A comparative study of the foundations of medical ethics in secular and islamic thought

The title is an article by Mohsen Rezaei Aderyani and Mehrzad Kiani published in “Journal for the Study of Religions and Ideologies”, Vol. 14, No. 40 (2015). The following is the article.

Abstract

The principles of medical ethics, common as they are in the world at the present time, have been formed in the context of Western secular communities; consequently, secular principles and values are inevitably manifested in all corners of medical ethics. Medical ethics is at its infancy in Iran. In order to incorporate medical ethics into the country’s health system, either the same thoughts, principles, rules, and codes of Western communities should be translated and taught across the country, or else, if the principles and values and consequently the prominent moral rules and codes of Western medical ethics are not consistent with the culture, customs, and religion of our country, then new principles and values should be formulated that are more in harmony with our society. According to the available literature in Iran, the four principles proposed by Beauchamp and Childress do not contradict the Islamic-Iranian culture and can thus be generally applied in the mentioned context. However, the application of these four principles and their derivatives (e.g. regulations and codes) requires careful examination and adaptation to Islamic ethics. A comparison of the ontological, anthropological and epistemological foundations of secular and Islamic attitudes shows the differences between these two attitudes to be deep-rooted. “Rationalism,” “scientism,” and “humanism” are the main foundations of secularism, whereas “Godcentrism,” “pure human servitude to God,” the belief in “returning of humans to God,” “resurrection day,” and also human’s accountability to God are all fundamental beliefs and principles of religion for Muslims of all cults and sects. It can thus be concluded that the principles of secularist thought are different from and to some extent inconsistent with the principles of Islam. Instructions derived from secular thought can therefore not be implemented in an Islamic community; rather, these communities should adopt Islamic foundations as the source for the norms and standards of their medical ethics. The capacities of religious thought (in particular, Islam) make possible the formation of an ethical system consistent with Islamic Ummah.

Key Words: Medical Ethics, Secular Thought, Religious Thought, Foundations, Muslim

Introduction

Medical knowledge has always been intertwined with human life.1 Human life in this world is not and will not be separated from disease and pain and their treatment. Just as medical knowledge has always been a part of humans’ daily life, debates about medical ethics are also heated. Secular ethics emerged during the Renaissance and the beginning of the development of the West.2 Medical ethics were brought to the fore from the mid twentieth century after the event of certain unethical behaviors on the part of physicians (in particular, tests conducted on prisoners of war during the World War II). With the rise of individual rights and freedoms and given the modern philosophical attitudes, the principles of medical ethics were developed based on the philosophical attitudes of secular ideology.3 As the principles of bioethics and medical ethics are formed in a philosophical context,4 many discussions about medical ethics and its different branches are being presented in Western communities in the context of the philosophical foundations of the community and its various aspects. Although the principles of biomedical ethics appear to be general at first glance and to be acceptable from various perspectives, certain aspects of them are not reasonable according to some other societies. For example, M.S.T. Tai states that the Western principles of biomedical ethics are extrospective while the doctrines of Confucius are introspective. He further emphasizes the pivotal nature of the inner virtues of his acceptable ethics and believes any charter, principle, or law to be superficial without internal guidance. He then emphasizes another actuality; that is, the autonomy of the family against the individual in Eastern communities.5 The four principles of Beauchamp and Childress,6 however, remain fairly accommodating to the context of Islamic culture in Iran and are not in full contradiction with it.

In any healthcare setting, every patient is entitled to his “human dignity.” The same respect for dignity holds for every Muslim healthcare provider, who has to deal with all his patients as a servant to God’s servants, that is, rightly, justly, and with all his power, and who should try to treat the misfortunes of any of God’s servants regardless of their religion, race, age and gender to the best of his abilities. There is no confrontation between Islam and the West in this respect; yet, there remain cultural differences that are absolutely acceptable in “particular ethics”, and which do not negate “common morality”.

