Muslim

The majority of the world’s Muslims belong to one of the two denominations or sects: Sunni or Shia.

Muslims are required to pray 5 times a day at specific times after performing wudu (ritual washing) which consists of washing certain parts of the body including the feet (the sick or elderly may need help with this). If water is likely to cause harm dry ablution (tayammum) can be undertaken. A prayer mat is laid on the floor facing the direction of prayer (Qibla) which is towards Mecca in Saudi Arabia. This can be located using a compass in a S/East direction from England at 118 degrees. If no prayer mat is available a clean towel or sheet can be used. Shoes are removed and the head is covered. Prayer consists of standing, bowing and prostrating on the floor. If unable to stand/prostrate due to illness or old age, prayers can be carried out sitting on a chair or lying on a bed (if possible, facing the Qibla). Once prayer has begun avoid interruption or walking in front of them. Prayer typically takes no more than 10 minutes.

Friday is an important day for Muslims they will attend mosque where an Imam will lead congregational prayers. Women can attend if there are facilities but are excused if menstruating or bleeding after childbirth.

Ramadan is the 9^th month of the Islamic calendar and Muslims fast from dawn to sunset. Fasting is obligatory for those over the age of puberty who are fit and healthy. The sick, elderly, or pregnant/breastfeeding mothers are exempt if they feel fasting would cause harm to them or their baby. Despite this some Muslims may refuse injections/medication and insist on fasting. If medical opinion is that this is likely to be detrimental to their health this should clearly be communicated to them.

If medication can be adjusted to accommodate this without harm this would be the preferred option (missed fasts can be made up at a later date or in certain cases a poor person can be fed for each fast missed).

Quran, The Holy book for Muslims, should only be touched after performing ablution. Should be placed on a high shelf and where possible not have anything placed on top of it. Muslims are encouraged to recite the Quran regularly and will recite certain verses for the sick or dying in order to bring them peace and comfort.

Prayer beads (available now as an electronic counter) are used for ritual recitations. Muslims believe that this assists in relieving anxiety and stress and helps regulate the nervous system therefore aiding healing.

Zamzam Holy water is used as an aid to recovery as believed to have healing properties. Muslims may wish their sick/dying to sip on this or use this for mouthcare when they are approaching death.

In cases where medical treatment is withdrawn, basic human rights including nutrition/hydration should be maintained where appropriate. However, Islamic law permits the withdrawal of life sustaining treatments from terminally ill patients when it is deemed to be futile, does not lead to any improvement in the quality of life, involves significant complications or prolongs the suffering associated with end of life.

Islam places great emphasis on spirituality and recognises just as our physical bodies need food and nutrients to grow and develop, so our souls need nurturing spiritually. In a healthcare setting Spiritual and Pastoral caregivers (or the Imam) can help assist patients through a health crisis by providing spiritual, pastoral and religious care. This can take the form of providing a listening ear, prayer requests, facilitation of resources such as sacred text/prayer mats/beads or exploration of questions (why is this happening to me/what is the purpose and meaning of life).

Muslims believe the body is a trust from God so to neglect/abuse it is something they will be held accountable for in the next life. Whilst Muslims believe God is the ultimate healer, seeking treatment is highly recommended.

In Islam nutritional support is considered basic care and not medical treatment and so in situations where medical treatment is withdrawn basic human rights including nutrition, hydration and pain relief should be maintained where appropriate.

Whilst Islam does not allow the withholding or withdrawal of treatment, Islamic law permits the withdrawal of life sustaining treatments from terminally ill patients where treatment is deemed to be futile and does not lead to an improvement in the quality of life.

When discussions are being held around the issue of “do not resuscitate (DNR)”, consultation with medical staff, family and the hospital Imam (or the families own faith representative) is necessary.

Muslim men and women are both required to dress modestly outside the family home (females can have a more relaxed approach at home/in the company of the same gender or close male family members). For men this would mean covering the area from the navel to knee and for females the whole body except the face, hands and feet. Whilst covering the hair is a faith obligation, some females will choose to wear the Hijab (headscarf) others may not. Culture and country of origin usually dictate the style of clothing but there are also differences in the way younger and older Muslims will interpret this.

Cleanliness is important in Islam and looking after your body is a duty. Regular washing, cutting of nails and removing pubic hair is recommended. Muslims may wish to shower in running water rather than sit in a bath. It is recommended to use the left hand to clean after using the toilet and to use the right hand for eating. This is something to take into account when deciding which hand to use for a cannula or any other medical equipment. If someone is unable to carry out their own personal hygiene due to illness or old age family may wish to do this for them.

There are two major celebrations in the Islamic year:

• Eid-ul-Fitr, which takes place immediately after the end of Ramadan and which is known as the festival of breaking the fast
• Eid-ul-Adha, which takes place after the day of Hajj

The greeting “Eid Mubarak” is exchanged.

There is an extra prayer and family/friends get together to celebrate.

Whilst Islam advocates equality between genders any diverse practices may be influenced by culture or tradition. The Quran does not make any distinction on the basis of sex and believes in human equality.

In a healthcare setting there may be a preference for examination/treatment or personal care to be carried out by a member of the same gender where possible. It is recommended that only the body part that requires examination is uncovered. Similarly, for reasons of respect and dignity single sex wards would be preferred.

