Aziz Sheikh MRCP MRCGP
J R Soc Med 1998;91:138-140
The care of dying patients and their relatives is one of the most difficult aspects of a doctor's job. Enabling an
individual to die with dignity can also be deeply rewarding. Britain today is a cosmopolitan society made up of people
from numerous religious and cultural traditions. The care of patients with backgrounds different from one's own
requires knowledge and skills. There are approximately 2
million Muslims in the UK1. Although most originate from
the Indian subcontinent2 substantial numbers have arrived
recently from Africa and to a lesser extent Central Europe.
Islamic Law (Shariah) is based on the Qur'an and Hadith
(the practices and sayings of the Prophet Muhammad)3. The
Shariah defines certain expected behaviours at the time of
death and these are generally adhered to by Muslims in
Britain. In this paper I offer some guidance on caring for
Muslim patients in their final illness.
MUSLIM BELIEF REGARDING DEATH, ABORTION
For a Muslim, death marks the transition from one state of
existence to the next. Islam teaches that life on earth is an examination-the life to come is the eternal abode where
one will reap the fruit of one's endeavours on earth. Death
is therefore not to be resisted or fought against, but rather something to be accepted as part of the overall divine plan4. Further, death is not a taboo subject in Muslim society and
is a matter upon which one is encouraged to reflect
frequently. In counselling of Muslims regarding a terminal
illness, or relatives after a bereavement, these points should be borne in mind.
Islam views life as sacred and a trust from God (Allah).
Termination of pregnancy is therefore generally not
permissible within the Islamic frameworks. If the subject
needs to be broached this should be done with extreme
sensitivity. To step outside the Islamic framework and have
an abortion may engender much guilt. Similarly, deliberate
euthanasia is prohibited6. Note, however, that undue
suffering has no place in Islam and if death is hastened in
the process of giving adequate analgesia then this is allowed. What is important is that the primary intent is not to hasten death.
THE FINAL ILLNESS
Certain death customs are almost universally practised by
Muslims. Ideally Muslims would wish to die at home7.
Making death clinical and remote in a hospital setting is not in keeping with the Islamic tradition. The dying person will expect to be visited by friends and relatives, who are
encouraged to pray for his or her welfare in the life to
come. This is a time when Muslims seek each others'
forgiveness for excesses that may have been inadvertently
committed. Fifty people visiting in the space of a few days
would not be exceptional; so strict adherence to '2 visitors per bed' will cause difficulty for all concerned. Members of the immediate family will often stay by the bedside reciting from the Qur'an. Having a copy of the Qur'an on the ward,
for those who have not remembered to bring their own, is a
The daily prayers play a pivotal role in the day-to-day
life of a Muslim, and prayer assumes an even greater role in times of suffering and distress. Family members will
encourage the dying to continue with their prayers as long
as they are able to do so. Before the prayer, ablution is
performed; bed-bound patients will need help in this
respect. Muslims pray towards Mecca, which is to the
south-east of Britain. Again for the bed-bound, positioning
the bed in the direction of Mecca will simplify matters.
Having a compass and prayer timetable available would be
very useful; a prayer timetable is easily available from most local mosques. Many of the visitors and relatives will also
need to perform their prayers and, unfortunately, hospitals
seldom cater for this need8.