  الدر المختار وحاشية ابن عابدين (رد المحتار) – دار الفكر-بيروت  (5/ 228)

[5]  الدر المختار وحاشية ابن عابدين (رد المحتار) – دار الفكر-بيروت  (1/210)

[6] الفتاوى الهندية (5/355)

[7] الفتاوى الهندية (5/355)

[8] Gerber MA, Baltimore RS, Eaton CB, et al. Circulation 2009; 119:1541.

[9] https://www.drugs.com/doxycycline.html

[10] https://gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Menveo/pdf/MENVEO.PDF

[11](1/204) مختصر القدوري

[12] Shulman, Pediatric Dentistry – 19:6, 199

[13](43/ 484) الفتاوى الهندية

[14] Wang JK, Klein HG. Vox Sang 2010; 98:2.

[15] Rogers DM, Crookston KP. Transfusion 2006; 46:1471.

[16] البرهاني في الفقه النعماني (1/ 206)