Wherever possible, these should be lessened or eliminated. Thus, depending on the circumstances, doctors would implement it intermittently or carry out the sedation continuously until the patient's death. Thus, just as palliative care is now provided in hospitals, care provision in hospices resembles hospital care. 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. After any toileting Muslims cleanse themselves with water (Table 3). Islam is a major world religion with 1.7 billion followers. Relatives and friends, for example, are strongly encouraged to visit. The authors argue that: “delivery of quality healthcare to Muslim patients calls for promoting health professionals’ awareness of the religion of Islam.”. to judgment before God), Muslims seek reward from the Almighty for enduring the pain and suffering and are mindful of the significance of death as the door to eternal life. Indeed, as pointed out by Bradshaw (1996, p. 414), drugs became “a solution and a first and last resort”. 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). Explore the religious attitudes and beliefs concerning immortality and life after death. Each and every moment of life is therefore precious and must be cherished and preserved. On the one hand, alleviation of the suffering of a human being is considered very righteous. May 11, 2021 - Aug 17, 2021. How Islam Influences End-of-Life Care: Education for Palliative Care Clinicians. 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. 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). However, as the preceding discussion demonstrated, not only does the idea of pain relief correspond to Islamic teaching on the care of the sick and the dying, pain management also holds faith-enriching potential. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. It may well be the case that they may refuse the intervention, preferring instead to endure the pain so as to maintain a better level of consciousness when it is clear that death is imminent. A Review of Palliative and Hospice Care in the Context of Islam: Dying with Faith and Family J Palliat Med. However, while the general ethos of palliative care which is to promote the quality of life of those facing life-limiting illnesses is consistent with Islamic values, this paper explores whether the same can be submitted for modern methods of pain control. The “medical good death” is consequently one where: they are fully aware of their prognosis and make their own choices as regards their care in the last days and months, and doctors manage a pain-controlled dying with dignity (Hart et al., 1998; Walter, 2003). The physical pain experienced can also be a source of emotional, economic and spiritual challenge on their families (Knight, Brand, Mchaourab, & Veneziano, 2007; Lloyd-Williams et al., 2008; Monroe & Oliviere, 2007). 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). Therefore, palliative care clinicians should have at least a basic understanding of major world religions. This work is not funded by any parties and the author does not anticipate any financial interest or benefit arising from the direct application of the research. Palliative care for Muslims and issues before death ties for the relatives and also the provision of a jug/ plastic bottle in the confines of the toilet would be greatly appreciated by Muslim families. FOREWORD Palliative care (PC) is a relatively new medical specialization that embodies a number of universally shared values. 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. 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. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. 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? 2016 Dec;14(6):635-640. doi: 10.1017/S1478951516000080. Pain relief would also help retain their belief in God. It was for these reasons that I was particularly intrigued by the sight of a Muslim cancer patient who was deeply sedated in a bed not far from the relative I visited in a hospital a few years ago. In the article, the authors consider aspects such as: They consider the particular requirements of Islam with regard to each of these aspects of healthcare and offer advice on how healthcare providers can be sensitive to these needs. For this reason, this model of care viewed the patients and their families as the unit or object of care, and carers worked with the family to solve problems and make decisions (Portenoy & Bruera, 2003). Islam and palliative care Lists. In situations where the patients' pain cannot be relieved by ordinary levels of pain medication, doctors may sometimes honour those patients' request for pain relief by administering opioids in a dosage so large that death is hastened. It has been observed that their physical presence is important to the patients' physical, emotional and spiritual well-being. 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. It does this by preventing and relieving suffering. delivery of quality healthcare to Muslim patients calls for promoting health professionals’ awareness of the religion of Islam It is also a time for seeking forgiveness from fellow human beings for past transgressions. Against this background, there is nothing redeeming or ennobling about pain and suffering. 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. In investigating the extent to which Muslim patients can avail themselves of these pain treatment options, the work takes a close look at what constitutes a good death in Islam and explores how far this new medical specialty sympathises with the Islamic outlook on death and dying. However, basic hydration and nutrition cannot be discontinued during sedation. Islam and palliative care. 