A doctor misdiagnosed a patient’s illness after making an effort to identify the disease, and based on this incorrect diagnosis, he gave the patient the wrong medication, resulting in the patient’s death.

The questioner : In this question, it seems to be from a doctor, meaning...

The Shaykh: All right.

The questioner : It is Dr. Adnan Hamadah. He says, “My Shaykh, the error resulting from medical treatment can be classified into two types: A: An error in diagnosing the disease, and consequently giving inappropriate medication. This error usually occurs after the doctor has made an effort to identify the disease.”
B: An error in giving inappropriate medication that is not given for this disease by the consensus of doctors. The question is: If this error, in either of its two types, leads to the patient’s death, does this fall under accidental killing? And what is the consequence for the doctor in both cases, whether regarding the rights of people or the rights of Allah (Blessed and Exalted is He)?

Another questioner : Is that the second part?

The questioner : The one that is an error in giving inappropriate medication that is not given for such a disease by the consensus of doctors? ... Let us repeat, my Shaykh, paragraph by paragraph. He says, “My Shaykh, the error resulting from medical treatment can be classified into two types: A: An error in diagnosing the disease. The doctor diagnosed the disease incorrectly, and based on this, he will give inappropriate medication because he made an incorrect diagnosis. And as the doctor says here, this usually occurs after the doctor has made an effort to identify the disease. He made the effort to find and diagnose the disease, so he diagnosed it after the effort, but it was an incorrect diagnosis. Based on this, he gave a treatment that does not suit the patient’s actual disease?”

The Shaykh : The answer.

The questioner: Yes.

The Shaykh : His saying (peace and blessings be upon him): This serves as an answer to the following question. The following question is: If he gave a treatment and this treatment was the cause of his death! Is that not so?

The questioner : ... An error in giving inappropriate medication that is not given for such a disease by the consensus of doctors. The question is: If this error, in its first and second types, leads to the patient’s death?

The Shaykh : I say the hadith is a dual-effect answer, in its explicit wording and its implied meaning. From a non-doctor, he is liable. So this is like accidental killing, do you understand? As for the one who is a doctor and makes a mistake, he is not liable because he is a doctor and not a quack.

The questioner : Yes, my Shaykh, in the viewpoint you raised, in the viewpoint customary in international courts and medical courts, there is something called in English “negligence,” meaning that the doctor performed a wrong action.

The Shaykh : Do not say “wrong action,” say “error.”

The questioner : A wrong action, an error in terms of diagnosis or treatment, and consequently his wrong action, the error, led to minor or severe complications, or led to death. All these complications, in their origin, started from the doctor’s deviation from the correct diagnosis due to lack of knowledge or lack of follow-up. And there is a doctor who tried his utmost to reach the diagnosis but could not, so he gave treatment based on his majority opinion that this is the disease and this is the treatment, and consequently it led to similar complications, which may be minor, moderate, or severe, or lead to death. So the two differ. The first, in the medical ruling, there is no doubt about the punishment around him, which is unintentional killing, unintentional killing, but he is punished. The second doctor...

The Shaykh : Punished with what?

The questioner : Punished, my Shaykh, for example, if there is a killing, if the deceased died, if the treated person died.

The Shaykh : This is the worst example. Punished with what?

The questioner : If there is a death penalty in that country, the intentional killer is... for the doctor here, it is considered manslaughter, meaning unintentional, accidental killing, not intentional, he has no design to kill, whatever happens.

The Shaykh : No problem, no problem. This question is understood from what was explained previously...

The questioner : He is imprisoned.

The Shaykh : He is imprisoned.

The questioner : Mostly imprisonment. In fact, if the killing, if the complications reached the stage of death, there is imprisonment. This is in the case of negligence, lack of follow-up, not following the diagnosis.

The Shaykh : This is not the first one, this is the second one.

The questioner : This is the first one, my Shaykh.

The Shaykh : But Abu Yahya, what he is saying is that he was negligent; the negligent one in your previous words is the second one!

