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Lecture delivered to 1st year medical students at Kuantan, Pahang on October 25th 1997 by Prof Dr Omar Hasan Kasule, Sr. Deputy Dean for Research and Post-graduate Affairs, Kulliyah of Medicine IIUM
OUTLINE
1.0 DEFINITION OF DEATH
Morally
legally
Biological
2.0 NATURE OF DEATH
Ajal
Inevitability
Temporary & Permanent
Cyclic
Finality
Transition
Comprehensiveness
Good and Bad
Cessation of human endeavor
Process
3.0 ATTITUDE TO DEATH
Welcoming & Looking Forward
Fear
Trial
calamity
4.0 CAUSES OF DEATH
Inevitable tear and wear
Causes: known and unknown
5.0 AFTER DEATH
Interregum (barzakh)
Resurrection
Hashr
Hisab
Jannat & Jahannam
6.0 DEFINITION OF THE MOMENT OF DEATH
Brain death
Cardiac Arrest
Respiratory Arrest
Temperature
Clinical
No Response to External Stimuli
No Reflexes
Bilateral Fixed Dilated Pupils
EEG Flat on all Channels
1.0 DEFINITION OF DEATH:
There are several possible definitions of death: moral, legal, biological, chemical, and others.
Morally a person may behave so badly that he no longer has human life but has the life of animals or even worse. This denial of human life is akin to death.
Legally several conventions are adopted by various countries and communities. These conventions change from time to time depending on the level of technological development and the underlying societal values. The shariat definition of death is guided by the fiqh concept of custom or precedent (aadat). Thus the shariat definition can change from time to time.
Biologically death is simply defined as irreversible damage of major organs. This is not an easy definition because the concept of reversibility is relative. The moment of death is also difficult to ascertain with any degree of certainty. This issue will be discussed in more detail below.
2.0 NATURE OF DEATH
The Qur’an uses several terms to refer to death such as gharq, halaaq, mawf, wafaat, firaaq
The Qur’an has taught the concept of a fixed time of death for every human (ajal al mawt) (p 1153 7:34…71:4). Only Allah knows this time; humans can not know it (jahl al insaan bi zaman al mawt, p 1155 31:34). Death occurs immediately when the appointed hour strikes (buluugh al ajal). The hour of death is fixed (ajal musamma, ajal ma’aluum). It can not be advanced or forwarded.
All humans will eventually die (hatmiyat al mawt) (p 1156-7 3:154…55:26). There can be no exceptions now or at any time in the future.
Death could be permanent or temporary. The Qur’an has described sleep as a form of death. In this case it is reversible and is temporary. Animals like amphibians can hibernate for long periods when their body metabolism is reduced to the minimum needed to preserve life. They can revive and resume normal activity when weather conditions allow. Medical research has yet to research the phenomena of temporary death and how it can throw light on the phenomenon of permanent death.
There is a continuous life-cycle involving life and death. Life arises from death and vice versa (ikhraaj al hayat mina al mawt, 3:27, 6:95, 10:31). Inanimate matter in the form of atoms and molecules become the basis for the physical component of human life. They eventually return to their inanimate nature when they are excreted or on death of the human. When you study the ecosystem and the food chains you realise that life of some living things is sustained because of the death of others.
Death can be temporary death such as sleep (nawm) or permanent death (mawt).
Death is inevitable (hatmiyyat al mawt). It is futile to attempt to avoid death (p 1154 3:154…62:8). The human and death have inevitably to meet (liqa al mawt, lihaaq al mawt bi al insaan). Death can not be prevented (isthalat man’i al mawt) by any human endeavour.
Human death has a finality. Each human has only one death. There is no reincarnation. There is only resurrection in the hereafter. There will be no more death after the day of judgement; it will all be eternal life (p 1158 14:17….87:13).
Death could be looked at a transitional event or rite de passage. Death is a transition to life after death. There is another life after the earthly one (p. 1156-6 2:28…80:21-22, 22:66, 26:81, 30:40). Life in the hereafter is better than earthly life. Death could therefore be a welcome event for good people who look forward to a better life in the future.
Death will come to all humans and all living things (shumuul al mawt kulla shay’i).(p 1156 73:154…55:26). The concept of death also includes non-living things for example the Qur’an talks about death of the earth (mawt al ardh).
Good death is to die in Islam (al mawt ala al Islam) (p 1157 2:132…3:102). Death in kufr is bad death (al mawt ala al kufr) ( p 1156-7 2:161…47:34). The best of death is to die when struggling in Allah’s way (al mawt fi sabilillahi) (p 1156 4;100…33:23).
All human endeavors cease with death (intiha al ‘amal bi al mawt, inqitau al ‘amal bi al mawt (p 839 4:18…99:7-8, p 1154 23:99-100…63:10). There are only three exceptions a good offspring who prays for the parent (waladu salihu yad’u lahu), knowledge that benefits others (‘ilm yuntafau bihi), charity of continous benefit (sadaqat jariyat).
The Qur’an has described the process of death using terminology such as sakrat al mawt (p 1156 6:93…79:1), ghashiyat al mawt (p 1157 33:19 and 47:20) and ghamrat al mawt (p 1157 6:93).
