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Background material for workshop on the Islamic Input in the Medical Curriculum by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) EM: omarkasule@yahoo.com. WEB: http://omarkasule.tripod.com
1.0 LIFE, hayat
1.1 DEFINITION OF LIFE
Life is a complex phenomenon with biological, chemical, and spiritual components. Both life and death are earthly phenomena. Life exists in the hereafter; but death does not. Humans share biological life with plants and animals. They share spiritual life with angels. No other creation of Allah resembles humans in having physical and spiritual life at the same time. Life without any spirituality is not a full human life but is a life of animals. Life can be described at various levels: ruh, the whole living organism, the organ, the tissue, the cell, sub-cellular structures, the molecule, and the atom. The highest level is that of the ruh about which we know very little. We however know that the ruh is the essence of human life and that it is eternal. The ruh is inserted in the fetus during intra-uterine life to give it human life, nafakh al ruh. Human life started with the stage of ruh when Allah took the covenant. This was life at a spiritual level. It became life in a material form with the creation of Adam and his wife Hawa. They were created from clay and became full perfect humans when the ruh was inserted into them. Biological life can be looked at in three stages: pre-uterine, uterine, the post-uterine phases. The post-uterine phase has in return got two stages: life on earth, hayat al duniyat, and life in the hereafter, hayat al akhirat. Life belongs to Allah and not the human. Allah gives and takes away life. Humans do not own their life but are temporary custodians of life enjoined to take good care of it. Humans have no control over life or death (25:3).
1.2 THE QUR'ANIC CONCEPTS OF LIFE
Allah gives life and takes it away. Nobody else has control over life. Humans created from the basic elements of earth and water. They result from semen and the union of male and female gametes, nutfat. The Qur’an has in many verses described the stages of creation starting with the soul, then the nutfat, then the clot then the flesh. The Qur’an describes processes of life after birth that are basic necessities of life, dharurat, such as eating, drinking, reproduction and defecation. The processes may also be needs, haajiyaat, that make life more meaningful for example vision, hearing, and speech. The processes may also be tahsiinaat such as the intellect, ‘aql, consciousness, shu’uur, and the qalb. The nature of the insertion of the ruh is not known for certain to us. It may be a purely spiritual phenomenon or may have some biological and physical aspects. The ruh is the permanent essence of life.
1.3 NATURE OF LIFE
There is a continuum in human life. The start is the state on non-existence, 'adam. Allah then created the souls and took an undertaking from them to worship him. Starting with Adam (PBUH) Allah created a physical body to house those souls during life on earth, hayat al duniyat. The physical part of existence on earth ends with physical death and the souls continue existing into eternity. Life in the integerrum, hayat al barzakh is an intermediate stage between life on earth, hayat al duniyat, and life in the hereafter, hayat al akhirat. In the hereafter human life will re-assume its physical form with the resurrection, al ba’ath. Life in the hereafter will be eternal. Human life on earth has a definite time span, ajal. No human endeavor including the most advanced medical procedures can shorten or extend this time span. The whole purpose of medicine is to exert maximum efforts to improve the quality of remaining life since Allah alone knows the timing of the ajal. The first and most important purpose of life is worship of Allah, ‘ibadat. Life can be a happy one, hayat saidat/hayat taibbat, or unhappy, hayat dhankat. A good life is related to good deeds (16:97). Success and failure are experienced both on earth and in the hereafter.
1.4 QUALITY OF LIFE
The quality of life can be defined in physical, mental, or spiritual dimensions. The physical criteria are: absence of disease, comfortable environment, and basic necessities. The mental criteria are: calmness, absence of neurosis and anxiety, and purposive life. The spiritual criteria are mainly correct relation with the creator.
1.5 VALUE OF LIFE
Human life is a gift from Allah, ni’imat al hayat. Humans must be grateful to Allah for the gift of life by worshipping Him, ibadat. The prophet said that good health, sihhat, and afiyat are two bounties that many people do not enjoy. Each human has an inalienable right to life from Allah, haqq al hayat. The sanctity of life, hurmat al nafs is guaranteed by the Qur’an. The life of each single individual whatever be his or her age, social status or state of health is important and is as equally important as the life of any other human. Protection of life, ‘ismat al hayat/hifdh al nafs, is the second most important purpose of the shariat coming second only to the protection of the diin. No material value can be put on human life. Every life is as important as any other life. Destroying the life of one person is equivalent to destroying the life of all humans.
2.0 DEATH, al mawt
2.1 DEFINITION OF DEATH
Death can be defined as moral, legal, or biological death. Death could be permanent with cessation of all physiological functions. It could be temporary such as in sleep.