The attitude of mankind toward his surroundings, and more accurately, his worldview, thoroughly affect the various aspects of his life. A person’s worldview underlies all his or her decisions. In Monotheistic Worldview, Mortaza Motahari writes, “Religion and the philosophy of life are inevitably based on the belief in and the perception and assessment of existence and also on the interpretation and analysis of the world. The view of a school of thought about the world and the existence constitutes a ‘worldview’ … All religions, schools of thought and social philosophies rely on some kind of a worldview. The objectives a school offers and calls its followers to pursue, the ways that it determines the do’s and don’ts that it is composed of and the responsibilities that it creates for its followers all are the essential outcomes of the worldview it offers.”7 Worldview is a general, and in some cases, philosophical, view of mankind and his surrounding world that guides his life plan. The principles of ethics in the two schools of thought under study are examined from three aspects, namely, their ontological foundations, their perspective on humans (anthropology), and the components of their epistemological foundations.

Examining the foundations of secular ethics

The word “secular” has had several definitions in the course of its historical development. “A key refinement in [the] literature is the recognition of the diversity of expressions of secularism.”8 In the late third century, this word was used to describe those clergymen who left the seclusion of their monastic life and returned to the worldly life.9 It then came to be used to connote several different things, such that it is now difficult to provide an all-inclusive definition that encompasses its exclusive nature. We thus presume to presenting two modern definitions of the word. In Secularism in Christianity and Islam, the word is defined as the separation of religion from politics, government and community; that is, the idea that religion should disregard issues related to humans and the world such as economy, education, and laws, and instead engage in minor individual matters such as, prayer, marriage, divorce and burial.10 “It was also used to mean a life or a life-style that is at odds with God.”11 Another definition, which the authors believe to be superior to the others presented, is that a secular person is someone who is not interested in spiritual and religious matters and satisfies all his needs and desires through experimental sciences, the material world, and his own wisdom.12

The proposed definition is consistent with the definition provided in the Oxford dictionary, “‘secular’: unrelated to religious or spiritual issues; not bound by religious rules.”13 In practice, the institutionalization of this definition decreases the role of religion and leads to its absolute separation from the government, now overruled by secularism.14 “The Secular Society as a group committed to a just world order and moral program of individual action that would address human problems without the use of supernatural explanations.”15 This overview of secularism shows that secular thought encompasses any idea that takes the validity and authority of human wisdom in planning for the path of his life solely by himself and the rejects all else, including religion.16 “The individual[s] believed that a modern rational scientific age of enlightenment would replace religion as the basis for understanding and running the world. … A recent edition of Sociology of Religion highlights the debate over whether secularization is a decline in religiosity—whether individuals are religious—or it is a decline in religion’s influence in the public sphere, particularly on political and social institutions.”17

Ontological foundations

According to secular thought, the whole of existence is limited only to life in this world. “The consequence of this worldview was that explanations referring to forces outside of this world were constantly being laid aside.”18 “Translation into ‘worldly’ and ‘mundane’ and ‘belief in the authenticity of worldly affairs’ is related to the ontological origin of secularism formed by ignoring the unseen.”19 If the human intellect is the only possible way for gaining knowledge, that is, through the five senses, and for finding the origin and the creator of the world, then he can only explore things that are tangible; inevitably, no place remains for him except the material world and the things that are in it. In other words, “Definitely, the thoughts of dissidents and opponents of the Abrahamic prophets in past centuries have emerged in the West today and tried to link the root of ontology and the origin of science to matter and material affairs.”20 Secular thought holds that creatures have accidentally come into being without the interference of any creator and only gradually turned into their present existence through the evolution of matter from the elements of nature by a process called “natural selection.” Through time, the elements of nature have undergone processes that have turned them into the materials and organic molecules we see today. These processes first created protozoan organisms, then multicellular organisms, then animals, and finally human beings. Secular thought does not believe in supernatural creatures or creators or a supernatural will overseeing the process. Secular views about the end of life on this earth and the existence of another world and life after death are also in keeping with the idea of natural selection. Human experience does not contain accounts of return from the life after death and after the body’s decay; therefore, the existence of any such world cannot be verified by human experience. If the subject of the origin of the world and resurrection are raised within the context of rational inquiry, secular thought argues that these subjects have nothing to do with life in this world. “It is even possible that secular thought says behind this universe there is another world, and does not consider the whole subject in a materialistic manner, but believes that another world has nothing to do with man in this world.”21

