Dr Fauziah - PowerPoint Presentation

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Dr Fauziah Abdul KarrimMBBS ( Malaya, MAFP,Fracgp( Aust.)Family Med SpecialistTapah Health CentrePerak, Malaysia

Islamic Medical Principles, Ethics and Care of the Muslim PatientSlide2
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DisclaimerMy speech/lecture today is on my personal accountMalaysian Moslem DoctorNot representing my employer/country of originThe opinions presented are my personal understanding Adapted from IMANA, Islamic Medical Association of North AmericaHealthcare Provider Handbook, QueenslandSlide4

I am…..Dr Fauziah Abdul KarrimFirst degree : MBBS ( Univ. Malaya) 1993Post-grad: MAFP/ FRACGP 2011Work for Ministry of Health, Malaysia Tapah Health Center, Perak state, MalaysiaMarried with 3 childrenSlide5

Islamconsiders access to health care as a fundamental right of the individualSlide6

Principles of Islamic MedicineEmphasis on the sanctity of human life which derives from al-Qur‟an: “ Whosoever saves a human life, saves the life of the whole mankind” Surah Al-Maidah 5:32Slide7

Principles of Islamic Medicine2. The second main principle is the emphasis on seeking a cure. “There is no disease that God has created, except that He also has created its treatment”“Seek treatment, for God the Exalted did not create a disease for which He did not create a treatment, except senility”~sayings ( Hadith)

of Prophet Muhammad (PBUH): Slide8

Muslims All Over the World Muslims constitute the world's second largest religious group. According to a 2010 study and released January 2011, Islam has 1.6 billion adherents, making up over 22% of the world population.Slide9

Muslims All Over the World Slide10

A Muslim's Islamic beliefs maybe…..Sunni Muslims include 84%–90% of all MuslimsShi`ite Muslims comprise 10%–16% Sufis are Islamic mysticsBaha'is and Ahmadiyyas are 19th-century offshoots of Shi`ite and Sunni Islam, respectively.Slide11

Islamic SectsSlide12
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Rules of Islamic medical ethics1) Necessity overrides prohibition ~ if there are certain items which are Islamically prohibited, under dire necessity they can become permissible. 2) Harm has to be removed at every cost possible. Accept the lesser of the two harms if both can not be avoided.

3) Public interest overrides the individual interest. Slide15

Care of the Muslim PatientSlide16

Guidelines for caring of Muslim patientsMuslim patients should be identified (MUSLIM/ Islam) in the registration information to prevent any mistakes happening unintentionally

violating dietary rules or privacy

Intrepreter ServicesSlide17

Dietary needsMuslims are required to follow a halal diet. Halal means lawful , that which is permitted in Islam.Not permitted: pork and any other pork product (e.g. bacon, ham, gelatine) : meat and derivatives not killed ritually AlcoholSlide18

Dietary needs Permitted: Meat and derivatives that have been killed ritually (halal meat) : fish; eggs; vegetarian foods.

Allow to bring food from home, as long as it is meeting the patient’s dietary restrictions. Slide19

Dietary needsUtensils which have been used in the preparation of pork products or non-halal dishes should not be used to prepare food for a Muslim patient.Slide20

Dietary needsMuslims are required to wash their hands before and after meals. Bed-bound patients may require portable hand washing facilities. Muslims will prefer to use their right hand for eating and drinking. Slide21

Dietary needsIf health care providers are required to feed a Muslim patient, the use of the right hand is preferred if they are required to touch the food ~ but either hand is acceptable if utensils are used.Slide22

Administration of medicinesSome medicines may not be suitable for Muslim patients Because they contain alcohol or are of porcine Nonhalal origin.Slide23

FastingFasting is an integral part of Islam and is seen as a means of purifying the body and the soul. Fasting in the month of Ramadhan is compulsory

for all healthy, adult Muslims Islam also prescribes other days which Muslims may choose to observe a voluntary fast.Ramadhan

: Muslims cannot eat

or drink

anything, including water,

: from

dawn

unti

till

dusk

.

It is a practice for Muslims to consume a pre-dawn meal

before fasting during the day

.Slide24

FastingEach individual is responsible for deciding whether tofast. Pregnant, breastfeeding or menstruating women,people who are experiencing a temporary illness andtravellers are exempted from fasting……..but must make up for the fast at a later date.Slide25

FastingA fasting person CAN take the following medications/treatments without breaking their fast:injections and blood testsmedications absorbed through the skingargling (as long as no liquid is swallowed)

ear and nose dropssuppositories and pessaries inhaled medications.Slide26

HygieneIslam places great emphasis on hygiene, in both physical and spiritual terms. Muslims must maintain a level of ritual

cleanliness Slide27

HygieneMuslims must also follow a number of other hygiene-related rules including: washing with water after urination or defecation the removal of armpit and pubic hair

keeping nostrils clean keeping fingernails trimmed and clean.Slide28

HygieneToilets should be equipped with a small water container/tap with rubber hose to assist with washingA beaker of water should be made available to a bedbound Muslim patient whenever they use a bed pan.Slide29

