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Lecture to 1st year medical students, Kulliyah of Medicine, International Islamic University, Kuantan on 31st October 1998 by Prof Dr Omar Hasan Kasule, Sr.
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 sharia definition of death is guided by the fiqh concept of custom or precedent (aadat). Thus the shariat definition can change from time to time and also from place to place depending on the level of technological development. Biologically death is simply defined as irreversible damage of major organs. This is not an easy definition because the concept of reversibility is relative. New technologies are showing us that what was previously irreversible is now reversible. The moment of death is also difficult to ascertain with any degree of certainty. This is because the process of death in an interval and not a point event.
NATURE OF DEATH
The Qur’an uses several terms to refer to death such as gharq, halaaq, mawt, wafaat, firaaq. 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 becomes 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 realize that life of some living things is sustained because of the death of others. There is continuous recycling of matter between the organic and inorganic. There is also recycling between the organic and the living.
All humans will eventually die (hatmiyat al mawt, shumuliyat al mawt) (p 1156-7 3:154, 3:154, 3:168, 3:185, 4:78, 4:10, 21:35, 23:15, 29:57, 39:30, 55:26). There can be no exceptions now or at any time in the future. Even prophets have to face death (p 1157 3:144, 19:15, 19:33, 21:34, 34:14, 39:30, 3:168, 3;185, 4:78, 4;10, 21:35, 23:15, 29:57, 55:26). All death is by Allah's permission (p 1258 3:145).
Death could be permanent (mawt) or temporary (nawm). Permanent death is irreversible until the day of resurrection. 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. In some cases people pass away during their sleep (p 1258 39:42).
Death is inevitable (hatmiyyat al mawt). It is futile to attempt to avoid death istihalat daf'u al mawt (p 1154 3:154, 3:156, 3:163, 4:78, 33:16, 62:8). The human and death have inevitably to meet liqa al mawt (p 1045 3;143, 62:8). Death catches up with the human,lihaaq al mawt bi al insaan. Death can not be prevented (isthalat man’i al mawt) by any human endeavor.
Death will come to all humans and all living things (shumuul al mawt kulla shay’i).(p 1156 73:154, 5:26). The concept of death also includes non-living things for example the Qur’an talks about death of the earth (mawt al ardh (p 1153 2:164, 7:57, 16:65, 25:49, 29:63, 30:19, 30:24, 30:50, 35:9, 36:33, 43:11, 45:5, 50:11, 57:17).
Human death has a finality to it. 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 after that (p 1158 14:17, 20:74, 35:36, 44:56, 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 al hayat ba'da al mawt (p. 1155-6 2:28, 256, 2:73, 2:154, 2:243, 2:259, 2:260, 3:49, 3:169, 5:110, 6:36, 6:122, 7:25, 7:57, 11:7, 16:21, 16:38, 19:15, 19:33, 19:66, 22:66, 23:35, 23:37, 23:82, 26:81, 30:40, 30:50, 36:12, 37:16, 37:53, 41:39, 42:9, 44:35, 45:26, 46:33, 50:3, 56:47, 7:40, 80:21-22 & 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.
Good death is to die in Islam (al mawt ala al Islam) (p 1157 2:132, 3:102). Death in unbelief, kufr, is bad death (al mawt ala al kufr) ( p 1156-7 2:161, 2:217, 3:91, 4:18, 9:55, 9:85, 9:125, 47:34). The best of death is to die when struggling in Allah’s way (al mawt fi sabilillahi) (p 1156 4;100, 22:58, 33:23).
All human endeavours cease with death (intiha al ‘amal bi al mawt, inqitau al ‘amal bi al mawt p 839 4:18, 6:27-28, 7:53, 23:99-100, 23:107-108, 32:12, 35:37, 99:7-8, p 1154 23:99-100, 23:91-100, 63:10). There are only three exceptions a righteous offspring who prays for the parent (waladu salihu yad’u lahu), knowledge that benefits others (‘ilm yuntafau bihi), and charity of continuous benefit (sadaqat jariyat).
