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Further, if Islam forbids acts that terminate life prematurely, what if the pain medication carries with it the potential to abbreviate life? The precise moment as to when death will occur is a matter of Divine decree rather than one determined by human beings (Qur'an 3:145, 3:154, 16:61, 29:57, 39:42). To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. The vast majority of such patients are therefore not receiving pain relief and are undergoing unnecessary and preventable pain and suffering (Daher et al., 2002). Instead of taking their own lives, they are advised to pray to God for strength and help in dealing with the trial (Qur'an 31:17; Sahih Al-Bukhari, 1994; Shah & Chandia, 2010). Islam is a major world religion with 1.7 billion followers. As such, they are usually referred to as a medical “last resort” or “last gasp” measure (Hasselaar, Verhagen, Reuzel, van Leeuwen, & Vissers, 2009; Koh, Lee, & Wu, 2009). However, despite the fact that their need for pain management is proportionally greater, palliative care services and programmes are currently only available in a small number of Muslim-majority countries (Al-Shahri, 2002; Harford & Aljawi, 2013; Wright, Wood, Lynch, & Clark, 2008). Still there is an impression that palliative care of a terminally ill is like euthanasia. Palliative care enhances the quality of life of people with a life-limiting illness. Further, the amount given must not transgress that which is needed to bring about the relief required (Malik, 2012). This provides assurance to the patient that he is still valued and has not been abandoned (Adeniyi, 2013; Al-Mutair, Plummer, & Copnell, 2012; Al-Muzaini, Salek, Nicholls, & Alomar, 1998). At the very least, however, they should concentrate on the provision of pain relief as a starting point, for reasons emphasised earlier. This is so, even where the pain relief used may compromise consciousness to various extents and even where the dosages used could lead to the abbreviation of life. This is in recognition of the roles that these play, both on their own or in an accumulative and interactive way, to patients' as well as their family members' suffering (Limonero & Gil-Moncayo, 2014). Spiritual care is a vital part of holistic patient care. It does this by preventing and relieving suffering. As such, the experience of death could involve and affect family caregivers in various ways. Terminal care in the United Kingdom, 1948–1967, Between hope and acceptance: The medicalisation of dying, From margins to centre: A review of the history of palliative care in cancer, Ethical issues in end-of-life geriatric care: The approach of three monotheistic religions – Judaism, Catholicism, and Islam, To die, to sleep: US physicians' religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support, An exploratory study of spiritual care at the End of life, Palliative sedation therapy in the last weeks of life: A literature review and recommendations for standards, The lived experience of Lebanese oncology patients receiving palliative care, Suffering, dying, and death: Palliative care ethics “after God”. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. Islamic Beliefs 5.Hajj (Pilgrimage to Mecca) Islam views death as something predestined by God. Some of the teachings are explained below; This is especially important since Muslims nearing the end of life, as emphasised previously, would like to optimise the time left to gain as much spiritual growth as possible and to prepare for the hereafter. Family members would additionally seek to ensure that the dying patient recite the syahadah (which reads “I bear witness that there is no God but Allah, and that Muhammad is the Messenger of Allah”) as they take their last breath. Practical aspects of care Islam Views life as a 'sacred trust' from God. This would in turn enable them to continue providing comfort and more effective care to their critically ill family members (Al-Hassan & Hweidi, 2004; Al-Mutair, Plummer, Clereham, & O'Brien, 2013; Omari, 2009). On the other hand, maintaining a level of consciousness as close to normal as possible is of great importance to allow for observance of the worship rites for the longest period possible before death.”. Religious observance Islam places the responsibility of practising religion on the individual and, as a result, it is important that health care providers discuss religious observance needs with each patient. This document focuses on similar beliefs and o… Copyright 2018 | ehospice | All Rights Reserved | Website Designed & Developed By B Online, Special journal issue highlights the global work of…, International organisations publish new fact sheet…, Implementing outcome measures in palliative care:…, article published in The Journal of Supportive Oncology. Thus, depending on the circumstances, doctors would implement it intermittently or carry out the sedation continuously until the patient's death. Alternatively, they may choose a level of sedation that brings some but limited pain relief, so as to enable them to still prioritise their religious commitments and values (Olsen, Swetz, & Mueller, 2010). The ethos and practices of palliative care are widely considered as congruent with orthodox Islamic theology. Death itself is not deemed as a transit to another world. Just as those endeavours were embarked on in the service of God, these institutions deemed their efforts as religious duties towards the sick and dying. Muslims are expected to be resolute in facing the hardships and tests that are sent their way. It has been observed that their physical presence is important to the patients' physical, emotional and spiritual well-being. The care of these different dimensions requires the involvement of a multidisciplinary team of formally trained carers, which include doctors, nurses, pharmacists, social workers, chaplains, physiotherapists, psychologists, and art and music therapists (Barnard, Towers, Boston, & Lambrinidou, 2000). Firstly, it supports many Muslim communities' family-centred approach to care planning and medical decision-making. However, it may not be easy to maintain a state of equilibrium allowing for optimal pain control and a normal level of consciousness (Al-Shahri & Al-Khenaizan, 2005). Forgiveness and reconciliation may likewise be sought during this period for excesses committed against fellow human beings (Qur'an 4:18; Sheikh, 1998; Smith & Haddad, 2002). 