The Application of Necessity in Medical Treatment: An Islamic Biomedical Perspective

This research paper examines the concept of ‘necessity,’ which derives its origin both in Islamic and common law and transcended progressively into medical law. Many aspects of medical and civil law remained closely related to each other, like ‘the concept of duress’, ‘self-defense’ and other aspects of human activities are embedded in both the systems. Likewise, the common law generally allows almost all forms of treatment, whereas Islamic law permits it, when it essentially saves one’s life. All forms of medical treatments are freely and readily available to overcome sterility dilemmas in western countries, whereas in Islamic law some of the modern interventional techniques and genetic engineering are disregarded as per Shariah injections. Whereas, Islam does approve necessary measures to sustain sound and good health, since it is considered a part of one’s obligations. Hence, its sustenance senses the subjects to avoid from undue pains and sufferings. For this purpose, medications and medical treatment is considered a recognized mode in Islamic law. Therefore, on one hand, this research paper presents arguments in favor of medical treatment, while, on the other hand, it will argue the evidences given by classical and contemporary scholars in favor of medical treatment within the framework of Shariah. This may attract the essence of Shariah doctrine of necessity.


Introduction
Professor John Candlish argues that; "the concept of necessity has its origin both in Islamic and common law, and in this way it is progressively becoming an important area in medical law 3 . Thus, in this sense, many aspects of both the systems remain closely related to each other, like 'the concept of duress', 'self-defense' and some other aspects of human activities related to civil and medical matters are embedded in both the systems. Likewise, the common law generally allows almost all forms of treatment, whereas Islamic law regards it, when it essentially saves one's life 3 . Certainly, many contemporary medical issues like CRISPR [4][5] and other recent developments in the field of bio-medical technology appears as divergent issues.
Normally, in western countries almost all forms of medical treatments are freely available to overcome sterility dilemmas, whereas in Islamic and jurisprudence, anyhow, does not approve all sort of novel fertilization and genetic manipulation tools 6 . Muslim scholars from around the globe agree with the Islamic ethical precincts, prior to permitting one or the other procedure, since, these innovations involve ethical bars that devolves on personal morality [7][8][9][10] .
In contrast, Islamic theology approves the permissible measures to withstand good health, since it is considered a part of one's obligations. Thus, its sustenance senses the subjects to avoid from undue pains and sufferings. For this purpose medications and medical treatment is measured a recognized approach in Islamic law 11 . So, themain theme of this research study is medical practice and tendency towards medication in an Islamic perspective. Besides, several other areas connected to medical treatment, like 'necessity in medical treatment' and'the usage of prohibited medicine' will be a center of debate in this research paper in order to determine the position of Shariah law on these issues in the following manner.

I-Necessity in Medical Treatment
The British medical association 12 holds that: "the doctrine of necessity emerged from the need to give lawful emergency treatment to adults who are unconscious and unable to consent, thus in such cases, health professionals are justified in providing treatment that is immediately necessary to save life or to prevent the deterioration in the patient's condition, unless there is a valid and applicable advance refusal" 13 .
As regard to the refusal of treatments; normally, almost all those who suffer from illness are willingly contest for appropriate medical treatment, as a research study (which is comprised on a group of two hundred forty four patients; facing multiple serious diseases) identified that "majority of them wanted to receive a life-saving treatment" 14 .
Certainly, very few patients refuse to consent for prescribed treatment, while majority will follow appropriate prescription by a physician But, refusal from treatment, however, can be imagined where life survival is in question in case of lethal diseases. Such as, cancer affected patients, as they generally required radical treatment justly to prolong their lives, comparing to other patients, those who arefacing usual sicknesses 14 .
Arguably, the treatment options might change between the time and space, that in which time it must be followed. Similarly, social values, faith base understanding and cultural variation can also affect the treatment preferences, which is why cultural and religion change play a vital role transforming various decisions of medical treatment, e.g., in case of surrogacy.The surrogate-mother if undertakes such procedures; she may not be ready to be labeled only as gestational carrier after giving birth to baby. Definitely, the overall result will be altogether different to that, what the (patient) intended-mother, or those facing infertility problems would want. Since, in Muslim societies such procedure would be believed to run counter to the intention of God's command. Resultantly, despite the moral and ethical values, cultural variation and religion(s) might affect the free choices to medical treatment 14 .
Obviously, in case of refusal of the treatment (due to various reasons as identified), the patient has a right to deny medical treatment. Consequently, patient will face the outcome. Though, medical practitioner cannot enforce his choice of treatment against the will of the patient, 15 but Shariah, emphasis on the right of the body on self 16 .

