Articles on Palliative care – End of life care – steps, stages and perspectives

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1 Palliative Care: Islamic Perspectives on “SPIRITUAL SUPPORT IN PALLIATIVE CARE & END OF LIFE EXPERIENCE” Presenter: Mr. Amjad R.M. Syed, Coordinator, Muslim Patient Visiting Services;

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Palliative Care: Islamic Perspectives on
“SPIRITUAL SUPPORT IN PALLIATIVE CARE & END OF LIFE EXPERIENCE”
Presenter: Mr. Amjad R.M. Syed, Coordinator, Muslim Patient Visiting Services; ISNA (Islamic Society of North America) HQ Mississauga ON 905-403-8406 x 206

What is Islam?
Islam means peace and complete submission to the will of Allah (God) and it is a way of life. Islam is the religion, and the follower of Islam is a Muslim.
Islamic Articles of Faith: Faith in Allah, His Angels, His revealed books His Messengers, The Last Day, and Predestination of fate which rests with Allah and finally our resurrection after death.

Five tenets of Islam: 1. Belief in Allah, 2. Five daily prayers, (about 5 minutes each) 3. Fasting during the month of Ramadan, 4. Compulsory portion of Charity, and 5. Pilgrimage to Mecca for those who can afford.

Islam is only revival of the teachings of Prophet Abraham and his descendents. ‘Allah’ is name of God. The word ‘Allah’ has no gender or number. He is indeed One and Unique with many attributes. Allah sent His Guidance to mankind through thousands of Guides and some Messengers. Muslims take Abraham, Moses, David, Jesus and Muhammad (570-632 CE) as major Messengers besides others. May the peace & blessings of Allah be upon them all.

Muhammad (Peace be upon him) was the final and last Messenger of Allah to mankind. He was unlettered, on whom the
final revelation Quran was revealed. This revelation was committed to memory and some of the Prophet’s companions wrote
it down there and then. Quran is available today in its original form and has been preserved word to word.

The religion ‘ISLAM’ is described in Quran and in the life of Prophet Muhammad 570-632 C.E (Peace be upon him – PBUH).
Quran teaches the good way of family life, rights of other people, care of the whole planet besides history, science and the
life Hereafter. When you read, read it with context. It is certainly not what is being portrayed by the biased media or some
authors, or the actions of ignorant and misguided so called ‘Muslims.’

1. Basic Beliefs, Attitudes, Responsibilities & Quranic Guidance towards Old (Parents) – Palliative Care:
• With reference to palliative care, Quran (Q 30:54) says that a child is born feeble and weak who needs care. He grows
into a strong person and then again becomes old weak and feeble [needing care].
• There are abundant of virtues in taking care and serving parents & the aged ones. Quran (Q 17:23) instructs us not
even to say ‘fie’ while serving the aged parents.
• Quran (Q 4:1) explicitly instructs us to be ‘Careful in duties towards mothers.’ Specially when old.
• Quran (Q 46:15) says, “And We (Allah) commanded unto man kindness towards parents….”
• Prophet Muhammad (PBUH) said that “Heaven lies under the feet of your mother; the pleasure of your father is the
pleasure of Allah & the displeasure of your father is in the displeasure of Allah.”
This is the way children are supposed to serve parents – ‘with pleasure’.
• A companion of Prophet said, ‘My parents are no more, does it mean I lost the rewards of serving my parents?’ To
this, the Prophet said, ‘Serve your aunts and uncles, you get the same rewards.’
• If possible, keep the palliative care patients around the family with children.