52, Issue. The ability to think clearly and to communicate well may be compromised in most situations where sedating agents are administered. Action Plan on Palliative Care. In so operating, they not only allowed themselves to be subjected to mainstream influence, but in effect integrate with the mainstream health system. They help provide answers to some of the complex concerns and fears surrounding life-limiting illness as well as death. However the Palliative care may be the moral and ethical alternative of euthanasia for some. This part of the work documents its journey from the periphery to the centre of Western medicine and highlights the impact which this transition has on its ethos and remit. Faced with the reality that cure was still not within reach for many cancers, yet with 50–90% of sufferers experiencing persistent pain in the late stages, major strides were made in pain and symptom management to alleviate the suffering of terminally ill cancer patients (Clark, 2002, 2007; International Association for the Study of Pain, 2008). Islamic Teachings That Can Help Support Palliative Care Patients Islamic teachings are important in counseling and providing hope for patients and their families. The depth and duration of the sedation should thereby be proportional to the patient's symptoms (Hasselaar et al., 2009; Khan, 2003). Their plight nevertheless garnered the sympathy of religious and charitable organisations. People also read lists articles that other readers of this article have read. If the medical model had initially paid scant attention to care of the dying, this changed in the 1960s when a new discourse of terminal care developed within the oncology setting. Cancer pain assessment – Can we predict the need for specialist input? pp. They can also be considered for invasive analgesic techniques like nerve blocks and regional or neurodestructive blocks, or for spinal delivery of opioids such as lignocaine, clonidine, midazolam and ketamine (Kahn, Lazarus, & Owens, 2003; Laird, Colvin, & Fallon, 2008; NHS, n.d.; Vargas-Schaffer, 2010; WHO, n.d.-b). The article concludes: “Terminally ill patients constitute a vulnerable group that deserves specialized and sensitive care that addresses their physical, psychosocial, and spiritual needs,” noting that a greater awareness by healthcare professionals of their patients’ faith will lead to more sensitive, and better, holistic palliative care. An earlier version of this work was presented at the UNESCO Chair in Bioethics 9th World Conference held in Naples between 19 and 21 November 2013. First, if pain and suffering could, as highlighted in the primary sources of Islamic Law, lead to the expiation of sins, can pain relief be taken? Therefore, palliative care clinicians should have at least a basic understanding of major world religions. It is important to note that irrespective of how severe or seemingly unbearable a person's pain and suffering may be, Islamic jurisprudence does not recognise a right to die voluntarily. This ability to effectively control physical pain and other symptoms (like nausea, depression, shortness of breath, distress, vomiting, fatigue and alopecia) transformed terminal care. Another positive effect on the dying patients is that it would prevent them feeling like a burden on their families, thereby lessening the thought of radical options like suicide or euthanasia (Adeniyi, 2013; Murray et al., 2004) both of which as discussed earlier, are strictly forbidden in Islam. Viewed from this perspective, pain and suffering when endured with patience can lead to spiritual and moral development. As regards the latter, this is sometimes combined with the withdrawal of life-sustaining measures including clinically assisted nutrition and hydration (Curlin, Nwodim, Vance, Chin, & Lantos, 2008; Materstvedt & Bosshard, 2009; Simon et al., 2007). Many arguments and discussions have ensued related to palliative care services such as end of life care. All these underline the necessity of a detailed explanation of the levels and mechanics of sedation, and their benefits and side effects to dying patients and their families. