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ISLAMIC MEDICAL EDUCATION RESOURCES-04

0603-HOLISTIC TERMINAL CARE

Paper prepared on 30 March but not delivered by Professor Omar Hasan Kasule, Sr.

Comfort:

Narcotics are given for severe pain. Drugs are used to allay anxiety and fears. The caregivers should maintain as much communication as possible with the dying. They should attend to needs and complaints and not give up in the supposition that the end was near. Attention should be paid to the patient's hygiene such as cutting nails, shaving hair, dressing in clean clothes. As much as possible the dying patient should be in a state of rutual purity, wudhu, all the time.

 

Ibadat:

The dying patient should as far as is possible be helped to fulfil acts of worship especially the 5 canonical prayers. Tayammum can be performed if wudhu is impossible, tayammum al mariidh[1]. The prophet gave guidance on salat foir the sick, salat al mariidh[2]. Physical movements should be restricted to what the patient's health condition will allow. There us guidance on salat even for the unconscious patient, salat al mughma ‘alayhi[3]. 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. llness does not interefere with the payment of zakat since it is a duty related to the wealth and not the person. It is also wrong for a patient in terminal illness to go for hajj with the intention of dying and being buried in Hejaz.

 

Allaying fear

There is a balance between fear and hope. Too much fear of death leads to despair, ghalabat al khawf ila al ya as. Too much hope may lead to a feeling of security with Allah, ghalabat al raja ila al amn min al Allah, that is dangerous. 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[4]. The believer dies with ‘araq al jabiin[5]. The soul of the believer is removed gently[6]. Believers will look at death pleasantly as an opportunity to go to Allah. Allah loves to receive those who love going to Him[7]. The patient should be taught to accept the illness and its consequences like physical anomalies and death. The patient should be patient. Patience is when we do not complain  The patient should be encouraged to look forward to death because death from some forms of disease confers martyrdom. Dying from plague is martyrdom, al ta’un shahadat[8]. Death from mabtuun is martyrdom[9]. Death by drowning is martyrdom[10]. Death from dhaat al janb is martyrdom[11]. Death in the post-partum period is martyrdom[12]. Accepting the disease, al ridha bi al maradh. Accepting disability, al ridha bi al ‘aahat.

 

Talqiin

Talqiin of kalimat al tauhid should be before and not after death. The prophet (PBUH) said : laqqinu mawtaakum la ilaaha illa al llaah[13]. He whose last word on earth is la ilaaha illa al llaah will enter paradise[14].

 

 

 

Spiritual preparation for death

They should be told that Allah looks forward to meeting those who want to meet Him[15]. Dying with Allah's pleasure[16] is the best of death and is a culmination of a life-time of good work. Thinking well of Allah is part of faith[17] 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[18] makes the process of dying more acceptable.

 

Repentance

The dying patient should be encouraged to repent because Allah accepts repentance until the last moment, allahu yaqbalu al taubat ma lam yugharghir[19].

 

Helping patient make a  will:

The prophet said that no Muslim with some property should sleep 2 nights without a written will[20]. There is no will for any inheritor, la wasiyat li waarith[21]. During the long period of hospitalization, the health care givers develop a close rapport with the patient. A relationship of mutual trust can develop. It is therefore not surprising that the patient turns to the care givers in confidential matters like drawing a will. The health carwe givers as witnesses to the will must have some elementary knowledge of the law of wills and the conditions of a valid will, shuruut al wasiyyat. One of these conditions is that the patient is mentally competent. The law accepts clear signs by nodding or using any other sign language as valid expressions of the patient's wishes. The law allows bequeathing a maximum of one third of the total estate to charitable trusts, waqf, or gifts. More than one third of the estate can be bequeathed with consent of the inheritors. Debts must be paid before death or before the division of the estate.

