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.
On CRISPR Technology:
What is your professional opinion on the applications of CRISPR technology?
I’m very leery of it, not for religious reasons, but I think it’s a dangerous game to walk into. We don’t really know the true ramifications of this technology yet. Even if we look at it from a non-religious standpoint, I think we are deliberately trying to mess with the development of future human generations and that’s a dangerous thing.
I think before this technology actually comes to our doorsteps, it may have some value in today’s context. For example, let’s say there’s a couple who has been trying to have a baby for 15 years and they even tried in-vitro fertilization, but it didn’t work. One day the woman becomes pregnant, and they discover early in the pregnancy that there is a genetic abnormality with the child. They would counsel the woman and tell her that the baby is going to have disease X. Let’s just say disease X is Down Syndrome since it is an easy thing to diagnose.
She can elect to have an abortion, that’s her choice. But if she decides to carry through the pregnancy, that’s going to change her entire life. She’s going to have to deal with the disabled child, which is not an easy thing. If we have technology that could correct the genetic abnormality before the fetus matures, to the point of being a viable baby, that would be something amazing. If we have the therapeutic technology to go in and correct the genetic abnormality where we know that it’s going to work and the baby’s going to come out healthy, I think that would be an amazing contribution to humanity and to the medical field.
However, I think there is a problem with all of these kinds of technologies, regarding their potential for abuse. It will end up being up to legal professionals, bioethicists, and the medical profession to regulate itself and ensure that there is no abuse as they become more realistic and more widespread in their use.
This concern is not unique to Muslims. You can’t go in and purposefully change the characteristics of a human being that God created. Islamic scholars also tell you plastic surgery in Islam is not allowed. However, there are so many exceptions to it. If a child is born with a cleft palate, they can’t eat — it interferes with their nutrition. In that case, you do plastic surgery because it’s going to save their life and make the child’s life better. So, there are certain circumstances that are always exceptions to the rule. And I think the same will be the case with these enhancement technologies where there will be multiple exceptions.
On Eugenics:
Going off of your example of those living with Down Syndrome, do you think that patients and families impacted by Down Syndrome would feel the use of CRISPR technology in “fixing” it, as an act of eugenics?
Yeah, I think they would. Parents of children with genetic disorders absolutely love their kids the way they are. They would not want them any other way. When you talk to Down syndrome patients, as they grow older, they are very happy with the way they are. So, would it be a form of eugenics? Yes, I do think so.
Eugenics has been tried by Nazis in Europe and it was a disaster. The U.S. tried it many times, but it didn’t work. But I think on an individual patient level, for example, that couple, where she’s pregnant, it’s early in the pregnancy and there is a real opportunity for them to make a choice. Even if they have a Down’s baby, they will love them and give them the best life that they possibly can. If they choose to have the gene therapy, that’s also their choice. So, it really goes both ways.
Here the parents have the choice, however, there are governments where such personal decisions are made for them. China had a one child policy for forever, and now that their population is declining, they announced a three-child policy. That’s a form of eugenics— it’s population control. And not because parents want more kids, but because they are worried about not having enough workers in 20 years to sustain their economy, which is what they are seeing in their statistical trends. Though it’s not a genetic manipulation, it certainly is a population manipulation by state.
Does Islam say anything in favor or against the philosophy of eugenics? And do you see any practice of it in your line of work?
Islam does not allow a manipulation of God’s creation. Islam is an absolute monotheistic religion and God is the creator of everything. We also believe that you can’t mess with God’s creation. Even people who are born with illnesses or who have genetic defects, or who later in life develop illnesses, that’s all part of God’s plan and even treatment of diseases is part of God’s plan.
That’s why we are compelled to get treated because it says very clearly in Islam that God created the illness, and he created the treatment for illness. So, you have to accept both. In terms of a strict religious viewpoint, eugenics is absolutely not allowed. You cannot manipulate the population to try to breed a healthier population and weed out those who you think are going to be a burden on the population. However, there is a very important concept in Islam: the philosophical foundation in Islam is that all humans are equal.
On Euthanasia:
As a medical professional and Islamic scholar, what is your opinion on euthanasia?
As a physician and as a follower and learner of Islam, I’m totally and completely against euthanasia — someone purposefully ending their life. Now there are a lot of nuances to that. Not just as a Muslim, but also as a medical professional. I spend my whole day trying to save and extend people’s lives; I don’t want them to take their lives. However, there are a lot of caveats here. For example, if somebody has a severe mental illness and they commit suicide, would we say as Muslim scholars, or even as physicians, that they’ve committed a sin?
No, I personally would not say that because they committed the suicide under circumstances of a severe illness. They didn’t make a conscious decision to end their life. They did it to relieve themselves of their misery. Or they’re so profoundly depressed that they’re not even competent to really think through what they’re doing; and so, can we really say they committed a sin? I say, absolutely not. And most Islamic scholars would agree with that. In fact, people with severe mental illness, in Islam, are not accountable for their actions because you have to be of sound mind to be able to practice your faith. And so, they’re exempt and excused. Now that’s totally different than what if somebody is really sick, in pain, it’s spread all over their body. They’re going to die anyway.
For example, a patient has cancer; they’re bedridden and they can’t walk. Their life is miserable, and that person says, “I’m done and I can’t live anymore. Inject me with a huge dose of morphine and just kill me.” They’ll probably die within two or three minutes of that injection. And it will be a peaceful death. They’re not going to feel anything. Is that allowed? No, I don’t believe in this. I would never do it as a physician nor as a follower of Islam. In Islam, that’s totally not allowed. That’s active euthanasia, where you are actively ending life.
Now, take another example. Same patient but with severe cancer that has spread everywhere and is dealing with severe pain. And that patient says, “I don’t want any more treatment. Just make me comfortable, just give me pain medicine to relieve my suffering”. Is that euthanasia? I would say no, it’s not, because the treatments barely work at that stage; they may only extend the patient’s life by a few weeks at best. You could argue that it’s a form of passive euthanasia, because by withholding treatment, you’re basically allowing yourself to die. What do religious scholars say about this? There is a lot of debate of this in every faith. Some scholars say no to euthanasia; if there is a treatment, then one should keep taking it to the bitter end.
In a circumstance where a patient requests to stop treatment, it is required that two trained, trusted, and reputable physicians who know about the disease agree that treatment won’t help, to allow for pain relief. Is that a form of euthanasia, relieving a terminal patient from suffering? I don’t think so.
Many times, where I know the patient is not going to get better, they don’t want us to kill them, but they want us to provide relief of their pain and their discomfort without actively killing them.
I have treated patients who have been in this exact situation. Some of them are very elderly who do not qualify for a kidney transplant because of their age. They’ve been on dialysis and their kidneys are not going to work again. I don’t have any ethical problem with relieving pain for such suffering patients either from the medical side or from the religious side of my psyche.
I didn’t have the full set of knowledge and research to really appreciate these nuances. After a lot of studying, research, discussions with other physicians, Islamic religious scholars, and with scholars of other faiths as well, I have come to understand how they interpret the scenario to help myself come to a satisfactory reconciliation within my own mind. In fact, this is the humane thing to do as part of our job, which is not just to treat disease, but is also to ensure that our patients are not suffering.