HygieneIf washing with water or having a bath is not medicallyadvisable or possible, an alternative method of purification, called Tayammum, can be performed. ~ the patient strikes the palms of both hands on any unbaked earthly matter (e.g. stone or sand) and symbolically washes in two simple steps.Slide30

PrayersMuslims are required to pray 5 times a dayExcept : cognitively incapacitated :Women with post-natal discharge : during menstruation Prayers are said while facing Mecca- Need to identify directionSlide31

PrayersPrayers are usually performed on a prayer matinclude various movements such as bowing,prostrating and sitting. It is not necessary for an ill patient to make all of the usual prayer movements.Therefore, prayers can be performed in bed or whileseated, if the patient cannot standSlide32

PrayersThose who are not physically or medically restrictedto bed could be provided with a space to pray in asecluded, clean and quiet place. A hospital chapel may be used provided there are no religious icons present.Slide33

Mental health and/or cognitivedysfunctionMuslims with cognitive dysfunction, a severe mental illness or an intellectual disability, is absolved from all the obligatory requirements in Islam. They are not requiredto say prayers, fast or perform their pilgrimage

The patient’s immediate or extended family is usually responsible for the patient.Slide34

Modesty and Medical Examinations Muslim men and women are usually shy about being naked and very reluctant to expose their bodies to a stranger. Some Muslim patients may not wish to have physical contact with, or expose their bodies to, the opposite sex. ~ affect health care as Muslim patients may be reluctant to expose their bodies for examination or to expose areas not directly affectedSome female patients may prefer a family member to be present

during an examination.Slide35

Modesty and Medical ExaminationsModesty is very important in IslamSlide36

For Muslim men, this usually means keeping the areabetween the navel and the knees covered For Muslim women, only the face, hands and feet are usually, left exposed. This standard may not be followed by all Muslims. Some interpret the requirement for modesty to mean dressing modestly relative to the norms of theSlide37

Medical ExaminationsMuslims (both men and women) prefer to be examined by a health care provider of their own gender ~ if possible, this should be arranged.If not possible possible, health care providers should show sensitivity and understanding for modesty concerns. Sexual or reproductive health matters ~ Women may be especially reluctant to be examined by a male health care provider forSlide38

Modesty and PrivacyMuslim women patients need a special gown to cover the whole body -to avoid unnecessary exposure during physical examination -examinations done over the gownSlide39

Medical ExaminationsAlways examine a female patient in the presence of another female (chaperon) or a female relative (except in medical emergency) Especially for labor and delivery, if the patient’s

obstetrician is unavailable and upon her request, provide a female healthcare provider, if feasible. Her husband is encouraged to be present during the deliverySlide40

Tests & TreatmentExplain test procedures and treatment language problem Muslim women can give consent for any treatment or

procedureSlide41

Maternity servicesAs soon as a child is born, a Muslim father may wish to recite a prayer call into the baby’s right ear followed by a second prayer call into the left ear. This will not take more than five minutes and, unless the newborn requires immediate medical attention, health careproviders should allow this to take place.Sometimes.. shortly after birth , a chewed/softened date/something sweet

is placed on the palate of the infantSlide42

8.Maternity services Muslims are required to bury the placenta (which is part of the human body and therefore sacred) after birth. If there are clinical reasons for not providing the placenta to the parents, this should be explained.A foetus after the age of 120 days is regarded as a viable baby. If a miscarriage, an intra-uterine death after 120 days, or stillbirth occurs, Muslim parents may wish to bury the baby.

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CircumcisionCircumcision is performed on all male children The timing of this varies but it must be done before puberty.Slide44

ContraceptionMuslims are permitted to use temporary contraceptive methods under certain conditions.However, permanent contraceptive methods such asvasectomy and tubal ligation are only allowed where the woman’s health is at risk from additional pregnanciesSlide45
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AbortionUnder Islam, a foetus is considered alive after 120 days gestation. Abortion is not permitted after this time unless the pregnancy constitutes a serious threat to the life of the mother.Abortion is permitted prior to 120 days under certain circumstances. For example, in the case of

: - foetal abnormalities, -when there is a serious health risk for the mother - when

pregnancy has occurred as a result of rape.

Abortion is not permitted on the basis of family planningSlide47

Foster care and adoptionFoster care and adoption, especially of orphans, isencouraged in Islam. However, under Islam, the child must always retain the family name of the biologicalSlide48

BreastfeedingIslam requires mothers to breastfeed their children for two years.If a woman breastfeeds a child aged two years or less, the relationship between the woman and that child is considered to be like mother and child. The woman’s biological children are also considered brother or sister to the breastfed child. However, the relationship between the child and its biological mother is not changed.Because of this, Muslim women may be reluctant to donate breast milk or to have their child fed from a milk bank.Slide49

Home visits• If a home visit is required, it is advisable for health care providers to be modestly dressed to avoidembarrassment.• As Muslims often pray on carpeted areas, health careproviders should ask if shoes should be removedbefore entering a carpeted area. Slide50

Visiting arrangementsVisiting the sick is an important part of a Muslim’s duties and is required by Islam.A communal obligation and a virtue to visit the sick.Large numbers of visitors, including those from outside their immediate family.