 

Settlement of outstanding debts

The caregiver should advise the terminal patient to remember all his outstanding debts and to settle them. The Prophet said that the soul of a believer is hanging by its debts until they are paid[22]. The prophet used to desist from offering the funeral prayer for anyone who died leaving behind debts and no assets to seetle them. He however would offer the prayer if someone undertook to pay the debt[23]. If the deceased has some property, the debts are settled before any distribution of the property among the inheritor, qadhau al dayn qabla qismat al mirath[24].

 

The last moments

The last moments are very important. The patient should be instructed such that the last words pronounced are the kalimat, the testament of the faith. Reciting Qur’an in the last moments is mustahabb, qira’at al qur’an ‘ala al muhtadhir mustahabb but reading it for the dead is considered bid’at by some jurists. The dying should be taught the testament 'la ilaaha illa al llaahu'[25]. Surat Yaasiin is read to them[26] in addition to supplications, dua[27]. On death, the body is covered[28]. It is placed in such a way that it is facing the qiblat. Eyes are closed and the body is covered. Qur'an and dua are then recited. Kissing the body is allowed[29]. Debts of the deceased must be settled before proceeding further with rituals of burial[30].

 

Etiquette of mourning:

The health care giver should take the initiative to inform the relatives and friends. They should be advised about the shariah rules on mourning. Weeping and dropping tears are allowed. Condolences for the bereaved, ta’aziyat al musaab, is in the form ‘inna li al llaah akhadha ma a’ata wa kullu shay I ‘indahu bi ajal musammah fa tasbiruu wa litahtasibuu (Bukhari). The prophet gave guidance about what the bereaved can say if informed of the death, ma dha yaqulu man balaghahu mawt insaan[31]. On receiving the news of death it suffices to say ' we are for Allah and to Him we will return' inna li laahi wa inna ilaihi raaji’una allahuma ajirni fi musibati wa akhlifuni khayran minhu[32]. The following are not allowed: tearing garments, shaving the head, slapping the cheek, wailing, and crying aloud. The deceased is punished for the loud crying of the relatives[33]. Words of condolence are as follows: ina li laahi ma akhadha wa lahu ma a’ata wa kullu shayi’i indahu bi ajalimusamma falitasbiru litahtasibu (Muslim).’ Relatives are conforted by telling them hadiths of the prophet about death. These hadiths talk about the reward of the person who loses his beloved one and he is patient[34]. Death of children protects the parents from hell fire[35].  Relatives and neighbors have to prepare food according to the order of the prophet for food to be prepared for the family of Ja’afar (Abudaud and Tirmidhi).

 

Preparation of the body for burial: 

The health care team should practise total care by being involved and concerned about the processes of mourning, preparation for bural and the actual burial. They should participate along with relatives as much as is possible. The preparation of the body for burial can be carried out in the hospital. There is no harm in reciting Qur’an before washing the body, la ba asa min qira at al qur’an ‘ala al mayyit qabla ghaslihi. The body must be washed and shrouded before burial. Perfume can be put in the water used for washing the body[36]. Men preferably should wash men and women wash women; a man could wash a woman (BG443 Ahmad and Ibn Majah, BG444 Darqutni). Care must be taken not to damage the body such as breaking bones (BG468 Muslim). The body is shrouded in simple white garments (BG439 Ahmad, Abudaud, Tirmidhi, Ibn Majah) with no extravagance (BG442 Abudaud). It is allowed to uncover the face of the corpse. The washing should start with the right. The organs normally washed in wudhu are washed first then the rest of the body is washed. Perfume can be used except for those who died while in a state of ihram, man maata wa huwa muhrim la yamussu taiba[37]. Women's hair has to be undone. After washing the body is shrouded, kafn, in 2 pieces of cloth preferably white in colour. It is an innovation to raise the voice while carrying the janazat even it it is recitation of the Qur’an. It is not an obligation to wash the body of shuhada but it is not forbidden. It is mustahabb to stand for a passing funeral bier out of respect.