II-Evidences Regarding Treatment and Remedies for Physical Ailments
In addition, the Prophetic traditions provide proper remedies for abnormal conditions and physical ailments, since the Prophet Muhammad (peace be upon him) used medicine himself and prescribed it for others 12 . The Prophet Muhammad (peace be upon him) said that: "For every illness there is a cure, and when it is properly applied to a disease; (means that when a dieses gets medical treatment), it cured (with) Allah almighty's willing" 17 .
Correspondingly, the Prophet (peace be upon him) said that: "Allah has not sent down any disease, except he sent down its cure" 18 .
So, it means that Allah does not create any illness until he creates a treatment for it.
Notably, as regard to the medical treatment and medication in Islam, a tradition was reported, when Bedouins came to the Messenger of Allah and then asked: "can we use medical treatment i.e. medication?' he (the Prophet) said: "yes, oh servants of Allah", (and he the Prophet replied to them that); "you can get medical treatment", because; "Allah Almighty does not create an illness without a cure for itexcept for one disease", they (the Bedouins) asked, what is that 'O' Messenger of Allah?, he (the Prophet) said that: an "senility" 19 .
Consequently, these traditions let us to mark that for every disease, Allah almighty has created a cure, but that is normally hidden from an ordinary/lay man, however, as per the Prophetic saying; when it is applied properly; indicates that medical treatment is an answer for every type of disease. Moreover, the above mentioned narrations evidently dictate that any person is allowed to seek appropriate medication and possible medical treatment 20 . similarly, for a non-Muslim some diseases might be incurable. But, for a Muslim physician it is obligatory to search for the treatment as Allah's Messenger (PBUH) has prescribed upon us being a Muslim physician to conduct research and find the solution of unsolved.
Ibn al-Qayyim stated that the role of physicians in this regard is very important to apply appropriate medical treatment; he pointed a Jewish tradition which states:"Once the Prophet Ibrāhīm (ʿalayhi al-salām) asked Allah almighty: "o my Lord!; where does the disease come from?" he (Allah almighty) said that: "from me" (i.e. from my side, or I send down it), he (the Ibrāhīm-ʿalayhi al-salām) then asked: "where does the cure come from?" he (the Allah almighty) replied: "from me" (i.e. from my side, or I send down its cure too), he (the Ibrāhīm-ʿalayhi al-salām) then asked: "where is the role of physicians then?" he (the Allah almighty) said that: "a man whose hands I send and cause the cure" 20 .
The above mentioned statement, however, strengthen the sayings of the Prophet Muhammad (peace be upon him), and encourages people to get medical treatments, and its proper application of this commandment is possible only when treatment is applied by a competent physician i.e. al-tabīb alkhāziq. Thus,medical intervention is a hope and way to recovery a good health, however, the end result is in Allah's hand, since it is he (almighty Allah) who cures; as the Holy Quran stated (the words of Ibrāhīm-ʿalayhi al-salām, arguing to his people): "And when I am ill, it is he (almighty Allah) who cures me" 21 .
Equally, almighty Allah directs medication and medical treatment in these words; 'ascribing honey which potentially cures', that: "From its belly comes forth a syrup/drink of different colors, which contains a healing for mankind" 22 .
The above verse of the holy Quran further states that: indeed "it is a sign for those who ponder"; signifies necessity for attaining treatments and cures to further diseases, since "Allah almighty has not inflicted a disease without prescribing a cure of it, known to whoever knows it, and unknown to who does not know it" 23 . This also indicate how important is to ponder upon and to do research in order to find the remedy of the ailment.
For the Christian physician, enhancement in human health is always subject to God's temptation, and hence, "redemption of humanity cannot come from humans but only from God". The Christians realize that; "from God the physician has his wisdom", "He endows man with knowledge to give glory to his mighty works, through which the physician eases, pain, and the pharmacist prepares medication, thus God's creative spirit continues without cessation ofefficacy on the surface of the earth" 24 .

