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• Conscientious objection by Muslim students to the cross-gender consultation startling
  Michelle McLean
  Published on: 17 December 2012

• Published on: 17 December 2012

  Conscientious objection by Muslim students to the cross-gender consultation startling

  • Michelle McLean, Professor, Medical Education

  I read Robert Card's recent paper entitled "Is there no alternative? Conscientious objection by medical students" with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five and half years (2006-2011), and, to the best of my knowledg...

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  I read Robert Card's recent paper entitled "Is there no alternative? Conscientious objection by medical students" with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five and half years (2006-2011), and, to the best of my knowledge, even in the conservative, gender-segregated traditional Muslim culture of the United Arab Emirates, not once did a male or female student refuse to examine a patient of the opposite sex.

  Several issues, many of which have been described by Padela and del Pozo,2 should be taken into consideration in relation to Muslim students' conscientious objection to the cross-gender consultation on religious grounds. Although Islam prohibits touching or physical contact by the opposite gender, unless appropriate (e.g. by a spouse), in some circumstances, the "prohibited becomes permissible".3 Medicine is one such circumstance. Islam does not preclude a doctor from examining the opposite gender where a same gender physician is not available or in life and death situations.2-6 Islam recommends first a same gender Muslim physician, followed by a same gender non-Muslim and, failing their availability, a Muslim of opposite gender, and lastly an opposite gender non-Muslim doctor. 3,5 In cross-gender consultations, however, Muslim women generally need to be accompanied by a same gender third party.3-5 The ancient literature on medical care attests to the possibility of and necessity for cross-gender examinations. In the eighth century, Ibn Quaddama wrote that it was permissible for a male doctor to inspect whatever parts of the woman's body warranted during the medical examination.4 Similarly, Ibn-Muflih stated that "A man doctor may inspect the awra of a women's body as far as the medical examination warrants if only a male doctor is available to treat her, even if he has to look at her private parts. The same would be true if a man is ill and there is but the woman doctor to treat him. She may inspect his body even his private parts" (p. 3).4 Furthermore, this literature attests to the need for Muslims to seek the most qualified practitioner for their medical treatment. Some 600 years ago, Ibn Qayyim Al Jawziyya wrote in The Prophetic Medicine that Muslims should seek the best authority in each matter and field because such expertise will ensure that the task is done with excellence.7 Implicit in this hadith (narrative originating from the words or deeds of Prophet Muhammad) would be the need to consult an opposite gender physician if he or she was the most qualified. The insistence of modern Muslim patients for the same gender physician or for Muslim medical students conscientiously objecting to the cross-gender consultation is interesting considering the Islamic history of medicine during Prophet Muhammad's life. During that time, the medical corps comprised "lady healers" or asiyaat, who were responsible for treating wounded soldiers, irrespective of the injuries. Cross-gender medical care was established during the battles of Badr and Uhud, and so according to the Prophet's tradition, the rule governing covering of areas of the body was waived in the interest of medical treatment.3,4

  During interviews with final year male and female clerks about the cross-gender consultation in a society (United Arab Emirates) where women are generally not free to travel without a member of their mahram (non- marriageable male chaperone), some female students (more so than their male colleagues) had initially been apprehensive about touching a male body. Their mutawa (religious leader) reassured them that as medical students, they had to treat both male and female patients and were therefore allowed to touch males. From this study, it also emerged that although students became more "comfortable" with cross-gender touching in the clinical consultation, Emirati female patients in Obstetrics and Gynecology and Emirati male patients in Urology often refused male and female students, respectively. As little has been published in this regard, a group of local female students surveyed Emirati women's attitudes towards male and female medical students as well as canvassed their physician preference. While their general preference was for a female student or physician, other factors such as physician certification and patient education impacted on what parts of the body the women would or would not allow a male student or physician to examine.8,9

  As I indicated at the start of my response, it was startling that Muslim students in America could conscientiously object to the cross- gender consultation. This is difficult to reconcile how Muslim students living in a conservative, gender-segregated and traditional Middle Eastern society were able to accept that in Islam medical care should supersede religious teachings and how Muslim students living in a Western country do not share the same understanding.

  References 1. Card RF. Is there no alternative? Conscientious objection by medical students. J Med Ethics 2012;38:602-4. 2. Padela A, del Pozo PR. Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective. J Med Ethics 2011;37:40-4. 3. Aldeen AZ. The Muslim ethical tradition and emergent medical care: An uneasy fit. Acad Emerg Med 2007; 14(3): 277-8. 4. Hathout H. The male gynaecologist. Medical examination of the other sex. 1986. http://www.islamset.org/bioethics/obstet/examin.html (accessed 21 November 2012). 5. Hedayat KM, Pirzadeh R. Issues in Islamic biomedical ethics: A primer for the pediatrician. Pediatrics 2001;108: 965-71. 6. Hammoud MM, White CB, Fetters MD. Opening cultural doors: Providing culturally sensitive healthcare to Arab American and American Muslim patients. Am J Obstet & Gynecol 2005;193: 1307-11. 7. El-Qadar A. trans. Ibn Qay'em El-Jozeyah on The Prophet Medicine, 2007. http://www.islamhouse.com/p/51834 (accessed 21 November 2012). 8. McLean M, Al Ahbabi S, Al Ameri M, Al Mansoori M, Al Yahyaei F, Bernsen R. 2010. Muslim women and medical students in the clinical encounter: A United Arab Emirates study. Med Educ 44:306-15. 9. McLean M, Al Yahyaei F, Al Mansoori M, Al Ameri M, Al Ahbabi S, Bernsen R. 2012. Muslim women's physician preference: Beyond Obstetrics and Gynecology. Health Care Women Internat 2012;33:849-76.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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