2. Death & Dying: beliefs and practices:
• Body dies and the soul is transferred to Hereafter for accountability.
• Prophet Muhammad (PBUH) said that the smartest person is one who constantly remembers his death!
• Allah hinted Muhammad about his on-coming death and instructed him to be ready. In Quran, (Q 90:1-3) chapter 90
Verses 1-3, it says, “… (O Muhammad!) Your mission is now complete & successful …, praise the Lord and seek
forgiveness of Him. Lo! The Lord is ever ready to show Mercy.” This is the lesson for mankind, the seniors?
• Regarding hope, the Prophet says, that “God has created medicine for every disease except old age.”
• Regarding importance of ‘Living with the Dying,’ which is in fact serving the dying, the Prophet says that “On the
Day of Judgment, God will ask man, “… I was sick; you did not come to see Me!” The man will say, ‘O Lord! You
are the Lord of the Universe, how could You be sick?’ At this point, God says, My such and such servant was sick.
Had you visited him, you would have found Me!” – this the importance of visiting and serving the needy.
• Package of ‘life’ on earth includes death! Quran (Q 2:156) says ‘To Allah we belong & to Him is our return.’ Again
Quran (Q 55:26) says, ‘Every thing will be destroyed on the Last Day.’ Every soul will have the taste of death (Q 3:185)
• Supplication from Quran is “O Allah! Bestow good in this world and good in the Hereafter and save us from the
Hellfire.” Q 2:201. This is recited by Muslims frequently.
• A Prophetic supplication is to ask for easier and comfortable life in the old age.
• Another supplication taught by Prophet Muhammad (PBUH) is to ask Allah by saying “Keep me alive as long as life
is better for me and let me die if death is better for me.” A Muslim does not take sickness as a punishment of God.
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• Quran (Q 2:155) teaches us the way to be patient at the time of calamities; practicing Muslims know this very well.
• One should submit his will to the will of God. It helps the mind to be at ease.
• One of the articles of Islamic faith is that our destiny, life & death, good or bad in life is predestined. Still it is the
will of God. Man is given he power of discretion and hence accountable of his deeds.
• Prophet Muhammad (PBUH) has left lots of examples to practice patience & how to take care of our self at times of
calamities. He was born orphan, suffered loss of mother at childhood, loss of grand father and his uncle who were
his caregivers and protectors, loss of his most beloved wife, his beloved daughters, sons and uncle & companions.

Practical Tips to the family or the professional caregivers while ‘Living with the Dying’;
• Palliative care of the dying child is a big subject. When we talk of children, try to be a little honest, straight
forward, diplomatic & tactful. But it all depends on age, maturity, strongly religious or not, and knowledge about
life and death. All this depends on the family background. It is the best to consult books written by psychologists.
Lot more care is necessary for the parents. Islamic concept is that every one has to taste death (Q 3:185). Quran clearly
states that some die at an early age and some at the ripe age (Q 22:5).
• Take out time for relaxation. Make a networking with family and take turns to care the dying.
• Try to uplift the mood and morale of the dying person by talking about the good times in the past and all the good
deeds that he/she did.
• Remind him about God’s Mercy and kindness and rewards here and Hereafter.
• Recite or play tape of Quran in the way music therapy is for some.
• Talk of hope and mercy of God as Prophet Muhammad said, “God has created medicine for every disease …;
and God is the Most Merciful and Benevolent.”
• Encourage the patient for patience as described in Quran about the Prophet Job (Ayyub – AS).
• Remind the dying person to pay off debts if any. And to write the last will. This is instruction of the Prophet.
• To ask for forgiveness and to reconcile with his family, friends, co-workers, the caregivers and the medical staff;
• Encourage to give charity;
• To be thankful to all those who helped him during his difficult times and to Allah for the life so far, no matter how
good or bad it was.
• To praise Allah all the time.
• Finally to make final arrangements for his funeral.

Caregiver’s part is not easy; they should learn to cope up with the situation, have patience & expect the reward
only from the Lord in Whom they believe.
It is certainly useful to know some signs of death as follows:
Loss of apatite, Carelessness; Indifference; Extremities going cold, Kidney shunt; Eyes remain fixed; Change in
breathing pattern; etc

