Since medieval times, palliative care principles have been incorporated within Islamic teachings and health practice. Values of quality of life, adherence to religious practice and “doing no harm” underpin healthcare decision-making.
PCV meets with Muslim Health Professionals Australia
On 7 December, members of the Muslim Health Professionals Australia (MHPA) met with clinical Board members of Palliative Care Victoria. At this meeting I had an opportunity to present a paper describing Islamic faith practices at end of life and how these parallel many of the principles of the palliative approach. This article summarises my presentation.
Healthcare in the Islamic tradition goes back to medieval times. The first Islamic hospitals called bimaristans were built in Damascus, Baghdad and Cairo. These hospitals were funded through endowments and provided medical treatment to any individual in need, free of cost. They were designed to have courtyards that allowed for fresh air and flowing water, while providing music therapy to the sick.
Holistic tradition of mind, body and soul
The Islamic paradigm upholds a holistic tradition of mind, body and soul: prayer, charity, fasting, belief in God (iman) and spiritual excellence (ihsan). According to one of the universals of the Sacred Law, preservation of life is a priority: “If anyone saves a life, it is as if he saves all of mankind” (Quran: 5:32). Since the intellect is essential to fulfil moral obligations, substances that compromise the intellect are usually forbidden. However, there are exceptions in medical settings, such as the use of opioids to relieve pain.
The ideal Muslim death
The ideal Muslim death includes the recitation of the testimony of faith and facing the patient towards the direction of Mecca. The presence of spiritual leaders or wise members of the community is recommended in order to facilitate the recitation of testimony of faith and remind patients of the Divine. Being in a state of ritual purity (for example, no faeces or urine on clothing), maintaining personal dignity and burying the deceased as soon as possible are also important practices at end of life. The importance of preparing a written will and settling inheritance matters are also mentioned in the Islamic teachings.
Overarching ethical principles of ‘warding off harm’ and ‘accruing benefit’ guide decisions of medical ethics. This means that Voluntary Assisted Dying (VAD) and suicide is prohibited since each individual lifespan is pre-ordained by God. DNR (Do Not Resuscitate) orders are acceptable if the medical intervention will not bring benefit to the patient. Withdrawal of treatment is acceptable if disease progression is advanced and treatment will bring no symptomatic relief. Artificial nutrition is to be assessed for whether the net gain outweighs potential losses from complications.
The distinction between culture and religion
Although culturally, Muslims come from a myriad of ethnic backgrounds, it is important to be aware that there is a distinction between culture and religion. The universal principles of Islam are one, yet the outward expression through culture is variable. Sometimes, issues arise because patients may come from a cultural background of paternalism in medical practice, which leads patients to place full responsibility on the doctor for decision-making.
Clarifying end of life preferences
There are many speculated reasons why Muslims may not prefer end of life care at home. One is due to the perception that palliative care is ‘giving up’, and the principle of preserving life at all cost. This belief comes from a lack of understanding of the Sacred Law and the nuances of medical treatments. Misinformation can often arise from conflicting interests of family members, unclear intention of practitioners/patients, difference in practitioner/patient values and often the lack of an Advance Care Plan. As with other cultures, palliative care is often confused with VAD/euthanasia among Muslim patients.
Rami Dawood is a final year medical student at Monash University.
For further information: contact the Muslim Health Professionals Australia
website: https://mhpaustralia.com.au/
email: mhpa.membership@gmail.com