Medical Rulings

Medical Rulings

(May his soul rest in peace)

Ayatollah Mohammad Reza Nekounam

Author: Mohammad Reza Nekounam

Title: Medical Rulings

Publisher: Sobhe Farda, Islamshahr, Second Edition, 2014

Pages: 238

ISBN (Second Edition): 978-964-2807-40-6

Subject: Medicine – Fatwas

Subject: Shiite Fatwas – 14th Century

Subject: Jafari Jurisprudence – Practical Treatise

Library of Congress Classification: BP183 9/ 8 A

Dewey Classification: 297.3422

National Bibliography Number: 373327-85 M

Publisher: Sobhe Farda

Edition: Second, Published in 2014

Print Run: 3000 copies

Price: 50,000 Toman

Location: Tehran, Islamshahr, Nasimshahr, Vajeabad, Javaherzadeh, 12 Meter, No. 36

Postal Code: 3769138575

Telephone (Distribution Centre): +98 32 90 78 15

Copyright: Reserved for the author

Foreword

Religious teachings encompass three domains: beliefs, ethics, and actions. Doctrinal and ethical tenets of religion are vast, and scholarly theologians have long provided these in the initial sections of their juridical works. However, due to the breadth of these teachings, they are now often presented in separate collections.

The jurisprudential principles of Islam delineate the boundaries of Islamic faith and guide the actions of its adherents, preserving the values of Shi’ism and playing a crucial role in resisting external invasions of culture.

These rulings are collected by pious and scholarly jurists through extensive effort and ijtihad (independent legal reasoning), and a selected compilation of them, known as Tawzeeh al-Masael (Explanatory Treatise), is presented to the public for teaching and disseminating religious laws.

Given the vastness of juristic data and the accumulation of numerous issues and rulings, it becomes necessary to write collections that focus solely on specific topics, making it easier for individuals to access the legal rulings pertinent to their particular concerns. This work specifically addresses the medical issues that every individual is likely to face during their lifetime, such as those encountered by physicians and patients, and the present text aims to tackle these.

The “Medical Rulings” work is divided into two sections: the first section deals with the specific rulings for medical professionals and addresses topics related to medical education, examinations, treatments, prescriptions, laboratory and pharmacy practices, and also covers issues related to preventive measures, artificial insemination, sterilisation, abortion, childbirth, surgery, organ transplants, dissection, and rulings on indemnity (diya). The second section clarifies the rulings that each patient faces during their illness and recovery period.

Although this work shares commonalities with other written works of Grand Ayatollahs, it differs significantly in its responses and includes some distinctive features, some of which are outlined below:

A) One of the most important modes of communication between a jurist and the public is through treatises such as Tawzeeh al-Masael and similar works. Consequently, such texts must be written in a style that is accessible, clear, and appropriate to the socio-cultural and psychological realities of the time, free from unnecessary complexity, and as close as possible to the truth. The present work has endeavoured to maintain this clarity.

B) Jurisprudence, in its lexical sense, refers to the “understanding of the meaning intended by the speaker” and, in its technical sense, is the knowledge of how to derive the intended meaning from religious texts (the Quran and the Sunnah), systematically. Thus, the scholar’s knowledge encompasses the determination of what is obligatory and forbidden, what exists and what does not. The practice of the early jurists is a testament to this understanding, where they often discussed fundamental principles before delving into the more specific aspects of religious law. This approach affirms that jurisprudence should be presented alongside logic, philosophy, and mysticism to prevent stagnation and isolation from the dynamic developments of life.

C) As noted above, the understanding of Sharia is a systemised process, and it is inappropriate to derive legal rulings based on fallible readings or preconceptions, such as analogy (qiyas) or personal judgment (istihsan), as these would mislead one’s understanding of religious teachings. Jurisprudence requires a systematic approach, and a jurist can only possess the capacity for ijtihad and correct legal reasoning by mastering this system and understanding the background and criteria for legal rulings.

D) Determining the specific external case to which a ruling applies is the responsibility of the jurist. It is a misguided approach to suggest that identifying the external case of a religious ruling is beyond the capacity of a jurist. Jurisprudence, and a deep understanding of religion, must be engaged with the actual events and issues of the time, so that it remains relevant, dynamic, and applicable to present and future societal needs.

E) Another essential duty of a jurist is understanding the criteria and rationale for rulings. The notion that all religious rulings are purely devotional and should be accepted without contemplation of their underlying wisdom leads to a flawed and incomplete understanding of religion. A focus on the superficial wording or apparent reasoning behind a ruling, while ignoring the underlying rationale, results in negligence and short-sightedness.

Thus, our approach to jurisprudence, grounded in wisdom, consists of three fundamental pillars:

1. The understanding of Sharia’s intended meaning in a systematic manner.
2. The identification of specific external cases to which rulings apply.
3. The comprehension of the true rationale and objectives behind the rulings, avoiding analogy, personal judgment, or unfounded considerations.

Neglecting these three principles leads to a reductionist approach to jurisprudence that focuses solely on superficial elements and hinders deeper analysis, leaving the jurist to resort to “precautionary” measures instead of issuing clear, unequivocal rulings.

Section One: Medical Rulings

Chapter One: Medical Education

Q: How necessary is it for medical staff to be aware of religious rulings?

A: It is obligatory for every individual to learn the obligatory and prohibited actions related to their profession, particularly when they may encounter such matters during their practice.

Q: If the instructions of some heads of teaching hospitals or laboratories conflict with Islamic law, what should students, who are required to follow the instructions of their professors during examinations, do? Should they follow these professors or not?

A: It is obligatory for the individual to act in accordance with Islamic rulings, and any action contrary to these rulings is not permissible, unless failure to follow such instructions causes significant hardship. In that case, one may act only to the extent necessary.

Q: Given the potential harmful consequences of women consulting male doctors, is it obligatory for women with sufficient ability to learn medical knowledge pertaining to women?

A: Learning medical sciences, like other skills required by society, is a communal obligation, and there is no distinction between men and women in this regard. However, it is desirable for women to learn women’s health care.

Q: In some hospitals, students are required to perform physical examinations on patients as part of their practical training. If a patient does not consent, can they be forced to allow students to examine them, such as when a treating doctor tells the patient that if they prevent the students from examining them, they will not be treated?

A: If the examination is part of the hospital’s program, it is not problematic, although the patient has the right to refuse. If the treating doctor wants the examination to be performed by students, the same rule applies. In general, medical treatments that involve saving a person’s life do not necessarily depend on a specific practitioner, and if the patient does not consent, it is not permissible to proceed.

Q: Is it permissible to use bones found in deserts or graveyards, whether from Muslims or non-Muslims, for medical education, provided these bones are donated to the educational institution or buried after use?

A: It is permissible as long as it does not violate the dignity of Muslims.

Q: Is it permissible to exhume the bodies of non-Muslims for educational purposes if there is a shortage of corpses or bones for training purposes?

A: If it is not certain whether the grave belongs to a Muslim or non-Muslim, exhumation is permissible.

Section 1: Medical Ethics and Islamic Jurisprudence

Q: Is it permissible to bury the bodies of non-Muslims in Islamic countries under Islamic law?

A: If necessary, as per the judgment of an Islamic authority (Hākim Sharʿī), there is no issue, and in Islamic countries, a graveyard for non-Muslims who adhere to the law is regarded as equivalent to a Muslim graveyard.

Q: What is the ruling regarding medical education in areas where there are religious prohibitions, such as touching and looking, by medical students?

A: It is permissible as long as it is done within the limits of necessity and without the intention of deriving pleasure.

Q: What is the ruling on close and unrestricted physical interactions between male and female medical students and doctors, and the breaking of boundaries due to illicit encounters with patients, such as looking or touching?

A: The relationship between a doctor or student and a patient differs from the interactions between doctors and students with each other. Care should be taken to avoid the normalization of sinful behavior among them.

Q: What is the ruling on examination and training in cases where religious prohibitions might apply, but there is a future medical necessity for such actions?

A: If it is logically probable and medically relevant, and done without the intention of deriving pleasure, it is permissible.

Q: If the view of teachers and doctors is that the best treatment is the most complete one, and this involves touching and looking in non-urgent cases, is it permissible to follow such methods?

A: There is no issue with this, as long as it is done in accordance with necessity and medical standards.

Q: Is it permissible for male students to look at their female professors, or vice versa, if a small amount of hair is visible or if the intention is to understand the lesson?

A: It is preferable to remind them of the prohibition of haram acts. If they do not accept or pay attention, there is no issue.

Q: In medical training related to diseases common to both men and women, such as sore throats and colds, is it required for students to only train with patients of the same sex?

A: If it is possible without disrupting the education, it is preferable, but if this is not feasible, there is no issue.

Q: What is the ruling on medical training in hospitals and medical centers where procedures like childbirth and curettage are performed in the presence of male and female students, and they participate in the process?

A: Such procedures in medical centers must be carried out with the approval of medical commissions that are lawful and in accordance with Islamic law. In this case, the participation of male and female students is permissible.

Q: Is it permissible to look at naked pictures in medical books for educational purposes? What if it is pleasurable? And if it is not pleasurable, is it allowed without the intent of education?

A: If the viewing is not for the purpose of deriving pleasure and there is no fear of falling into the unlawful, it is permissible. However, if there is a fear of committing a haram act, it is not permissible, whether for educational purposes or otherwise.

Section 4: Dental Treatment and Patient-Doctor Interaction

Q: What is the ruling on a female patient visiting a male dentist and vice versa?

A: If treatment is necessary, and it is not possible to consult a same-sex doctor or there is a difficulty in doing so, or if the doctor of the opposite sex has more expertise, there is no issue. If possible and there is no problem, gloves should be used.

Q: If there are both male and female doctors available, should the patient be referred to a same-sex doctor or the more skilled one?

A: The deciding factor is the necessity and urgency, which is for the patient to determine.

Q: If both male and female doctors have the same expertise, but based on experience, male doctors’ treatments are generally more accepted or bring more confidence in surgery, is it permissible for a female patient to visit a male doctor?

A: A consultation with a doctor of the opposite sex can only take place if access to a same-sex doctor is not available or if the opposite-sex doctor has significant expertise.

Q: Who is responsible for determining the skill level of a doctor— the patient or other people?

A: Ultimately, it is the responsibility of the patient.

Q: Can patients be forced to visit a same-sex doctor, even with claims of necessity and religious justification?

A: It is not permissible to force patients to do so, except in cases where it would promote immorality. In such cases, both the public and officials should act accordingly in a situation where doctors are plentiful, by enacting religious prohibition against immorality.

Q: Can a doctor refuse to examine a patient of the opposite sex who has consulted them?

A: A doctor can refuse to examine a patient if they deem the treatment unnecessary.

Section 5: Examination and Treatment

Q: How much can a doctor expand their examination when treating a patient of the opposite sex?

A: The doctor is required to conduct all necessary examinations for diagnosis, within the limits of necessity. If the doctor neglects this, they are held accountable. Any unnecessary examination of a person of the opposite sex is considered a grave sin.

Q: There are many specialisations in medicine, and currently, female specialists are few, especially in smaller cities where there is a high patient volume and a shortage of female doctors. In such cases, what is the duty?

A: If necessary, it is permissible for the patient to consult a male doctor for treatment.

Q: If a female doctor is unavailable or if there is a specific need for specialised expertise that male doctors are more skilled in, such as certain medical procedures, and waiting for a female doctor is not an option due to time constraints, what is the ruling?

A: In all such cases, treatment by a male doctor is permissible due to necessity.

Q: What is the ruling on a male doctor placing an intrauterine device (IUD) or examining the arm of a female patient, where only a small part of the arm is exposed, provided gloves and full clothing are worn?

A: If a same-sex doctor is unavailable or if the male doctor is more skilled, this is permissible.

Q: If a couple must prevent pregnancy for health reasons, and the only effective method suggested by doctors involves some form of physical examination by a male doctor, is this an example of “necessity in treatment”?

A: This is considered a case of necessity in treatment and is therefore permissible.

Q: Is it permissible for a male doctor to perform sterilisation procedures on a female patient, such as tubal ligation, when the patient is sedated, and the procedure involves no direct view or examination of the private parts?

A: If necessary, the doctor can perform the procedure. There is no issue with touch or examination during treatment when required for medical necessity.

Q: During laparoscopic surgery, where the body is fully covered and only small incisions are made, can a male doctor perform the procedure, given that there is no need for direct touch or visual inspection?

A: Since there is no direct touching or viewing of private areas, the procedure is permissible.

Q: What is the ruling on a male doctor washing his hands up to the elbow in an operating theatre where a female colleague or assistant is present, and there is no way to avoid contact?

