Beginning of Life in Islamic (Scriptural) Sources

Investigating the Islamic perspective on any ethical concern begins with consulting the Qur’an and the Sunna (Prophet Muḥammad’s tradition), the most authoritative religious sources for Muslims (Brockopp and Eich 2008). The different schools of law (madhāhib) within the two main Islamic denominations (Sunnī and Shī‘ī) emerged due to the varying interpretations of these sources. When the main Islamic sources are silent on a certain issue, qualified religious scholars practice independent legal reasoning (ijtihād) and develop religious opinions (fatāwā) based on Islamic principles (Gatrad and Sheikh 2001; Ghaly 2012). Therefore, and in order to understand the different ethical perspectives on prenatal diagnosis and termination of pregnancy, it is important to start our review by presenting the main texts in the Qur’an and Sunna, which have laid the basis for all the ethical views, discussions, and debates on issues at the beginning of life, including prenatal diagnosis and termination of pregnancy.

In its twenty-third chapter, the Qur’an explains the journey of human life:

And indeed We created man from a draught of clay. Then We made him a drop [nuṭ fa] in a secure dwelling place. Then of the drop We created a blood clot [‘alaqa], then of the blood clot We created a lump of flesh [muḍgha], then of the lump of flesh We created bones and We clothed the bones with flesh; then We brought him into being as another creation [khalqan ākhar]. Blessed is God, the best of creators! Then indeed you shall die thereafter. Then surely you shall be raised up on the Day of Resurrection. (Qur’an 23:12–16)¹,²

The fetal developmental phases explained in this passage demonstrate the humble origins of the human being (Sachedina 2009). Importantly, they indicate that the creation of the human being remains a divine matter despite the seemingly scientific information presented in the passage (Atighetchi 2007; Sachedina 2009). This is evident in the Qur’anic term “another creation” (khalqan ākhar), which by itself formed the core element of Islamic thought about the beginning of human life (Atighetchi 2007; Eich 2009).

Religious scholars and interpreters of the Qur’an unanimously agreed that the development of “another creation” refers to the moment of ensoulment (Albar 2001; Badawī 2019). They also stress that this is the phase where the fetus starts to have a human shape (ṣūrat ādamī) (Eich 2009; Wizārat al-Awqāf wal-Shuʾūn al-Islāmiyya 1983). The moment of ensoulment distinguishes two fetal states, one with a soul and one without, according to which the moral status of the fetus is defined and different legal rights and rulings are applied (Atighetchi 2007; Rispler-Chaim 1993; Sachedina 2009).

The Qur’an, however, does not specify the timing of the moment of ensoulment. But this information has been provided by the Prophet Muḥammad in three main prophetic traditions (ḥadīths), all of which are narrated with a high level of authenticity, in Ṣaḥīḥ Al-Bukhārī and/or Ṣaḥīḥ Muslim.³

The first ḥadīth⁴ explains that after the drop (nuṭfa) has settled in the womb for forty or forty-five nights, an angel enters the womb and determines the destiny of the fetus as dictated by God. But this ḥadīth does not explicitly mention the moment of ensoulment. Nonetheless, the second ḥadīth⁵ states that ensoulment takes place 120 days after conception. The third ḥadīth⁶ explains that an angel is sent to the fetus forty-two nights after it has settled in the womb to give it a form and “create” its senses, skin, flesh, and bones.

According to these ḥadīths, ensoulment takes place forty, forty-two, forty-five, or 120 days after conception. Scholars have sought to analyze and reconcile these ḥadīths both metaphorically and literally (Al-Bar 1989; Ghaly 2012). The different interpretations and considerations have resulted in the existence of varying religious opinions among both early and contemporary scholars on issues related to the beginning of human life (Atighetchi 2007).

It is worth pointing out that religious embryology and the different developmental phases defined in the Qur’an and ḥadīth (drop–clot–lump) do not fully accord with the biological phases identified by means of recent technological advancements in medical embryology (Atighetchi 2007; Ghaly 2014; Sachedina 2009). Religious scholars, through the controversial genre called “the scientific miracles in Qur’an and Sunna,” sought to reconcile scientific data with religious texts to prove the existence of modern medical knowledge on embryology in scriptural texts centuries ago (Ghaly 2014; Guénon 2019).