Some points to remember for the staff of hospitals, hospice or home care.
• If possible, staff or the family attending to this person should be of same gender. Even the dead should be attended
by the same gender staff.
• ‘Tahara’ or Personal cleanliness: i.e., washing away any blood or other exudates stains on the body or on the bed;
Wiping with wet paper towel after urinating or after passing stools is appreciated. Just cleaning with paper tissue is
not enough.
Dietary laws: no pork or pork products like pepsin, gelatin or lard even in small quantities as ingredients. Beef or
chicken has to be killed in Islamic way, which is ‘Halal’. Kosher meat is acceptable if Halal is not available. Fish
and dairy products are acceptable.
• Dress code for men: minimum is from navel up to the knees; and for ladies, the only parts of the body that
could be exposed to non-family male members are face, hands below wrist and feet below ankles. Ladies wear head
cover called Hijab. For a sick person, his or her comfort should be considered regardless of dress code.
• Help patient in preparing for daily prayers. For bed patients, give wet towels to wash their faces.
• If the patient is in his last breath a relative or any Muslim should remind the person to recite the declaration of
faith viz. “There is no god except Allah; Muhammad is His Messenger”. In fact, a practicing Muslim works all his
life just to remember Allah’s Mercy at the time of death, and to remember to say the declaration of faith.

3. Death, Funeral & Bereavement:
An Arabic proverb says: wealth & family are only a loan & a day will come when you have to return them.
• Death: If possible, before the death occurs, turn the face towards Mecca, which is North East from Ontario
• Any Muslim can recite parts of the Quran (Sura Yaa seen) and Shahada.

• Once the person dies, keep the eyelids closed and hold for a few minutes till they set closed.
• Straighten arms and legs. Never lay the arms crossed over the chest.
• Keep the mouth closed by wrapping gauze or a piece of cloth around the chin and the head.
• Cover the whole body with a sheet of cloth. At no point and time, the body is kept naked.
• Inform the family, Muslim Imam if available on call (not essential) or call the nearby Mosque administration
regarding the death of a Muslim
Organ retrieval is acceptable. Leave it to the living will and the family.
• Release the body ASAP since Muslims want to bury the dead without any unnecessary delay.
• Funeral: Most commercial funeral companies know about Muslim funerals. Bodies are brought to the Mosques if
they have funeral preparation facilities. Bodies are washed, and shrouded in most simple white cloth and placed in a
simple casket. This is done by the same gender family members and volunteers. Funeral prayer is done in the
Mosque and it is transported to the cemetery.
• Absolutely no cremation or embalming. Transportation to far off lands for burial is discouraged.
• Bereavement: Mourning is only for three days, except for the Widow, which is for four months and 10 days.

4. Practical Tips and Recourses regarding Palliative Care:
1. Visit to the family at home:
• Inform the family about the visit in advance.
• Preferably the family or same gender visitors go to see the patient.
• Gift of flowers is acceptable but not expected.
• Short visit is advised by Prophet Muhammad.
• It is customary to remove your footwear at the entrance or at the sitting room; check with the family.
• Accept any treat that the family offers.
2. Death at home:
• Many Muslims prefer to die at home. It is nice to educate concerned families to call the doctor, ambulance or what?
• Families should talk to the doctor about the imminent death & action to be taken, in advance.
• Please provide necessary medical devices or supplies that are immediately needed
• It is not necessary for an Imam to be present at the time of death as there is no priesthood in Islam.
• Friends and family recite portions of Quran & Shahada near the dying person
• Soon after the death, lay the arms and legs straight. Keep eyes closed for a few minutes till they are set closed.
Cover the body with a sheet.
• Gather tel. numbers of funeral companies, and Mosques which have funeral services and pass on to the family.
• Arrange to release the body ASAP since it has to be buried without unnecessary delay
• Cremation or embalming are not allowed
3. Actual funeral procedure:
• Body is picked up by the funeral company and transported to the Mosque
• Body is washed by the same gender family members and volunteers, shrouded in plain white sheets.
• Prayers are conducted in the Mosque where men and women gather.
• Body is transported to the cemetery for burial.
4. Participation of hospital staff and friends of other faith:
• People of other faiths are welcomed to Mosque to witness the prayers. Islamic prayers are done on the carpet. Many
Mosques have chairs assigned for the visitors. Any one can join the funeral procession and attend the burial.
• Flowers are not Islamic tradition, nor it is expected
• Attendees are requested to wear clothes that cover their legs. In addition, ladies cover their head.
• Color of clothes is not an issue.
• Shoes are removed before entering the prayer area.
• Mosques have separate entrances and sections for men and women.
• Eulogy is not a tradition but not restricted.