2.2 NATURE OF DEATH
There is a continuous cycle involving life and death. Life arises from death and vice versa (3:27 & 10:31). All human endeavors cease with death (4:18 & 63:10). Death is followed by burial in the grave, qabr (90:21). There may be reward or punishment in the grave. Barzakh (23:100) 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 (6:36 & 86:8-10). The Qur’an makes it clear that it will be physical life with physical bodies. On resurrection people will be gathered, al hashr ba’da al mawt (2:203 & 100:9-10). 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 forever. Paradise, jannat, will be the permanent abode of the righteous. There will be no more death in the hereafter (14:17 & 87:13). All humans will eventually die, shumuliyat al mawt (3:154 & 55:26). Humans fear death, hadhar al mawt (2:19 & 2:243). In view of the inevitability of death, hatmiyyat al mawt, it is futile to attempt to avoid death or think of its removal, istihalat daf'u al mawt (3:154 & 62:8). Modern biotechnology discoveries of artificial life support, cloning, and frozen embryos are not in essence prolongation of life. Human death has finality to it. There is no reincarnation. There is only resurrection in the hereafter. There will be no more death after the day of Judgment and life will be eternal (14:17 & 87:13). Death is a transition to life after death, al hayat ba'da al mawt (2:28 & 30:40). 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 (2:132 & 3:102). The best of death is to die when struggling in Allah’s way, al mawt fi sabilillahi (4:100 & 33:23). Death in unbelief, al mawt ala al kufr (2:161 & 47:34) is bad death.
2.3 ATTITUDES TO DEATH
Death and its occurrence are in the hands of Allah, taqdiir al mawt mina al llah (2:243 & 76:28). 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 approach of death is an opportunity for repentance, tawbat (4:18 & 23:99). Death is an occasion for reminding and remembering the hereafter. Humans are apprehensive about death, al hadhr mina al maw and often fear it, khawf al mawt (2:19, 2:243). Wishing for death, isti’ijaal al mawt, tamanni al mawt, in desperation with severe painful illness is discouraged. The wish for death, tamanni al mawt (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 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 (21:35 & 77:2) and is a calamity, musibat al mawt (5:106).
2.4 PROCESS OF DEATH
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 thus separating the essence from the body (4:97 & 47:27). The Qur’an has described the process of death using terminology such as sakrat al mawt (6:93 & 79:1), ghashiyat al mawt (33:19 and 47:20) and ghamrat al mawt (6:93). The process of terminal death following Allah's laws, sunan al llaah, can not be reversed except in exceptional cases of divine intervention such as when Allah gave the prophet Isa (PBUH) the ability to revive the dead, ihyaa al mawta (3:49 & 19:29-33).
2.5 CRITERIA OF DEATH
Technological developments in intensive care units have 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. The traditional criteria of death were respiratory failure, cardiac failure, and loss of consciousness. 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. There is also disagreement whether criteria used for adults can be used for children.
3.0 HEALTH, sihat & ‘aafiyat
3.1 CONCEPT OF GOOD HEALTH
Health is a positive state of being and not just absence of disease. Individuals who are disease-free may not be healthy. The components of good health are spiritual health, physical health, psychological and mental health, and social health. Islam looks at health in a holistic sense. If any part of the body is sick the whole body is sick If a member of a family is sick the rest of the family are affected emotionally and psychologically. Any sickness in the community will sooner or later have some negative impact on all the members. The holistic outlook also means that physical, emotional, psychological, and spiritual health are considered together. Health is relative and subjective. It varies by age, place, norms, gender, and state of iman or tawakkul. The Qur'an has used terms that refer to the general concept of holistic well being such as raahat and raghad. Health is often assessed subjectively using terms such as ‘good health’, ‘healthy’, ‘poor health’ and ‘unhealthy’. Attempts have been made to measure health more objectively based on the ‘disease model’ which defines health is absence of disease. The best index would be one that includes both spiritual and physical parameters. Such an Islamic index has not yet been constructed to our knowledge. This index would also include criteria that reflect relations with Allah, with the self, with other humans, and with the environment. Keeping body in good health is a responsibility, amanat. Good health is a gift from Allah,. An ordinary person may not understand or appreciate the value of good health when in good health. On falling sick, the value of good health is understood and is appreciated but most often for a limited time. Everything is forgotten as soon as the illness is over.
