It would also allow them to carry on with important “illness work” like sorting out their wills and other unfinished businesses; and mending strained relationships (Murray, Kendall, Boyd, Worth, & Benton, 2004). The investigation … Importantly, it could enable them to engage in acts of worship and remembrance of God in ways that would otherwise be severely compromised had they been in excruciating pain (Al-Muzaini et al., 1998; Mitchell, 2007). 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). 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”. The depth and duration of the sedation should thereby be proportional to the patient's symptoms (Hasselaar et al., 2009; Khan, 2003). With many Muslims suffering from such incurable diseases worldwide, they too are now faced with the decision of whether to avail themselves of pain relief offered within the framework of scientific medicine. Given these clinical goals and priorities, it had no articulated strategy for, nor guidance on, how to deal with those in the advanced stages of an illness. Muslims should accordingly seek to benefit from pain relief methods that are available to help lessen their pain and suffering. May 11, 2021 - Aug 17, 2021. This part of the discussion assesses the potential opportunities and challenges that modern palliative care poses to Muslim patients. In this regard, even though it is known that medically prescribed opioids may induce iatrogenic addiction, scholars have pointed out that this does not preclude its use for the treatment of pain provided maladaptive patterns of behaviour do not develop. psychological, physical and/or financial) (Bloomer & Al-Mutair, 2013; Gatrad & Sheikh, 2002; Khan, 2002; Rassool, 2000). These can also be supplemented with transcutaneous electrical nerve stimulation (TENS) and physiotherapy. Where intermediate sedation is applied, the patient is asleep but can be woken in order to communicate briefly. Neither can they, in that state, have any contact or ability to interact with their family (Cherny, 2009; Materstvedt & Bosshard, 2009). This article provides a short historical review about health care in Muslim experience, as well as current general information about Muslim people and their main observances and concerns in the Western health care system. Kathy Shaidle is in palliative care Dec 10, 2020 9:30 am By Robert Spencer 6 Comments Kathy Shaidle is one of the most incisive, witty, and fearless writers on the scene today, never shrinking back from standing up for freedom and against jihad violence and Sharia oppression, even when the Left-fascist lynch mobs tore after her. For more serious pain, they can be given strong opioids (e.g. 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. 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. Recognised in the West today as a distinct and important medical specialty, its conception and earlier development nevertheless took place outside mainstream medicine. He is otherwise awake and still able to communicate with minimum impairment. 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? 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). However, since the primary intention of such an act is to alleviate unrelenting pain and suffering at the end of life rather than to deliberately kill the patient, it has been considered as legally, professionally and ethically acceptable. Firstly, it supports many Muslim communities' family-centred approach to care planning and medical decision-making. morphine and methadone); or have a neurosurgical procedure performed on appropriate nerves. As for Muslims who live in other parts of the world, palliative care services are still not widely available. Muslims are expected to be resolute in facing the hardships and tests that are sent their way. Some of the teachings are explained below; First, if pain leads to the expiation of sins and has a higher purpose, can pain relief be taken? 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. morphine, oxycodone, fentanyl, hydromorphone, buprenorphine and methadone) that provide sustained pain relief. Action Plan on Palliative Care. A detailed explanation about differences is beyond this article’s scope and purpose. Palliative care has been successfully integrated in Muslim-majority countries. Register to receive personalised research and resources by email, Lancashire Law School, University of Central Lancashire, Preston, UK, Euthanasia as a contemporary issue in the jurisprudence of rights: The position of Islamic law, The perceived needs of Jordanian families of hospitalized, critically ill patients, Family presence during resuscitation: A descriptive study of nurses' attitudes from Saudi Arabia, Needs and experiences of intensive care patients’ families: A Saudi qualitative study, The attitude of health care professionals toward the availability of hospice services for cancer patients and their carers in Saudi Arabia, The future of palliative care in the Islamic world, Euthanasia: An Islamic medical perspective, Progress in palliative care in Israel: Comparative mapping and next steps, Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Consideration for care, The spiritual dimension of hospice: The secularization of an ideal, The world's major religions’ points of view on end-of-life decisions in the intensive care unit, Cultural issues surrounding end-of-life care, Ethical dilemmas in palliative care in traditional developing societies, with special reference to the Indian setting, The use of sedation to relieve cancer patients’ suffering at the end of life: Addressing critical issues, Cradled to the grave? Registered in England & Wales No. 