Kasih Interfaith Dialogue 2021 - Chaplain Sakinah Alhabshi

1. CONFRONTING LIFE & DEATH IN
PANDEMIC TIMES:
AN ISLAMIC PERSPECTIVE
Ch. Sakinah Alhabshi
Ziyara Spiritual Care
Kasih Hospice Foundation Interfaith Dialogue
3 December 2021

2. Dialogue prompts from Kasih
• What have you experienced during the Pandemic in your place of
worship/practice?
• Death Anxiety & Existential Crisis – how does your faith define it, and
how does your faith deal with it?
• How should people face great uncertainty, loss of loved ones, and end
of life?

3. Content
• Concepts of life, death, and afterlife
• Perspectives on illness and healing
• Assessing priorities in a time of crisis based on the Objectives (Maqasid) of the
Shariah
• Key principles in Islamic ethics
• Considerations for serious illness and the end of life
• Case Review of a COVID-19 patient
• Guidance from Prophet Muhammad’s (pbuh) dying process and adapting to
pandemic limitations
• Personal reflections / lessons

4. Existence of Life – Death – Afterlife
• The essence of our existence is as spiritual beings, souls, in a temporary body. We have existed before this present
"world", and will continue to exist beyond this world.
• Themes of Life: a test, temporary, preparation ground for spiritual refinement, humankind as a
caretaker/steward/vicegerent (khalifah) on Earth
• "And We will surely test you with some fear, and hunger, and a loss of wealth, and lives and crops, but give good tidings to
the patient." (The Qur'an, Al-Baqarah 2:155)
• God does not burden anyone beyond their capacity. (The Qur’an, Al-Baqarah 2:286)
• God says that, “I am as you think of me.” (Sahih Bukhari)
• "... Allah intends for you ease and does not intend for you hardship… “. (The Qur'an, Al-Baqarah 2:185)
• “And when My servants ask you, [O Muhammad], concerning Me—indeed I am near. I respond to the invocation of the
supplicant when they call upon Me.” (The Qur'an, Al-Baqarah 2:186)
• God is closer to us then our own jugular vein. (The Qur’an, Al-Baqarah 50:16)
• Death is at an appointed time, cannot be hastened or delayed. (The Qur’an, Al-A’raf 7:34, Al-Munafiqun 63:11)

5. Perspectives on Illness and Healing
• The body is a trust (amanah) - we are entrusted with its care - do no harm - physical, emotional, mental, spiritual.
• Illness, struggles, suffering: growth, elevation of status, refinement of spirituality, removal of sins in this world,
opportunity for compassion
• “Verily, with every hardship comes ease! verily, with every hardship comes ease!” (The Qur’an, As-Sharh, 94: 5-6)
• “And when I am ill, it is God who cures me.” (The Qur’an, As-Shu’ara, 26:80)
• “Allah did not send down any disease but that He also sent its cure.”
• "Every Muslim has five rights upon another: to return the greetings, to visit the sick, to accompany funeral processions, to
accept an invitation, to respond to the sneeze.”
• Oh Allah! The Sustainer of All Creation! Remove the illness, cure the disease. You are the One who cures. There is no cure
except Your cure. Grant us a Cure that leaves no illness. Ameen.

6. Assessing the priorities in a time of crisis based on the
Objectives (Maqasid) of the Shariah

7. Key Principles in Islamic ethics
• Preservation of life
• Non-maleficence, ease of hardship/harm to self/others (la dharar)
• Beneficence (ihsan)
• Informed consent (idzin), no obligation
• Public interest (maslaha)
• Prioritize what is apparent/known

