Analysis of Bvt Practices by Traditional Practitioners from Islamic Ethics Perspective

Bee venom therapy (BVT) is one of the ancient traditional treatments. BVT is believed as capable to cure a variety of diseases despite of having significant negative impacts upon its usage. However, the BVT method has raised questions as Islam forbids the killing of bees as a result of getting its venom, as well as the use of venom as a treatment method. Therefore, this study was conducted to examine the BVT practices from the standpoint of Islamic ethics. Data collected through a triangulation of document analysis and unstructured interviews with three BVT practitioners. The findings found two major ethical issues of BVT. First, the practitioners are not aware that killing bees is contrary to Islamic ethics and the BVT should be the last option to be used if there is no other treatment works for the diseases. Second, several practitioners are not qualified to carry out medical procedures due to the lack of medical knowledge and unawareness about the risk of the treatment for a certain group of people. Therefore, this study suggests BVT practitioners, especially Muslim to follow Islamic ethics when performing BVT to reduce any possible risk.


Introduction
Bee venom therapy (BVT) has been used in Eastern traditional medicine since 1000 to 3000 B.C. It is an alternative medicine approach which is applied through direct bee sting or injection of bee venom (BV) that has been extracted by an electric stimulus. At the outset, the use of BVT is based on the fact that beekeepers (who often get stung) are very rarely suffering from arthritis or troubles with their joints and muscles (Zhang et al., 2018). The BVT method is also increasingly popular as it is claimed as capable to cure critical illnesses such as cancer and HIV (Oršolić, 2012).
However, honey bees that commonly used in BVT will die right after stinging their prey. This is because honey bees have a barbed stinger that will stick to the skin after it stings. The barbed stinger is connected to a part of the bee's abdomen that will be pulled together as it attempts to escape from its sting. Such injuries would cause bees to die (Steen et al. 2005). This method of treatment raises questions as Islam forbade the killing of bees, as per mentioned in two hadiths of the Prophet (al-Bukhari, 1422H;Ibn Hanbal, 2001). Therefore, since there are Muslim practitioners of BVT in Malaysia, this study will examine the practice this therapy according to their perspective and analyse it from the ethical standpoint of Islamic treatment.
From the perspective of previous studies, the study focused on the potential and negative impacts of BVT treatment, which can be seen through (Zhang et al., 2008;Ali, 2012;Köhler et al., 2014). However, the present study differs from previous studies where it will examine the BVT treatment method performed by traditional medical practitioners in Malaysia and analyse it from the ethical point of Islamic treatment.

Ethics of Islamic Treatment and Methods of Bee Venom Therapy
Ethics is derived from the Greek word 'ethos' which signifies behaviour that is determined by attitude and custom. Ethics is something related to human actions, whether right or wrong, good or bad (Daud, 1996). In Islam, ethics is a human behaviour that is accepted as the norm, as long as it does not violate Islamic law (Khairuldin et al., 2019;Asni & Sulong, 2018). According to Sahad and Asni (2018), ethics is the guideline for determining good and bad behaviour.
From the ethical point of Islamic treatment, Islam does not prevent any traditional treatment as long as it does not against the rules of the religion (Asni & Harun, 2020). Thus, Muslims can be benefited from medicines that are based on halal sources which include both traditional or modern methods (Shaharom, 2008). However, there are a few substances that are prohibited by Islam for the treatment purposes; they include illegal and impure (najis) substances such as blood, carcasses, pigs, dogs and liquids or alcohol (Shaharom, 2008). Treatment that might cause harm and risk to life are forbidden in Islam. Besides, the ethics of Islamic treatment also proposes to leverage modern medical knowledge and current data (Gatrad & Sheikh, 2001).
For the Islamic view of using animal venom as a treatment such as in BVT, the original law is illegal based on the hadith of the Prophet (PBUH) which emphasises on whoever drinks (benefits) the venom, he is killed by the venom, then the venom will be by his side on the Day of Judgment and he will drink it at hell for an indefinite period (al-Bukhari, 1422H). But, if it can be proven that venom can cure the disease, then it has the exception of the Islamic law where most scholars including Hanafi, Maliki, Shafi'i and Hanbali allowed its utilisation (Ibn Qudamah, 1405H). This indicates that the Sharak law allowed venom to be part of a therapy, as long as the procedure is getting the approval from medical professional (Al-Mubarakfuri, n.d.).
There are three methods of BVT, namely live bee sting, BV injection and BV acupuncture (BVA) (Zhang et al., 2018). The live bee sting belongs to traditional BVT, which is the most commonly used in China and Korea. It is applied by inserting a live bee sting apparatus and the venom sac directly into the patients' skin. After the insertion, the embedded stinger continues to inject venom into the muscle due to the autonomous repetitive contraction of the sting apparatus (Zhang et al., 2018). However, scientists found that this method might increase the risks of serious allergic reactions. BVT can lead to several risks due to factors such as age, allergies and lack of advice from a medical professional. Therefore, to adopt the BVT method, these factors must be taken into account (Park et al., 2015). For this reason, BVT is a traditional method that differs from modern medicines that are produced by following the stages of disease, age and sophisticated scientific methods (Vazquez-Revuelta & Madrigal-Burgaleta, 2018).