A: There is no issue for a male doctor in this situation. For a female doctor, as long as there is no intent to look or derive pleasure, it is also permissible.

Section 6: Necessity and Medical Decision-making

Q: What is the definition of necessity in medical matters?

A: Necessity is a secondary concept meaning “compulsion” and encompasses several levels. All levels of necessity are considered legitimate under Islamic law, and necessity is broader than terms such as hardship, distress, and harm.

Q: Who is the authority in determining the level of necessity in medical treatment— the patient, the doctor, or others?

A: The determination of necessity lies with the patient, as well as with those responsible for the treatment, including the doctor and those involved in the examination or surgery.

Q: Is a shortage of medical facilities, equipment, or staff considered a case of necessity?

A: Yes, it is considered a form of necessity.

Q: Is waiting too long for medical treatment considered a form of necessity?

A: Delay that results in harm or hardship is indeed considered a case of necessity.

Section 7: Doctor-Patient Confidentiality and Ethical Considerations

Q: Doctors often become aware of patients’ private information. Are they ever allowed to disclose this information?

A: Doctors are never permitted to disclose patients’ confidential information unless required by law, in which case, only the necessary information should be revealed.

Q: What is the doctor’s responsibility when dealing with patients suffering from terminal illnesses like cancer?

A: The doctor is obliged to provide effective treatment, including administering necessary medications, and even if the treatment involves psychological suggestions, these should be carried out as part of the doctor’s ethical, national, and humanitarian duty. In cases where telling the truth might negatively affect the patient’s well-being, it may be justified for the doctor to withhold certain information, provided this is in the best interests of the patient.

Q: What is the ruling on euthanasia?

A: Euthanasia is classified into three types:

1. Active euthanasia, where a lethal drug is administered by the doctor to end the patient’s life.
2. Passive euthanasia, where treatment is withheld from a terminal patient.
3. Indirect euthanasia, where the patient is provided with a lethal dose of medication to self-administer.

Only the second type, passive euthanasia, is considered permissible under necessity. The first and third types are considered murder and are strictly prohibited.

Q: If a doctor knows that revealing certain patient secrets would lead to uncovering a crime, such as the discovery of a drug ring, should they disclose this information to the authorities?

A: Yes, it is permissible to reveal such information when it pertains to the rights of society, regardless of whether the court has specifically requested it.

Chapter 7
(Medical Diagnosis and Treatment)

Q: Given that numerous research groups around the world are constantly conducting studies and publishing their findings, and considering that the individuals involved may not always be scientifically or ethically reliable—meaning there is no guarantee that the results announced align with reality, and that there is no single authority to approve or reject such studies, or if there is, it may take a long time for accurate results to be presented—what should we do if the results of these studies, which are published in the media or even reputable journals, contradict or complement previous methods whose benefits are not fully confirmed? Should we continue with the old methods, or adopt the new ones?

A: The approach should be based on whichever method the medical community or the physician trusts more.

Q: Considering that each year new discoveries or research results in the field of medicine are announced, and given that it is not possible to memorise all the previous methods during medical school, let alone the new ones, can a doctor rely solely on the methods previously learned? Or should they only learn new methods to the extent that time permits? If they fail to notice significant new issues, is there any responsibility on their part?

A: The doctor must, in accordance with the regulations and following the conventional practices of physicians, continuously keep up-to-date with scientific and medical developments. Failure to do so, which is a violation of the medical system’s regulations, results in responsibility.

Q: If a doctor intends to continue their medical practice considering the differences between new and old methods and their uncertainty about the accuracy of previous or new theories, and due to the impossibility of retaining all methods and the various limitations, the medical field would face a complete disruption. In such cases, would the doctor’s practice be considered correct only if they have sufficient expertise and experience? In practice, however, every doctor must undergo initial stages of specialization with limited experience, and because of the large population, limited resources, and insufficient opportunities, it is not feasible to expect only fully proficient doctors to practice. With this in mind, the following issues arise:

1. If a doctor forgets an effective medication for a disease or its dangerous complications, and lacks sufficient time or resources to gather more information or consult with another specialist, what should they do?
2. If a doctor is certain that a particular drug will benefit the disease but is also certain or suspects that its use may cause side effects, ranging from mild to severe, or even death, can the doctor leave the patient to their fate, assuming that the doctor’s role is to avoid responsibility and leave everything to divine providence? Or, in principle, when a doctor does not know what treatment to provide to save the patient or alleviate their suffering, what is their duty? Should they proceed with treatment despite the uncertainty, which may lead to death or more severe complications, or should they refrain from any treatment? If the doctor causes harm or death by attempting uncertain treatment, are they responsible? If the doctor does not treat at all, should they be held responsible?

A: If a doctor is genuinely unable to diagnose or identify a treatment pathway in accordance with medical principles and regulations, they are not required to proceed with treatment. However, if they identify a treatment method that is not harmful and has some chance of benefiting the patient, they should proceed with it and not leave the patient without care. If no treatment path is clear, the doctor has no special obligation, and they and others are in the same position regarding responsibility.

Q: Given the weaknesses and harms in the existing medical system’s regulations, can relying on those regulations be considered sufficient from a rational and customary perspective, without imposing any responsibility on the doctor?

A: Although it is rational and customary to base treatment on the existing regulations, appropriate actions should be taken to prevent harm caused by these regulations, without undermining them or exposing the doctor to personal risk.

Q: If a mentally ill patient has the potential to commit murder at any time and develops another illness, is it permissible to withhold treatment for the new illness in order to prevent them from having the physical strength to commit murder and endanger others?

A: The patient must be treated to prevent death, and it is the responsibility of the government and authorities to protect the lives, reputation, and property of individuals.

Q: If two patients are brought to a doctor, both in critical condition, and one of them is a family member of the doctor’s—such that treating one requires neglecting the other, which would result in their death—what should the doctor do?

1. Which patient should the doctor treat first?
2. If the doctor has no specific religious obligation to treat the family member, what should their duty be?
3. If the doctor has a religious obligation to treat the family member, what should they do?
4. If the family member’s condition is critical but the other patient’s risk of death is greater, what should the doctor do?

A1: The two patients are like two drowning individuals, and saving either one is not possible. The choice is at the discretion of the doctor. If the doctor chooses to treat the family member, this is not problematic unless one of them is an enemy or an adversary, or if the other has more faith and virtue.

A2: In this case, the doctor must fulfil their commitment and treat the family member first.

A3: If the doctor is bound by a religious obligation, they should treat the family member whose risk of death is greater.

Q: Given the scarcity of resources in hospitals and the limited number of beds in intensive care units, what should be done if admitting a patient who has less chance of survival prevents another patient, who has a higher chance of survival, from being admitted?

A: The priority for admitting patients should be based on the order of arrival, not the likelihood of survival, unless other factors, such as individual risk or priority, are involved.

Q: How is the “greater harm” assessed in medical matters?

A: It is the responsibility of the doctor to assess the greater harm, unless the patient has more trust in their own opinion.

Q: If it is known or suspected that a patient will soon die from a disease such as leukaemia, metastasis, or certain cancers, is it permissible to use high-risk, side-effect-laden treatments like chemotherapy in order to extend their life (even for a few months)?

A: If the treatment is in accordance with medical regulations, it is permissible and even obligatory.

Q: What is the ruling on the use of hypnosis in medical sciences and the treatment of diseases with this method?

A: Treating patients with any method that is not harmful and is accepted by medical regulations is permissible.

Chapter 8
(Medications)

Prescribing Medication

Q: As long as a doctor has not conducted the necessary examinations and fulfilled their clinical duties according to medical regulations, prescribing medication is considered a violation of medical ethics and unlawful, except in cases where a painkiller is necessary.

Q: Is it permissible for a doctor to prescribe medications containing haram or impure substances, or those with small amounts of alcohol, like wine or whisky, if it is necessary for the treatment?

A: Using medications containing alcohol is permissible if the alcohol is not intoxicating, provided it is necessary for the treatment.

Q: Can a doctor prescribe a medication at the patient’s insistence, even if it goes against medical regulations?

A: No, a doctor cannot prescribe medications at the patient’s insistence if doing so violates medical regulations.

Q: If a medication is highly effective but comes with severe side effects, can the doctor prescribe it if it is the only option to save the patient’s life?

A: It is permissible to prescribe such medication if it is necessary to save the patient’s life, even with the associated risks.

Q: If effective medications are not available, can a doctor prescribe alternative medications that they believe may work, even if there is a risk of side effects, and if they inform the patient of the risks involved?

A: If the doctor informs the patient of the potential side effects and the alternative is the best option available, the doctor is not responsible for any adverse effects, though it is recommended to disclose all relevant information.

Q: What is the ruling on medications containing ethyl alcohol (ethanol), used either topically or orally in medical treatments?

A: Medical-grade ethanol is considered pure and permissible to use.

Q: If medications vital for treatment are derived from impure or forbidden sources, such as parts of humans or animals, what is the ruling on their use and trade?

A: The consumption of such medications is permissible, as long as it is necessary for treatment, and the substances are considered pure according to medical regulations.

3) If the benefits of experiments serve the interests of all human beings—friends and enemies alike—can such experiments be accepted, considering the two scenarios where the individual is either aware of the potential harm or unaware of it?

4) If the experiment poses no harm to the patient for the aforementioned purposes, can a doctor proceed without the patient’s consent or knowledge?

Answer 1: If the experiment is conducted out of self-sacrifice and for the advancement of medical science to benefit Muslims and their treatment, it is permissible. Such sacrifice holds its reward, provided it does not cause hardship or distress for the individual or their dependents. However, if it causes difficulty or distress for the individual or their dependents—such as their spouse, children, or parents—it is prohibited.

Answer 2: If the risk of harm to life is neither reasonable nor significant, the experiment is permissible. If the risk is considerable, it falls under the category of the first type of individuals.

Answer 3: When the benefit is for all of humanity, whether friends or enemies, or only for some of them, it remains a form of self-sacrifice and there is no distinction in the ruling.

Answer 4: Performing any medical experiment without the patient’s consent, except in cases of necessity, is not permissible, let alone for advancing medical science.

Question: Are animal experiments for the advancement of medical science, which result in their death, permissible, regardless of the guarantee?

Answer: They are permissible.

Chapter Ten

(Prevention, Fertility, and Childbirth)

Artificial Insemination

Question: Is it permissible for a woman to be artificially inseminated with her husband’s sperm? If possible, precautions should be taken to avoid prohibited actions, such as the inseminator being a non-mahram. Such actions do not render the sperm or the child haram, as they concern the means, not the result. The child belongs to the woman and man whose sperm and egg are involved, and all the child’s rights are to be granted to them.

Question: If the sperm of a woman and her husband is removed from her womb and transferred to another woman’s womb (a rented or borrowed womb) where the embryo grows and the child is born, the child belongs to the first woman—the one who provided the egg and whose sperm was involved in the conception. The second woman—provided she nurses the child under the conditions of foster care—becomes the child’s foster mother.

This question, regarding the woman’s milk not originating from her husband’s sperm, is not valid. To clarify, the woman’s milk is not considered part of the husband’s sperm; however, the key is that the milk is considered sufficient to establish foster care rights due to the birth, not necessarily because of the sperm. If the sperm is extracted and grown in a laboratory or artificial womb, the child belongs to the first woman who provided the egg.

Question: If a man’s sperm is mistakenly placed in another woman’s womb, and it is later discovered that the child belongs to the sperm donor, but it was originally done under the assumption that the sperm belonged to the woman’s husband, would the act be considered haram? What is the ruling on such a situation?

Answer: No haram act has occurred in this case. The child belongs to the man whose sperm it is, and all the rights associated with fatherhood apply. The second woman, if she nurses the child according to the conditions of foster care, becomes the foster mother, and the woman’s husband is not considered the father of the child.

Question: Is it permissible to take a man’s sperm and place it in an artificial womb with an artificial egg for reproduction purposes? If a child is born this way, does it belong to the sperm donor, and does it have a mother?

Answer: This process is permissible. The child belongs to the sperm donor, who is considered the father. However, there is no “mother” in the traditional sense since there was no direct involvement of a woman’s egg. The sperm donor is recognized as the father.

Question: What if a woman cannot produce eggs or release them for fertilisation, and so her eggs must be surgically removed, mixed with her husband’s sperm outside the body, and then implanted in her womb?

Answer: This procedure is permissible.

Question: Is it permissible to strengthen a husband’s sperm by mixing it with another man’s sperm—whether known or unknown—and then inseminating the woman’s womb with the enhanced sperm? Does this harm the husband’s sperm in any way?

Answer: This is permissible. The enhancement does not alter the original source of the sperm, which remains the husband’s. The sperm enhancement merely acts as a supplement, and the husband’s sperm is still the origin of the child’s parentage.

