 Aseem will be speaking on the topic of organ donation among Muslim communities, reading interventions through the lens of applied Islamic bioethics. Good evening. It's a pleasure to be here to round out the near end of a long marathon. I want to try to keep it short today and give you an overview of a few concepts, hoping that we can have an engaged discussion at the end. So thank you Mark and Peter for the introduction. I'd like to talk to you a little bit about Muslim communities and Islamic bioethics. So I'm going to give you a snapshot of organ donation attitudes amongst Muslim communities. I'll introduce just two concepts related to Islamic bioethics. The first being that judgments and Islamic law are non-binding. Judgments and Islamic law are called fatawa or fatwa singular. So they're non-binding. That's the first concept. The second concept is that there are different types of Islamic scholars, that they're not just one monolithic body. So two of those different scholars I would call one academic and the other spiritual. And that will be important because at the end of that, at the end of this talk I'm going to talk about organ donation interventions that have been done amongst the Muslim communities in light of these two concepts. So to begin our snapshot view of the Muslim world and organ donation, there was a few studies done in the West. The first one here was done of an internet survey done of Muslims living in the UK, the United States, and Canada. They had an N of 891 and they assessed a lot of different measures. One of them was around organ donation attitude. And in this study they found that only 39% believed organ donation was compatible with Islam. And they had several measures of religiosity. Predominantly it was about intrinsic religiosity. So how important is Islam in your life? And they found that individuals who had a higher level of intrinsic religiosity were less likely to hold positive views for organ donation. Building upon this, I did several studies in Michigan where I was before I went to the University of Chicago. And one of them was a population-based representative survey of Arabs residing in three counties in Michigan. We had about 1,000 people in this survey. We found that Muslims as opposed to Christian Arabs were 1.5 times less likely to believe that deceased organ donation was justified. And we controlled for socioeconomic factors, education factors, language factors, healthcare access issues. This was an independent predictor of negative attitudes. I wanted to see how prevalent this was amongst Muslims who are not of the Arab ethnicity. So we did mosque-based sampling with South Asian Muslims as well as African American Muslims. And in that group we did a very small pilot survey and we found the same finding that 55% believed that deceased organ donation is not justified. So I'm going to just give you one or two data points from Saudi Arabia which may be considered to be a very Muslim country, a very conservative. Interestingly enough, Saudi Arabia has the largest organ transportation program in the Middle East. If you include Iran and Iran, they vibe with each other on how big they are. So survey done in Riyadh. Riyadh is a very cosmopolitan city within Saudi Arabia, with South Asians as well as Indigenous Arabs over there. I made a survey from a health clinic where they found 56% believed that Islam permitted donation. So it was 56%. You would think it would be much higher given that they had a huge transportation program within Riyadh itself. They did a survey of high school students in Riyadh, 830 students. Here the minority, less than half, 42% believed that Islam permitted organ donation. So this is just a snapshot, but in general when you look at the dozens of studies that have been done within Western countries, Western contexts as well as those within Muslim major nations, you find that Muslims are less likely to support organ donation. This is just supporting by lip service. To give you an idea of what happens in the United States, there are some advocacy groups that say 90% of the United States population supports organ donation and 57% would be willing to donate. Now we don't know how that attitude willing to donate translates to will donate, but at least they give lip service to the fact that they support organ donation. And many believe that it's ethically justified. Muslims, on the other hand, have this problem where they don't know if it's compatible with Islam or it's ethically justified, and they are less likely to sign a donor card. So this is the empirical evidence where people suggest there's an independent Muslim factor. In my own study I found this is an independent predictor of negative attitudes towards organ donation. Hence, interventionists think, well, Islam might be the barrier towards organ donation. So this empiric Muslim reality begets a theological intervention. This is the second part of my talk. And before I get there, I would like to point out that these studies have had an impact upon the discourse, the popular discourse around Muslims and organ donation. So this first headline, organ donation describes Wales Muslims. So currently there is a, I think there is a bill in the parliament to have an