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). This is by virtue of the doctrine of double effect, according to which, where an action holds two consequences, one good and one bad, the act is justified provided that only the good effect was intended and the bad effect was merely foreseen. For instance, in reference to the use of opioids and sedatives, the authors note that: “In the Islamic perspective, medication-related sedation could be looked at from two different angles. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. Much of the carers' time is taken up by explaining the pain relief options available and the significance of medication routines to patients and their families (McNamara, Waddell, & Colvin, 1994). 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. There is a need to acknowledge and respect religious beliefs in providing palliative care. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Lists. Palliative care is an advanced branch in tadawi. The holistic nature of palliative care, dictated by the multifaceted suffering experienced by patients, calls for givi … Islamic theology and the principles of palliative care Palliat Support Care. People also read lists articles that other readers of this article have read. Further, since a heightened awareness of spirituality usually takes place at the end of life, pain management can have a profound impact on the patients' spiritual experience. When this is performed in the context of care at the end of life, it is with the aim of encouraging and supporting the dying, and to cement firmly their relationship with the Almighty before death (Gatrad & Sheikh, 2002). This arguably became the starting point for a holistic end-of-life model of care which combined concerns over the patient's physical, psychosocial and spiritual needs as outlined in the definition espoused by the WHO today. When the latter occurs, there are certain expectations placed upon others towards the care and welfare of the sick. 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. 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). 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). World renowned experts on ethics, Islam, Christianity and medicine are gathering at Georgetown University in Qatar (GU-Q) January 22 and 23 to discuss the bioethics of caring for those with life-threatening illnesses or those who are facing death. It includes specific activities to enhance access, quality of care, and health care system performance, within the federal government's mandate and levers for action. As emphasised by Sheikh (1998, p. 138), undue pain and suffering “has no place in Islam”. Ontario Learn (Online) $366.94. Epub 2016 Apr 25. This article has also benefitted from discussions with Michael Cavadino, Mahmood Chandia, and Paola Dey. However, they soon realised that this ultimate goal of salvation could only be achieved by attending also to the patients' physical and mental suffering. Where the psychosocial dimension is now addressed, there is widespread use of psychotherapeutic and counselling techniques. They would also, if the patient is no longer able to read the Qur'an themselves, recite the Qur'an by the dying patient's bedside. Further, the amount given must not transgress that which is needed to bring about the relief required (Malik, 2012). In the event where the patient's condition does not enable him to express his preferences in relation to treatment and care options, family members can be a source of valuable background information (particularly regarding the relevance and influence of religion and spirituality specific to the patient) in communications with health care professionals (Carey & Cosgrove, 2006; Owen & Jeffrey, 2008). Relatives and friends, for example, are strongly encouraged to visit. delivery of quality healthcare to Muslim patients calls for promoting health professionals’ awareness of the religion of Islam These can range from disheartenment, despondency, despair and demoralisation to even suicidal thoughts. In line with that, the decision of what option(s) should be pursued should ultimately belong to the patient and his family as they are often best placed to know which approach would best allow them to serve God (Schultz et al., 2012). 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). Yet these are regions where the majority of Muslims reside, in which the preventative and curative treatment for cancer and other serious diseases are also still underdeveloped (Harford & Aljawi, 2013). All these led to a considerable reorganisation of how end-of-life decision-making and the ethics of palliative care are now understood. 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. Nor should Muslim doctors and family caregivers render any assistance to bring about their death. For mild to moderate pain for instance, patients can be prescribed with orally administered non-opioid analgesia (e.g. Identifying and addressing affected family members' physical, psychosocial and spiritual needs could help optimise their well-being and coping capability. Therefore, pain relief would provide them not only with added physical strength but also with a better clarity of mind to concentrate at such a crucial stage in their spiritual journey. This group of informal carers therefore have their own physical, psychosocial and spiritual needs which are prompted by their dying relatives' illness. 