palliative care - a muslim perspective - ahpcc five pillars of islam (actions) arabic urdu/punjabi...
TRANSCRIPT
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Ms Rehanah Sadiq
Muslim Chaplain
Copyright © Reflection Training Ltd (UK) 2005
Palliative Care -
A Muslim
Perspective
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Muslim Beliefs
6 articles of faith
• Allah – Arabic word for God
• Angels (unseen realm)
• Scriptures/books
• Prophets
• Day of Judgment
• Divine decree (good and bad)
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Five pillars of
Islam (actions)
Arabic Urdu/Punjabi
Testimony
of faith Shahadah Shahadat
Prayer Salah Namaz
Alms-giving Zakah Zakat
Fasting Siyam Roza
Pilgrimage Hajj Hajj
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Testimony of Faith
(1st pillar)
Witnessing (shahadah) A Muslim is one who believes and declares, “There is no god except Allah and Muhammad is the
messenger of Allah” Muhammad (pbuh)
• Prophet & last messenger
• Role model
• Descendant of Abraham
through line of Ishmael
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Abraham
Isaac Ishmael
Muhammad
(born 571 CE) Jesus
Testimony of Faith
(1st pillar)
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Obligatory Prayers (Salah) For the practising Muslim, ritual prayers are offered at:
Dawn
Noon
Late afternoon
Sunset
Night
Prayer timetables are easily downloaded
Prayer
(2nd Pillar)
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Location for prayer
• Quiet space/chapel/prayer room
(ideally without symbols or icons)
• Room for bowing and prostrating
• Secure space in front
• For women, the backside
secured from onlookers
• Depending on a person’s degree
of incapacity, prayers may be
performed sitting or lying down
• Qiblah direction marked if
possible (South East in UK)
Prayer
(2nd Pillar)
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Direction of Makkah (Qiblah)
• Qiblah sign
• If possible, the incapacitated
patient might require physical
assistance in positioning his
chair or bed in the right direction
Prayer
(2nd Pillar)
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Washing for prayer (Wudu’)
• The hands, face, arms and feet
are washed
• Ambulatory patients may need
help to the bathroom for washing
for prayer.
• Bedridden patients may request
a jug of water and a large bowl
• Dry washing (tayammum)
• Women are excused from the
ritual salah prayer during their
periods of menstruation or post-
partum bleeding
Prayer
(2nd Pillar)
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Paying Welfare
(3rd Pillar)
Alms-giving (Zakah)
• 2.5% of excess wealth
• Distributed to the needy,
including those in debt
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Fasting (4th Pillar)
Fasting (Sawm)
• Abstinence of food, drink, sex between dawn and sunset
• Exemptions: elderly, children, ill, pregnant, those on a journey…
• May also be performed
outside of Ramadan
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Pilgrimage to Makkah (Hajj)
• Once in a life-time
• Only for those who are able
physically, circumstantially,
financially …
• Great physical hardships
for many in rites of Hajj
• Humility and equality before God
Pilgrimage to
Makkah (5th Pillar)
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Sources of Guidance
The Quran
• Revelations given to
Muhammad
• Covers all walks of life;
spiritual, social, economical,
political
• Builds on previous texts sent
before eg. Torah, Psalms,
Gospels
• The last testament, the
completion
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The Sunnah
• Way of life of Muhammad
• Prophetic sayings and
behaviours (hadith)
• Culmination of the previous
Prophetic traditions
Sources of Guidance
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Culture
&
Religious
Belief
Making assumptions!
• Not all Muslims practice all
aspects of the Islamic faith
• Many have not had the opportunity of increasing their knowledge of Islam
• Some who are aware of Islamic teachings put them into practice, others choose not to
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Misconceptions
• Some traditions clash with
Islamic teachings
• Man-made traditions and
superstitions that are
confused with religion
Culture
&
Religious
Belief
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Diversity
• Many traditions are in line with
Islamic teachings and these
may vary between groups of
people
• Different schools of thought
• Very diverse, both in culture
and in religious belief
Culture
&
Religious
Belief
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Hospice Need for greater awareness
• ‘Palliative’, ‘Hospice’, ‘Chaplain’
– not in vocabulary!