3.2 DETERMINANTS OF HEALTH
The state of health is determined by nutrition, exposure to environmental risk factors, lifestyle, behavior, and iman. Diet is at the root of many diseases. The habitat also determines the character and behavior of people. The life style that people choose affects physical and mental health. The Qur’an has described several life-styles that are injurious to health such as taraf and fasaad. There is a strong relation between iman, character, behavior and health. Humans suffer from diseases of the heart such as jealousy, hasad and rancour, hiqd, that lead to violence in the person or those around him. These diseases may manifest physically as psychosomatic illnesses or may manifest more dramatically such as homicide or bodily injury. Addiction to alcohol or drugs is a reflection of weak iman. It leads to many physical and psychological diseases
3.3 FAMILY HEALTH
A healthy family promotes the health of all its members. There is no alternative to the family for child up-bringing. The family teaches trust, loyalty, a sense of belonging, and rights and responsibilities. It is an economic unit. It is the main source of primary health care. It is a source of calmness and tranquility. Threats to the family are extra-marital sexual relations, neglect of family duties in pursuit material goods, extreme individualism and self-interest, and bad socio-economic circumstances. Dysfunctional families are not healthy in the physical and psychological sense and have long-term impact on the children. The causes of family dysfunction are multiple: economic pressures, a hedonistic life-style, and decline of moral and religious values in the society.
3.4 COMMUNITY HEALTH
The Qur’an has described good and bad communities in the past. It described communities that were punished or destroyed by Allah sue to moral deviations. No community is destroyed or is punished until it receives a warning from Allah. Community diagnosis is identifying and describing health problems in a community with a view to initiating public health interventions. Many communities are unhealthy in the physical and social or mental sense. Underlying causes of poor community health are social and moral such as social injustice, immorality, sexual promiscuity, over-nutrition, and addiction to alcohol and drugs. Community health can be improved by having healthy individuals in the community, fulfilling communally obligatory functions, and establishing mutual cooperation and mutual complementation.
3.5 HEALTH PROMOTION
Most diseases can be prevented using spiritual approaches. These involve aqiidat, ibadat, avoiding haram and promoting halaal. Spiritual promotion at the community level involves enjoining the good and forbidding the evil. Physical health promotion at the individual level includes immunization, good nutrition, personal hygiene, and disinfection. Physical promotion at the community level involves environmental saniation. Health promotion involves pro-active measures that make health better such as exercise, good nutrition; adequate rest; mental calmness; tranquility of family life, iman and spiritual calmness.
4.0 DISEASE, al maradh
4.1 CONCEPTS OF DISEASE
Disease is divergence from the normal, gaussian mean, but not all deviation is disease because of the reserve capacity and ability of the body to adjust to variations. The demarcation between pathology and normal physiological variation can be fine. The definition of disease is very relative being affected by age, gender, culture, beliefs, socio-economic status, attitudes, and prevalence of diseases. Definition of disease considers several dimensions that may operate singly or in combination: moral or spiritual, biological or pathological, psychosocial, or normative statistical. Overall disease is a state of dis-equilibrium, khuruuj al badan ‘an al i’itidaal. A distinction must be made between disease as a pathological manifestation and illness that is a subjective feeling. Symptomatology is perhaps a better indication of disease severity because it includes the personality of the patient and reactions. Thus the same pathology does not produce the same symptomatology in all patients. Those with strong iman may complain less about pain than others. Prognosis is an empirical estimate of the future course of the disease based on available data and is not definitive because the final outcome is part of the knowledge of the unseen, ‘ilm al ghaib. The physician does not have the privilege to say anything definitive about the future prognosis. There is a 2-way interaction between diseases of the heart, amradh al qalb, and diseases of the body, amradh al badan. The Islamic position is to approach most diseases empirically and to be guided by experimental science. Islam rejects superstitious beliefs and practices in all their various forms and manifestations.
4.2 BASIS OF CLASSIFICATION OF DISEASE
Diseases may be classified by their duration as acute or chronic, by cause as diseases of the heart, amradh al qalb, (2:10 & 74:31) and diseases of the body, amradh al badan, by life-stage as congenital or acquired, by nature as mental or organic, as local or systematic, and by organs afflicted. The physical environmental causes of disease are: infection, physical energy, degeneration, and breakdown of homeostatic control. Most disease processes are actually attempts by the body to repair damage. Some diseases are gender-specific because of the organ that is affected.
4.3 NATURE OF DISEASE
Disease is a pathophysiological disturbance is normally a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including their symptoms and signs are a reaction to the injury and an attempt to re-adjust. In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. It forces us to rest, its pain teaches patience and forbearance, it is an opportunity for expiation/atonement for previous sins, al maradh kaffaarat ‘an ba’adhi al dhunuubi (MB1949). The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness (MB1948, MB1951). Some diseases are due to disobedience. Acts of disobedience may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship. The prophet taught that when communities commit inequities, Allah sends them diseases unknown in their ancestors. Many of the diseases of industrialized societies are related to lifestyle and may be Allah’s punishment for various transgressions. Allah in recognition of the burden of disease and the need to give the body a chance to recuperate excused the sick from some physical religious obligations (2:10 & 73:20).
