Dr. Omaran Abdeen is a nephrologist practicing in Los Angeles, who was born in Chattanooga, Tennessee. He is also a scholar of Islam and is actively involved in his local Islamic center. He graduated from Cal Poly Pomona and graduated from UC San Diego School of Medicine. He started as an internal medicine physician but later specialized in nephrology. Over the past two decades of his practice as a physician, his personal beliefs and viewpoint on many topics strengthened as he became more immersed into patient care.
This interview is published in two parts. Part 1 discusses Dr. Abdeen’s personal beliefs, bioethics, and challenges of medical practices. Part 2 consists of his perspective as an Islamic scholar on hotly debated topics such as CRISPR, euthanasia, and eugenics.
Did you face any setbacks or experiences that related to your religion (Islam) or personal set of beliefs and how were you able to overcome them?
I didn’t face any setbacks, but I did have some interesting experiences. I remember September 11, 2001 very distinctly. I was a new faculty member at UC San Diego, and I had just finished my training in June of 2001. When 9/11 happened, I was very active in our local Islamic Center in San Diego. Most of the people in the Islamic center had come from other countries and I was one of a few who spoke English without an accent. They wanted me to be the spokesperson for the Islamic center. I addressed several press conferences and gave interviews at TV stations as questions were being raised about some of the 9/11 attackers due to their connections with San Diego.
We were in the spotlight and were getting a lot of death threats and even hate mail. Having said that, what I did experience, more than anything, was support from the non-Muslim part of the San Diego community.
Even when I walked the hospital floor, I was the only Muslim doctor there. Some people were very anxious, and they didn’t know what to say, even though they knew me for many years. And at that time, the department Chair, along with other staffers, expressed their full support towards me and that really meant a lot. My experience made me see the good in a lot of people and in a lot of different communities. We had people coming to the Islamic center from churches, synagogues, just to show their support. They were our neighbors, and it was a great and meaningful gesture for us at the Islamic Center.
How have your personal set of beliefs affected your medical practice?
My personal set of beliefs are really influenced by Islam. But within Islam there are so many different opinions about these ethical issues which I’ve studied extensively and adopted. As a medical practitioner it is important to feel comfortable in your heart. One could read various books with different perspectives and facts, but if it doesn’t sit well with them inside, then nothing’s going to change that.
I think every medical practitioner faces that at some point in their career where they are faced with ethical considerations and ethical issues that they don’t feel comfortable with. But we have to also consider the law here because the law sometimes forces us to take a course of action that we may be in conflict with. In a way it’s beneficial that there are those laws set in place, because otherwise everyone would do whatever they thought was right — and that’s not good either. The laws are really there to protect the rights of the patients. When it comes down to balancing the law and one’s own beliefs, it is important to identify that just because you did something legal, it doesn’t mean that it’s always moral or ethical.
For example, smoking marijuana is legal, but as a Muslim, it’s not moral whatever the law says. Anything that alters your mind is not allowed — that’s an example of something being legal, but not moral or ethical. And that happens in medicine as well. It gets very difficult to deal with some of these issues.
In California, if the patient cannot make their decision, then the spouse has to make the decision. And in most states, if the spouse is unable to make the decision or is unavailable to make the decision, then the next of kin gets the responsibility. So, the next of kin would be the children, and if the children are unable or unavailable, then the responsibility gets passed down to their siblings — there’s a whole hierarchy. Quite often, I see a spouse or child making decisions which are not always in the patient’s best interest but serve their other vested interests.
What do you feel about the role of religion and bioethics? And do you see any commonalities between modern sciences and religion with respect to Islam?
Bioethics, or medical ethics, has its own rules that are based on ethical and philosophical principles that are universal with the major faiths accepting them. However, some of them do conflict with certain faiths, including Islam — that’s always been an internal struggle, for every physician, not just me. For example, there are patients who elect to not be treated, and as a doctor I know they can feel much better after they are helped, but they choose not to. Well, in Islam, we are not allowed to refuse treatment. It’s prohibited and if a Muslim is sick, they must seek treatment.
So, there is a conflict for me. How can I override the important principle in Islam, which necessitates the seeking of treatment for illness and also respect the faith of others: to respect their wishes and to have the freedom to make their own choices. You cannot force people to do things. So even though there is that conflict, there’s a different perspective that one can take within one’s own faith. When I was young, I didn’t know that. I had to go study and ask scholars to try to reconcile these differences and understand them better.
Muslims who are in the medical field do have problems with that; they do experience conflicts like that, which bother them.
