Lecture for 1st year medical students on Friday 23rd March 2001 by Professor Omar Hasan Kasule, Sr.
1.0 DEFINITION OF DEATH:
A. Moral/Spiritual Death
B. Legal Death
C. Biological Death
D. Qur'anic Terminology For Death
E. Temporary And Permanent Death
2.0 NATURE OF DEATH
A. The Life-Death-Life Cycle
B. Inevitability Of Death
C. Finality Of Death
D. Death As A Transition
E. Good And Bad Death
3.0 ATTITUDE TO DEATH
A. Death In The Hands Of Allah
B. Positive Attitude
C. Negative Attitude
D. Wishing For Death
E. Death As A Trial And A Test
4.0 PROCESS OF DEATH
A. Growth And Degeneration
B. Causes Of Death
C. Lifting The Ruh
D. Qur'anic Description Of The Last Moments
E. Reversal Of The Death Process
5.0 CRITERIA OF DEATH
A. Need For Criteria
B. Respiratory Failure
C. Cardiac Failure
D. Loss Of Consciousness
E. Brain Death
1.0 DEFINITION OF DEATH:
A. MORAL/SPIRITUAL DEATH
There are several possible definitions of death: moral, legal, and biological. Morally
a person may behave so badly that he no longer has human life but has the life of animals or even worse. This denial of human
life is akin to death. In practice moral death leads sooner or later to physical death. Abuse of alcohol leads to fatal motor
vehicle accidents, racial prejudice leads to genocide. Promiscuity leads to fatal sexually transmitted diseases. Lack of purpose
in life often leads to depression and suicide.
B. LEGAL DEATH
Legally several conventions are adopted by various countries and communities. These conventions change from time
to time depending on the level of technological development and the underlying societal values. The sharia definition of death
is guided by the fiqh concept of custom or precedent, aadat. Thus the shariat definition can change from time to time and also from place to place depending on the
level of technological development. The current debate is about acceptance of brain death as a definition of death. Definition
of death for the lost person, hukm al mafquud, can rely on the average expected life expectancy that varies by place, ethnicity,
and socio-economic status.
C. BIOLOGICAL DEATH
Biologically death is simply defined as irreversible damage of major
organs. This is not an easy definition because the concept of reversibility is relative. New technologies are showing us that
what was previously irreversible is now reversible. Many dead organs can now be replaced by transplantation. Multi-organ transplantation
is now feasible and is becoming common. Preventive transplantation using cloned organs may become common in the foreseeable
future. The moment of death is also difficult to ascertain with any degree of certainty. This is because the process of death
in an interval and not a point event.
D. QUR'ANIC TERMINOLOGY FOR DEATH
The Qur’an uses several terms to refer to death such as gharq, halaaq,
mawt, wafaat, firaaq. The Qur'an mentioned death by drowning (p. 960 18:71,
36:43). Drowning was mentioned as a form of punishment, al ‘iqaab bi al
gharq (p. 861 7:64, 7:136, 8:54, 10:73, 10:90, 11:37, 11:43, 17:6, 17:103, 21:77,
23:27, 25:37, 26:64, 26:120, 29:40, 37:82, 43:55, 44:24, 71:25). The Qur’an uses the term halaq to mean death, al halaaq bi ma’ana al mawt (p 1291-1292 4:176, 5:17, 7:155, 8:42, 9:42, 12:85, 27:49, 40:34, 67:28). Mawt is used to refer to death (p. 1153
4:15, 17:75, 35:22, 36:43, 49:12, 52:30, 77:26). Wafaat is another Qur’anic term for death (p 1315 2:234, 2:240, 3:193, 4:15, 4:97, 6:61, 7:37, 7:126, 8:50, 10:46,
12:101, 13:40, 16:28, 16:32, 16:70, 22:5, 32”11, 37:42, 40:67, 40:77, 47:27). Firaaq is a term whose root word is separation. It is used to mean separation
from the earth signifying death (p 887 ).
E. TEMPORARY and PERMANENT DEATH
Death could be permanent, mawt, or temporary, nawm. Permanent death is irreversible until the day of resurrection. The Qur'anic reference to death is usually
to the permanent death. The Qur’an has described sleep as a form of death. In this case death is reversible and is temporary.
In some cases people pass away during their sleep (p 1258 39:42; p 1316 6:60). Animal biology can throw more light on the
phenomenon of temporary death associated with sleep. Animals like amphibians can hibernate for long periods when their body
metabolism is reduced to the minimum needed to preserve life. They can revive and resume normal activity when weather conditions
allow. Medical research has yet to research the phenomena of temporary death and how it can throw light on the phenomenon
of permanent death.