Question: Is it permissible to mix the sperm of a couple with the egg of another woman outside the womb and inseminate the wife, or even a third woman? Does this lead to a case of adultery?

Answer: This is not considered adultery. The child, born through this method, belongs to the man who provided the sperm and the woman whose egg was used, regardless of whether she was the biological mother or not. There are no prohibitions regarding this procedure.

Question: If it is possible to produce sperm through plant-based methods and inseminate a woman with it, would the child born be considered to belong to the mother, and would it lack a father?

Answer: The child born through plant-derived sperm would be considered the mother’s child but would have no father.

Question: If fertilisation is done through artificial sperm and artificial egg under laboratory conditions and results in the birth of a son and a daughter, are they considered siblings from the father’s side, but without a mother?

Answer: Yes, they would be considered siblings from the father’s side and have no mother, as there was no natural mother involved.

Question: If sperm is produced from plant products and mixed with artificial eggs in a laboratory, leading to the birth of a child, who would the child belong to?

Answer: Such a child, were it to be successfully produced, would be without parents and would not belong to anyone specifically.

Question: If identical twins are born through artificial sperm and egg, would they be recognised as siblings?

Answer: Yes, if the twins originate from a single fertilised egg, they would be recognised as full siblings.

Contraception and Prevention of Pregnancy

1. Prevention of Pregnancy: It is permissible to prevent pregnancy and to use contraceptive methods.
2. Consent of the Husband: For the use of contraceptive methods that impede the husband’s full sexual enjoyment, the husband’s consent is required. The wife cannot take such measures without obtaining her husband’s consent.
3. Health Risks: If pregnancy poses a threat or danger to the woman’s life, she may prevent pregnancy until the risk subsides, whether the danger is immediate or manifests over time.
4. Conditional Prevention: This refers to a situation in which, at the time of marriage, the woman stipulates that she will prevent pregnancy for a specified period or indefinitely, and the husband agrees to this condition. Such an arrangement is permissible and does not pose any issues.
5. Natural Contraception – Coitus Interruptus (Withdrawal Method): The use of coitus interruptus, where the male withdraws during ejaculation, is permissible. However, if it results in physical or psychological harm to either the man or the woman, it is not allowed.
6. Family Planning and Population Control: Family planning and population control methods should be based on both quantitative and qualitative considerations, and the community’s interests take precedence over individual desires. Therefore, in an Islamic society, weaker or problematic generations should be limited, while reproduction among strong and healthy generations should be encouraged and supported.
7. Implantable Contraceptives: There are implants such as the “Norplant” capsules, which are placed under the skin in the upper arm and are considered a form of contraception. If these implants cause permanent infertility or bodily harm, their use is not permitted.
8. Voluntary Use of Contraceptives: Individuals who are aware of the potential risks and side effects of contraceptive methods can voluntarily choose one of the permissible methods, as long as it does not involve committing any unlawful acts.
9. Intrauterine Devices (IUDs): There is a difference of opinion among doctors regarding whether intrauterine devices (IUDs) prevent fertilisation or if they work after fertilisation by preventing the embryo from implanting in the uterus. The ruling for each case is as follows:
   1. When it is confirmed that the IUD works by preventing implantation after fertilisation: The use of the IUD in this case is permissible.
   2. If there is doubt between the two mechanisms: The use of the IUD is still permissible, as doubt regarding its prohibition implies permissibility.
10. Contraceptive Pills and Devices: It is common for women to use various methods, such as pills, IUDs, diaphragms, creams, jellies, and injections, to prevent unwanted pregnancies or avoid the risk of abortion that might threaten their health. If these methods are used with the consent of both the husband and wife, they are permissible and fall under the same category as coitus interruptus, rather than the destruction of an embryo or the termination of a pregnancy.
11. Medical Necessity for Contraception: In cases where the use of contraception involves medical intervention, such as a male doctor assisting a woman with the insertion of an IUD, this is permissible only if it is necessary for treatment or contraception. In such cases, the doctor should avoid direct physical contact whenever possible.
12. Sterilisation and Permanent Contraception:
    1. Tubal Ligation (Female Sterilisation): The practice of permanently sterilising a woman by blocking her fallopian tubes is not permissible if it leads to bodily harm or infertility, even with the husband’s consent.
    2. Vasectomy (Male Sterilisation): Similarly, male sterilisation is not allowed if it leads to permanent infertility or harm, even with the consent of both partners.
13. Abortion for Health Reasons: If carrying a pregnancy threatens the woman’s health or life, she may, in consultation with a medical professional, choose to abort the pregnancy, even after the soul has been breathed into the fetus, but only in extreme cases where no other option is available.
14. Consent of Husband for Contraceptive Measures: It is required for the husband’s consent in all cases where contraception or sterilisation is involved. However, if obtaining the husband’s consent is impossible or if carrying the pregnancy poses a serious danger to the woman’s life, the need for the husband’s consent may be waived.
15. Use of Contraceptives without Husband’s Consent: If a woman uses contraceptives without the husband’s consent, particularly if this interferes with his right to have children, the act is not permitted, unless there is a serious health threat to the woman’s life.
16. Sterilisation for Population Control: The state’s implementation of sterilisation policies for population control purposes, such as vasectomy or tubal ligation, is not permissible under Islamic law, even with the consent of the individuals involved.
17. Use of Contraceptive Implants and Sterilisation for Health Reasons: If a woman faces serious health risks during pregnancy, such as heart or kidney disease, and is advised by medical professionals to avoid pregnancy, methods of contraception or sterilisation may be considered, but only if they do not lead to permanent infertility or harm.
18. Informed Consent: Contraceptive procedures that lead to permanent infertility must not be done without the full, informed consent of the individuals involved. This includes both male and female sterilisation procedures.
19. Temporary Contraceptive Measures: The use of temporary contraceptives such as pills or IUDs is permissible as long as they do not cause permanent infertility and are done with mutual consent between the couple.
20. Ethical Considerations: Any form of contraception, particularly permanent methods like sterilisation, should not be undertaken unless there is a valid medical or ethical reason. In cases where sterilisation may be needed for health reasons, alternative methods should be considered before permanent measures are taken.

Q: In cases where carrying the fetus in the womb is unbearably difficult for the mother, and a medical commission approves this, abortion before the soul is breathed into the fetus (before the fourth month) is permissible. After the soul is breathed into the fetus, abortion is also permissible if it poses a threat to the mother’s life.

Q: If the life of the mother depends on removing the fetus, and this results in her death, the removal of the fetus both before and after the fourth month is permissible.

Q: If keeping the fetus in the womb would cause the death of both the mother and the fetus, an abortion that results in the survival of the mother—even if it leads to the death of the fetus— is permissible. In such cases, it does not matter if the fetus is aborted before or after the soul has been breathed into it.

Q: If the fetus is aborted before the soul is breathed into it, it is not considered impure (najis).

Q: Is abortion permissible if the soul has not yet been breathed into the fetus?

A: Abortion is absolutely forbidden. However, in cases of uncertainty, such as when there is a possibility of the sperm or menstruation being fertilised, using medication or similar methods to induce abortion is not allowed. Yet, to protect the mother from harm, and in cases where it is unbearable, abortion is not considered unlawful before the soul is breathed into the fetus (before the fourth month). After four months, it is only permissible if keeping the fetus poses a threat to the mother’s life.

Q: My daughter got married nearly four years ago, and they have separated a few times due to incompatibility, but have reconciled through mediation. She has been pregnant for about a month and a half and intends to divorce her husband. She now wants to have an abortion. Is abortion permissible in this case for a 1.5-month-old fetus?

A: Abortion is forbidden, and incompatibility in the marriage does not justify abortion.

Q: If the soul has been breathed into the fetus, what is the ruling on abortion?

A: Terminating the fetus after the soul has been breathed into it (after the fourth month) constitutes murder and is forbidden. It is also subject to full compensation (diya). However, if keeping the fetus poses a threat to the mother’s life, she may abort the fetus.

Q: With advancements in medical science, specialists have developed a new method to prevent hereditary and genetic diseases. In this method, within a day or two after fertilisation and the formation of the embryo, it is removed from the womb in the early stages of development, examined in a laboratory, and if it is found to carry a specific genetic disease, it is not re-implanted in the womb. If the embryo is healthy, it is returned to the womb for normal development. Is this preventative measure and the failure to return the embryo to the womb permissible?

A: The removal of the embryo (with the consent of the parents) for the diagnosis of genetic diseases, which might lead to severe mental and emotional distress or societal stagnation, is permissible. There is no obligation to return the embryo if a genetic disease is identified.

Q: In some families, there are specific genetic diseases that only appear in offspring. This method used by doctors—mentioned in the previous question—also allows specialists to determine the gender of the fetus. If the gender of the fetus is one that could lead to the development of a genetic disease, the embryo would not be returned to the womb. Is this permissible?

A: In the case discussed earlier, there is no difference between whether the disease is hereditary for all children or specific to a certain type.

Q: In some cases, there is no concern about genetic diseases, and healthy individuals request genetic testing to choose the gender of their child. What is the ruling on such genetic tests?

A: Extracting the sperm or egg for gender selection is not forbidden. As long as the extraction is done to determine the gender, so that if it does not align with the parents’ preference, it is not returned to the womb, it is permissible. This method does not pose any risks and is not problematic.

Q: Given that my wife has diabetes, and she has been pregnant for nearly fifty days, a forensic doctor has advised abortion due to medical reasons. However, another doctor has recommended that she rest for seven months. But, given she already has four children, the second suggestion is not possible. What is the ruling in this case?

A: Given the hardship described and the medical advice, if this is before the soul has been breathed into the fetus (before four months), abortion is permissible.

Q: Is it permissible to terminate the pregnancy of a woman diagnosed with advanced cancer, whose survival depends on treatment that could cause the death of the fetus?

A: If the treatment depends on abortion, it is permissible for the mother to undergo treatment, even if it results in abortion.

Q: Considering that my first wife has passed away and her child from her first marriage also died in an accident, my second wife is now pregnant with an unplanned pregnancy. She is suffering from severe psychological issues due to past trauma, and she is at risk of harming herself or the fetus due to her depression. Is it permissible to terminate the fetus that is about 25 days old to resolve this issue?

A: If prescribed by a doctor who takes religious matters into consideration, it is permissible.

Q: If the doctor confirms that keeping the fetus in the womb would cause the mother’s death, please clarify:

1. Is it permissible to terminate the fetus in the womb to save the mother’s life?
2. Is it permissible to leave the mother in her condition so that the fetus survives, even at the cost of the mother’s life?
3. If leaving the mother in her condition risks the death of both the mother and the fetus, what is the ruling?

A1 & 2: If the presence of the fetus would cause the mother’s death, for instance, due to a disease that affects her and leads to her death, the mother may terminate the fetus, even after the soul has been breathed into it, as long as there is no alternative.

A3: If leaving the fetus in the womb would result in the death of both the mother and the fetus, the abortion, which would allow the mother to survive, is permissible. In this case, it makes no difference if the abortion occurs before or after the soul has been breathed into the fetus (before or after four months).

Q: If we assume that the removal of one or more organs from a living person could lead to mild or severe complications in the near or distant future, and on the other hand, saving the life of another patient depends on this action, and there is no other alternative, can we perform such a procedure without informing the organ donor? And if we inform them and, with their consent, remove the organ for transplantation, what is the ruling on this matter?

A: Without the individual’s consent, it is not permissible. However, with their knowledge and consent, it is permissible if it does not pose a serious danger or harm to their life. The life of the patient in this case does not affect the individual’s obligation, and the needs of one person do not impose duties on another in this context.

Q: If it becomes medically feasible to transplant an ovary from one woman to another, and the second woman, through marriage, becomes pregnant, considering that the egg is the result of the fertilization of the first woman’s egg by the sperm of the husband (the male’s sperm with the egg of the first woman), from a genetic and personal characteristic perspective, fifty percent of the child’s traits would belong to the first woman. What is the ruling regarding the relationship between the husband’s family and the second woman’s family, as well as the relationship between the child and the first and second women? Would the relationship of the child’s mahrams be attributed to the first woman, the second woman, or both?

A: Transplanting an ovary, if it is similar to transplanting other organs from one person to another, which becomes part of the body of the second person, will have similar effects in matters like the mahram relationships, inheritance, and others such as diya (blood money) or compensation. For instance, if a kidney from one person is transplanted to another and the second person loses the kidney, the compensation is given to the second person, as the kidney now belongs to them, not the first person. However, if the identity of the transplant does not change and the egg of the first woman with her identity is fertilized by the husband’s sperm, the first woman remains the biological mother, regardless of whether she acknowledges this or not, unless the first woman is not recognized, in which case the child would be considered without a mother unless the second woman breastfeeds, making her the foster mother.