Please discuss with the patient & their family, the possibility of large numbers of visitors and the impact this may have on rest or care requirements, or other patients.Slide51

Care of older persons• Islam emphasises respect for all older people, with children having a special responsibility towards theirparents.Slide52

Care of Older PersonIt is considered a communal obligation and a virtueto care for the elderly, even for extended familymembers.• Health care providers should take this into accountwhen developing care plansSlide53

End of life issuesThe preservation of life is considered paramount inIslam. However, Islam recognises that death is aninevitable part of human existenceSlide54

End of Life IssuesIslam does not require treatment to be provided if itmerely prolongs the final stages of a terminal illness.Health care providers should discuss advance careplanning and end of life issues with patients and their families.Slide55

Death occurs when : The physician has determined that after a standard examination A person’s cardiopulmonary function has come to a permanent stop. A specialist physician (or physicians) has determined that after standard examination, the function of the brain, including the brain stem, has come to a permanent stopSlide56

Mechanical Life Support in Terminally Ill / Persistent Vegetative State Muslims does not believe in prolonging the misery of dying patients who are terminally ill or in a persistent vegetative state (PVS- more than 2 months)When death becomes inevitable, as determined by a team of physicians, including critical care physicians the patient should be allowed to die without unnecessary procedures Slide57

Euthanasia Muslims opposed to euthanasia and assisted suicide in terminally ill patients ~by healthcare providers or by patient’s rela-tives. Suicide and euthanasia are prohibited in IslamSlide58

As Death nears ….Family : Sit near the bed of the patient Read some verses from the Qur’an Pray for the peaceful departure of the soul. If the patient is in a state of consciousness, they may wish to recite the Shahadah (declaration of faith) and pass away while reciting these words.If the patient’s family is not present, health care providers should contact the

local Islamic CouncilSlide59

Deceased patients The whole body and face of a deceased person should be covered by a sheet.Muslims believe that the body ‘feels’ any pressure that is applied after death. Muslims also believe that the soul remains close to the body until burial. If possible, the body should only be handled by a person of the same sex.Slide60

Deceased patients If possible, the body should not be washed. Relatives or people from the Muslim community will wishto make arrangements for the washing, shrouding and burial according to Islamic requirements. If no relatives are available, health care providers can contact the local Islamic Council/ Malaysia embassy Slide61

Deceased patientsMuslim burials are performed as soon as possible after death, sometimes on the same day.Slide62

AutopsyIslam forbids the disfigurement of dead bodies and,on these grounds, some Muslims may not wish for anautopsy to be performed.Slide63

AutopsyHowever, it is permitted if medically indicated or required by law. Muslim burials are usually performed as soon as possible after death, sometimes on the same day, andautopsy may affect this practice.Health care providers should consult with the family of a deceased Muslim before proceeding with autopsySlide64

Organ DonationOrgan donation is permitted with some guidelines and is encouraged. Islam instructs all Muslims to save life. Transplantation of organs, both giving and receiving organs ~is allowed for the purpose of saving life. Slide65

Guidelines for Organ Donation and TransplantationThe medical need is definedThe possible benefit to the patient has to be defined Consent from the donor as well as the recipient must be obtained. There should be no sale of organs by any party. Slide66

Organ Donation and TransplantationNo financial incentive to the donor or his relatives for giving his organs, but a voluntary gift may be permitted There should be no cost to the family of the donor for removing the organ Any permanent harm to the donor must be avoided Transplants of sex organs (testicles or ovaries) which would violate the sanctity of marriage is forbiddenSlide67

Blood DonationBlood Transfusion is permissible. Giving blood to or receiving blood from people of other faiths is permissible. Slide68

Assisted reproductive technologiesHowever, there are some techniques and practices thatare not permitted:• the use of donor sperm is strictly prohibited• the use of sperm that has been cryopreserved isprohibited if the father has died• surrogacy is not permitted.Slide69

Assisted Reproductive Technologies and SurrogacyThe use of assisted reproductive technologies is generally permitted in Islam.Islam believe in the sanctity of marriage and the importance of preserving lineage The Qur’an says: It is He who has created man from water: then has He established relationships of lineage and marriage :

for thy Lord has power (over all things)Slide70

Based on these Qur‟anic guidelines, All forms of assisted reproductive technologies (ART) are permissible between husband and wife during the span of their marriage using the husband’s sperm and the wife’s ovaries and uterus. No third party involvement is allowed. We believe in the sanctity of marriage and that the death of the husband terminates the marriage contract on earth, thus frozen sperm from a deceased husband can not be used to impregnate his widow

. 2. Sperm, ova and embryo donation are not permitted. 3. Additional embryos produced by IVF between husband and wife can be discarded or given for genetic research, if not to be used by the same couple for a future attempt. Slide71

Thank youArigato Gozaimasu