Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Islam (Muslim)

The Five Basic

Principles of Al-Islam/ Beliefs

• Shahadatain (Declaration of Faith) - To declare there is only one God, Allah, and that Muhammad is his messenger.
• Salat (Prayer/Worship) - Muslims must pray five times a day.  The Qur’an is the final revelation to Humanity.
• Zakat (Charitable Contributions) - Requires that once a year a Muslim is to give at the rate of 2.5% to a charitable cause.
• Sawm (Fasting) - Participate in the month long fast of Ramadan, in which they restrain from food, drink, and sex during daylight hours.
• Hajj (Pilgrimage to Mecca) - if in good health and with enough money, one must make the pilgrimage to Mecca once in their lifetime.

Beliefs

• One God, or Allah, is most important principle
• Complete submission to God
• Prophet Muhammad and Holy Qur’an
• A judgment day and life after death
• Commitment to fast during the holy month of Ramadan: abstaining from food, drink, sexual intercourse and evil intentions and actions
• Commitment to attempt a pilgrimage to Mecca (in Saudi Arabia) at least once in life
• Duty to give generously to poor people
• Belief in Oneness of God
• Belief in His Angels
• Belief in His Books (All the revealed Scriptures)
• Belief in His Messengers (All of them)
• Belief in Hereafter (Life after Death)
• Belief in the day of Judgment
• Belief in Reward and Punishment

Daily practices

• May engage in prayer 5 times a day facing Mecca (dawn, mid-day, mid-afternoon, sunset, night); face, hands and feet are washed before prayer. Do not interrupt or walk in front of patient when he/she is saying prayers unless it is an emergency
• Days of observance occur throughout the Muslim lunar calendar

Dying and death

• Death is controlled by God’s plan
• Euthanasia or any attempt to shorten life prohibited
• Organ or body donation acceptable
• Autopsy permitted only for medical or legal reasons
• Confession of sins and begging forgiveness often occurs in presence of family upon death
• Important to follow five steps of burial procedures which specifies washing, dressing, and positioning of the body. First step is traditional washing of the body by Muslim of same gender
• As moment of death approaches, Islamic Creed should be recited
• Grief expressed by shedding tears, but forbidden to wail, beat breast, slap face, tear hair or garments, or complain or curse
• The Janazah Prayer (Prayer for the deceased) must be said in Arabic and led by a male- an Imam is preferred.  This process should take place within 72 hours after death.  Therefore, a death certificate should be signed quickly to facilitate the process.

Facilitating practices

• Explore what practices are most important to patient/family
• Be aware that some customs prohibit  handshakes or any contact between genders
• Female patients may want a female physician
• Be aware of language barriers.

Food

• Tayyib= what is good, pure, clean, wholesome, nourishing, pleasant and tasteful.
• Halal= what is lawful and allowed for Muslims to eat
• Halal Diet – Pork, and some shellfish prohibited; alcohol is possibly prohibited
• Only vegetable oil is to be used
• Any food invoked by a name besides God’s may be prohibited
• Children, pregnant women and those who are ill are exempt from fasting laws, however may resist and need support from faith group/leader
• May only eat with right hand, which is considered to be the clean hand

Health

• No restrictions on blood or blood products, medications, amputations, organ transplants, or biopsies
• Most surgical procedures permitted
• Doctors are seen as helpers of God’s will
• Abortion is prohibited except in cases of rape, incest and if the life of the mother is threatened. A fetus is considered a human being after 25-week gestation.

Holy days and festivals

• Fasting during the month of Ramadan is included in the 5 pillars of Islam and is considered to be a spiritual obligation. Fasting happens from sunrise to sunset.  The ill and children are exempt from fasting, but they may join anyway if safe to do so.
• Jum’ah Prayer (Congregational Prayer) held ever Friday, the Holiest Day for Muslims and takes place at noon prayer.  One may not work during this time.
• Islamic days are based on the lunar calendar. Muslims do not work on two Holy Days during the year; 1) Eid-ul-Fitr (Celebration of the Fast Breaking)-this is held on the first day of the ninth month of the lunar calendar. 2) Eid-ul-Aha (Celebration of the Sacrifice of Abraham) - a three day celebration beginning of the 10^th day of the twelfth month called Dhul Hijjah.
• These Holy Days consist of prayer and a short sermon in congregation followed by food, entertainment, feeding, of the poor and visiting the sick and shut-in.

Sunni

• Sunni roughly means ‘words and actions’ or example of the Prophet Muhammad
• Believe that when the prophet Muhammad died, it was his wish that the next leader would be elected.  Abu, Bakr, Muhammad’s closest friend, was elected.
• Believe the caliphs (leaders) of Islam should continue to be elected (and they are).
• 85% of Muslims are Sunni

Shia

• Shia roughly means , Party of Ali’
• Believe that when the prophet Muhammad died, it was his wish that Ali, his cousin and son-in-law would be the new caliph
• Shia Muslims choose to ignore the elected Sunni leaders, and instead follow their own leaders, direct descendents of Muhammad called Imams
• 15% of Muslims are Shia
• Iran and Iraq are the only countries that have a majority of Shia Muslims. Shia Muslims are the minority in the rest of Islamic world.
• Can also be found in Pakistan, Azerbaijan, Afghanistan, India and Syria
• Some Shia Muslims pray only 3 times a day; all Sunni Muslims pray 5 times a day