• Misconceptions of being a place
for Christians exclusively
• Dying at home
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Communication Explanation needed
• Patient entitlements
• Provision for religious
needs
• Any tests, procedures and
treatment needed
• Use of interpreters
• Availability of Muslim
Chaplain
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Religious Figures in Islam
Religious scholar, leader, guide
Imam
Mawlana
Molvi
Mufti
Mullah
Shaykh
‘Alim Hafiz
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Acknowledging religious
and spiritual needs
“I don’t know if you have any
religious needs – but I
thought I would let you
know…"
e.g. a copy of the Qur’an
“If you want some quiet time
to yourself – or you want to
pray, I can close the curtain
around you.”
allowing the patient to have
that space…
Communication
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Perception of
Illness and
Death
Generally
• Muslims receive illness and
death with patience and
prayers
• Illness is considered a
purification and may be an
atonement for wrong actions
• Reward in the Hereafter
• Death is considered a journey
to meet their Creator and a
passage into eternal life
• However, to seek treatment
and care is strongly
encouraged
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When faced with illness
Serious time of deep reflection of
the self and meaning of life
Qur’an, 32:9
‘Then He fashioned him and
breathed into him of His spirit;
and appointed for you hearing,
and sight and hearts…’
… Fitra (innate nature)
connecting with the self is more
important now than ever
Perception of
Illness and
Death
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Taking an account of one’s
deeds
Qur’an, 74:38
‘Every soul is a pledge for its
own deeds’
Last chance of doing good deeds;
charity, prayer, forgiveness, Qur’an
recitation, supplication etc.
Perception of
Illness and
Death
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• Nuclear family
• Extended family and neighbours
• Community as a family
• Global Muslim family
• Humankind as a family
Muslim
Family
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Muslim
Family
Power relations
• Vary from family to family
• Parents, spouses, elder
children in descending order,
generally
• Useful for staff to identify
who might be the
spokesperson for the family
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Treatment Refusal to take medication
“It is God’s will!”
Treatment is also God’s will…
Hadith
“Your body has a right over
you, and so seek treatment,
servants of God, for every
illness God created, He created
a treatment for it.”
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Opioids and Sedatives
• Alleviation of suffering
• Maintaining a level of
consciousness
Treatment
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Visitors A religious duty
• Visiting and assisting the
indisposed is a basic
form of worship to bring
one closer to God
• Many visitors, other than
family and friends may
come to see the patient
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A religious duty Hadith Qudsi ‘O son of Adam, I fell ill and you visited me not. He will say: O Lord, and how should I visit You when You are the Lord of the worlds? He will say: Did you not know that My servant So-and-so had fallen ill and you visited him not? Did you not know that had you visited him you would have found Me with him?...’
Visitors
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Provisions for
Worship
Resources
• The Qur’an – provides
solace and comfort in
reciting or listening to
(audio tapes, CD’s etc.)
• Availability of copies for
personal recital
• Etiquette regarding the
Qur’an
• Prayer beads
• Prayer mats
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Halal food
• halal (lawful)
• haram (unlawful)
Diet
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Forbidden (haram)
• Pork and pig products
• Flesh-eating animals
• Birds of prey
• Carrion
• Blood
• Alcohol and intoxicants
• Food ingredients, e.g. lard,
animal fat, gelatine derived
from non-halal sources
Diet
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Lawful (halal)
• All other food is lawful
• “All things are allowed except
that which is specifically
forbidden.”
• If in doubt Muslims would prefer
to eat fish, eggs, or dairy
products instead of meat
• Any products suitable for
vegetarians (and not containing
alcohol) will be halal
• Family will often bring food if
there are no restrictions
Diet
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Personal
Hygiene Keeping Clean
• Cleanliness is considered •half
of faith!