The questioner : Oh Shaykh, from a medical perspective, for your sake, I put a point that there is no such thing as negligence. I say in the second example, he is not negligent, no negligence is attributed to him. He tried hard to get out, he tried hard to reach the diagnosis, and then he treats that disease according to his diagnosis.

The Shaykh : I understood that this is the first one, may Allah reward you.

The questioner : No, my Shaykh, this is the second one. The first one, my Shaykh, that one made a mistake by first trying to close the abdominal wall after the surgical operation without checking if there was a piece of cloth or scissors...

The Shaykh : So I made a mistake, no problem!

The questioner : This punishment is considered a punishment if the patient dies, it is accidental killing.

The Shaykh: All right.

The questioner : The second one tried hard to diagnose the disease but could not, my Shaykh, to reach the precise diagnosis, and this happens to many doctors or most of them. Consequently, he reached the conclusion that the disease is that and the treatment is that, and he gave the treatment and the patient died. This one has nothing on him, although the point I noticed, the point you put down, my Shaykh, is that there is negligence. Where is the negligence, my Shaykh?

The Shaykh : Where is the negligence?

The questioner : Here there is negligence, my Shaykh, regarding...?

The Shaykh : The second one, according to your expression, has no negligence.

The questioner : No, there is no negligence, rather he tried hard.

The Shaykh : No, I... Yes?

The questioner : ... Unclear speech... A doctor or not a doctor.

The Shaykh : But. However, I had the opposite in my mind from what you alerted me to recently. I thought that the first one in your classification was the one who exhausted his effort without negligence, and it turned out to be exactly the opposite. The first one is the one who was negligent in your last explanation. The second one performed his duty completely, with all effort, but he made a mistake in the treatment, and the consequence of this mistake and that mistake was the death of the patient. Let us now repeat, according to your explanation, the second doctor who exhausted his effort but did not hit the disease with his medication, rather he increased the disease, and the consequence of that was that this one died. He has no responsibility at all legally, and I say with pride that this law is taken from our religion, from the previous hadith. But the first one, you mentioned an example, the first one’s image is that he was negligent, he was negligent, meaning he did not follow up the research and effort. So he is undoubtedly, according to the Shari'ah, now I say he is wrong, not mistaken. He is wrong because he is negligent. Like this wrongdoer, like many scholars in the past and students of knowledge in the present, when they exert effort and are not qualified for independent legal reasoning, they are held accountable, unlike the scholar who exerts effort and makes a mistake, who is rewarded with a reward. So these legal rulings in reality represent true justice, which they call in the terminology of the modern era social justice. There is no social justice in Shari'ah justice, because social justice adapts to the adaptation of societies, and societies differ greatly. It is enough for you to know a democratic, republican, communist society, and so on. But true justice is Shari'ah justice, and it is not permissible to deviate from it at all. So the two doctors you described, the second of them is the one indicated by the implied meaning of the hadith its implied meaning, its explicit wording includes the one who is not a doctor and does not include the first doctor because he is a doctor, but the one it includes is that he did not exert effort, so he fell short in effort, so he is undoubtedly held accountable according to the Shari'ah.

The questioner : Does he have an expiation, my Shaykh?

The questioner : My Shaykh, but there is a point here to clarify the brother’s question.

The Shaykh : Please.

The questioner : He suggested, we said the first one worked ignorantly and made a mistake, the second one...
The question for the honorable doctor says that he diagnosed a patient and prescribed a treatment, which harmed the person who took it, and by the agreement of the doctors, this man’s initial diagnosis was wrong. I just want to make a note here, meaning the question should be asked of the doctor so that we do not hold him accountable. It is possible that he asked, and they said, for example, yes, it is possible that the majority of doctors who hear this diagnosis and this situation in his treatment would say that he may have made a mistake. This is not a ruling, because we are supposed to know what his specialty is. For example, if he is a general practitioner and he clarified that, he is punished. For example, he enters a field...