Contact with members of the opposite sex to whom one is not closely related is limited to necessity, and so some males and females may not wish to shake hands with a member of the opposite gender. This is intended as a sign of respect and not dismissiveness or bad manners.

Muslim birth rites include the Adhan (the call to prayer in the baby’s ear) which can be carried out by any male family member or by an Imam as soon as possible after the baby is born. The act of recitation ensures that the child is called towards Islam. Audios of these prayers are offered here (link to self help resources audio). The baby should be faced towards the Qibla as the prayers are recited, first in the right ear (the Azaan) and then in the left ear (the Iqamaah).

Family may wish to place a small amount of softened date or drop of honey on the baby’s mouth (circumstances permitting). The baby is named on the 7^th day and the head shaved when the baby is taken home. Muslim boys are circumcised as soon as practically possible.

There is complexity in dealing with the remains of Muslim babies who do not survive. The age of gestation (pre-17 weeks or post 24 weeks) and whether a baby shows signs of life at birth, are critical factors in determining if a baby should be given a name, washed, or wrapped in a cloth. Further details about this can be found in the ‘When a Muslim baby dies’ section. There is no formal funeral prayer but the Dua may be helpful. For neonatal death there is religious guidance as to the type of funeral required so it is best for family to seek guidance from their own faith leader or from the hospital Imam. It is a faith requirement for the burial to take place as soon as practically possible. Cremation is not allowed in Islam and so in cases of pregnancy loss or miscarriage all parts of the human body including the navel cord and placenta should be buried.

Baby less than 16 weeks gestation age who dies in the womb or without sign of life on delivery:

• wrap in clean cloth
• bury

Baby 16+ weeks gestation age who has died in the womb or without sign of life on delivery:

• give the baby a name
• bathe or give Ghusl (ritual purification)*
• wrap in clean cloth or shroud*
• say funeral prayer (Dua)*
• bury

*depending on tradition or school of thought

Baby delivered alive but dies shortly afterwards – body only released with death certificate or coroners report:

• give the baby a name
• give Ghusl (ritual purification)
• wrap in shroud
• say funeral prayer (Dua)
• bury

Care should be taken to ensure the patient/family understand the concept of palliative care. Muslims receiving palliative care may wish to be looked after at home with support from family as opposed to in a hospice however, current lifestyle choices have seen a change in the extended family system and it should not routinely be assumed that family members will want to or are able to offer this care.

Whilst Muslims believe that God has predestined death, Islam also encourages Muslims to remain hopeful during these times and so the patient/family may not like to be continually reminded of their terminal illness (however it is important to remain realistic).

Muslims have a firm belief in the afterlife and so do not consider death to be the end of life but rather a transition into the next stage when they will return to their creator.

When death appears imminent, family may wish to sit close and recite/play a recording of the Quran (on their phones or Quran cube) to pray for the peaceful departure of the soul. If possible, the dying should be turned to face the direction of Qibla and the head turned to the right side. Those present may start to recite “the declaration of faith” in the hope that the dying will also hear and recite it.

When a Muslim dies the eyes are closed, arms and legs straightened (feet may be tied together) to keep the legs straight to stop them becoming rigid to enable washing and shrouding to take place easily. The lower jaw is bandaged to the head, so the mouth does not gape. Modesty and dignity should be maintained at all times, if it was a female who observed the Hijab, it is respectful to ensure that this is maintained. Wherever possible the body should be handled by same sex staff.

Family will usually want to take charge immediately following death and will contact Muslim funeral directors in the community who will transport the body to their facilities for the washing and shrouding to take place. Islam recommends burial as soon as practically possible and so there is usually a great urgency to speed up the process to release the body as soon as possible.

A post-mortem should not be carried out unless the family consent or is required by law. There are differing views around organ donation and a discussion with the family should take place to avoid assumptions being made either way.

Muslims are always buried not cremated and funeral prayers can take place in the mosque or at the cemetery. Attending another Muslims funeral is a faith obligation that is highly rewarded and so many Muslims will attend even if they are not acquainted with the person.

Visiting and spending time with the bereaved is a virtuous deed and so the family of the deceased will be visited by friends and family to offer their condolences during the first 3 days. They will provide practical support such as providing food as well as emotional support.

Muslims follow a halal diet and so only eat meat which has been killed using the halal method whilst a prayer is recited (Muslims do not eat pork or products derived from non-halal meat). Medications that contain these products are forbidden unless there is no alternative. Alcohol and recreational drugs are forbidden.

Muslims eat with their right hand as the left hand is used for personal hygiene.

Islam places great emphasis on family and on keeping ties of kinship and so for this reason there may be a large number of visitors that may wish to visit and pray for and with the patient in hospital. Should this however cause inconvenience to other patients or become difficult to manage visitors should be encouraged to set up a visiting rota or be directed to the hospital prayer/quiet room where they can pray/recite the Quran for the patient.

When visiting a Muslim home there may be an expectation that you remove your shoes. Some households may be comfortable in both genders sitting together whilst others may wish to sit in separate areas of the house.

The religion of Islam has always been an advocate for the disabled. The Holy Prophet (peace be upon him) stood for human rights, and abolished discrimination based on disability. The Prophet was instrumental in transforming the lives of the disabled people, by educating society regarding disabilities. He emphasised that disability itself cannot affect the individuals if they have strong faith.

• Muslim Council of Britain
• Introduction and Resource Guide to Islam