Islamic Laws of Medicine – According to the rulings of Grand Ayatullah
al-Sayyid Ali al-Husseini al-Sistani

Imam Mahdi Association of Marjaeya, Dearborn, MI 48124, www.imam-us.org. ©2023 by Imam Mahdi Association of Marjaeya (I.M.A.M.), Inc. All rights reserved. Published 2023. Printed in the United States of America. [Paperback] ISBN: 979-8-9856667-0-0

No part of this publication may be reproduced without permission from I.M.A.M., except in cases of fair use. Brief quotations, especially for the purpose of propagating Islamic teachings, are allowed.

 

I.M.A.M.’s Foreword 

In the name of Allah, the Most Gracious, the Most Merciful

All praise is to God, Lord of the worlds, and may His salutations and peace be upon Muhammed (pbuh&hp) and his family (p). It is no secret that Islam embraces all aspects of life and draws a clear and detailed path for mankind to follow towards the purpose for which they were created. Moreover, it has designated this path so they can truly be the vicegerents of God on His earth, be adorned with lofty virtues, and revive and establish His way with reasoning, spirituality, purity, and strong character.

Medicine is an essential field in the lives of human beings. The symptoms of life (e.g., strength, weakness, health, illness) are part of being human, and each body requires attention and treatment, both from an internal and external perspective. For this reason, the field of medicine and physicians have always held a respected status throughout the history of human civilization. It has been narrated in a tradition from the Noble Prophet that, “Knowledge is two types, knowledge of religions and knowledge of bodies.”[1] Therefore, if a person seeks to pursue this role in life, they must be well-informed of the essential religious details that accompany the science, its theories, training, career, treatment, and everything else related to its practice. It has been reported that the Noble Prophet said, “When God wishes good for a person, He bestows upon them the understanding of religion.”[2]

Medicine has developed drastically in the modern era, along with its various related fields, specialties, and methodologies, which have advanced and increased in number. As such, the religious questions and inquiries regarding it have increased. Some of these questions are essential in the proper execution of religious practice, while others are complicated and require clarification. Many have not been researched or previously answered. The respected reader will find many fascinating discussions on matters such as brain death, organ transplantation, organ trade, transgender surgeries, artificial insemination, and many other topics. The Twelver Imamate jurisprudential school, which follows the path of the virtuous Imams (pbut), excels in deriving the authentic rules. Its intellectual foundations were covered by Imams Muhammed alBaqir and Jafar alSadiq (pbut) who established the general criteria and allowed the learned religious students who had reached a level of understanding and practice to interpret the branches of religion and its applications based on the religious scriptures. Therefore, we find that the Imamate jurisprudential school automatically keeps up with developments of life and has an edict on most, if not all, modern and contemporary issues. With its continuously dynamic approach, firm juristic foundations, and precise research methods, the Imamate jurisprudential school continues to provide clarity to the believers in all the religious needs of their life and personal pursuits, including their medical care.

Therefore, this book is an example of the comprehensive and robust knowledge of the religious seminaries, which provide splendid services to those who want to faithfully apply Islamic rules to every aspect of their lives. It is a compilation of questions and inquiries submitted to the supreme religious authority, His Eminence Grand Ayatullah Sayyid Ali alHussaini alSistani (may God prolong his life), on different medical matters to which he responded with his blessed opinion. The book begins with an introduction about the importance of medicine as  narrated in the Holy Quran and concludes with a number of recommendations from His Eminence to doctors, nurses, medical students, and those who work in this field. They are moral and heartfelt recommendations which bear our attention and implementation. I.M.AM. deemed it necessary to translate and publish this compendium to fulfill the needs of many who continuously ask us about these issues. We ask the Lord Almighty to benefit the believers from its publication.

Sayyid M.B. Kashmiri

Jurist Representative

I.M.A.M.

Acknowledgements 

We would like to bring to the respected reader’s attention that the jurisprudential content of this book was previously published in Arabic by the Department of Religious Matters in the Shrine of Imam Ali (p) in the noble city of Najaf in 1438 AH (2016 CE). We have verified that it is consistent and in agreement with the rulings of His Eminence Sayyid alSistani through authentication we received from his office in the noble city of Najaf through his representative, the respected Sayyid Murtadha alKashmiri, during his presence there on the 12th of Rabi alAkhir 1443 AH, which corresponds to the 15th of January 2022.

We would like to thank and extend our sincere appreciation to everyone involved in the translation, editing, reviewing, and proofreading of this work and those who made it possible.

We ask God Almighty to accept it from us and forgive us for any error, mistake, or shortcoming, as perfection is for Him alone.

Part One – Medicine in Islam [3] 

There is no doubt that the bestower of health, safety, and well-being (in both the mind and body) is God Almighty. He is the healer and curer as well. God Almighty said regarding health, “And We reveal of the Quran that which is a healing and a mercy for believers though it increase the evil-doers in naught save ruin.”[4] It has been narrated that the Commander of the Faithful (p) said, “Surely, destitution is a calamity, but worse than destitution is illness of the body, and worse than illness of the body is illness of the heart. Surely, one of the bounties is abundant wealth, yet a healthy body is better than abundant wealth, and even then, piety of the heart is better than a healthy body.”[5] It has also been narrated from Imam alBaqir (p) in his advice to Jabir alJu’fi that he said, “And know that there is no science like asking for safety, and there is no safety like the safety (i.e. health) of the heart.”[6] As for physical health and treatment, God Almighty referred to treatment with honey when He said, “Your Lord inspired the bees, ‘Make hives in the mountains, in the trees and in the trellises, then eat of every fruit and follow the path of your Lord submissively.’ From out of their bellies comes a drink of different color in which there is a cure for the human being. In this there is evidence (of the truth) for the people of understanding.”[7] He then explained that He is the complete source and giver of treatment when telling the story of Prophet Ibrahim (p) in the Quran, “and heals me when I am sick.”[8] Through verses and noble traditions, we find that Islam has given great importance to health, medical care, fighting diseases, treatment, and prevention, because health is a worldly blessing from God and an aid for the afterlife. It has been narrated from Imam alSadiq (p), “Bliss in this world is safety and physical well-being, and complete bliss in the afterlife is entering heaven.”[9] Therefore, we will now discuss a number of these topics and categorize them based on their details.

The Status of Medicine 

Islam has distinguished medicine as an essential science because of the body’s reliance upon it. It has been narrated that the Commander of the Faithful (p) said, “Sciences are four kinds: Jurisprudence for religions, medicine for bodies, grammar for tongues, and planetary bodies for determining time.”[10] Imam alSadiq (p) is reported to have described the importance of medicine in an even more clear statement: “Three are indispensable for every people. They are sought in the matters of their life and afterlife, and only the despicable do not seek them: a knowledgeable pious scholar, an obeyed righteous commander, and a trusted perceptive doctor.”[11] Therefore, medicine has an important status in Islam and is considered  an essential component of life.

For Every Illness is a Cure 

As mentioned in the introduction of this chapter, God Almighty is the healer and the complete cause for everything, a belief no Muslim can repudiate because it is one of the most prominent principles related to the oneness of God. However, God has created this world, including humans, with means, causes, and motives. Therefore, whenever the human body encounters a health issue, it must first be identified and then treated so that the human can return to their normal life. This concept became a practical scientific specialty to which people turn to identify and cure their illnesses. It has been narrated from Imam alSadiq (p) that the Messenger of God (p) said, “Seek treatment, for God has not sent an illness without sending its cure with it, except the eventual poison (meaning death), as there is no cure for it.”[12] It has also been narrated from Jabir ibn Abdullah that the Messenger of God was asked, “O’ Messenger of God, should we seek treatment?” He said, “Seek treatment, for God has not sent an illness without sending its cure.”[13]

Recovery is in the Hand of God 

One of the most important principles of belief in God Almighty is rejecting polytheism in its theoretical and practical forms. Sometimes material reasonings overcome the feelings of a human, so that they think, at least for a moment, that the medicine itself is the cure! We should not forget that God is the ultimate curer, as He is the one who placed the benefits in everything. It has been narrated that Imam Zain alAbideen (p) said, “O’ God, praise be to You, for You created, then casted, ordained and decreed, gave death and bestowed life, made ill and healed, made well and afflicted.”[14] It has also been narrated from Imam alSadiq (p) that “a Prophet became ill, so he said, I will not seek treatment as He who made me ill will heal me. So, God Almighty revealed, I will not heal you, instead seek treatment, as recovery is from Me.”[15] This means a person must use the available means to recover because it is a part of the system God has put in place, and it is the best system, “All blessings belong to God, the best Creator.”[16]

Part Two – Medical Manners and Morals 

Many recommendations and moral guidelines have been presented by Islam. The following are recommendations for every doctor and all those responsible for the lives of others to which they should pay close attention. These guidelines include:

1. Assuming Responsibility 

A doctor may underestimate and disregard a patient’s illness because they are accustomed to seeing what they perceive as more serious illnesses. This is highly forbidden in the holy teachings because it has repercussions and violates the responsibility placed on certain people. It is especially obligatory for children’s guardians, students’ supervisors in schools, heads of families, and all those who bear responsibility for the lives of others to not take this burden lightly and to fulfill it with all their ability. It has been narrated from Imam alSadiq (p), “Isa (p) used to say, ‘the one who does not treat a wound, is an accomplice to the injurer.’ This is because the injurer wanted to hurt the wounded and the one who does not treat themselves does not treat the wound. So, if they refuse to treat the wound, they seek to hurt themselves.”[17]

2. Piety and good counsel 

In some cases, a doctor may be placed in a situation where they must explain what is best or most appropriate for the patient, or to specify a treatment that is in the best interest of the patient in terms of quality, price, and value. In other cases, a guardian or someone who is responsible for a child, who complains or shows certain symptoms, may prescribe a treatment or medication despite not being a doctor or a specialist. In such cases the doctors and guardians must observe piety, honesty, and fear of God, who sees everything we do. Advice must be taken seriously and given to the best of our ability. It has been narrated from the Commander of the Faithful that he said, “Whoever becomes specialized in medicine must fear God, give good counsel, and endeavor [to what’s best for the patient].”[18]

3. Identifying the illness before prescribing the medication 

A doctor may sometimes rush to prescribe a medication without confirming the illness and conducting the necessary tests. There are plenty of cases in which a doctor prescribes a medication hastily, but they turn out to be mistaken and the “treatment” causes the patient’s health condition to deteriorate even more, either directly from the wrong treatment or because the disease was left untreated and worsened due to improper treatment. It has been narrated that the Messenger of God said to a physician, “Do no treat anyone without knowing their illness.”[19] It has also been narrated from Imam Zayn alAbidin (p) that, “If the illness of a person is not known, medication [only] damages them.”[20]

4. Give the patient hope 

It has been narrated that the Commander of the Faithful said, “The greatest affliction is the loss of hope.”[21] After God, the patient relies on the doctor for their treatment. Therefore, the behavior of the doctor when meeting the patient and their approach to speaking  and examining them, as well as determining the course of treatment, greatly affects the patient’s morale and can boost their health with positive energy and hope of recovery.

It has been narrated that Imam alSadiq said, “Whoever greets his brother, God will greet him on the Day of Resurrection.”[22] He also said, “He who smiles at his brother is rewarded a good deed.”[23] A truly kind word may give hope and revive the patient psychologically, contributing to the efficacy of the treatment. It has been narrated that the Prophet, in his guidance to Abu Dhar AlGhafari, said, “A good word is charity.”[24]

5. Limiting medicine to specialists 

A health issue sometimes needs a specialized diagnosis and treatment, such that a general doctor will not suffice. In that case, the patient must be directed to someone who specializes in treating the condition from which they suffer; even if the consulted doctor is a specialist in the field, but the issue requires a more learned, skilled, or experienced doctor, the consulted doctor must not be too proud to refer the patient for a second opinion. Pride or material benefit must not prevent the patient from receiving the professional treatment they require. Living beyond the value of material possessions and quest for personal praise is what gives a person dignity, which is what God Almighty truly blesses humans. It is also very important for non-specialists and people who are not doctors especially to not interfere with what does not concern them. A doctor should not prescribe something to the patient ignorantly, simply because they were prescribed a similar medication before. It has been narrated that the Commander of the Faithful said, regarding the duties of leadership and administration in a country, that “The immoral scholars must be held captive as well as the ignorant among the doctors.”[25] Otherwise, corruption and harm would spread.

The Religious Aspects

This book will discuss various aspects related to medicine and its practice in detail. We have also decided to mention some of the religious terminology and parameters that the jurists consider when providing a ruling. Some of these include the following:

1. Dhamman:[26] It has been narrated that the Messenger of God said, “Whoever practices medicine without knowledge or expertise is a dhamin (i.e., becomes responsible for any negative consequences).”[27] Similarly, it has also been narrated that the Commander of the Faithful said, “Whoever learns medicine or veterinary science should take the approval of the [patient’s] guardian, or else, he is a dhamin.”[28]

2. Treatment with the possibility of death: sharia directs the doctor to treat the patient even if they are in a situation where the possibility of death is very high. This is because the abandonment of treatment results in inevitable corruption, while through treatment there is the possibility of recovery, however slim, and saving lives is a priority in Islam. It has been narrated from Hamdan bin Ishaq that he said, “I had a son, and he was ill with kidney stones. I was told [by specialists] there is no treatment for him except to perform an incision and remove the cause of pain, so I did, but he died shortly thereafter. So, I wrote to Abu alHassan alAskari (p), and he replied saying, “There is nothing wrong with what you did, you sought treatment, but his time [of death] had arrived.”[29]

3. Avoid touching and looking at forbidden things except when necessary: this is usually an issue when treating sensitive areas that are forbidden to look at or touch. It is permissible to uncover these areas, look at and touch during treatment, but only as necessary. It is not permissible to choose a doctor of a different sex for treatment unless it is extremely necessary, or if the doctor who is of a different sex is more learned, skilled, and experienced in the treatment than the other. This will be explained in detail throughout this book. It has been narrated by Ali Ibn Jafar that he asked Imam alKadhim (p) if it is permissible for a man to perform hijama for a woman. He said, “No.”[30] It has been narrated by Abu Hamza alThumali that he asked Imam alBaqir (p), “If a Muslim woman is afflicted in her body with a fracture or wound in a place that cannot be seen, and a man would be more diligent in performing treatment than a woman, is it permissible for him to look at her?” He said, “If it is necessary, he can treat her if she wants.”[31]

4. Treatment with something that is religiously prohibited: The general rule for taking prohibited or najis substances is the same for the healthy and ill, unless the treatment truly depends on it or is limited to its use, which is usually rare. It has been narrated that Imam alSadiq (p) said, “Verily, God Almighty has not made anything that He forbade a treatment or medicine.”[32] It has also been narrated that Qaid Ibn Talha asked Imam alSadiq (p) about wine used in medicine. He said, “No, no one should seek medicine in the forbidden.”[33]

Part Three – General Medical Guidelines 

1. Habits that reduce the need to visit a doctor: 

It has been narrated by alAsbagh Ibn Nabatah that the Commander of the Faithful told his son alHasan (p), “O’ son, shall I teach you four traits by which you will be free from needing medicine?” He answered, “Yes, O’ Commander of the Faithful.” He said, “Do not sit for food (to eat) unless you are hungry, do not leave the (table of) food without having an appetite for it, chew well, and relieve yourself before going to sleep. If you follow these [guidelines], you will not need medicine.”[34] It was said to the Commander of the Faithful, “The Quran has every science except medicine,” so he said,  “verily, the Quran has a verse which summarizes the entirety of medicine: [and eat and drink, but do not be extravagant].”[35] [36]

2. Avoid medicine except when necessary: 

It is well established in the specialized fields of medicine that every treatment has the potential for some negative side effects on other parts of the body. This is why patients are often directed to limit their use of medication to what is necessary rather than becoming dependent. The body should be allowed to perform its functions naturally and strengthen the immune system. It has been narrated from the Messenger of God that he said, “Avoid medicine as long as your body tolerates illness. If it does not tolerate the illness, then take medicine.”[37] It has also been narrated that the Commander of the Faithful said, “Taking medicine for the body is like soap for the cloth, it cleans it, but also wears it out.”[38] It has been narrated that Imam alSadiq (p) said, “Whoever takes medicine while their health is more apparent than their illness has helped [the illness] against themself.”[39] It is narrated that Imam alKadhim said, “avoid the treatment of doctors as long as you are far from illness because it is like [the process of] building, its minimum amount requires more.”[40]

3. Prevent illnesses: 

It is known that prevention is more important than cure. It was said in the old days that a carat of prevention is better than a dinar of cure. Logically speaking, precaution obligates the human to be cautious with anything that may affect their health or cause illness. This is achieved by following the health guidelines issued by qualified professionals. It has been narrated that Imam alSadiq (p) said to an herbal doctor, “Know that the stomach is the house of illness, and that diet is the cure.”[41] In addition, there are narrated Islamic teachings which, if followed, may increase immunity and improve health. For example,

(1) Fasting: it has been narrated that the Messenger of God said, “Fast and [you will] flourish.”[42]

(2) Travel: it has been narrated that the Messenger of God said, “Travel, [you will} flourish and prosper.”[43]

(3)   Worshiping during the night: It has been narrated that the Commander of the Faithful said,  “Worshiping [during] the night is a prosperity to the body.”[44]

(4) Meeting the needs of the body: It has been narrated that Imam alKadhim (p) said, “If you become hungry, eat. If you become thirsty, drink. If you must urinate, urinate. Do not have sex unless you need it. If you become sleepy, sleep. In this is prosperity for the body.”[45]

4. Habits that increase fitness: 

There are many things which contribute to the body’s wellbeing besides health and safety. These may improve physical appearance, vitality, and energy. It has been narrated that the Messenger of God said, “Three [things] please the body and help it improve: fragrance, soft clothing, and drinking honey.”[46] It has also been narrated from Imam alSadiq (p), “Three [things] increase weight and three [things] decrease it. Those which increase it are excessive bathing, smelling good fragrances, and wearing soft clothes.”[47]

5. Habits that increase longevity: 

There is some guidance that appears to be spiritual but also has a physical effect. For example, it has been narrated from Imam alSadiq (p) that he said, “Wash your hands before and after eating, it repels poverty and increases life,”[48] meaning it affects health and safety in a way that increases lifespan.

6. Habits that destroy the body: 

In contrast, there are some habits that Islam forbade due to their destructive effect on the body by reducing its energy and lifespan. It has been narrated from the Messenger of God that he said, “Do not abstain from dinner, even if it is a dry date, for I fear weakness in my ummah caused by abstaining from dinner. Surely, dinner is strength for the old and young.”[49] It has also been narrated from the Commander of the Faithful that he said, “Avoid cold weather in its beginning, and welcome it at its end, because it does to the bodies as it does to the trees—its beginning dries and burns and by its end, the new leaves begin to sprout.”[50] It has been narrated from Imam alSadiq (p), “Two things are good. They do not enter a bad stomach without healing it. Two things are bad. They do not enter a good stomach without hurting it. The good are pomegranates and temperate water. The bad are cheese and dried meat.”[51]

Part Four – Spiritual Treatment 

Just as physical medicine is important and crucial because it is a natural cause [for cure] placed by God Almighty in His great system (as we explained earlier), the believers must not forget the spiritual aspects by dedicating themselves to the Creator of the causes, the Healer and the Curer, God Almighty, by supplicating and asking others to supplicate for them during sickness. The Almighty described His Prophet Ayoub (p), who was afflicted with sicknesses and calamities but overcame them and reached the highest station [due to his patience] near his Lord until eventually, the Almighty returned all that was taken from him in an even better form. Prophet Ayoub (p) called to God saying, “And Ayoub, when he called upon his Lord: ‘Great harm has touched me, yet You are the Most Merciful of the merciful.’”[52] So the answer came “So We responded to him and lifted the harm which had afflicted him, and We brought him his family and their like with them—a mercy from Us, and a reminder for the worshipers.”[53] It is related in the supplication of Kumayl which is narrated from the Commander of the Faithful Ali (p),  “O’ He whose name is a medicine, and whose remembrance is a cure,” and it has been narrated from Imam alSadiq (p), “Treat your ill with charity, and repel calamity with supplication.”[54]

Part Five – Studying Medicine 

Question 1:    What is your opinion regarding students entering the field of medicine knowing that the training will require seeing the intimate body parts of patients, touching the bodies of men and women, and performing autopsies on dead bodies, usually people who are Muslims in our countries? Otherwise, a student cannot pursue this field.