Q: Is it permissible to transplant the head of one human being onto another? If permissible, would the rulings of the head’s original owner apply, or those of the new body, or would it be considered a new person?

A: Since the possibility of such an operation may exist in the near future, and it is not impossible, it could, in principle, be permissible based on the circumstances and public interest. The rulings would depend on the person who possesses the consciousness and knowledge (the mind), as it would be their identity that would define the individual in question.

Q: Can a living person donate or sell any part of their body for transplantation to another person, as long as it does not result in their death or serious bodily harm?

A: A living person can donate or sell parts of their body for transplantation, provided that such donation or sale does not endanger their life or cause significant harm to their health.

Q: What is the ruling on the sale and donation of organs from a living person to patients for transplantation?

A: It is permissible to donate or sell organs from a living person for transplantation to save others, provided it does not pose a serious risk to the person’s life. This can include a transaction with an official price. However, this should not be done due to financial desperation in society.

Q: Can a person who is sentenced to execution sell their organs? Is there a difference between a sentence of execution and a sentence of qisas (retribution)?

A: If there is no hindrance to the execution or punishment, or an undue delay, it is permissible.

Q: Can a person sentenced to death donate or sell their organs to someone in need, and request a reduction in their punishment?

A: This is permissible.

Q: What is the ruling on selling or donating organs, such as a kidney, or using such organs after a person’s death, for transplantation (e.g., selling a heart or eyes)?

A: If a person has made a will to donate their organs, and the heirs agree, it is permissible.

Q: Is it permissible to donate or sell an organ, knowing that it may shorten the person’s life in the long term?

A: It is not permissible if the preservation of life depends on that organ being retained.

Q: Can a person make a will to donate or sell their organs after death?

A: A person may make a will to donate or sell their organs after death, and any proceeds from the organs will be considered part of their estate if not used.

Q: Can a person bequeath the donation of their organs after death, such as giving their eyes to another person?

A: It is obligatory to follow the will of the deceased regarding organ donation, regardless of whether the heirs are pleased with it, unless it would cause disgrace or dishonor to the family.

Q: Is it permissible to allow dissection of a body or donation of organs after death, based on a valid will?

A: It is permissible to sell or donate parts of one’s body after death, provided the will is valid and the heirs agree.

Q: Can a person, during their lifetime, consent to the donation of their organs in the event of brain death for the purpose of helping others in need?

A: Such a will is permissible and does not require the consent of the heirs, provided it is duly signed and validated.

Q: Is it forbidden to dissect a corpse, for medical research, if it does not involve disrespect?

A: Dissecting a corpse for medical purposes is permissible if it is for scientific advancement, provided it does not involve disrespect and is done for a valid reason, such as furthering medical knowledge or proving a legal right.

Q: If the organs of a deceased person are transplanted without the consent of their heirs, can this be done?

A: This is not permissible unless in cases of necessity, and it must be done under the supervision of an Islamic authority.

Q: What is the ruling regarding dissection of bodies for research purposes, where there is no explicit consent from the deceased?

A: If there is no explicit consent, and it is necessary to resolve legal disputes, the Islamic government may permit dissection within limited circumstances.

Q: Can the body of a deceased person be considered impure, and is it permissible to have contact with the body of someone who has passed away?

A: The body of a deceased Muslim is not impure before the ritual washing (ghusl), and it does not require purification unless contact occurs with the body before it is washed.

Chapter Fourteen
(Dentistry)

1. A dentist must obtain the patient’s consent before extracting a tooth. If the dentist removes the tooth without the patient’s consent and the patient is dissatisfied, the dentist is liable, and the blood-money (diyah) responsibility falls on them.
2. It is permissible to use gold crowns or to place artificial teeth made of gold, as well as to strengthen a tooth with gold.
3. For the correction of anterior teeth that are visible, it is allowed to use gold, even if the intention is for cosmetic purposes.
4. There is no distinction between Muslims and non-Muslims when it comes to visiting a dentist, having artificial teeth made, or other dental and oral treatments. However, non-Muslims have their own ritual impurity (najasa), while Muslims, due to their faith and purity, are given a higher status in terms of acceptance.
5. If part of the gum comes off along with the tooth during extraction, and there is no blood present with it, the tissue and part of the tooth that is in contact with it are considered pure.
6. If, during procedures like filling teeth, plaque removal, gum surgery, jaw treatment, etc., a person’s mouth becomes contaminated with blood, there is no need to rinse the mouth. The inside of the mouth, upon contact with impurities, does not become impure.
7. In dentistry, when using a turbine tool to drill cavities, water is automatically sprayed onto the tooth and the drilling site. Depending on the water source connected to the unit—whether it is connected to running water (kor) or limited water (qaleel)—what is the ruling on the fluids that come into contact with the dentist’s clothes and body, and the patient’s body, if the mouth is bloodied?

Answer: In this case, the blood is impure. If the secretions are not contaminated with blood, they are considered pure. When purifying impure substances, there is no need to rinse again if the unit is connected to running water (kor).

1. If blood reaches an artificial tooth in the mouth and is removed, does the artificial tooth carry the same ruling as the mouth?

Answer: An artificial tooth, while inside the mouth, carries the same ruling as a natural tooth. Therefore, if it contacts impurity and it is removed, there is no need for it to be purified.

1. During dental examinations, tools such as mirrors and probes are used, and often a suction device is employed to remove saliva and blood-contaminated secretions from the patient’s mouth. What is the ruling on the following situations?
   1. Repeatedly introducing an instrument into the mouth of the patient that has become contaminated with their own blood, given that frequent purification of the instrument is difficult, what is the ruling?

Answer: Introducing the instrument into the mouth before it is purified is not problematic. The mouth itself becomes pure once the impure substance is removed. However, the body and clothing, if contaminated, need to be purified.

• 1. What is the ruling if an instrument appears to have been disinfected before use but was previously contaminated with blood and not purified with water?

Answer: The blood and impurity do not become purified by disinfection and drying alone; they must be washed with pure water. Using an impure instrument does not transfer impurity to the mouth of another patient.

1. In dental units, a device called an “air-water syringe” is used to wash and dry the mouth and teeth. If the working environment is contaminated with blood, what is the ruling on the secretions from the syringe if they come into contact with the clothes and body of the dentist or patient?

Answer: If the secretions are not contaminated with blood, they are pure.

1. If a person’s clothing or body is contaminated with less than the approximate size of one stroke of a 250-riyal coin’s worth of blood, can they still perform the prayer? Does the same ruling apply if blood from a patient’s mouth reaches the body or clothes of the dentist?

Answer: In this case, because it is mixed with something other than blood, the ruling does not apply the same as in the case of blood only.

1. Is it necessary to agree on the cost of dental treatment before beginning the procedure?

Answer: It is not obligatory. If the dentist has not specified the cost, they are entitled to charge the standard consultation fee.

1. Sometimes, patients insist on extracting a damaged tooth due to severe pain or the high cost of treatment, even though it is possible to repair the tooth. Is it permissible for the dentist to extract the tooth solely with the patient’s consent and insistence?

Answer: It is not problematic for the dentist to extract a damaged tooth if the patient insists. The dentist is not liable for any damages, even if the extraction is not based on a rational or conventional purpose, and the patient has the financial ability or other means for treatment.

1. If someone in the state of ihram suffers from severe toothache, what is the ruling on extracting the tooth? Should the dentist pay a penalty (kaffarah)?

Answer: In this case, extracting the tooth is permissible, but the penalty of one sheep (kaffarah) applies. The dentist is not liable for the kaffarah.

1. Given that it is disliked (makruh) for a fasting person to have blood drawn from the mouth or for any substance to be introduced into the mouth without purpose, does the dentist commit an act of dislike if blood is drawn or water is introduced during treatment?

Answer: The dislike applies specifically to the fasting person, and it does not apply to the dentist.

Chapter Fifteen
(Medical Certificates)

1. A doctor’s certificate in matters that are observable, provided that the doctor meets the criteria for testimony, is considered valid as a witness.
2. A doctor’s certificate does not serve to prove crimes such as adultery, sodomy, or other offenses. These crimes are proven through confession, testimony, and other legal means, and their consequences are established according to Islamic law.
3. A blood test alone cannot be used as evidence of a crime. The legal consequences are established through normal, traditional methods prescribed by Islamic law.
4. It is mandatory for a doctor to issue a factual certificate showing the illness or health status of the patient upon their request.
5. A doctor must avoid issuing false certificates. Issuing a false certificate is prohibited and sinful for both the doctor and the recipient.
6. If a patient visits a doctor requesting a medical certificate for work purposes, such as saying they missed two days of work due to a cold, is it permissible to issue such a certificate if the doctor is confident in the truth of the patient’s statement?

Answer: Confidence in the patient’s statement is generally sufficient for issuing the certificate.

1. What is the ruling on a doctor issuing a false certificate, either intentionally or by mistake?

Answer: If the false certificate is issued intentionally, it is prohibited, and the doctor is liable.

Chapter Sixteen
(Liability and Compensation)
Diagnosis and Prescription of Medication

1. Even if the doctor is highly skilled, if they fail in their scientific or practical duties, they are liable, even if the patient has given permission for treatment. However, if the patient or the patient’s guardian has given consent to a qualified specialist, and the patient dies (provided that there was no violation of medical regulations), the doctor is not liable.
2. If due to a lack of resources or other logical reasons, diagnosing the illness takes time or is impossible, and this results in worsening of the illness or the patient’s death, and the doctor has not been negligent, the doctor is not liable.
3. Sometimes, diagnostic methods require time and cost, even though in the end, the initial diagnosis is confirmed. Despite this, since the doctor is acting as an agent and there was no fault, they are not liable for the time or costs incurred by the patient.
4. If a doctor is unable to diagnose the type of illness and does not know which medication to prescribe, and this results in the illness worsening or the patient’s death, the doctor is not liable as long as they made every effort, even though they did not diagnose the illness correctly.
5. If a doctor prescribes a medication that is ineffective or causes side effects due to negligence or forgetfulness, the doctor is liable for the consequences.
6. Question (S): Given the vast scope of medical knowledge, which makes it impossible to learn and memorise all diseases, medications, and their side effects, if a doctor, due to normal forgetfulness or based on their judgement, prescribes an ineffective medication—whether in urgent situations to save the patient’s life or to relieve their pain—and the patient suffers unnecessary costs or side effects, is the doctor liable, especially if there is no access to another specialist?
7. Answer (J): If the medical regulations permit such treatment, the doctor is not responsible unless they have been negligent or violated the rules, causing harm to the patient or incurring additional costs. In cases of negligence or carelessness, the doctor is liable.
8. Question (S): If a doctor prescribes a medication for pain relief or treatment in cases such as fever, itching, or wounds, knowing or suspecting the medication’s effectiveness, and considering that most effective medications have many side effects over the short or long term, will the doctor be held responsible if severe side effects occur?
9. Answer (J): If this treatment is in accordance with medical regulations and is the only available treatment, and assuming there is no breach of medical rules, the doctor is not liable.
10. Question (S): Considering that one of the crucial steps in discovering and producing new medications is testing on human volunteers (healthy or ill) to assess the effects and potential side effects, and that even for commonly used medications, sometimes new effects need to be studied through tests, if these tests result in adverse effects for the participants, does the consent of the volunteers exempt the researchers from liability for damages or side effects?
11. Answer (J): If adverse effects occur, the research centres are obligated to provide compensation, and the mere consent of the participant is not enough to absolve the researchers of liability unless the consent is such that it completely exonerates the researchers.
12. Question (S): If, due to current medical knowledge, it is not possible to determine the sensitivity of a patient to a specific drug, and the patient experiences side effects, is the doctor responsible?
13. Answer (J): If the only available treatment requires administering such a medication, and there is no breach of medical regulations, the doctor is not liable.
14. Question (S): If we know or suspect that a patient’s life depends on the use of a medication that is harmful, and such harm is likely for most patients using that medication, and the doctor prescribes it, resulting in various side effects, is the doctor responsible?
15. Answer (J): If medical regulations state that prescribing that specific medication is the exclusive treatment, the doctor is not liable.
16. Question (S): In cases where a patient’s life is at risk, and there is not enough time to determine their sensitivity to a particular drug, if the patient develops side effects or dies due to sensitivity after being administered the drug, is the doctor responsible?
17. Answer (J): If, according to medical regulations, the only available treatment requires such a drug, the doctor is not liable. If another safer option exists, it must be chosen. If both options carry risks, the doctor should opt for the one with the lower risk.
18. Question (S): In some diseases, such as hypertension, due to unknown factors, one or more drugs are prescribed based on current knowledge. If these drugs do not work, other drugs may be used. Given that these medications may not have the same effects on all individuals, and each may have its own specific side effects, is the doctor liable for any additional costs or side effects that occur while experimenting with these different drugs?
19. Answer (J): If the treatment method follows medical regulations and is the exclusive treatment option, the doctor is not liable.
20. Question (S): If medications that are fully effective are not available for any reason, can the doctor prescribe medications that they believe to be less effective? If these medications fail, is the doctor liable for the side effects or unnecessary costs incurred by the patient?
21. Answer (J): If the prescription is in accordance with medical regulations and constitutes an acceptable treatment, the doctor is not liable.
22. Question (S): If the doctor prescribes a medication based on the patient’s insistence, knowing that it may harm the patient, and harm occurs, who is responsible?
23. Answer (J): If the prescription violates medical regulations, the doctor is liable due to negligence and failure to comply with medical standards.
24. Question (S): If a skilled doctor mistakenly or negligently gives the wrong medication to a patient, and the nurse administers it without paying attention, causing harm to the patient, is the doctor liable? If the doctor is liable, who is responsible for the costs and damages: the doctor or the nurse?
25. Answer (J): In this case, the nurse is not liable, but the doctor, if negligent, is responsible and liable.
26. Question (S): If a doctor diagnoses that a certain medication is beneficial for a particular disease or says that treatment requires a specific medication, without forcing the patient to take it or writing a prescription, and the patient takes the medication based on the doctor’s advice, is the doctor responsible if the medication is ineffective or causes side effects?
27. Answer (J): In this case, the doctor is not liable.
28. Question (S): If a doctor, due to the vastness of medical knowledge, forgets or does not know that certain medications or treatments are harmful for pregnant or breastfeeding women, and harm occurs to the fetus or mother, is the doctor responsible?
29. Answer (J): The doctor is liable if they have been negligent.
30. Question (S): If a doctor fails to ask the patient if they are pregnant and the patient does not mention it, and side effects occur, who is responsible?
31. Answer (J): If asking the question is customary and the doctor fails to do so, the doctor is liable for negligence.
32. Question (S): If a doctor recommends a diagnostic method or medication that is considered safe for all, but later it turns out to be harmful to the mother or fetus, does the doctor have any responsibility for the side effects?
33. Answer (J): In this case, the doctor is not liable.
34. Question (S): If the patient denies being pregnant, even though they know or suspect that they are, does the doctor’s failure to ask absolve the doctor of responsibility for any possible side effects?
35. Answer (J): A negative answer from the patient is sufficient, and if the doctor did not ask, but simply advised that the medication could be harmful to pregnant women, that would be sufficient.
36. Question (S): Given that pregnancy cannot always be diagnosed in the early weeks with simple methods, and most dangerous side effects from treatments and medication occur during this period, if, due to lack of facilities, the patient’s unwillingness to undergo pregnancy tests, or ignorance of pregnancy, the doctor does not identify the pregnancy and treats the patient accordingly, resulting in harm to the mother or fetus, is the doctor responsible?
37. Answer (J): In such cases, the doctor must take precautions and use medications with caution. The patient must be informed of the risks of drug use for themselves or the fetus. If the patient uses the medication after being warned, they are liable for any harm caused.