Another questioner : Regarding the treatment, not regarding the diagnosis. He diagnosed.

The Shaykh : Read it again, read it again.

Another questioner : It was a mistake to give an inappropriate medication that is not given for such a disease, by the agreement of the doctors.

Another questioner : I mean, this is known by necessity that a patient like this should not take such a thing, so he gave it... He criticized, he criticized that this man is ignorant in this science because he is not aware... I want to say that medicine in general and doctors in general say that giving him this medication is ignorance, so he gave it, and this is an indication of his ignorance. That is how I understand the question.

The questioner : You are right, but I have a point I want to inquire about. The doctor who posed the question: do you think the person who performed the diagnosis and gave the treatment, which the doctors agreed he got wrong, is a general practitioner or a specialist? If he is a specialist, it is very different. If he is a specialist, then the accountability is valid without any doubt. If he is a general practitioner and the specialists said he made a mistake, he remains a general practitioner, so he is not held accountable for his work. I wanted to clarify this regarding the issue.

Another questioner : You are interfering in what does not concern you.

The questioner : My Shaykh, it is not... I mean, he...

The Shaykh : You are interfering in what does not concern you! The issue he has been talking about since morning is reversed!

Another questioner : Oh my Shaykh, this is a student of knowledge! He issues fatwas.

The questioner : A general practitioner. What is the original status? There is a small part here. We took general medicine, and it tells you that I have the right to do anything I learned as general medicine. The specialty is a specific part taken from medicine: eyes, nose, throat, larynx, and others. We know that. But I mean, if this man is a general practitioner and wants to hold himself accountable, I wanted to direct the matter from the perspective of our Shaykh, in fact, to answer him. If he is a general practitioner, my Shaykh, and he made a mistake, and despite the ruling of the specialist doctors, he made a mistake and it was not necessary for him to do this, then he is not held accountable, my Shaykh, because this is the limit of his knowledge. Just as I speak in religion and hadith, and you hear me, and I think to myself about a hadith I studied, that I understood the whole science, even though I only understand a simple thing. But if he is a specialist doctor, for example, a specialist doctor who ruled on that disease, and by the agreement of his specialist colleagues, they said he made a mistake, here he is held accountable, because this man is not following, and he does not know what medicine is, and he is bad as a doctor. If the majority of doctors say this disease is treated with that treatment, and he says something else, then consequently, my Shaykh, in my opinion, it is certain that if he is a general practitioner, and my strong suspicion is that he is a general practitioner, then this doctor is not held accountable, even if he did it intentionally, because originally, scientifically, originally, scientifically, we are now in a thing called a specialist in gynecology and obstetrics. The association fights and battles the female doctors who perform deliveries at home. The medical law in our country, Jordan, does not prevent that. And I qualified from the very beginning to perform a delivery as a general practitioner, so you cannot prosecute me. Why do you deliver? You cannot. But whom do you prosecute? You prosecute the doctor who comes to do an appendix operation, and he is not a surgeon. An internal medicine specialist performing a surgical operation... You prosecute him. Or you prosecute a surgeon who knows he is a surgeon and performed an appendix operation, which in the opinion of all doctors is a very simple operation. He caused new complications, and instead of cutting the appendix, he cut the cecum and the large intestine. Here you know that this man made a mistake. But if a general practitioner performed it, by the medical judgment, and the most likely case here is the treatment...

The Shaykh : Well, some questions arise here!

The questioner : He is not held accountable, oh Shaykh.

The Shaykh : If we leave the picture: the specialist doctor was found to be wrong by the general practitioner. Is this the same ruling?

The questioner : No, oh Shaykh, it differs completely. The doctor... First of all, he must be qualified. I mean, when I come, I judge in the science of hadith. I do not verify, because I do not know. I do not have the ability to verify in that. But as you mentioned, a general practitioner wants to come...