Resource information:
Mosques with Book stores & Funeral facilities:
Islamic Centre of Canada (ISNA Mosque) Mississauga Tel. 905-403-8406 Ext. 00 or 206,
Ext. 315 has recorded information regarding funeral procedure.
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Jame Mosque, Brampton. Tel. 905-458-8778; Jamia Mosque Toronto. Tel. 416-769-1192
Madinah Masjid Toronto 416-465-7833; Islamic Foundation, Scarborough 416-321-9191;
Jafary Mosque Markham 905-881-1763
An interesting Quranic verse (Q 22:5-7) on today’s topic as translated by Muhammad F. Malik:
O mankind! If you doubt that there is life after death, remember that We(Allah) first created you from dust, then
from a sperm, then from a leech-like mass, then from a morsel of flesh (Embryo), partly formed and partly unformed,
so that We may manifest to you Our Power. We cause (it) to remain in the womb whom We wish for an appointed
term, and then We bring you forth as infants; then We nourish you so that you may reach your age of full strength;
there are some of you who die young (Infant mortality) and some who live on to their abject old age when all that they
once knew they know no more (Walking, eating, Alzheimer’s D). You some times see the land dry and barren; but no
sooner do We pour down rain upon, it then begins to stir and swell, putting forth every kind of beautiful growth in
pairs (male & female).
This is because Allah is the Reality: it is He Who gives life to the dead and it is He Who has power over everything;
And this is a proof that the Hour of Doom is sure to come – there is no doubt about it; and that Allah will raise up
those who are in the graves.
Some useful references:
The Meaning of the Glorious Quran. Translation by M.M. Pickthal
The Holy Quran. Translated by A. Yusuf Ali
English Translation of the meanings of Al-Quran. By M.F. Malik ISBN # 0-911119-77-9
The Life of Muhammad. By Haykal
Don’t Be Sad. By ‘Aaidh ibn Abdullah al-Qarni; ISBN #996-850-36-6
Islamic Perspectives on Prayers & Coping with Sickness. By Amjad R.M. Syed.
ISBN #0-9731641-0-7 Published by ISNA Canada Mississauga. Tel. 905-403-8406 ext. 218
My personal remarks: I like to congratulate and praise all those people who are in the service of the
sick and palliative care. This is certainly a noble profession. God will certainly love reward you.
Amjad
*******************************************************************************
About the speaker: Amjad R.M. Syed
Researcher, plant Cytogenetics – India 1958-1965
Technologist in Clinical Chemistry Lab. Sunnybrook Hospital Toronto 1965-95; Retired.
Volunteer Patient Visitor / Advisory Committee member in Pastoral & Spiritual Care Depts. in hospitals
– 1995 – 2013 and still going.
‘Husband and Wife Team’ Volunteers in hospitals for Pastoral visits and general Islamic Community Services
– 1965 – 2013 and still going.
Chair, Funeral Committee at ISNA, 2002-uptodate.
Co-author of Multifaith Information manuals in Mississauga hospitals.
Author: “Islamic Perspectives on Prayers & Coping with Sickness” Published by ISNA Canada. Available at
ISNA’s Islamic Book Service tel. 905-403-8406 Ext. 218.
Author, Communication guide for Hospital Patients who do not speak English. This work is translated into 23
different world languages. Adopted in Spiritual Care of Trillium Health Centre, Mississauga.
Author of the following flyers: Available from ISNA Tel. 905-403-8406 Ext. 206
• Handy Information for Hospital and Nursing Home Staff regarding Muslim Patients & Islam
• Coping with Sickness
• R U 4 Surgery?
• Islamic Funeral Service Information
• Welcome New Baby
• Islam … at a Glance (by ISNA)
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