In the same vein, some physicians, such as Mukhtar Al-Mahdi and Abd Allah Basalama, argue that the moment of ensoulment can be identified through the development of the fetal neural system. Interestingly, those physicians drew an analogy (qiyās) between the beginning and end of human life, saying that the functioning of the brainstem, which takes place around the twelfth week of pregnancy, marks the beginning of human life in analogy with (stem)brain death marking the end of human life (Ghaly 2012). Mohammed A. Albar (2001) also argues that the two timings of ensoulment mentioned in the ḥadīths refer to two different points in the development of the fetal central neural system; forty days marks the development of the brain stem, and 120 days marks the functioning and synapses between the higher and lower centers of the cerebrum. Yet, despite various reconciliation attempts, the prevalent Islamic position defends that the moment of ensoulment can only be known through revelation and conjecture (ẓann) (Atighetchi 2007; Eich 2009; Ghaly 2012).

Islamic Ethical Perspectives on Abortion

Islam holds that protecting human life (ḥifẓ al-nafs) is among the five higher objectives of Islamic law (maqāṣid al-sharī‘a) (Al-Bar and Chamsi-Pasha 2015). According to multiple scriptural texts, Islam equates the killing of a human with the killing of mankind, prohibits infanticide, and particularly warns its followers from killing their children out of fear of poverty (Qur’an 5:32; 17:31, 33; 6:151). The ethical question regarding abortion in Islam is thus not a question about the value of life per se but rather about when this value becomes absolute (Sachedina 2009). In other words, the question is about whether the obligation to protect human life starts prenatally, and whether respect for life is a supreme or determinative ethical principle that is also relative to other considerations (Bowen 2003).

Throughout history, Islamic scholars have unanimously agreed that abortion is not allowed after ensoulment except to save the mother’s health. Ensoulment thus has provided a decisive criterion for considering the obligation to protect human life. However, these scholars vastly disagreed on whether this would be after forty or 120 days from conception and whether there have to be compelling reasons for abortion (Al-Bar 1989; Atighetchi 2007; Bowen 2003; Khorfan and Padela 2010; Rispler-Chaim 1993; Wizārat al-Awqāf wal-Shuʾūn al-Islāmiyya 1983).

The Ḥanafī school of law were the most open towards abortion. The majority of Ḥanafīs tolerated abortion up to 120 days from conception, provided there is a valid justification. Some Ḥanafīs allowed abortion without the father’s permission, and a minority allowed it without a justification, as long as it takes place within the lapse of 120 days. By contrast, the Mālikīs were far stricter, and the majority did not tolerate abortion even within the first forty days of pregnancy. A minority, however, tolerated abortion within the first forty days, but even those still considered it reprehensible. Between these two poles lies the Shāfi‘ī school of law, who allowed abortion up to 120 days in the presence of valid reasons (except for Ghazālī (d. 1111), who prohibited abortion at any stage), and the Ḥanbalī school, who allowed abortion up to forty days at the request of both parents (Al-Bar 2021; Al-Khatib 2021; Atighetchi 2007; Bowen 2003; Eich 2009, 2021; Rispler-Chaim 1993; Sachedina 2009; Shapiro 2014; Stodolsky and Padela 2021; Wizārat al-Awqāf wal-Shuʾūn al-Islāmiyya 1983; Yaseen 1996). At the same time, the majority of Shī‘īs tended to prohibit abortion at any stage during pregnancy, apart from the Zaydī sect, who permitted abortion until 120 days from conception (Al-Awqāf al-Miṣriyya, n.d.; Atighetchi 2007; Bagheri and Afshar 2011; Sachedina 2009) (see Table 3).

Although some jurists permitted abortion with minor restrictions, Albar (2001,1989) explains that the majority did not allow abortion without strong medical or social reasons. Notably, there exists a remarkable heterogeneity in opinions towards the permissibility of abortion for reasons other than those pertaining to the health of the mother (Shapiro 2014). Attention has been mainly directed to the mother’s health, since she is the established life upon which the health and the survival of the fetus rely (Al-Bar 1989; Hedayat, Shooshtarizadeh, and Raza 2006; Sachedina 2009). Therefore, abortion was permitted to save the mother’s life and physical or, at times, psychological, health (such as in the case of rape and incest). Abortion was also permitted to save the life of an existing suckling infant whose parents cannot afford a wet nurse, according to the Hanafī school. Anyhow, abortion was exclusively considered for reasons other than the fetus itself.

The reason for this exclusion is mainly due to uncertainty in identifying the presence of fetal health problems, not least the presence of the fetus itself (Al-ʻAwwārī 2010; Al-Matary and Ali 2014; Al-Qaḥṭānī 2003; Badlis and Kashnit 2019; Jabr 2007; Sachedina 2009).

