Intended for healthcare professionals

Education And Debate Ethical dilemma

Sharia punishment, treatment, and speaking outSupporting sharia or providing treatment: the International Committee of the Red CrossLearning to express dissent: Médecins Sans Frontières

BMJ 1999; 319 doi: (Published 14 August 1999) Cite this as: BMJ 1999;319:445

Sharia punishment, treatment, and speaking out

Humanitarian aid organisations may face situations which challenge their guiding ethics and principles. Amputations after convictions under sharia law, in countries such as Afghanistan, have posed just such a problem. Should the aid organisation continue to provide health care, including treatment to the person who had been punished, or would this make it complicit in a practice that it sees as contrary to human rights? The conclusions and the actions taken by the International Committee of the Red Cross and Médecins Sans Frontières differ, as outlined in these two accounts. But the ethical bases of their positions are remarkably similar.

Supporting sharia or providing treatment: the International Committee of the Red Cross

  1. Pierre Perrin, chief medical officer (
  1. International Committee of the Red Cross, 19 Avenue de la Paix, 1202 Geneva, Switzerland
  2. Médecins Sans Frontières, Max Euweplein 40, PO Box 10014, 1001 EA Amsterdam, Netherlands

    In 1997 an Afghan surgeon who was being paid by the International Committee of the Red Cross but who was working in a Ministry of Health hospital was taken by the local authorities to a marketplace. There he amputated the hand of a person who had been convicted under sharia law. Following an appeal by the international committee to the Taliban authorities, an agreement was eventually reached that ensured that neither hospitals assisted materially by the international committee nor staff paid by it would be involved in this practice.

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    Subsequent requests made by the authorities to the assisted hospitals to provide an ambulance or surgical instruments to perform public amputations were refused. Many of the international committee's personnel working with and training Afghan staff were health professionals from Western countries and they faced a dilemma in treating people brought to hospital after having suffered an amputation under sharia. Did treating these victims constitute offering support to a process of torture or cruel and degrading treatment, or was it treating a patient in need of urgent surgical care?

    Examination of relevant laws and standards of medical ethics

    These dilemmas forced the International Committee of the Red Cross to examine its position on corporal punishment, its field operations, …

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