4.4 CAUSES OF DISEASE
According to the Islamic perspective every phenomenon in life has an immediate cause, sabab that humans can search for and find. However behind all these causes is the power and majesty of Allah who alone is the source of all causes, musabbib al asbaab. When all the factors that produce a certain pathological condition exist, we say that there is a sufficient cause of disease. There are empirical factors that must operate for a certain pathological condition to occur. These are referred to as necessary causes. Denying their existence is denying the cardinal principle of sunan Allah fi al kawn and is akin to superstitious belief. Human diseases, like the human organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act in sequence, knowledge of only one may be sufficient to interrupt the causal pathway. The causation, progression, and resolution of disease are in the hands of Allah and are part of qadar. It is Allah’s pre-determination that a person falls sick. Humans try to understand disease processes in order to reverse them. This is not contradicting or opposing Allah’s will. All what a physician does is with Allah’s permission and is therefore part of pre-determination. Treatment and prevention of disease are not against qadar but are subsumed under the principle that qadar can reverse another qadar, radd al qadar bi al qadar. In the end all cure is from Allah and not the human (26:80).
5.0 MEDICAL TREATMENT, al tatbib, al tibaabat
5.1 CURE OF DISEASE
Every disease has a treatment. Allah did not reveal any disease without also creating its cure. Humans are encouraged to seek treatment. Some people may know the cure and others may ignore it but it nevertheless exists. The Qur’an described cure of prophet Ayyub’s disease (21:83-84 & 38:41-44) and how Isa (PBUH) cured chronic diseases (3:49 & 5:11). Humans try, but it is Allah who cures (21:83-84 & 38:41-42). Disease treatment is part of qadar (Tirmidhi K26 B21). Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr and is reversal of qadar by another qadar, rad al qadr bi al qadr.
5.2 PREVENTIVE MEDICINE, tibb wiqa’i:
Preventive medicine, tibb wiqa’i, is covered under the Qur’anic concept of wiqayat. The Qur’an has used the concept of wiqaya in many situations to refer to taking preventive action. Prevention is therefore one of the fixed laws of Allah in the universe and its application to medicine therefore becomes most obvious. The concept of prevention, wiqayat, does not involve claiming to know the future or the unseen, ghaib, or even trying to reverse qadar. The human using limited human knowledge attempts to extrapolate from the present situation and anticipates certain disease conditions for which preventive measures can be taken. Only Allah knows for sure whether the diseases will occur or not. The human uses knowledge of risk factors for particular diseases established empirically to predict disease risk. Preventive action usually involves alleviation or reversal of those risk factors.
5.3 CURATIVE MEDICINE, tibb ‘ilaji:
Curative medicine, tibb ‘ilaj, may be spiritual, physical or both. Non-invasive approaches aiming at assisting the body fight disease are preferred to riskier invasive approaches.
5.4 MODALITIES OF TREATMENT
Among spiritual approaches to disease management is use of dua from the Qur’an (17:82) and hadith as ruqiy.The formulas for ruqy reported from the prophet, al ruqiy al mathuur, are surat al fatihat, surat al falaq, surat al naas, ayat al kursi, and various supplications by the prophet, dua ma’athurat. Other spiritual cures are reciting the Qur’an (Ibn Majah K31 B28, dua (Ahmad 2:446), asking for protection from Allah, isti’adhat and salat (Ibn Majah K31 B10). Among physical approaches to disease management are: diet, natural agents (chemical, animal and plant products), manufactured chemical agents, surgery, and physical treatment like heat. Physical approaches can reverse disease pathology, mitigate its effects or just stop farther progression. All therapeutic agents and procedures are allowed unless they contravene a specific provision of the law. This provides a wide scope for the practice of medicine. Medicine is bad and is forbidden (Tirmidhi K26 B7) if it causes more harm than benefit. Haram material is not allowed as medicine except in special circumstances where the legal principle of necessity, dharurat, applies. The side effects of medication must be considered alongside the benefits. Choice of what treatment modality to use involves careful weighing of benefits and possible harm or injury. Islamic Law gives priority to preventing harm over accruing a benefit. There should no dichotomy between spiritual and physical modalities of treatment. Both approaches should be used for the same condition; they are complementary. Each cures the disease each using a different pathway. There is no contradiction but there is always synergy. It is a mistake to use one and reject the other.