Secular thought does not scrutinize what has been interpreted in Abrahamic religions as “resurrection” and life after death; rather, their views on this matter are limited to the development of the worldly life. Secular thought devotes all its power to man’s maximum enjoyment of his life, because when one’s life ends, everything is assumed to be over for him; nothing should be able to prevent humans from gaining benefits and pleasure from this present life.

When the entire human existence is limited to this world in secular thought, all efforts should be turned toward maximizing productivity in this world. “The modern secular state not only eliminated hierarchical social structure, but also rejected the spiritual and metaphysical framework upon which it was predicated. The focus became economy and work, and mathematical and abstract modes of operation became institutionalized even as “calculation” superseded divination.”22 The logical conclusion that can be drawn from this worldview is that humans should maximize their benefits and pleasure in this world by any means possible and should not tolerate any barriers against this end. Laws, ethics, human rights, even religion and the like should all serve mankind in maximizing their self-interest and pleasure in this world. In other words, these notions will be used insofar as they are effective in helping mankind reach his worldly goals, that is, greater benefit from life; and when these notions are themselves barriers against achieving this end, they will be removed by all means.

Anthropological foundations

The view of secular thought concerning humanity conforms to its view on the universe and its epistemological foundations. Man was created by the same process as other creatures, that is, evolution, and based on natural selection. By accepting the theory of natural selection, we should inevitably also accept that weak people are doomed to earlier death and elimination from the earth in the process of natural evolution. Consequently, all attempts at preserving the life of such individuals become unethical. Attempts at implementing the “rational utility” project in Nazi Germany based on Hegel’s thought exemplify the plausible outcomes of this way of thinking.23

In secular thought, man does not have a creator to be accountable to – no God to obey. There is no power superior to humans, who it sees as the center of existence: “secularism manifests the potency of human thought finally liberated and liberating, a demythologizing force that replaces God with Man, that sees human beings as the architects of their own destinies.”24 “Humanists believe that man’s perfection is achieved regarding other people and not God and ethics and acquiring the most good in the world is the highest purpose that should be followed by man.”25 This line of thinking holds humanity to be completely free and autonomous, whose freedom is limited by nothing -except by freedom itself.

This worldview presents human beings as “rational animals” whose distinction from other animals lies in their power to speak and think. In the human sciences, humans are viewed as living creatures that share many characteristics with other animals and yet are different from them in that they think and speak.26 Advances in human sciences over time, particularly over the last few centuries, have all been aimed at investigating man with regard to the stated aspects. When man’s authenticity lies in his physical body, then everything should serve to his welfare. The impressive advances in different fields of knowledge have made humans aware of their abilities more than ever before, and have led to the development of humanism as one of the bases of secular thought while also emphasizing the uniqueness of humans in the world.27 Consequently, all creatures are viewed as existing to serve humanity’s benefits. Humans, proud of their abilities and with no consideration for the future, exploited the natural world to their self-interest and did not take note of the damages their actions were causing their world as well as themselves. Then came a time when humans realized they were harming the planet, and so they started pondering these self-interested actions. Such harms and intrusions inflicted by humans on other creatures are perhaps the reason for the development of “bioethics.” Of the numerous dimensions of human existence, the tools of experience and sense can only represent the body. Without damaging the principle of “the authenticity of man’s physical body,” scientists have recently begun to consider another dimension of human beings called the “psyche.” This new dimension was defined in union with the physical body and in an effort to improve it. Since human existence is still construed along physicalist lines, any deliberation of a psychic dimension must be restricted to the “well-being” of the body.