III-Prophetic Guidelines on Lifestyle
Certainly, the Prophetic guidelines for each and every aspect and activity of human life is very important, for example, the imbalance and excess in the enjoyment of God's bounties, however, lead to physical and moral agony 25 . Henceforth, the Prophet Muhammad (peace be upon him) recommend moderation and advised to stop eating before feeling of satiety. So, the Prophet said that: "human does not fill any pot that is worse than his stomach, so it is sufficient for the mankind to eat what will support his back, (however) if it is not possible, then (leave space) as third for food, and third for drinking, and third for breathing" 26 .
Resultantly, excess in eating and drinking from the God's bounties and its enjoyment deemed as wastage in the Holy Quran, as it stated: "it is he who produces gardens, with trellises and without, and dates, and crops of different shapes and tastes (of all kinds), and olives and pomegranates, similar (in kind) and different (in variety): eat of their fruit when they repine, but render the dues that is proper on the day of its harvest, and waste not by excess: for Allah loves not the wasters" 27 .
It reported from Ibn 'Umar (May Allah be pleased with him) said that: "A man burped in front of the Prophet (peace be upon him), so he (the Prophet) said that: "keep away (withhold) your burps from us! For the most hungry of you on the dooms day (of resurrection) will be those who ate most (here) in this world" 28 .
Particularly, excess in eating and drinking cause pains and severe illness and sufferings, so to release human beings from those suffering and illness, medical sciences seek to satisfy bodily cure and treatments. Thus physicians are required to treat the patients in a requisite way 29 . Usually, 'the goal of medical treatment is the restoration of life' 30 , since those who are suffering from various diseases may possibly benefit from medical treatment. 29 Definitely, it must be noted that, 'treatment itself does not prevent or postpone the death'; however, 'it does make one's life better than it would otherwise be for a certain temporal period of the life'. Notably, whenever treatment is properly provided to the patients, "it may briefly postpone the life ending situation in such a way that the quality of life during the rest of life becomes high than that of the ailing conditions" 29 . So, in this sense, medical treatments prolong one's life, and makesit dependable 29 . Thus, the purpose of medical treatment is to benefit the patient 29 . However, the question in case of organ transplantation; "where an organ is removed from the donor for the sake of another, then how can the physician justify causing harm to a healthy person, and also the pain he will have to borne"? 31 The risk factors and the resulting disabilities during the medical treatment, however, considerations are given to various types of diseases to minimize them, hence for this purpose to achieve the required results, physicians are keenly aiming that which treatment is best to be used. Therefore, medical scientists and bioethicist are thus undertaking ethically approved research projects, like, 'cancer', 'HIV-AIDS', and other 'degenerative neurological diseases' are primarily under investigation, which can benefit the human beings and might enhance their life standard 30 .

IV-The Use of Prohibited Substances as Medicine
Indeed, almighty Allah has created cure for every kind of diseases, and hence medicine is considered a recognized tool and hope for the patients that might benefiting them. The human body is a residence of various ailments, thus using of suitable and favorable medicine is prescribed to the sick persons by the physician in order to avoid bodily harms and disorders. Various Prophetic traditions indicating that, seeking medical treatment and medicine is an obligation, 32 since the body has a right over you, and its due rights must be given properly 33 . The act of sending a physician towards one of his companions by the Messenger of Allah signifies that medical treatment is necessary. It is narrated from Jābir, he said that: "Ubay bin Ka'b fell ill, so the Prophet (peace be upon him) sent a physician to him, who cauterized (Burn, sear, or freeze the tissue) of him on his medial arm vein" 34 .
Another hadīth which is reported by Imām Mālik in his book al-muwaṭṭā on the authority of Zayd bin Aslam said that: "a man received a wound/injury in the time of the Prophet (peace be upon him); and the blood clotted in his wound, so the (injured) man called two (other) men from banu anmār tribe, (in order to) looked at (to treat him), so the Messenger of Allah (peace be upon him) said to them; "which one of you is better physician?" they said, "o Messenger of Allah! Is there any good in medicine?" Zayd (further asserted that) the Messenger of Allah (peace be upon him) said; "the one who sent down the disease sent down the cure" 35 .
Similarly, Ibn al-Qayyim stated that Hilāl bin Yasaf said:"The Prophet (peace be upon him) visited an sick person and said; "send for a physician", a man said 'do you say that, o Messenger of Allah (peace be upon him)?' he (the Prophet) said; "yes"; "Allah has not sent down a disease, until he sent down a cure for it" 36 .
Questionably, various sayings of the prophet Muhammad (peace be upon him) have prohibited using of those things which are forbidden by the Allah almighty, but what if on the one hand, the nature is forbidding one thing at one time and made allowed at another time as an exemption or dispensation? For example; when the Prophet (peace be upon him) was asked about use of alcohol for medicinal purposes, he (the Prophet) expressed hatred, and said; "this is not a medicine, rather a disease" 37 .
Commenting on the abovementioned hadīth al-Baydāwī, expressed; it is possible that he (the Prophet) termed it in general sense, while Tāriq bin Sūaid needed it in particular, since, he may have the knowledge of the disease, which may be cured through application of alcohol. However, he learned (from the Prophetic saying) that alcohol might cause an increase and does not absolve him (from the sin). Thus, for this reason jurists have differed in the permissibility of alcohol for medication 38 . While, 'Aynī explaining the hadīth stated that, medication by unlawful substance, like, using wine for medicinal purposes have the same effect. Equally, drinking it in case of extreme thirst, also to swallow and gulpdown the bread. He further stated that, according to Ibn Ḥazm; 39 'in case of necessity', one can use alcohol as medicine, since Allah almighty has made an exemption in case of duress. Thus, eating and drinking of the prohibited in state of necessity has the same effects as for the medicinal purpose 40 .
In addition, Ibn al-Jawzī, said: the above mentioned hadīth indicates that, it is not permissible to drink alcohol, even for the sake of necessity, such as quenching thirst and medication, and that is the view of Imām Ahmad. Whereas, according to Imām Abū Ḥanīfah; it is permissible, and Imām al-Shāfi'ī have three views in this regard: the two of his views are similar to (Hanbalī's) doctrines, while the third view is about the permissibility for medicinaluse and not to alleviate the thirst" 41 . Now the question arises that whether alcohol and other unlawful substances can be used as medicine? So, this question will be responded separately under the head of 'medication by unlawful substance' right after the brief discussion on the subsequent interconnected issues, as follows: ii-