Q1: Is obtaining consent from the guardian of the patient sufficient?

A1: Yes, it is sufficient to obtain consent from the guardian of the patient.

Q2: Is the patient similar to a minor or an insane person in this regard, and must consent be obtained from their guardian or caretaker?

A2: Yes, the patient is treated similarly to a minor or an insane person, and consent must be obtained from their guardian or caretaker.

Q3: If the treatment is urgent, is there a need for consent, or is the doctor exempt from such a requirement?

A3: In urgent situations, no consent is needed, and it is not considered negligence. If the treatment is not urgent, and it is customary to obtain consent, the doctor should wait for it to be provided. In this case, the doctor is not liable, and the act of the patient seeking treatment is considered a form of consent.

Q4: What is the duty of the doctor when it is certain that a certain disease will soon cause the patient’s death, and the doctor knows that surgery may either improve the patient or hasten their death? If the result is uncertain, and if the doctor causes premature death, is he liable? Additionally, if no treatment is provided, is the doctor responsible?

A4: If there is no significant risk and the method being used is considered a legitimate form of treatment according to medical standards, the doctor is not liable in the case of surgery. If treatment is required and the doctor abandons it, he is responsible for neglecting to treat the patient.

Q5: In cases where chemotherapy is required to prevent organ rejection after a transplant, but it may cause mild or severe side effects, is the doctor responsible for the side effects?

A5: If the treatment is necessary, the doctor is not liable for the side effects.

Q6: Is there a fixed amount of blood money (diya) for the amputation of limbs?

A6: Amputating a limb from a dead body due to necessity or for preventive purposes does not incur liability or blood money.

Q7: Does the removal of a limb from a living person for transplantation incur blood money?

A7: If it is medically necessary and done at the request of the patient, there is no liability or blood money.

Q8: What is the ruling if a doctor or someone else causes the loss of multiple organs due to negligence or intention?

A8: They are liable for blood money, and if multiple injuries occur, blood money is owed for each individual injury.

Q9: If a doctor causes paralysis or disables a patient’s limb due to negligence, is the doctor liable?

A9: Yes, the doctor is liable.

Q10: Dental Blood Money

Q: If a licensed dentist causes harm during treatment without negligence, is the dentist liable?

A: No, if the dentist has a valid license and no negligence occurs. However, if there is negligence, the dentist is liable for any potential harm.

Q: Sometimes, during the treatment of a tooth close to the nerve, the dentist may accidentally damage the nerve, leading to a decrease in the tooth’s lifespan and additional treatment costs. Is the dentist liable?

A: No, the dentist is not liable for accidental errors, and the patient’s visit to the dentist serves as a form of consent for potential non-deliberate harm.

Q: If a patient requests a treatment that may reduce the lifespan of their teeth for cosmetic reasons, can the dentist refuse? If the dentist proceeds with the treatment at the patient’s request and harm occurs, is the dentist liable?

A: If a better treatment is available and the harm is evident, the dentist should refrain from proceeding. However, if the dentist proceeds with the patient’s consent, they are not liable for the harm caused.

Q: In cases where dental treatment is inadequate or insufficient, does the dentist owe the patient the difference in treatment cost?

A: The dentist is liable if the treatment is incomplete or inadequate. However, if no specific treatment type is agreed upon and the treatment is not defective, the dentist is entitled to charge for the service rendered.

Q: If a dentist pulls out a tooth that could have been preserved, at the patient’s insistence, is the dentist liable?

A: No, the dentist is not liable.

Q: If a tooth becomes discolored after being hit, and although treatment is provided, it resembles a healthy tooth in appearance, does the patient receive full blood money?

A: Yes, the patient is entitled to the full blood money for a discolored tooth, even if it appears healthy after treatment.

Q: If a tooth is fractured due to a blow, and it is restored with a crown, does the patient receive full blood money?

A: Yes, the patient is entitled to full blood money, as the crown does not affect the original liability.

Q: If a person with loose teeth due to gum disease has a tooth knocked out by a blow, do they receive blood money for the tooth?

A: Yes, the person is entitled to full blood money for the tooth, regardless of its condition prior to the injury.

Q: If a doctor or dentist causes permanent injury to a tooth or organ through negligence, what is the appropriate remedy?

A: The injured party is entitled to the appropriate blood money, and if the injury is more severe, additional compensation is owed.

Miscarriage (Saqṭ al-Janīn)

Q: In Islam, after conception, abortion is forbidden and incurs blood money. Who is responsible for the blood money in the case of a miscarriage caused by a doctor?

A: If the doctor causes the miscarriage, he is responsible for paying the blood money. If the mother causes the miscarriage by ingesting prescribed medicine, she is liable. If the father is unaware and did not consent, he is not liable.

Q: If the doctor causes a miscarriage, who should pay the blood money? Can the doctor waive this liability through a contract?

A: If the doctor is directly responsible for the miscarriage, the doctor is liable for the blood money. A waiver contract does not exempt the doctor from liability unless the abortion was legally permissible.

Q: A woman has undergone an abortion and is unaware of the stage of pregnancy (whether it is a conceptus or a clot of blood). What is the blood money for the miscarriage, and who should receive it?

A: If the fetus is in the stage of ‘alqa’ (attached to the uterine wall), the blood money is forty dinars (equivalent to 2.138 grams of gold). The doctor or anyone directly involved in the miscarriage is liable for the blood money, which should be paid to the parents of the fetus.

Q: If the pregnancy is from a non-Muslim man, and the woman seeks an abortion from a Muslim doctor, is the abortion allowed, and is the doctor liable for the blood money?

A: The rules regarding the sanctity of the fetus apply to all fetuses, regardless of the parents’ religion, but the fetus of a non-Muslim does not incur blood money.

Q: If a woman becomes pregnant as a result of an illicit relationship and has an abortion, is she liable for the blood money? What is the amount?

A: Yes, the fetus is still considered to have blood money, and it is equivalent to the blood money of a legitimate child.

Q: According to the law, if a woman seeks an abortion from a doctor and the doctor performs it intentionally, does the doctor owe blood money and face criminal penalties?

A: If the abortion is performed intentionally, the doctor is liable for the blood money and may face legal consequences according to the law.

Q: The law states that if a woman causes an abortion, and the fetus has a soul (i.e., after four months), the doctor may be liable for blood money or even face criminal penalties. Does this law align with Islamic jurisprudence?

A: The law is in accordance with the opinions of certain jurists, but in terms of Islamic jurisprudence, the fetus is not subject to retaliation (qisas) unless it reaches the stage where the soul is breathed into it, which occurs after four months.

The Value of Blood Money for Miscarriage:

1. Miscarriage after the soul has been breathed into the fetus (after four months): Full blood money: 1000 dinars, equivalent to 3.456 kilograms of gold.
2. Fetus in the stage where flesh covers the bones (complete bodily formation): 100 dinars, equivalent to 6.345 grams of gold.
3. Fetus in the stage where flesh has not formed (cartilage or bones only): 80 dinars, equivalent to 5.276 grams of gold.
4. Miscarriage in the stage of ‘alqa’ (attachment to the uterine wall): 40 dinars, equivalent to 2.138 grams of gold.
5. Miscarriage in the stage of sperm and ovum (prior to implantation): 20 dinars, equivalent to 1.69 grams of gold.
6. For twins or multiple fetuses: The same amount of blood money is due for each fetus.
7. Miscarriage due to the death of the mother: The mother’s blood money is also owed, in addition to the fetus’s.

Q: What is the basis for determining compensation for injuries in Islamic law?

A: Compensation (Arsh) is determined based on expert opinion and assessment. The expert’s judgement helps in determining the extent of the harm and appropriate compensation.

Treatment Costs:

If the patient’s life is in danger, and they cannot afford treatment, it is  a moral and legal obligation of the state or the community to provide financial assistance.

 If a patient has insurance, and treatment is covered under the policy, the responsibility of the patient to pay any excess costs depends on the contract.

The Rulings Concerning Patients

Part Two

Chapter One
(Purity and Impurity)

1. Question: In three cases, the anal opening can only be cleansed with pure water:
   • First: When excrement is accompanied by another impurity, such as blood.
   • Second: When an impurity from outside reaches the anal opening.
   • Third: When the area around the anal opening becomes excessively contaminated. In all other cases, the anal opening can be cleansed with water or with cloth, stones, or similar materials. However, washing with water is preferable.
2. Question: The urinary opening cannot be purified with anything other than water. If it is washed once after the urine has been expelled, it is sufficient. For those whose urine does not exit from the natural opening, it is necessary to wash it twice. However, in the case of flowing water, such as from a tap, washing once is sufficient.
3. Question: If meat or any other item containing life is separated from the body of a living human or an animal that has flowing blood, it does not become impure.
4. Question: Thin skins that are detached from the lips or other parts of the body are pure.
5. Question: The blood of humans and any animals that have flowing blood (meaning when their vein is cut, the blood gushes out) is impure. Therefore, the blood of animals such as fish and mosquitoes, which do not have flowing blood, is pure.
6. Question: Blood that exits from between the teeth, if it is mixed with saliva and disappears, is considered pure, and swallowing the saliva in this case is permissible.
7. Question: If blood under the nail or beneath the skin dies to the extent that it is no longer considered blood, it is pure. However, if it is still considered blood and the nail or skin is punctured but without difficulty, it is necessary to expel the blood for the purpose of ablution (wudu) and ritual washing (ghusl). If it is difficult, only the surrounding area needs to be washed in such a way that the impurity does not spread, and a special ablution (wudu) known as “Jabirah” should be performed.
8. Question: If someone is unsure whether the blood beneath the skin has died or the flesh has turned into that state due to being bruised, the blackness beneath the skin is considered pure.
9. Question: The yellow discharge that appears around a wound during healing, if it is uncertain whether it has mixed with blood, is pure.
10. Question: Industrial and medicinal alcohols, if there is doubt whether they are intoxicating beverages or contain intoxicants, are considered pure, and there is no need to investigate further.