The Shaykh : I was upset, so what can you say?Abu Layla : He needs to see the rattle, it is...

The questioner : Is it possible that the general practitioner, my Shaykh, says that the specialist doctor may have made a mistake in his judgment on that case? It is very possible in his opinion. Or is he qualified to judge me? He is not qualified, and consequently, he does not judge me.

The Shaykh : Why is he not qualified? And regarding the specialist doctor, he was a specialist. Regarding the general practitioner, meaning the specialist does not know general medicine. So when he treated a patient like a general practitioner, he fell into error. So the general practitioner judged the specialist that he made a mistake because you exceeded your specialty.

The questioner : No, oh Shaykh, may Allah reward you with good. Originally, everyone studies general medicine. The first degree, the original, meaning the specialist doctor has gone through the stage of general medicine.

The Shaykh : But is that enough?

The questioner : ... He went through the stage of practice, the stage of general medicine. It is not enough, my Shaykh, that he only took it and then went to the specialty. He must enter the stage of practice in general medicine. So if he entered the stage of practice in general medicine, my Shaykh, he chose the track he wants.

The Shaykh : But there is something here.

The questioner : And consequently, he cannot, my Shaykh, judge the specialist doctor.

The Shaykh : There is something here. This practice is enough for him to equal the general practitioner who practiced to get the degree, and then practiced the profession practically for many years. Are they equal, for example?

The questioner : In the opinion of my Shaykh, but...

The Shaykh : Please go ahead.

The questioner : My Shaykh, in medicine, even in the specialty, until you reach a high stage of the general practitioner, even if he acquired experience, my Shaykh...

The Shaykh : Even if what?

The questioner : Even if he acquired knowledge, intelligence, treatment, and precision in diagnosis with time and experience. The specialist doctor, my Shaykh, even in gynecology, we study lessons about joint pain in specialized medicine. We study about heart diseases in specialized medicine. We study about diseases... We study about skin diseases in specialized medicine. Why, my Shaykh? We study them because if a woman, a gynecological patient, the woman is susceptible to many diseases... But my Shaykh, the point I want to say, which you mentioned, you say, my Shaykh, that the practicing general practitioner with experience may be able to judge. This is possible if he is intelligent, if he has breadth in knowledge, and by looking, he may be able to criticize. But is the criticism of his criticism possible? Can his judgment be accepted in the medical community? It is not accepted, my Shaykh, because the angle he looks from is a very simple angle, and it is simple. No matter how far the general practitioner reaches, his scientific level is weak and his knowledge is weak...

Another questioner : The research, I see it is not specific!

The Shaykh : Not what??

Another questioner : It is not specific because its generality appeared, we cannot reach a result.

The Shaykh: Perfect.

Another questioner : We must focus on the issue, the path of the research. Meaning, did the specialist or the expert doctor speak or give treatment outside his specialty or not? Here the comparison becomes correct, right?

The Shaykh : Very good.

Another questioner : But if it was a specialist doctor who gave treatment or diagnosed a disease in his specialty, he is certainly assumed to be more knowledgeable, aware, and practiced than the general practitioner. But if we want to ask a question so that the results appear: if the specialist in gynecology treated and gave treatment to a patient, let us say, in another field, in the eyes.

The Shaykh : In what??

Another questioner : In the eyes.

The Shaykh : In the eyes.

The questioner : So the question now is simple and valid: which one is more capable of this treatment? The general practitioner, who among the things he treats are popular and non-popular diseases, because until now the medical... specialized, or the specialist? The question that imposes itself: the specialist must be more aware and knowledgeable than the general practitioner in his specialty.

The Shaykh : Even in the eyes? ...