Replacing Missing Organ with Gold
Generally, the usage of gold for men is prohibited in Shariah, however a ḥadīth clearly indicating the permissibility. The story of 'Arfajah bin As'ad in very important to note that, "whose nose was cut off at the battle of al-Kilāb, and he got a silver nose, but it afflicted an infection, so the Prophet (peace be upon him) ordered him to get a gold nose" 56 .
Commenting on the said ḥadīth, al-Ḥaṭṭābī maintained; 'using of gold is permitting for men out of necessity, such as tying teeth with it, and in similar cases", 57 as an exemption 58 . 'Aynī, said; 'the one whose nose is cut down, he can take a nose of gold', since, a node made of silver (for nose) is rusted; hence it is necessary to get a node made of gold on the basis of necessity. He further stated that; 'Ibn Munzīr argued on the ḥadīth of 'Arfajah: that it is easy for men to use gold out of necessity, such as tying teeth etc 59 . Kasānī maintained, 'it is unanimously permissible; for the men, for tying their teeth with gold, so, there is no disagreement in this regard; if a nose is made of gold, since a node made (for nose) of silver is rusted, as "necessity override the prohibition" is a golden rule in Islamic law 60 . Similarly, this rule can be extended to other organs, like finger, ear, etc., 61 so, if necessity demands, auxiliary damaged organs can also be made of gold 62 .
The view of Ibn al-Humām is very important to note in this regard, as he stated; according to Imām Abū Ḥanīfah: originally it is prohibited, but permissible out of necessity 63 .

V-Conclusion
Consequently, the Prophet Muhammad (peace be upon him) permitted the silk and gold for men out of necessity, since silk was considered a cure for the itch, however, initially it was not allowed for them to wear, becausethe companions were aware of its prohibition due to the text. But, the Messenger of Allah upon necessity granted permission to the patients (ill/sick persons), and not for others. In the same way usage of gold was made allowed in case of dire need and the story of 'Arfajah bin As'ad is worth noting.Similarly, using camel's urine as medicine; the Prophet of Islamalso granted permission to the patients from the tribe of 'uraina ('urnīan) and 'ukl. Nevertheless, consuming camel's urine is factually impure, but its proscription is relaxed formedical necessity. Accordingly, Ibn Raslān asserted that, unlawful items become permissible in case of necessity formedication. Save for, using ḥarām substances as medical remedy is permissible when there is certainty of cure, in the absence of a ḥalāl alternative as per ῾Uthmāni's assertion.Correspondingly, the Quranic verses: "make not your own hands contribute to (your) destruction", and "do not kill yourselves", undoubtedly indicatesimpermissibility for the patients to refuse from getting treatment through unlawful substances in case of nonavailability of lawful alternatives. 'Aynī contended that,the evidences regarding 'wearing of silk dress, drinking of camel's urine and using of goldenvisages permissibilityout of necessity and one cannot deny it permissiveness due to the text. Resultantly, same is the case with wine; which is absolutely ḥarām, but patients may use it asmedicinein the absence of ḥalāl, on the recommendation of an expert Muslim physician 64 .
Competing, Financial Interests : The authors declared that they have no competing financial interests.

Conflict of Interest :
The authors declared that they have no conflict of interest.

Source of Funding: Nil Contribution of Authors:
FD perceived, conceived and designed the study, while MMS participated in its design and helped FD in critical review. FD solely did data collection and its analysis. FD did manuscript writing and drafting. AKA did final review of the manuscript. FD takes responsibility/accountability for all aspects of work in ensuring that queries related to the integrity of the study are appropriately investigated and resolved. All the authors read and approved the study. Press, 2009