Civitas Blog

Whether, provided these conditions are met, a liberal democracy should have an established religion or state-funded faith schools are issues incapable of resolution by appeal to considerations of justice alone. Some, and I would count myself among them, would maintain that no liberal democracy can, in the long run, survive unless among its members is a widely shared belief in their moral equality that, ultimately, can only be grounded in, and therefore maintained by, faith in a transcendent benevolent Creator before whom all humans are equal and required to honour their moral equality in their mutual dealings with each other.

In debating matters of public policy within a liberal democracy, however, appeal to such transcendent considerations is neither needed nor desirable. It is not needed, for, within this political context, the moral equality of human beings is to be assumed, only its implications being at issue. Nor is appeal to such transcendent considerations that ground moral equality desirable, for not everyone will share the faith which ultimately sustains this egalitarian ideal. Liberal democracy within a pluralistic setting requires that all policy decisions be capable of being argued for and justified solely through recourse to a form of public reason, to use John Rawls’ term, in which there is no appeal to any transcendent values or metaphysical schemata.

All this is by way of preamble to consideration of the question of what special provision, if any, within a liberal democratic state such as ours should be made for the special needs of its different faith groups arising from their different faiths in relation to healthcare. This question is especially pressing, when, as has ours, its electorate has opted for a publicly funded healthcare system that, in the words of a Department of Health spokesman quoted in the Times today, ‘delivers healthcare according to clinical need, not ability to pay’.

Some would say, and I am of this view, that, where possible without undue disruption of medical routine, compromise of hygiene, or incurring undue cost, there is nothing a state-funded health service need do to accommodate the religious requirements of its patients within other than ensure any special dietary needs of theirs are met and that treatment is accessible to all regardless of their faith, and, so far as this is clinically and economicaly feasible, all patients have access to whatever they might need, whilst undergoing treatment, to be able to live in accordance with the precepts of their faith.

This is by no means enough for British Muslims, according to Aziz Sheikh, Professor of Primary Care, Research and Development in the Division of Community Health Sciences at the University of Edinburgh.

Writing in the current issue of the British Medical Journal (hat-tip: the Sun), Professor Aziz argues their equitable treatment within the NHS demands that it takes far greater account of the special needs that arise from the demands placed on them by their faith. He writes:

‘ Male infant circumcision should be available throughout the NHS. Although a handful of NHS trusts provide it, most parents are forced into the poorly regulated private sector. Hospitals also need to do more to accommodate Muslims in other ways. Many, out of a wish to maintain, modesty, may prefer to see a clinician of the same sex. Such choice is typically unavailable… in the NHS. Better access is required to prayer and ablution facilitie4s for patens and staff in many hospitals. And Muslim “chaplains” need to be established to provide spiritual care.

‘Another important service [that is currently not provided would] enable Muslims to avoid porcine and alcohol derived drugs… General practices should offer consultation before Ramadan and Hajj to inform their [Muslim] patients ..with long-term conditions how to modify their treatment regimens during Ramadan, and avoid the health risks associated with the Hajj pilgrimage to Mecca, which is a religious obligations (and not a holiday).’

Before commenting on how truly in accord with considerations of equity fulfilment by the NHS is of all or any of this wish-list, it is, perhaps, worth pointing out that, in a seemingly mandatory box at the end of BMJ articles requiring authors of articles in it to state any ‘Competing Interests’, Professor Sheikh, cites, as well as having been a former chairman of a committee of the MCB, his current status as principal investigator on a Scottish Executive supported grant to investigate the end-of-life care needs of South Asian Sikhs and Muslims in Scotland.

Beneath his article in which he calls for these additional measures from the NHS on behalf of fellow Muslims in the name of equity, there is a critical response to its proposals by a Professor Aneez Esmail, Professor of Primary Care at Manchester University who declares no special interests. In it, Professor Esmail offers to my mind the following cast iron objections to Professor Sheikh’s proposals:

‘Going down the path of providing special services for defined groups risks stigmatisation and stereotyping. This means that when we see someone with a Muslim name in a maternity ward we assume that she will need to pray five times a day, have special dietary requirements, and want to have her male child circumcised, We make no allowance for the fact that different Muslims conduct their lives in different ways.’

With equal perspicacity, Professor Esmail further observes that:

‘We cannot assume that religious identity is homogeneous. Members of the same religion are not all the same and their needs may be different. There are many sects within Islam that place different emphasis on many of the core tenets of the religion, and that they do not translate into the same requirements for faith based services.’

There is an important sub-text here which I shall not elaborate of which the authorities need to take great heed before proceeding one step down the road proposed by Professor Sheikh.

There is only one further point I should wish to add to what Professor Esmail writes. I find it odd indeed that, with all Professor Sheikh’s apparent concern on behalf of the special health needs of his co-religionists here, he fails to make one obvious suggestion that, at a stroke, would substantially improve their average life-chances and level of health. This would be for the state to ban marriage between first cousins something widely engaged in by British citizens of Pakistani origin, of whom virtualy all are Muslim, but the progeny of which are known to run a very great risk of serious congenital disorder.

Another step that easily could be taken to improve their health would be much their better education about the medical risks associated with smoking and chewing tobacco, not taking exercise, not eating regularly a substantial quantity of fresh fruit and vegetables, not to mention having large numbers of children whilst living on a low income. In relation to each and all these matters, there are large sections of the British Muslim community whose life-style is woefully remis from a health point of view.

Rather than go down the path Professor Sheikh suggests, my proposed set of health measures would have over his the advantage of being liable to improve their health prospects without rendering them vulnerable to coercion from conservative religious authorities in their own communities.