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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0406-UNDERSTANDING SPIRITUAL NEEDS OF PATIENTS

Lecture for 1st year nursing students at Indera Mahkota Campus on 24th June 2004 by Professor Omar Hasan Kasule, Sr.

1.0 SPIRITUAL PURIFICATION, tazkiyat al nafs

The essence of a person and personality is the nafs and not the physical body. The states of the nafs in increasing grades of perfection are: nafs ammarah, nafs lawamah, and nafs kamilat that manifests in 5 ways: nafs mulhamah; nafs qanu’ah, nafs mutma’inna, nafs radhiyah, and nafs mardhiyat. The nafs can can be polluted by diseases of the heart such as covetousness, passion, pride, evil, hiwa al nafs, and waswasat. These pollutants may have inner promptings within the human that are encouraged by external social influences.

 

Correct and firm ‘aqidat, ‘ibadat, avoiding the forbidden, generally being conscious of the creator, and constant meditation about creation are paths to tazkiyat that lead to development and improvement of personality, good character, good behavior, assertiveness, and self-confidence. Living in a righteous community is necessary to motivate and encourage tazkiyat. Islam is a practical religion. Achievement of purity is through action.

 

Tazkiyat is based on ikhlaas, sidq, istislam, and  tadharu'u. Tazkiyat is answering the call of Allah by sticking to the straight path, renouncing materialism, constant vigilance against shaitan. Tazkiyat can be achieved by dhikr, isti'adhat, istighfar, tasbiih, tahmiid, tahliil, dua, and physical ‘ibadat: salat, saum, and  infaq.

 

2.0 HEALTH

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. The holistic outlook also means that physical, emotional, psychological, and spiritual health are considered together. Good health has both physical and spiritual parameters. Keeping body in good health is a responsibility, amanat. Good health is a gift from Allah.

 

DETERMINANTS OF HEALTH

The state of health is determined by nutrition, exposure to environmental risk factors, lifestyle, behavior, and iman. 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

 

3.0 LIFE, hayaat

DEFINITION OF LIFE

Life is a complex phenomenon with biological, chemical, and spiritual components. Human life is a duality: physical and spiritual life at the same time. Life without any spirituality is not a full human life but is a life of animals. The highest level of life is that of the ruh. The ruh is the essence of human life. The ruh is eternal. The ruh is inserted in the fetus during intra-uterine life to give it human life, nafakh al ruh.  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[i].

 

NATURE OF LIFE

Life can be described as life on earth, hayat al duniyat; life in the middle stage, hayat al barzakh; 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[ii]. Success and failure are experienced both on earth and in the hereafter.

 

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.

 

VALUE OF LIFE

Human life is a gift from Allah. 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. The sanctity of life 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.. 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.

 

4.0 DEATH, maut

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.

 

NATURE OF DEATH

There is a continuous cycle involving life and death. Life arises from death and vice versa[iii]. All human endeavors cease with death[iv]. Death is followed by burial in the grave, qabr[v]. There may be reward or punishment in the grave. Barzakh[vi] 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[vii]. The Qur’an makes it clear that it will be physical life with physical bodies. On resurrection people will be gathered[viii]. 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[ix]. All humans will eventually die[x]. Humans fear death[xi]. In view of the inevitability of death it is futile to attempt to avoid death or think of its removal[xii]. 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[xiii]. Death is a transition to life after death[xiv]. 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[xv]. The best of death is to die when struggling in Allah’s way[xvi]. Death in unbelief[xvii] is bad death.

 

ATTITUDES TO DEATH

Death and its occurrence are in the hands of Allah[xviii]. Good people welcome death as a rite de passage to a better existence in the hereafter. They look forward to death, al as a happy event. The approach of death is an opportunity for repentance[xix]. Death is an occasion for reminding and remembering the hereafter. Humans are apprehensive about death and often fear it[xx]. Wishing for death in desperation with severe painful illness is discouraged. The wish for death[xxi] can be negative for the escapist who looks to death as a relief from present psychological or physical distress Committing suicideis definitely forbidden and puts someone outside the fold of Islam. Death is a trial[xxii] and is a calamity[xxiii].

 

5.0 DISEASE, al maradh

CONCEPTS OF DISEASE

Disease is divergence from the normal 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. 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.

 

NATURE OF DISEASE

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[xxiv]. The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness[xxv]. Some diseases are due to disobedience. 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[xxvi].

