Islam, Fatalism, and Medical Intervention: Lessons from Egypt on the Cultivation of Forbearance (Sabr) and Reliance on God (Tawakkul)

Article excerpt

Abstract

One of the most fundamental ways that religious devotion is held to be "anti-biotechnology" is in its emphasis on submission to divine will. This article seeks to re-orient discussions of religious "fatalism" through ethnographic analysis of terminally-ill dialysis patients in Egypt who argue that they would rather "accept God's will" than pursue kidney transplantation. I argue against the presumptions that this is a religious constraint on a potentially beneficial treatment, or that this reaction is merely a "comfort mechanism" to appease those without access to treatment. I argue that we should not think of people's perceptions of the amount of control they can exert over their lives in terms that would place analyses of social benefit and religious belief in opposing or even in discretely separate categories. I also demonstrate that, far from being passive, the disposition of accepting God's will must be actively cultivated through work on the self. [Keywords: medicine, Islam, Egypt, fatalism, bioethics, organ transplantation, illness, suffering, divine will]

This article draws upon fieldwork among poor dialysis patients in Egypt (2002-04) to revisit questions about fatalism and medical treatment. I analyze when and under what conditions devout Muslims in contemporary Egypt appeal to utter submission to divine will and when they seek particular medical interventions. The cultivation of steadfastness is highly valued in many religious traditions. Yet many historical accounts by European travelers and Orientalist scholars describe pious Muslims as "fatalists" for cultivating this disposition,1 a descriptor that has persisted in the contemporary Western media.2 It is critical to unpack the various implications of the charge of fatalism as well as the social realities that it masks for a better understanding of the practices of both Islam and biomedicine.

I argue in this article that the common formulation of passive Muslim fatalism grossly misunderstands the ways in which religious dispositions are embodied. Dispositions of acceptance of divine will are far from passive and must be actively cultivated. Further, such a disposition is not necessarily contrary to acting in the world. Whether and when to ultimately cultivate such a disposition is necessarily contingent upon how much control patients feel they have in the face of illness and other trials, and on whether they have any options that would really provide an appropriate "solution" that could be lived with medically, socially, and spiritually.

Among many Western observers, the Islamic theological premise that believers should utterly submit themselves to the will of their omnipotent Creator is taken to be a causal determinant of the way that Muslim adherents live their lives-the assumption, among polemicists, being that they are condemned to irrationality, with little incentive to work for social progress in this world. Not only is Muslims' supposed proclivity to fatalism said to be politically dangerous, but it is also imagined to be a major impediment to the development of scientific knowledge and to the reception of new technologies.3 If bad conditions are accepted as a sign of God's will, then why should the faithful develop the technological means to improve them? If illness is a test of faith, then should devotees not seek medical treatment?

Social scientists have generally had poor critical tools for analyzing how believers face and experiences these questions, particularly given the prevailing secularist presumptions in academia about human agency and the normative subject who transcends cultural norms and religious bounds (Asad 1993, Asad 2003, Mahmood 2005, Hirschkind 2006). Faith in divine will has often been interpreted as passivity, inaction, or false consciousness-a functionalist mechanism to alleviate poverty and suffering. Or, too often, religion is assumed to be a tool of manipulation by the powerful to keep the disadvantaged downtrodden. …