Beliefs and Barriers in access of Palliative /Hospice Care at the End of Life Decisions among Muslims
Badaruddin Abbasi, MD, MA, University of Dammam
Objectives
To discuss the evidence regarding beliefs and barriers in making critical health care decision at the end of life.
Explain how death is understood and defined in Muslim communities
What are the choices and preferences in terms of Palliative care or Hospice when treatment is declared futile?
Background
End of life care among Muslims especially in Muslim world is still a new subject considering options like Palliative care / Hospice and organ donation are not yet widely agreed or practiced. Dying is a family matter to many. Some people still die in hospitals but majority still die at home with the support of their families, very little or no help of health care providers therefore many people with malignant illness live with great deal of pain until they die at home.
Still there is an impression that palliative care of a terminally ill is like euthanasia. However the Palliative care may be the moral and ethical alternative of euthanasia for some. Another concern among Muslims on using morphine in Palliative / hospice care when it is not a part of medical treatment is accepted treatment options. In one of the high-tech hospitals (King Faisal Hospital and research center Saudi Arabia); the hospital has a protocol of “No Code” similar to “Do not resuscitate” order in the west. When such patients die, death is allowed to occur with dignity. There is a verse in the Qur’an, which supports organ transplantation: “Whosever gives life to a soul shall be as though He has given life to mankind” Rashid Gatrad in his article 3 stated that “many Muslim scholars particularly from Arab world, agree that organ can be received both from Muslim and non Muslims, based on the principle that the needs of the living override those of the dying or already dead”. Where as Islamic scholars from India and Pakistan, however believes that the body is trust and therefore no one has the right to donate any part of it. This disagreement between rich and poor Muslim scholars influenced with the fact that Arab scholars spoke on only interested in getting organs but not donating one due to their ability to buy like most of the westerns support organ purchase.
However opposition from relatively poorly trained Muslim scholars seems to be based on their experience of illegal ‘selling’ of organs in India and Pakistan where the buyers are mostly from Gulf, as trafficking is forbidden by Islam. Both points of views are not truly representative reflection on Qur’anic teachings. Interestingly Muslims of Secular UK based on Muslim Law (Shariah) Council strongly supportive of Muslims donating organs. It is therefore interesting to note that, although Islam is a flexible religion, individual Muslims may not be.
Many Muslim patients might not want to be told or remind of their terminal illness, however Hospice care actually can help the family fulfill a cultural and religious obligation by focusing on the comforting the patient. Muslim patients do not give up hope because they believe that God not medical science has the power to create life and cause death. Another study in Saudi Arabia on Cancer patients in relation to the acceptability to hospice care, 92% of respondents accepted completion of their care at a hospice rather than in a hospital.
1.The seventh Conference of the Fiqh Academy. Arab News. May 16,1992
2. Christina M.Puchalski, MD, Rabbi Elliot Dorff PhD, Imam Yahya Hendi MA Spirituality, religion, and healing in Palliative care Clin Ceriatr Med 20 (2004) 689-714)
3. Rashid Gatrad, Aziz Sheikh “ Palliative care for Muslims and issues after death” International journal of Palliative Nursing ,2002, Vol8,No12
Objectives
To discuss the evidence regarding beliefs and barriers in making critical health care decision at the end of life.
Explain how death is understood and defined in Muslim communities
What are the choices and preferences in terms of Palliative care or Hospice when treatment is declared futile?
Background
End of life care among Muslims especially in Muslim world is still a new subject considering options like Palliative care / Hospice and organ donation are not yet widely agreed or practiced. Dying is a family matter to many. Some people still die in hospitals but majority still die at home with the support of their families, very little or no help of health care providers therefore many people with malignant illness live with great deal of pain until they die at home.
Still there is an impression that palliative care of a terminally ill is like euthanasia. However the Palliative care may be the moral and ethical alternative of euthanasia for some. Another concern among Muslims on using morphine in Palliative / hospice care when it is not a part of medical treatment is accepted treatment options. In one of the high-tech hospitals (King Faisal Hospital and research center Saudi Arabia); the hospital has a protocol of “No Code” similar to “Do not resuscitate” order in the west. When such patients die, death is allowed to occur with dignity. There is a verse in the Qur’an, which supports organ transplantation: “Whosever gives life to a soul shall be as though He has given life to mankind” Rashid Gatrad in his article 3 stated that “many Muslim scholars particularly from Arab world, agree that organ can be received both from Muslim and non Muslims, based on the principle that the needs of the living override those of the dying or already dead”. Where as Islamic scholars from India and Pakistan, however believes that the body is trust and therefore no one has the right to donate any part of it. This disagreement between rich and poor Muslim scholars influenced with the fact that Arab scholars spoke on only interested in getting organs but not donating one due to their ability to buy like most of the westerns support organ purchase.
However opposition from relatively poorly trained Muslim scholars seems to be based on their experience of illegal ‘selling’ of organs in India and Pakistan where the buyers are mostly from Gulf, as trafficking is forbidden by Islam. Both points of views are not truly representative reflection on Qur’anic teachings. Interestingly Muslims of Secular UK based on Muslim Law (Shariah) Council strongly supportive of Muslims donating organs. It is therefore interesting to note that, although Islam is a flexible religion, individual Muslims may not be.
Many Muslim patients might not want to be told or remind of their terminal illness, however Hospice care actually can help the family fulfill a cultural and religious obligation by focusing on the comforting the patient. Muslim patients do not give up hope because they believe that God not medical science has the power to create life and cause death. Another study in Saudi Arabia on Cancer patients in relation to the acceptability to hospice care, 92% of respondents accepted completion of their care at a hospice rather than in a hospital.
1.The seventh Conference of the Fiqh Academy. Arab News. May 16,1992
2. Christina M.Puchalski, MD, Rabbi Elliot Dorff PhD, Imam Yahya Hendi MA Spirituality, religion, and healing in Palliative care Clin Ceriatr Med 20 (2004) 689-714)
3. Rashid Gatrad, Aziz Sheikh “ Palliative care for Muslims and issues after death” International journal of Palliative Nursing ,2002, Vol8,No12