2.0 NATURE OF DEATH
A. THE LIFE-DEATH-LIFE CYCLE
There is a continuous cycle involving life and death. Life arises from death and vice versa, ikhraaj al hayat mina al mawt (p 1953 , 6:95, ). Modern scientific knowledge enables to understand this cyclic phenomenon in more detail at
the cellular and molecular levels. Inanimate matter in the form of atoms and molecules becomes the basis for the physical
component of human life. They eventually return to their inanimate nature when they are excreted or on death of the human.
When you study the ecosystem and the food chains you realize that life of some living things is sustained because of the death
of others. There is continuous recycling of matter between the organic and inorganic. There is also recycling between the
organic and the living.
DEATH SIGNALING THE END OF THE HUMAN MISSION
All human endeavors cease with death, intiha al ‘amal bi al mawt,
inqitau al ‘amal bi al mawt (p 839 4:18, 6:27-28, 7:53, 23:99-100, 23:107-108, 32:12, 35:37, 99:7-8, p 1154 23:99-100,
23:91-100, 63:10). There are only three exceptions a righteous offspring who prays for the parent, waladu salihu yad’u lahu; knowledge that benefits others, ‘ilm
yuntafau bihi; and charity of continuous benefit, sadaqat jariyat.
CLOSURE OF THE LIFE-DEATH CYCLE ON THE LAST DAY
Death is followed by burial in the grave, qabr (p. 1158 90:21). There may be reward or punishment in the grave. Barzakh
(p 189 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 (p 196 6:36,
7:29, 7:57, 10:4, 10:34, 11:7, 16:38, 17:49-52, 17:99, 18:48, 21:103, 22:7, 23:16, 23:100, 26:87, 28:85, 29:19-20, 30:11,
30:25-27, 30:50, 30:56, 31:28, 32:10-11, 34:7, 36:12, 36:32-36, 36:51-52, 36:78-83, 37:16-21, 36:33, 56:47-50, 58:6, 71:18,
75:3-4, 83:4-6, 86:8-10). Resurrection will be bringing the dead back to life,
ihya al mawta, which will be life after death al hayat ba’da al mawt (p 1155 2:28, 2:56, 2:73, 2:154, 2:243,
2:259, 2:260, 3:49, 3:169, 5:110, 6:36, 6:122, 7:25, 7:57, 11:7, 16:21, 16:38, 19:15, 19:33, 19:66, 22:6, 22:66, 23:35, 23:37,
23:82, 26:81, 30:40, 30:50, 36:12, 37:16, 37:53, 41:39, 42:9, 44:35, 45:26, 46:23, 50:3, 56:47, 75:40, 80:21-22). The
Qur’an has not provided details about this life whether it will be exactly like that on earth or there will be some
differences. The Qur’an makes it clear that it will be physical life with physical bodies. On resurrection people will
be gathered; all generations and all geographical areas will be together, al hashr
ba’da al mawt (p23-24 2:203, 2:281, 3:158, 4:87, 5:48, 5:105, 5:109, 6:21,
6:22, 6:72, 6:128, 6:164, 8:24, 9:94, 10:28, 10:45, 14:21, 14:47, 15:25, 17:97, 18:47, 18:99, 19:85-86, 19:95, 20:108, 20:124,
25:17, 27:83, 34:26, 34:40, 36:29-32, 36:51-53, 37: `19-23, 40:16, 41:19, 42:15, 50:44, 64:9, 67:24, 70:43-44, 77:38, 99:6,
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 (p 1158 , 20:74, 35:36, 44:56, 87:13).
B. INEVITABILITY OF DEATH
All humans will eventually die, shumuliyat al mawt (p 1156-7 3:154,
3:154, 3:168, 3:185, 4:78, 4:10, 21:35, 23:15, 29:57, 39:30, 55:26). There can be no exceptions now or at any time in the
future. Even prophets have to face death (p 1157 3:144, 19:15, 19:33, 21:34, 34:14, 39:30, 3:168, 3:185, 4:78, 4:10, 21:35,
23:15, 29:57, 55:26). All death is by Allah's permission (p 1258 3:145). Humans fear death, gadhar al mawt (p 1155 , 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 (p 1154 3:154, 3:156, 3:163, 4:78, 33:16, 62:8). The human and death have inevitably to meet, liqa al mawt (p 1045 3:143, 62:8). However much the humans try to escape it, death catches up with them, lihaaq al mawt bi al insaan (p 1156-7 3:154, 3:154, 3:168, 3:185, 4:78, 4:10, 21:35, 23:15, 29:57, 39:30, 55:26).