opt out policy. Where in Wales you will be assumed to have presumed consent for organ donation, but the Muslim community there is adamantly against this. I actually got an email this week about it, asking me to kind of write something to the parliament there. So this is the headline from there. We have this issue in Egypt. This was several years ago where there was the Egyptian, the previous Egyptian government had felt that the poor Muslims in Tanta, which is a small city in Egypt, were being taken advantage of by Christian businessmen. That was the context. So they would come and buy their organs, give them money, and they would do transplants. So they wanted to ban this. But the headlines that came out was that Egypt seeks to ban Christian Muslim organ transplants. Like there was some religious issue here, but we didn't want to have organs go across religious boundaries, as opposed to this socioeconomic issue that was at hand. We have this here in the Netherlands. I'll just look at the last paragraph. So the Dutch health minister says, if you say I refuse to donate an organ because of my religion, but I don't want to receive one either, then I'll respect it. But I won't respect the one-sided attitude of receiving and not giving organs. I find that problematic. So they had found in a small survey in several cities that Muslims were less likely to donate, but they didn't see that they were less likely to receive. And hence they said, well, this is a problem. Why will Muslims receive organs but not donate? And this is a survey that was done in many different countries around different religious groups. And the headline of that survey in the news media was that Muslims are the most opposed to organ donation. I mean, comparing to Christians and Jews, the Muslim population, when they say they are affiliated with Islam, are most likely to oppose organ donation. So there is a social political climate that this data plays into. So the second part of my talk, we'll look at Islamic scholars here who look at organs in the body and they decide whether or not the Muslim community should become repoments where they take organs from one and give to another. Before I get into this idea of Islamic law and Islamic bioethics, I want to put this up there. And the reason you're going to read this from the right to left is because the Arabic script goes from right to left. And I sometimes forget which language I'm speaking in and I want to make figures that come from right to left. But in any case, there you have Islamic law, which is based on a revelation of the Qur'an, which is believed in the holy book, and the sunnah, the sayings of the prophet. So you get normative values that come from these two textual sources. And then you have things that are part of mankind's sort of, we can call them, ethical moral character. So when Islam judges upon something, the law system judges upon something, either comes out of these sources and you can simply be part of law. They have ethical, moral content, positive law. Or you have things that reside within the common humanity and then the revelation confirms them as positive values. So this is how normative values come out from the tradition. In the case of Islamic bioethics, you have other data here in the blue boxes here, blue figures here, from clinical practice, social science, the medical sciences, contemporary discourse around philosophy and bioethics and health policy, which all give data to these scholars of law to come up with judgments around Islamic bioethics. So simply what happens is that you have either a singular scholar who is a textual expert of the law who looks upon the data from the clinical practice or other quality sciences and issues of legal ruling. You can have many of them. Or they sit together in a council and they come together to some sort of consensus statement and again they issue a fatwa, which is the first concept of Maranjijan to know about. So a fatwa is a non-binding legal opinion. You can have many different legal opinions. They all are considered to be the same and equally right. And these fatwa are taken up by three primary audiences. One would be the patient themselves or the health care institutions that take care of most of the patients and the idea that you want to provide culturally sensitive and appropriate care. So what does the religion say about XYZ? The second audience or consumer are Islamic scholars, second level scholars who have researched the opinions and offered their own advice to the Muslim patient or provider population or academic researchers, which is myself, who look at this material as part of the religion and science discourse. And the third primary audience would be physicians themselves or health care practitioners who want to understand the boundaries of their medical practice in light of Islamic ethical and moral discussions. So I'm just going to look at the medical literature here and what they say about organ donation. Now bear in mind, as I presented to you, the Muslim communities are more likely to have negative attitudes. So the question is, what does the law say? Well, the legal system here, the end line here and the results that I snipped out here, I hope you can read it, says that