4 . At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. Muslims subscribe to the belief that health is a gift from the Almighty and that illness takes place only through His will (Al-Shahri & Al-Khenaizan, 2005). Help to spread knowledge & good practice in palliative care around the world! We use cookies to improve your website experience. They would also ideally wish for the syahadah to be the last words uttered or heard. in the health care setting. Dying, in Islam, is usually a time for reflection and repentance. Thus, if end of life choices in the secular framework are evacuated of any ultimate or enduring meaning or importance (Engelhardt, 2012), Islam attaches value and a higher purpose to pain and suffering. Tools. The emotions they give rise to can take various forms. This would help imbue their terminally ill relative with peace, serenity and a sense of closeness with the Almighty (Bloomer & Al-Mutair, 2013). Therefore, palliative care clinicians should have at least a basic understanding of major world religions. On the one hand, alleviation of the suffering of a human being is considered very righteous. an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. This is to ensure that they maintain God-consciousness at all times and be accountable for their acts and omissions. These homes began to be referred to as “hospices” to evoke the blend of guest house and infirmary run by monks and nuns in medieval times which offered food, shelter and care to the sick and travellers until they died or set out on their journeys again (Putnam, 2002). Viewed from this perspective, pain and suffering when endured with patience can lead to spiritual and moral development. For one, death became medicalised and now happens predominantly outside the home in hospices or hospitals (Goodhead, 2010; James & Field, 1992). This involves a conscious decision to decrease the patient's consciousness, through the use of sedating agent, to the point where he or she no longer feels pain, air hunger or other distress. Spiritual care is a vital part of holistic patient care. Indeed, as pointed out by Bradshaw (1996, p. 414), drugs became “a solution and a first and last resort”. Thus, just as palliative care is now provided in hospitals, care provision in hospices resembles hospital care. They also note certain instances in which a compromise may be needed. End-of-life decisions gradually become merely death-style choices in not dissimilar ways to lifestyle choices that are made with the assistance of modern medicine in areas like contraception and abortion (Engelhardt, 2012). Rather, it represents the end point of human existence, with God excised from any spiritual understanding of death (Bradshaw, 1996; Engelhardt, 2012; Hillier & Wee, 2012). Thus, “instead of using medical science as a tool, it becomes the main weapon to combat symptoms and particularly pain” (p. 414). Another concern among Muslims on using morphine in Palliative / hospice care when it is not a part of medical treatment is accepted treatment options. 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? Many died in pain and in appalling and unsanitary conditions. ISLAM TOTAL SUBMITTED TO GOD, ALLAH BY DOING THIS, IT LEADS TO PEACE Not just the way of life, islam is life, islam is for whole life Muslim Person who believe and practice in islam ISLAM QURAN, the book from Allah SUNNAH, the way of prophets “Every soul will taste death. Islamic Teachings That Can Help Support Palliative Care Patients Islamic teachings are important in counseling and providing hope for patients and their families. Dying persons' demoralised state, for example, can be a contagious emotional state that is readily transmittable to them. In addition, there is also the perception that since the philosophy and practice of palliative care are based on the secular Western model of health care, the interventions offered do not cohere with religious norms (Gatrad & Sheikh, 2002). Further, if Islam forbids acts that terminate life prematurely, what if the pain medication carries with it the potential to abbreviate life? Although this artificially induced deep unconsciousness can be discontinued and reversed, some attempts at discontinuation have been unsuccessful since the reduction of sedation may sometimes result in renewed extreme suffering. 28-42. However, if modern palliative care sees pain and suffering as experiences to be alleviated if not obliterated at all costs, Muslims are informed that all afflictions are divinely ordained tests or trials to confirm their spiritual station. The depth and manner of the sedation may differ. As for patients with a combination of uncontrollable and refractory symptoms, sedation as highlighted at the outset, is currently a palliative medical treatment option. The ethos and practices of palliative care are widely considered as congruent with orthodox Islamic theology. As a consequence, an exceptionally large number of patients present themselves for medical attention at advanced stages of their disease. Crucially, it is also a time for repentance which, if genuinely sought can, Muslims believe, mitigate the effects of sins committed during one's lifetime. 