Palliative Care: Taking care of Muslim patients

1. Palliative Care:Taking care of Muslim patients By Khadija Haffajee @ Canadian Association of Spiritual Care Ottawa 2013

2. Spirituality In Arabic the term ‘spirituality’ means ‘ruhaniyyah’ ‘Ruh’, which is the root word of ‘Ruhaniyyah’ means spirit and constitutes the immortal part of human exixtence

3. A man talking to his house by Jalal Ad-din Rumi I say that no one in this caravan is awake and that while you sleep, A thief is stealing the signs and symbols of what you thought was your life Now you’re angry with me for telling you this ! Pay attention to those who hurt your feelings telling you the truth Giving and absorbing compliments is like trying to paint on water, that insubstantial Here is how a man once talked to his house “Please ,if you ‘re ever about to collapse, let me know” One night without a word the house fell. “What happened to our agreement?” The house answered “Day and night I’ve been telling with cracks and broken boards and holes appearing like mouths opening But you kept patching and filling those with mud. so proud of your stopgap masonry You didn’t listen’ This house is your body always saying .I’m leaving, I’m going soon Don’t hide from one who knows the secret

4. Health and illness Islam regards both health and illness to emanate from God, closely linking the art of healing to worship. The one who practices the art of healing does so for the sake of God’s pleasure. In this context, both the provider and recipient become united through a spiritual bond.

5. Badiuzzaman Said Nursi Medicine is both a science and an art. The goals of medicine depend on the inclusion of God as the ultimate Healer. Doctors find the perfection of their profession through seeing God’s compassionate manifestations in the vast natural pharmacy of mother earth.

6. Fethullah Gulen “The perfection of medicine is fulfilled with prayer, because prayer allows the patient to become an active member of the medical team.” Prayer is “a mysterious key to Allah’s everlasting treasures, a point of support for the poor and hurt, and the most secure shelter for those in distress. Those who step into this shelter are considered to have obtained this key, and the poor, weak and needy who join this governance attain that which they had hoped.”

7. Soul You don’t have a soul You are a soul You have a body C.S. Lewis

8. Spiritual care Healthy spiritual care recognizes diversity respects it and honours it treats all as equals does not compel conformity or uniformity comfortable with own sense of spiritual concepts not threatened by differences

9. Islamic view of suffering and death Be sure We shall test you with something of fear and hunger, and a loss in wealth and lives and fruits of your toil, but give glad tidings to the patient who when disaster strikes them say “Indeed to God we belong and to Him is our return” Qur’an 2: 155-156

10. Types of treatment Modern medicine Spiritual healing (Recitation of Qur’an, the Prophetic supplications) Traditional healing (use of Zam–Zam water from Mecca, honey)

11. Modesty Health care providers of the same sex (if not possible then another staff member or family member should be present) Permission sought before entering (knock) Exposure of body parts should be limited

12. Cleanliness/Prayer Clothes and body of patient free from any amount of urine, stool, vomit or blood if at all possible because soiling with any of these renders the patient ritually unclean and unable to perform prayers Ritual washing (Wudu) a prerequiste for prayer Dry ablution (Tayammum)

13. Cleanliness/Prayer Patients with maglignancies, complicated by chronic fecal, urinary, or bloody gyneocological discharge required to perform wudu prior to each prayer at the designated time Mandatory 5 daily prayers except when patient is cognitively unable Prayers may be combined to 3 instead of 5 Format modified – sitting, lying down If medically induced sedation?

14. Social aspects Visitors are a source of comfort, both to patient and family Visiting encouraged Health care providers are encouraged to show a high degree of sensitivity if it becomes necessary to intervene

15. Role of family A family member always present Contributes in decision making Power relations vary within families Usually patient, spouse, parents and elder children It is a collective decision

16. Death and dying Aim of care: encourage and support the dying to cement firmly their relationship with family and God before the imminent meeting with God Muslims believe that the longevity of every person is only known by God Who predetermines the exact time of death Keep family informed about progression of patient’s condition Recitation of Qur’an or play recording Families try to gently prompt dying patient with Shahada (bearing witness that there is no deity but God and that Mohammad is His Messenger) – final statement of Faith

17. After death Sanctity of dead person Handle the body gently with care Eyes of deceased to be closed. All connected tubes to be removed, hands at side, legs straight, cover entire body with a sheet of cloth Once death is pronounced, the rite of washing, shrouding, funeral prayers and burial should follow as soon as possible

18. Role of healthcare team Comfort the family Ensure timely documentation to prevent unnecessary delay in proceeding with burial rites Help in any way to ease the loss of family member Contact community/spiritual care team in the hospital Attend funeral if possible Follow up with family