When a man is in pain but the law blocks treatment

Amy Hasbrouck

• Last Updated: May 28. 2008 10:12PM UAE / May 28. 2008 6:12PM GMT

No one would dream of withholding a wheelchair from a paralysed person. In fact, Article 10 of the United Arab Emirates’ Law Number 29 of 2006 Concerning the Rights of Individuals with Disabilities stipulates that individuals with disabilities are entitled to medical services including evaluation, treatment, surgery, medications, rehabilitation services and specialised equipment. Yet there are people in the UAE with physical and mental disabilities who are denied access to the treatment they need to function on a daily basis.

Take first the example of an expat I met who works in Abu Dhabi – we’ll call him Roger – who has osteo-arthritis in his spine. Roger is a 50-something engineer whose condition has been slowly worsening over the past 10 years. He explained that, while the pain in his back is manageable during the day, when he is sitting or standing, lying down makes it unbearable. He can sleep for no more than two hours before the excruciating pain wakes him up, and he has to sit for at least an hour until it subsides. This obviously makes getting a full night’s sleep – and working effectively the next day – impossible.

In his home country, Roger tried many ordinary pain relievers, none of which were effective. At last Roger’s doctor prescribed a medication called oxycodone (also known as Oxycontin), which is in the same family as codeine. Taken in small doses, it enabled him to sleep for up to four hours at a stretch. Though he still has to get up a couple of times at night, he is able to get enough sleep to function during the day.

The problem is that oxycodone, a widely-used pain reliever in Europe and North America, is derived from opium, and is thus illegal in the UAE, under Federal Law Number 14 of 1995, the narcotic and psychotropic medication law. Roger cannot get a prescription for oxycodone here – his doctor explained that he would have to have a terminal illness to use such a medication. So, Roger has become disabled, not so much by his back pain as by a Government policy that forbids him from using a treatment that works.

The same policy that deprives Roger of effective pain medication also prevents people with mental health problems from having access to the full range of effective drugs. Most psychiatric medications are strictly regulated, and some are not available at all in the UAE, such as anti-depressants including Lexapro (escitalopram oxalate), and monoamine oxidase inhibitors (an older anti-depressant still used by people who cannot use the new class of medications known as SSRIs).

The 2006 statute concerning people with disabilities calls for “any provision contrary to this law” to be repealed (Article 38). This sets the public policy of protecting the rights of people with disabilities against the priority of controlling access to psychoactive and addictive drugs. This policy, in turn, reflects the tension in Islam around pain and medical treatment.

On the one hand, the Prophet Mohammad encouraged medical treatment, saying that “Allah did not send down any disease but He also sent down its cure”. According to Sheikh Muhammed Salih Al-Munajjid on his website, “Islam Question and Answers”, (Fatwa Number 2148), the giving of medication “is obligatory in cases where not giving medication could cause death, disability or the loss of a limb…”

This coincides with the progressive medical treatments developed in the Muslim world beginning in the 9th century. During that era, Muslim scholars, scientists and physicians advanced medical knowledge by translating Greek, Indian and Persian medical texts, organising and cataloguing the information, then increasing their understanding through rigorous scientific experimentation. They introduced hospitals, nursing, dentistry, anaesthetics (including the use of opium and cannabis), surgery, pharmacology, and many other practices that preceded Western science by 1,000 years.

On the other hand, the Prophet stated that pain and misfortune were an expiation of sin, and so Muslims should endure pain with patience. There also exists in Islam a prohibition against altering the body, which is the creation of Allah. Finally, Muslims may not use a medical treatment that is haraam; “Whatever causes intoxication in large amounts, a little of it is haraam.”

This ambivalence, set against the backdrop of current medical science and practice, is bound to generate tension for an Islamic society seeking to modernise and accommodate the many Europeans and North Americans working here.

While it seems unwarranted to repeal Law No 14 of 1995, the two statutes – and the underlying policy issues – must be reconciled. The Ministry of Social Affairs (which is responsible for implementing the 2006 law) should consider amending the narcotic and psychotropic medications law, or issuing regulations to make it possible for people with all kinds of disabilities to get effective treatment to mitigate the effects of physical and mental conditions that, untreated, limit their ability to function as productive members of society.

Amy E Hasbrouck is a lawyer and disability rights advocate living in Abu Dhabi.