Death is followed by questions and punishment in the grave (qabr). Barzakh is a transitional phase between life on earth and life in the hereafter. On the last day humans will be resurrected 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 committed shirk who will be condemned to stay in hell for ever. Paradise (jannat) will be the permanent abode of the righteous. There will be no more death in the hereafter (p 1158 14:17, 20:74, 35:36, 44;56, 87:13).
Death is a test for humans (p 382 67:2). The test for the deceased is to aware of death and prepare for it by doing good work, amal hasan. For the relatives and loved ones death is a calamity calling for patience and forbearance.
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. The wish for death (tamanni al mawt) (p 1154 2:94-95…62:6-7) can be negative for the escapist who looks to death as a relief from present psychological or physical distress. 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. Death may be feared because of leaving behind beloved ones. 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) and is a calamity, musibat al mawt (5:106). 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.
PROCESS OF DEATH
Human cells show signs of aging 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, and neoplasms. Humans may not be able to ascertain the immediate cause of death in some cases. Death and its occurrence are in the hands of Allah, taqdiir al mawt mina al llah (2:243, 2:258, 3:273, 3:27, 3:145, 3:156, 6:95, 6:162, 7:158, 9:116, 10:31, 10:56, 15:23, 22:66, 23:80, 25:3, 26:81, 30:19, 30:40, 39:42, 40;11, 40;68, 44;8, 45:26, 53:44, 56:60, 57:2, 67:2, 76:28). 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 (p 1145 4:97, 6:61, 6:93, 7:37, 8:50, 16:28, 16:32, 32:11, 47:27). The Qur’an has described the process of death using terminology such as sakrat al mawt (p 1156 6:93, 33:19, 47:20, 50:19, 56:83-85, 75:26-30, 79:1), ghashiyat al mawt (p 1157 33:19 and 47:20) and ghamrat al mawt (p 1157 6:93).
CRITERIA OF DEATH
In general death is defined as irreversible loss of the integrated functioning of the organism as a whole. For most of human history, death has been defined in a more subjective way with little attention being given to objective criteria. There were not legal or practical necessities for early diagnosis of certification of death. The earliest criteria of death that humans used were respiratory arrest. The Qur'an and sunnat describe death mostly in terms of respiratory failure. Later circulatory arrest as absence of a heart beat or a pulse was also used. Unconsciousness was another criterion used and it related to the brain.
Technological developments in intensive care units has blurred the demarcation between life and death that was taken for granted before. Many brain-dead people can be kept apparently alive on artificial respirators. The increase in transplantation has given momentum to the need to develop new criteria for death. This is because organs have to be harvested quite early in the death process to prevent them from further degeneration. Brain death is quite an early event and was first proposed as criterion for death by an adhoc committee of the Harvard Faculty that redefined death as brain death in 1968. Use of brain death as a criterion gives rise to ethical and legal problems because in cases of brain death, many other organs and functions of life are still alive. There are also controversies about the definition of brain death as a pathological entity. There is controversy whether it is death of the whole brain or specific parts of it. It is not yet possible to agree on what constitutes irreversible brain death. There is disagreement whether criteria used for adults can be used for children.
Brain death is assessed clinically and by use of laboratory and electrical assessments. Clinically brain death is indicated by: absence of pupillary reflexes, dilated pupils, absence of the corneal reflex, absence of eye movements, absence of spontaneous respirations, absence of cephalic reflexes, absence of motor response to poain, absence of the cough reflex, and absence of the gag reflex. These clinical criteria are considered less accurate that laboratory measurements. They also are sometimes too late for purposes of declaring death to enable harvesting organs for transplantation.
Laboratory assessment are considered confirmatory and include: electrocorticogram measurements, electro-retinography, cerebral blood gas analysis, cerebral angiography to show cerebral circulatory arrest, retinal fluoroscopy, assessment of brain stem auditory responses, and the orbicularis oculi reflex.