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Background reading material by Professor Omar Hasan Kasule Sr. for Year 2 Semester 1 PPSD session of 23rd September 2008
1.0 COMFORT:
Narcotics are given for severe pain. Drugs are used to allay anxiety and fears. The caregivers should maintain as much communication as possible with the dying. They should attend to needs and complaints and not give up in the supposition that the end was near. Attention should be paid to the patient's hygiene such as cutting nails, shaving hair, and dressing in clean clothes. As much as possible the dying patient should be in a state of ritual purity, wudhu, all the time.
2.0 RELIGIOUS OBLIGATIONS
The dying patient should as far as is possible be helped to fulfill acts of worship especially the 5 canonical prayers. Dry ablution can be performed if use of water is impossible. Physical movements of prayer should be restricted to what the patient's health condition will allow. The terminal patient is exempted from puasa because of the necessities of medical care. It is wrong for a patient in terminal illness to start puasa on the grounds that he will die anyway whether he ate enough food or not. Illness does not interfere with the payment of zakat since it is a duty related to the wealth and not the person. The terminal patient is excused from the obligation of hajj. It is also wrong for a patient in terminal illness to go for hajj with the intention of dying and being buried in Hejaz.
3.0 SPIRITUAL PREPARATION.
Spiritual preparation involves allaying anxiety, presenting death as a positive event, thinking of Allah, and repentance. Caregivers should allay fear and anxiety about impending death. Death of the believer is an easy process that should not be faced with fear or apprehension. The process of death should be easier for the believer than the non-believer. Believers will look at death pleasantly as an opportunity to go to God. The patient should be encouraged to look forward to death because death from some forms of disease confers rewards in the hereafter. The patient should be told that God looks forward to meeting those who want to meet Him. Dying with God’s pleasure is the best of death and is a culmination of a life-time of good work. Thinking well of God is part of faith and is very necessary in the last moments when the pain and anxiety of the terminal illness may distract the patient's thoughts. Having hope at the moment of death makes the process of dying more acceptable. The dying patient should be encouraged to repent because repentance is accepted until the last moment.
4.0 LEGAL PREPARATION
During the long period of hospitalization, the health care givers develop a close rapport with the patient. A relationship of mutual trust can develop. It is therefore not surprising that the patient turns to the care givers in confidential matters like drawing a will. The health care givers as witnesses to the will must have some elementary knowledge of the law of wills and the conditions of a valid will. One of these conditions is that the patient is mentally competent. The law accepts clear signs by nodding or using any other sign language as valid expressions of the patient's wishes. The law allows bequeathing a maximum of one third of the total estate to charitable trusts or gifts. More than one third of the estate can be bequeathed with consent of the inheritors. Debts must be paid before death or before the division of the estate. A terminal patient can make living will regarding donation of his organs for transplantation. The caregiver must explain all what is involved so that an informed decision is made. The caregiver may be a witness. It is however preferable that in addition some members of the family witness the will to ensure that there will be no disputes later. The caregiver may be a witness to pronouncement of divorce by a terminally ill patient. The pronouncement has no legal effect if the patient is judged legally incompetent on account of his illness. If the patient is legally competent, the divorce will be effective but the divorcee will not lose her inheritance rights. The caregiver should advise the terminal patient to remember all his outstanding debts and to settle them. The prophet used to desist from offering the funeral prayer for anyone who died leaving behind debts and no assets to settle them. He however would offer the prayer if someone undertook to pay the debt. If the deceased has some property, the debts are settled before any distribution of the property among the inheritor.
5.0 DEATH, BURIAL, and MOURNING
The last moments are very important. The patient should be instructed such that the last words pronounced are the testament of the faith. Once death has occurred the eyes are closed and the body is covered. The health care giver should take the initiative to inform the relatives and friends. They should be advised about the etiquette on mourning. Weeping and dropping tears are allowed. The following are discouraged: tearing garments, slapping the cheek, wailing, and crying aloud. Relatives are comforted by telling them sayings of the prophet about death. The health care team should practice total care by being involved and concerned about the processes of mourning, preparation for burial and the actual burial. They should participate along with relatives as much as is possible. The preparation of the body for burial can be carried out in the hospital. As many persons as possible should participate in the burial. After burial, the relatives are consoled and food is made for them. Only good things should be said about the deceased.