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. Download Citation | Islam and palliative care | Palliative care is experiencing an upsurge in interest and importance. This period, in view of how death is the point at which actions in this life are sealed, represents a Muslim's final opportunity for spiritual connection and refinement (Bloomer & Al-Mutair, 2013; Qur'an 29:7, 99:7–8; Sheikh, 1998). The sanctity of life is such that the taking of one life without just cause is considered as tantamount to the killing of all of mankind (Qur'an 5:32, 17:33). Muslims should accordingly seek to benefit from pain relief methods that are available to help lessen their pain and suffering. After any toileting Muslims cleanse themselves with water (Table 3). K. A. Choong. For mild to moderate pain for instance, patients can be prescribed with orally administered non-opioid analgesia (e.g. Against this background, there is nothing redeeming or ennobling about pain and suffering. Further, although it was the patients who were ill, recognition was given to the fact that they are a part of a wider network of family relationships. codeine). The latter campaigned to allow dying patients to have control over their own death rather than to undergo prolonged agony and loss of dignity. In fact, not only are they allowed to avail themselves of such assistance, efforts in this direction are obligatory and regarded as highly virtuous (Al-Shahri & Al-Khenaizan, 2005; Sachedina, 2012). Medical ethics and Islam: Principles and practice, Palliative care for Muslims and issues before death, A textual analysis of memorials written by bereaved individuals and families in a hospice context, Palliative care and pain management in the United States, Dr Balfour Mount and the cruel irony of our care for the dying, The need for more and better palliative care for Muslim patients, Whose dying? Ontario Learn (Online) $366.94. This would help imbue their terminally ill relative with peace, serenity and a sense of closeness with the Almighty (Bloomer & Al-Mutair, 2013). It is therefore important that this lack of awareness and general understanding be addressed so that more people from this faith group will access and benefit from palliative care. Palliative care has been successfully integrated in Muslim-majority countries. paracetamol and non-steroidal anti-inflammatory drugs) and mild opioids (e.g. The large dosage of opioids must, however, be prompted by a pressing need since necessity negates prohibition (Qur'an 2:173, 6:145). The authors suggest a conversation with the person to modify medication schedules to allow for fasting during daylight hours. The emotions they give rise to can take various forms. This stemmed from the fact that this system of medicine, which rapidly gained social and political recognition as the dominant model of health care, had focused predominantly on curing and rehabilitating patients (Bowler & Morus, 2005). But palliative care is actually a new medical specialty that has recently emerged -- and no, it's not the same as hospice. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. some considerations towards and understanding of the Islamic perspectives on caring, Reflections on palliative care from the Jewish and Islamic tradition, The relations between suicide and Islam: A cross-national study, Spirituality and the care of people with life-threatening illnesses, Attitudes towards terminal sedation: An empirical survey among experts in the field of medical ethics, Jordan palliative care initiative: A WHO demonstration project, Palliative care and hospice: Opportunities to improve care for the sickest patients, Is the WHO analgesic ladder still valid? Second, is it religiously permissible to choose pain treatment options that could bring about iatrogenic addiction, the hastening of death and the impairment or obliteration of consciousness? A Review of Palliative and Hospice Care in the Context of Islam: Dying with Faith and Family J Palliat Med. Dying persons' demoralised state, for example, can be a contagious emotional state that is readily transmittable to them. Similarly, the paramount impact of Islamic wholeness on Muslims' perceptions, beliefs, and way of living makes it necessary for non-Muslim palliative care professionals who are caring for Muslim patients to increase their awareness about the parts of Islamic theology pertinent to the principles of palliative care. The institutionalization of the good death, Spirituality and cultural issues at the end of life, Continuous deep sedation in patients nearing death, Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers, Palliative sedation of terminally ill patients, Relieving pain and foreseeing death: A paradox about accountability and blame, Ethical decision-making with end-of-life care: Palliative sedation and withholding or withdrawing life-sustaining treatments, Perceived and unmet needs of adult Jordanian family members of patients in ICUs, Communication: Common challenging scenarios in cancer care, Religious groups' views on end-of-life issues, Religious and spiritual beliefs in end of life care: How major religions view death and dying, Opioid Use in patients presenting with pain in Zahedan, Islamic republic of Iran, The crescent and Islam: Healing, nursing and the spiritual dimension. Hospices too readily embrace these skills and resources to assist their patients. Lists. The process blurred the ideological boundaries and oppositional practices of the past (Hart et al., 1998; James & Field, 1992). Twenty-four years of experience, Historical and cultural variants on the good death, Vulnerability and access to care for south Asian Sikh and Muslim patients with life limiting illness in Scotland: Prospective longitudinal qualitative study, Mapping levels of palliative care development: A global view, The history and development of palliative care, Modern pain management and Muslim patients, http://www.dartmouth.edu/~dcare/pdfs/yusuf.pdf, http://www.nhs.uk/conditions/tens/pages/introduction.aspx, http://www.pewforum.org/2013/11/21/religious-groups-views-on-end-of-life-issues/, http://www.who.int/cancer/palliative/definition/en/, http://www.who.int/cancer/palliative/painladder/en/. In addition, Muslims are advised to be steadfast in dealing with any pain and suffering they are confronted with, since such forbearance would not only lead to the expiation of sins, but would also be rewarded in the afterlife (Qur'an 2:54, 4:146, 39:10, 99:7–8; Sahih Al-Bukhari, 1994). Indeed some would find this more desirable than to have a clouded sensorium or even a complete lack of awareness of the moment of death (Al-Shahri & Al-Khenaizan, 2005; Kemp, 2005; McCulloch, Comac, & Craig, 2008). Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Importantly for all cancer and non-cancer patients, a wide range of pharmacological and non-pharmacological pain control methods are now available for the whole spectrum of pain experience. piritual care is recognized as an inte- gral component of comprehensive pal- liative care.1,2Muslims, estimated to number 1.3 to 1.7 billion worldwide,3,4 regard Islam as both a belief system and a way of life, as per the teachings of the Qur’an.5 Nor should Muslim doctors and family caregivers render any assistance to bring about their death. They advise that those caring for Muslim patients make themselves aware of observances required by the person’s religion which may impact on the way that they would prefer to receive care. morphine and methadone); or have a neurosurgical procedure performed on appropriate nerves. Moreover, given the interdependency and mutual care commended in Islam, the inclusion of the family within palliative medicine's remit of decision-making and care can also be beneficial. In addition to those highlighted previously, these include: changes in social and family roles; fear of the disease process; disconcerting feelings about being a burden on others; resentment at being pitied by others; a fractured sense of dignity; diminished ability to work and the anxiety over the financial pressures this may cause; feeling of being unproductive at professional and personal levels; concerned about the afterlife; worried that family members are worrying about them; and concerned about the dependants they are about to leave behind (Doumit, Abu-Saad Huijer, & Kelly, 2007; McClement & Chochinov, 2008; Sheehan, 2005). Palliative care is experiencing an upsurge in interest and importance. In fact, medicine's current ability to treat pain should help to allay the public's concerns of a prolonged and painful death – fears that have served as the impetus for the euthanasia and physician-assisted suicide movements. 2016 Dec;14(6):635-640. doi: 10.1017/S1478951516000080. In other words, where the abbreviation of life is a necessary and foreseeable incident of pain relief medication, the doctor's action would not ordinarily be met by any legal liability, professional sanctions or moral condemnation (Haugen, 1997; Nuccetelli & Seay, 2000). It is pertinent to observe that although palliative care today has a wider remit than cancer care, the close association between the two is kept to the present decade. They have no self-awareness and are not able to perform any act of worship, nor steep themselves in remembrance of God. Deemed as “medicine's failures”, patients who were certified as dying by doctors were simply sent home with no further after-care offered (Clark, 1999; Humphreys, 2001). In furtherance of this commitment, their foremost aim was to provide spiritual care particularly for those “whose souls had not yet been saved” (Humphreys, 2001, p. 154). Inevitably, the ethos and secular nature of other areas of medicine have also permeated this specialty. However, this was more as a critic of and a small rebellion against the manner in which it dealt with dying patients (Clark, 1999; James & Field, 1992). How Islam Influences End-of-Life Care: Education for Palliative Care Clinicians. With death consequently identified as the end point of human existence, a new ethos of pain-free and dignified dying saw the introduction of a range of pain relief and symptom control methods. •Contemporary Palliative Care focuses on the ideal of a good death: comfort, self-affirmation and dignity •EOL in Islam: focuses also on relationship to God and preparation for the Afterlife . Having compared and contrasted the philosophical underpinnings of secular palliative care with the Islamic notion of death and dying, several important questions come to the fore. However, if pain management can have faith-enhancing and faith-preserving qualities, there are challenges that require scrutiny. Therefore, palliative care clinicians should have at least a basic understanding of major world religions. Besides, end of life also tended to provoke profound mental distress as triggered by, among other things, loss of meaning and purpose, loss of independence and frailty. In order to ascertain how far this new medical speciality holds relevance for Muslims, this part of the discussion will firstly explore the extent to which its philosophical outlook coheres with the Islamic perspective on death and dying. For more serious pain, they can be given strong opioids (e.g. This is for the purposes of: honouring the patient; praying for their welfare; mutual seeking of forgiveness for wrongdoings that have been knowingly and inadvertently committed in the past; and offering support in various means wherever possible (e.g. The experience of death could involve and affect family caregivers in various ways as emphasised by Sheikh (,. As for those with acute pain syndromes, they can be woken in order to communicate minimum. Practical aspects of care Islam Views death as something predestined by God for medical attention advanced. To our use of cookies the opportunities and challenges which modern pain management go well with. 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