Proving Impurity

1. Question: The impurity of any item is proven through three means:
   • First: The person himself is certain that something is impure, and if he merely suspects it, there is no need to avoid it. Thus, it is not problematic to eat food in a restaurant or coffee shop where some people are careless about cleanliness and impurity, provided the person is not certain that the food served to him is impure.
   • Second: A person who has something in his possession says it is impure, for example, a spouse or a cook says that a dish or something else in their possession is impure.
   • Third: A reliable person says that something is impure.
2. Question: If there is doubt about whether an impure item has been purified, it is still considered impure. Similarly, if there is doubt whether a pure item has become impure, it remains pure. Even if one can distinguish whether it is impure or pure, there is no obligation to investigate it.
3. Question: If a pure item comes into contact with impurity, and there is doubt whether both or either has become wet, the item remains pure and does not become impure.

Chapter Two
(Ablution)

1. Question: If a person is ill in such a way that his urine drips continuously, or he cannot prevent his excrement from coming out, and if he is certain that he has enough time between the start and end of the prayer to perform ablution and pray, he should perform the prayer in that time. If the time is only sufficient for the obligatory actions of the prayer, he should limit himself to those and forgo the recommended actions like the call to prayer, the qama, and the supplication (qunut).
2. Question: If a patient does not have enough time to perform ablution and pray, and urine or excrement exits multiple times during the prayer, the initial ablution is sufficient for that prayer.
3. Question: If someone suffers from a continuous discharge of urine or excrement, and no other major impurity (such as sexual impurity) occurs, the initial ablution is sufficient for the prayer.
4. Question: A person suffering from a condition in which they cannot prevent the release of wind (flatulence) should act according to the instructions given to those who cannot prevent urine or excrement from exiting.
5. Question: Someone whose urine drips continuously should protect themselves using a bag filled with cotton or some other material that prevents the impurity from spreading. Similarly, someone unable to prevent the release of excrement should, if possible, prevent it from reaching other places during the time of prayer.
6. Question: If a person cannot prevent the continuous release of urine or excrement, the first purification (ablution) is sufficient for two prayers.
7. Question: If a person cannot prevent the continuous release of urine or excrement, they do not need to make up for the prayers performed during the period of illness. However, if the illness subsides during the prayer time, the prayer performed in that time must be repeated.
8. Question: If a disabled veteran suffers from continuous urine leakage, and they wish to attend congregational or Friday prayers, can they perform ablution or tayammum in their care home or do they need to do it at the prayer site?

Answer: If no droplets are expelled during the transition from the care home to the prayer place, they may perform ablution in the care home. However, if droplets are released during the transition and the distance between the two places is significant, ablution should be performed at the prayer site. If the distance is short, no new ablution is required.

• Q: Due to illness, I am unable to perform ablution myself and must hire a proxy, who requests payment for their service. What is my duty in this case?
• A: If the proxy demands a fee for performing ablution, ghusl, or tayammum, it must be paid if it is feasible.
• Q: I am a disabled veteran living in a care home, and I need a proxy to perform ablution for me. However, due to a shortage of staff and caregivers, it is difficult to find a proxy. What should I do: perform ablution or tayammum?
• A: If there is sufficient time, wait until a caregiver can be assigned to perform your ablution. If time is short, perform tayammum instead.
• Q: Due to my disability, I cannot perform ablution on my own and need several people to help me. This is difficult for myself, those around me, and the person performing the ablution. Should I perform ablution or tayammum?
• A: If performing ablution is difficult for you, your duty is to perform tayammum.
• Q: If someone wishes to perform ablution by the conventional method but needs a proxy for part of the ablution, whereas if they perform a contact-based ablution, they do not need a proxy, what is their duty?
• A: They may perform a contact-based ablution.
• Conditions for Ablution
• Q: If someone fears that performing ablution will make them ill or that they will remain thirsty from using water, they should not perform ablution. However, if they do not know that the water is harmful and perform the ablution, only later realizing that it caused harm, is their ablution valid?
• A: Their ablution is valid.
• Q: If the amount of water needed to perform ablution does not harm the individual but using more of it would cause harm, it is necessary to use only the minimum amount of water to perform ablution.
• Q: If someone knows that something is attached to their ablution organs but is unsure whether it prevents water from reaching them, they should remove it or ensure water reaches under it.
• Q: If someone has swelling on their face, hands, forehead, or legs due to burning or another reason, washing and wiping over the area with water is sufficient. If the skin tears, it is not necessary to wash under the skin; if part of the skin is torn, it is not necessary to wash under the part that is intact. However, if the torn skin intermittently adheres to the body, it should either be removed or water should be applied beneath it.
• Q: If someone is unsure whether something is attached to their ablution organs, and their doubt is reasonable—such as after plastering, when they are unsure if the plaster is stuck to their hand—they must check or rub it until they are certain that the attachment is removed, or water has reached under it. However, attention to the white traces left by plaster is not necessary.
• Q: If someone knows beforehand that something prevents water from reaching parts of their ablution organs and later doubts whether the water reached those areas, their ablution is still valid.
• Q: Due to burns, I use artificial hair on the front of my head. What is the ruling on wiping and washing artificial hair?
• A: In this case, it is necessary to wipe and wash the skin of the head. If the artificial hair is fixed and cannot be removed, it is considered to be like natural hair.
• Q: The skin on my hand is torn, but it is still attached to my body. Should I wash under it during ablution or ghusl?
• A: If the skin normally covers the surface, washing under it is not necessary, and washing the surface is sufficient. However, if the skin intermittently adheres and is easy to remove or wash under, it should be either removed or washed. If it is difficult to do so, washing the surface is enough.
• Q: Sometimes, when performing ablution, I have a wound that bleeds. After washing and rinsing the wound, some blood comes out, clotting and turning brown and black after a few days. Does this wound still have the same ruling as blood and remain impure? What should I do for ablution and ghusl if the wound is impure?
• A: The wound is treated as a “Jabirah” (a bandage or covering) and the areas of ablution that remain should be washed. It is unnecessary and ineffective to wash the wound, as doing so may invalidate the ablution due to the spread of impure moisture. Blood that has dried and turned black is impure.
• Q: If someone holds the water jug and pours water on my hands for ablution, and I wash my hands in this way, with my right hand being in a cast due to a fracture, does this invalidate my ablution?
• A: In this case, there is no issue, as you are washing your own face and hands.
• Q: A person whose hands are bandaged up to the wrist or in a cast cannot perform the ablution in the usual manner. How should they perform the ablution, especially when they cannot use their fingers and palms to wipe over the head or feet?
• A: They should wash their face and hands up to the wrist, then use the wrist to wipe over the areas where water remains, such as the head or feet.
• Q: I have been injured in the stomach and part of my large intestine was surgically removed. Now, feces exit from my abdomen. Does this invalidate my ablution, and does the passing of wind also break my ablution?
• A: Urine and feces, regardless of the route they exit from, invalidate ablution. Likewise, the passage of wind from the same location, even if unusual, also invalidates the ablution.
• Ablution with “Jabirah” (Covering)
• Q: If there is a wound, boil, or fracture in one of the areas of ablution, and the wound is open and water does not harm it, it is necessary to perform ablution in the usual manner.
• Q: If there is a wound or fracture on the face or hands, and the area is open, but water causes harm, it suffices to wash the surrounding areas. If wiping with a wet hand does not harm, one may wipe the area. If even wiping with a wet hand is harmful, or if the wound is impure and cannot be washed, it is sufficient to wash the area around the wound from above to below, then place a clean cloth on the wound and wipe it with a wet hand. If it is impossible to place the cloth, washing the area around the wound is enough, and tayammum is not required.
• Q: If the wound or fracture on the head or legs is open and it is impossible to wipe it, a clean cloth should be placed on it, and then the cloth should be wiped with the remaining water from the ablution. Tayammum is not necessary unless it is impossible to place the cloth. If the cloth cannot be placed, tayammum should be performed instead.
• Q: If the wound is closed and it is possible to open it without difficulty or harm, it is necessary to open it and perform ablution. This applies whether the wound is on the face, hands, or any other part of the body.
• Q: If the wound is closed and it is not possible to open it, but the skin covering it is clean and water can reach it without harm, it is necessary to wash it. If the wound or anything covering it is impure, and it is possible to wash it and bring water to the wound without harm, the area should be cleaned. If the water would harm the wound, or if it is impossible to reach it with water, the area around the wound should be washed, and wiping the clean covering is enough. If the covering is impure, the wound area should be washed properly, and if the covering is clean, wiping it with water will suffice.
• Q: If the covering (Jabirah) covers the entire face or one of the hands, the ruling of “Jabirah” applies, and performing ablution according to the rules of “Jabirah” is sufficient. If the covering does not cover the entire limb but covers a large portion of the ablution area, a “Jabirah” ablution should be performed. However, if the ablution with “Jabirah” is difficult or impossible, tayammum may be performed.
• Q: If the covering (Jabirah) covers the entire ablution area, it is necessary to perform tayammum.
• Q: A person whose palms or fingers are bandaged, and they perform ablution by wiping over them with the remaining moisture from other parts of their body, may wipe over their head and feet with this moisture or take moisture from other areas of the ablution to do so.
• Q: If the covering (Jabirah) covers the entire width of the foot, but part of the foot is exposed, the exposed part of the foot should be wiped, while the covered portion should be wiped according to the rules of “Jabirah.”
• Q: If there are multiple coverings (Jabirah) on the face or hands, the areas in between should be washed, and where there are coverings on the head or feet, those areas should be wiped according to the rules of “Jabirah.”
• Q: If the covering (Jabirah) extends excessively around the wound and cannot be removed, it should be treated according to the rules of “Jabirah” for ablution.
• Q: If maniyy (semen) does not leave its place, or if a person doubts whether it has exited, or if someone is unsure whether it has come out or not, then the obligatory ritual bath (ghusl) is not required.
• Q: If someone is unable to perform ghusl or tayammum, and becomes junub (sexually impure) after the time for prayer has arrived, they have not committed a sin.
• Q: For touching a deceased child, even a miscarried child whose four-month term has ended, the ghusl for touching the deceased is obligatory. Therefore, if a four-month-old deceased child is born, the mother must perform the ghusl for touching the deceased.
• Q: If a person ejaculates without sexual desire, is the person considered junub or not?
• A: If a person is certain that the fluid that has exited is semen, even though it came out without sexual desire, they are considered junub.
• Q: I am disabled and paralyzed and cannot shower or perform ghusl. However, when others lay me on the ground and bathe me, I intend to perform ghusl by having water poured over my head, neck, and body. Is this method of ghusl valid?
• A: There is no problem with this method.
• Q: If someone’s entire leg is in a cast, and they become junub, is ghusl obligatory or is tayammum required, or both? Can they enter the mosque?
• A: If they can perform a ghusl for a cast and it is not difficult for them, they must perform ghusl. Otherwise, they should perform tayammum. After fulfilling their obligation, there is no issue with entering the mosque.
• Q: If a person feels sexual desire but due to a spinal cord injury cannot determine whether they have become junub, do they have the ruling of junub or not?
• A: The mere feeling of sexual desire does not make one junub, unless they are certain that semen has exited. If there is doubt about whether semen has exited, junub status does not occur.
• Q: Individuals with spinal cord injuries may sometimes have exciting dreams and are unsure if they have become junub. Are they obligated to perform ghusl?
• A: If they are uncertain about becoming junub, they do not have the ruling of junub.
• Q: A person who is unable to perform ghusl due to a leg injury must perform ghusl for the cast. How is ghusl for a cast performed?
• A: The procedure for a cast ghusl is similar to a wudu for a cast. It must be performed in sequence. For example, if part of the left leg is in a cast and they cannot apply water to it, after washing the head, neck, and other parts of the body, they may wipe their cast with a wet hand, or if this is not possible, they may place a clean cloth on the cast and wipe it with the wet hand. If this is not possible, tayammum should be performed in place of ghusl.
• Q: In hospitals, spinal cord injured veterans often have semen extracted for tests or fertility purposes using special devices. If this is done while the person is unconscious, should they perform ghusl after semen is extracted?
• A: If the semen is extracted from the natural passage, whether the person is unconscious or conscious, it results in junub and requires a ghusl. If it is extracted through an unnatural passage, it does not result in junub and does not require a ghusl.
• Q: Should spinal cord injured veterans perform ghusl after intercourse, considering that the release of semen is not visible?
• A: If intercourse has occurred and there is certainty that semen has exited, ghusl is required.
• Q: A person, due to an illness, constantly ejaculates and cannot control it. Should this person be considered always junub?
• A: They should perform ghusl the first time, but for subsequent occurrences, a ghusl is not necessary.