Islamic Ethical Perspectives on Termination of Pregnancy due to Fetal Anomaly

In light of recent medical advancements in fetal imaging, prenatal diagnosis, and gene sequencing, which reveal highly accurate information about the health of the fetus, traditional considerations for abortion have had to be revisited. As mentioned before, the resolution of such ethical issues, on which the Islamic sources are silent, is left to qualified religious scholars who are called upon to practice ijtihād. Currently, this is done through transnational fiqh organizations (such as the Islamic Fiqh Council, the International Islamic Fiqh Academy (IIFA), the Islamic Organization for Medical Sciences (IOMS), and the Islamic Medical Association of North America (IMANA)) in the form of collective legal reasoning (ijtihād jamā‘ī), where religious scholars, together with medical professionals, discuss and issue rulings on ethical matters (Brockopp 2008; Ghaly 2012). The rulings of these organizations are authoritative and respected because they are grounded in Islamic sources (Gitsels-van der Wal, Manniën, Ghaly, et al. 2014).

Against this backdrop, a major shift in abortion fatwās occurred in 1990, when the Islamic Fiqh Council in Mecca passed a fatwā in its twelfth session that pays particular attention to fetal health and anomalies. The fatwā states that termination of pregnancy is permissible before the lapse of 120 days from the moment of conception if the fetus is severely malformed with an untreatable condition that will be present at birth and cause pain and suffering for the child and their family. This has to be proven by a committee of competent and trustworthy physicians on the basis of clinical examinations and laboratory findings and following the request of both parents. Termination of pregnancy after 120 days remains unlawful even if the fetus is malformed, unless it is proven by the committee that the continuation of pregnancy will cause definite danger to the mother’s life (IFC 1990).

The significance of this fatwā lies in relaxing the approach towards abortion in the case of fetal anomaly. Previous fatwās—in Saudi Arabia—allowed abortion only in the first forty days from the moment of conception. This forty-day limit may work for families who are aware of their genetic risks and undergo prenatal screening very early. However, it certainly does not work for others who are not at high risk or do not suspect being so, since it is almost impossible to ascertain congenital diseases within this period (Albar 2002; Rispler-Chaim 1999).

Similarly, IMANA (2005, 20) issued a statement and provided specific examples of fetal anomalies that justify termination of pregnancy:

Fetal congenital malformations in which abortion can be sought and is permitted are lethal malformations not compatible with extrauterine life such as bilateral renal aplasia, trisomy 13, 18, etc. But even in these situations it is preferable to do it before the 120th day after fertilization or 19 weeks of gestation,⁸ calculated from the first day of the last menstrual period. In non-lethal malformations such as severe hydrocephalus, cervical meningomyelocele, chromosomal aneuploidies and unbalanced translocations, abortion may be permissible before the 120th day of conception after consulting Islamic scholars and medical experts in the field.

Furthermore, in Iran, where law conforms to Shī‘ī principles, the Single Article Act of Therapeutic Abortion (2005) authorizes abortion for a wide range of fetal and maternal conditions before nineteen weeks of gestation. The act states that the consent of the pregnant woman, a definitive diagnosis of a profound fetal anomaly (developmental or physical) or a life-threatening maternal disease made by three medical specialists, and the permission of the Legal Medicine Organization have to be obtained for termination to be legal (Hedayat, Shooshtarizadeh, and Raza 2006; Mahdavi et al. 2020).

The European Council for Fatwa and Research (ECFR 2018), Jordan’s Board of Iftaa’ (1993), the Committee of Fatwa in Kuwait (Atighetchi 2007), the Mufti of Egypt (Muhammad 2012), former grand imam of Al-Azhar Jad Al-Haqq (Al-ʻAwwārī 2010; Badlis and Kashnit 2019), and the well-known scholar Yusuf Al-Qaradawi (Al-Qaradawi 1994; Al-Shawabka 2019; Badlis and Kashnit 2019) also issued similar fatwās. While all of them shared the core idea of the permissibility of termination of pregnancy due to fetal anomaly prior to ensoulment, some differences between these fatwās exist. For instance, Al-Qaradawi allowed the termination only within the first forty days of pregnancy (Rispler-Chaim 1999; Shapiro 2014). Similarly, the Committee of Fatwa in Kuwait allowed abortion within the first forty days, but tolerated termination of pregnancy between forty and 120 days when certain serious, untreatable physical or mental anomalies exist (Atighetchi 2007). The rest, however, permitted the termination up to 120 days.