 

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. Denying the existence of physical causes of disease is denying the cardinal principle of sunan Allah fi al kawn and is akin to superstitious belief. 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. In the end all cure is from Allah and not the human[xxvii].

 

6.0 MEDICAL TREATMENT, al tibaabat

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.. Humans try, but it is Allah who cures[xxviii]. Disease treatment is part of qadar[xxix]. Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr and is reversal of qadar by another qadar.

 

SPIRITUAL  MODALITIES OF TREATMENT

Among spiritual approaches to disease management is use of dua from the Qur’an[xxx] 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[xxxi], dua[xxxii], asking for protection from Allah, isti’adhat and salat[xxxiii].

 

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[xxxiv], amulets[xxxv], fortune telling[xxxvi], divination[xxxvii], astrology[xxxviii], sorcery[xxxix], 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[xl]. A good Muslim should not be involved with jinns and should ask Allah for protection against them[xli]. 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[xlii]. Other humans do not this ability. Therefore dreams of ordinary humans should have no role in the diagnosis, treatment and prognosis of disease.

 

QADAR AND HUMAN DISEASE

Human illness is part of qadar. Medical treatment is not denial of or attempting to reverse qadar. Both the disease and its treatment are part of Allah’s all-embracing qadar. The human in his limited knowledge can not distinguish between curable and incurable disease. He therefore plays safe by treating all diseases to the best of their ability being fully aware that this is an attempt and leave the rest to Allah. Allah alone determines the life and death. No human can give life or take it away. The human can be involved as an agent but not as a cause. These are matters of qadar that the human intellect cannot understand fully. Trying to search into such matters leads to perdition. It is therefore advised not to go deep in matters of qadar. 

 

7.0 NURSE’S OBLIGATIONS FOR PATIENTS

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, salat al mughma ‘alayhi. The terminal patient is exempted from saum 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. lllness 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.

 

 

 

SPIRITUAL PREPARATION.

Spiritual preparation involves allaying anxiety, presenting death as a positive event, thinking of Allah, 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. The process of death should be easier for the believer than the non-believer. The soul of the believer is removed gently. Believers will look at death pleasantly as an opportunity to go to Allah. Allah loves to receive those who love going to Him. The patient should be encouraged to look forward to death because death from some forms of disease confers martyrdom. The patient should be told that Allah looks forward to meeting those who want to meet Him. Dying with Allah's pleasure is the best of death and is a culmination of a life-time of good work. Thinking well of Allah 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 away from Allah. Having hope in Allah at the moment of death  makes the process of dying more acceptable. The dying patient should be encouraged to repent because Allah accepts repentance until the last moment.


[i] (25:3)

[ii] (16:97)

[iii]  (3:27 & 10:31)

[iv] (4:18 & 63:10)

[v] (90:21)

[vi] (23:100)

[vii] (6:36 & 86:8-10)

[viii]  (2:203 & 100:9-10)

[ix] (14:17 & 87:13)

[x] (3:154 & 55:26)

[xi] (2:19 & 2:243)

[xii] (3:154 & 62:8)

[xiii] (14:17 & 87:13)

[xiv] (2:28 & 30:40)

[xv] (2:132 & 3:102)

[xvi] (4:100 & 33:23)

[xvii] (2:161 & 47:34)

[xviii] (2:243 & 76:28)

[xix] (4:18 & 23:99)

[xx] (2:19, 2:243)

[xxi] (2:94-95 & 62:6-7)

[xxii]  (21:35 & 77:2)

[xxiii] (5:106)

[xxiv] (MB1949)

[xxv] (MB1948, MB1951)

[xxvi] (2:10 & 73:20)

[xxvii] (26:80)

[xxviii]  (21:83-84 & 38:41-42)

[xxix] (Tirmidhi K26 B21)

[xxx]  (17:82)

[xxxi] (Ibn Majah K31 B28

[xxxii] (Ahmad 2:446)

[xxxiii] (Ibn Majah K31 B10)

[xxxiv] (Muslim K39 H121)

[xxxv]  (5:3 & 5:90)

[xxxvi] (Muslim K39 H121)

[xxxvii] (Bukhari K76 B17)

[xxxviii] (Ibn Majah K23 B28)

[xxxix] (Bukhari K76 B17)

[xl] (15:17-18 & 72:8)

[xli] (3:36 & 114:1-6)

[xlii] (12:6 & 12:100-101)

Professor Omar Hasan Kasule Sr. June 2004