9 September 2016
RESPONSE OF THE ISLAMIC MEDICAL ASSOCIATION OF MALAYSIA (IMAM)* ON ISSUES SURROUNDING TERMINATION OF PREGNANCY (TOP) OF WOMEN INFECTED WITH THE ZIKA VIRUS
1. IMAM takes serious cognizance of the aforementioned issues as deliberated by both the Mufti of the Federal Territories (http://www.muftiwp.gov.my/ind
ex.php/perkhidmatan-s/bl/1165- bayan-linnas-siri-68-hukum-huk um-berkaitan-virus-zika) and the Minister of Health (http://www.thestar.com.my/new s/nation/2016/09/06/subra-on-a bortions-for-those-with-zika/) .
2. The obstetrician & gynaecologist is often in a dilemma when presented with circumstances involving TOP because it involves the professional code of ethics, whereby one promises to save and protect lives throughout one’s professional career.
3. TOP is a major issue not only within medical circles but also within the context of bio-ethics and religion. In Islam, two higher objectives of the Islamic jurisprudence (Maqasid Shari’ah), is the preservation and protection of life (Hifz an-Nafs) and progeny (Hifz an-Nasl).
4. IMAM urges that any recommendations or decisions about TOP in Zika infected pregnant women is managed with extreme care and sensitivity to avoid any misunderstandings and injustice to the patient and the foetus.
5. The presence of legal statutes and clinical recommendations on TOP from the relevant authorities provides a general guideline to the medical doctor. The implementation of TOP must be individualized within the ambit of the law.
6. To achieve the abovementioned objectives, IMAM recommends the establishment of a medical bio-ethics advisory board at the Ministry of Health, comprising of expert authorities in obstetrics (foetal medicine specialists), infectious diseases, bioethics, religion (in Islam from the mufti’s office or academia) and psychiatry whom the hospitals and doctors can refer to.
7. The medical bio-ethics advisory board should meet regularly to set the best practice guidelines through collective decision-making (ijtihad jama’ei) and thus acknowledges the role of both experts (ahluz zikr) in the domain of medicine and religion, which in Islam is enjoined as per surah al-Anbiya’ verse 7; “And We sent not (as Our messengers) before thee other than men whom We inspired. Ask the followers of the Reminder if ye know not?”
8. This process of decision-making would be more safe and just to the mother and foetus, and would avoid unilateral decision-making which may cause conflicts between the practice of medicine and the tenets of the Shari’ah.
9. IMAM also suggests a policy of contraception or pregnancy planning in Zika positive parents or those who live in highly endemic Zika zones. This is in keeping with the concept of planning of progeny (Tanzim an –Nasl) which is permissible (harus) in Islam. This is more natural and parenting friendly and obviates the need for unnecessary TOP, since the association between Zika in early pregnancy and neurological complications, namely microcephaly is mainly anecdotal and medically unproven as yet.
10. Since the knowledge of short and long-term risks and complications of Zika infections is still limited and being investigated by global health authorities, the public is advised not to be gullible to the rumours in social media about treatment options for Zika infections. Please do not forward these ill-evidenced messages and avoid being part of these rumour mongering machinery.
11. IMAM urges the public to fully abide by the recommendations, prevention and treatment strategies of the Ministry of Health.
12. IMAM urges every Malaysian to be civic conscious, act promptly and cooperate with local and state authorities, by keeping our home compounds and neighbourhoods free from the breeding sites of the Aedes mosquito, the vector of the Zika, Dengue and Chikungunya viruses. The management committees of villages, housing estates, the local surau and mosque etc should be proactive by initiating gotong-royong activities to clean the environment. It is a Fardu Kifayah obligation on all Muslims to undertake this communal task since cleanliness is a major part of the Islamic faith.
13. IMAM will continue to organize seminars and dialogue sessions by our various public health, obstetric and religious experts to further inform the public on the Zika virus and its health implications.
Dr Jamali bin Wagiman
Islamic Medical Association Malaysia (IMAM)
* Islamic Medical Association Malaysia (IMAM) is a professional medical NGO founded in 1990 and comprises of 4,000 Muslim medical specialists, doctors and health professionals.
Musa Mohd Nordin