For many people the decision to get the flu vaccine is simple. Anyone who has had the flu, or has cared for someone who did, knows about the painful muscle aches, the spiking fevers, and the terrible coughing and sneezing and therefore would like to avoid the flu at almost all cost. Given its marginal cost and widespread availability, many people don’t think twice about getting the vaccine when their doctor advises them to obtain it. Yet for some people getting the flu vaccine might pose a problem because of their religious values.
There are several different types of the flu vaccine made by pharmaceutical companies and the most common formulations contain porcine gelatin, an ingredient that some religions find objectionable. Consequently an ethical dilemma arises: Should the religiously-inclined individual ignore the religious dictum in order to prevent disease via the vaccine?
Some Muslims, Jews, and Hindus face this choice every year and often seek out religious counsel for guidance. These religious leaders may advise that when one’s health is danger, religious law allows for exemptions and that taking the vaccine is permissible due to necessity. Others may view the flu as nothing more than a nuisance and suggest that invoking necessity is not appropriate for this “minor” disease. Others still might consider the gelatin component to be present in such a minute quantity as to deem it ignorable from a religious standpoint. Thus, as we dig deeper, we see that the way religious scholars understand the severity of disease, as well as the vaccine’s make-up, can inform their interpretations of religious law and the advice they gave. Simple changes in the interpretation of the medical context can lead to vastly different answers to the ethical dilemma.
A meeting of two worlds
The educational worlds of religion and medicine do not meet regularly. It is rare for a religious scholar to have health-related training and expertise, and health care practitioners by and large have few opportunities to study religion in-depth. Thus, when religious leaders and clinicians meet to discuss an ethical dilemma presented by health care they often see different values at stake and use different conceptual algorithms in carrying out the moral calculus. Importantly, if the calculations are incorrect, patients may suffer needlessly. Therefore religious scholars need to understand how clinicians assess, weigh, and consider disease risk and severity, while clinicians need to recognize the religious values at stake, and how religious scholars take medical advice into consideration when generating religious decrees and offering guidance to patients.
At the University of Chicago, I wanted to address these gaps and brought together a group of 9 Islamic scholars, clinicians, and educators to learn from one another and come up with ways in which religious and medical knowledge can be integrated together. The group included traditionally trained seminarians Shaykh M. Amin Kholwadia, and Shaykh Jihad Brown, Islamic law academicians M. Volkan Stodolsky and Taha Abdul Basser, Muslim clinicians Drs. Ahsan Arozullah, Faisal Qazi, and Katherine Klima, and science educator Omar Qureshi. Funded by the John Templeton Foundation, this 3-year project involved 6 intensive weekend retreats where Islamic scholars provided clinicians with an overview of Islamic moral theology, epistemology and law, and clinicians helped Islamic scholars understand medical and statistical concepts of risk and medical decision-making. Together we worked on several papers that highlighted how the two disciplines, medicine and religion, can work together in mutually informative ways, and how more nuanced religious advice can be provided to those facing bioethical challenges.
For example two papers published in the Zygon and the Journal of Medicine, Healthcare and Philosophy discuss how each medical science can inform religious law and how religious ethics can inform medical practice. Traditionally, seeking health care is not a moral obligation according to Islam, save for when one’s life is at-risk. This judgement is informed by Islamic law scholars doubting the effectiveness of medicines. The papers suggest that epidemiological data, in certain cases, can satisfy the threshold for “certain” knowledge according to the Islamic epistemology as it corresponds to a knowledge source termed al-mujarrabāt. With this being the case, jurist’s doubts about the certainty of medical science and their views on its moral status might be amenable to updating. The papers also suggest that Islamic theological notions of harm can broaden the ethos of medical practice so that it attends to the spiritual aspects of health alongside the physical. An illustration of this occurs at the end-of-life, where Islamic ethico-legal stances note that clinical interventions are not automatically morally obligated; rather, quality-of-life and preventing harms from life-support therapies with marginal benefits should inform ethical decision-making.
Ultimately the project culminated in a multidisciplinary conference where we scholars presented our research and learning, and were joined by over 20 scholars who also shared their own research at the interface of religion and medicine. The conference was attended by over 100 individuals from around the world. The project modelled how religious scholars and clinicians can work together and learn from one another so that patients can get more nuanced and appropriate advice on how to receive religiously-sensitive, high-quality, health care.
Reconciling risk and religion
There are multiple valid Islamic positions on the permissibility of seeking what for many people seems like routine health care. These viewpoints are derived from traditions from the Prophet Muhammad that relate that God does not provide cure in prohibited and/or filthy substances (the porcine gelatin in flu vaccines is considered such by Islam), but at the same time he allowed certain individuals medical exemptions. The entry-point for epidemiology and biostatistics in providing nuance and calibrating the Islamic ethico-legal positions is to judge the risks of disease and the harms that might ensue if once contracted the flu. Where the medical science finds the harms to be significant and real, Islamic law might allow, through a contingent exemption, taking of the vaccine. Yet importantly, the threshold for certain knowledge should be met with the appropriate studies providing evidence of the prevalence, morbidity and mortality of the flu and of the efficacy of the vaccine. These ideas are further elaborated on in several other publications.