all fatwas, all 70 fatwas that this group looked at allow for organ donation and blood transfusion. They did not find a single one that said that it's not permissible. These include five former grand muftis of Egypt and the Saudi senior alumna council, the Islamic Fiqh Academy of the Organization of Islamic Conference and the European Council for Fatwa and Research. However, there's also a minority view that declares it impermissible. Some of them only restricted to living donation. Others say both living and dead is impermissible. And the reasons they do that, let's be on the scope of this talk, is they're privileged human dignity and they're unsure whether brain death is death or is it legal death in Islam. They decide not to judge around organ donation. So there was no change even 10 years after of any of the organ donation attitudes in the Muslim population nor was there an increase in donor rates from the Muslim community. So the question is why? So I'm going to, for a moment, look at this paradigm of Islamic scholarship per second. So you have a scholar here who's sitting at his desk. He's reading a lot of texts from religious sources and he's thinking about what are the root values or the normative values in Islamic law? How does that apply to organ donation? He's an academic, what we call an almi scholar in Arabic. He's trying to figure out what God wants us to do. What are the textual sources, the Quran and the prophetic statements? What do they say about us in action? On the other hand, you have another scholar who might be a teacher at an Islamic school or a Sunday school who might be the imam at a mosque and gives a sermon on Fridays. He might be a chaplain who takes care or gives counsel to patients in the hospital. He's what I would call an Islahi scholar. Someone who's concerned with the spiritual warfare of the community. His goal in life is to encourage people to care about what God wants you to do. So on one hand you have this can I do something from Islamic law? On the other hand, should I have an inner disposition to want to do what God wants me to do or what God says is permissible? And I think this sort of idea here, if I play it out in the contemporary theories around health behavior change, I will become clearer. So at the end here, you want someone to sign a donor card or donate their organs. What the theory of planned behavior says is that the most proximate predictor of someone doing an action is their intention to have that action. So 50% of individuals have intention to do something will end up doing that thing. So what you want to intervene upon is to have people form an intention to do something. And there are three components to forming an intention. They say the attitude, someone's overall attitude towards donating organs of various different beliefs, but they have some to become an overall attitude towards something. The subjective norm, which is how individuals who are important to you view you're doing the action. So in this case, our organ donation, which is so important to me, be there my mother, my sister, my wife, my religious leader, my whoever, how do they believe, what do they think about my donating organ? And the third component towards forming an intention is perceived behavioral control. So if I want to do something, in this case I want to sign an organ donor card, do I believe I have control over doing that? Am I empowered and have agency to do that? So these are the three components of forming an intention. And the most behavioral intentions work at the subjective norm component. So in the end, I think there are clear implications for Islamic biotics interventions. First, that these Islahi scholars, or the locally MAMS, must be involved. The second is, and I think this is the issue for me when I think about these things, there's a pluralistic theology in Islam. All Fatah are equal. If they're all equal, then should we really be promoting organ donation? I'm going to skip over this for a second. To give you two snapshots from my own interviews of religious leaders in the community. And this is what they said. So about the idea of using religion to promote a health good. I think using religious venues and sharing common values is okay. So going to the mosque and encouraging women to get mammograms and prostate exams to get colonoscopies, that's totally cool. When you go to the next step, being said, Allah, God wants you to get a colonoscopy, I get nervous. That's not my understanding of my religion. And then we talked to someone who was involved with healthcare chaplaincy and said, you know, the only time they come to me, meaning the healthcare team, is to encourage the patient to do the procedure if the doctor says to do it. So the only time they involve me is when they want me to have the patient do something that they think is right. And I think this is a challenge for when we bring religion into the healthcare system. I believe that we should have a more responsible ethics. Healthcare response should be in this idea of our organ donation to promote informed choice. Not co-opting religion for medical end. And it might be reasonable to have Muslims who think about their choice and decide not to have organ donation. Thank you.