Answer: If the student knows that this knowledge that they gain, which requires committing some forbidden acts, will have a religiously required benefit, meaning something God would not approve of abandoning, such as saving a life or preventing serious harm, then it is permissible, but the aforementioned forbidden acts must be limited to what is necessary.

Question 2: We are in urgent need of female physicians to examine female patients, thus, what is your opinion regarding women’s enrollment in medicine?

Answer: It is permissible provided they comply with their religious duties if they enter this field.

Falsifying Reports for Benefit: 

Question 3: What is the ruling on a doctor who writes a false report for a healthy individual seeking to benefit [from the report] or be exempt from responsibility? What is the ruling on that individual?

Answer: It is not permissible for the doctor to do so nor for the individual to request it because it is a lie that could lead to further repercussions.

Cost of a medical checkup:  

Question 4: What is the ruling on a doctor who increases the cost of his medical checkup because the landlord of the place in which they practice has increased the rent or the costs related to their specialty have increased? What is the responsibility of the landlord who increased the rent?

Answer: It is permissible for the doctor to do so, but they must not take more than they need. Similarly, it is permissible for the landlord to increase the rent when the contract ends and the doctor chooses to renew, but they must not increase it more than they need.

Sexually-Transmitted Diseases (STD), including due to prohibited acts: 

Question 5: What is the ruling for a doctor who treats a patient with a disease transmitted due to an act admitted by the patient to be adultery or fornication? What if not treating the disease will cause it to spread to the spouse who does not know about the adultery, infection, or that the disease was transmitted to them? What is the religious ruling if the disease is transmitted to the spouse, who does not know about it, and asks the doctor about the symptoms from which they suffer ?

Answer: It is permissible for the doctor to treat the patient who was infected due to an impermissible sexual act. As for the patient, it is not permissible for him to have sexual intercourse with the spouse if there is a possibility of infection unless he informs her and the latter willingly agrees to it. If he does have sexual intercourse with her without her consent, and she becomes infected, he is considered a dhamin.[55] It is not obligatory for the doctor treating the wife to tell her that her husband was the cause of her infection, unless not doing so has repercussions, which would then obligate the doctor to tell her.

Question 6: Is it permissible for a doctor to refuse to treat a patient infected with chronic sexually transmissible disease (e.g., AIDS) out of fear of contracting the disease from the patient since the healthcare facilities do not always provide the necessary personal protective equipment or procedures necessary to prevent risk to the doctor?

Answer: It is permissible for the doctor to refuse to treat the patient if this harms them.

Question 7: What is the ruling on isolating a patient with a highly communicable disease (e.g., chronic sexually transmissible disease (e.g., AIDS))?[56] Is it obligatory for the patient to isolate themself? Is it obligatory for their family to isolate them?

Answer: It is not obligatory for the patient to isolate him or herself nor is it obligatory for others to isolate them. In fact, it is not permissible to prevent them from attending public places such as mosques if it is not certain they will spread the disease to others. However, they must carefully monitor themselves and others must also monitor them, especially in situations or conditions that will facilitate transmission of the disease, irrespective of the probability of doing so.

Question 8: What is the ruling on intentionally spreading the disease?

It is not permissible, and if it results in the death of someone who contracted it, even after some time has elapsed, his or her religious guardian has the right of qasas (religiously-ordained retribution) upon the person who transmitted the disease, if the latter knew at the time that it could lead to death and intentionally spread it. However, if they were ignorant or unaware [that the disease would spread], they are only obligated to pay the diyah (blood-money) and fulfill the kaffarah (expiation).

Question 9: Is it permissible for someone with  chronic sexually transmissible disease (e.g., AIDS) to marry a healthy person?

Answer: Yes, but it is not permissible to deceive the prospective spouse during the proposal and engagement by describing themself as healthy when they know they have the disease. It is also not permissible to engage in sexual activity with them in a way that spreads the disease. But if it is not certain that the disease will spread, it is not obligatory to avoid sexual activity with the permission of the partner.

Question 10: What is the rule for people with  chronic sexually transmissible disease (e.g., AIDS) marrying each other?

Answer: There is no objection to this; however, if sexual intercourse between them [as a married couple] results in the disease spreading to a dangerous degree then it should be avoided.

Question 11: What is the ruling on someone with  chronic sexually transmissible disease (e.g., AIDS) having sexual intercourse [with their spouse]? Is it permissible for the healthy partner to refuse to engage in sexual intercourse since it is the primary method of the spread of the disease?

Answer: It is permissible for the healthy wife to refuse her infected husband from having sexual intercourse with him if it causes the spread of the disease (even if it is just probable). In fact, it is obligatory for her to prevent him from doing that. On the other hand, if it is possible to reduce the risk of spreading the disease to such a degree, like 2%, by using condoms or other means, then it is permissible for her to allow sexual intercourse, rather, it becomes impermissible based on obligatory precaution to prevent him in that case.

The same ruling applies to a healthy husband in dealing with his infected wife. It is not permissible for him to engage in sexual intercourse with her if there is a risk of spreading the disease, such that reasonable people will consider it veritable. As such, she loses her right to sexual intercourse every four months, except if she can use various means that will ensure the disease is prevented from spreading.

Question 12: What is the ruling on abortion for a pregnant woman with  chronic sexually transmissible disease (e.g., AIDS)

Answer: It is not permissible, especially after the soul enters the fetus[57]. However, if continuing the pregnancy is harmful to the mother, then it is permissible for her to abort it before the soul enters and not after it based on obligatory precaution.

Question 13: What is the ruling regarding an infected mother’s custody and care for her healthy child, including breastfeeding?

Answer: She does not lose her right to care for the infant, but the appropriate measures must be taken to protect the child from the infection. If there is a significant probability, one that is veritable, that the disease will spread due to breastfeeding, then it must be avoided.

Question 14: Can we consider chronic sexually transmissible disease (e.g., AIDS) to be a “death-illness” (i.e., certain to cause mortality)?

Answer: Due to the fact that this disease is chronic and can persist for a long time, only its final stages before death are considered “death-illness,” such as when the patient experiences immunodeficiency and neuropathy.

Question 15: Is it permissible or obligatory for the doctor to inform the people who care for the patient and are involved with them, such as the spouse, of the patient’s infection with HIV?

Answer: It is permissible to inform them if the patient or their guardian permits, however, it is obligatory if it saves the patient’s life, even if it only extends it for a longer time. It is also obligatory if the doctor knows that not doing so will cause the disease to spread to them because not knowing will stop them from using the necessary precautions, and God knows best.

Question 16: If a Muslim knows he has contagious  chronic sexually transmissible disease (e.g., AIDS)is it permissible for him to engage in sexual intercourse with his wife? Is it obligatory for him to tell her?

Answer: If he knows that intercourse will cause her to be infected with the disease, even if there is only a high probability, it is not permissible for him to do so [and it is better that he tells her].[58]

Prescribing medications that are addictive 

Question 17: What is the ruling on a doctor who prescribed medication to a mentally ill patient for a limited time, but the patient continued to use it and eventually became addicted to it  without consulting the doctor. Moreover, the pharmacist enabled the patient by continuing to dispense the medication to them, as if the doctor was continuously prescribing it. So, what is the responsibility of the doctor, patient, and pharmacist?

Answer: There is no responsibility on the doctor. As for the patient, it is not permissible for them to do so if addiction to the medication will have severe harm on them. It is also not permissible for the pharmacist to dispense them that medication without the approved medical prescription because doing so violates the set standards of pharmacy.

Question 18: The great harm of illicit drugs on its users and society is well-known, whether due to the resulting addiction or other reasons. Therefore, doctors/ specialists and health departments have initiated campaigns and enacted laws to combat them and their dangerous effects. What is the opinion of the respected sharia in this matter?

Answer: It is forbidden to use illicit drugs for the great harm they cause, both in terms of addiction and other aspects. Rather, it should be avoided completely based on obligatory precaution, except in situations of medical necessity, in which it should be limited to the extent required, and God knows best.

Cosmetic Surgery 

Question 19: Is it permissible to undergo necessary cosmetic surgery for different parts of the body based on a medical recommendation for cases of burns, fractures, or injuries from car accidents?

Answer: The procedures themselves are permissible, but they usually require the surgeon to see or touch the part undergoing the surgery. Thus, if the patient has the choice between a surgeon for whom it is permissible to see and another surgeon for whom it is not, then the first surgeon should be chosen, unless the second is more proficient [and has greater expertise in that procedure]. This is the ruling for the patient. As for the surgeon, it is permissible for them to accept the surgery even if it requires impermissible looking or touching if the choice is left to the patient.

Question 20: Is it permissible to undergo cosmetic surgery on the face and head for other than necessities (i.e., to change the physical features such as nose reshaping, facelift, or hair transplant)?

Answer: It is permissible as long as the part undergoing the surgery or other parts of the body are not touched or seen impermissibly, if there is a choice [in the surgeon]. As such, it is permissible for a woman to undergo cosmetic surgery on her face or head with a female surgeon and it is also permissible for a woman to go to a male surgeon to undergo surgery on her face if it does not require uncovering other parts of the head or touching the body without a barrier. This is the ruling for the patient. The ruling for the surgeon is apparent from this. It is impermissible for the surgeon to touch or see what is prohibited when there is the option to not do so when undergoing a surgery (i.e. elective) that is not necessary.

Question 21: Is it permissible to undergo dental and orthodontic procedures?

Answer: The ruling is the same as what was mentioned in the previous answer.

Question 22: Is it permissible to undergo cosmetic surgery for the body, like weight loss/liposuction or aesthetic breast procedures?

Answer: The ruling is the same as what was mentioned in the previous answer.

Question 23: Is it permissible for women to undergo elective cosmetic surgeries to their private area (e.g., labiaplasty) to resolve an emotional issue, based on the husband’s desire, or for another reason unknown to the doctor and solely based on the patient’s request?

Answer: It is not permissible except in situations of necessity or extreme difficulty that is not normally bearable, even if it is not medical in nature, like if not performing it will cause unbearable difficulty on the woman. It is also not permissible for the female doctor to perform it before being sure that the patient meets these conditions.

Question 24: Is cosmetic surgery to the face and nose permissible for men or women with the surgeon being male or female?

Answer: There is no problem with cosmetic face and nose surgeries per se, but it is not permissible for a non-Mahram man to operate [on a woman] it if it requires touching.

Question 25: What is the religious ruling on liposuction?

Answer: There is no problem with it per se.

Question 26: What is your Eminence’s opinion on a woman undergoing liposuction by a male surgeon?

Answer: If the presence of body fat causes serious illness or extreme difficulty that cannot be normally tolerated, it is permissible for the woman to consult [and seek the procedure from] a male surgeon. However, if the procedure is only for elegance and beauty, or the woman is not in extreme difficulty [due to not getting it], it is not permissible for her to go to a male for the surgery, instead, she should consult a female doctor.

Question 27: Is it permissible to undergo breast reduction surgery?

Answer: There is no objection to it, but it is required for the surgeon to be a female.

Question 28: Is it permissible for men and women to receive hair transplants?

Answer: It is permissible if it is transplanted with the hair bulb such that it [takes root and] grows [naturally]. If it does not grow after transplantation then it is not considered a part of the body it was transplanted onto, whether it is natural or artificial, and regardless of whether it was transplanted using an adhesive material or not. Therefore, it is considered a barrier that prevents valid ghusl (ritual wash) because it covers the body surface and is not valid for wiping during wudu (ablution).

Question 29: If transplanting hair prevents the act of ritual purification with water as is explained in the previous answer, then is it permissible to substitute water purification with tayammum [dust purification]?

Answer: Voluntarily undergoing a procedure that prevents one from performing ritual water purification and makes it necessary to depend on dust purification for a long period of time is problematic.

Question 30: Is it permissible to attach permanent false eyelashes knowing that it is attached at the natural hairline? Does it affect ghusl or wudu?

Answer: Yes, it invalidates ghusl and wudu, therefore, it is not permissible based on obligatory precaution if there is no religiously acceptable reason for it, like removing an extreme harm. Furthermore, it must be covered as an obligatory precaution if it is considered decoration (i.e., beautification).

Question 31: If attaching [false] eyelashes invalidates ghusl and wudu, is it permissible to perform tayammum for prayer if removing the false eyelashes damages my natural eyelashes?

Answer: It is not permissible to attach eyelashes in a way that invalidates ghusl and wudu (such that it prevents water from reaching some of the fine visible hairs on the surface of the skin) unless there is a religiously acceptable reason. If they are attached for an acceptable reason or due to inculpable ignorance, then it is not obligatory to remove it if doing so causes severe harm or veritable difficulty, and therefore, tayammum is sufficient. This applies even if attaching it was without an acceptable reason and the person repented, and God knows best.

Transplant Surgeries 

Question 32: If a person has an infection in their cornea and the doctor says that they can remove the cornea and replace it with the cornea of someone who has died, would such a surgery be permissible or prohibited?

Answer: It is not permissible to remove the cornea of a dead body to be transplanted into the eye of a living person, and the remover must pay the diyyah. However, it is permissible for the patient to allow the doctor to implant the cornea in their eye.

Question 33: Is it permissible to remove the corneas of a dead person (whether Muslim or non-Muslim) who was executed (for some reason) immediately after death to transplant to a living person (whether Muslim or non-Muslim) if the deceased’s family have agreed, or the deceased themselves agreed to it before the execution? Even if they did not agree, what is the ruling on the surgeon who performs the procedure?

Answer: There are many different cases:

1. If the deceased is a Muslim then it is not permissible to remove their eyes to use the corneas for transplantation to someone else, whether Muslim or not, and if the doctor does so, they must pay the diyyah, and it would not be permissible to transplant. Rather it must be buried with the dead. However, if it were to already be transplanted into another body (for whatever reason), and it revives, it is no longer obligatory to remove it. In fact, it is not permissible to remove it because it has become a part of the recipient’s body.

In this case. there is no difference if the deceased’s guardian agrees to the removal or not, or if the deceased themself have directed it to be done after their death for transplantation. In fact, execution of the deceased’s directive and permitting the removal is then problematic. Precaution should still be observed, however, the remover would not have to pay diyyah.

2. If the deceased is a protected non-believer, such as a dhimmi, it is also not permissible to remove their eyes based on obligatory precaution. However, if their religion permits it generally, or with their approval, or the approval of their guardian, then it is permissible.

3. If the deceased is an unprotected non-believer, or their status is not known, it is permissible to remove their eyes to transplant to a Muslim or non-Muslim.

Question 34: Is it permissible for a doctor to perform the aforementioned surgery under compulsion, or on the other hand, willingly, and what is the ruling in both cases?

Answer: The ruling has previously been explained in the event that the doctor has a choice. If the doctor is compelled, then it is permissible to remove (the corneas), however, the diyyah, which is enacted upon performing the procedure, is not lifted upon the person who performs it.

Question 35: Is it permissible for a Muslim who has a corneal infection to receive a cornea whether they know its source or not? What is the ruling for one who receives it as a transplant?

Answer: If the person knows the cornea is from a Muslim, then it is not permissible for him to receive it and have it transplanted to his body. However, if they do not know, there is no issue. In both cases, if the transplant surgery of the cornea from the removed eye has already occurred, it is not obligatory, rather it is not permissible, to remove the transplanted corneas, as mentioned earlier.

Question 36: A person has a parent, child, spouse, or other relative whose life depends on a kidney donation. Is it permissible for them to donate one of his kidneys to them?

Answer: There is no objection to donating one kidney for someone who has the other healthy kidney as long as it does not cause severe harm to the donor.

Question 37: What is the ruling of a non-believer, whether living or dead, donating an organ/tissue to a Muslim?

Answer: It is permissible, and it is treated as part of the Muslim’s body after it is revived because it becomes part of it.

Question 38: Is it permissible to transfer an organ from a healthy body to a sick person’s body, whose life is facing deterioration, [continued] sickness and long-lasting suffering? (Like in the case of kidney disease)?

Answer: It is not permissible if removing that part (tissue/organ) severely harms the donor. However, if it does not, it is permissible to do so, like in the case of donating a kidney for a donor with another healthy kidney.

Question 39: Is it permissible to transfer an organ from a dead body to someone who is sick, whose life depends on receiving the organ, if the deceased agreed before their death or their guardian agreed? What is the rule on someone other than the guardian giving permission to harvest the deceased’s organ?

Answer: It is permissible if saving a Muslim patient from death depends on it, however, the person who cuts the body [to remove the organ] must pay diyyah as an obligatory precaution, unless the donor gave permission prior to their death, in which case, diyyah would not be enacted. It is irrelevant whether the guardian gives permission or not.

Question 40: Some people direct in their will for their organs to be donated after their death to help someone in need. Is it permissible for the executor or guardian to refuse to fulfill the directive or is it obligatory to perform it?

Answer: If a Muslim needs it to be saved from death or extreme suffering, then it is obligatory to execute the will and the successor is not permitted to go against it. In any other case, executing the directive and permissibility of removing an organ is problematic.

Question 41: A baligh and sane person directs that some of their organs should be donated after their death. However, they are in a serious accident and the doctors describe them to be “brain dead” with the body on life support and no further recourse of treatment. So:

a. Is it permissible to use some of their organs given they are clinically considered dead without consulting their guardian?

b. Is it permissible for their guardian to give permission to use their organs in this situation, especially because some organs cannot be used one or two hours after death?

Answer:

a. There is no significance to them being considered clinically dead if they are still considered alive based on common understanding. Therefore, it is not permissible to remove organs, such as the heart, which would cause them to die.

b. The guardian has no authority to do so (i.e., give permission).

Question 42: You have mentioned in the new issues’ chapter of the Minhaj alSaliheen book the condition of “severe harm” with respect to the transfer of organs from a living body, so what are the criteria of “severe harm?”

Answer: The determining factor is common understanding, and it is not prohibited to endure it in the case of doubt [about the severity of harm].

Question 43: Is it permissible for a healthy person to donate one of his kidneys to save a patient with kidney failure?

Answer: It is permissible for them to do so, given that they have another healthy kidney, and donating would not severely harm them.

Question 44: Is it permissible to donate a kidney in exchange for some money if the donor is in extreme financial need (e.g., to pay for critical treatment of a child)?

Answer: It is permissible if it does not cause them severe harm, otherwise, it is not permissible.

Question 45: Is there a difference in the ruling if the money given had been agreed upon prior to the transplant or if it was an unconditional gift given by the donor after the transplant?

Answer: It is permissible in both cases, although the second option is preferable if the conditions of permissibility are fulfilled.

Question 46: Is it permissible for a patient to pay financial compensation to receive a kidney if there are no donors who will donate it for free?

Answer: It is permissible for them, in fact, it is obligatory if it is necessary to save their life.

Question 47: In the case of it being impermissible to purchase the organs [for transplantation], is there any issue with the surgeons performing the procedure if they know that the donor is being paid for the organ and that the patient insisted on buying it for the transplantation?

Answer: There is no issue with the surgeon who transplants the organ.

Question 48: Is it necessary to have a will that directs the donation of organs or the permission of the donor’s guardians (if there is no will) if the conditions that permit the donation of organs of a newly-deceased body are met? Who has the right to give permission or not?

Answer: It is permissible if removing the organ from a specific deceased will save the life of a Muslim, even if it was not directed in a will, nor is the guardian’s permission required.

Question 49: If someone is brain dead, meaning they no longer have brain function and have been confirmed as such by a team of specialists, is it permissible to disconnect the artificial life support given other body systems can still perform their functions?

Answer: It is not permissible to disconnect or remove the artificial life support as long as the heart beats and blood continues to circulate.

Question 50: In the event that removing artificial life support is permissible (as described in the previous question), is it permissible to harvest functioning organs such as the kidneys, heart, lungs, or liver to transplant to another patient?

Answer: It is not permissible before they are considered deceased based on common understanding; there is no significance to brain death in this matter.

Question 51: Is it obligatory to pay diyyah for removing the organs of a deceased person? If it is obligatory, who must pay it? What is the required amount? To whom is it paid?

Answer: Diyyah is obligatory if the organs of a deceased Muslim are cut [and removed] and it is levied upon the person performing the cutting. However, it is not obligatory if there is a will directing it. It should be spent in acts of charity on behalf of the deceased, and the heirs have no right upon it. As for the amount of the diyyah, it varies depending on the organ.

Question 52: Is it permissible to pay financial compensation to the family of the deceased for taking their organs?

Answer: It is permissible to give them some money as a gift for taking the organs of their deceased, however, it is obligatory for the person removing the organ to pay a diyyah based on obligatory precaution if there is no will [allowing the harvesting of the organs].