The process of death is long. It starts with the humanly-understood causes like infection or trauma. The body progressively fails until a point of no-return is reached. There is a point during this process when the angels take away the ruh (qabdh al ruh), thus separating the essence from the body (al malaika wa qabdh al arwaah, malak al mawt)
3.0 ATTITUDE TO DEATH
The attitude to death varies according to the spiritual well-being of those involved.
The good people welcome death as a rite de passage to a better existence in the hereafter. They look forward to death (al shawq ila al mawt) as a happy event. They wish for death (tamanni al mawt) (p 1154 2:94-95…62:6-7) in the positive sense that is different from those who wish for death because of the suffering of an illness.
Death is an occasion for reminding and remembering the hereafter. It makes the good prepare better by doing more good deeds.
Some fear death (al hadhr mina al mawt, khawf al mawt) (p 1155 2:19…2:243). This is basically the human fear of the unknown. It is useless to fear an event that is inevitable and over which a human has no control. Whereas fear of death itself in illogical, anxiety about the manner and circumstances of death is reasonable and is expected from a normal human.
Wishing for death (isti’ijaal al mawt, tamanni al mawt) in desperation with severe painful illness is discouraged. Committing suicide (qatl al nafs, intihar) is definitely forbidden and puts someone outside the fold of Islam.
Death is a trial (ibtila’a bi al mawt) (p 1153 21:35, 77:2). This trial involves both the person dying and the relatives and friends left behind.
Death is a calamity for the relatives, friends, and the society but not the deceased (musibat al mawt,). If he is good he is going earlier to his lord. If he is bad he has no more time to do bad; however he might have made tawbat and improved his situation had he lived longer.
4.0 CAUSES OF DEATH
Human cells show signs of ageing and metabolic processes get weaker with time. Thus the human has both degenerative and regenerative processes at the same time. Death overwhelms him when the degenerative forces have the upper hand.
Death is inevitable; it will occur. What are called causes are actually associated factors. These may be trauma, infections, metabolic impairment, neoplasms or even unknown. Death and its occurrence are in the hands of Allah (taqdiir al mawt mina al llah). Humans may not be able to ascertain the immediate cause of death in some cases.
5.0 AFTER DEATH
Death as a transitional event is followed by questions and punishment in the grave (qabr). Barzakhis a transitional phase between life on earth and life in the hereafter. Humans will be ressurrected back to life (ba’ath, ihya al mawta, al hayat ba’da al mawt). The Qur’an has not provided details about this life whether it will be exactly like that on earth or there will be some differences. The Qur’an makes it clear that it will be physical life with physical bodies. On resurrection people will be gathered; all generations and all geographical areas will be together (al hashr ba’da al mawt). Those who committed transgressions will be punished in hell for a limited time with the exception of those who commited shirk who will be condemned to stay in hell for ever. Paradise (jannat) will be the permanent abode of the righteous.
6.0 DEFINITION OF THE MOMENT OF DEATH
The customary definition of death has not been very rigorous because there was no urgency in determining that a person died. Therefore cardiac arrest, respiratory arrest and other very obvious and perhaps quite late indicators of death have been used as shown in the table below:
Clinical Definition of Death for Person not on Sedatives
No response to external stimuli
No Spontaneous respiratory movement for 3 minutes
No reflexes
Bilateral fixed dilated pupils
EEG Flat on all channels.
Transplantation created a novel situation because death had to be declared before organs start deteriorating. Cadaveric kidneys must be harvested within 100 minutes of cardiac arrest The concept of brain death evolved to solve this problem but it gave rise to new problems.
Brain-death as a definition of death is not yet accepted customarily and has a big element of uncertainty that organs are being harvested from a living person who is thereby killed. The motive behind using brain death as a definition of death is also questionable. It could be argued that the need to harvest organs is behind the adoption of brain-death as a definition of death. The other definitions of death in the table above are quite classical and are widely accepted by precedent and have no uncertainty associated. They however are too late for organs to be harvested. Organs start deteriorating quite early in the death process.
There is now a doubt whether brain death is actually a terminal event and can not be reversed by yet an undiscovered procedure. The success of transplantation is its own worst enemy. By making it possible for patients with end-organ failure to survive, transplantation creates enough doubt about the finality of brain death. medical technology may soon discover a way of reviving persons who are brain dead to normal physiological functioning. This possibility makes the harvesting of organs from such patients a very doubtful matter legally. Where there is a doubt, we have to proceed very carefully.
The principles of custom and certainty are invoked in the definition of death and thus the earliest time for organ harvesting. Under the PRINCIPLE OF CUSTOM ( al aaadat), brain-death does not fulfil the criteria of being a widespread, uniform, and predominant customary definition of death which is considered a valid precedent (al aaadat muhakamat). The successes of biotechnology in transplantation and other fields introduces a strong doubt (shakk) that brain-death could be reversed. Under the principle of certainty, existing customary definition of death should continue in force until there is compelling evidence otherwise (al asl baqau ma kaan ala ma kaana).
The principles of the law (qawaid fiqhiyyat) can be applied to the various definitions of the timing of death as summarised in the table below:
Situation maqasid and qawaid reference
Brain death Certainty, Motive
Cardiac arrest Certainty,Custom
Respiratory arrest Certainty, Custom
Rigor mortis Certainty, Custom
Temperature Certainty, Custom