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Presentation to 4th year medical students
at Salman University on May 14, 2013 by Professor Omar Hasan Kasule Sr.
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, 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 IBADAT:
The dying patient should as far as is possible be
helped to fulfill acts of worship especially the 5 canonical prayers. Tayammum can be performed if wudhu is impossible. Physical movements
of salat should be restricted to what
the patient's health condition will allow. The prophet gave guidelines on salat even for the semi-conscious
patient. The terminal patient is exempted from puasa because of the medical condition. It is wrong for a patient
in terminal illness to start fasting on the grounds that he will die anyway
whether he ate enough food or not. Illness does not interefere 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 God,
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. Believers will look at
death pleasantly as an opportunity to go to God. God loves to receive those who
love going to Him. 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 in God at
the moment of death makes the process of dying more acceptable. The dying
patient should be encouraged to repent because God accepts repentance 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. Islamic Law allows bequeathing a maximum
of one third of the total estate to charitable trusts, waqf, or gifts. More than one third of the estate can be bequeathed
with consent of the inheritors.
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..
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 faith. Once death has occurred the body is placed in such
a way that it is facing Makka. Eyes are closed and the body is covered. Prayers
are then recited. The health care giver should take the initiative to inform
the relatives and friends. They should be advised about the rules on mourning.
Weeping is allowed. The following are not allowed: tearing garments, shaving
the head, slapping the cheek, wailing, and crying aloud. Relatives are
comforted by telling them traditions about death. These talk about the reward
of the person who loses his beloved one and he is patient.
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. The body must be washed and shrouded
before burial. Perfume can be put in the water used for washing the body. The
washing should start with the right. The organs normally washed in wudhu are washed first then the rest of
the body is washed. Perfume can be used except for those who died while in a
state of ihram. Women's hair has to
be undone. After washing the body is shrouded, kafn, in 2 pieces of cloth preferably white in color. As many
persons as possible should participate in the funeral prayer, salat al janazat. Burial should be
hastened. Following the funeral procession is enjoined. There is more reward
for accompanying the funeral procession and staying until burial is completed.
Hurrying in marching to the grave is recommended. The body should be buried in
a deep grave facing Makkah. After burial, the relatives are consoled and food
is made for them. Only good things should be said about the deceased.