Epistemological foundations

Studies show that no specific epistemological foundations have been defined for secular thought. One of the elements of this thought is “pluralism,” which seems to have also affected its epistemological foundations. The main components of the principles of secularism are:

1. Rationalism: “Rationalism, in Western philosophy, is the view that regards reason as the chief source and test of knowledge.”28 In epistemology, the main principle of secular thought is the exclusive reference to human intellect as a source of guidance in life rather than the review of Holy Scriptures and the orders and guidance contained in these texts for the purpose of bringing success and happiness:29 “Rationalism became the ambit of natural science and the development of new social theories.”30 “Moreover, secularism is not only linked with science but also is embodied in rationalism. Rationalism is considered as the intellectual foundation of secularism, which proposes the separation of religion and politics as its main political and social purpose.”31 Secularism is an epistemological perspective that holds the inherent capabilities of humans are the only source for acquiring knowledge, values, actions, ethics and dominance over the human biology. Based on this theory, anything with a supernatural origin should be generally rejected or else its authority should not be accepted.32 In other words, arguments presented on the issue of death and life in bioethics (and similar issues in medical ethics) are “merely rational” and without reference to any other source of knowledge except human intellect.

Secularism is defined as the “belief in the authenticity of wisdom” as opposed to the “belief in the authenticity of church fathers’ beliefs.” In other words, secularism transfers the satisfaction of church fathers to human satisfaction.33 The origin and basis of this satisfaction is only that which human intellect can recognize without reference to the Holy Scriptures.

2. Scientism: Based on this theory, human knowledge is so powerful that it can solve any problem in life in such a way that there is no need for any superior power beside science and knowledge. “American secularists tend to place a high level of faith in science and to affirm its epistemic authority—sometimes to the perceived antagonism of purportedly transcendent sources of authority. A substantial proportion of American nonbelievers, and especially disbelievers, affirm narratives of scientism. Belief in a narrative of conflict between science and religion relates strongly to atheism, moderately to agnosticism, and is unrelated to non- affiliated belief.”34

The advocates of this thought gradually came to believe that scientific testing and experiencing are prerequisites for humans’ acceptance of and belief in a number of things. This thought culminates in the theory of logical positivism, which holds that only those things that can be experienced and tested are scientifically acceptable. In other words, nothing that cannot be experienced and tested through the tools of empirical science is acceptable for humans. “The principle of empiricists’ perspective is giving authenticity to the sense and experience on cognition. The empiricists in the field of epistemology limited the unique instrument of cognition and knowledge to experience and test, based on this, anything that was not able to be observed and experienced, was considered not only unknown but also unreasonable. The positivists stepped up even further and claimed that non-experienceable objects are basically meaningless or have no real meaning.”35

3. Humanism: “The philosophy of Humanism is based primarily on a physical reality.”36 As discussed in the section on the ontological foun- dations of secular thought, all components of this line of thinking center around “humans.” “Within a Humanist philosophy, we believe in the centrality of the person, in mankind and in womankind – we believe in people as opposed to a supernatural being.”37 All attempts should be directed toward satisfying human needs and desires. Anything that can satisfy these needs will be valuable, and any barrier to their satisfaction will be eliminated. “According to this idea, man is the center of the universe and all plans and religious laws should lead to his benefit, otherwise they will not be valid. Thus, authenticity in all fields belongs to man and his ‘understanding.’38

This attitude can be considered as one of the main bases of secularism, i.e. based on this thought, Godcentrism changes into anthropocentrism”39. Human freedom can be assumed as one of consequences of humanism. For example, consumerism emerged from this freedom. “[This] philosophy departs from three important presuppositions: the complete freedom of the individual; […]. Even health care and education are shifting from non- profit to profit-seeking providers. All areas of public space are invaded by advertising and marketing efforts.”40

Reviewing the foundations of Islamic ethics

It should first be noted that what is offered here as the foundations of Islamic ethics are the summarized opinions of a number of scholars in this field. The offered views are open to review and can be challenged in part or in whole through scientific discussions and the citing of Islamic texts.