According to several scholars (Al-Alaiyan 2014; Al-Matary and Ali 2014; Haidar et al. 2015; Sachedina 2009), terminating pregnancy due to fetal anomaly is ethically justified based on the principle of no harm (lā ḍarar). Remarkably, the Saudi Council of Senior Scholars made an explicit reference to this principle in its fatwā (no. 240 dated January 16, 2011). The fatwā refers to the principle of no harm mentioned in the following Qur’anic verses: “He has chosen [for] you and has placed no hardship for you in the religion” (Qur’an 22:78); “No soul is tasked beyond its capacity. Let no mother be harmed on account of her child, nor father on account of his child” (Qur’an 2:233). In this context, Abdulrahman Al-Matary and Jaffar Ali (2014) explain that Islam does not expect its followers to endure harm, nor does it intend to inflict difficulties upon them.

Furthermore, this latter fatwā, the fatwā of Al-Qaradawi, and others also refer to the principle of necessity (ḍarūra) (Al-Alaiyan 2014; Al-Shawabka 2019; Haidar et al. 2015; Rispler-Chaim 1993). According to Qur’an 2:173,⁹ any unlawful act becomes lawful in the case of necessity (i.e., when any of the higher objectives of sharī‘a is threatened). A closer look into these fatwā shows that this principle justifies terminating pregnancy to save the mother’s life but not in the case of anomalous fetus (Sachedina 2009).

A more relevant principle that justifies the termination of pregnancy due to fetal anomaly, argues Abdulaziz Sachedina (2009), states that preventing harm has preponderance over advancing benefit (daf‘ al-ḍarar ’awlā min jalb al-maṣlaḥa). Likewise, Saleh Al-Alaiyan (2014, 2) explains that diagnostic and therapeutic medical interventions, such as prenatal diagnosis and the termination of affected pregnancies, “can be expected to result in a greater balance of benefits over harms for the child or person the fetus can later become.” Accordingly, he argues, any attempt to understand the anomalous fetus as a person in terms of independent moral status should be abandoned.

It is worth mentioning that some Muslim scholars still prohibit the termination of pregnancy due to fetal anomaly even before ensoulment (among them are the renowned scholars Muhammad Said Al-Buti and Misbah Al-Mitwalli Hammad). This group defends the sanctity of human life regardless of the existence of anomalies and argues that termination of pregnancy transgresses this sanctity. They also consider fetal anomalies part of God’s will and wisdom, which should be accepted in any case. Additionally, they argue that allowing termination of pregnancy for fetal anomaly is a slippery slope that may lead to the misuse of abortion for unwanted pregnancies (Al-ʻAwwārī 2010; Al-Barbari 2021; Al-Shawabka 2019; Badlis and Kashnit 2019; Bowen 2003; Jabr 2007).

Islamic Ethical Perspectives on Prenatal Screening and Diagnosis

According to the previously mentioned fatwās, the termination of pregnancy for fetal anomaly should take place prior to 120 days from the moment of conception. For Muslims, the possibility of obtaining diagnostic information early in the pregnancy is thus of vital importance (Haidar et al. 2015). It allows Muslims to consider all possible options, including termination of pregnancy, in a timely manner (i.e., before the moment of ensoulment). To that end, the different prenatal diagnostic methods play an important role in the timing of the diagnosis, hence, some elaboration on those methods is due.

Prenatal screening and diagnosis comprise a number of tests performed at different stages during pregnancy. Distinction has been made between noninvasive prenatal screening and invasive prenatal diagnostic procedures. Noninvasive screening include biochemical screening of maternal blood, ultrasounds, and noninvasive prenatal testing (NIPT) using cell-free fetal DNA found in maternal blood. Current technologies in NIPT offer early screening for the most common chromosomal abnormalities, such as trisomy 13, 18, and 21 and X/Y syndromes (Levy and Stosic 2019; Strom 2022). Latest advancements in NIPT also allow the identification of some smaller anomalies that cause single-gene disorders. The major advantage of NIPT is its ability to detect a number of disorders as early as nine weeks of gestation with a quite high accuracy, and without the risk of miscarriage usually associated with invasive procedures. However, to date, confirmatory invasive tests are still required (Di Renzo, Meyyazhagan, and Tsibizova 2023).