Question 53: What is the ruling on transplanting reproductive organs such as testes and ovaries?

Answer: It is permissible in principle, meaning disregarding the prohibited exposure and touching of the body required to achieve it.

Tests to determine virginity 

Question 54: If a female doctor checks for the virginity of a newlywed woman on the request of her husband who questions her virginity, and she determines that the woman is not a virgin or the signs of it are not present, is it permissible for her to lie about it and tell the husband that she is a virgin if telling the truth may result in divorce, death, or shame to the girl? If she lies to the husband, would she be committing a sin or will she be rewarded for protecting the girl?

Answer: In principle, examinations to determine virginity are not permissible if they require prohibited looking or touching by other than a spouse. However, it is allowed when necessary, such as when it refutes a false accusation against a woman. If an examination takes place and the doctor finds that she is not a virgin or that it is unconfirmed, and the doctor fears that providing her results will cause problems like divorce for the woman (in both cases), then she should excuse herself from sharing the results, but not lie. On the other hand, if doing so might cause the death of the woman or a similar harm, then there is no objection to lying to protect her if tawriyah[59] is not possible. Also, if the doctor suspects that the sign indicating non-virginity might not be caused by a sexual act, she should explain this to the husband so that he does not impetuously accuse the woman of lewdness. In fact, if she is sure of it, she must immediately inform him and convince him to the best of her ability.

Question 55: Is it permissible for a female doctor to perform hymenoplasty for a non-virgin woman to help her marry another man who does not know that she is not a virgin?

Answer: This is fraud and deception and it is not permissible unless the woman is in need of doing so to protect her life.

Medical procedures 

Question 56: Doctors sometimes perform some procedures such as biopsy and tissue collection with a needle. Such procedures may not directly benefit the patient or help diagnose their illness, but they have a general benefit. As such, the question is:

a. Is it permissible to perform such procedures if they do not directly benefit the patient. If so, can they be performed with extra payment or without?

b. Is it obligatory to inform the patient of such procedures even if they are not for extra cost and do not cause any harm?

c. Is it permissible to delay a patient’s tests for a day or two because of conflicts in [the doctor’s] schedule or to guarantee a more accurate diagnosis, knowing that it will cost the patient more money?

Answer:

a. It is permissible, both with and without payment, with the patient’s permission, if they are in the position to do so, or with the permission of their guardian if they are incapable of giving consent if it is for their benefit.

b. As stated above, it is obligatory to obtain the patient or their guardian’s permission because it is not permissible to act on a patient’s body without their permission.

c. It is permissible if the delay does not severely harm the patient, and they approve.

Question 57: Some doctors perform medical or surgical procedures for cases that require urgent treatment to save the patient’s life, like loss of consciousness due to unknown reasons, falling from some place high or a car accident. If they fail, such procedures may result in the doctor being subject to legal liability, but if the doctor does not intervene, the patient could pass away. What is the ruling in such a situation?

Answer: If it was done with the permission of the patient or the permission of their guardian (if it is not possible for the patient), then there is no religious issue. Furthermore, if the doctor has prior release from liability, then there is no dhamman obligatory on them as long as they did their best [in treating the patient].

Question 58: Is it permissible to inject ethyl alcohol during variceal ligation to prevent bleeding for esophageal varices patients, especially because there is no alternative substance to be used. Is it obligatory to inform the patient of this substance, its effects, and that it may intoxicate and prevent them from fulfilling their religious duties?

Answer: It is permissible when absolutely necessary and with the patient’s knowledge.

Procedures that cause cognitive side effects 

Question 59: Respiratory interventions or intubation for medical procedures is sometimes necessary to save the life of a child that has health complications after birth. However, these procedures can cause negative mental/cognitive side effects, and if they are not performed, the child will most likely die. Thus, what is the view of Islamic law in such a case?

Answer: If there is no way to save the child’s life except by what has been mentioned, then it must be carried out even if it causes negative mental/cognitive effects.

Dispensation of medications 

Question 60: A doctor can sometimes procure a medication which they think is needed [for other patients] by adding a paid requisition to a given patient’s prescription without harming or neglecting that patient’s treatment. What is the ruling on this if the requisition is paid for but the medication is received for free?

Answer: It is not permissible to do so.

Question 61: Is it permissible for hospital employees to buy the medications used in the hospital?

Answer: With regards to what is mentioned, it must comply with the official rules established by the authorities responsible for its administration. Any action that complies with it is permissible. Any action that does not comply is not permissible.

Question 62: Is it permissible to sell the medications of a recently deceased person to other patients:

a. If the medications were bought from a private hospital?

b. If the medications were acquired from the hospital?

Answer: With regards to what is mentioned, it must comply with the official rules established by the authorities responsible for its administration. Any action that complies with it is permissible. Any action that does not comply is not permissible.

Question 63: Is it permissible for a specialist doctor to prescribe a medication using the hospital’s internal medical system in the following scenarios:

a. If the patient is from outside the hospital?

b. If the patient is an employee in the hospital?

Answer: With regards to what is mentioned, it must comply with the official rules established by the authorities responsible for its administration. Any action that complies with it is permissible. Any action that does not comply is not permissible.

Question 64: Some medications are readily available and remain unused in hospitals but are not available in private pharmacies. Thus, is it permissible to use the hospital’s requisition card to acquire and give them to private pharmacies to give to patients for free?

Answer: With regards to what is mentioned, it must comply with the official rules established by the authorities responsible for its administration. Any action that complies with it is permissible. Any action that does not comply is not permissible.

Question 65: What is the ruling on those who sell medications and medical equipment without a proper license, and in the following cases:

a. If the medications were stolen from government institutions such as hospitals?

b. If they were smuggled into the country?

c. If the person doing this is a nurse rather than a pharmacist?

Answer: It is not permissible in all the cases mentioned above.

Question 66: If medications are procured and circulated without proper authorization and are then confiscated by the authorities, is it permissible to send them to hospitals to give to patients and be used in the appropriate manner?      

Answer: All available legal measures should be taken to protect oneself while maintaining public interests.

Question 67: What is the ruling on buying medical supplies or equipment that is known to be stolen, been misappropriated in any way, or is donated through certain private entities and acquired by those in authority? Not doing so might prevent certain medical professionals from working and earning a living.

Answer: There are several points:

a. Selling donated items by those in authority to do so does not make it impermissible to use by the buyer. Thus, if there is a strong probability that the supplies/equipment that were bought are from such donated items then it is permissible to use and there is no problem.”

b. If they bought the supplies that were stolen from storage facilities or government hospitals assuming that it is permissible, and they are unable to return them to their [rightful] owners, they must give them or their equal (value) as alms for the needy believers, and if the patient is a needy believer, they can consider what they use for them as alms.

c. They must restitute for what they previously used of the stolen supplies by giving their equal value in alms or returning them to their sources to absolve themselves.

Question 68: Nowadays, alcohol, which is known to be an intoxicant, is used in many medicines, especially liquid medications, as well as in perfumes and colognes. So, is it permissible for people who either know of this ingredients or not to buy, sell, or use for benefiting the mentioned substances?

Answer: It is permissible to buy, sell, and use [the mentioned products]. As for drinking the medication, it is permissible if the alcohol content is very small percentage of the solution that does not cause intoxication.

Question 69: What is meant by permissible use for benefit?

Answer: The permissible benefit gives something a veritable market value, even if it is only known by people who have specialized knowledge of it, whether it is sought after by the general public or a select group, at all times or in certain cases, such as the medications used for treatment.

Question 70: Counterfeit medications of global brands, which are manufactured in secret locations, have spread throughout the market. Even doctors and some pharmacists cannot differentiate them [from the authentic medications]. Furthermore, they are ineffective, as they do not have the real therapeutic ingredients. What is the ruling on dealing with these “medications” when it is known that that they have no efficacy, whether encountered by a pharmacist or a supplier?

Answer: It is not permissible to manufacture these false medications, nor is it permissible for suppliers to provide them to pharmacies, even if the latter are aware of them. It is also not permissible to sell them without alerting the buyer of the condition. 

Circumcision with electrical equipment 

Question 71: An electric tool has become popular in circumcision because it helps complete the procedure without causing any bleeding, supposedly. Thus, is it permissible to use this device in circumcision?

Answer: It is permissible as long as there is not a strong probability, one that is veritable, of harming the child, even if in the future.

Hospital employees 

Question 72: Is it permissible for a doctor to refuse to treat a patient in a place not suitable for treatment (such as the patient’s home) because the procedures require preparation to protect the patient’s privacy?

Answer: The doctor is allowed to do so, unless the patient is in a critical condition such that they cannot be transferred to a clinic or hospital, in which case the mentioned excuse is not sufficient to deny treatment.

Question 73. Oftentimes, overly abundant medications in medical centers expire. Is it permissible to sell these medications to clinics instead of giving them to patients, and does it matter if the management knows or not?

Answer: If it is not against the rules of the center, then there is no issue.

Question 74. Some medications and medical equipment are unavailable in pharmacies. Is it permissible to sell them to patients during work hours for personal benefit?

Answer: The ruling is the same as what was mentioned in the previous answer.

Question 75: Is it permissible to use excess equipment or materials from the hospital in my personal clinic, given that the hospital is not in need of it and using the equipment does not affect the hospital’s operations in any way since there is an abundance of it and I plan on buying it as soon as I am able?

Answer: That does not justify it unless it is allowed according to the hospital’s rules and legal standards.

Question 76: Some doctors send their patients to certain laboratories or pharmacies for x-rays, ultrasound scans, or ECG. What is the religious stance on this if:

a. The doctor has an agreement with the laboratory/ pharmacy such that they receive a percentage of the profits.

b. The doctor does not have an agreement, but the laboratory or pharmacy sends a certain amount of money to tempt them to send their patients to them.

c. There is no need for the scan.

Answer:

a. and    b.  If it is not beneficial for the patient, such as if the laboratory is less accurate or more expensive, then it is not permissible. Furthermore, it is not permissible if there is a law prohibiting it.

c. It is not permissible.

Question 77. Some doctors give less medical attention to patients in government hospitals than in their personal clinics, which compels the patient to consult them in their personal clinic. What is the ruling on this?

Answer: It is obligatory for the doctor to comply with their professional contract and completely and appropriately fulfill their obligation to the hospital, and they are not allowed to violate it.

Question 78. Some doctors agree with the patient to personally perform a particular surgery in the government hospital, but then the resident doctor (who is less experienced than the specialist) performs the surgery on the patient under the supervision of the specialist. Is this permissible?

Answer: It is not permissible.

Question 79. Sometimes the doctor agrees with the patient to receive a certain amount of money for surgery in a government hospital, despite that surgeries in government hospitals are free. Is this permissible?

Answer: It is not permissible.

Question 80. Is it permissible for a doctor to exploit their patients by not diagnosing the illness in the first, second, or even subsequent visits so that they can take advantage of them (i.e., monetarily) despite being able to diagnose them from the first visit?

Answer: It is not permissible because the doctor is being compensated for their medical services to the patient. If they do so, then they have committed a sin and do not deserve the compensation.

Question 81. Is it permissible for the doctor to exploit the patient in other ways, such as by specifying the pharmacy from which the patient’s medication is bought, since the doctor might receive a percentage of the profits from the pharmacy owner?

Answer: If it is under the false pretext that the pharmacy is the best for the patient’s treatment because it has a large supply of the medication, and it actually is not, then it is not permissible. This is also the case if it is against the patient’s interest due to its high prices, etc.

Question 82. Some doctors treat patients differently in their clinic than in the hospital. What is your recommendation for such doctors?

Answer: It is impermissible for a doctor to treat patients in the hospital in a way which contradicts his occupational oath.

Question 83. What is the ruling on a surgeon or doctor who performs surgeries in government hospitals in the following cases:

a. If the surgeon requires a certain amount of money (determined by the kind of surgery and patient’s need), which, if not paid for by the patient, would result in the surgery being canceled?

b. If the surgeon does not require a certain amount of payment but asks the patient for a (benevolent) gift?

c. If the patient gives the surgeon some money as a gift for performing the surgery without the surgeon’s request?

Answer:

a. It is not permissible to require the patient to pay this amount if it is against the hospital’s policies and established system.

b. Answer: There is no issue with this if the patient pays it willingly (out of kindness and not forcibly) and if it is legally permitted.

c. Answer: There is no issue with it except if it is legally prohibited.

Question 84. Some doctors force patients to visit them in their personal clinics rather than examining them in the government hospital. This is sometimes directly (through a direct request) and other times indirectly (by not giving enough care, examining them well, prescribing a medication, making the patient believe he requires intense treatment, or requesting a test unavailable in the government hospital). What is the ruling of one who does that? What is the ruling of the money gained in these ways?

Answer: The doctor must fulfill the duty required from him in the hospital by examining patients, prescribing medications, etc. It is impermissible to neglect or disregard his duty, or to use fraud and deception. It is also impermissible to neglect his work purposely or violate the system for personal gain. As for the money gained in such illegal ways, there are issues with it, and he does not deserve the wage received when violating the occupational contract.

Question 85. What is the patient’s obligation in the aforementioned case?

Answer: There is no specific obligation on the patient in the mentioned cases. However, if they are able, they should encourage good and forbid evil.

Question 86: What is the Islamic ruling of a doctor, nurse, or other hospital or medical center employee who negotiate [with patients on the fee] before performing a surgery?

Answer: It is not permissible to take more than what the hospital management has decided.

Question 87: In some cases, patients leave without taking the prescribed and issued medication. Thus, is it permissible to give this medication to other needy patients, knowing that the medication cannot be returned to the hospital?

Answer: If the matter is between letting it spoil and go to waste or giving it to a needy patient, then it is permissible to give it.

Question 88: Based on hospital protocols, employees discharge the patient under the care and responsibility of the latter’s family. Thus, does the employee bear any religious responsibility if they follow the proper procedure?

Answer: If it is not allowed legally, the employee does not have the right to discharge the patient. The same is the case if death or medical complications will result if the patient is released early. As such, this must be prevented, and the right to discharge the patient does not apply unless there is a resulting problem.

Question 89: I am an obstetrician-gynecologist. Sometimes, I am called for delivery outside of my normal work hours, so I go to the hospital and use the hospital’s equipment during the delivery. Is it permissible for me to take some compensation for this, and if so, is it determined by the hospital?

Answer: It is permissible to take a compensation in this case if it is not against the hospital’s policies. It is also obligatory to consider the policies when determining the compensation.

Question 90: Is it permissible to buy or sell medications given for free by medical institutions?

Answer: It is not permissible to deal with if it has been obtained illegally. However, if it has been obtained legally, such as through a legitimate requisition, and there is no legal issue, then it is permissible to deal and transact with.

Question 91: Is it permissible for pharmacy owners to buy medications taken from hospitals?

Answer: It is not permissible to deal or transact with medications taken illegally from medical centers and government hospitals.

Question 92: Is it permissible for a pharmacist to overprice a medication?

Answer: It is not permissible.

Question 93: Alcohol is used in many medications. Is it permissible to consume it? Is it considered pure?

Answer: It is pure and permissible to drink if the alcohol percentage is very small and it deteriorates or subsumes into the solution (undergoes istihlak).

Question 94: I have specifically found a mouthwash which contains alcohol, is there an issue with using it?

Answer: There is no issue in using a mouthwash that contains alcohol.

Question 95: What is your opinion on a pharmacist or doctor who sells some medications outside the medical center in the black market, regardless of whether it is needed by patients, doctors, or if it is in limited supply?

Answer: We do not permit it in all cases.

Question 96: Buying and selling donated medications has become a popular phenomenon lately. Some people buy medications given as donations and sell it to travelers coming from foreign countries. What is the ruling on this?

Answer: It is not permissible.

Question 97: Some medications enter the country without proper medical regulation and are sold directly in the markets. What is the ruling on such medication?

Answer: If it is legally acceptable and there is no significant or even reasonably probable harm in selling them, then it is permissible to sell. Otherwise, it is not permissible.

Question 98: Is it permissible to buy medications from street vendors?

Answer: It is permissible. [However, the laws of the land should be obeyed and such practices avoided]

Question 99: Gelatin is used in pharmaceutical capsules and many products that are imported from non-Islamic countries. Gelatin is a jelly-like ingredient derived from collagen which is taken from bones or other parts of animals and undergoes laboratory and chemical processing before use. Is this considered a form of istihalah, or change, which results in purity and permits consumption?

Answer: The purity of an impure dead animal’s bones does not make it permissible for consumption or the consumption of an ingredient derived from it. As for istihalah or transformation, it is when the properties of the original substance are completely changed, not when its name has changed or its parts are separated, or even if other ingredients are added to it. It is permissible to consume, if there is doubt about whether or not it is impure. [Note: all gelatin is known to be derived from animal sources, so in the West, it must be verified to be halal prior to consumption]

Question 100: Insulin, which is used to treat diabetes, is sometimes derived from pig pancreas. Is such insulin permissible to use?

Answer: There is no issue with injecting it in the muscle, vein or below the skin with a needle.

Question 101: Pharmaceutical companies in the West test their medications before releasing them in the markets. Is it permissible for a doctor to prescribe such experimental medications to their patient without the patient’s knowledge if they think that such medication is beneficial to the patient?

Answer: It is obligatory to inform the patient and receive their consent to the experimental medication, unless it is certain that it does not have any side effects and the doubt was only about its benefits.

Question 102: Doctors in government hospitals receive great numbers of patients to the extent of exhaustion during work hours. Thus, is it permissible to see some of these patients in their private clinics?

Answer: It is obligatory on the doctor to comply with their professional contract and fulfill their obligation in the government hospital. If it is not allowed by the hospital’s policies, then it is not permissible to ask patients to visit the doctor in their private clinic.

Question 103: Doctors sometimes work night shifts, in addition to the day. Is it permissible for a doctor to take extra money from the patients for the extra time not compensated by the hospital?

Answer: It is not permissible.

Men specializing in women’s health  

Question 104: What is the ruling on a man who specializes in gynecology and obstetrics? Is it permissible, especially for those who have become specialized in this field and it is their source of income, such that they can no longer change their profession or it would be very difficult to do so?

Answer: Studying and practicing gynecology and obstetrics for men requires impermissible exposure or touching in most cases. The aforementioned does not justify it unless studying it saves the life of a Muslim, even if in the future, in which case it is permissible based on necessity.

Question 105: Some [male] doctors specialize in gynecology and obstetrics. What is the ruling if there are [female] alternatives, and what is your guidance for male specialists in this field?

Some female patients visit male doctors due to the shortage of female internal medicine physicians, surgeons, and heart specialists. So, what is your guidance regarding this? Is it obligatory for female patients to look for female doctors?

Answer: It is not permissible for a [male] doctor to treat a woman if it requires impermissible exposure and touching, unless there are no female doctors from which they can seek treatment. It is also not permissible for a woman to visit a male doctor with the presence of a female doctor who can perform the necessary service. However, if the treatment is only restricted to exposure or touching of the non-private areas then a woman can visit a male doctor if he is more skilled and efficacious in treating her.

Seeking treatment from a doctor of the opposite sex 

Question 106: Medical necessity may require direct touching [between a nurse and patient of opposite sexes], like when there is no one of the same sex available, requesting one would be difficult, or the nurse of the opposite sex is more attentive to the patient?

Answer: It is permissible if necessity demands examination and treatment that require direct touching, like in the mentioned situations, but it should be limited to the extent of necessity.

Question 107: Is it permissible for a woman to visit a male doctor with the availability of a female doctor?

Answer: If it requires touching the body without a barrier or exposure to what is prohibited to look at by choice (i.e., everything but the face and palms), then it is not permissible.

Question 108: If there is a female alternative, but the male doctor is better, then is it permissible for her to visit the latter?

Answer: If she must seek treatment and the male doctor is more competent in treating her, then it is permissible.

Question 109: If she visited the male doctor for a necessary reason that warrants it, then is it permissible for her to show parts of her body that are [normally] prohibited to expose, if the doctor requests it for the examination?

Answer: It is permissible if it is required for the necessary examination, but only limited to what is needed.

Question 110: If the male doctor (who was visited out of necessity) requested to touch her body or examine her private area, front or back, by the insertion of certain diagnostic equipment, then is it permissible to do so?

Answer: If the diagnosis or treatment requires it then it is permissible, but it must be limited to what is necessary.

Question 111: What should she do if she feels sexually aroused by the procedure described above?

Answer: If it is necessary for treatment and she is unable to find a skilled female doctor then there is no issue.