No human endeavor can prevent death, isthalat man’i al mawt (p. .). Modern biotechnology discoveries of artificial life support, cloning, and frozen embryos are not in
essence prolongation of life as will be discussed in later sections of the manual. Death will come to all humans and all living
things, shumuul al mawt kulla shay’I (p 1156 73:154, ).The concept of death also includes non-living things
for example the Qur’an talks about death of the earth, mawt al ardh (p 1153 2:164,
7:57, 16:65, 25:49, 29:63, 30:19, 30:24, 30:50, 35:9, 36:33, 43:11, 45:5, 50:11, 57:17).
C. FINALITY OF DEATH
Human death has finality to it. Each human has only one death. There is no reincarnation. There is only resurrection
in the hereafter. There will be no more death after the day of Judgment (p. 158 14:17, 20:74, 35:36, 44:56, 87:13). Life after
the Day of Judgment will be eternal (p 1158 , 20:74, 35:36, 44:56, 87:13).
Humans in their arrogance and folly find it difficult to accept the finality of death. They try various means to achieve some
form of immortality. Some as an attempt at achieving immortality strive to have children who will carry part of the biological
heredity and family name into the next generation. Some humans endeavor to leave behind physical monuments that will remind
future generations of their achievements like the pyramids of the pharaohs and the Aztecs. Many human acts are motivated by
the desire to achieve fame or notoriety in order to enter the books of history. Belief in ghosts in superstitious societies
can also be seen as a form of prolonging human existence on earth after physical death.
D. DEATH AS A TRANSITION
Death could be looked at a transitional event or rite de passage. Death
is a transition to life after death. There is another life after the earthly one al
hayat ba'da al mawt (p. 1155-6 2:28, 256, 2:73, 2:154, 2:243, 2:259, 2:260, 3:49, 3:169, 5:110, 6:36, 6:122, 7:25, 7:57,
11:7, 16:21, 16:38, 19:15, 19:33, 19:66, 22:66, 23:35, 23:37, 23:82, 26:81, 30:40, 30:50, 36:12, 37:16, 37:53, 41:39, 42:9,
44:35, 45:26, 46:33, 50:3, 56:47, 7:40, 80:21-22 & 80:21-22, 22:66, 26:81, 30:40).The only way to life after death is through physical death on earth. Life in the hereafter is better than earthly life.
Death could therefore be a welcome event for good people who look forward to a better life in the future.
E. GOOD and BAD DEATH
Good death is to die in Islam, al mawt ala al Islam (p 1157 2:132, 3:102).
The best of death is to die when struggling in Allah’s way, al mawt fi sabilillahi
(p 1156 4:100, , 33:23). Death in unbelief, al mawt ala al kufr (p 1156-7 2:161, 2:217, 3:91, , , 9:85, 9:125, 47:34) is bad death. Death while committing a major sin is bad death because iman
is temporarily lifted from a person engaged in sin. It may not be possible to tell whether a person lived a righteous life
by the manner of death, demeanor or attitude of the dying person. However empirical observation of the death of many righteous
persons, salihiin, shows that they generally die in a calm way.
3.0 ATTITUDE TO DEATH
A. DEATH IN THE HANDS OF ALLAH
Death and its occurrence are in the hands of Allah, taqdiir al mawt mina
al llah (2:243, 2:258, 3:273, 3:27, 3:145, 3:156, 6:95, 6:162, 7:158, 9:116, 10:31, 10:56, 15:23, 22:66, 23:80, 25:3,
26:81, 30:19, 30:40, 39:42, 40:11, 40:68, 44:8, 45:26, 53:44, 56:60, 57:2, 67:2, 76:28). The believer surrenders all matters
pertaining to death to the Lord.
B. POSITIVE ATTITUDE
The attitude to death varies according to the spiritual well being of those involved. The 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 Qur'an challenged the non-believers
to wish for death if they were sure of a good life after death. The approach of death is an opportunity for repentance, tawbat
(p. 1158 4:18, 23:99). Death is an occasion for reminding and remembering the hereafter. It makes the good prepare better
by doing more good deeds.
C. NEGATIVE ATTITUDE
Humans are apprehensive about death, al hadhr mina al maw and often fear it, khawf al mawt (p 1155 ,
2:243). This is basically the human fear of the unknown. It is useless to fear an event that is inevitable and over which
a human has no control. Fear of inevetible death itself in illogical but anxiety about the manner and circumstances of death
is reasonable and is expected from a normal human. Death may be feared because of leaving behind beloved ones.