5.5 SHIRK IN SEEKING CURE
Shirk arises when humans seek and expect cure of disease from anything other than Allah. Forbidden shirk practices in disease treatment include: talismans (Muslim K39 H121), amulets (5:3 & 5:90), fortune telling (Muslim K39 H121), divination (Bukhari K76 B17), astrology (Ibn Majah K23 B28)sorcery (Bukhari K76 B17), and worshipping or asking cure from humans called saints by visiting their graves. Other superstitious practices usually associated with shirk are: claiming knowledge of the unseen and claiming supernatural powers by any human. Many people with disease conditions resort to shirk practices due to misguidance by shaitan. These practices nullify ‘aqidat al tauhid because they attribute disease and its cure to other than Allah. They also distract from seeking true treatment based on rational scientific medicine. Jinn possess limited power that is used to misguide and give credibility to shirk and superstition. The jinn do not know the unseen (15:17-18 & 72:8). A good Muslim should not be involved with jinns and should ask Allah for protection against them (3:36 & 114:1-6). Some forms of dream interpretation, tafsir al ahlam, are forms of shirk. Only Allah knows for sure the correct interpretation of dreams. Limited ability to interpret dreams was given to some prophets (12:6 & 12:100-101). Other humans do not this ability. Therefore dreams of ordinary humans should have no role in the diagnosis, treatment and prognosis of disease.
6.0 INTRA-UTERINE GROWTH AND DEVELOPMENT, rahim
6.1 ORIGINS
Adam was created de novo and not from any previous life. The rest of humans start life when maternal and paternal DNAs are combined in the process of fertilization. The rest of the human body is then built from basic elements of the earth: water and soil. Human biological life manifests cyclicity. The human physical body is derived from the earth. On death of cells or the whole organism, elements found in one body return to the earth. The nutfat is a basic constituent of life. It is the primary germinal cells, the sperm in the male and the ovum in the female. In essence nutfat is parental DNA. The prophet in many hadiths described the formation of the fetus in details that are akin to textbooks of embryology. Humans have one origin from Adam and from the earth. Various human races are one species that can interbreed. Humans however have different colors and structures. The biological differences among humans were created in a deliberate fashion by Allah and did not arise by chance.
6.2 CONCEPTION
The male gamete is the sperm and the female gamete is the ovum. About 50-100 sperms reach the ovum but only one penetrates it. The statistical probability of a particular genetic individual is low because only one sperm out of so many fertilizes the ovum. Chromosomal rearrangements are millions of possible combinations and permutations. An individual human is a unique creation of Allah selected out of trillions of possibilities. The start of a new human life legally recognized is at conception. However from a purely biological point of view there was life in the gametes even before conception. Sex determination involving the X and Y chromosomes is not a random process but a deliberate design by Allah to make some offspring male or female. The prophet explained that the offspring resembles both parents because they both contribute to its heredity. The fetus and child can acquire biological features not inherited from either parent due to environmental effect on the genotype. Behavioral characteristics can be transmitted from the parent as learning and culture but not as inheritance.
6.3 EMBRYOLOGICAL CORRELATIONS
Intra-uterine growth and development have been described by the Qur’an and hadith as occurring in stages. Allah had the power to make an adult de novo as He did with Adam and Hawa. The likely reason for staged growth is to allow gradual interaction and adaptation to the external environment. The Qur’an has described 4 consecutive stages of embryological growth and development: implantation, ‘alaqat, mudhghat, ‘idhaam, and nash'at, the stage of establishment. It is at the stage of nash'at that the spirit is inspired, nafkh al ruh. The Qur’an has also described historical incidences on ensoulment of Adam, nafakh al ruh fi adam and Isa. Several studies have been published of the correlation between descriptions of intra-uterine growth by the Qur'an and embryological sciences. Care must be exercised not to carry the correlation too far because the Qur’an is divine and its facts are stable whereas scientific facts change from time to time.
6.4 EXTERNAL AND INTERNAL ENVIRONMENTS
The placenta mediates between maternal and fetal circulations. It enables exchange between the fetus and the external environment so that the fetus to satisfy its respiratory, circulatory, and excretory needs without laboring its growing organs. The organs still play a role because they need testing and preparation for later independent existence. The blood-placental barrier protects the fetus from environmental toxins by being very selective in what molecules are allowed to transit. It also protects the mother from some fetal products that could give rise to immune reactions. The amniotic membranes provide some mechanical protection. The amniotic fluid absorbs mechanical forces and thus cushions the fetus from harm. The fluid in the amniotic cavity plays a role in regulation of temperature. The growing fetus can respond to environmental stimuli. Scientific research in this area will yield more information in the future. The fetus is calmed and is reassured by hearing and feeling the maternal heartbeat. The fetus exercises all its muscles constantly. This is necessary for their growth.
6.5 DISORDERS OF INTRA-UTERINE GROWTH
The common disorders of intrauterine growth are growth retardation, immaturity of organ systems, malformations, fetal disease, and fetal death.