Question 112: Female nurses often check pulse, bandage wounds, measure blood pressure, inject medication, and perform other medical procedures. What is the ruling if the patient is a male?

Answer: It is not permissible for her to touch a male patient or look at the parts of the body that are prohibited to look at unless the patient requires bandaging or similar procedures that necessitate some form of touching or looking and a skilled male nurse is not available, in which case it is permissible to look or touch to the extent that is necessary.

Question 113: If the wound is in the private area, is it obligatory to wear gloves or use a barrier when touching it?

Answer: Yes.

Question 114: If gloves or a barrier is not available, then is it permissible for a female nurse to directly touch the private area of a male patient?

Answer: It is not permissible except when absolutely necessary.[60]

Question 115: Male doctors sometimes need to view certain areas of a non-mahram woman’s body, including some sensitive areas, so is it permissible for her to reveal her body in the following cases:

a. If there is a female doctor who can be visited but at a higher price?

b. If it is not a dangerous illness, but an illness, nonetheless?

c. What is the rule if she was asked to reveal an intimate part?

Answer:

a. It is not permissible [to visit a male doctor] if a female alternative is available, unless the cost of the doctor’s visit harms her financially and the treatment is necessary.

b. It is permissible if neglecting treatment causes harm or severe unbearable hardship.

c. The ruling for this has already been mentioned, and in all cases the exposure and touching should be limited to what is necessary.

If it is possible to provide treatment without directly looking at prohibited body part(s), like through a screen or mirror, then it is an obligatory precaution to do so.

Question 116: Some cosmetic surgeries only require an injection in the face (with botox or filler), so is it permissible for a male doctor to perform such surgeries on women since it does not require exposure of prohibited body areas or touching? Besides, the doctor uses gloves when performing the procedure.

Answer: It is not permissible unless it is assured that he will not look at her in a lustful way or with suspicion. However, if the cosmetic surgery is required, for example, to treat an abnormality, and the doctor is more proficient in the treatment, then it is permissible for him to look or touch but only to the extent that is required for the treatment.

Question 117: Some physical therapy students are required to touch the bodies of female patients and interact with them during their procedural training. If they refuse to learn this or train, they will fail the class. Thus, is it permissible to learn and specialize in this field?

Answer: It is permissible if they know that this specialty will save lives, even if it is in the future. But they must make sure that their training in this does not cause any lust.

Transsexuality 

Question 118: What is the ruling of changing sex from male to female or vice versa in terms of marriage, inheritance, and general permissibility?

Answer: In principle, there is no religious evidence prohibiting such a transformation, without taking into consideration its requisites and necessities. So, if a male were to truly transform into a female or vice versa, they must observe the rulings of the sex they have changed into. However, it is difficult to establish that such a transformation has actually taken place.

Question 119: A hermaphrodite visited a doctor, who, after examining her, decided to perform surgery to remove the testes. However, despite the surgery, the female reproductive organs were still incomplete, making it unsuitable to mate with a male spouse. Therefore, is it permissible for her to perform a surgery to become a male?

Answer: If she has internal female reproductive organs, such as ovaries or a uterus, whether partial or complete, she is considered a female, even if it is an incomplete. Therefore, she does not become a man by merely [surgically] receiving what resembles a penis.

Question 120: In western countries, there are surgeries to change the gender from male to female or vice versa, so that the physical appearance changes. However, it [still] does not permit pregnancy, menstruation, or similar female characteristics. Thus, what is the ruling regarding hijab and other religious matters for such a person?

Answer: The physical changes [solely] do not have any effect given that it does not change the internal state of the person. Therefore, in reality, the man should observe the rulings of men, and so is the case for women, and God knows best.

Exposing intimate parts  

Question 121: I am a university professor and surgical consultant. I am sometimes required to examine (both female and male) patients with their approval, and sometimes we may even be required to perform surgeries on their private parts, such as removing parts of it. Thus, my questions are:

a. What is the ruling on exposing the intimate area (when necessary), knowing that we cannot perform the procedure without it?

Answer: It is permissible to the extent that it is necessary.

b. What is the ruling of removing parts of the organ when necessary, such as when keeping it causes extreme harm to the patient?

Answer: It is permissible in such cases.

Question 122: Does the permissibility of touching or looking at the parts that are normally prohibited depend on the necessity of treatment or can it be applied to any treatment?

Answer: It requires the treatment to be necessary for the patient, but in such cases, if it is between visiting a male or female doctor, and the doctor of the opposite sex is more proficient in the treatment, then it is permissible to visit the doctor of the opposite sex.

Question 123: Is it permissible for a man to touch a non-mahram woman as required for examination/ treatment in a hospital? It is sometimes required to touch the arm to take a sample of blood, for example. There are women in the workplace, but they are less experienced. Therefore, is it permissible?

Answer: If the female patient requires the test, then there is no issue with touching to the extent that is necessary for the examination.

Question 124: To diagnose cancer in females, a doctor or medical student must touch the female patient’s breasts or private parts, and they cannot [just] look at it [and perform their task]. By touching the body part, the doctor can diagnose the disease at an earlier stage, which can help save the life of a Muslim. Therefore, is it permissible to touch?

Answer: With regards to the medical student, the ruling was previously discussed in the question concerning autopsy. As for the doctor who the female visits for regular examination, it is permissible to touch to the extent of necessity if there is no female doctor capable of performing the same examination.

Question 125: A married man who has children married a second woman. The man and his second wife are unable to consummate so he took her to a female doctor for consultation. The doctor said that her hymen is preventing penetration, meaning he cannot have sexual intercourse with her without a surgical operation that must be performed on her. In this case, is it permissible to perform such a procedure on her, knowing that it would require revealing her private parts and touching them?

Answer: In this case, it is permissible since it prevents severe harm or unbearable difficulty, and God knows best.

Question 126: Is it permissible for a woman suffering from infertility to reveal her private parts for treatment when necessary?

Answer: It is permissible if there is a need to do so for becoming pregnant, or if not having a child causes extreme difficulty that would make it [circumstantially] permissible.

Question 127: When a woman undergoes a pregnancy exam, a non-mahram doctor will perform an internal examination using a device. Is this considered exposing a private part since it [only] reveals the woman’s womb and whether or not she bears a child?

Answer: There is no problem with a female doctor examining the insides of a woman because the womb does not have the same ruling of the front and back private areas. However, this must be avoided based on obligatory precaution if the doctor is a non-mahram male, unless it is necessary.

Question 128: The jurists have stated that an exception to prohibited touching and looking by the opposite sex is when it is [absolutely] necessary, such as during treatment when a same-sex doctor is not available. Thus, is urf or common understanding sufficient to define necessity in these cases?

Answer: It is not sufficient. Necessity must be defined based on Islamic jurisprudential criteria, such as if a woman required treatment and the non-mahram male doctor was more proficient in the treatment, then it is permissible for her to visit him, and as such, it is then permissible for him to look and touch to the extent necessary for the treatment.

Question 129: Is it permissible to treat infertility if the treatment requires something impermissible?

Answer: In principle, it is permissible to treat infertility, however, it may require something impermissible, such as exposing parts of the body not permissible to do so to a male or female doctor. Such prohibition is not removed except in cases of necessity, such as if the infertility results in extreme worry and anxiety to the woman that is not commonly bearable.

Question 130: A young girl’s treatment requires exposure to a non-mahram male doctor. The treatment will take a long time and the girl will become baligh during the treatment. Her illness is an abnormality in her ear which makes hearing difficult. Therefore, in this case, is the fear that she would be unable to bear this abnormality sufficient to continue the treatment (i.e., by the non-mahram) or must she suffer from the abnormality first [for it to become permissible]?

Answer: It is not permissible for her after becoming baligh to expose her body to prohibited looking or touching, unless she fears harm due to not getting the treatment or she determines that it would cause her severe difficulty that is not normally bearable.

Question 131: If a man is sterile and the doctor prescribed an injection by which sperm cells are implanted into his reproductive system, then he has intercourse with his wife and she becomes pregnant, is the child considered his, and is this procedure permissible?

Answer: This is merely a theoretical case and it is unrealistic. However, if it were to take place, the child belongs to the biological father who donated the sperm cells. Furthermore, it is not permissible for the semen of any man, other than the husband, to enter the wife in any way.

Question 132: Does infertility make it permissible for a woman to undergo treatment by a non-mahram male doctor, knowing that it requires looking and touching?

Answer: It is not permissible unless not having a child causes severe difficulty that is not normally bearable, or if it helps prevent some psychological illness or remediates conditions that are caused by the infertility. In such a case, it is permissible for her to visit the non-mahram male doctor, but it must be limited to it (i.e., what is necessary).

Question 133: Is it permissible to place the sperm from a man and the ovum of a woman into the womb of another woman?

Answer: If the man is not the husband of the second woman then it is not permissible for his semen to enter her. On the other hand, if the ovum is inseminated outside (e.g., in a test tube) and then placed into the womb of the second woman, then it is permissible in principle. However, this should be avoided.

Question 134: In the case mentioned above, do both women [automatically] assume the position of motherhood and all its requirements and details as determined by Islam, or is one specified to be the mother? Does it make a difference if both women or only one of them are married to the father, or if neither are?

Answer: It is [religiously] problematic to assign the child to either woman (the ovum-donor or the womb-bearer). Therefore, precaution must be observed with both of them in all relative motherhood and child-related rulings. There is no difference in this matter, whether both or only one are/is married to the father or neither.

Question 135: A doctor performs tests on non-mahram women to diagnose their infertility. The doctor does not touch the women during the test and only sees the area in which the device is inserted. Is this permissible? Does it make a difference if it is a matter of difficulty versus necessity (for the patient), or even neither of these? Is it permissible for the doctor to open a clinic for such purposes? Is there a difference in the ruling if the women are Muslim versus non-Muslim?

Answer: The permissibility of performing this for a woman is limited only to cases in which infertility causes severe difficulty, which would then make it permissible, or if there is a need which makes it necessary to be pregnant. If it becomes permissible for her, then it is also permissible for a male or female doctor to look [at her during the examination] to the extent that is necessary. This is regarding Muslim women. The same conditions should be observed with non-Muslim women based on obligatory precaution.

Question 136: A religious female doctor seeks to specialize in the field of obstetrics and gynecology to serve the community and provide a more appropriate [religious] option for female patients. To specialize in this field, she must supervise an intentional abortion. What is the ruling in such a case, knowing that abortion is allowed in the community in which we live?

Answer: If learning medicine requires committing some acts that are religiously unacceptable like performing an autopsy on a Muslim body, supervising an abortion prior to the entry of the soul into the body, or similar acts, then it is permissible as long as learning this is a necessary prerequisite to save a respected life, even if it is in the future.

Question 137: In some western countries, medical professionals are required to wear short-sleeved clothes when interacting with patients to prevent contamination. Thus, what is the ruling for female doctors who are required to reveal part of their arms?

Answer: It is not permissible to reveal it to the non-mahram viewer, but the conditions mentioned in the previous answer should be taken into consideration.

Question 138: A wound which requires dressing may sometimes occur in a private area, so what should be done?

Answer: If it cannot be dressed by the spouse, then the patient should ask the nurse, whether male or female, to wear gloves or barrier to prevent them from directly touching the private area. If this is not possible, then it is permissible to touch to the necessary extent to perform the dressing.

Question 139: Is it permissible for a young girl to work as a nurse?

Answer: There is no issue with it as long as she observes the religious boundaries, including: not being alone with a non-mahram if she is not safe from committing a prohibition, not touching a man without a barrier, such as gloves, except when necessary, and if someone of the same sex is not available.[61]

Question 140: Is it obligatory to help a pregnant woman during delivery, knowing that it requires looking and touching?

Answer: It is important to help a woman during delivery. In fact, it is wajib kifai or collective obligation that drops from everyone as soon as it is fulfilled if there is a risk on her or the baby’s life, or a similar danger. If the delivery requires prohibited looking or touching by non-mahram men, then the husband, women or mahram men must perform it. If it requires prohibited looking or touching by someone other than the husband, while he is more capable of performing the delivery without difficulty, then it is preferred to choose him, unless a midwife is more proficient, in which case it is permissible to choose her. This is the case if there are options. However, when there are no options, then a non-mahram is allowed to help deliver the baby, it may even be obligatory sometimes. Regardless, touching and looking must be restricted to the extent of necessity, which is determined based on the individual conditions.

Human cloning 

Question 141: What is your Eminence’s opinion on human cloning, is it permissible or prohibited?

Answer: In principle, this operation is not forbidden, but those with religious authority can forbid it given the dangerous risks associated with it, which would then make it forbidden.

Question 142: Is animal and plant cloning permissible?

Answer: It is permissible per se. However, if someone with religious authority forbids it in the public interests, then it is obligatory to follow his prohibition.

Cesarean procedures 

Question 143: Is it permissible to perform a cesarean section for a pregnant woman if she does not need it, for example to undergo tubal ligation, especially if such a procedure can be dangerous for her or the child. What if she can deliver the baby naturally and without any surgical intervention, and the ligation operation can be performed later with less risk than the c-section?

Answer: If the harm on the mother or baby’s life is significant according to reasonable people such that it creates fear for them, then it is not permissible to perform the procedure.

Question 144: Cesarean section procedures have become very common in recent years. What is Your Eminence’s opinion regarding it in the following cases:

a. To perform the cesarean section under the [false] pretense that she cannot deliver the baby naturally, and to persuade the patient’s family of that?

b. To retract the baby’s head into the mother’s womb to perform a cesarean section?

c. To [falsely] convince the patient that her condition is very dangerous and that the blood pressure is very high, which would cause her or the baby to die,  to force her into agreeing to the surgery?

d. What is the religious ruling of a doctor who agrees with the patient’s family for a certain compensation to perform the surgery, otherwise they would not perform it. What if this is done knowing that the doctor objected to performing a natural delivery for several other patients who eventually gave birth naturally not long after?

Answer:

a. It is not permissible if natural delivery is possible.

b. That is religiously not permissible.

c. That is also not permissible.

d. It is not permissible to perform the procedure in the above case, it is also not permissible to take compensation for it.

Artificial Insemination 

Question 145: A man married a woman who cannot conceive. So, they harvested her sister’s ovum and implanted it in the wife’s womb, then inseminated it with his sperm. Is this permissible? Who is considered the mother of the child?

Answer: If the insemination took place outside the womb, then there is no issue with implanting it in the womb in principle. It is problematic [from a jurisprudential perspective] to assign either the ovum-donor or the owner of the womb as the biological mother. Obligatory precaution must be observed in this matter, and God knows best.

Question 146: A husband and wife cannot have children except through artificial insemination. Is it permissible? What are its conditions?

Answer: Artificial insemination with the husband’s sperm is permissible in itself, but it may require some impermissible actions for either the husband or wife, such as requiring the husband to masturbate to release the sperm, or for the wife to reveal her private parts to the doctor to harvest the ovum from her ovary to then be fertilized with the husband’s sperm and returned to the uterus. The impermissibility of these acts is not nullified unless a secondary factor is present, like extreme difficulty, such as if the husband or wife will experience anxiety and difficulty that is not normally bearable if they are unable to bear a child.

Question 147: If artificial insemination takes place with other than the husband’s sperm:

a. Is the child considered illegitimate (born to zina)?

b. What is the husband’s responsibility if the wife does not know that the semen used in the procedure is not his, and instead from a non-mahram man?

Answer:

a. No, the child is not considered illegitimate even though insemination with other than the husband’s sperm is prohibited.

b. He should tell her based on obligatory precaution unless it causes greater harm.

Question 148: Is it permissible for the doctor to perform the artificial insemination procedure in the following cases:

a. If the semen was collected from the man through masturbation?

b. If the insemination of the woman is through the cervix, knowing that the doctor must look and touch the private part?

Answer:

a. It is not permissible for the husband to masturbate for the mentioned purpose, but if he does, it is permissible for the doctor to use the sperm.

b. It is not permissible for the woman to reveal herself to the female or male doctor for the mentioned purpose. It is also not permissible for the doctor to look or touch in the mentioned case. However, if not having a child would cause severe difficulty that is not normally tolerated or veritable harm, then it is permissible for her to do so, and it is also permissible for the doctor to touch and look to the extent necessary. As such, it is not permissible to use a male doctor if a female doctor is available.

Question 149: Is it permissible to extract an ovum from a woman’s womb, fertilize it with the sperm of a non-mahram man using in-vitro procedures, and then transfer the embryo to the womb of the non-mahram man’s wife after its formation? This is because the ovum donor is unable to support fertilization in her womb, necessitating such a procedure.

What is the ruling if the woman from whom the egg is extracted is the man’s wife, and he is not a non-mahram to her, and after the embryo’s development [fertilization], it is transferred to the womb of the man’s second wife for the aforementioned reason?

With regards to both cases, what is the child’s relationship with the woman in whose womb it grew, and is the woman from whom the egg was extracted considered the mother, and does she have the right to demand custody or any other rights?

Answer: In principle, there is no issue with the aforementioned procedures. However, they may require some prohibited prerequisites like revealing the private parts to other than the husband to extract the ovum or implant the embryo. Assigning the mother to be either the ovum-donor or the one who carries the pregnancy is problematic. Obligatory precaution must be observed in it.

Question 150: If the ovum taken from the wife and the sperm taken from the husband are fertilized in an artificial tube, and because the wife is sick to the extent that she cannot bear pregnancy and delivery based on the doctors’ evaluation, is it permissible to place the fertilized ovum in the womb of the wife’s mother or another woman for it to develop and be delivered?

Answer: Placing the ovum in the womb of the wife’s mother conflicts with the obligatory precaution that should be observed regarding mahram women. As for non-mahram women, there is no issue with it in principle. But if implanting the fertilized egg requires prohibited looking or touching, then it is not justified.

Question 151: I have been married for ten years and I have only been blessed with one child to this day. I have not been able to have another child due to sperm defects.

After nearly six years of treatment, the doctors suggested that I try artificial insemination, which is done by taking sperm from me, selecting the healthy ones, and placing them directly in my wife’s womb. However, this procedure requires looking at the private parts of my wife, and there is no alternative method.

Therefore, in this case, is it permissible [for the doctors] to look at my wife’s private parts, and is it permissible for her to reveal those parts to the female doctor, knowing that not having another child will cause social difficulty for my wife and I?

Answer: If not having another child causes severe difficulty that is not normally bearable, then it is permissible for her to expose herself to the female doctor for insemination, otherwise it is not permissible.

Question 152: If the insemination of the wife requires exposing her private parts to other females, then is it permissible given pregnancy and the marital relationship depend on it?

Answer: If not giving birth causes her severe difficulty that is not normally bearable, then it is permissible for her to do so.

Question 153: A woman can have children, but her womb is unable to carry a pregnancy to term. As such, the doctors suggest that the fertilized ovum be moved to another womb. The ovum is fertilized with her husband’s sperm but the embryo is implanted in the woman’s mother’s womb (i.e., the child’s grandmother) until delivery. What is the religious ruling regarding the following issues:

a. Is a male child considered a brother to the mother because they were born from the same womb?

b. Is the husband considered to have committed zina (adultery) with his mother-in-law?

c. Does the child inherit from the grandmother (i.e., the one who carried the pregnancy) directly, and is he or she considered a co-heirs to the mother in inheritance?

d. Does the grandmother who carried the child in her womb inherit directly replacing the mother or do they both become heirs to the inheritance?

Answer: The husband is not considered an adulterer. As for the inheritance, there are two juristic views; thus, precaution should be observed in determining whether the mother is the ovum-donor or the owner of the womb from which the child was born.

 Question 154: A sterile man needs treatment, but it requires examination of his semen. Thus, if he is unable to ejaculate [for collection of his semen] with his wife, is it permissible for him to release it through masturbation or some medical method?

Answer: Masturbation is prohibited, whether it is with the hand, a medical method, or any other way, except if ejaculation occurs by the wife. Therefore, it is not permissible just because treatment for sterility depends on it, unless the inability to have children causes extreme anxiety resulting in difficulty that is not normally bearable and there is no way other than masturbation, then it is permissible to the extent necessary.

Question 155: Is artificial insemination, which is taking the husband’s semen and using it to fertilize the wife using an artificial method, permissible if pregnancy is not possible through usual intercourse and it is more likely in this type of fertilization?

Answer: In principle, it is permissible. However, its requisites may be impermissible, like if it required impermissible touching or looking from other than the husband.