Ontological foundations

Based on the monotheistic worldview, God Almighty is the creator and owner of the universe. (Why, surely to God belongs everything that is in the heavens and earth.)41 “Human and nature, and all creatures of the world are owned by and affiliated to the Divine Holy Essence and are His slaves.”42 According to the interpretations of Muslim philosophers, God is self- existent while all other creatures are exist contingently. He is the creator of the world and all creatures are completely dependent on Him for their survival and sustainability, (Say: ‘Who is the Lord of the heavens and of the earth?’ Say: ‘God.’ Say: ‘Then have you taken unto you others beside Him to be your protectors, even such as have no power to profit or hurt themselves?)43 It is therefore imperative for all creatures to only obey Him and take Him as their guardian. Commands are solely His ([…] the judgment is God’s alone. […])44 All the do’s and don’ts of human life should be rooted in His commands. This verse of the Holy Quran implies the exclusiveness of the subject and deems the decree and ruling specific to God and to none else. Other verses call violators of the holy decree and ruling of divine religion unbelievers ([…] Whoso judges not according to what God has sent down -they are the unbelievers45), evildoers ([…] Whoso judges not according to what God has sent down -they are the evildoers.46) and ungodly ([…] Whosoever judges not according to what God has sent down -they are the ungodly).47

Using the words ‘slavery’ and ‘devotion’ and the emphasis on humans ‘belonging to’ and ‘being dependent on’ God may create the impression that religion and religious doctrines seek to imprison and exploit man. This is the wrong impression, as based on Islamic doctrines, which are in full harmony with rational reasons, “God is free from any need.” His intention to command His creatures to obey Him and act on the basis of the necessity of their slavery to Him is not for His own benefit; rather, His sole intention is to consider the real interests of man,48 (O men, you are the

ones that have need of God; He is the All-sufficient, the All-laudable49), for the Creator of humans and all creatures is the Almighty God and He only has knowledge of the future, (Knower He of the Unseen, and He discloses not His Unseen to anyone50). He alone recognizes the best interest of all creatures and He only is competent to provide guidance to man for living a prosperous life. In religious ontology, Nature is not the whole truth but only a small part of it; that is, another part is devoted to an existence that overcomes Nature and dominates it.51 This line of thinking holds that the universe is not simply limited to matter. Nature and material creatures constitute only a small part of this world – with the supernatural existing beside and above them.

Anthropological foundations

In Islamic instructions, man has a spiritual dimension and a divine spirit in addition to his physical dimension ([…] When I have shaped him, and breathed My spirit in him, fall you down, bowing before him!52), that comprise the main part of man ([…] thereafter We produced him as another creature. So blessed be God, the fairest of creators!53). Human knowledge cannot be acquired without the full recognition of man and his truth as composing of a spirit; it is also impossible to recognize man himself without knowing his spirit; and as man’s spirit is immaterial, he cannot be recognized without reference to ontology and the truth of immaterial existence. The fact that man has another dimension called the spirit in addition to his physical body is derived from religious texts and has been variously expressed in Persian literature. In one poem, Sa’adi writes, “Man is noble for humanity/ No nice clothes show humanity.” Elsewhere, in one sonnet of Divan-e Shams-e Tabrizi, Rumi writes, “Thou blew in all our breaths/ For it’s thy breath that gives life to Nei, don’t cry without our Nei.”54