Regarding Menstruation, Postpartum Bleeding, and Abnormal Bleeding:

• Q: Some doctors prescribe special pills to women who have reached menopause to regulate their menstrual cycle, causing them to experience bleeding each month at a specific time, similar to pre-menopausal periods. From a religious perspective, is this bleeding considered menstruation (hayd) or abnormal bleeding (istihadha)?
• A: In this case, it is considered abnormal bleeding (istihadha) and the rulings related to it apply.
• Q: After undergoing a surgical procedure, a woman experiences bleeding for more than seven days, continuing for up to twelve days. The first seven days occurred in a predictable manner. Is the additional bleeding considered istihadha or does it relate to the surgery?
• A: Bleeding lasting beyond the normal duration of menstruation is considered istihadha and should be treated according to its rulings. However, if the bleeding meets the conditions of menstruation, then the first ten days may be considered menstruation, and the remaining days are considered abnormal bleeding.
• Q: What is the ruling on ghusl after a miscarriage? Is it the same as the postpartum ritual bath, or is the presence of a soul in the fetus required for it to be considered postpartum bleeding (nifas)?
• A: The blood seen after a miscarriage is considered postpartum bleeding (nifas) and requires a ghusl. The presence of a soul in the fetus is not a condition for it to be considered nifas.
• Q: A woman who undergoes a cesarean section and sees bleeding after childbirth, is this bleeding considered postpartum bleeding (nifas) or abnormal bleeding (istihadha)?
• A: Blood that is discharged naturally during childbirth is considered nifas, even if the child is delivered by cesarean section. However, blood discharged from the surgical incision is not considered nifas.
• Q: A woman uses an intrauterine device (IUD) for birth control and no longer experiences a regular menstrual cycle. For example, she may experience intermittent bleeding for less than three days at a time, without consecutive days of bleeding. What is her obligation regarding prayer and ghusl?
• A: A woman should consider intermittent bleeding as abnormal bleeding (istihadha). In this case, she should perform the necessary actions according to istihadha rulings and may need to use her family’s pattern of menstruation (if they have one) to determine the exact days for ritual purposes.

A Dying Muslim

It is obligatory to position a Muslim who is in the state of dying (whether male or female, adult or child) on their back, such that the soles of their feet are directed towards the Qibla. If it is not fully possible to position them in this manner, then one should do so to the extent possible. If positioning them in this manner is not at all feasible, they should be laid on their right or left side facing the Qibla.

As long as the dying person has not been moved from the place of death, they must face the Qibla. Once moved, it is not necessary for them to face the Qibla.

Facing the Qibla is obligatory for every Muslim, and there is no need to seek permission from their guardian or caretaker.

Chapter Five: Prayer

The Qibla

A person performing the obligatory prayer while standing must do so in such a way that it is recognised as facing the Qibla.

If a person is unable to sit normally while praying, and their feet rest on the ground while sitting, they must ensure that their face, chest, and stomach face the Qibla during the prayer. However, it is not necessary for their shins to face the Qibla.

If a person cannot sit while praying, they should lie on their right side such that the front of their body faces the Qibla. If this is not possible, they should lie on their left side in the same manner, and if this too is not feasible, they should lie on their back such that the soles of their feet face the Qibla.

If a person is unable to lie in the prescribed manner due to disability or injury, they must lie in whatever way possible to ensure that their feet face the Qibla.

Regarding the Prayer of Invalids

If a person who is disabled, particularly a war hero, is unable to lie on their back or side to face the Qibla while praying, they are required to lie in such a way that their feet face the Qibla.

Regarding the Purity and Clothing of the Prayer Performer

If an individual has an excuse that would necessitate performing the prayer at the beginning of its time by tayammum (dry ablution), and they know or suspect that their excuse will persist until the end of the prayer time, they may perform the prayer at the beginning of the time. However, if their excuse is related to having impure clothing or other reasons, and they expect the excuse to be resolved before the prayer time ends, they should wait until the issue is resolved and then pray, even if they still have time to perform the recommended actions of the prayer, such as the call to prayer, the Iqama, and the qunoot.

A man must cover his private parts during the prayer, even if no one else is present. It is recommended that he cover the area from the navel to the knees.

A woman must cover her entire body during the prayer, including her hair and neck. However, it is not necessary to cover her face, and she only needs to cover her arms and legs up to the wrists and ankles.

The five conditions for the clothing of the prayer performer are:

1. It must be pure;
2. It must be lawful (halal);
3. It must not be made of the flesh of an impure animal;
4. It must not be made of silk, if the performer is male.

The clothing of the prayer performer must be pure, and if someone intentionally performs the prayer with impure clothing or body, their prayer is invalid.

If someone is unaware that their clothing or body is impure and performs the prayer, the prayer is invalid.

Impurities and Their Effect on the Prayer

If someone does not know that their clothing or body is impure and later realises this after the prayer, their prayer is valid. However, if they realise this during the prayer, they must repeat it.

If someone forgets that their body or clothing is impure and remembers in the middle of or after the prayer, they must repeat the prayer, or if the time has passed, they should perform it as a qada (make-up prayer).

In case of extreme time constraints, if someone’s clothing becomes impure during the prayer but before performing any other act of the prayer with the impurity, they can remove, wash, or replace their clothing without invalidating the prayer.

If a person performs the prayer with impure clothing and becomes aware of the impurity during the prayer, and they cannot clean or replace the clothing, they should continue the prayer as prescribed for someone who is unable to clean their clothing or body.

If someone doubts the purity of their clothing or body and later realises they were impure, the prayer is invalid only if this is realised during the prayer time.

Conclusion

This text contains various rulings related to prayer, such as the proper orientation towards the Qibla for both the healthy and the sick, the conditions regarding purity and covering during prayer, and the allowances for individuals with disabilities or temporary health conditions.

• Chapter 6: Obligations of Prayer
• Takbir al-Ihram (Opening Takbir)
• Q: A person who is mute or unable to pronounce “Allahu Akbar” correctly due to illness, what should they do?
  A: They must say it in whatever way they are able to. If they cannot pronounce it at all, they should recite it mentally and gesture with their hand. If they are able to move their tongue, they should do so as well.
• Qiyam (Standing in Prayer)
• Q: If someone is unable to stand during prayer, as explained in the next issue, what should they do?
  A: They must sit, and if they are unable to sit, they should lie down, but they should not recite anything until their body is at ease.
• Q: As long as a person is able to stand, they should not sit. For instance, if a person has to lean or bend their body while standing, they must stand and pray in whatever way possible. However, if they cannot stand at all, even in a posture like in ruku (bowing), they must sit upright and perform the prayer sitting down.
• Q: If someone can sit, they should not pray lying down. However, if they cannot sit upright, they should sit in whatever way they can. If they cannot sit at all, they must lie on their right side as explained in the rules of the qibla. If that is not possible, they should lie on their left side, and if this is also impossible, they should lie on their back with the soles of their feet facing the qibla.
• Q: If someone praying sitting down can stand after reciting Al-Fatiha and Surah, they should stand and bow from the standing position. If they are unable to do so, they should bow while sitting.
• Q: If someone praying lying down can sit in the middle of their prayer, they should sit as much as possible and pray. If they are able to stand, they should stand and pray. However, they should not recite anything until their body has calmed down.
• Q: If a person praying sitting can stand in the middle of their prayer, they should stand and continue praying. However, they should not recite anything until their body is at ease.
• Q: If a person can stand but fears it will harm them or cause a negative consequence, they may sit to pray. If they fear sitting will harm them, they may pray lying down.
• Ruku (Bowing)
• Q: In every rak’ah, after reciting, the worshiper must bow to the extent that they can place their hands on their knees. This is called ruku.
  A: If the worshiper bows sufficiently but does not place their hands on their knees, there is no problem.
• Q: A person praying sitting should bow enough for their face to be aligned with their knees, and it is better for their face to be as close as possible to the place of prostration.
• Q: If the worshiper cannot remain in the bowing position due to illness or other reasons, their prayer is valid. However, they must recite the obligatory dhikr, i.e., “Subhana Rabbiyal Azim wa bihamdi” or three repetitions of “Subhana Allah,” before exiting the bowing position.
• Q: If a person cannot bow fully, they should lean on something while bowing. If they cannot bow in the usual manner even while leaning, they should bow to the extent they can. If they cannot bow at all, they should perform ruku sitting down.
• Q: If a person can stand, but cannot perform ruku while standing or sitting, they should stand and make an indication of ruku with their head. If they cannot do so, they should close their eyes to indicate their intention for ruku and say the corresponding dhikr. If they cannot even do that, they should intend ruku in their heart and say the dhikr.
• Sujud (Prostration)
• Q: In every obligatory and voluntary prayer, after the ruku, the worshiper must perform two prostrations. Sujud means placing the forehead, palms of both hands, knees, and toes on the ground.
  A: The worshiper must place the palms of their hands on the ground, but in cases of necessity, placing the back of the hand is also acceptable. If placing the back of the hand is not possible, they should place the wrist, and if even that is not possible, they should place their forearm on the ground.
• Q: A person who has a part of their big toe missing must place the remaining part of the toe on the ground. If there is no remaining part, they should place the other toes, and if none are left, they should place whatever part remains of the toes on the ground.
• Q: If a person has a pimple or similar condition on their forehead, they should prostrate on the healthy part of their forehead. If that is not possible, they should prostrate in a way that at least the healthy part of the forehead touches the ground enough to fulfill the requirement. If this is also not possible, they should prostrate in any way they can, even if it is only the side of their forehead.
• Q: If the pimple or wound covers the entire forehead, they must prostrate on one side of the forehead. If that is not possible, they can prostrate on their chin. If they cannot prostrate on their chin, they can use any part of their face that can touch the ground.
• Q: If someone cannot place their forehead on the ground, they should bend as much as possible and place a prayer mat or something else that is suitable for sujud on a raised surface, and their forehead should be placed on it as much as is required for sujud. They should also place the palms, knees, and toes on the ground in the usual manner, if possible.
• Q: A person who is unable to bend at all must sit for sujud and indicate with their head. If they cannot indicate with their head, they should use their eyes to signal. If this is also not possible, they should intend sujud in their heart and use their hands or another part of their body to indicate sujud.
• Things Suitable for Prostration
• Q: Prostration must be performed on earth and things growing from it, such as wood and tree leaves. Prostration on food or clothing is not allowed, nor is it valid to prostrate on materials like gold, silver, agate, or turquoise. However, prostration on minerals like marble and black stone is permissible.
• Q: Prostration is valid on things that grow from the earth and are used as food for animals, such as grass and straw.
• Q: Prostration is permissible on various types of paper, even if it is made from something like cotton, as prostration on cotton itself is not valid due to its being clothing.
• Prayer and Fasting: Jurisprudential Questions and Answers

Standing in Prayer

• Q: Can a person who needs to lean on something while praying lead others in prayer?
• A: There is no objection, as standing is still achieved.
• Q: Is it permissible to pray behind an Imam who has a bent in their lower back?
• A: It is permissible.

Making Up Missed Prayers

• Q: As long as a person is alive, even if they are unable to perform the prayer for reasons such as illness, no one can perform their missed prayers on their behalf.
• Q: A person suffered a stroke and lost mental faculties, unable to distinguish between good and bad, or to determine correct prayer recitations. For several years, they often mistakenly ended their prayer during the second rak’ah or repeated prayers after finishing. After four years of this state, they passed away. Is it required to make up their missed prayers and fasts?
• A: Prayers and fasts are not obligatory if there is a disruption in mental faculties. Since nothing was required of them, no one is obligated to make up those prayers or fasts.

Fasting

Intention for Fasting

• Q: If someone makes the intention to fast before dawn and then loses consciousness, and later regains consciousness during the day, do they need to complete the fast and make it up later?
• A: Yes, they must complete the fast that day, and if they break it before completion, they must make it up.
• Q: If a sick person recovers before noon in Ramadan and has not broken the fast by that time, must they make the intention to fast for the rest of the day?
• A: Yes, they must make the intention and fast the remainder of the day. However, if they recover after noon, fasting is not obligatory for them.