 

Accompanying the funeral procession, tash'yii an janazat:

 Burial should be hastened, ta'ajil bi al janzat[38]. Following the procession is enjoined[39]. There are big rewards for accompanying the funeral procession[40]. There is more reward for accompanying the funeral procession and staying until burial is completed[41]. The funeral bier is carried by men. Women do not follow the janazat. Hurrying in marching to the grave is recommended.

 

After burial:

The relatives are consoled and food is made for them. It is against the sunnat for the bereaved to make food for the mourners. The prophet taught the etiquette of mourning, hidaad, and condolences, ta’ziyah. Women in mourning should not touch any perfume, la taqrabu al haadat al taib[42]. The mourning of a woman does not exceed 3 months unless the deceased was her husband. Weak hadiths were reported about talqiin al mayyit after burial. Talqiin is not waajib. Some jurists consider it makruuh but not haram. Shafe’e jurists consider it mustahabb. Some jurists consider talqiin a form of bid’at. It is not correct to bring a person to recite Qur’an at the qabr after burial. It is however allowed to make dua for the deceased and to give sadaqat on his behalf. It is however forbidden to give the sadaqat from the maal of the orphans. If the deceased died in kufr and shirk, no dua or sadaqat is made for him. It is allowed to recite Qur’an, to offer salat, and to make tawaaf with the intention of donating the thawaa to the deceased. It is wrong to partition the thawaab of any good act done between the living and the dead. A child born of zina can donate thawaab of his work to his father even if he did not know him. It is forbidden to slaughter animals at the grave or to eat what what slaughtered at the qabr. It is however allowed to slaughter away from the qabr and to distribute the meat to the poor as thawaab for the deceased. It is forbidden to build structures on the grave but putting something to identify who is in the qabr is allowed. Building a mosque at a qabr is prohibited. It is also prohibited to build mosques between graves. Putting lamps on the qabr is shirk. Making dua to the deceased is major shirk.

Visiting the qabr is desirable since it reminds the living of death. The following is recited while visiting the qabr ‘assalaam alaykum ahl al diyaar min al mu uminiin wa al muslimiin wa inna in shaaha al allaahu bikum laahiquun, nas al al llaahu lana wa lakum al ‘aafiyat’. Does the visitor face the grave of face the qiblat during the recitation?. Some jurists allow reciting Qur’an in the cemetery but others consider it makruuh. There is argument among jurists on whether prohibition of women visiting graves is nahy tanziih ir nahy tahriim. Visiting graves of kuffaar for I’itibaar is allowed. It is permitted for a kaafir to visit the grave of a Muslim.

 

Talking about the deceased:

Say only good things. The good words about the dead, thanau al nass ala al mayt[43]. It is forbidden to curse the deceased. The exception are the leaders of kufr. Aimmat al kufr, who had influence on people.

Reward and punishment

The ruh and body of the deceased is rewarded, tana’um, or is punished, ‘adhaab'.


[1] (KS146 Bukhari K7 B7, Abudaud K1 B124, Abudaud K1 B125, Ibn Majah K1 B92, Zaid H65, Ahmad 4:265)

[2]  (KS506 Zaid H237, Zaid H241)

[3] (KS505 Zaid H235)

[4]  (KS525 Muslim K51 H75, Nisai K21 B9, Ibn Majah K37 B31, Ahmad 2:364, Ahmad 4:287, Ahmad 4:295, Ahmad 6:139, Tayalisi H753, Tayalisi H2389, Ibn Hisham p269)

[5] (KS525 Tirmidhi K8 B10, Nisai K21 B5, Ibn Majah K6 B5, Ahmad 5:357, Ahmad 5:360, Tayalisi H808)

[6] (KS525 Tirmidhi K8 B8, Abudaud K19 B10, KS525 Ahmad 1:297, Tayalisi H753)

[7]   (KS525)