Let us take the case of a 3-week pregnant young woman wanting to abort the pregnancy because she does not want to have a child. I was feeling conflicted as abortion is allowed in Islam under certain circumstances, but this patient, they didn’t have a unique circumstance. She just wanted an abortion and didn’t want to take care of another child. In Islam, if you’re forced to do something or if you have to – then, you have no choice. These are learning experiences for me.
Have you had to face any ethical considerations during your 18 years as a Nephrologist?
Quite a few. Nephrology is a little bit of a unique field in medicine because we get to know our patients very well; I see my patients more than I see my family. I know them in and out and have become good friends with many of them over the years. So yes, there are a lot of ethical considerations. One of the biggest ones we face is when the patient doesn’t want treatment.
One of the more common situations is when we see a patient, they are diagnosed with kidney failure, and are not going to live more than three months. Their best course of treatment in such a situation would be to start dialysis — the D word — and as soon as we utter that word, it creates a sudden silence in the room, and they often refuse treatment. They’re suffering, vomiting every morning. They have swollen legs, they are short of breath, they can barely walk to the bathroom, and can’t work — and yet they refuse treatment. And I know that I can help them. I know that if I hook them up to a dialysis machine, it will solve most of their symptoms within three hours.
What I’ve come to learn over time is that it’s very hard when a patient walks out of the office refusing treatment and you know you can help them. Ethically that’s so difficult to deal with, but we’ve come to learn different ways of handling that. One way is to reach out to the patient’s family, their spouse, children, siblings, whoever means something important to them. We reach out and try to have that person help convince the patient. Sometimes we can’t do anything. We just have to wait it out until the patient’s symptoms become so dire that they come and tell us that they want the treatment.
They’re suffering so much that they want relief and 99% of the time, that’s what happens: either a third party convinces them, or they become so dire that they want to start dialysis. So that’s a big dilemma that we face — the dilemma of the end of life. Quite often patients who’ve been on dialysis for a very long time are not candidates for kidney transplant. They may have cancer, or they have some other medical condition that precludes them from getting a transplant. Due to their prolonged suffering, they may choose to stop dialysis; and we know that if they stop, they’ll die within a week. That becomes an internal struggle — to draw the line between euthanasia and relief of suffering.
Even after 20 years of practice, it’s sometimes very hard to know where one stands on that spectrum between euthanasia and relief from suffering. It requires a lot of internal discussion and thinking about, should I be encouraging a patient to stay on dialysis even though I know they’re suffering. Or should I go with their request and stop the procedure. And that’s a big internal struggle that we face from time to time in nephrology.
Have you ever had a case where a kidney transplant was the best course of treatment, but the patient refused it?
Yes. There are certain communities, who don’t agree to transplantation and they have refused it; and it’s so hard to see that because they’re otherwise healthy. They’re otherwise great candidates. They really should get a transplant and yet they refuse. From a medical ethics standpoint, there’s patient autonomy. So, if the patient wants or doesn’t want something, we have to respect their wishes. Even though we may not agree with their course of action, we have to certainly respect their wishes, and there are many other circumstances. I mean, there are people who refuse a transplant, not because of religious reasons, but for other reasons. For example, I have a patient who is on dialysis. She’s otherwise healthy. She should get a kidney transplant from one of her three healthy grown daughters. Yet, the patient refuses to ask her daughters to give her a kidney when she has been offered. Her reason being, she wouldn’t want to take away a kidney from her own daughter that could — potentially in the future — impact her or her daughter’s life. Also, she didn’t want her grandchild to be in a position to be donating her kidney to their mother.
It’s an ethical dilemma, really, but in her mind, it’s very clear. She’s not going to do it and I have to respect her wishes, whether I agree with it or not. In the big picture, she’ll live longer if she gets a transplant, she’ll feel better and healthier. And we know statistically that the daughter will do absolutely fine. She won’t have any problem and the risks are extremely low for the donor. I know all that book science and statistics. But when I talked to her, she was very convincing, and it’s not a religious thing. It is just that she is worried about her daughter and grandkids. We see this with Jehovah Witness patients who refuse blood transfusion. In cases where the patient is extremely anemic, a blood transfusion is the best course of treatment. However, when it comes to anemic Jehovah Witness patients, they really need the blood, yet they refuse the transfusion and take any other treatment. We do our best to manage it. So, this is something not unique to nephrology; I think in every field of medicine, there are these ethical dilemmas that present themselves.