The Holy Quran does not define man in terms of his ability to speak and his distinction from animals; rather, what is ultimately obtained as the genus of human being becomes the representation of a “living theology.” What is considered the genus of human being is therefore not an “animal” quality that man shares with animals; instead, the genus of human spirit is composed of “living” and is reason enough for man to be equal to angels, whose genus is not destroyed by physical death and lives on eternally. According to the Holy Quran, what distinguishes man from other creatures is his deification, that is, his God-seeking nature, preceded by “theology”, and his attraction to the Divine flow. Unlike the logical definition provided for human beings, man is not differentiated from other animals only by his capacity for speech. The existence of man in the two realms of theoretical and practical reason extends to all his actions and tendencies, which are directed toward God. And nothing but the infinite truth, pure existence, and absolute perfection that is the Holy Essence of Divinity –Glorified and Exalted– can quench his thirst, and he will be disappointed by all but his Creator.55 In Islamic doctrines, man is presented as the “most illustrious of all creatures” in the universe, and under whose dominance all creatures have been placed (And He has subjected to you what is in the heavens and what is in the earth, all together, from Him. Surely in that are signs for a people who reflect.)56 The Almighty God, the Creator of man, has assigned man the role of His agent and successor on earth (And when thy Lord said to the angels, ‘I am setting in the earth a viceroy.’ […]),57has bestowed dignity on him ([And] We have honored the Children of Adam […]),58 and through the guidance of his own wisdom as his inner prophet and also through divine prophets as his outer wisdom, He has taught man the way to prosperity and happiness, and warned him of the path leading to human misery and atrocity. God has taught man the way to distinguish between good and evil and has made him free to choose between the two (Surely We guided him upon the way whether he be thankful or unthankful […]).59 If man is to find happiness, he should bind it to the observance of virtue and piety (Surely for the Godfearing awaits a place of security).60 It is in the light of this piety that his level in the order of dignity is increased ([…] Surely the noblest among you in the sight of God is the most Godfearing of you […])61 and if he follows cruelty and misery by misusing his free will and deviates from the path of God, then no destiny awaits him except hell and being apart from the mercy of the Almighty God (As for the wretched, they shall be in the Fire, wherein there shall be for them moaning and sighing, therein dwelling forever).62 He will then be reduced to the lowest levels of the order (Then We restored him the lowest of the low).63 In the course of this descent, humans might go so far as to become inferior even to animals and livestock merely by their own actions and by disobeying the commands of God ([…] They are like cattle; nay, rather they are further astray. Those -they are the heedless […]).64

The commands of the Almighty God are not just about overseeing the individual’s happiness in the Hereafter; rather, Islam considers both the worldly life and the heavenly life (And God gave them the reward of this world and the fairest reward of the world to come; and God loves the good-doers).65 According to the noble hadiths of the Prophet’s family, this world is presented as a prelude to the Hereafter. In the noble hadiths of Imams, which are in full harmony with the Quran, life in this world has been presented as unstable and transient, whereas the hereafter, i.e. life after death, is presented as man’s stable life - his “house of permanence.” Authenticity has thus been attributed to life after death, a part of human life that should not be ignored for the sake of planning for his worldly life; in fact, humans should all plan their life based on the Hereafter and should seek their true happiness in that world. According to the Holy Quran, everyone in search of happiness in this world should be aware that happiness in both worlds belongs to God (Whoso desires the reward of this world, with God is the reward of this world and of the world to come; God is All- hearing, All-seeing).66

According to Islamic instructions, the purpose of human creation is for them to achieve perfection and happiness, which only come about through closeness to the Almighty. If a human follows the same path to perfection that revelation and tradition have portrayed for him, and as reason guides him, he can achieve real prosperity and happiness both in this world and the next. On Islamic views of humans, Mortaza Motahari writes, “Man has a free and independent personality; he is God’s trustee; he has missions and responsibilities; he has been asked to work with his own initiative to cultivate the earth and choose between two ways of prosperity and misfortune.”67 Motahari is only reiterating what the Holy Quran has told us.68

Epistemological foundations

The universe was established based on identifiable, accessible truths. Man is responsible for discovering the truths and cultivating the earth through the wisdom God has bestowed on him (And to Thamood their brother Salih; he said, ‘O my people, serve God! You have no god other than He. It is He who produced you from the earth and has given you to live therein; so ask forgiveness of Him, then repent to Him; surely my Lord is nigh, and answers prayer.)69 Man was forbidden by God to disobey Him and corrupt the earth (Do not corruption in the land, after it has been set, right; and call on Him fearfully, eagerly -surely the mercy of God is nigh to the good-doers).70