Methodology
As a qualitative study, the researchers collected the data through a mix of document analysis and interviews. The document analysis was accomplished by analysing books and articles related to ethics in Islamic treatment. Then the finding was used to construct a structure for the field study. For the empirical side, the researchers have interviewed three Muslim BVT practitioners using the purposive sampling technique, and classifies them as practitioners A, B and C. The interviews were conducted to obtain the detailed information of BVT treatment methods (Etikan et al., 2016;.

Result and Discussion
Generally, the study found two major ethical issues of BVT; first, the practitioners are not aware that killing bees is contrary to Islamic ethics and the BVT should be the last option to be used if there is no other treatment works for the diseases. Second, some of the practitioners are not qualified to carry out medical procedures due to the lack of medical knowledge and unawareness of practitioners upon the risk of treatment towards certain group of people. a. The practitioners are not aware that killing bees is violating Islamic ethic since bee is one of the four animals that is forbidden to be killed in Islam. The Prophet (PBUH) prohibited the killing of four kinds of animals, namely ants, bees, hud-hud (bird's name) and surad (bird's name) (Ibn Hanbal, 2001). Due to these restrictions, BVT should be the last option if there is no other treatment that capable to treat diseases. This is in line with the view of Islamic scholars such as al-Nawawi (n.d.) that bees are kept from being killed unless their killing can benefit or prevent harm. However, the practitioners claim the treatment as not against the religion as killing bees and using their sting are for the good purpose of curing diseases. They also believe that BVT is a significant form of treatment even though the relevant authorities do not recognise it. This practice is inconsistent with Islamic ethics, as the religion emphasises its adherence to avoid any painful behaviours to other creatures without the urgent need, especially for animals guarded by Islam such as bees. In addressing this issue, Gatrad and Sheikh (2001) and the Department of Religious Development of Malaysia (2015) suggest that the implementation of BVT can only be done when there are no other alternatives, or the incapability to undergo this treatment would cause to other health risks. This is in line with the principle of maqasid al-Shariah where lives need to be saved even if forced to violate the principles of Shariah law if there is no other alternative that is Shariah compliant. Yusli et al., 2021;. Its effectiveness can be used in order to measure the importance of BVT. However, Korošec et al (2015) suggest that evidence of the efficacy of BVT is very limited while at the same time has high allergic effects towards certain group of patients. b. Some of the practitioners are not qualified to carry out medical procedures where they are unaware that BVT can pose a huge risk to patients. The biggest risk in BVT is obvious for vulnerable groups, including pregnant women, infants, children and the elderly who may not be able to respond or allergic to bee stings. However, practitioners' B and C said that individuals of all ages could be treated with BVT without any exception. Meanwhile, only practitioner A excludes pregnant women, infants, children and the elderly from the BVT method. The statement of practitioners' B and C show that they are not aware of the side effect of bee venom that might lead to death as what has been mentioned in Park et al.'s study (2015), which shows a significant risk of BVT treatment on the vulnerable group. There are reports that an older woman dies after receiving BVT treatment (Vazquez-Revuelta & Madrigal-Burgaleta, 2018). Besides, according to Ali's (2012) study, there is a significant relationship between venom content with age at which children and older persons are exposed to higher risk than healthy and young people.
In addition, it can be concluded that the practitioners are not qualified as they did not consult to any expert or at least medical officer before implement the treating procedure. They just practice the treatment by following other traditional BVT practitioners and learn from their past experiences. This practice is also contrary to the Islamic ethic which emphasises that a nurse must have adequate knowledge and experience of treatment before performing any treatment onto patient. This is mentioned in the hadith which means, whoever treats a person (becomes a doctor) and does not know the science of medicine, he is responsible (for the consequences to the patient) (Abu Dawud, 2009). This practice also contradicts to conventional medical practice which emphasises that expert opinion should be obtained before any treatment is done in order to ensure the effectiveness and to avoid allergies-sideeffects possibilities, especially when dealing with venom-based-medicine (Ali, 2012). According to Vazquez-Revuelta and Madrigal-Burgaleta (2018), knowing the side effects of BVT is crucial as it can lead to the risk of death if the treatment is not compatible with the disease or might causes allergy to the patient. Therefore, if there are medicines for the diseases with minimal risk and authorised by the relevant authorities, then the BVT which carries higher risk should be avoided (Zhang et al., 2018). For them to continue the BVT, then the practitioners should at least seek for adequate medical advice, study the content of sting and the appropriateness of the disease, and knowing the side effects of the treatment before treating a patient who might have an allergy to bees.
Finally, based on the findings and discussion, after taking into account the ethics of Islamic treatment that should be grouped in these three (3) components; (i) Shariah-compliant, (ii) beneficial, and (iii) avoiding the harm and risks inherent in the procedure, it is recommended for practitioners to adhere to the following ethics in their BVT practice:

Conclusion
BVT is a traditional medical method that has the potential to cure illnesses and has been reported to have a negative impact. It also has a place in Malaysia. Also, the BVT method seems to have contradiction with the hadith of the Prophet Muhammad (PBUH). Therefore, this study aimed to evaluate the practice of BVT by three Muslim practitioners in Malaysia and analyse it from the ethical point of Islamic treatment. The findings show that the practice of all three practitioners is not in line with Islamic ethics; does not seek medical professional advice, does not prioritise other medicines that are safer than BVT, does not take into account allergies, and does not exclude high-risk patients except for practitioner A who excludes children, pregnant women and the elderly from undergoing this treatment. There is a limitation in this study, as this study did not represent all BVT practitioners in Malaysia as it involved only three respondents.