• Body waste such as urine,
stools and menses can make
the Muslim body impure
preventing them from practicing
their religious rituals
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Clothes
• The patient should not be left
in clothes soiled by body
waste
• Any clean clothes should
conform to the code of dress
especially while praying
• For patients who are
incontinent pads should be
provided and regularly
changed especially before
prayer times
Personal
Hygiene
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Modesty
&
Etiquette
Hijab
• For men and for women
• ‘Mahram’
• e.g. her father, brother, son,
uncle, nephew, grandfather
etc. (i.e. the people to whom
marriage would be prohibited)
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Social Interaction
• Behaviour and mannerism
between men and women
who are not ‘mahram’ to one
another
• Being alone in privacy
• Physical contact, e.g. shaking
hands
• Exceptions
Medical conditions
Emergencies
Modesty
&
Etiquette
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To allay anxiety
• Separate ward/bay for •female
& male patients
• Examinations – only exposing
the part to be examined at any
one time while keeping the rest
of the patient covered
• Preferably by staff of the same
sex or if not possible in the
presence of a chaperone
• Avoiding affectionate physical
contact with members of
opposite sex!
Modesty
&
Etiquette
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Dignity and privacy
• The Hijab can be removed in
privacy or in front of mahram
• Respect for patient’s feelings
by keeping hijab on even in
theatre unless operation
necessitates removal
• Permission should be sought
from patient before allowing
staff/visitors in, even if •they
are family members
Modesty
&
Etiquette
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Longevity of terminally ill
• Usually sceptical about
definitive life expectancy
responses
• Knowledge of time of death
only with God
• However, families still prefer to
be informed of imminent death
Dying
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Hope for the next journey
Muhammad (pbuh) visited a
young man who was dying and
asked him, ”How do you feel?”
The man replied, “By Allah, O
Messenger of Allah, I have hope
in Allah and I fear my sins.”
to which the Prophet (pbuh)
replied, “These two qualities do
not dwell together in a person’s
heart in this situation(of dying)
but Allah will grant him what he
hopes, and save him from what
he fears.”
Dying
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Hope in the next life
Qur’an, 39:53
‘Despair not of the mercy of
Allah, Who forgives all sins.
Lo! He is the Forgiving, the
Merciful’
Dying
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When death is imminent
• The shahadah is recited in the
ear of the dying patient to help
them say it
• Members of family will keep a
vigil by the patient’s bed
• Chanting
• Qur’an recitation
• Positioning of bed to face qiblah
• Single bed/side room
Dying
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Issues at Death
• Regard for the sanctity of life is
an injunction
• Maintaining terminal patient on
artificial life support for
prolonged period in vegetative
state not encouraged
• Assisted suicide and euthanasia
not permitted
• Organ donation is a sensitive
issue though allowed by many
scholars
• Autopsy is not permitted unless
required by law
• Cremation prohibited
Dying
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After Death Sensitive preparations
• Gender – male carer for
male, female carer for
female
• Use of gloves
• Removal of all connecting
tubes
• Legs together, arms
straightened
• Bandage to keep jaw
closed
• Covering body e.g. hair on
female
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Preparation for burial
• The dead body is treated
with gentleness, dignity and
respect as in life
• Washing of the deceased
by member of the same sex
• Wrapping in white shrouds
• Congregational prayer for
the deceased
• Expeditious burial
After Death
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Death &
Bereavement
Bereavement
• Different generations… a
changing culture
• Expressions of grief
• Women attending burials
• Counselling
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Death and sleep
Qur’an 39:42
‘It is Allah that takes the
souls (of men) at death; and
those that die not (He takes)
during their sleep: those on
whom He has passed the
decree of death, He keeps
back (from returning to life),
but the rest He sends (to
their bodies) for a term
appointed. Verily in this are
signs for those who reflect.’
Connection with those who
have passed away…
Death &
Bereavement
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Bereavement
• Family and community
support network
• Need to identify families
with sub-optimal resources
Death &
Bereavement
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And lastly… Supplication of Prophet Ibrahim (Abraham)
Qur’an, 26:80-82
‘And when I am ill, it is He Who
cures me; Who will cause me
to die, and then live (again);
And Who, I hope will forgive
me my faults on the Day of
Judgment.’