7.0 INFANCY & CHILDHOOD, tufuulat
7.1 PARENTHOOD
Childhood, tufuulat, the period from birth to puberty, is a period of limited ability and responsibility (24:31, 24:59, 40:67). Infancy is not a useless period. Great things happened to infants. Yahya was given wisdom while a baby 19:21. Isa spoke as a baby (19:29). The fetus is a person addressed as an individual by the Qur’an (53:32). A child or an infant is not a miniature adult. It has a distinct personality, identity, needs, and has to be handled differently. The scope of parental responsibility is wide starting with pregnancy (39:6, 53:32) and continuing until puberty and in most cases even beyond puberty. Parents are responsibility for material support of their children and for educating and upbringing, tarbiyat al awlad (18:80-81 & 74:13). Children must be reared in a family (3:47 & 19:20). The Qur’an mentioned love for the child (20:38-40 & 28:10-13). Islam enjoins equal treatment of children, 'adl bayn al awlad (Bukhari K51 B12). Islam teaches good treatment of female children as a preventive measure against abuse (Ahmad 1:235). Breast-feeding by the mother, ridha’at, has been emphasized by the Qur’an (2:233 & 46:15). It establishes both a biological and psychological bond between the mother and the baby. In order to complete the infant’s biological and psychological growth and development, breast-feeding must continue for not less than 2 years (2:223, 31:14, 46:15).
7.2 CHILDREN IN QUR’AN and SUNNAT
The following children later became prophets: Ismail, Musa, Yusuf, Yahya, Isa, and Muhammad. Maryam and the children that Khdhr met were children of the righteous. The stories of the children of the prophet and his companions were also told. Also told were stories and the fate of children of evil doers.
7.3 GROWTH: PHYSICAL, SOCIAL, and PSYCHOLOGICAL
Babies can learn and retain information. The injunction to make adhan in the right ear for the newborn is perhaps an indication of this (Abudaud K40 B106). Under-estimation of infants is the cause of under-stimulation by many parents. Children are born in a state of natural purity, fitra (Bukhari K23 B80). It is the parents who can misguide them (Muslim H6428). Good parents and a virtuous social environment will guide them to the good. Inadequate parents and a poor social environment will guide them to evil. Islamic law recognizes the age of 7 as the age of discrimination, sinn al tamyiiz. Full intellectual maturity is not reached until the age of puberty. Children are therefore ordered to start praying at the age of 7 and are punished for missing prayers at the age of 10. Full legal responsibility is at puberty and by this time they have, according to Piaget, acquired abstract thinking to supplement the concrete thinking on which children rely. Social development starts with awareness of the self then the family and the neighborhood. As the child grows older, it becomes aware of membership in larger groupings: the tribe, qabiilat; the nation, the ummah, and the universe. At a later stage it learns about the history and the future. Gender identity is acquired quite early but its meaning and implications become deeper as the child grows. ‘Aqiqat is a social occasion when the newborn is introduced into the community (Bukhari K71 B2). Development of social responsibility and accountability differ among children. That is why orphans are tested before they are given control over their inheritance (MB1199). Personality is the nafs. The Islamic view of personality in based on the Qur'anic concept of nafs. Fitrat to refer to what some call nature; the term nature has atheistic connotations. Each individual has a distinctive fitrat. Nurture introduces even more differences among individuals as environmental factors interact with the basic fitrat. A lot of behavior is copied or is assimilated from parents and other social role models. That is why it is very important to provide children with positive role models. They should never be exposed to negative role models even for brief moments.
7.4 DISORDERS OF INFANCY
Common disorders of infancy are birth injuries, congenital malformations, perinatal infections, metabolic disorders, and neoplasms.
7.5 DISORDERS OF CHILDHOOD
Common disorders of childhood are developmental (especially sexual differentiation), nutritional, behavioural, and injuries.
8.0 YOUTH, sinn al shudd
8.1 DEFINITIONS
Adolescence is a period of transition from childhood to adulthood. It is rapid, complex, difficult, and can go wrong. It is part of the teenage period defined as ages 13-19 years. Puberty, buluugh, is the period when gonads are sufficiently developed to allow reproduction to occur. Puberty in males is the appearance of the first sperms and in females it is the first menstruation. In both genders attainment of the age of 15 years automatically defines puberty even if the biological signs have not been seen. The period of youth, shabaab, is that between puberty and the age of 40 years. It is the period of strength and physical maturity. At puberty a person becomes a legally responsible adult, mukallaf. Physical growth may not correlate with emotional and intellectual development and this is a source of problems.