D. WISHING FOR DEATH
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 (p
1154 2:94-95, 3:143, 19:23, 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.
E. DEATH AS A TRIAL and a TEST
Death is a trial, ibtila’a bi al mawt (p 1153 , 77:2) and is a calamity, musibat al mawt (5:106).
This trial involves both the person dying and the relatives and friends left behind. Death is a calamity for the relatives,
friends, and the society but not the deceased. If he is good he is going earlier to his Lord. If he is bad he has no more
time to do bad; however he might have made tawbat and improved his situation had
he lived longer. Death is a test for humans (p 382 67:2). The test for the deceased is to be aware of death and prepare for
it by doing good work, amal hasan. For the relatives and loved ones death is a
calamity calling for patience and forbearance.
4.0 PROCESS OF DEATH
A. GROWTH and DEGENERATION
Human cells show signs of ageing and metabolic processes get weaker with time. Thus humans have both degenerative
and regenerative processes at the same time. Death overwhelms them when the degenerative forces have the upper hand. Death
has got its own appointed time, ajal al mawt(p. 1153 7:34, 10:49, 15:4-5, 16:61,
17:58, 35:45, 63:10-11, 71:4). Humans have no way of knowing the ajal (p 1155 71:34).
B. CAUSES OF DEATH
Death is inevitable; it will occur. What are called causes are actually associated factors. These may be trauma,
infections, metabolic impairment, and neoplasms. Humans may not be able to ascertain the immediate cause of death in some
C. LIFTING THE RUH
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, al malaika wa qabdh al arwaah, malak al mawt (p 1145
4:97, 6:61, 6:93, 7:37, 8:50, 16:28, 16:32, 32:11, 47:27).
D. QUR'ANIC DESCRIPTION OF THE LAST MOMENTS
The Qur’an has described the process of death using terminology such as sakrat
al mawt (p 1156 6:93, 33:19, 47:20, 50:19, 56:83-85, 75:26-30, 79:1), ghashiyat
al mawt (p 1157 33:19 and 47:20) and ghamrat al mawt (p 1157 6:93).
E. REVERSAL OF THE DEATH PROCESS
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
(p 858 3:49, 5:110-115, 19:29-33).
5.0 CRITERIA OF DEATH
A. NEED FOR CRITERIA
In general death is defined as irreversible loss of the integrated functioning of the organism as a whole. For
most of human history, death has been defined in a more subjective way with little attention being given to objective criteria.
There were not legal or practical necessities for early diagnosis of certification of death. They had the luxury of waiting
until all signs of life disappeared before pronouncing death. The earliest criteria of death that humans used were respiratory
arrest. The Qur'an and sunnat describe death mostly in terms of respiratory failure. Later circulatory/cardiac arrest as absence
of a heart beat or a pulse was also used. Unconsciousness was another criterion used and it related to the brain. 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.
B. RESPIRATORY FAILURE
The main purpose of the respiratory system is to deliver oxygen to the tissues. Oxygen is necessary for tissue
metabolism. Tissues cannot survive prolonged hypoxia. Thus respiratory failure is followed by death of tissues due to oxygen
C. CARDIAC FAILURE
In cardio-vascular failure, tissues are not perfused sufficiently with blood that carries food and oxygen as well
as takes away tissue metabolic waste. The brain is more sensitive to circulatory failure than other tissues of the body.
D. BRAIN DEATH
Brain death is quite
an early event and was first proposed as a criterion for death by an adhoc committee of the Harvard Faculty that redefined
death as brain death in 1968. 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. It is not yet possible to agree on what constitutes irreversible brain death. There is also disagreement whether criteria
used for adults can be used for children. Brain death is assessed clinically and by use of laboratory and electrical assessments.
Clinically brain death is indicated by: absence of pupillary reflexes, dilated pupils, absence of the corneal reflex, absence
of eye movements, absence of spontaneous respirations, absence of cephalic reflexes, absence of motor response to pain, absence
of the cough reflex, and absence of the gag reflex. These clinical criteria are considered less accurate that laboratory measurements.
They also are sometimes too late for purposes of declaring death to enable harvesting organs for transplantation. Laboratory
assessment are considered confirmatory and include: electrocorticogram measurements, electo-retinography, cerebral blood gas
analysis, cerebral angiography to show cerebral circulatory arrest, retinal fluoroscopy, assessment of brain stem auditory
responses, and the orbicularis oculi reflex.