Invasive diagnostic tests can identify nearly all known genetic conditions and are performed at a later point in the pregnancy, typically during the second trimester between twelve and twenty-one weeks of gestation. Invasive procedures include amniocentesis (fifteen weeks), fetoscopy, chorionic villus sampling (CVS) (ten to twelve weeks), and percutaneous umbilical blood sampling (eighteen to twenty weeks). Notably, CVS has a relatively higher risk of miscarriage compared with the other invasive procedures, but at the same time, it has the advantage of providing diagnostic information about six weeks earlier than the other procedures, thus allowing earlier decision-making (Levy and Stosic 2019; Shulman, Dungan, and Wagner 2022). In the near future, invasive testing may be completely replaced by noninvasive prenatal diagnosis (NIPD), which does not require access to the uterus or the confirmation of invasive procedures (Hui 2019). Currently, available NIPD is limited to cases of preidentified genetic risk of monogenic diseases. Yet, and despite the technical challenges, ongoing research suggests that NIPD has the potential to diagnose a wide range of disorders through noninvasive whole genome sequencing using cell-free fetal DNA found in maternal blood (Scotchman et al. 2023).

In principle, Islam encourages the prevention of diseases rather than only curing them (Albar 2002) and welcomes scientific research and technologies that offer knowledge and help prevent the transmission of diseases to future generations (Rispler-Chaim 1999). According to Albar (2002), Mohammed Ghaly (2008), and Al-ʻAwwārī (2010), a number of Islamic teachings surrounding marriage and reproduction concentrate on preventing hereditary diseases. Albar (2002) argues that prenatal screening and the termination of affected pregnancies are among the reproductive options capable of preventing and managing a wide variety of genetic diseases.

Prenatal diagnosis of fetal anomalies needs to fulfill a number of conditions to justify termination of pregnancy from an Islamic perspective. According to the aforementioned various fatwās, the diagnosis first has to be confirmed by a committee of competent, trustworthy physicians. A number of fatwās, such as the Saudi Council of Senior Scholars’ fatwā and the Iranian Act of 2005, specify that the number of physicians in this committee should be at least three (Al-Alaiyan 2014; Mahdavi et al. 2020). Second, the diagnosis should either confirm fetal incompatibility with extrauterine life and/or the certain death of the child within a short period of time after their birth, or the existence of an anomaly that will result in the suffering of the affected child and a poor quality of life. Third, the diagnosis, and consequently, the termination, should be done before the lapse of 120 days from the moment of conception. Finally, both diagnosis and termination requests should come from both parents (IFC 1990; IMANA 2005; Jordan’s Board of Iftaa’ 1993; Sasongko et al. 2010).

Prenatal diagnosis is intrinsically linked to the abortion debate. While abortion has been extensively debated in Islam, all religious scholars, the lenient as well as the strict, agree that the gravity of abortion at any point prior to ensoulment is less than that of abortion after ensoulment (Atighetchi 2007; Sachedina 2009; Wizārat al-Awqāf wal-Shuʾūn al-Islāmiyya 1983; Yaseen 1996). Here, it becomes critical for Muslim women to undergo prenatal tests and have their diagnostic results confirmed before the time limit of 120 days from conception (nineteen weeks of gestation) (Al-Matary and Ali 2014; Gitsels-van der Wal, Manniën, Ghaly, et al. 2014).

Considering this time limit for Muslims in antenatal care is, in fact, life-changing. Al-Matary and Ali (2014) argue that the prolonged suffering by the mother, disabled child, and family at large resulting from not performing prenatal diagnosis, and consequently, termination of pregnancy, in a timely manner, can be completely avoided if attention is paid to religious considerations in antenatal care. In support of this argument, a study shows that about 7 percent of abortion requests in Iran were rejected only because of late referrals (gestational age of more than nineteen weeks), repeatedly resulting in devastating scenarios that could have been prevented (Mahdavi et al. 2020). Other evidence suggests that not performing in a timely manner prenatal diagnosis and termination of pregnancy for anomalies incapable of surviving birth has the potential to increase maternal morbidity and even mortality (Al-Matary and Ali 2014).

Islamic Ethical Perspectives on Disability

Prenatal diagnosis is also fundamentally linked to the question of disability. Ghaly (2008) explains that Islam neither views disabilities as a blessing nor a punishment; they are simply a human condition. Still, Islam emphasizes that the disabled must be treated with respect, integrated into society, and comforted with love and care (Ghaly 2008; Rispler-Chaim 2019). Veardit Rispler-Chaim (2019) states that Islamic law promotes the acceptance of disabled people and views disability as something that can be handled with medicine, while allowing for certain exemptions, but in no way should disability lead to discrimination in duties and rights in Islam. This has also been confirmed by the IIFA in its resolution on the rights of people with disabilities. Importantly, in this resolution, the IIFA (2015) encourages research that benefits the disabled and emphasizes the need to do “everything possible” to reduce the causes of disability, such as premarital examinations and vaccination. Remarkably, however, the resolution does not refer to prenatal diagnosis and termination of pregnancy as methods of reducing disabilities, despite its focus on the importance of treating and preventing disabilities.