8.2 YOUTHS IN THE QUR’AN and SUNNAT
Youths who became prophets were Muhammad, Musa, Ismail, and Yusuf. The people of the cave were righteous youths. Luqman’s son was also a righteous youth who obeyed his father. Stories of righteous youths among the companions are told about Ali Ibn Abi Talib, Usamah Ibn Zayd, Abdullah Ibn Abbas, Abdullah Ibn Omar, Abdullah Ibn Amre Bin Al Aas, and Abdullah Ibn Al Zubayr.
8.3 THE ADOLESCENT
Spermache marks puberty in males. It is accompanied by the pubertal growth spurt and appearance of male secondary sexual characteristics (testicular enlargement, penile enlargement, sexual hair growth, voice changes, muscle enlargement, regular frequent erections with ejaculation). These physical changes are accompanied by behavioral changes. Physical changes in females are more dramatic. Thelarche is development of breasts. Puberchy is development of pubic hair. Menarche, the 1st menstrual period, is the legally accepted definition of puberty. Female secondary sexual characteristics include breast development, sexual hair growth, and increase in body fat. Other changes include changes in sensory organs, and changes in functional organs. Among the accompanying behavioral changes are intellectual and psychological changes, emotional changes (moodiness and depressive effects). Adolescence is a time of tension and contradictions. The adolescent is physically an adult who could even start a family. He feels independent but cannot live without dependence on parents. His behavior is impulsive and he tries to rebel against childhood restrictions but is yet unsure of what roles to play: childhood or adult roles? Acquisition of abstract thinking gives the teenagers more powerful reasoning abilities and they feel very intelligent. They become intellectually arrogant reasoning things out and acting on erroneous conclusions. They are often wrong in their reasoning because they lack wisdom and experience. Females experience an earlier pubertal spurt. There is hikmat in this because females start their reproductive careers earlier.
8.4 THE YOUNG ADULT (early adulthood)
Physical growth essentially stops at the age of 21. Then the period of young adulthood starts and ends at the age of 39. It is characterized by optimal health status, maximal energy, and ambition. It is a period of starting a career and a family. It can also be a time of stress and tension as career and family are balanced. It is a period of balance between cognition and emotion, idealism and pragmatism, moral living and hedonism.
8.5 DISORDERS OF ADOLESCENCE and YOUTH
The problems of teenagers and adolescents are problems of a rapid transition. They arise as discordance between biological maturity on one hand and psychological and emotional maturity on the other. Other problems are delayed puberty, and precocious puberty, growh anomalies. Youths have a lot of energy which they may expend in harmful activities if they make wrong choices.
9.0 MIDDLE AGE, sinn al rushd 40-60
9.1 DEFINITION OF MIDDLE AGE
Middle age is the period of full human growth and development defined as the age 40-60. The age of forty is the age of guidance. By the age of 40 a person's character and personality have stabilized. The age of 60 is the start of old age. It represents the completion of growth and development.
9.2 CHARACTERISTICS OF THE MIDDLE AGES
Middle age is characterized by rushd, actualization, balance, caution, and completion of family and career. Rushd is the stage of complete wisdom and moral rectitude. Actualization is a stage of feeling of fulfillment. There is balance between intellect and wisdom; balance between impulse and caution; and balance between conservation or maintenance and innovation. By middle age there is a more cautious approach to life. Risks and reactions are weighed carefully before taking any drastic action. Because of physical and intellectual decline after middle age, no new major achievements or break-throughs are expected. The end of middle age completes the family. For most people there are no more new children to look after. The older children are themselves becoming adults and setting up their own families.
9.3 BIOLOGICAL ASPECTS
Biological decline is progressive. Each person and each organ declines at a different rate. Tissue growth declines until the equilibrium between growth/repair and degeneration is tipped in favor of degeneration. Immunological response declines making the elderly more prone to infectious and neoplastic diseases. Sensory organs decline gradually decreasing the impact of environmental stimulation. Male testicular function declines but there is no male climacteric. Sexual difficulties are due to the associated diseases. In female menopause the ovary is not responsive to gonadotrophins so that the menstrual cycles disappear. Menopause like adolescence has many biological and psychological problems because it is a period of transition. The post-menopausal syndrome consists of the physical symptoms of hot flushes as well as psychic changes. There is general decline in cognition and memory. The speed of intellectual processing is slower than in the youths. The incipient intellectual decline may not be easily noticed because of the compensatory effect of the accumulated wisdom and experience of middle age. Memory decline is more serious for short than long-term memory. Long-term memory is remarkably well preserved.
