Removing certain body Parts due to Medical Risk

3rd March 2018

 

السلام عليكم و رحمة الله و بركاته

Question: My wife has been diagnosed BRCA1 gene disorder that puts her at a risk of developing breast cancer and ovarian cancer. This is partly due to this being inherited through family as her mother and sister are now suffering cancer from them both. The consultant advised her to have both of her breasts removed to avoid the risk of developing cancer in the future. She must also consider surgery to remove her ovaries to reduce the risk of ovarian cancer. Ovarian and breast cancer runs in her family and that preventative surgery will reduce her risk of developing the Cancer. In such circumstances, is it permissible to remove those parts of her body because of the high risk she faces?

 

الجواب حامداً و مصلياً

In the name of Allāh, the Most Gracious, the Most Merciful

Answer

Preserving ones health by curing an illness is part of our Islamic teachings. Every Muslim has the right to remove harm from them-self especially if such a harm is more likely to result in a greater harm.[1] Based on the information gathered on the subject through reliable websites and talking to medical professions, BRACA1 are human genes that produce tumour suppressor proteins that help repair damaged DNA. When genes are mutated and don’t function properly, the damaged DNA are not repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer. Further sources suggest that women who suffer BRACA1 disorder are of greater risk of developing breast cancer compared to ovarian cancer (the chances being around 40% only).[2] This shows the strong connection between BRACA1 disorder and cancer, particularly breast cancer. The surgical procedure varies depending on the size of the tumour in the breast.[3] Hence as a preventative surgery, parts of the breast tissues are removed so to prevent the cancer developing in the breast. Where the risk of ovarian cancer increases then her ovaries are then removed.

From the Islamic legal perspective, Muslim Jurists have allowed severing a defective limb as a necessity if the illness found in the limb is likely to spread throughout the body. Likewise, they have also allowed to surgically remove a harmful substance so to recover from an illness caused by it.[4] For the rule of necessity to apply, the potential harm must be near certain or strong probability (ghalaba dhann) that is based on sound knowledge from experts and that such surgical operation is necessary to prevent a greater harm.[5] This should be indicated by an existing illness that if not treated, then a greater harm is more than likely to ensue. Many scholars state that this expert advice should come from a Muslim profession, because of him being aware of the commands of Islām and being able to differentiate between Halāl and Harām.[6]

In the above such case, if the above condition of necessity is fulfilled then your wife, suffering from BRCA1 disorder putting her at a high risk of developing breast cancer, is permitted to undergo a surgical operation of removing some parts of her breast if this happens to be the only effective procedure effective in preventing cancer considering that the symptoms of the cancer have already begun. With regards to removing her ovaries, then it is permissible only if the risk of ovarian cancer is high like in the case with breast cancer otherwise not permitted.

 [Allãh Knows Best]

Written by (Mufti) Abdul Waheed

Answer Attested by Shaykh Mufti Saiful Islam

JKN Fatawa Department

[1] Ibn Nujaym, Al-Ashbah wan Nazair,  p. 72

أَصْلُهَا قَوْلُهُ عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ {لَا ضَرَرَ وَلَا ضِرَارَ} أَخْرَجَهُ مَالِكٌ فِي الْمُوَطَّإِ عَنْ عَمْرِو بْنِ يَحْيَى عَنْ أَبِيهِ مُرْسَلًا، وَأَخْرَجَهُ الْحَاكِمُ فِي الْمُسْتَدْرَكِ وَالْبَيْهَقِيِّ وَالدَّارَقُطْنِيّ مِنْ حَدِيثِ أَبِي سَعِيدٍ الْخُدْرِيِّ، وَأَخْرَجَهُ ابْنُ مَاجَهْ مِنْ حَدِيثِ ابْنِ عَبَّاسٍ وَعُبَادَةَ بْنِ الصَّامِتِ رَضِيَ اللَّهُ عَنْهُمْ.

[2] https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q17

https://www.cancer.gov/types/breast/patient/breast-treatment-pdq

https://ghr.nlm.nih.gov/gene/BRCA1

[3] The two known methods are Lumpectomy; preserves shape of the breast if the tumour is small, and Mastectomy; removal of the entire breast if the tumour is too large.

[4] Fatawa Hindiyyah, Kitāb al-Karāhiyyat, Bāb al-Jarahat Bani Adam, vol 5, p. 440 – Shamila

لَا بَأْسَ بِقَطْعِ الْعُضْوِ إنْ وَقَعَتْ فِيهِ الْآكِلَةُ لِئَلَّا تَسْرِيَ كَذَا فِي السِّرَاجِيَّةِ

لَا بَأْسَ بِقَطْعِ الْيَدِ مِنْ الْآكِلَةِ وَشَقِّ الْبَطْنِ لِمَا فِيهِ كَذَا فِي الْمُلْتَقَطِ.

وَلَا بَأْسَ بِشَقِّ الْمَثَانَةِ إذَا كَانَتْ فِيهَا حَصَاةٌ وَفِي الْكَيْسَانِيَّاتِ فِي الْجِرَاحَاتِ الْمَخُوفَةِ وَالْقُرُوحِ الْعَظِيمَةِ وَالْحَصَاةِ الْوَاقِعَةِ فِي الْمَثَانَةِ وَنَحْوِهَا إنْ قِيلَ قَدْ يَنْجُو وَقَدْ يَمُوتُ أَوْ يَنْجُو وَلَا يَمُوتُ يُعَالَجُ وَإِنْ قِيلَ لَا يَنْجُو أَصْلًا لَا يُدَاوَى بَلْ يُتْرَكُ كَذَا فِي الظَّهِيرِيَّةِ.

Zuhayli, Fiqhul Islami wa adillatihu, Nadwatu Hayat al-Insāniyyah, vol 8 p. 817

Surgeries with the purpose of treating congenital illnesses or those due to accident after birth to either restore the shape (of a defective limb) or the safe functioning of a limb for habitual use is permissible in the Shari’ah which the majority view as consistent with the ruling of treatment to restore a defect or fault occurred to a person that is harmful to the limb or body.   

[5] Zuhayli, Fiqhul Islami wa adillatihu, Kitāb al-Hadhr wal Ibāhat, Matlab Thalth-Halat Dharoorah, vol 3 p. 513

1 – أن تكون الضرورة قائمة لا منتظرة في المستقبل، أي أن يحصل في الواقع خوف الهلاك على النفس أو المال بغلبة الظن بحسب التجارب، أو التحقق من خطر التلف، لو لم يأكل، ويكفي في ذلك الظن، كما في الإكراه على أكل الحرام، فلا يشترط فيه التيقن ولا الإشراف على الموت، بل لو انتهى إلى هذه الحالة لم يفد الأكل ولم يحل الأكل كما صرح الشافعية.

[6] For more details of the condition of Dharoorah see Zuhayli, Fiqhul Islami wa adillatihu, vol 9 p. 429-32