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ISLAM and the Muslim Patient Why do we need to know about Muslims? There are 1.7 billion Muslims on earth! 1 in 4 of world population (Oct 2009) There are approximately 7 million Muslims in the United States There are 100,000 Muslims in the state of Connecticut. The chances of meeting a Muslim in hospital are increasing! What is the connection between Islam and Muslim? What is the Hebrew word for the word “Peace”? Shalom Like Hebrew, Arabic is also a semitic language. Can anybody tell me the Arabic for the word Peace? Salaam SALAAM is the Arabic word for PEACE Every word in Arabic has a 3 or 4 letter root – in this case the root letters are ‘S’, ‘L’ and ‘M’. SALAAM I SLAM SLIM MU Islam The Arabic word Islam simply means submission. Submission to the will of God so one can attain peace. Muslim A Muslim is one who follows the way of Islam - that is someone who submits to the will of God so that one can live in peace. Where do Muslims come from? Muslims come from all over the world! The country having the most number of Muslims is Indonesia. Only 18% of the Muslim population are actually Arab. As in any faith there is great cultural divergence between people from different ethnic backgrounds. Women and men are instructed by the Qur’an to dress and behave modestly. People may interpret this differently. Some women may be clothed from head to toe with the exception of the face. Men should be covered from the waist to the knees. Gender Issues Due to modesty issues the Muslim patient would usually prefer to have a doctor and nurse of the same gender. If possible someone of the same gender should be available to counsel the patient in terms of sensitivities that may occur to minimize emotional distress. For instance it is important to ask Muslim women for permission to wash or uncover their arms for intravenous access. Islamic Sources The Qur’an - the word of God revealed through Angel Gabriel. Today, it remains unchanged, 1400 years later, still in its original language - Arabic. It was revealed over a period of 23 years. The Hadith - the words and traditions of the Prophet Muhamad (pbuh). The Qur’an The Hadith - traditions and sayings of the Prophet Muhamad HADITH Sayings of the Prophet Muhammad “The merciful bestows mercy to those who are merciful. Therefore show mercy to those on earth and the One in heaven will show mercy on you.” "If a Muslim visits his/her fellow Muslim who is ill in the morning, then 70 000 Angels pray for that person until the night and if that person visits at night then they pray for him/her till the morning, and due to his/her good intentions he/she gains a garden in Paradise." “The rights of one Muslim over another Muslim are six.” Someone asked, “What are they?” The Holy Prophet replied, “When you meet him you greet him with salaam (peace), when he invites you, you accept his invitation, when he consults you in a matter, you give him sincere advice. When he sneezes and praises Allah, you ask Allah to have mercy on him. When he is sick, you visit him and when he passes away attend his funeral. “The world is green and beautiful, and God has appointed you his stewards towards it.” “Modesty and faith are joined closely together and if one is lost, the other goes as well.” “The most perfect of your in faith is the best in morality and the best of you is the one who is best to his wife.” Hadith on Knowledge “Acquire knowledge!” The prophet would tell his followers. “Seeking knowledge is the duty of every Muslim – male or female. It will befriend you in solitude, it will guide you to happiness, it will sustain you in misery, it will adorn you when you are amongst people and it will be your shield and protect you against those who attack you. Whoever goes out in search of knowledge is on the path of God until returning.” Seven Major Beliefs God Angels Messengers and Prophets Holy Books Day of Judgment Power to do good or bad is from God, yet God gives us the choice Life After Death Pillars of faith 1. 2. 3. 4. 5. Bear witness that there is One God Prayer Charity Fasting Pilgrimage 1. Bearing witness that there is One God and Prophet Muhammad is the last messenger of God – the Shahadah When someone becomes a Muslim he/she states the Shahadah. Patients, especially those who are terminally ill are encouraged by family members to recite the “shahadah” or ‘declaration of faith’ as it reaffirms ones connection with God. Allah The term Allah basically means “the ONE God”. Arab Christians and Jews use the term Allah as well! The term Allah cannot be pluralized or gendered and this is why Muslim prefer to use this term when referring to God. Semitic Roots Hebrew : Eloheim Arabic : Allah Aramaic : Allaha 2. Prayer Muslims pray five times each day Muslims usually pray on a prayer mat or specific clean area Muslims pray in a specific direction Compass used for prayer The Adhan – The call to prayer Patients may feel especially comforted on hearing a recording of the ‘Adhan’. The Muslim Patient may want to adhere to his/her prayers and so Medical staff can show a lot of sensitivity by: Letting the patient know the direction toward Mecca. Bed-bound patients may ask to be positioned toward Mecca. Getting a prayer schedule from the internet Giving patient privacy for prayer December Prayer Schedule Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday 20 21 22 23 24 25 26 27 December December December December December December December December Dawn Sunrise Noon Afternoon Evening Night 05:50 05:50 05:51 05:51 05:52 05:52 05:53 05:53 07:14 07:14 07:15 07:15 07:16 07:16 07:16 07:17 11:48 11:48 11:49 11:49 11:50 11:50 11:51 11:51 14:05 14:05 14:06 14:06 14:07 14:07 14:08 14:09 16:22 16:23 16:23 16:24 16:24 16:25 16:25 16:26 17:46 17:46 17:47 17:47 17:48 17:49 17:49 17:50 To obtain a prayer timetable for your area refer to the Internet website http://www.islamicity.com/prayertimes March Prayer Schedule Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday 14 15 16 17 18 19 20 21 March March March March March March March March Dawn Sunrise Noon Afternoon Evening Night 04:48 04:46 04:45 04:43 04:41 04:39 04:38 04:36 06:04 06:03 06:01 05:59 05:58 05:56 05:54 05:52 12:00 11:59 11:59 11:59 11:58 11:58 11:58 11:58 15:19 15:20 15:20 15:21 