Things that Break the Fast

• Q: A fasting person should avoid using nutritional supplements such as injections. However, using an injection that numbs a body part or acts as medicine is permissible.
• Q: Swallowing phlegm from the nose or chest is permissible as long as it does not reach the mouth. If it does, it should not be swallowed.
• Q: A person who is weak cannot break their fast to relieve weakness, unless the weakness is severe and they cannot bear it.
• Q: Someone who has touched a deceased body can fast without the need for purification, and fasting is not invalidated if they touch a corpse while fasting.
• Q: Using rectal suppositories for medical reasons does not invalidate the fast, though those for nourishment should be avoided.
• Q: If a fasting person deliberately vomits, even if caused by illness, their fast is invalidated. However, if the vomiting is accidental or unintentional, it is permissible.
• Q: If a fasting person knows they will vomit due to something they eat at night, they must make up the fast for that day.
• Q: A fasting person must avoid intentional belching if they are certain that something will exit their throat. However, if they are unsure, it is permissible.
• Q: I am a veteran with a respiratory issue and rely on medication to live. During Ramadan, is it permissible to use a respiratory inhaler when I am experiencing extreme discomfort, without breaking my fast?
• A: In this case, using the inhaler does not invalidate your fast.
• Q: People with spinal cord injuries are instructed by their doctors to consume liquids at regular intervals. What is the ruling on fasting for them?
• A: Fasting is not obligatory for them, but they must give one “mod” of food (about 750 grams of wheat or similar) to a poor person for each day they miss fasting. If they regain the ability to fast after Ramadan, they must make up the missed fasts.
• Q: Is it permissible for a fasting person to use vaginal creams during Ramadan?
• A: It is permissible.
• Q: Does the use of eye drops while fasting invalidate the fast?
• A: It does not invalidate the fast, though it is disliked if the taste or smell reaches the throat.
• Q: Can a person break their fast due to weakness caused by fasting?
• A: Fasting naturally causes weakness, but if the weakness is normal and tolerable, breaking the fast is not permitted.
• Q: Can a pregnant woman or a nursing mother break their fast if it harms them or their child?
• A: If fasting is harmful to the mother or the child, fasting is not obligatory. In such cases, the person must give one “mod” of food to the poor for each missed day of fasting.

Expiation and Making Up Missed Fasts

• Q: If someone deliberately breaks their fast and later has a valid excuse such as menstruation or illness, must they provide an expiation?
• A: If the fast was deliberately broken, the person must offer an expiation.
• Q: If a person is insane, do they need to make up missed fasts from when they were not in a sound mental state?
• A: No, it is not obligatory to make up missed fasts from the period of insanity.
• Q: If a person misses fasting due to illness or menstruation and dies before Ramadan ends, they do not need to make up the missed fasts.
• Q: If a person is ill and unable to fast and their illness continues until the next Ramadan, they do not need to make up the fasts, but must give one “mod” of food for each missed day of fasting.
• Q: If a person recovers from an illness after Ramadan and cannot fast until the next Ramadan due to another excuse, they must make up the missed fasts and give one “mod” of food for each day missed.
• Q: If someone has missed fasting for several years due to chronic illness, they must make up the missed fasts when they recover, and for each year they missed, they must give one “mod” of food to the poor.
• Q: A girl who has been ill with rheumatoid arthritis since the age of five and has not been able to fast due to the illness must provide expiation or make up missed fasts.
• A: If she has been unable to fast due to illness, and the illness has been continuous, there is no obligation to make up the missed fasts, but she must give one “mod” of food for each missed day of fasting.

Who is Not Obliged to Fast

• Q: If a person suffers from extreme thirst and cannot bear it, fasting is not obligatory. However, they must give one “mod” of food for each day they miss fasting.
• Q: A pregnant woman who is near delivery and fasting is harmful to her or her child is not obligated to fast. She must give one “mod” of food for each missed day of fasting and make up the missed fasts later.
• Q: A woman who breastfeeds and either has insufficient milk or is nursing someone else’s child (whether for payment or not) is not required to fast if it harms her or the child. She must give one “mod” of food for each missed day and make up the fasts later.
• Q: A girl who has just reached puberty but cannot fast due to severe weakness or illness should give one “mod” of food for each missed day of fasting and is not obligated to make up the fasts.
• Q: A person suffering from leg weakness due to anemia, as diagnosed by a doctor, and fearing worsening of the condition, is not obligated to fast. However, they must give one “mod” of food for each missed day and may make up the fasts later.
• Q: If someone suffers from a stomach condition or intestinal swelling, and cannot fast due to weakness and exhaustion, what should they do?
• A: If a person is ill and fasting would harm them, they are exempt from fasting. They must give one “mod” of food for each missed day and later make up the fasts once they recover.
• Q: Is the permission to break a fast due to illness dependent on a doctor’s advice, or is it based on the individual’s reasonable assessment of the potential harm?
• A: The decision is based on the individual’s reasonable assessment of potential harm, whether guided by a doctor’s advice or their own experience.

3rd – Leprosy:

4th – Blindness:

5th – Lameness: In a manner that is evident and noticeable.

6th – Fusion or unification of the urinary, menstrual, or fecal passages:

7th – The presence of flesh, bone, or a gland in the vagina that prevents intercourse:

Article 1 – If a woman discovers after the marriage contract that her husband is insane, lacks male genitalia, is impotent, or is unable to engage in sexual relations due to having his testicles removed, she may annul the marriage. Similarly, if her husband suffers from incurable contagious diseases like leprosy or others that would cause hardship and distress for her, she may annul the marriage.

Article 2 – Either the man or the woman may annul the marriage because of one of the defects mentioned earlier. In this case, the annulment will occur without divorce, and there is no need to pronounce a divorce.

Article 3 – If a woman annuls the marriage due to her husband’s impotence (which means he is unable to perform sexual intercourse), the husband must pay half of the dowry. However, if the annulment is due to any other defect mentioned earlier, and the husband has not yet had intercourse with the wife, he is not obligated to pay anything. If they have had intercourse, he must pay the full dowry.

Question 1:

After marriage, it was discovered that there are light burn marks between the woman’s legs, and her hymen is unusually thick, making intercourse impossible without surgery. There was no discussion regarding her health before the marriage. Does this qualify for an annulment?

Answer: The condition of a thick hymen is not a valid reason for annulling the marriage. As for the burns, if there was a prior condition of health discussed, the woman has the option to annul the marriage through divorce. Otherwise, she cannot divorce her husband unless a specific condition was agreed upon.

Question 2:

If a person has AIDS, can a Muslim woman marry him? If she later discovers this after marriage, does she have the right to annul the marriage?

Answer: Contagious and life-threatening diseases such as AIDS, if concealed before marriage, can cause harm and hardship for the spouse. If the disease existed before the marriage and was hidden, the woman has the right to divorce once the disease is proven. If the man does not divorce, the court will annul the marriage. However, this defect does not automatically annul the marriage.

Question 3:

If a man knowingly marries a woman who has leprosy, is the marriage valid? Does the woman have the right to annul the marriage after the fact?

Answer: If a man knowingly marries a woman with leprosy, the marriage is valid. There is no valid reason for annulling the marriage except through divorce.

Question 4:

If intercourse causes harm to a woman, is she allowed to refuse to engage in it?

Answer: A woman who refuses intercourse due to illness, which prevents sexual activity, is not considered disobedient (nushooz). Her refusal does not constitute an objection or disobedience because it is based on a valid excuse.

Glossary of Terms and Legal Concepts

• Euthanasia: The act of killing or causing the death of a person suffering from an incurable disease out of mercy.
• Anencephalic: A severe brain injury where the person may have no brain tissue and may be severely intellectually disabled.
• I.U.D (Intrauterine Device): A device inserted into the uterus to prevent pregnancy.
• Mubah: An action that is neither religiously commendable nor reprehensible; neutral in Islamic law.
• Release of Liability (Ibraa’ al-Dhimmat): The act of waiving an obligation or responsibility.
• Lease (Ijara): A contract in which one party transfers the usufruct of a property or labor to another party for a specified time and compensation.
• Equivalent Payment (Ajr al-Mithl): Compensation paid for work done to replace or cover a loss.
• Non-mahram (Ajnabi): A person who is not a close relative and to whom marriage is permissible.
• Diyya (Blood Money): A financial compensation paid for murder or injury, as mandated by Islamic law.
• Thalassemia Major: A severe genetic blood disorder requiring lifelong blood transfusions.
• Reproductive Health Issues: Related to conditions such as impotence, infertility, or the inability to conceive or perform sexual intercourse.
• Third — Leprosy;
• Fourth — Blindness;
• Fifth — Limping; to the extent that it is noticeable;
• Sixth — Confluence of the urinary, menstrual, or fecal passages;
• Seventh — The presence of flesh, bone, or a gland in the vaginal area that prevents intercourse.
• Article () — If, after the marriage contract, a woman discovers that her husband is insane, lacks a male genital organ, is impotent and unable to consummate the marriage, or if his testicles have been removed, she has the right to annul the marriage contract. Similarly, if the husband suffers from diseases such as leprosy, tuberculosis, or other contagious and incurable diseases that cause hardship and distress to the wife, she may annul the contract.
• Article () — Either the man or the woman may annul the marriage contract due to one of the aforementioned defects. In such a case, the marriage is dissolved without the need for a formal divorce procedure.
• Article () — If a woman annuls the marriage due to the husband being impotent and unable to engage in sexual intercourse, the husband must pay half of the agreed dowry. However, if the annulment is due to any other defect mentioned earlier, if the husband has not consummated the marriage, he is not required to pay any dowry. If consummation has occurred, he must pay the full dowry.
• Question () — It is discovered after the marriage that there are old burn marks on the woman’s genital area and her hymen is of a thick, fleshy type, making penetration impossible without surgery. If no prior discussion regarding the health of the wife was held before marriage, does this constitute grounds for annulment?
• Answer — The condition of a thick hymen does not provide grounds for annulling the marriage. As for the burn marks, if health was stipulated before marriage, the woman may annul the marriage via divorce. Otherwise, she cannot divorce the man without following the regular process.
• Question () — A person has been diagnosed with AIDS. Can a Muslim girl be married to him? If after the marriage, the wife discovers his condition, does she have the right to annul the marriage?
• Answer — Contagious and life-threatening diseases, such as AIDS, can cause harm and distress to the spouse. If the disease existed prior to marriage and was concealed without informing the woman, she has the right to divorce after the disease is proven. If the husband refuses to grant the divorce, the judge may intervene. However, this does not automatically annul the marriage.
• Question () — If a man knowingly marries a woman who suffers from leprosy, is the marriage valid? Does the wife have the right to annul the marriage after the contract?
• Answer — If the man marries a woman with leprosy knowing of her condition, the marriage is valid. There are no grounds for annulment other than divorce in such a case.
• Question () — If sexual intercourse is harmful to the wife, can she refuse to engage in it?
• Answer — The refusal of the wife due to a health condition that prevents intercourse does not constitute disobedience, and she cannot be compelled. This refusal is considered a valid excuse.

Glossary of Terms

• Euthanasia (Atanasia): The act of mercy killing or causing the death of a patient for compassionate reasons.
• Anencephalic (Anansefali): A severe brain injury where the patient lacks brain tissue and is severely underdeveloped.
• I.U.D. (Intrauterine Device): A contraceptive device inserted into the uterus to prevent pregnancy.
• Mubah (Permissible): An action that is neither obligatory nor prohibited by Islamic law. It refers to actions that are neutral in terms of religious merit, such as the opposite of prohibited, obligatory, recommended, or discouraged actions.
• Abandonment of Debt (Ibra’ Dhimmah): The cancellation or removal of a debt or responsibility.
• Lease (Ijara): A contract where one party transfers the benefit of an asset or service to another in exchange for a fixed amount of compensation for a certain period.
• Compensation for Equivalent Work (Ujr al-Mithl): A wage paid for the performance of work that compensates for the loss of a service or asset.
• Foreign (Ajnabi): Any man who is not a husband to a woman.
• Foreign Woman (Ajnabiya): Any woman who is not a wife to a man.
• Arsh (Compensation): The amount paid to compensate for damage in cases where a fixed blood money (Diyya) has not been specified.
• Discharge of Physical Impurity (Izalat al-‘Ayn al-Najas): Removal of physical impurities.
• Sperm (Sperm): The male reproductive cell.
• Egg (Ovule): The female reproductive cell.
• Istihada (Intermittent Bleeding): The abnormal bleeding that a woman may experience that is neither regular nor heavy, occurring outside of menstruation.
• Metastasis (Metastaz): The spread of cancer cells from the primary site to other parts of the body.
• Leukemia (Lukemia): A type of blood cancer.