Another major point to consider is that, due to the limited resources and tools available for man, human wisdom alone cannot consider every aspect of different issues or recognize all the aspects of the truth of the universe (That is of the tiding’s of the Unseen, that We reveal to thee; thou didst not know it, neither thy people, before this. So be patient; the issue ultimate is to the Godfearing).71 Consequently, in order to plan the path of achieving happiness in this world and the Hereafter, man needs the guidance of the Wise God. This guidance is communicated to him through the prophets appointed by God. Prophets have come to show man the hidden treasures of his own wisdom. They were nurtured so as to stimulate and extract the hidden treasures of the wisdom of mankind that lie in the depths of his heart and soul,72 and receive and furnish him with what has never been accessible to him due to his human limitations (as also We have sent among you, of yourselves, a Messenger, to recite Our signs to you and to purify you, and to teach you the Book and the Wisdom, and to teach you that you knew not.)73

In Islamic epistemology, wisdom has a special place as far as it confirms and is confirmed by Sharia, “Rationality itself requires not denying the universe and religious consciousness, but reason through proving the truths and meta-rational instructions, is in the range of religious knowledge as a proof by which believers worship God and respects the sanctuary of the divine traditions.”74 Reason and holy citations (Revelation and Sunnah) are presented as a source for obeying religious decrees; however, reason alone and without its support base, i.e citations, is unable to find the right path to happiness in this world and the Hereafter. One reason for the insufficiency of human wisdom despite his many capabilities and talents might be the carnal desires and wickedness he possesses, which have the ability to trap his wisdom and prevent him from accessing the truths of the universe through contemplation of the invisible world. In Nahjul Balagha, sermon 211, Imam Ali elucidates this actuality, “There are many wisdoms that are under the dominance of passions.” According to Islamic instructions, if human wisdom is under the influence of carnal desires, it will order man to only develop his animalistic dimensions – and a man as that cannot focus on the true essence of his being, which is the Divine Spirit, and like animals, or even worse, like beasts, he will dedicate all his inner forces to the satisfaction of lust and wrath.

Discussion and conclusion

According to the available literature in Iran, the four principles proposed by Beauchamp and Childress do not contradict the Islamic- Iranian culture and can thus be generally applied in the mentioned context. However, the application of these four principles and their derivatives (e.g. regulations and codes) requires careful examination and adaptation to Islamic ethics. Comparison of the ontological, anthropological and epistemological foundations of secular thought and Islamic perspective shows vast differences between the two. There are contradictions and inconsistencies between the “rationalism,” “scientism,” and “humanism” of secularism and the fundamental beliefs of Islam. “Godcentrism,” “pure human servitude to God,” the belief in “human return to God,” in the “Resurrection day” and in man’s accountability to God are considered the basic beliefs and principles of Islam in all its movements and sects. There are bound to be differences between the rights, duties, and decrees advised by the worldview that assumes man as an independent creature and the view that man is a creature dependent on God. The idea that man is an independent creature not indebted to a creator, and the other idea that he is dependent on the creator, that is, God, impose two very different normative systems on humans. Anyone who does not assume a creator for himself has a legal and ethical system that is anthropocentric, while anyone who assumes a creator for himself and recognizes His presence in his life, has a legal and ethical system with duties that are consistent with his having been created and God being his Creator. A religious person who knows the Almighty Creator as his source of existence cannot for one moment ignore that truth. There are no scientific and intellectual assumptions based on which man comes to know the origin of his identity as dependent on God while he acts independently of his subjective origin (i.e. God) on legal and ethical issues.75 When planning the right path to happiness, the aim,

strengths and weaknesses, as well as threats and opportunities should be carefully determined and predicted. According to religious teachings and due to the limitations of human perception and the impossibility of accessing the whole past and future knowledge, the fate of humans cannot be entrusted to their senses, the tool of experience, and limited human reason and knowledge. The management of these affairs should be assigned to a source free from these limitations. Wisdom holds that the guidelines for human life should be issued from an origin whose commands man can wholeheartedly trust and in which he can invest all his life energies, irretrievable and unenduring as they are, with complete certainty and peace of mind about its being in his own interest and without worries about the possibility of error on the part of that origin or his own failure (Surely those who recite the Book of God and perform the prayer, and expend of that We have provided them, secretly and in public, look for a commerce that comes not to naught.).76