Question 156: What is your Eminence’s opinion about a woman who was married for 12 years and could not have any children, then it was medically determined that her husband was sterile despite ten years of treatment. The doctor then suggested that she should be inseminated with another man’s sperm. Thus, she was inseminated with her brother-in-law’s semen and became pregnant with a girl and boy.

a. Did the wife commit a sin or is it permissible?

b. If her actions are sinful, what is her punishment, and are there any religious measures to be taken against her?

c. Are the children considered illegitimate (from zina)?

d. Do the children inherit the woman’s husband?

Answer:

a. She committed a sin in doing that because it is not permissible for a woman to be inseminated with other than her husband’s sperm.

b. She should repent to God Almighty and ask Him for forgiveness.

c. They are not considered illegitimate (children of zina), and are attributed to their mother and the sperm donor (i.e., the brother-in-law).

d. They do not inherit from him because they are not his children.

Question 157: What is the ruling of a woman who takes ovum-stimulating (fertility) drugs to try to have twins?

Answer: There is no issue with it in principle.

Question 158: The semen of men is sometimes preserved in a special bank. Thus, is it permissible for a divorced Muslim woman to use the sperm of a non-mahram man [to get pregnant] with his permission but without a [marriage] contract, or even without his permission? What is the ruling if the semen is from the husband during the iddah of a revocable divorce or after the iddah is over?

Answer: It is not permissible for a woman to be inseminated with the sperm of a non-mahram man; however, it is permissible with the husband’s sperm, even if it is during the revocable iddah, but not after it.

Question 159: Is it permissible to extract an ovum from the wife or husband’s mahram relatives, such as their mothers, and then implant it in the wife’s womb after fertilizing it with the husband’s sperm?

Answer: There is no problem in doing so if it were not for its prohibited prerequisites like exposure and masturbation, which are not permissible unless not having a child causes extreme anxiety that results in severe difficulty for the one wanting to carry the pregnancy. This is the case for those (i.e., ovum-donors) who are non-mahram to the husband. As for those who are his mahram, it is not permissible based on obligatory precaution.

Question 160: Sperm was taken from a man to be later used to inseminate his wife. It so happened that the husband died and thereafter his sperm was used to inseminate the wife. What is the ruling of the child born to her and its inheritance?

Answer: The child is attributed to the husband whose sperm it was, but in this case, the child does not inherit him.

Question 161: Is it permissible to use facilities like sperm banks that freeze and preserve sperm or those that provide fertilized ova (the egg and sperm of some married couple) for those who need it? Is it permissible to fertilize the eggs of the wife with frozen semen taken from the bank, knowing that the person (husband) is completely sterile?

Answer: It is not permissible to transfer sperm to the uterus of any woman other than the wife for insemination. However, if the insemination takes place in a test tube and is then implanted in the womb of someone other than the wife, then it is a recommended precaution to avoid it, despite it appearing to be permissible. In either case, the child is legitimate and is attributed to the sperm-owner.

In-Vitro Fertilization 

Question 162: What is the ruling of children born through in-vitro fertilization procedures from a married couple?

Answer: They are attributed to their mothers and fathers like the other children.

Question 163: Is in-vitro fertilization permissible or prohibited?

Answer: The procedure of inseminating the wife’s ovum with the husband’s sperm in a test tube, then re-implanting it in the womb of the wife is permissible in itself. But it usually requires certain prohibited requisites, which have been mentioned earlier, and their impermissibility is not removed except in cases of necessity as explained.

Question 164: What is the ruling of test-tube pregnancies in the following cases:

a. If the sperm is taken from the husband?

b. If the sperm is taken from other than the husband in cases of necessity?

Answer:

a. In principle, it is permissible to implant the wife’s ovum which was [artificially] fertilized with the husband’s sperm in her womb. However, the prohibited requisites, like exposing the woman’s body to impermissible looking and touching, should be avoided.

b. It is permissible to implant the wife’s ovum, which was [artificially] fertilized with the sperm of someone other than the husband in her womb, but it should be avoided. Nonetheless, the child is attributed to the owner of the sperm.

Question 165: In the field of genetic engineering, some scientists claim to have the ability to improve people by modifying their genes, for example by removing unattractive features and/or replacing them with attractive ones. Is it permissible for scientists to do that? Is it permissible for a Muslim to allow the doctors to improve their hereditary genes?

Answer: On its own, there is no objection in doing so if it does not have any side effects.

Question 166: There are some genetic disorders which are passed down from parents to children and pose a danger to their lives in the future. Modern science has reached the ability to eliminate some of these diseases by artificially inseminating the ovum in a test tube, then examining the fertilized ovum (embryo) and keeping the healthy one to be implanted in the mother’s womb while getting rid of the rest. Is this procedure permissible?

Answer: There is no issue with it in principle.

Ejaculating and storing semen 

Question 167: Is it permissible to perform sexual intercourse with my wife for the purpose of ejaculating for a pregnancy-related medical exam, especially because I have been married for nearly five years and have not been blessed with children, which may cause internal and external pressure on my wife and disturb her psychological state. Thus, is it permissible knowing that all the medical examinations have already been performed on the wife and the only exams that remain are related to the husband?

Answer: There is no issue with ejaculating by performing sexual intercourse with the wife and [collecting the semen and] then taking it to a medical professional for examination.

Question 168: For a doctor to identify the cause of a man’s sterility, he must examine his semen. To do so, a device is attached to the genitals, which then performs certain motions that cause the semen to be ejaculated. Is this considered masturbation, and thus, prohibited, or is it permissible because it is for a medical examination? Is there a difference for the patient in cases of difficulty or necessity or not?

Answer: Yes, it is considered masturbation, and it is not permissible if the examination does not depend on it. In fact, it is also not permissible even if the examination depended on it and there was no other way [to ejaculate] other than masturbation, except in the two cases described (difficulty and necessity), if they are fulfilled as described in the question.

Question 169: In cases of infertility, is it permissible for the husband and wife to perform medical exams on the semen by ejaculating without sexual intercourse or extracting it using certain equipment, or extract the wife’s ova to be fertilized with the husband’s sperm after preparing them, knowing that all of this is done through a male or female doctor and requires the husband and wife to reveal their intimate parts, perhaps even to be touched. Is this permissible? Is the need for pregnancy considered a “necessity that makes the prohibited permissible?”

Answer: It is not permissible to ejaculate through any means other than sexual intercourse with the wife, and it is also prohibited to reveal one’s intimate parts and expose them to impermissible touching and looking. Usually, the need to get pregnant does not reach the level of necessity that would make “the prohibited permissible.” However, it may reach this level in one of the following two cases:

a. If not conceiving causes mental anxiety, which results in difficulty that is unbearable and tolerated through patience, and this may happen to the husband, wife, or both.

b. If the woman has a certain illness that cannot be treated except through pregnancy, which requires treatment, or if not conceiving leads to some of these illnesses.

In either of these cases, the prohibition is lifted to the extent that is necessary.

Question 170: If semen is taken from the husband:

a. Is it permissible to inject it into the wife using a needle or some other means?

b. Is it permissible to inject it in other than the wife?

Answer:

a. It is permissible in and of itself.

b. Answer: It is not permissible.

Question 171: Semen is taken from a man and the sperm is used to fertilize the ovum of a woman other than his wife, then after fertilization, it is implanted in his wife’s womb:

a. Is this procedure permissible?

b. To whom is the child attributed to in this case, the ovum-donor or the woman whose womb the child developed in? In other words, who is the lineal mother?

Answer:

a. Yes, it is permissible in and of itself.

b. Answer: Assigning either the ovum-donor or the woman who carried the pregnancy as the lineal mother is religiously problematic. Therefore, obligatory precaution must be observed when dealing with the rules of motherhood and children. Nonetheless, it is veritable that the woman who carried the pregnancy is considered a mahram to a male child, even if he is not attributed to her lineally.

Question 172: What is the ruling on surrogacy, meaning a woman who cannot conceive a child due to an issue with her womb transfers one of her fertilized ova to another woman who has a healthy womb. Is this permissible?

Answer: In principle, it is permissible. But if it requires revealing the private parts, then it is not permissible except in necessity. Furthermore, assigning lineal motherhood [solely] to the ovum-donor is religiously problematic. Therefore, obligatory precaution must be observed in the matters of inheritance and custody. Nonetheless, a male child is mahram to her because he is her husband’s child, and he is also mahram to the woman who carried the pregnancy, even if she does not breastfeed him.

Birth Control 

Question 173: What is Your Eminence’s religious ruling regarding a man who seeks to become permanently sterile using a surgical procedure after having several children and fearing that his wife will face harm if she becomes pregnant again?

Answer: It is permissible per se if these procedures (e.g., vasectomy) do not cause serious harm. However, if they require prohibited looking or touching when pursued voluntarily (i.e., without a legitimate need), then they must be avoided. 

Question 174: Some women use contraceptive pills to delay their monthly periods to perform the following acts of worship:

Pilgrimage (Hajj or Umrah)

Fast during the blessed month of Ramadan

Visit the Holy shrines

What is the ruling on doing so?

Answer: There is no issue with it as long as it does not cause significant harm.

Question 175: A married man has sickle cell anemia, which is a heritable disease with symptoms, and his wife is a carrier of the same disease. Is it permissible to perform a contraceptive procedure on the wife if both agree?

Answer: In principle, there is no issue with tubal ligation or sterilization, even though it causes permanent contraception.

Question 176: Implantation of an intrauterine device (IUD) safely and free from complications requires a professional in obstetrics and gynecology. Although direct touching can be avoided by using a glove, the procedure requires the female doctor to look at the vagina to perform it properly. This raises the following questions:

a. Based on these issues, is it permissible for a woman to reveal herself to the female doctor simply because she wishes to perform the procedure to stop herself from becoming pregnant?

b. If it is not permissible for her as an option, is it permissible in cases of necessity, and what is considered ‘necessary’ in the religious jurisprudential view?

c. Has the doctor committed a sin by looking at the patient’s private parts for the purpose of the procedure?

d. Does the doctor sin if she looks at the private parts in a check-up if the patient complains about certain symptoms caused by the IUD or to confirm that it is properly implanted so that it does not cause any infections or other diseases?

e. Does the doctor sin if she looks at the patient’s private parts to remove the IUD, if it caused health complications, expired, or if the patient wants to remove it to be able to become pregnant again?

Answer:

a. It is not permissible for her to do so.

b. If pregnancy is harmful to her health, or causes serious difficulty that is not normally tolerable, and other religiously permissible contraceptive methods are not available to her, or are harmful to her health, or place her in difficulty, then it becomes permissible for her to reveal herself to the female doctor to the extent of necessity for the purpose of placing the IUD.

c. Yes, she has committed a sin, unless the patient required the IUD [based on necessity described above], in which case it becomes permissible for the doctor to look to the extent required for placing it.

d. There is no culpability upon her in doing so to the extent necessary for the check-up.

e. It is permissible in the first two cases, but in the last (to be able to become pregnant) it is not permissible unless she is compelled somehow to become pregnant.

Question 177: What is the ruling on using birth control methods for family planning, and what is the ruling on using methods which require revealing the private parts to the doctor when other methods (e.g., condoms and IUDs) fail?

Answer: There are several permissible methods for preventing pregnancy when there is an option, like condoms, with the wife’s permission based on obligatory precaution, and pills, if they do not cause severe harm. As for IUDs, there are two factors to consider. First, if it is proven not to damage the fertilized ovum, then there is no issue with using it from that perspective. Secondly, if it requires revealing oneself to the doctor to have it implanted, then it is not permissible except when one is compelled.

Question 178: Is it permissible to use IUDs to prevent pregnancy? If it is permissible but requires the doctor to place it, then what is the ruling given it requires the woman to reveal the private parts that are prohibited to be revealed?

Answer: If the IUD damages the ovum after its fertilization, then it is not permissible based on obligatory precaution. Otherwise, it is not forbidden in that respect. As for the other issue, that IUD implantation requires revealing the private parts to the female doctor, it is not permissible except in cases of necessity, like if pregnancy is harmful to the woman’s health and other contraceptives are not available to her or are harmful to her health. If that is the case, the impermissibility of revealing the part is removed to the extent necessary.

Question 179: What is the ruling of tubal ligation for women (a form of permanent pregnancy prevention) if the mother has a sickness or if the family is poor and financially incapable [of supporting children]?

Answer: In principle, there is no issue with it. However, it may require a prohibited act like revealing a part of the body that is not permissible, in which case, it is not permissible except in cases of necessity.

Question 180: Is it permissible to perform tubal ligation for a woman who experiences extreme exhaustion during pregnancy to the extent that it may cause her death?

Answer: In principle, there is no issue with it.

Question 181: Is it permissible for a woman to use contraception without her husband’s permission?

Answer: It is permissible to use contraceptive pills even if her husband does not agree.

Question 182: What is the ruling of using IUDs if other natural contraception methods prove ineffective and the doctor advises not to use pills because they might increase the chance of a genetic chronic illness, and knowing that by overthinking this issue I have neglected my husband’s need?

Answer: If it is not proven to the woman that the IUD harms the ovum after its fertilization, then in principle, there is no issue with it. However, if placing it in the womb requires impermissible looking or touching by the doctor, then it is not permissible for the woman to reveal herself to the doctor to implant the IUD, except in cases of necessity.

Question 183: Some people contend that IUDs do not kill the fertilized ovum, instead they prevent it from reaching the womb, thus preventing pregnancy. So, what is Your Eminence’s opinion regarding this, and if this is correct, would it be permissible to use it?

Answer: If the mechanism by which the IUD prevents pregnancy is not clear to the woman, then it is permissible for her to use it. However, because it requires revealing the private parts to the doctor, it is not permissible except in the case of religiously valid necessity.

Question 184: Is it permissible for a man or woman to undergo sterilization procedures to prevent themselves from pregnancy, temporarily or permanently, and is it permissible for them to reveal their private parts to a specialist of the same gender if other contraceptive methods are difficult, and having several children is difficult for them financially, educationally, and in regards to their health – making them certain that their children would be deviated?

Answer: Permanent sterilization are of two kinds:

The first kind is subdivided into two types-

Those that cause extreme harm to the man or woman, like removing certain genital organs.

Those that do not cause extreme harm like tubal ligation for women, or vasectomy for men.

The former is not permissible in and of itself. However, if there is a health condition that requires removing a genital organ, then it would be permissible, but it is not permissible merely for the sake of preventing pregnancy.

As for the second kind, it is permissible per se, but it often requires revealing parts of the body to the doctor that are not permissible, like the private parts, when it is optional. Thus, it is not permissible in that sense, and the difficulty of having several children, if it is not difficult to the extent that it is normally unbearable, will not justify committing such a prohibition.

As for temporary contraceptives, there is no issue with using them if they prevent the formation of the ovum in a woman or prevent the sperm from reaching the ovum. As for those methods that prevent the fertilized ovum from growing and subsequently causing it to die, as described about IUDs, they should be avoided as an obligatory precaution.

It is also important to note two things:

The permissibility of using the first two kinds of temporary contraceptives depends on two conditions. First, that it does not cause serious harm to its user, otherwise it is not permissible, unless it prevents a greater or equal harm. Second, that using it does not require a prohibited prerequisite like revealing that which is impermissible to reveal of the body to others, and it does not become permissible except in cases of where the person is compelled to use it, meaning if no other contraceptives were available, or if using it was harmful or difficult such that it and the pregnancy are not normally bearable.

If the wife’s use of the contraceptive affects the husband’s pleasure during intercourse, then it is not permissible for her to use except with his approval, and in any other case, his approval is not necessary. As for the husband’s use of a condom during intercourse, it requires the wife’s approval based on obligatory precaution because it involves inserting an foreign object in her vagina. The wife’s approval is not necessary in all other contraceptives used by the husband.

Question 185: Is it permissible for a woman to take contraceptive pills out of fear of giving birth to children with hereditary illnesses, knowing that she gave birth to several children before who had these illnesses?

Answer: It is permissible for her to do so if it does not cause her severe harm.

Question 186: Perhaps one of the main issues with using IUDs is that it requires [impermissible] looking and touching. So, what if it can be placed by the female doctor inside the woman’s vagina without directly touching by using gloves, would it be permissible?

Answer: If it does not require touching or looking, then there is no issue in that sense. The issue that remains is the mechanism by which the IUD prevents pregnancy. If it causes harm to the ovum after fertilization, then it is not permissible as an [obligatory] precaution.

Question 187: A woman underwent a surgical operation for tubal ligation due to having many children and being incapable of raising more, without realizing the religious objection to it. Now, after realizing this, is it obligatory for her to undergo another operation to undo the tubal ligation?

Answer: It is not obligatory on her, in fact, it is not permissible because it requires revealing her private parts. Furthermore, in principle, tubal ligation is permissible.

Question 188: Pregnancy is harmful to a woman, so doctors suggest that she undergoes an operation to permanently prevent pregnancy, and the doctor who carries it out is a male and not a female. Knowing that her husband agrees, what is Your Eminence’s opinion?

Answer: If the operation described requires removing some reproductive parts like the womb, then it is prohibited. However, if it is like sealing the fallopian tubes, then there is no issue with it in principle. Nonetheless, it is not permissible for her to use a male doctor to perform the procedure if it requires impermissible looking or touching willingly (i.e., it is not a necessity).

Question 189: Is it permissible to perform hysterectomy to permanently prevent pregnancy?

Answer: It is not permissible to perform hysterectomy to permanently prevent pregnancy. However, if there is a medical need for it, then it becomes permissible and with it ends the ability to reproduce.

Question 190: What is the ruling on vasectomy if it does not cause harm to the man, and if it is done with his and his wife’s approval, knowing that the procedure is reversible?

Answer: In principle, it is permissible.

Question 191: If a woman is having difficulty using medications that prevent the sperm from reaching the ovum, is it permissible for her to undergo an operation to close the [fallopian] tubes to prevent pregnancy, whether temporary or permanent? What are the religious conditions if she wants to undergo this type of procedure?

Answer: It is permissible to close the fallopian tubes to prevent the ovum from reaching the site of fertilization, even if it causes permanent sterility, if it does not cause serious harm. However, if performing this procedure requires the woman to reveal some parts of her body which are not permissible to reveal to others willingly, like the private parts, then she should avoid it except in cases of necessity.

Question 192: What is the ruling on vasectomy in cases regardless of whether it is for a serious purpose and irrespective of whether harm occurs as a result if it is performed?

Answer: In principle, there is no issue with vasectomy, but it may require exposing the body to prohibited touching or looking, therefore, it should be avoided for this reason except in cases of necessity.

Question 193: What is the ruling of temporary contraceptives like IUDs and permanent contraceptives like tubal ligation, knowing that female professionals perform the operation?

Answer: With regards to tubal ligation, there is no issue with it in principle. As for IUDs, if it is not known that it causes harm to the fertilized ovum, then it is also permissible in principle. However, it is not permissible for a person other than the husband to perform the mentioned procedures if they require looking or touching that are not permissible for other than the husband.

Question 194: Is it permissible for men and women to undergo surgical procedures to permanently prevent pregnancy?

Answer: If it does not require the removal of certain body parts and does not cause any other serious harm, then there is no issue in it in principle.

Question 195: Is it permissible for a woman to use certain contraceptives despite her husband’s disapproval? If so, what is the ruling of IUDs which requires revealing the intimate parts during insertion? What is its ruling when necessary?

Answer: It is permissible for her to use birth control pills and similar methods under the condition that it does not cause any extreme harm, and there is no difference whether the husband agrees or not. As for IUDs, if it is known to harm the fertilized ovum, it should be avoided based on obligatory precaution. Otherwise, there is no issue with it. However, if it affects the husband’s pleasure [during intercourse], then it is not permissible without his permission. It is also not permissible for it to be placed by other than the husband if its insertion requires touching or looking that are prohibited to other than him, except if there is a necessity that justifies committing a forbidden act.

Question 196: A man has two wives and several children from his first wife who were born over a long span due to his insufficient sperm. He does not have any children from his second wife, who he has lived with for some time, so she accuses him of negligence and that he does not plan to have children with her because he is satisfied with the children he already has with his first wife. The doctor told the second wife that she can become pregnant if her husband undergoes a certain harmless procedure, and because she is convinced that the husband does not want to have children, she has prevented him from his right of sexual intercourse with her. Based on this, is it obligatory for him to submit to her request for pregnancy, and is her denying him sexual intercourse considered an act of disobedience or nushuz such that it exempts him from providing her with maintenance?