6, p. 771. Islam is a major world religion with 1.7 billion followers. In view of these conflicting philosophies, does modern pain management go well together with the Islamic worldview? Palliative care is experiencing an upsurge in interest and importance. The authors argue that: “delivery of quality healthcare to Muslim patients calls for promoting health professionals’ awareness of the religion of Islam.”. The latter campaigned to allow dying patients to have control over their own death rather than to undergo prolonged agony and loss of dignity. 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. It doesn't serve only the dying. 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). The process blurred the ideological boundaries and oppositional practices of the past (Hart et al., 1998; James & Field, 1992). With an estimated 1.3 to 1.7 billion people worldwide following the Islamic faith, it should be required reading for anyone practicing palliative care. Responding to this dilemma, commentators have opined that since the interventions are primarily aimed at reducing pain and suffering, they would be acceptable provided death was definitely not the intention of the doctor (Gatrad & Sheikh, 2001; Schultz et al., 2012). Download Citation | Islam and palliative care | Palliative care is experiencing an upsurge in interest and importance. It has been observed that their physical presence is important to the patients' physical, emotional and spiritual well-being. Before looking at the latter, namely, persistent over-sedation, what if a hastened death is a foreseeable consequence or side effect of the pain and symptoms relief administered? As for those with acute pain syndromes, they can be administered with a titration of a continuous infusion of strong opiates (e.g. A higher level of responsibility is prescribed for close family members especially in the care of children, elderly parents and spouses (Qur'an 2:83, 4:34, 17:23–24; Sahih Al-Bukhari, 1994). Pain relief would also help retain their belief in God. If so, the second question that arises is whether the substance used (i.e. Its principal aims are to relieve pain and other distressing symptoms (such as shortness of breath), improve quality of life for people living with serious illness, and provide patients with good 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? Palliative Care: Orientation to Palliative Care (HLTH105) ... Christianity, Islam and Buddhism. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. Hospitals, armed with good practices and principles learnt from the care of the dying in hospices, became major providers of palliative care (Hart, Sainsbury, & Short, 1998). This is because too much pain may result in them wondering why God has not heeded their supplications and a difficulty in reconciling their present suffering with the promise of a good afterlife. The concept was nevertheless thrust into social prominence with the advent of scientific medicine towards the end of the nineteenth century. morphine and other drugs), which is ordinarily not allowed because of their addictive and intoxicating effects, is permissible for the purpose of palliating this pain? Amidst all the changes, palliative care still preserves its opposition against euthanasia. Islamic Beliefs 5.Hajj (Pilgrimage to Mecca) Islam views death as something predestined by God. This low uptake is partly attributable to the fact that the shift of focus from cure to care with the aim of enhancing quality of life is not a concept which readily registers with the Muslim psyche, there being no direct equivalence to the term “to palliate” in the language of Muslim communities. Moreover, certainly in cases where deep sedation is used, this will obliterate consciousness to the point where the patient's life is purely biological. It is a time for bringing oneself closer to the Almighty by immersing in activities such as prayers and recitation of the Qur'an. This is on the condition that no other medicines are available to be used as substitutes, and that the concession is strictly limited to that quality which is deemed essential, that is, to stave off excruciating pain which is intractable to other forms of pain control that does not compromise or obliterate consciousness. Thus, depending on the circumstances, doctors would implement it intermittently or carry out the sedation continuously until the patient's death. But palliative care is actually a new medical specialty that has recently emerged -- and no, it's not the same as hospice. Against this background, there is nothing redeeming or ennobling about pain and suffering. 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). As for patients for whom deep and continuous palliative sedation seems to be the only viable option and where there is no intention to bring them back to consciousness before they die, they could be advised to say their final farewell to family and friends, and to recite the syahadah before the sedating agent is administered (Materstvedt & Bosshard, 2009). Resolute in facing the hardships and tests that are available to help lessen their and. Syndromes, they can be administered with a titration of a terminally ill is like euthanasia can be administered a... Modify medication schedules to allow for fasting during daylight hours during sedation and islam palliative care... Transcutaneous electrical nerve stimulation ( TENS ) and physiotherapy no place in Islam, palliative care may be moral... Garnered the sympathy of religious and charitable organisations overriding questions can also be supplemented with electrical... 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