[8] (KS298 Bukhari K60 B54, Bukhari K76 B30, Bukhari K76 B31, Bukhari K82 B15, Muslim K33 H166, Ibn Majah K6 B61, Ibn Sa’ad J8 p356, Ahmad 3:150, Ahmad 3:220, Ahmad 3:223, Ahmad 3:258, Ahmad 3:265, Ahmad 4:128, Ahmad 4:185, Ahmad 4:200, Ahmad 4:395, Ahmad 4:413, Ahmad 4:417, Ahmad 5:81, Ahmad 6:64, Ahmad 6:145, Ahmad 6:154, Ahmad 6:251, Ahmad 6:255, Tayalisi H534, Tayalisi H2113). Death in a strange place is martyrdom,mawt al ghurbat shahadat (KS298 Ibn Majah K6 B60)

[9] (KS298 Bukhari K76 B30, Nisai K21 B110, Ahmad 4:200)

[10] (KS298 Abudaud K15 B9)

[11] (KS298 Ahmad 4:157)

[12] (KS 298 Ahmad 4:200, Ahmad 5:409)

[13] (Muslim)

[14] (Hakim)

[15] (KS525)

[16] (KS525 Ibn Majah Intr B9)

[17] (KS525 Muslim K51 H81, 82, Abudaud K20 B21, Ibn Majah K37 B14, Ibn Sa’ad J2 Q2 p45, Ahmad 3:293, Ahmad 3:315, Ahmad 3:325, Ahmad 3:330, Ahmad 3:334, Ahmad 3:390, Tayalisi H1779)

[18] (KS525 Tirmidhi K8 B11)

[19] (KS143 Muslim K49 H46, Muslim K49 H47, Muslim K49 H48, Ibn Majah K37 B30)

[20] (Muslim and Bukhari)

[21] (Darqutni)

[22] (Ahmad)

[23] (KS162 Bukhari K38 B3, Bukhari K39 B3, Abudaud K18 B5, Bukhari K69 B15, Abudaud K22 B9, Ibn Majah K15 B9, Darimi K18 B53, Ahmad 2:290, Ahmad 2:380, Ahmad 2:399, Ahmad 2:453, Ahmad 3:330, Ahmad 4:47, Ahmad 4:50, Ahmad 5:297, Ahmad 5:301, Ahmad 5:304, Ahmad 5:311)

[24] (KS239 Bukhari K57 B13, Tirmidhi K28 B6, Ibn Majah K15 B20, Darimi K21 B39, Darimi K22 B16, Ahmad 1:79, Ahmad 1:131, Ahmad 1:144, Ahmad 4:136, Ahmad 5:7, Tayalisi H179)

[25] (BG428 Muslim, Abudaud, Nisai, Tirmidhi, Ibn Majah)

[26] (BG429 Abudaud, Nisai)

[27]  (BG430 Muslim)

[28] (BG431 Bukhari and Muslim)

[29] (BG432 Bukhari)

[30] (BG433 Ahmad and Tirmidhi)

[31] (KS525 Zaid H960)

[32] (Muslim)

[33] (Bukhari and Muslim)

[34]  (KS524 Ahmad 2:265, Ahmad 2:417)