9.4 PSYCHOLOGICAL ASPECTS
Psychological balance predominates towards the end of middle age. There is psychological and emotional stability as a result of a conscious renunciation of the pursuit of material achievements. The middle aged has realized that there are things in life that will never be achieved. He also has learned to accept and live with his limitations and failures. He has the balanced view of the world in which he appreciates the successes and does not lose sleep over failures. Apart from depression that is common the middle aged does not suffer from major psychological or emotional crises. He is able to cope with the social or psychological stresses that he meets. The mid-life crisis is a major and drastic change in personality and behavior in a few people. It is more due to psychological than physical factors. The mid-life crisis is due to the realization that many of the youthful ambitions will never be fulfilled. In a few persons it manifests as a return to more youthful behavior like promiscuity and seeking youthful entertainment. It also may manifest as an attempt to deny the onset of middle age. In females the mid-life crisis is intertwined with the onset of the climacteric. There are behavioral changes mediated by hormonal changes. There are also behavioral changes due to fear of old age and loss of sexual attractiveness.
9.5 SOCIAL ASPECTS
Late middle age is the last stage of family rearing. By this time children are either adolescents or are young adults. There are still youth problems that the middle-aged parent may have to cope with. Late middle age is also a time of transfer of leadership to the new generation. The middle-aged parents must train their offspring and give them increasing responsibilities so that a smooth transition can be achieved without the problem of a ‘generation gap’
10.0 OLD AGE, shaykhuukhat, kibr, haram
10.1 DEFINITION and CHARACTERISTICS OF OLD AGE, AGE 60-130
Ageing is a natural process. It is a long and variable process with much individual variation. Genetic, social, dietary, and disease factors determine the rate and extent of ageing. Old age has physical, social, and religious dimensions. Old age is associated with degeneration and decreased or deranged physiological function. It is not true that old age is illness. A practical definition of disease in the elderly must distinguish between the normal changes of aging and pathological conditions. Old age represents the close of the family cycle. It is also the period of maximum wisdom. The age of 60 is generally taken to be the start of old age. The proportion of the elderly in most human populations is increasing due to general socio-economic improvement and medical technology. The life span of each individual is fixed by Allah. No human effort or endeavor will alter the span. Longevity has always been a desirable objective of humans of all ages and all places. Longer life has advantages. There is more to contribute to society, to do good deeds to expiate for past failures. However the physical disabilities of old age reach a point when they outweigh the psychological and social advantages.
10.2 PHYSICAL DECLINE
The capacity for cell division declines with age. The reasons for this loss of division capacity are not known but it seems to be part of genetic programming. With age the following phenomena increase and their cumulative effects lead to ageing or death of the cell: the cumulation of somatic mutations, error rates in protein synthesis, and failure of error-correcting mechanisms. The increase in these phenomena is due to cumulative environmental insults and decreasing ability of the aging body mechanisms to correct the errors. Aging, degeneration, and eventual death can be explained at the cellular level. Aging in accompanied by physical, psychological and social changes as well as challenges. There is no point in time when development ceases and degeneration starts. The two processes are contemporaneous. In advanced age degeneration becomes predominant. Normal aging is a gradual process of physical decline and degeneration. Aging affects the structure and function of all organs. Old age because of its multiple incapacities is sometimes not a pleasant period. Physical decline starts from the age of 30. There is functional decline in the performance of all organs of the body. The difference between the normal physiology of ageing and pathology is very fine. As people age, the quality of their life deteriorates. The elderly are dependent but very important members of society whose rights must be respected. It is a grave sin to neglect these rights.
10.3 SOCIAL AND PSYCHOLOGICAL ASPECTS
A person is psychologically as old as he feels. An elderly person may feel young. The prophet mentioned that people stay young in 2 ways: love of the world and long hopes. Old age in unpleasant for several reasons. Physical incapacities reduce independence. Accumulated negative life experiences with no hope of returning and doing things again. Materialistic societies do not respect elders because it is felt that they are unproductive and are a burden on society. This is a major transgression. They were productive at a time and the new generation was at that time dependent children. Mistreatment of parents is a major sin. This covers parents of others. If you mistreat someone’s parent someone else may mistreat your parents. The prophet spoke a lot about recognizing and respecting the rights of the elderly. The elderly have a legal right of physical support by their offspring. The offspring must bear with patience any annoying demands from their parents.
10.4 RESEARCH ON AGEING
Medical science has set itself an unrealistic objective of preventing aging. Research is carried out on causes of cellular aging and the effect of nutrition. The process of aging is one of Allah’s sunan. It cannot be prevented but it can be made more pleasant such that growing old does not mean pain and suffering. The efforts of scientists should rather be directed to ensuring good physical health in old age.
10.5. DISORDERS OF OLD AGE
Listing the disorders of old age is like making a catalog of all subjects in the textbook of pathology. Anything that can go wrong is found to be wrong in the elderly because of their decreased ability to cope with environmental insults.