Another questioner : Because now he is specialized in gynecology ... women ... it is possible if a woman is in postpartum bleeding at a moment ... these are consequences of the matter, but we are speaking now of the precise specialization of the case. Also, on the other hand, the general practitioner may discover a practice, and through his exposure to various medical cases, he may become skilled as well. Therefore ... the comparison is actually incomplete for a reason, and I want to add here, 'Isa, when his leg ... he had a specialist friend, a very senior specialist, and they said, "I ... so and so." He gave him a blood-thinning medication, diagnosing the condition theoretically and giving the medication that is commonly agreed upon by everyone to be beneficial. But the medication did not help, even though that man was a specialist, because a bulletin came out now stating that this medication is only beneficial, for example, in certain cases. So this skilled specialist ... was ignorant, or it had not reached him, or he was not informed that this medication, despite its common use, did not benefit him.

The questioner : This is a scientific event, O Shaykh.

Another questioner : Allow me. The comparison is what should not actually be taken, because the self-evident assumption is that the specialist is skilled in his specialty and should be referred to, because he has passed the stage of general medicine; he practiced a little, but he specialized more and more, whether in knowledge or in practice in this field, so he is the one to be referred to.

The Shaykh : Let us see where it ends up!

Another questioner : Now, your question was whether, if the general practitioner contradicts ... because the general practitioner said that the specialist made a mistake. If it is not in his specialty, meaning if he is criticizing him in his specialty, then it is assumed that his words are not to be relied upon, because you are not a specialist and have not studied this field. The criticism should be directed by specialists like him in his field. But if it is the reverse now, then this question becomes, to some extent, of a type that is acceptable, that ...

The Shaykh : This is my question in the first place!

Another questioner : This is your question, and my answer, or my ijtihad in this, is that in the same specialty, the specialist is referred to and his opinion is taken, and the general practitioner is not relied upon. If it is the reverse now, that the specialist wants to criticize a general practitioner in his diagnosis and treatment and so on, what does Dr. 'Isa say? He says that the specialist did not become a specialist until he was a general practitioner and practiced so and so ... and we do not differ with him in this statement, because it is the truth, and these are scientific experiences, meaning life experiences, that the doctor who becomes a specialist, and a very specialist, will forget much ... of the others if he does not follow up and read and see what the medications are regarding other specialties. So he becomes distant, and perhaps one general practitioner who follows up and reads books and reads bulletins ... and has contact with pharmacists, and has skill, and Allah, the Exalted, has given him a type of precision in diagnosis, so the abundance of cases, because medicine also has ... like ... of the cases that have come to you, your knowledge of the current disease for children!

The Shaykh : This is correct.

Another questioner : So in my estimation, there is no precise scale, but a law ... protects the general practitioner, because he is originally licensed to practice the profession of medicine in general.

The questioner : My Shaykh, on one point ... put a question that I am afraid that the one who asked the question will fall into sin and letter with himself in the punishment of the conscience, which is called the punishment of the conscience ... meaning he erred religiously in the right of the patient who gave him ... so I really care about the doctorThe questioner : The point is the doctorThe questioner : The doctor matters to me too, that he clarifies points for our Shaykh from a medical perspective.

The Shaykh : May Allah reward you with good.

The questioner : Our Shaykh, I noticed that here, for example, doctors judged, they said fifty doctors or the majority of doctors who heard the story that this doctor may have made a mistake. But my case, when I showed it to the one with the American Board, and the Board is the high American certificate, if we asked the majority of doctors in Jordan, not one of them ... in the bulletin that came out a month ago, this medication is given to thin the blood and to prevent the wound, but scientifically it was proven in a new research center in America that this medication is not beneficial unless there is an abnormal valve, but if there is a normal valve, it is not beneficial. So, if the new information that was obtained were discussed, just if a general practitioner brought it and said there is information, they would say to him, "You are stupid, this is not correct." But because it came from a research center of specialists ... it is acceptable. So in the original matter, my Shaykh, the majority said that the treatment, the treatment is undoubtedly a trust. Taking the treatment, you take the treatment without benefiting, my Shaykh, and what is in it!

The Shaykh : Did harm occur?

The questioner : Yes, naturally, my Shaykh ... the clot increased, meaning I was taking medication.