[35] (KS575 Bukhari K3 B36, Bukhari K23 B92, Bukhari K96 B9, Muslim K45 H150, Muslim K45 H151, Muslim K45 H152, Muslim K45 H153, Muslim K45 H154, Muslim K45 H155, Muslim K45 H156, Tirmidhi K8 B36, Tirmidhi K8 B64, Nisai K21 B24, Nisai K21 B25, Nisai K21 B26, Ibn Majah K6 B56, Muwatta K16 H38, Muwatta K16 H39, Muwatta K16 H40, Ibn Sa’ad J4 Q1 p172, Ibn Sa’ad J4 Q2 p24, Ibn Sa’ad J8 p327, Ahmad 1:375, Ahmad 1:421, Ahmad 1:429, Ahmad 1:451, Ahmad 2:239, Ahmad 2:246, Ahmad 2:276, Ahmad 2:378, Ahmad 2:417, Ahmad 2:419, Ahmad 2:473, Ahmad 2:479, Ahmad 2:510, Ahmad 2:536, Ahmad 3:14, Ahmad 3:34, Ahmad 3:72, Ahmad 3:152, Ahmad 3:306, Ahmad 3:467, Ahmad 4:144, Ahmad 4:183, Ahmad 4:184, Ahmad 4:212, Ahmad 4:386, Ahmad 4:415, Ahmad 5:83, Ahmad 5:151, Ahmad 5:153, Ahmad 5:155, Ahmad 5:159, Ahmad 5:164, Ahmad 5:166, Ahmad 5:230, Ahmad 5:237, Ahmad 5:241, Ahmad 5:253, Ahmad 5:312, Ahmad 6:376, Ahmad 6:396, Ahmad 6:431, Tayalisi H508, Tayalisi H562, Tayalisi H2304)

[36] (KS355 Bukhari K23 B8, Bukhari K23 B9, Bukhari K23 B13, Bukhari K23 B15, Bukhari K23 B18, Bukhari K23 B20, Bukhari K23 B21, Bukhari K23 B22, Bukhari K28 B20, Muslim K11 H36, Muslim K11 H40, Muslim K15 H93, Muslim K15 H94, Muslim K15 H95, Muslim K15 H96, Muslim K15 H97, Muslim K15 H98, Muslim K15 H99, Muslim K15 H100, Muslim K15 H101, Muslim K15 H102, Muslim K15 H103, Abudaud K20 B28, Abudaud K20 B78, Tirmidhi K7 B105, Tirmidhi K8 B15, Nisai K21 B28, Nisai K21 B32, Nisai K21 B34, Nisai K21 B35, Nisai K21 B36, Nisai K21 B41, Nisai K24 B46, Nisai K24 B95, Ibn Majah K6 B8, Ibn Majah K25 B87, Darimi K5 B35, Muwatta K16 H2, Ibn Sa’ad J8 p70, Ahmad 6:407, Ahmad 6:408)

[37] (KS355 Bukhari K23 B22, Bukhari K28 B13, Bukhari K28 B21, Muslim K15 H99, Muslim K15 H100, Muslim K15 H101, Muslim K15 H103, Abudaud K20 B78, Nisai K24 B95, Nisai K24 B96, Nisai K24 B97, Ibn Majah K25 B87, Muwatta K20 H14, Ahmad 1:221, Ahmad 1:266, Ahmad 1:286, Ahmad 1:328)

[38] (KS161 Bukhari K23 B51, Bukhari K23 B52, Bukhari K23 B53, Bukhari K23 B91, Muslim K11 H50, Bukhari K23 B51, Abudaud K20 B33, Abudaud K20 B45, Tirmidhi K8 B30, Tirmidhi K8 B73, Nisai K21 B44, Ibn Majah K6 B15, Muwatta K16 H56, Ibn Sa’ad J4 Q2 p62, Ahmad 1:394, Ahmad 1:415, Ahmad 1:419, Ahmad 1:432, Ahmad 2:240, Ahmad 2:258, Ahmad 2:280, Ahmad 2:292, Ahmad 2:295, Ahmad 2:363, Ahmad 2:474, Ahmad 2:488, Ahmad 2:500, Ahmad 3:41, Ahmad 3:58, Ahmad 4:397, Ahmad 5:36, Ahmad 5:37, Ahmad 5:38, Tayalisi H883, Tayalisi H2236)