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). At the other extreme, deep sedation may be carried out where the patient would be unconscious and unresponsive (de Graeff & Dean, 2007; Nogueira & Sakata, 2012; Simon, Kar, Hinz, & Beck, 2007). 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 Recognised in the West today as a distinct and important medical specialty, its conception and earlier development nevertheless took place outside mainstream medicine. morphine, oxycodone, fentanyl, hydromorphone, buprenorphine and methadone) that provide sustained pain relief. 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). 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. This ability to effectively control physical pain and other symptoms (like nausea, depression, shortness of breath, distress, vomiting, fatigue and alopecia) transformed terminal care. 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. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. 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. 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. 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. Firstly, it supports many Muslim communities' family-centred approach to care planning and medical decision-making. 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. This part of the discussion assesses the potential opportunities and challenges that modern palliative care poses to Muslim patients. 52, Issue. However the Palliative care may be the moral and ethical alternative of euthanasia for some. From there, it assesses the opportunities and challenges which modern pain management and other aspects of palliative care present to Muslim patients. 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). He is otherwise awake and still able to communicate with minimum impairment. The concept was nevertheless thrust into social prominence with the advent of scientific medicine towards the end of the nineteenth century. 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. 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. 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). 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). However, they soon realised that this ultimate goal of salvation could only be achieved by attending also to the patients' physical and mental suffering. Moreover, certainly in cases where deep sedation is used, this will obliterate consciousness to the point where the patient's life is purely biological. Understandably, issues such as poverty, the sheer number of patients to be served, inadequate health infrastructure and the need to compete with other priorities like primary health care, education and defence means that the provision of multi-professional teams may not be a realistic goal in many countries (Chaturvedi, 2008). 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. 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. 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). These characteristics – namely, concerns over the patients' emotions and spirituality rather than just their bodily well-being; the inclusion of family members as focus of care and co-decision-makers rather than the usual patient-centred structures that characterise clinical practice in the West; and the involvement of numerous carers including those trained outside the medical model – make palliative medicine unique among all medical specialties. There is nevertheless a tendency to focus significantly more on physical care over the psychosocial and spiritual aspects of care. It can purify the soul, atone for one's sins and is expected to yield rewards in the afterlife (Laird, Amer, Barnett, & Barnes, 2007; Pew Research Center, 2013; Qur'an 2:153–157, 39:10; Sachedina, 2012; Sahih Al-Bukhari, 1994). First, if pain leads to the expiation of sins and has a higher purpose, can pain relief be taken? This group of informal carers therefore have their own physical, psychosocial and spiritual needs which are prompted by their dying relatives' illness. Palliative care is experiencing an upsurge in interest and importance. 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. As for patients with a combination of uncontrollable and refractory symptoms, sedation as highlighted at the outset, is currently a palliative medical treatment option. Muslim religious scholars have given various opinions regarding 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. As for those with acute pain syndromes, they can be administered with a titration of a continuous infusion of strong opiates (e.g. This is driven, paradoxically, by modern medicine's increased ability to provide effective pain relief on the one hand and an acknowledgement of its limitation in delivering a cure for certain diseases on the other. 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”. Muslims are expected to be resolute in facing the hardships and tests that are sent their way. 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? However, if pain management can have faith-enhancing and faith-preserving qualities, there are challenges that require scrutiny. 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. paracetamol and non-steroidal anti-inflammatory drugs) and mild opioids (e.g. Many arguments and discussions have ensued related to palliative care services such as end of life care. Therefore, palliative care clinicians should have at least a basic understanding of major world religions. Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Islam (Muslim) This subject guide is a collaborative project with the Children's Medical Center Pediatric Palliative Care Team, the Lamar Soutter Library, and Interpreter Services. 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