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Poster at the Palliative Care Session of the 4th International Conference of the Asian Clinical Oncology Society held in Bali, Indonesia 4-7 August 1999 by Prof Dr Omar Hasan Kasule, Sr. Deputy Dean, Faculty of Medicine, International Islamic University, Malaysia PO Box 141 Kuantan MALAYSIA 25720.
DEFINITION OF DEATH: 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. All humans will eventually die. There can be no exceptions now or at any time in the future. Human death has a finality to it. Each human has only one death.
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. The wish for death, tamanni al mawt can be negative for the escapist who looks to death as a relief from present psychological or physical distress. Some fear death, al hadhr mina al mawt,khawf al mawt (2:19). This is the human fear of the unknown. 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 early death, isti’ijaal al mawt, tamanni al mawt, in desperation with severe painful illness and committing suicide, qatl al nafs are forbidden.
NATURE OF 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). 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 realise 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. Understanding the nature of this death in this way, helps patients and caregivers to look at it as a normal process.
DEATH AS A TEST: Death is a trial, ibtila’a bi al mawt (21:35) and is a calamity, musibat al mawt (5:106). Death is a test for humans (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. For palliative caregivers the event of death is a test of their powers of hope. Frequent deaths that they are powerless to stop may make the lose self-confidence. They may begin to look at their work as bearing no fruit. Death tests caregivers in another way by challenging them to be humble and accept their limitations. Despite all the resources that technology places at their disposal there is a limit to what they can achieve.
TEMPORARY & PERMANENT DEATH: Death could be permanent, mawt or temporary as in sleep, nawm. Permanent death is irreversible until the day of resurection. 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 (39:42).
DEATH AS A TRANSITION
Death is a transitional event, rite de passage, to life after death, al hayat ba'da al mawt (2:28), which is better than earthly life. Good death is to die in Islam, al mawt ala al Islam (2:132, 3:102). Death in unbelief, , al mawt ala al kufr, is bad death (2:161). The best of death is to die when struggling in Allah’s way< al mawt fi sabilillahi (4:100). All human endeavors cease with death, intiha al ‘amal bi al mawt (4:18). 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.
INEVITABILITY of DEATH: Death is inevitable, hatmiyyat al mawt. It is futile to attempt to avoid death istihalat daf'u al mawt (3:154). The human and death have inevitably to meet liqa al mawt (62:8). Death inevitably catches up with the human. Lihaaq al mawt bi al insaan. Death will come to all humans and all living things, shumuul al mawt kulla shay’i. The concept of death also includes non-living things for example the Qur’an talks about death of the earth, mawt al ardh (2:164). 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 (35:36, 44:56).
PROCESS OF DEATH: The human has both degenerative and regenerative processes at the same time. Death occurs when the degenerative forces have the upper hand. Death and its occurrence are in the hands of Allah, taqdiir al mawt mina al llah (3:145). 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 soul, qabdh al ruh, thus separating the essence from the body (32:11). The Qur’an has described the process of death using terminology such as stupor, sakrat al mawt (50:19), fainting, ghashiyat al mawt (33:19) and agony, ghamrat al mawt (6:93).
CONCLUSION: Successful management of terminal cancer cases requires good understanding of the cultural and religious background of patients and their families. This paper provides Islamic perspectives on the death process as a guide to clinicians taking care of patients in South-east Asia, a region with more than 200 million Muslims.