Ethical practice in psychiatry is underpinned by a secular, anthropocentric concept of autonomy. While this reflects the cultural heritage of the communities where modern psychiatry was developed, it might not be suitable for populations with different understandings of autonomy. This presentation outlines some Islamic cultural/ethical issues of particular relevance to decision-making in psychiatry.
First, the scope of autonomy is considered. Outside one’s personal relation with God, autonomy is secondary to community. A collectivity can only achieve salvation when the conduct of each member is aligned with the norms of the faith. Moral/social violations are not individual choices but a threat to this order, and therefore of concern for others. Shared responsibility for the actions of others renders decision-making a collective enterprise guided by figures of authority. This has implications for informed consent, confidentiality, privacy, and the duty of clinicians towards patients.
Second, the paradox of agency is considered. Action in Islamic theology is both predetermined and the full responsibility of the agent. Suffering, in a determinist theodicy, is foreknown to God and is a trial and expiation for sins. This may promote fatalism towards treatment. With a free-will theodicy, humans bring suffering upon themselves through their actions, and must take an active attitude towards relieving it. Deterministic attitudes complicate the clinician’s duty to relieve suffering within the available means, and render sharing information (e.g. about prognosis) irrelevant. The presentation concludes by asking whether and to what extent a clinician should abandon her secular ethical principles in favour of other religious or cultural ones.