15:22 15:22 15:23 15:23 17:55 17:57 17:58 17:59 18:00 18:01 18:02 18:03 19:12 19:13 19:14 19:15 19:17 19:18 19:19 19:20 To obtain a prayer timetable for your area refer to the Internet website http://www.islamicity.com/prayertimes June Prayer Schedule Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday 20 21 22 23 24 25 26 27 June June June June June June June June Dawn Sunrise Noon Afternoon Evening Night 03:32 03:32 03:32 03:33 03:33 03:33 03:34 03:34 05:15 05:15 05:16 05:16 05:16 05:17 05:17 05:17 12:52 12:52 12:52 12:52 12:53 12:53 12:53 12:53 16:54 16:54 16:55 16:55 16:55 16:55 16:55 16:56 20:28 20:28 20:29 20:29 20:29 20:29 20:29 20:29 22:12 22:12 22:12 22:12 22:12 22:12 22:12 22:12 To obtain a prayer timetable for your area refer to the Internet website http://www.islamicity.com/prayertimes 3. Charity or Zakat One of the most important principles of Islam is that all things belong to God, and that wealth is therefore held by us in trust. Each Muslim calculates his or her own zakat individually – 2.5% of ones income and wealth The word zakat actually means “purification” - it is a purification of ones wealth! Patients who are severely ill or terminal may feel a greater need to fulfill their Islamic responsibilities and so may want to meet with family and religious leaders to discuss such matters including ones will and death issues. Death in Islam Defined as the departure of the soul from the body – however neither the Qur’an nor Ahadith give clear signs of the soul’s departure. This is the reason why ‘brain death’ may not be accepted as death by some Muslims. Most Muslims consider death as a cessation of all bodily functions. Therefore the ‘brain dead’ may be considered in the dying process but are not dead yet. Islam considers life as sacred and a trust from God. Every living creature will die one day. The Qur’an states “Every soul shall have a taste of death – In the end to Us (God) shall you be brought back.” Chapter 29, verse 57 Suicide is strictly forbidden in Islam. According to Islamic Law, God is the creator of life and therefore an individual has no right to end it. Euthanasia and abortion are also not allowed because of the same reason. Advance Directives Prolongation of life by supportive machines is strongly discouraged for those who are terminally ill – when the quality of life is poor A DNR order is acceptable but it should be carefully explained Muslims believe in the Day of Judgment and the Afterlife. The Qur’an emphasizes that death is only a transition from this existence to a future life. This knowledge does provide some comfort to the dying and his/her family. Ethical Issue The Imam should work closely in discussion with medical staff and so determine the condition of the patient. If the patient is on a ventilator and there is total organ failure the ventilator can be withdrawn and if the patient breathes alone or stops breathing that is considered to be the will of God. The ventilator cannot be withdrawn to end the patient’s life. When a Muslim patient dies in hospital. The Medical team should call a Muslim chaplain or the Islamic center if they are not familiar with the Islamic traditions. After death the face should be turned toward Mecca (Northeast). Arms and legs should be straightened with toes tied together by a thread The mouth and eyes should be closed. Clothes should be removed by a person of the same gender and the body should be covered with a sheet. Arrangement should be made with the Islamic Center for the ritual body wash – usually the body is moved to a specific ritual washing area. Post-Mortems Postmortems are discouraged because the body is sacred and belongs to God. Post Mortems are only allowed when the law demands Burial Usually burial occurs within 24 hours Religious requirement to bury as soon as possible Bodies are not embalmed or cremated 4. Fasting at Ramadan Use of Lunar Calendar Muslims go by the lunar year. This is why their calendar changes each year losing about 10 days each solar year. The month of Ramadan begins with the sighting of a new crescent moon. In 2003, the month of Ramadan began on October 26th. In 2004, the month of Ramadan began on October 16th. The Patient and Fasting Fasting in Ramadan means strictly no food or drink from dawn until sunset for approx. 30 days. The sick, the old, the young, menstruating women, pregnant women, nursing women and travelers do not need to fast. Although the sick do not need to fast they may want to and so a Muslim physician may be useful in advising and counseling the patient. Dietary Restrictions No pork, ham, lard etc. (no products from pig) No gelatin Shellfish for some Muslims No alcohol – patients may need to be counseled about medicines containing alcohol. Muslims will eat fish and meat that is ‘halal’ a similar concept to Kosher Pilgrimage -the Hajj Muslims have Two Festival One at the end of the month of Ramadan The other at the time of the Hajj pilgrimage Muslims say “Eid Mubarak” which means ‘Have a blessed festival’. Family in Islam Provides the strong support structure for most Muslims. Play an active part usually when family member is ill or terminal. Emphasis on looking after ones parents and the elderly. Muslim patients may get many visitors from the family and community. Take time to KNOW your patients! Knowledge of patients’ religious belief, customs, rituals and traditions greatly improves communication between medical staff and patient. Better communication increases the well-being of the patient and greatly decreases the potential for conflict and so increases ones chances of a positive outcome. A publication that may interest you …… References Islamic Approaches to Patient Care [Paperback] by Ra’ufa Sherry Tuell A VERY GOOD REFERENCE June 2010 Journal of Hospice and Palliative Nursing Vol 12, No. 5, May/June 2010 A good paper dealing with the bioethical debate – more intense reference The Muslim World Jan 2011 A article with the bioethical debate – more intense reference MOST RECENT Islamic Horizons Magazine November/December 2012 Other References The Muslim Next Door The Qur’an. The Media and that Veil Thing. By Sumbul Ali-Karamali Light Reading Love in a Headscarf by Shelina Janmohomed Nice Movie! “Arranged” About Arranged Marriages In Islam and Judaism