The Ḥakīm – Akhlāq and Ādāb of the Physician in Islam

Modern medical ethics as an independent discipline emerged in Europe only around 1803, when Thomas Percival coined the term “Medical Ethics” in Manchester.¹ Yet what the West celebrates as a nineteenth-century innovation had long been a mature body of teaching in the Islamic world. As early as the ninth century, Muslim scholars were composing systematic works on the Akhlāq and Ādāb of the physician.²

Akhlāq and Ādāb: Two Sides of One Coin

Akhlāq denotes inner character, the virtues of the soul, that is, who the physician is before God: his sincerity, humility, mercy, patience, and God-consciousness.³

Ādāb, by contrast, describes outward conduct, professional etiquette, that is, how the physician presents himself: his manner with the patient, his dress, his speech, his discretion, the ordering of his day.⁴ Together the two shape the virtuous physician, the Ṭabīb Fāḍil.

Two Pioneers at the Forefront

Ādāb aṭ-Ṭabīb by Isḥāq ibn ʿAlī ar-Ruhāwī (9th century)

Hailing from Ruhā, present-day Urfa, the physician ar-Ruhāwī composed in Ādāb aṭ-Ṭabīb the world’s first systematic work on medical ethics, roughly a thousand years before Percival.⁵ He structured his treatise along three relationships: the duties of the physician toward the patient, toward himself, and the duties of the patient toward the physician.⁶

A key passage captures his stance with precision:

Akhlāq aṭ-Ṭabīb by Abū Bakr ar-Rāzī (Rhazes, 865–925)

Ar-Rāzī, among the greatest clinical physicians in history, addressed his treatise Akhlāq aṭ-Ṭabīb to his students.⁸ In it he emphasizes the inner disposition:

Medicine as a Collective Duty in al-Ghazālī and Ibn Qudāmah

Alongside these two dimensions of virtue, Imām al-Ghazālī reminds us in his monumental Iḥyāʾ ʿUlūm ad-Dīn that medicine belongs to the Farḍ al-Kifāyah of the Umma, a collective duty. Should it go unfulfilled, the entire community stands in sin.¹⁰

Ibn Qudāmah al-Maqdisī (d. 1223) supplies the converse of this duty in his work al-Mughnī: accountability through competence.

Medical competence, then, is not a merely technical demand but a moral and religious obligation.

The Qurʾānic Foundation

The Qurʾān lays the ethical foundation for both dimensions, Akhlāq and Ādāb:

And on the sanctity of the life the physician is charged to protect:

To this we add the well-known saying of Imām ʿAlī ibn Abī Ṭālib:

And Today? The Physician Between Billing and Decency

Anyone who reads this classical ideal quickly feels the gulf that separates it from today’s reality. The contemporary physician labours under pressures ar-Ruhāwī and ar-Rāzī would not have recognized: economic pressure, time pressure, staffing shortages, a system in which the patient no longer stands at the centre, only the billable code does. Diagnoses become codes, human beings become cases, treatments become revenue.

From this arises a creeping erosion of physicianly virtue. Decisions follow billing logic rather than medical indication. In the staff room, patients are gossiped about, colleagues picked apart, nursing staff derided. Empathy gives way to brusqueness; listening, to mere processing. The patient is no longer seen as a human being entrusted to us by Allah, but as a machine to be repaired, or worse, as merchandise meant to yield a return.

Much of this is systemic and afflicts the individual physician through no fault of his own. Yet it is precisely here that the Islamic tradition speaks: the system does not absolve one of personal responsibility before God. Taqwā, Iḥsān, and Naṣīḥah are not luxuries for quiet times; they are demanded most urgently when everything around us pulls in the opposite direction. The physician who, despite the ten-minute slot, truly looks his patient in the eye; who does not gossip the moment the door closes; who refrains from billing a service because it was not medically necessary, that physician lives Akhlāq and Ādāb in the year 2026.

The Ḥakīm, Responsibility in Three Directions

All of this converges into a single, encompassing concept: the physician’s responsibility in three directions, before God, before society, and before himself.

This is what we call the Ḥakīm, the wise physician, who unites his faith with his knowledge and serves his fellow human beings. Not a mere technician of the body, but a person whose heart fears God, whose character radiates mercy, and whose hands serve every seeker of help with competence, justice, and discretion.

For healing itself comes from Allah alone, ash-Shāfī. The Ḥakīm does not heal. He strives, through his knowledge, his character, and his fear of God, to become worthy of being an instrument in His hand.