Answer: The husband is not obligated to submit to her request for pregnancy, whether it requires treatment or not. In fact, it is permissible for him to separate from her so that she does not become pregnant. As for her denying him sexual intercourse without a legitimate religious excuse, it is considered a form of nushuz that exempts the man from providing maintenance as mentioned in detail in question 1014 from the Masail alMuntakhaba.

Question 197: You mentioned in question 71 from Minhaj alSalihin, volume 1 of the latest edition, “that is if it is not proven that using IUDs harm the ovum after fertilization.” What is meant by  “the ovum after fertilization?” Is it the common definition of the fertilized ovum implanting in the womb, or the scientific definition of the sperm penetrating the ovum? This is because there are different types of IUDs in use, including those that block the entrance of the womb preventing the sperm from reaching the ovum, and those that do not block it but rather release a substance which prevents the fertilized ovum from implanting in the womb.

Answer: Perhaps what is meant by pregnancy is the fertilized ovum implantation in the womb, but the zygote that is religiously prohibited to abort is the ovum fertilized with the man›s sperm, even if it does not implant in the womb. This is based on the religious text that indicates that it is not permissible for a woman to take medication to abort what is inside her. Therefore, if the IUD prevents the sperm from reaching the ovum, then there is no issue with it in that regard. However, if it prevents the fertilized ovum from implanting in the womb, causing it to die, then it should be avoided based on obligatory precaution.

Question 198: What is the ruling on hysterectomy, with and without a religiously acceptable excuse?

Answer: It is permissible with an excuse, and as an obligatory precaution, it is not permissible without an excuse.

Question 199: A woman is sick with several illnesses like joint pain and blood-related illnesses, and pregnancy causes her difficulty, fatigue, and leads to arguments with her husband. So, she decides to use what is called an IUD whose insertion requires revealing the private parts before the gynecologist. Would it be permissible for her to do that knowing that there are alternative methods like contraceptive pills and condoms, but which are known and confirmed by specialists to have side effects?

Answer: If pregnancy and contraceptives other than IUDs are harmful to her health to the extent that compel her, then there is no issue in doing so in that regard (i.e., revealing the private part). However, it is said that IUDs harm the fertilized ovum, therefore, there is an issue with it from that perspective.

Question 200: Is it permissible for a man to wear a condom during intercourse to stop semen from entering and prevent pregnancy without the wife’s knowledge?

Answer: There is an issue with using it without her approval, not because it prevents pregnancy, as it is most likely permissible in that regard even without her approval, but rather because it involves inserting an foreign object in her, and there is no evidence that this is allowed without her approval.

Question 201: Is it permissible for a woman to use temporary contraceptives like pills and medications without her husband’s knowledge?

Answer: It is permissible as long as it does not cause serious harm to her.

Question 202: I am a female specialist and I would like to explain to you how IUDs work according to professional medical books. It is important to note that it is not completely clear how it works but it may involve several factors:

–          It seems that its main function is to prevent the fertilized ovum from implanting in the womb.

–          Furthermore, there is a type of IUD used nowadays known as “Copper IUD” which limits the effectiveness of the sperm in the fallopian tubes (where the fertilization takes place).

My question is:

a. Is it permissible to take compensation for implanting IUDs?

b. Is it forbidden if it results in killing the fertilized ovum, and if so, what is its kaffarah (expiation) and is the doctor responsible for it?

Answer: There are two aspects regarding the permissibility of IUDs:

a. Inserting and positioning it in the proper place in the vagina

b. Its role in preventing pregnancy

With regards to the first aspect, it is not permissible for anyone other than the husband to insert it if doing so requires forbidden looking or touching by others. However, if the woman is compelled to use it and the husband is incapable of placing it, then it becomes permissible for her to consult a female doctor and for the doctor to insert it from that perspective.

As for the second aspect, if the woman knows that it results in the killing of the fertilized ovum, then it is not permissible for her to use it as an obligatory precaution. Otherwise, there is no issue with it. In the latter case (i.e., the woman does not know), it is permissible for the doctor to take compensation for placing it. However, for the former, it is not permissible based on obligatory precaution. Either way, if the doctor placed it and it resulted in the killing of the fertilized ovum, the doctor is not responsible for its kaffarah.

Question 203: Is it permissible for a woman or man to undergo a sterilization procedure to permanently prevent pregnancy after giving birth to a sufficient number of children? If it is impermissible, does the ruling differ if one lives in an Islamic state that promotes family planning for public interest?

Answer: Doing so is not free of issues, even if it is permissible if it does not cause serious harm like removing some organs such as the ovaries in a woman.

Question 204: Is it permissible for a man to ejaculate outside of his wife to temporarily prevent pregnancy?

Answer: It is permissible.

Question 205: Using IUDs can sometimes result in bleeding for a long-time, sometimes even several months. So, is this blood considered a form of istihadah or a wound?

Answer: If the IUD-related bleeding is caused by a injury or inflammation, then it is to be dealt with as the blood of a wound or sore, but if is causes a disturbance in the monthly menstrual cycle, then it is an istihadah if it is not continuous to be considered hayd (menstruation).

The Diyyah and Kaffarah of Abortion 

Question 206: What is diyyah?

Answer: A reparation that should be given to a victim or the heirs of someone who was killed.

Question 207: A pregnant woman consulted a gynecologist who referred her to a sonographer. The sonographer’s medical report stated that the fetus had died. Based on this report, a procedure is performed to remove the dead fetus. After the operation, it turns out that the woman was pregnant with twins, one was dead and the other was alive. What is the ruling on the sonographer whose report resulted in the abortion of the living twin?

Answer: Based on the details in the question, the sonographer is required to pay the fetus’ diyyah because her report resulted in its death.

Question 208: Is the diyyah and kaffarah obligatory on a mother who aborts her fetus? Who inherits the fetus if both parents participated in the abortion? What is the exact amount of the diyyah in gold equivalent?

Answer: It is not permissible to abort a pregnancy even if it is still at the stage of a recently fertilized ovum, unless the mother fears harm to herself due to the pregnancy or if it results in extreme difficulty that is not normally tolerated, in which case it would be permissible for her to abort it as long as the soul has not entered it. But if the soul has entered it, then it is absolutely not permissible to abort it, even if it causes harm or difficulty based on obligatory precaution. If the mother aborts the pregnancy, then it becomes obligatory on her to pay the diyyah to the father or the other heirs, and if the father performs the abortion, then he must pay the mother. If someone else performs the procedure, like the doctor, then they must pay the diyyah to the parents, even if the abortion is at their request. The diyyah for pregnancy after entry of the soul is 5,250 mithqals of silver if it is a male, and half if it is a female, whether it is after being delivered alive or while in the womb based on obligatory precaution. As for the diyyah before entry of the soul, it is 105 mithqals in silver if it is a zygote (nutfa), 210 mithqals if it is an early embryo (alaqah), 315 mithqals if it is a late embryo, 420 mithqals if the bones have started forming, 525 mithqals if it has fully developed bones and organs, and there is no difference in this between males and females based on obligatory precaution. It is also obligatory for the person who performs the procedure to fulfill the kaffarah or expiation, which is two months of consecutive fasting and feeding a mudd of food to each of sixty needy people.

Question 209: What is the ruling on a woman who aborts her child due to a disagreement with her husband and under the orders of her family to hurt her husband?

Answer: She has committed a sin, and if she is the one who performs the abortion and not the doctor, then she must give the diyyah to the father. Otherwise, the doctor must pay it, and the person(s) owed the diyyah can pardon it.

Question 210: In His Eminence Sayyid’s answers, the diyyah is measured in mithqal. Is this mithqal that of a dirham, which equals 2.436 grams of silver or something else?

Answer: What is mentioned is fulfilling the diyyah with the appropriate amount of silver that equals it, but it is permissible to compensate for it in gold based on the narrations which valuate it in dinar for the purposes of reparation. What is meant by mithqal is the monetary or sayrafi mithqal which equals 4.64 grams.[62]

Question 211: According to His Eminence, is the religious diyyah obligatory for cases in which abortion is permissible?

Answer: Yes, it is obligatory.

Question 212: If both parents participate in aborting the fetus, to whom is the diyyah paid?

Answer: The diyyah is given to the second tier [of heirs], meaning the brothers and grandparents.

Question 213: If a woman purposefully aborts her fetus, to whom is the diyyah given if  she became pregnant by fornication?

Answer: If the fornication was from both the man and woman’s sides, then the diyyah is given to the Imam (p), and the religious authority/jurist should be consulted.

Question 214: A doctor inserts an intravenous tube with difficulty to save the life of a patient who was near death. But, another person accidentally removes the tube making it difficult for the doctor to insert it once again, which causes the patient’s health to deteriorate and die. So, what is the obligation of the person who removed the tube?

Answer: If removing the tube hastened the patient’s death, then the person must pay the diyyah. However, because the killing was by accident, his family (meaning the paternal relatives) must pay the diyyah.

Question 215: Sometimes doctors reach the conclusion that an unborn child has a dangerous illness, so they suggest aborting it, because if it is born, it will be deformed or will die soon after birth. Is it permissible for the doctor to abort it in such a case?

Is it permissible for the mother to agree to this abortion, and who is responsible for the diyyah?

Answer: The mere assumption that the child will be deformed or that it will not live for too long does not justify aborting it at all. Therefore, it is not permissible for the mother to allow its abortion, and it is also impermissible for the doctor to perform its abortion. The person who performs the abortion is responsible for the diyyah.

Question 216: A woman aborted her child under pressure from her husband. Did she commit a sin, and is she responsible for the diyyah of her embryo who was four months old?

Answer: She must repent and ask for forgiveness. The performer of the abortion is responsible for the diyyah and the husband can pardon her [from paying it].

Question 217: If a doctor gives a heart patient a strong dose of medicine and the patient dies some minutes later, what is the ruling on the doctor?

Answer: If the medication was the reason for the death, then the doctor is a dhamin or responsible for the diyyah, unless they released themselves of any liability before treatment,  exerted effort, and were sufficiently skilled [to treat the patient].

Question 218: Please explain the religious ruling of the following:

a. A Muslim doctor in the West neglected the treatment of a non-Muslim patient and forgot to give them the medication that could have improved their health to some degree. However, the doctor’s preoccupation with other patients resulted in their health deteriorating and eventual death. So, is there any obligation upon the doctor for this negligence?

b. What is the ruling on removing life-support from patients who are clinically pronounced dead based on the doctor’s orders?

c. If the patient themself or their family ask to remove life-support, does it justify the doctor doing so?

Answer:

a. If the patient’s death was caused by the doctor’s negligence, even if due to forgetfulness, then they must pay the necessary compensation as required by the law of that country.

b. It is not permissible to remove a Muslim off life-support, which would lead to the patient’s death, even if not removing it causes difficulty upon the person (i.e., the doctor) because it is killing a sacred life. If the patient is considered clinically braindead, even if not fully established due to the limitations or lack in modern means and it is possible to revive them, then they are considered alive (religiously). Even if it is not possible [to revive them somehow], there is a religious issue with removing the life-support.

c. Same answer as #b.

Question 219: A surgery was performed on a young woman’s big toe by a specialized doctor. While dressing the wound, the toe was strongly wrapped and the doctor instructed the parents not to undress it for a week. When the dressing was opened, the toe was dead, and after consulting another specialist, they were instructed to amputate it because it had become infected with gangrene. Based on this, the toe was amputated to protect the rest of the body. However, this affected her psychological and physical state negatively. So, what is the responsibility of the doctor whose negligence resulted in this and what is the diyyah for the big toe?

Answer: If it is established that the issue described was caused by the doctor’s action and negligence, then they are responsible for the diyyah. The diyyah for the big toe of a woman is between 1/10 and 1/6 of the complete diyyah of a person. One-tenth is sufficient, and 525 mithqals of silver fulfill it, and any extra reparation for that should be agreed upon by them.

Question 220: Is it permissible to abort a fetus before the soul enters it if the mother is sick and she thinks it is probable that her sickness will get worse due to the pregnancy, or is told so by specialists?

Answer: If she fears harm from continuing the pregnancy, then abortion is permissible for her. As for what the doctors tell her, it does not have any significance [from a religious perspective] if she is sure that what they are saying is not correct.

Question 221: If a pregnant woman is sure, or she becomes content, of extreme harm, or that death will occur if the pregnancy continues due to what the specialists say, then is it permissible for her to undergo abortion after the soul enters the child, or must she keep it even if it causes her death? In other words, is this not a case of two obligations conflicting with one another?

Answer: This is a case of conflicting obligations between preserving one’s life and the prohibition on killing someone, and the latter is probably of great importance if not certainly more important. Therefore, it is not permissible to have an abortion based on obligatory precaution.

Question 222: If a pregnant woman is sick with a harmful disease like diabetes, hypertension, or heart disease, and the specialist doctors tell her that keeping the child poses a danger to her life, then is it permissible for her to abort it before or after the soul enters it? Is there a diyyah for the one who performs the abortion?

Answer: It is permissible to abort it before the soul enters, and diyyah is required for it based on obligatory precaution. As for after the soul enters, permissibility of aborting the child is problematic in the case described.

Question 223: A woman is two months pregnant and becomes sick with some disease. The doctors prescribe her some medications and say that these medications will affect the child and cause it to be deformed. Thus, they must abort it so that it is not born deformed. Is it permissible to abort the child if delaying the treatment to after the child’s birth is not possible and if there is no other alternative that will not harm the child?

Answer: It is not permissible to abort the child simply because it will be born deformed. However, if the doctors are unable to perform the treatment except after the abortion, then it is permissible for her to do so based on the details of this case.

Question 224: A woman’s menstruation was late for several days and the medical exam revealed that she is pregnant. Is it permissible for her to quickly remove what is in her womb which may be a fetus in its early stages of development, knowing that her health may deteriorate during pregnancy? If it is permissible in this case, are difficult financial and living conditions considered the same as health-related difficulties in this situation?

Answer: It is not permissible to perform an abortion unless her health will be harmed by the pregnancy more than is considered to be tolerable, in which case it becomes permissible to do so before the soul enters it, not after, based on obligatory precaution.

Question 225: A relatively old woman (around forty years of age) who has hypertension has become pregnant, which causes her blood pressure to rise more and to the extent that it threatens her life according to medical experts. Is it permissible for her to abort the fetus before the soul enters it or even after it enters if there is a danger to the life of the mother?

Answer: It is permissible before the soul enters the fetus, and not permissible after based on obligatory precaution.

Question 226: A woman who is two weeks pregnant aborted her fetus because the pregnancy was causing her difficulty, but not to the degree that it was life-threatening from a health perspective. Is it obligatory on her to pay a kaffarah, and what is its value?

Answer: If the extent of harm the pregnancy causes to her health is more than what is considered to be tolerable for a pregnant woman, then there is no kaffarah for the abortion.

Question 227: A woman became pregnant from a temporary marriage and she fears for her reputation, especially from her family and friends. Is it permissible for her to abort the child after four months of pregnancy or even after?

Answer: After the soul enters, it is not permissible to abort the child based on obligatory precaution if there is harm and extreme difficulty that is not normally tolerated. However, before the soul enters, if the difficulty she faces from others finding out is normally not bearable and there is no other way to prevent it, even if she travels to live in another country and delivers the child there, then abortion is permissible to her.

Question 228: A woman who is two to five months pregnant is in the hospital in a serious life-threatening condition. So, the doctor decides to abort the child to save the woman, and states that there is no other option. What is Your Eminence’s opinion on this matter? Is there a difference in the ruling if it is through a surgical procedure or induced abortion?

Answer: Abortion is permissible [in this case] before the soul enters the child (the soul enters towards the end of the third month or the beginning of the fourth), but after the soul enters, there is no justification for permitting abortion based on obligatory precaution. There is no difference in this ruling whether the abortion is through a surgical procedure or induction.

Question 229: Doctors say that pregnancies after the age of 38 years have a high risk of giving birth to a child with Down syndrome. Today, they can identify whether the child has this syndrome four months into the pregnancy and the exam requires twenty days. Performing this exam carries the risk of abortion and the doctor leaves the decision to the parents.

a. What is your opinion on performing this exam?

b. If the exam is performed and the results show that the child will have this syndrome, what is your opinion on aborting it knowing that there is no danger on the mother’s life, rather the danger is that the child will live a very difficult life and so will the child’s parents, who will have to cover treatment that is very expensive when there is no real cure?

Answer:

a. If the probability of the exam causing an abortion is to such a degree of certainty that it justifies fear, then it is not permissible to perform.

b. It is not permissible to abort a child merely because it has a deformity, especially after the soul enters it, as is described in the question.

Question 230: Is it permissible to abort a fetus for a necessity like protecting the mother from being killed or defamed?

Answer: As an obligatory precaution, it is not permissible after the soul enters it, even for the mother [to perform it]. But before the soul enters, it is permissible for the mother if she fears harm on herself from the pregnancy. In fact, it is apparent that it is even permissible for others if they fear that she could be killed or something similar.

Question 231: Some women become pregnant from adultery or from a marriage that has occurred without the knowledge of the families, like often occurs with temporary marriage, and they fear a scandal, which they perceive to be possible, or even being killed [as a consequence]. Is abortion permissible for them in all stages of pregnancy, some stages, or is it completely impermissible?

Answer: If she fears harm to herself, then it is permissible for her to abort before the soul enters the fetus. However, it is not permissible after the soul enters based on obligatory precaution.

Question 232: If it is proven through scientific approaches that a fetus is afflicted with one or more congenital defects that will make it a burden on its parents and society, then is abortion permissible?

Answer: A child’s deformation does not justify aborting it. However, if its continued presence in the mother’s womb causes harm to her health, then it is permissible for her to abort it, as long as it is before the soul enters. As for after its entry, it is not permissible based on obligatory precaution.

Question 233: Ultrasound tests performed on a four-month old fetus in its mother’s womb show that it has no spinal cord, indicating that it would be born paralyzed. In this case, is abortion permissible?

Answer: Based on the description in this question, abortion is not permissible.

Question 234: Is it permissible to abort a newly fertilized zygote if the husband agrees? Or is it prohibited up to when the soul enters?

Answer: Abortion is not permissible, even if it is just a fertilized zygote, and the husband’s approval does not make a difference in this matter.

Question 235: If both parents agree on abortion, God-forbid, do they both have to give a kaffarah of intentional killing (i.e., freeing a slave, fasting two months consecutively, and feeding sixty needy people)?

Answer: No, the kaffarah is obligatory on the performer of the abortion not anyone else if it is performed without a religiously-acceptable excuse, even before the entry of the soul.

Question 236: If a father orders that his child be aborted and the mother or midwife perform the abortion, is there a punishment for him for his order, and if there is a punishment but it cannot be performed (like in our current time), what should he do other than displaying remorse and asking for forgiveness, and is the kaffarah of intentional killing obligatory on him?

Answer: If he threatened to harm her or her relatives if she refuses to perform the abortion, then the religious authority should punish him for that. But other than that, repentance and seeking forgiveness is enough. As for the kaffarah, it is only obligatory on the person who performs the abortion.

Question 237: A woman became pregnant in a temporary marriage and her temporary husband ordered her to abort the child. She went to the doctor who gave her pills or a shot to abort the fetus. The cost of the abortion were paid by the husband. In this case, who must pay the diyyah or blood money, the husband who ordered the abortion, the wife who took the pill, or the doctor who performed it by giving a shot, and to whom is the diyyah given? Do the fetus’ parents inherit it? Does the mother inherit the fetus if she was forced into the abortion, or is it given to the second tier of heirs, like the brothers, or is it given to the religious authority?

Answer: The person who performs the abortion is required to pay the diyyah. So, if it is the mother (who caused the abortion by taking the pills), then she must give the diyyah to the father, or he can pardon her. If it is the doctor (who caused the abortion by giving the shot), then she must give the diyyah to the child’s parents, or they can pardon her.

Question 238: A doctor performed an abortion with the approval of both parents. So, if we are to say that the doctor or the wife who performed the abortion is responsible to pay the diyyah, does the father have the right to pardon them, especially since he agreed with their action or because it was by his order? Or, does he not have this right (i.e., to pardon them), and it is given to the other heirs?

Answer: The person who performs the abortion is required to pay the diyyah, who in this case is the doctor. The parents can pardon her because their approval of the abortion does not deprive them of their right in the diyyah.

Question 239: What is the ruling in a situation where either the mother dies or the unborn fetus in her womb dies, given that the doctors have made it certain that one will die?

