According to Islam, life is a sacred trust from God and death is a return to Him. For Muslims, death is not an end but a transition to the afterlife where all are held accountable to God:
"Every soul shall have a taste of death: In the end to us shall you be brought back (Qur'an 29:57)."
What is a 'good death' for Muslims?
It it when a person is surrounded by family and has an opportunity to reflect on past sins and seek forgiveness. "When death approaches, the patient and family environment usually become charged with emotions as they seek forgiveness from one another", according to an article by Dr. Mohammad Zafir al-Shahri and Dr. Abdullah al-Khenaizan on palliative care for Muslim patients in the Journal of Supportive Oncology.
Spiritual comfort is provided by the recitation of the Qur'an and Hadith (that refers to the sayings of Prophet Mohammed) and the performance of Islamic end-of-life rituals including a final statement of faith from the dying patient that there is no true God but Allah, and Muhammad is His Servant and Messenger.
Finally, the body of the dying person should be turned toward Mecca as he or she dies. If this cannot be accommodated in a hospital or care facility, many will accept having just their face turned to Mecca.
How many Muslims are there in Canada and where do they live?
According to Canada's 2001 census, there were 579,740 Muslims in Canada, almost two per cent of the population. By 2006, the Muslim population had grown to an estimated 800,000 or about 2.6 per cent of the population. The total Muslim population across Canada is projected to rise to 1,421,400 by 2017.
- Ontario (352,530) with most settled in and around the Greater Toronto area.
- Quebec comes second with 108,620 Muslims.
- In British Columbia, there are 56,220 (about 53,000 in Vancouver)
- Alberta has 49,040 (Calgary has approximately 29,000 Muslims and Edmonton has close to 20,000 Muslims.)
What role does prayer play in end of life?
Muslims pray five times a day. Prayer plays an even greater role in times of suffering and is especially important at end of life. Prayer at end of life helps Muslims to seek forgiveness, feel closer to God, accept their mortality, and prepare for death or the afterlife.
Prayers, once begun, cannot be interrupted. This can create problems in health care facilities as health care providers may inadvertently enter a patient’s room when they are praying and misinterpret the lack of a response from the patient.
Another problem for Muslim patients praying in care facilities is that, according to Dr. Shabbir Alibhai, a geriatrician at Mount Sinai Hospital in Toronto who is involved in end-of-life care, "not every hospital has a Qur'an immediately available. The majority, as far as I do understand, do not easily have them around".
What care do Muslims require near the end of life?
For Muslims, talking to an Islamic spiritual care provider about God, the afterlife and prayers may be helpful at the dying stage. But for hospitalized patients this is not always easy. "Most hospitals have chaplains and they are available around the clock. But, chaplains are predominantly trained in the Christian paradigm," says Alibhai. "Very few hospitals have Muslim chaplains. For instance, my hospital does not, and my hospital is one of the biggest in the city and one of the biggest in the country".
Modesty is important for Muslims but when a patient is cared for in a hospital and clothed in a relatively immodest hospital gown, this cannot always be fully respected. "And for male patients particularly if they need hygiene assistants, so bathing and shaving and those kinds of things, then many observant Muslim men are more comfortable obviously with a male nurse. And there's a scarcity of male nurses," says Alibhai.
"Islam prohibits discontinuing of nourishment and hydration; if the patient is able to swallow, small sips of water can be given. If he/she is unconscious and does not respond a moistened cotton swab can be used," state Khlood Salman and Rick Zoucha in an article on terminally ill Muslim patients published last year in the Journal of Hospice and Palliative Nursing. The authors add, however, that "prolonging life on machines is not encouraged".
There is some debate about medication-related sedation for dying Muslims according to the Journal of Supportive Oncology article. "On the one hand, alleviation of the suffering …is considered very righteous. On the other hand, maintaining a level of consciousness as close to normal as possible is of great importance to allow observance of the worship rites for the longest period possible before death."
The making of a proper Islamic will, and arrangements for a proper Islamic burial, can greatly ease end-of-life anxiety for Muslims.
When discussing life-expectancy with their health care providers, terminal Muslim patients and their families may feel more comfortable than non-Muslims with less definitive answers. "This is because Muslims believe that the longevity of every person is only known by Allah who predetermined the exact timing of death," explain al-Shahri and al-Khenaizan in their Supportive Oncology article.
What is the role of the family at end of life?
As with many other religions and cultures, family plays a central role in providing support to dying Muslims. "In the Islamic culture … although patients reserve the right to make their own decisions, physicians should communicate with the family before they communicate with the patient…," according to Salman and Zoucha.
Large numbers of family and friends tend to gather around a death bed. Showing this care to a dying patient is important from an Islamic perspective but in hospitals and other care facilities, it can be viewed as a hindrance or a burden by health care providers and other patients sharing a hospital room.
How do Muslims mourn the deceased?
Muslims are to be washed immediately after death by someone of the same gender, wrapped in a plain cloth that is usually white. The body is to be treated with the same modesty and gentleness as that of a living person. Muslims are buried and never cremated. The burial must happen within 24 hours. The grave is dug deeper than the deceased person's height and the body is laid in the grave facing towards Mecca.
Dr. Raza Naqvi, a Toronto internal medicine resident and member of the Muslim Medical Association of Canada, says a lack of certainty about whether these requirements will be met within 24 hours after death in a non-Muslim country "can be added stress for both the patient and the family, when they don’t know exactly how it will be coordinated with the hospital."
After death, the loved ones and relatives are to observe a three-day mourning period. Islamic mourning is marked by increased devotion, receiving visitors and condolences, and avoiding decorative clothing and jewelry.