[39]  (KS159 Bukhari K23 B2, Bukhari K46 B5, Bukhari K67 B71, Bukhari K74 B28, Bukhari K75 B4, Bukhari K77 B36, Muslim K37 H3, Muslim K39 H4, Muslim K39 H5, Tirmidhi K8 B50, Nisai K21 B53, Nisai K21 B80, Ibn Majah K6 B1, Ahmad 1:105, Ahmad 2:68, Ahmad 2:321, Ahmad 2:322, Ahmad 2:356, Ahmad 2:357, Ahmad 2:327, Ahmad 2:388, Ahmad 2:412, Ahmad 2:540, Ahmad 3:23, Ahmad 3:27, Ahmad 3:31, Ahmad 3:48, Ahmad 4:284, Ahmad 4:287, Ahmad 4:299, Ahmad 5:272)

[40] (KS159 Bukhari K2 B35, Bukhari K23 B58, Muslim K11 H52, Muslim K11 H53, Muslim K11 H54, Muslim K11 H55, Muslim K11 H56, Abudaud K20 B40, Nisai K21 B54, Nisai K21 B79, Nisai K46 B26, Ibn Sa’ad J4 Q2 p57, Ahmad 1:97, Ahmad 2:2, Ahmad 2:16, Ahmad 2:246, Ahmad 2:371, Ahmad 2:387, Ahmad 2:430, Ahmad 2:458, Ahmad 2:470, Ahmad 2:474, Ahmad 3:20, Ahmad 3:96, Ahmad 3:440, Ahmad 5:241, Ahmad 5:276)

[41] (KS160 Bukhari K23 B59, Muslim K11 H52, Muslim K11 H53, Muslim K11 H54, Muslim K11 H56, Muslim K11 H57, Abudaud K20 B40, Abudaud K20 B42, Tirmidhi K8 B49, Nisai K21 B54, Abudaud K20 B79, Abudaud K20 B80, Ibn Majah K6 B34, Ahmad 2:2, Ahmad 2:233, Ahmad 2:280, Ahmad 2:320, Ahmad 2:401, Ahmad 2:430, Ahmad 2:458, Ahmad 2:470, Ahmad 2:474, Ahmad 2:493, Ahmad 2:503, Ahmad 2:521, Ahmad 2:531, Ahmad 3:25, Ahmad 3:27, Ahmad 3:37, Ahmad 3:41, Ahmad 3:48, Ahmad 3:51, Ahmad 3:85, Ahmad 4:86, Ahmad 4:294, Ahmad 5:57, Ahmad 5:131, Ahmad 5:276, Ahmad 5:277, Ahmad 5:282, Ahmad 5:283, Ahmad 5:284, Tayalisi H985, Tayalisi H2184, Tayalisi H2190, Tayalisi H2581)

[42] (KS356 Bukhari K68 B46, Bukhari K68 B47, Bukhari K68 B48, Bukhari K68 B49, Bukhari K76 B18, Muslim K18 H124, Muslim K18 H125, Muslim K18 H126, Muslim K18 H127, Abudaud K13 B41, Muslim K18 H44, Tirmidhi K11 B18, Nisai K27 B55, Nisai K27 B63, Nisai K27 B64, Nisai K27 B65, Nisai K27 B67, Nisai K27 B68, Ibn Majah K10 B35, Darimi K12 B11, Muwatta K29 H101, Muwatta K29 H102, Muwatta K29 H103, Muwatta K29 H104, Muwatta K29 H106, Muwatta K29 H108)

[43]  (KS160 Bukhari K23 B86, Muslim K11 H60, Abudaud K20 B74, Tirmidhi K8 B63, Nisai K21 B50, Ibn Majah K6 B20, Ahmad 1:22, Ahmad 1:45, Ahmad 1:54, Ahmad 2:261, Ahmad 2:408, Ahmad 2:466, Ahmad 2:470, Ahmad 2:498, Ahmad 2:528, Ahmad 3:179, Ahmad 3:186, Ahmad 3:197, Ahmad 3:211, Ahmad 3:242, Ahmad 3:245, Ahmad 3:281, Tayalisi H2062, Tayalisi H2388)

Professor Omar Hasan Kasule Sr. March 2006