24.2.1 ENDOCRINE DISORDERS

In diabetes mellitus, blindness exempts from salat al jama’at. Diabetics with leg ulcers make yatammum instead of wudhu and adopt the most confortable salat position. Insulin-dependent diabetics and pregnant diabetics are exempted from saum. Diabetics controlled on oral medication and diet can fast under physician supervision. Patients anterior hypoparathyroidism and hypothyroidism offer salat and saum depending on clinical severity. They are treated sexual failure before marital dissolution is considered. They perform tayammum instead of wudhu for cold intolerance. The default age of 15 is used to define adulthood if puberty is delayed. They can use growth hormones can be used for growth retardation. Wet nurses, milk banks, or artificial formula are used for lactation failure. In cases of amenorrhoea, the presumptive period of 4 months + 10 days is used as the ‘iddat. Patients with diabetes insipidus are exempted from saum until electrolyte and fluid imbalances are corrected. Patients with hyperthyroidism with restlessness preventing concentration offer brief salat with short recitation. Patients with Addison’s disease offer salat sitting down to avoid postural hypotension and delay saum and hajj until correction of fluid and electrolyte imbalances. Patients with primary hyperaldosteronism exempted from saum until correction of electrolyte imbalances. In adreno-cortical excesss standing and posture of salat are altered (because of myopathy and possibility of fractures due to osteoporosis), saum is delayed during the treatment, hajj is delayed, and legal competence in impaired if psychotic symptoms are severe. Hormonal treatment of testicular and ovarian disorders, pseudohermaphroditism, gynecomastia, and hirsuitis is allowed if benefits outweigh risks. Legal liability is decreased if criminal behavior is due to hormonal status.

24.2.2 INFECTION

Infectious persons may be excluded from hajj and congregational salat. Under the principle of public interest superseding private interest, the following are allowed in an epidemic: restriction of movement, quarantines, involuntary measures (mass immunization, treatment, and prophylaxis), destruction of property (eg infected animals). Premarital screening is obligatory in places with endemic infectious diseases. Conjugal sexual rights can be denied for fear of infection. Conviction for zina cannot be based on incidental finding of STD in an unmarried person. Seeking divorce or khulu’u can be based on discovery of STD in a spouse. A spouse is legally liable for transmitting STD. Islam gave detailed teachings on personal hygiene, food hygiene, excreta disposal, and waste disposal in order to keep the environment clean and healthy.

24.2.3 NEOPLASIA

Intervention against cancer risk factors is based on the principle that harm should be relieved, al dharar yuzaal. Laws on sexual, body, and environmental hygiene decrease risk exposure. The tobacco-cancer link is considered yaqeen by physicians making tobacco haram. It is considered ghalabat al dhann by jurists making tobacco makruuh. The diet-cancer link does not reach the level of yaqeen or ghalabat al dhann. The Law can regulate institutional but not home diets. Parents are liable for child malnutrition due to negligence. Early disease screening is is obligatory if scientific evidence shows benefit. Treatment of advanced disease is based on the bakance of harm and benefit, both immediate and long term.

24.2.4 GENETIC CONDITIONS

Jurists are not unanimous on the obligation of pre-nuptial genetic testing and advice. Results of genetic testing could be used as a basis for refusing marriage or refusing to get pregnant. Pre-natal genetic screening in the form of amniocentesis for sex selection may encourage illegal abortion. Amniocentesis for disease detection may be of benefit to the parents to make preparations to take care of sick newborns. Marriage of close relatives has to be considered in the light of the balance of disease risk due to consanguinity and social advantages of marrying within the family. Treatment by genetic engineering is allowed under the rubric of permissibility of change of fitra as long as it is not done with the purpose of defying Allah’s creation. Widespread genetic testing may introduce systematic social discrimination based on gene profile for diseases and provide a false scientific basis for racial discrimination

24.2.5 TRAUMATIC INJURY

It is allowed to wash a patient in ablution. Tayammum is preferred for cases of profuse or active bleeding at sites of wudhu. In cases of wounds, a wet hand is rubbed on the bandage. Tayammum is carried out instead of ghusl in cases of burns or other conditions preventing use of water. Patients with physical disabilities pray in the most comfortable position. The disabled are exempted from physical participation in jihad; they can however make monetary and other contributions. Impotence in paraplegia and physical disability preventing working to support the family are grounds for marriage nullification if the wife requests. The Law provides for financial compensation in cases of accidental injuries.