Answer: It is not permissible for the mother to [preemptively] abort the fetus in her womb to protect herself based on obligatory precaution. It is also not permissible for the doctor to preemptively kill either of them, if the emergency has established that one of them or both will die (as such the ruling is based on precaution and so it is permissible to follow the fatwa of the next most knowledgeable jurist), it is permissible if the soul has not entered.

Question 240: If the parents forged a religious ruling to mislead the doctor into aborting the child, and the doctor did so, who is required to pay the diyyah and to whom should it be given?

Answer: If the doctor depended on that ruling [and carried out the abortion], believing it to be true, then the parents are required to pay the diyyah and it should be given to the second tier of heirs, and God knows best.

Question 241: When is it permissible to abort a child? Does its age make a difference?

Answer: Abortion is not permissible after the sperm fertilizes the ovum unless the mother fears harm on herself or if continuing the pregnancy results in difficulty that is not normally bearable, and there is no way to avoid this except by abortion, in which case abortion is permissible before the entry of the soul. However, after its entry, it is not permissible based on obligatory precaution.

Conjoined Twins 

Question 242: If two children are born conjoined to one another, is it permissible to separate them when it is known that one of them may die during the surgical operation? Is there any prohibition if they stay as they are if one is male and the other is female?

Answer: There is no issue with keeping them conjoined, and it is not permissible to separate them if there is fear that one of them will die [as a result].

Blood Transfer, Testing, and Selling 

Question 243: Is it permissible to donate blood to patients and take compensation for it?

Answer: It is permissible to donate blood to patients in need of it. It is also permissible to take compensation for it.

Question 244: Is it permissible to buy and sell blood for treatment?

Answer: It is permissible.

Question 245: What is the ruling on donating blood during the days of the month of Ramadan while fasting?

Answer: It is permissible but disliked if it causes weakness.

Question 246: Is it permissible to transfuse the blood of a non-believer to a Muslim who needs it by choice and without necessity, when blood from a Muslim donor is available?

Answer: It is permissible.

Question 247: What is the ruling of selling and bartering blood?

Answer: It is permissible to sell it for transfusion.

DNA and Paternity Tests 

Question 248: Science can determine a child’s biological father through blood tests, which establish paternity. So, if the husband suspects that his wife had a relationship with another man and then became pregnant, and the test result proves that the child is the other’s biological child, then should the results of the test be accepted or should the principle of “the child belongs to the owner of the bed” be followed?

Answer:  “The child belongs to the owner of the bed” is a principle for those in doubt [of paternity]. So, whoever has [legitimate] evidence to its contrary by way of a blood test or something else, then they should act based on their knowledge. However, this same knowledge does not establish that the wife committed zina (adultery), and she is not to be punished unless her zina is proven through the known and accepted methods of religious law, and God knows best.

Question 249: I work in a DNA testing laboratory and would like for Your Eminence to answer the following questions:

a. Is DNA testing considered a religious proof to establish paternity if it is a 100% match [to the father’s DNA]? If it is not a match, does it prove that the person is not the father?

If fatherhood occurs out of religious wedlock, is it obligatory to attribute the child to the father, even if it causes problems for the child (especially if it is a girl)? Is it permissible to register such a child (especially if it is a girl) under the name of a man other than the real father to prevent a legal problem?

Answer: The aforementioned test is considered a religious proof if it is a clear scientific method that does not depend on personal judgment.

a. Yes, it is obligatory, and the occurrence of a problem that lifts the prohibition of registering the child under other than the father’s name, which can cause its own problems, is not evident [religiously].

Question 250: A man has been married to a woman for nearly twelve years, and after eight years, he was blessed with two daughters. Over the course of a few months, the man claims that his wife was in a relationship with another man, so he begins to doubt whether he is the real father of the two daughters or not. Therefore, DNA tests are performed on him, his wife, and the daughters, and the tests prove that the daughters are not his. My question is:

a. Do these tests prove that the daughters are not attributed to him?

b. If so, is it permissible to keep the two daughters under his name knowing that they are not his?

c. It has been reported that the late Grand Marja’ Sayyid Abul-Qassim alKhoei said that the husband remains the father based on religious rules, even if the DNA tests prove otherwise. To your knowledge, is this true?

Answer:

a. If the DNA test occurs with a clear scientific method that does not depend on personal judgment, then its results should be accepted.

b. It is not permissible.

c. According to the late Ayatollah’s opinion, the principle “the child belongs to the owner of the bed” applies for those who are in doubt [about paternity]. Therefore, if there is evidence that proves otherwise, then those involved should act according to that evidence.

Organ Donation, Selling, and Transplanting 

Question 251: Is it permissible for a person to direct in their will that their organs be donated after death?

Answer: It is not permissible for a Muslim to direct in a will that some of their organs be removed after death and be implanted in a living body, unless saving a Muslim’s life depends on it, in which case, it is permissible and the person removing the organ(s) does not have to pay the diyyah.

Question 252: [Medical] students are sometimes required to search for bones from cadavers, and there are people who sell them, so is it permissible to buy?

Answer: It is not permissible to sell or buy the bones of people whose lives are sanctified (e.g., a Mumin), and so is the case with others based on obligatory precaution.

Question 253: Is it permissible to transplant organs from an animal into a human?

Answer: It is permissible to transplant an animal organ into a human, even if the animal is a dog or pig, and it is treated as part of the human body. It is permissible to pray with it as part of the body because it becomes pure after joining the human body and perfusion of [human] life in it.

Question 254: Is it permissible to donate the body parts of someone who is sentenced to death?

Answer: It is not permissible to remove a part of a living human to be transplanted to another body if it causes extreme harm, as would be the case of removing the eye or cutting the hand or leg.

Question 255: Is it permissible for someone to direct that some of their healthy internal organs, like the heart, kidneys, liver, or lungs be removed and transplanted to a believer in need in the following cases:

a. If their health condition is severe and there is no hope of recovery, like due to certain accidents, falls, gunshot wounds, or burns that damage certain organs/parts making it impossible for them to survive, but other organs/parts remain healthy. Can they direct for their organs to be donated, and should their will be executed?

b. If they recently passed away and it is possible to benefit from some of their internal organs, should their directive to remove some of their internal organs after death to help a patient in need or for use in medical education be executed, especially if the life of a believer depends on it?

Answer:

a. It is not permissible to remove any of their vital organs before they are considered dead, which according to common understanding is the when the heart stops, even if it is for transplant to the body of another Muslim to save their life, and there is no significance to their will in this matter whatsoever.

b. It is permissible to remove that which the life of another Muslim depends on, and there is no diyyah required of the remover apparently. However, it is not permissible to remove the parts merely for the sake of teaching and learning.

Question 256: My job in the hospital is to coordinate between those who would like to donate certain organs, whether the person is dead or alive, and those in need of it. There are some cases in which donation is permissible, as mentioned in your rulings, and others in which it is not permissible. My job involves both [the permissible and impermissible] kinds. For example, I may be required to coordinate with the family of a bedridden [braindead] patient whose heart remains alive to remove certain organs, either to help save the life of another Muslim or to preserve one of the living organs. Is my job religiously permissible?

Answer: It is permissible in the religiously permissible cases.

Question 257: In some western countries, there are organizations to whom you can donate bones for use after death. Is it permissible for me to enroll in such organizations and donate certain body parts?

Answer: It is religiously problematic to execute the directive of a will when it involves removing parts of a dead Muslim to be transplanted to a living body without the living person’s life depending on it.

Transplanting Pig Liver 

Question 258: In recent years, and in the field of transplantation surgery, it was discovered that transplanting pig livers to humans can help treat patients with liver disease. So, if the life of a patient can be saved with the liver of a pig or another animal, is it permissible for it to be used, especially if it is a prohibited animal to be eaten in Islam?

Answer: It is permissible to transplant pig livers to the human body.

Removing Human Parts 

Question 259: If a woman’s uterus bleeds constantly, sometimes for twenty days or more, and the doctors decide that keeping it is unhealthy and that it would negatively affect the woman’s health. Is it permissible to remove it if the woman is younger or older than fifty years of age?

Answer: It is permissible in both cases.

Question 260: What are the obligations and responsibilities of the doctor in the following cases: When they remove part of an organ or a whole organ upon discovering that it will harm the patient or that its presence will increase the spread of a disease, with the knowledge that the surgeon has likely taken permission from the patient, their religious guardian, or someone responsible for their affairs. Or, if there is no guardian and sometimes, they act to save the life of the patient without taking permission.

Answer: It is permissible with the patient’s permission if they are able to consent, and if not, then with the permission of their religious guardian like the father, grandfather or religious authority. If the procedure must be performed to save the patient’s life or prevent serious and clear harm, then, if it is not possible to get permission from those mentioned above, they can proceed with the permission of some believers who are the patient’s contemporaries.

Question 261: In many surgical operations, some parts of the human body like the intestines, appendix, uterus, gallstone, kidney, or some fat are removed. In other cases, even the hand, foot, or fingers are amputated. Is it obligatory to bury these parts with ghusl and shroud, or without shroud?

Answer: Ghusl and shrouds are not obligatory, but they must be buried. As for very small parts, they do not have to be buried. However, in both cases, touching them with moisture causes impurity.

Question 262: Is it permissible to transplant a fertile testicle to a sterile man suffering from a damaged testicle, knowing that this operation is regularly being performed in the west and given the abundance of patients suffering with this issue, we present this question to Your Eminence.

Answer: There are several issues with this operation:

a. Removing the testicle. It is not permissible in some cases like removing it from the body of a dead Muslim.

b. Looking and touching the private parts while performing the removal and transplantation operations.

c. The child born is not to be attributed to the man the testicles were transplanted to if he was born from the sperm fertilized prior to the transplant.

If these issues are resolved, then it is permissible.

Clinical (Brain) vs. common understanding of death 

Question 263: Is it permissible to pay financial compensation to the dead donor’s family for the donated organs?

Answer: It is permissible to give them some money as a gift or something similar, but not as a compensation for taking the organs of their dead, and God knows best.

Question 264: Doctors say that death is established by the complete loss of brain function, even if the heart, pulse, and partial movement have not completely stopped (like with a slaughtered sheep). However, common understanding considers death to be the complete stopping of the heart and a resulting cessation of pulse and movement. Thus, if common understanding is to consider what the doctors say (from a scientific perspective) like in the aforementioned example, then perhaps our definition would change. So, what is the criterion for death?

Answer: The criterion [for establishing death] regarding religious laws is by discerning the common understanding of people, not the scientific determinations, and not a common understanding that adapts to the latter. This is what has been established in Islamic theological standards. As such, common understanding of death requires that the heart stops completely and not just the loss of brain function.

Question 265: Is it permissible to remove the life support machine which keeps the heart beating?

Answer: It is not permissible for the doctor to remove the medical equipment that keeps the heart beating from a Muslim patient even if they are brain dead. Thus, the life of the patient becomes like that of a plant, it does not continue except by the machine, and this is [carried out] because of the sanctity of the respected life according to Islam. Furthermore, the doctor should not pay attention to the request of the patient or their family to remove the life support. If the doctor removes the machine and the Muslim patient dies because of that, the doctor is responsible for their death.

Question 266: Before I ask, I would like to explain the following system which is used by some hospitals around the world. My wife is currently a resident doctor in one such hospital. Sometimes, patients with chronic conditions ask to be classified as DNR (Do Not Resuscitate), or those who should not be rescued by the doctors and medical personnel.

For example, a patient has kidney failure, and the medical diagnosis indicates that they will not live for a long time, and sometimes during their stay in the hospital, their heart stops beating and the doctors rush to perform CPR or other resuscitation procedures to save them. By performing such processes, the doctor could keep the patient alive for another six months or so.

Under the DNR order mentioned above, the patient and their family have signed hospital documents requesting DNR, so the doctor will not rush to perform CPR or other methods to save the patient in a case like above, and they will instead allow the patient to die comfortably.

Patients choose DNR because they do not want doctors to perform CPR or help save them in any way, rather they prefer to die comfortably.

Hospital protocols require doctors to explain the DNR system to patients with chronic conditions or suggest to them to sign its papers because it saves money and time for the hospital. Moreover, it allows the patient to die in peace without medical intervention, and they know that there will be no improvement in their condition.

The question: Is it obligatory for my wife to follow the hospital protocols and suggest the DNR system to the families of patients with chronic conditions? If the heart stops beating, is it obligatory for her to accept the DNR order and not attempt any resuscitation procedures to save the patient?

Answer: If the patient is a non-Muslim, then there is no issue in not attempting to save their life with CPR or similar procedures that would help prolong their life. But if they are a Muslim, it is obligatory to help them in any way possible, and their or their relatives’ request to not be resuscitated should not be regarded.

Mental Conditions 

Question 267: What is the religious stance regarding those who take chemical substances (e.g., alcohol and glue) or drugs without consulting a doctor, or those who abuse medical drugs and cause themselves addiction, which is a psychological disorder that leads to further complications, and as a result, perform religiously unacceptable behaviors?

Answer:

a. Some substances, like alcohol, are not permissible to consume by drinking, regardless of their negative complications.

b. Other substances, like many medications, are prohibited to use because they cause serious harm to the person, whether [the harm] is from using it as prescribed, by overdosing, or addiction.

c. If the mukallaf or religiously obligated person knows that using a certain substance will result in them committing something prohibited, then they should avoid it. For example, if consuming a certain amount of a medication will result in a nervous breakdown causing them to assault others physically or insult them, then it is prohibited for them to use that medication in that amount, and so on. This is regarding the mukallaf themself. As for how others deal with them, they should forbid evil in the manner mentioned in the Islamic manual and their [extent of] obligation is based on the conditions mentioned [in it].

Question 268: What is the religious stance regarding individuals who are suffering from mental conditions and behave in a religiously unacceptable manner even when knowing that their actions are not acceptable. But, it does not affect their conscience, like people suffering with psychopathy (antisocial behavior disorder)?

Answer: If the unacceptable behavior is religiously prohibited, and the disturbed individual commits it willingly and intentionally, then they must stop, and others should forbid them from that evil within the religious conditions.

But, if the individual with the mental condition cannot control themself or have the ability to choose to prevent themself from committing what is forbidden, then they should attempt to get treatment, even if it is by referring to a psychiatrist. This is so they do not experience a mental breakdown in which they commit something forbidden without being able to prevent it at the time. In this case, they are obligated to treat themself, and others must urge them to do so according to the conditions of enjoining the good.

Question 269: What is the religious stance on individuals who have mental conditions and commit behavior knowing that it is religiously-unacceptable and who personally recognize it as such and suffer from it, like unwanted obsessive thoughts that drive the person to have notions of disbelief or similar things?

Answer: If the mental condition is caused by obsessive thoughts, then it is important to inform the individual that they will not be considered sinful for the thoughts of disbelief and so on. If the person is able to possibly convince themself of this through repetition, then it will help ease their condition without a doubt. They should also consult a mental health specialist to get treatment with medications and other forms of therapy, in fact, it may be obligatory on them if the continuation of these disturbances causes negligence of religious obligations like the obligatory prayers.

Question 270: What is the religious stance on an individual with a mental condition who completely believes that they belong to the opposite gender, act based on this belief, and if their reproductive organs are not medically altered based on what they are convinced of, it may even lead them to commit suicide? Is it permissible to alter their reproductive organs surgically [in this manner]? Are they dealt with according to the physical appearance of their outer reproductive organs or what they believe is their gender with regard to their rights and obligations?

Answer: Castrating the male organ and creating a vagina-like hole does not make a male into a female according to the religious rulings that apply to them. Similarly, surgically attaching a penis-like organ to a female after removing the internal and external feminine organs does not make her a male when it comes to religious rulings.

As for implanting organs [from one sex to the other] that actually perform the same role as the real reproductive organs [in the recipient], this is not possible yet (scientifically). Therefore, the procedure that is known today as “gender-reassignment surgery” is not permissible in itself. In addition to that, it requires willingly exposing the body to prohibited touching and looking. As for the individual who has a mental condition and feels that they belong to the other gender, they should seek another form of treatment, if possible.

Question 271: What is the religious stance on an individual with a mental condition whose sexual desire is limited to something that is religiously prohibited, and this is caused by an inherent disorder?

Answer: They must resist their [prohibited] desire, and not give in to it no matter how strong it is, and if they decide to do so willingly, then others should prevent them according to the established criteria of forbidding evil if the conditions of obligation are met. In fact, if the prohibited sexual desire is like adultery, homosexuality, or lesbianism, then it must be prevented even if the individual performing it does not meet the criterion of religious obligation (e.g., they are not sane).

Question 272: What is the religious stance on an individual with a mental condition or their parents who resort to traditional practices that contradict the specialist doctor’s advice to continue medical treatment? This then may result in the deterioration of the patient’s health, causing them to die of an epileptic seizure, suicide, etc.

For example: A man convinces an individual with a mental condition or their family that their condition is not an illness, but rather a result of magic or possession by jinn, and that this disturbance can be healed by his hands with a spiritual intervention inherited from his ancestors or that was revealed to him. That man indicates in one way or another to the family that everything they pay for what he does will not be lost. Then the man uses the touch of his hand, his saliva or something else to destroy that “magic,” to expel “the jinn” or other popular myths.

What is the responsibility of this man and the mentally afflicted individual’s family? What is the accountability for these practices and what is the responsibility of the victim?

Answer: Resorting to these practices is the result of a lack of understanding. If the mentally-afflicted individual’s guardian knew about the dangers of neglecting medical treatment and resorting to these practices known as “traditional treatment,” they are responsible for the harm inflicted upon the patient from it.

As for those who practice such “treatment,” they sometimes believe it is beneficial but most times only seek material benefit. Either way, they are responsible for everything that is caused by these practices, unless they explain the possible effects to the individual (if they are fully competent) or to their guardian if they are not fully able to fully comprehend the full extent of what is being done.

Question 273: What is the religious position on an individual with a mental condition, or their relatives, who hide the mental condition from the spouse before performing the marriage contract? What is the responsibility of the doctor who approved the marriage in a court of personal record (and did not fulfill their professional duty of performing a mental health exam for the couple)?

Answer: Regarding the condition that is considered a flaw, but does not reach the extent of insanity, merely staying silent [about it] does not give the other spouse the option to annul the marriage contract. It is only given if the condition was concealed, like if they are to describe the afflicted person as sound during the engagement and the contract is enacted based on that description.

As for the doctor who does not fulfill their required duty, they have committed a sin, and do not deserve the wage they received because they neglected their duties. However, this does not affect the validity of the [marriage] contract.

Question 274: What is the religious stance on an individual with a mental condition whose health improves with medication, and to prevent relapse, they are given daily/permanent medication to maintain the aforementioned improvement. During the month of Ramadan, they must continue to take the medication to prevent relapse. Do they have to fast?

Answer: If the individual fears harm, like relapse, then it is permissible for them to not fast but they should make it up later. If they are unable to make it up by the following month of Ramadan [due to this condition], then they no longer have to make it up, and instead, must give a fidya of ¾ of a kilogram of food for each day missed.

Question 275: An individual with a mental condition had sexual intercourse with one of his mahrams during a state of [mental] disturbance. She hid what he did but became pregnant. What is the religious stance on the individual with the mental condition, the pregnancy, and the child? To whom is the child attributed?

Answer: If the mental illness is to the extent of insanity, then he is not punished, but if it is not, then he must be punished with death. As for the pregnancy, it is not permissible to abort it unless its continuation causes harm or difficulty that is not normally bearable to the pregnant woman, in which case it is permissible for her to abort it before the soul enters. If the pregnancy is complete, and the child is delivered, it is attributed to the sperm-owner and the pregnant woman. However, there is no inheritance between the child and their adulterer father if the latter was not insane during the adultery.

Question 276: A patient or their family insists upon a doctor to prescribe a specific medication which they repeatedly took with a renewed prescription based on the suggestions of others (non-professionals). The doctor was unable to change their view [about the medication] and convince them that there is a better medication for the mental condition. What is the responsibility of the doctor who gave in to their request [and gave them the medication they wanted]?

Answer: If there is no serious harm in it, then there is no objection to doing so, unless the doctor is prohibited from doing that based on the legal standards of medicine.

Question 277: If a doctor finds that an individual with a mental condition is harmful to himself or others, and that they are not aware of this during their episodes, then does the doctor have the right to take legal action against the individual to have them committed in a psychiatric hospital for compulsory treatment, especially since the individual’s family are not convinced of the threatening severity of the condition?

Answer: The doctor does not have this authority until they raise the issue to the religious authority as a form of hisbah. Then, if the religious authority rules that the patient should be taken to a psychiatric hospital, and enforcing the ruling requires returning to legal courts, then it is permissible to do so.