Man lives only once; he should therefore take maximum advantage of his brief, transient earthly opportunity for developing his eternal life. In Nahjul Balagha, sermon 77, Imam Ali addresses the world, “Oh world! Your life is very short and your importance is low and the longing for you is of no value. Oh, oh the scarcity of the provisions, the long way ahead, the remote destination and the greatness of the final abode.” To achieve happiness and perfection and pass through the dangerous path that is life in this world, man should not proceed on a trial and error basis for the simplest issues. Instead, he should choose an approach to the truth, validity, and reliability of which he fully trusts. Do any of us cross confidently a frightening, winding road in a car with a driver who has no driver’s license, has never before used that road, and who is not at all familiar with the it? Common sense and reason dictate that to find the right path in life, man should abide by a set of instructions and "do’s and don’ts.” No error, forgetfulness and mistake is accepted in this life; due to the sensitivity of the issue and its importance, a tiny mistake can irreversibly change the fate of human beings. Islamic instructions tell us that man has an eternal life and nothing ends for him with death; rather, he enters a new phase of his life. This new state and the ecstasy after death are his real life, the life in which he fully perceives the consequences of his deeds on earth. In the Hereafter, life is permanent and inevitable. Once life ends for man, that is, immediately after his death, the truths of the universe will be wholly revealed to him and the curtain of neglect will be removed from his eyes (‘Thou wast heedless of this; therefore We have now removed from thee thy covering, and so thy sight today is piercing.’)77 Then there will be no returning for him seeking to compensate for his past mistakes (Till, when death comes to one of them, he says, ‘My Lord, return me; haply I shall do righteousness in that I forsook.’ Nay, it is but a word he speaks; and there; behind them, is a barrier until the day that they shall be raised up.)78

“Therefore, man in the course of the study of resurrection, ethics and self-purification and tens of other cases needs the guidance of one who is aware of both sides of beginning and eternity, and knows the past and future – no matter how far it is; i.e. God whose knowledge surpasses everything. The disadvantage of the secular thought is that it wants to plan for human life without knowing two sides of beginning and eternity of man’s life; a man whose truth does not harbor destruction and his life is composed by a very far past and a very long and complicated future and a man that the meaning and basis of his life would have no value without considering his resurrection.”79

It can thus be concluded that secularism, some forms of which try to entirely remove religion from the public sphere and personal life, is deeply different from Islamic thought.80 Prescriptions and instructions derived from secular thought cannot be implemented in an Islamic community. Believing in and adhering to the three basic principles of “unity,” “prophecy,” and “resurrection” is in apparent contradiction to the principles and values of secularism. If the scholars of Muslim communities believe in and adhere to the doctrines of Islam, it is impossible for them to manage Muslim communities by merely transferring the prescriptions of secular communities and seeking to implement the same guidelines in their own communities. As the conventional principles of medical ethics have been formed in the context of Western secular communities, and as the principles and values of secularism are inevitably manifested in all corners of medical ethics, it is logically impossible to implement the guidelines and common charters of Western codes of medical ethics in Muslim communities, particularly in the Islamic Republic of Iran, as it was founded based on the Divine sovereignty and the guardianship of the family of the Prophet and the absolute guardianship of the Jurist. It is necessary for Muslim and Shia scientists to collect their own set of moral principles and values for implementation in Muslim communities after careful examination of the traditional resources of their culture (Revelation and Sunnah of the Infallibles) as well as their intellectual resources. They should then formulate medical guidelines and ethical charters for Muslim communities based on these more harmonious principles and fundamental values.

Notes

Notes are available on the URL address of the journal.