Question 278: A doctor who is not specialized in psychiatry/psychology treats a mental patient based on the latter’s request during their episode. What is the ruling on the doctor?

Answer: If the mental patient was not fully competent during the episode, then the doctor does not have the right to perform any procedures on their body, nor deal with the patient without consulting their religious guardian. However, if the patient is fully competent, then there is no issue with the doctor [treating them] if the latter is sure that it will not cause serious harm.

If the patient is harmed during treatment, then the doctor is a dhamin, unless they religiously absolve themselves of liability prior to that and were not negligent in the treatment.

Question 279: What is the ruling on a [male] psychiatrist/psychologist who sits in a private session with a female mental patient to evaluate or treat her condition, knowing that this evaluation or treatment cannot be done without privacy?

Answer: If he is safe from committing something prohibited, then there is no problem with him doing so, and if she is safe from committing something prohibited, then there is no problem with her doing so too.

Question 280: Some studies in psychology are based on principles that Darwin explained in the theory of evolution (which contradicts religion according to some Muslim scholars). So, is it permissible to research such studies, knowing that the findings of some of them have diagnostic and therapeutic applications in psychology?

Answer: There is no issue with researching such studies for the sake of benefiting from them for treatment, while making sure that it does not negatively affect the researcher’s faith in the true principles and rejection of everything in conflict with it.

Question 281: What is the ruling of a psychiatrist/ psychologist who uses the principles of  Freud when it is known that this theory discusses subjects like a son developing an unconscious infatuation towards his mother and seeing his father as a rival? Does the Freudian theory of psychoanalysis contradict Islam?

Answer: There may be some exaggerated aspects of this theory that are not in agreement with the religion of Islam, but this does not prohibit studying or benefiting from it for psychological treatment, while keeping in mind the condition mentioned in the answer to the previous question.

Question 282: What is the ruling on a doctor who writes an accurate medical report about a mental patient but then delivers it to an entity other than the patient and their family based on its request, resulting in something the patient may not want?

Answer: It is not permissible for the doctor to do so unless that entity has an established relationship with the patient, whether it is a business relationship, a family relationship, or something else. As such, the doctor should confirm such conditions to prevent problems. Thus, it is then permissible for the doctor to inform the concerned entity to the limit of what concerns them and prevents problems and no more. In fact, the doctor can [even] let the entity know without them consulting him/her if the doctor knows that there will be great harm in not doing so. In any case, it must be ensured that the report is not used to defame and harm the mental patient. If there is a possibility [that the report will be used to defame and harm the patient], then it is necessary to limit it to a verbal communication only.

Suicide in Shariah 

Question 283: According to psychology, all suicides are complications of medical conditions. So, does that mean that the Quranic verse “Do not take the life God has made sacred, except by right][63] does not include any of these people? What is the religious jurisprudential guidance on this issue?

Answer: The fact that suicide is a symptom of a disease or a complication of a mental condition does not justify committing it. This is because many actions, like insulting others, cursing, assaulting, and even killing others are complications of nervous system and psychological disturbances, some of which may reach the level of disease, while others that may not, but are an unprompted condition that takes control of the person. Of course, a person cannot be excused for all of that. If we were to contend that it was due to illness and people should be excused, then it might suggest that people do not choose to do anything because in fact they solely arise due to the genetics and family and social upbringing that lead to their mental and psychological state. Thus, the only reasonable explanation is that human beings can consciously protect/avoid sins and crimes in three stages:

Stage 1 – Establishing psychological virtues and firm beliefs through education, training, and discipline. This proper education leads to self-reassurance, tranquility, and trust in God’s grace, mercy and the Hereafter, and prevents deviation from moderation in life.

Stage 2 – The signs of offense and sin begin to appear in the human themself. They are then able to treat themselves (nafs) in this stage by opposing and refuting the crime and sin by moving closer to virtue and reminding themself of the consequences of their actions.

Stage 3 – Upon nearly committing the offense, in many cases, the person can control themself and resist their strong will [to sin]. Therefore, even if we are to say that they are unable to prevent themself from committing the sin in the third stage due to loss of self-control, it does not mean that they do not have the ability to resolve the issue before its escalation in the first and second stages.

As for the proof of the prohibition of suicide, it is not this noble verse, as this verse discusses the impermissibility of killing [other] believers.

Informing patients they have a deadly disease 

Question 284: Is it permissible for a doctor to tell a patient that they have a disease from which they will die in some months in order to prepare the patient that will return to Allah? Given that the person actually has the disease, of course.

Answer: It is permissible if it does not harm them or if it is according to their request.

Question 285: Is it obligatory, permissible, or prohibited to inform patients of the reality of their illness in cases like cancer, or should the diagnosis be limited to their families and those responsible for them to maintain the patient’s positive psychological state and help complete the treatment?

Answer: It is not obligatory to inform them in the case described in the question. In fact, it is not permissible if maintaining their psychological state is necessary for the completion of the treatment. It is also not permissible if it causes a mental breakdown, leading to the deterioration of the illness and hastening of the patient’s death. On the other hand, if not informing the patient causes them to neglect the treatment, which would worsen the illness and hasten death, then it is obligatory to inform them.

Seeking refuge in the Ahl alBayt (p) at the expense of seeking medical treatment 

Question 286: The Ahl alBayt (p) are held in high regard and respect by Muslims, and so are their shrines, the workers in their shrines, as well as the religious scholars and jurists. Because of this status and respect, Muslims seek refuge in them during sickness, and this may sometimes be at the expense of heeding medical advice, thus it may lead to the deterioration of the patient’s health. Would Your Eminence be kind enough to explain the boundary between seeking refuge in the Ahl alBayt (p) and turning to medical experts [for treatment]?

Answer: Seeking refuge in the Ahl alBayt (p) and their followers of pious scholars and virtuous believers, and asking them to pray to God Almighty to give them health, is a very good thing. Nonetheless, it should not be at the expense of following the rational scientific methods of treatment.

Smoking 

Question 287: You mentioned in the Code of Practice for Muslims in the West page 251 in regard to sitting near smokers that,  “It is not permissible if it causes serious harm, even in the future, regardless of whether that serious harm is certain, very probable, or just probable such that reasonable people would demand caution.” Personally, I am harmed by smokers and their smoke and constantly face this issue in my day-to-day life, whether at home, work, school, or in transportation. Therefore, is it prohibited for me to sit near them when they smoke, or is it prohibited for them to smoke when someone who would be harmed by their smoke is near?

Answer: If sitting near smokers causes you serious harm to the extent mentioned, then it is not permissible to sit near them. As for the smoker themself, smoking is not forbidden for them if they do not believe that it causes real harm to someone else. However, they should refrain from doing so if it goes against public decency.

Question 288: Many medical reports explain the harmfulness of smoking. For example, smoking is said to be a primary cause of cardiovascular diseases, hypertension, lung cancer, and heart attacks. Furthermore, it has harmful effects on family and society. Based on this, is it permissible for a non-smoker to begin smoking? Is it permissible for a compulsive smoker to continue smoking? Is it permissible for a pregnant woman to smoke, knowing that doctors say that the fetus is affected by the mother’s smoking?

Answer: If smoking causes serious harm to the smoker, or the female smoker’s fetus, then it is not permissible, whether the smoker is a beginner or a compulsive smoker who is not seriously harmed by quitting it. As for those who are harmed by quitting it, the two (quitting or continuing) should be compared, and whichever is less harmful, should then be pursued.

Adoption 

Question 289: A woman raises a non-biological child from day one [of his life] until he grows up. Is it obligatory for this woman to wear hijab in his presence when he grows up, given that she did not breastfeed him?

Answer: Adoption[64] is not legislated in Islam, and the adopted child does not become like a biological child to the adopting parents, rather he is a complete stranger (i.e., non-mahram) to them.

Question 290: Is it permissible to gift a child to a married couple who cannot have children, and to whom is the child attributed in this case? If it is a girl, is it permissible for the adopting father to play with her as she grows up and physically contact her?

Answer: A child cannot be gifted to anyone because he/she is not a possession. However, there is no issue if a stranger takes care of their upbringing and cares for them while maintaining their (biological) lineage. The child does not become a mahram through that, and the ruling is that of any other stranger. As for adoption that results in loss of (biological) lineage and committing religiously impermissible acts, it is not permissible.

Rulings of Ritual Purity and Impurity 

Question 291: A fetus is enclosed in fluid in the mother’s womb that is released before or during delivery, sometimes it is combined with blood and other times without it. If this fluid is released without blood, is it pure?

Answer: Yes, it is pure.

Question 292: It is known that touching a dead body before it has been washed and after it has cooled obligates ghusl, but if the body is warm, then the one who touches it does not have to perform ghusl. The question is: what is the ruling on touching the dead body if it is cool at the moment of death, perhaps even before death, due to cold weather or certain diseases like hemorrhagic shock?

Answer: Ghusl of touching the dead is obligatory in this case.

Fasting with Illness 

Question 293: When is it permissible for an ill person to break their fast?

Answer: It is permissible for an ill person to break their fast in the following cases:

a. If fasting causes the person to become sick with an illness of some kind, whether it has visible symptoms like fever and headache, or not.

b. If fasting increases the severity of the illness.

c. If fasting delays recovery from the illness.

d. If fasting causes the person to become sick with another illness, or causes the symptoms of the current illness to become visible or increase (like an increase in fever).

Fasting and Pregnancy 

Question 294: Is the doctor allowed to stop a pregnant woman from fasting? Is it permissible for the pregnant woman to rely on the doctor’s recommendation?

Answer: It is permissible for the doctor to advise the pregnant woman to not fast if there is an assumption or possibility of [it causing] harm. But, the doctor’s advice should cause fear in the woman herself that fasting will cause harm. Nonetheless, the cause of this fear can be the doctor’s words. In other words, the doctor’s words are not a proof [for legitimately not fasting] if the woman herself does not feel that it will harm her. However, if the pregnant woman felt that it would harm her or her child, or that it would cause her difficulty that is not normally bearable, then it becomes permissible for her to break her fast, and perhaps it may even become obligatory if it causes harm that is not tolerable to either of them (the mother or child).

Fasting and Breastfeeding 

Question 295: Is it permissible for the doctor to instruct a breastfeeding woman not to fast? Is it permissible for the woman to rely on the doctor’s recommendation?

Answer: It is permissible for a doctor to instruct a breastfeeding woman who has little milk to stop fasting if there is a possibility of harm that causes fear in her, and it is permissible for her to break her fast for it. So, if a breastfeeding woman has little milk and fears harm to herself, or to the infant, then it is permissible for her to break her fast. As an obligatory precaution, she should only do that if the child depends on her milk completely and there is no other alternative (i.e., artificial breast milk), otherwise it is not permissible for her to break her fast.

Part Six – Guidance of the Religious Authority to Medical Professionals 

Below is guidance given to a select group of doctors from the holy city of Najaf by the Supreme Religious Authority (marjaeya) during a special meeting, and mentioned by his representative during the second Friday Prayer sermon on the 11th of the blessed month of Ramadan 1437 AH or the 6th of June 2016 in which he stated, “This week, His Eminence the Grand Marja’ (may God prolong his life) met with and advised them of points that we will mention because of their importance.”

“The Supreme Religious authority advises that you provide good service to all patients at the same level and quality without any difference between rich and poor or strong and weak. This guidance, although directed to doctors, because a number of them were present, applies to all those who deal with citizens and provide services to them in any field, like government employees.”

Shaykh Abdul-Mahdi alKarbalaie also said that His Eminence Ayatollah alSistani directed the doctors to provide good service, and this guidance can be explained in the following points:

1. Taking care of the patient by paying attention to the accuracy of the medical diagnosis and doing all that the doctor can to implement their professional medical understanding and skills to reach the diagnosis that is closest to reality by giving it sufficient attention and consulting other medical experts and skilled professionals.

2. Sympathizing with the patient by displaying compassion for their condition and showing that they care for the patient and hope for their recovery. They should also treat the patient as if they are an ill member of their own family and use reassuring phrases and words that give them hope of recovery.

3. They should have as little concern as possible for financial profit, and not benefit at the expense of the patient’s health by raising the cost of medical tests, examinations, or surgical operations. Instead, their goal should be to treat as many patients as they can to save their lives and do good deeds whose reward and hope is with God Almighty.

Shaykh alKarbalaie added that His Eminence directed to not differentiate between patients (between the rich and poor), and to explain that:

The professional and moral treatment of patients should not be different depending on their social status or wealth. Rather, everyone should feel that they are treated equally, because each one of them is a human suffering from a disease, and their suffering does not depend on their wealth or status. Their lives should be saved, and their sufferings should be eased without any bias. The doctor should not care more for a wealthy person in hope of benefitting financially or for a person of status and power in hope of benefitting from worldly things.

The representative of Ayatollah alSistani explained:

“This guidance from His Eminence, despite being directed to doctors as they were the ones present, is not limited to them. Rather it is to all those responsible for serving the public, especially government employees. We hope that they will meet the citizens’ needs and process their requests in the quickest time possible and not delay them, especially families of martyrs, orphans, widows, and the weak. They should not differentiate [in treatment] between the poor citizens and the rich, or between the powerful and the weak who have no one but God Almighty to ask for aid. This guidance is further affirmed for officials responsible for the primary services, like water, electricity, health, and education.”

He also said:

“Teachers should keep in mind that their behavior and logic have a very great effect on their students, and they should not imagine that they simply teach the subject of medicine. Therefore, the teacher should give importance to the religious and moral characteristics of their words and actions. One of these characteristics is being humble before their students and not looking down on them.” This guidance too is not limited to doctors who teach medicine in universities but is a general guidance to all teachers and educational professionals.

The representative of the Marja’ added:

“It is [our] hope that the dear teachers in the field of medicine as well as other sciences know that their mission is not limited to professional education in their field of specialization. Rather, the mission of teachers is to educate and teach the principles of morality and good citizenship in addition [to professional education]. As there is no fruit to education without morals and advancing on them, and the teacher who has most effect on their students is the one who begins with their own self, and who tames it on the best of morals and most beautiful of characteristics, then reflects them through their behavior with their students. One of these characteristics is treating students with humility and not looking down on them by saying that they are better than them, more knowledgeable, or of a higher status. They should tolerate and accept their mistakes and incorrect behaviors and remind them that displaying good behavior and morals is as important as having good grades in their classes. They should respect all students and not make fun of those who do not have the intelligence or skill [required] for this field; rather they should teach them how to develop their scientific capabilities and further explain the lessons. They should also explain to the students that success in school or university is important but is only a portion of the greater expected success in life, which is building a good relationship with God Almighty and other members of society, and that part of that [success] is [accomplished] by feeling responsibility after graduation and building a righteous family and treating other members of society well.”

It has been narrated from the Commander of the Faithful (p) that he said, “Teach people good with other than your tongues, be preachers to them with your actions, and maintain truth and piety.”

It has also been narrated from him (p), “The more a man’s knowledge increases, the more he cares for himself and puts effort in its righteousness.”

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Endnotes

1. Al-Majlisi, Bihar al-Anwar, vol. 1, p. 220.

2. Ibid.

3. This part of the booklet was prepared by I.M.A.M. so that the content is comprehensive and exhaustive from a theoretical and not just jurisprudential perspective. It is not from the writings attributed to alSayyid alSistani.

4. The Holy Quran 17:82.

5. Sayyid al-Radhi, Nahj al-Balaghah, p. 220.

6. Ibn Shu’ba al-Harrani, Tuhaf al-Uqul, p. 286.

7. The Holy Quran 16:68-69.

8. The Holy Quran 26:80.

9. Shaykh al-Saduq, Ma’ani al-Akhbar, p. 408.

10. Allamah al-Majlisi, Bihar al-Anwar, vol. 1, p. 218.

11. Ibn Shu’ba al-Harrani, Tuhaf al-Uqul, p. 321.

12. Al-Qadhi al-Nu’mani al-Maghribi, Daa’im al-Islam, vol. 2, p. 143.

13. Al-Himyari al-Qommi, Qurb al-Isnad, p. 110.

14. Shaykh al-Kafami, Al-Misbah, p. 123.

15. Shaykh al-Tubrusi, Makarim al-Akhlaq, p. 362.

16. The Holy Quran 23:14.

17. Shaykh al-Kulayni, Al-Kafi, vol. 8, p. 345.

18. Al-Qadhi al-Nu’mani al-Maghribi, Daa’im al-Islam, vol. 2, p. 144.

19. Ibn Hijr, Al-Isabah, vol. 3, p. 289.

20. Allamah al-Majlisi, Bihar al-Anwar, vol. 74, p. 161.

21. Al-Laythi al-Wasiti, Oyoun al-Hikam w al-Mawa’idh, p. 117.

22. Godah al-Majlisi, Bihar al-Anwar, vol. 71, p. 298.

23. Ibid.

24. Allamah al-Majlisi, Bihar al-Anwar, vol. 80, p. 369.

25. Shaykh al-Saduq, Man La Yahdhuruhu al-Faqih, vol. 3, p. 31.

26. In Islamic jurisprudence, “Dhamin” is a term referring to a person who is responsible for blood-money/reparation.

27. Al-Nisai, Al-Sunnan al-Kubrah, vol. 4, p. 241.

28. Shaykh al-Kulayni, Al-Kafi, vol. 7, p. 364.

29. Shaykh al-Kulayni, Al-Kafi, vol. 6, p. 53.

30. Al-Himyari al-Qommi, Qurb al-Isnad, p. 227.

31. Shaykh al-Kulayni, Al-Kafi, vol. 5, p. 534.

32. Shaykh al-Kulayni, Al-Kafi, vol. 6, p. 413.

33. Ibid., vol. 6, p. 414.

34. Shaykh al-Saduq, Al-Khisal, p. 229.

35. The Holy Quran 7:31.

36. Qutb al-Din al-Rawandi, Al-Dawat, p. 75.

37. Allamah al-Majlisi, Bihar al-Anwar, vol. 59, p. 66.

38. Ibn Abi al-Hadid, Sharh Nahj al-Balaghah, vol. 20, p. 300.

39. Allamah al-Majlisi, Bihar al-Anwar, vol. 59, p. 65.

40. Shaykh al-Saduq, Ilal al-Shara’i, vol. 2, p. 466.

41. Shaykh al-Saduq, Al-Khisal, p. 512.

42. Qutb al-Din al-Rawandi, Al-Dawat, p. 76.

43. Ibid., p. 76.

44. Ibn Babawiyah al-Qommi, Fiqh al-Redha (p), p. 340.

45. Allamah al-Majlisi, Bihar al-Anwar, vol. 59, p. 261.

46. Ibid., vol. 59, p. 295.

47. Shaykh al-Saduq, Al-Khisal, p. 155.

48. Al-Barqi, Al-Mahasin, vol. 2, p. 425.

49. Al-Barqi, Al-Mahasin, vol. 2, p. 422.

50. Sayyid al-Radhi, Nahj al-Balaghah, Sermons of Imam Ali (p),
p. 492.

51. Shaykh al-Kulayni, Al-Kafi, vol. 6, p. 314.

52. The Holy Quran 21:83.

53. The Holy Quran 21:84.

54. Shaykh al-Kulayni, Al-Kafi, vol. 4, p. 3.

55. In Islamic jurisprudence, “Dhamin” is the term used for a person who is responsible for reparation.

56. While this question directly mentions AIDS, these guidelines apply to any communicable disease.

57. The soul enters the body at four months of pregnancy and may be sooner if confirmed by modern means.

58. In the past, the communicability of HIV and disease characteristics of AIDS were less well understood, but the principles and rules of chronic sexually transmissible diseases apply for other conditions.

59. Tawriyah – not exposing the complete truth to prevent some adverse effect (e.g., instead of telling someone their loved one has died, they are told their loved one has transferred to the next world).

60. Prohibited touching is for a male to touch a non-Mahram female directly.

Prohibited looking is to look at a part other than the face or palms of a non-Mahram woman›s body.

61. It is important to note that the religious boundaries which must be observed are not limited to the aforementioned details. So, the nurse must ask and search further.

62. The holy narrations from Ahl al-Bayt (peace be upon them) and most of the books concerned with Islamic law mention the mithqal as a unit of mass. The mithqal is 4.64 grams. Silver could be replaced by gold depending on its material and pure form and how commonly it is used in a specific country.

63. The Holy Quran 6:151.

64. “Adoption” in Islam is that a person sponsors and takes responsibility for providing for a child and maintaining them. It is not a means to consider the child as one of their biological children for the application of Islamic law.