8. Considerations for Serious Illness or End of Life:
Assess and Ask: general vs specific fatwa may differ
• Cessation of life-extending measures:
Permissible in case of total irreversible loss of brain function after thorough / diligent investigation and consensus of
medical professionals. (As with most religious rulings, there are a range of scholarly opinions, so navigate with care, and
focus on the loved one's emotional-spiritual pain around the decision/discussion.)
• Obligated vs non-obligated treatments:
Elements of timeline, immediacy, acuity, luxury vs need vs necessity spectrum
• Language matters:
"We are withdrawing care / withdrawing life-support on your mother" vs "We are stopping artificial breathing / artificial
nutrition not to prolong suffering/harm and allowing natural process of dying".
• Fear and caution around "ending life" - "... whoever kills an innocent life, it is as if they have killed all of humanity, and
whoever saves a life, it is as if they have saved all of humanity..." (Qur'an 5:32)
• Pain medication / opioids: may reduce mental alertness, increase drowsiness, depress breathing.
- While most pts will likely choose to focus on comfort and reduce pain, there are some pts / family who may choose to try
maintain mental alertness towards EOL.
• Organ donation: "... whoever kills an innocent life, it is as if they have killed all of humanity, and whoever saves a life, it is as
if they have saved all of humanity..." (Qur'an 5:32) - encouraged with conditions - body treated with dignity, not desecrated,
returned clean for ritual bathing and Islamic funeral / burial.
• Bedside care / support:
- Recite the "Testimony of Faith" (Shahadah) - Laa ilaaha illallaah (there is no god but God)
- Supplication / prayers / reciting or playing audio of Qur'an (refer to earlier slide), specifically chapter/ surah Yasin

9. Case Review
Male, 60s - presented with fever, shortness of breath, bilateral pneumonia, tachycardia.
Diagnosis: COVID-19 and sepsis of unknown origin.
Prognosis: Life expectancy, from days to 1-2 week.
Anticipated cause of death: Respiratory failure (ARDS) or multi-organ failure.
Spiritual considerations: Pt identified as a practicing Muslim. Pt and family understood the flexibility and range of scholarly
opinions on navigating the end of life and pt’s terminal prognosis – pt’s family chose to not transition to “comfort care”.
Considerations:
- Pandemic restricted visitation policy: defining end-of-life, comfort care, terminal. Limit only one end-of-life visit, but when?
- pt autonomy
- ethics of prioritization of limited resources
- pt & family wish of a “good ending” (husnulkhaatimah)
Chaplain intervention:
- facilitate discussion on clarifying understanding and expectations of emotional & spiritual needs
including processing of grief, guilt, feelings of manipulation/mistrust
- advocate for pt / family autonomy within hospital guidelines
- provide compassionate care / support, may include prayer: to pt and family
Outcome:
- pt autonomy respected: pt did not transition to comfort care
- family was allowed to visit per “end of life” policy: 15 mins x 2 family members
- family agreed this was a one-time exception, regardless if pt lived another 1-2 weeks

10. Guidance from Prophet Muhammad’s Dying Process
and adapting to pandemic limitations
1. Knowledge and acknowledgement of the nearness of death
– communicated with his family & publicly
2. Rituals, choices, and practices
– final Hajj pilgrimage, final sermon, leaving a legacy
3. The moment of death
- location, loved ones, seeking forgiveness
4. Postmortem care
– bathing (ghusl), shrouding (kafan), prayer and burial (solat jenazah)

11. The Evolution of
Community Rituals
through the
global pandemic

12. "Chaplain, what are 3 things my team should have in mind
when caring for a Muslim patient?" – Stanford ICU Attending
HYGIENE (Taharah)
physical, religious, spiritual purification
DIGNITY (Karamah)
honour, agency/autonomy, modesty
COMPASSION (Rahmah)
kindness, family involvement, Merciful Loving God
(ACTION +) ACCEPTANCE (Tawakal)
due diligence effort alongside acceptance of the Wisdom
& Will of God (Qadr)

13. My 3-Cs: What being a hospital chaplain through
the pandemic has taught me about living
• COMFORT in the uncertainty & unknown
– finding peace in the wisdom of the One who knows (God as the Ultimate
Seer, Knower, Designer), a balance of action & acceptance
• COMMUNICATION & COMMUNITY
– communicate early and clearly with loved ones, and invest in relationships
and community
• COURAGE & COMPASSION
– live and love fearlessly, authentically, with no regrets

14. Don't get lost in the details
Relationship over being Right
Curiosity + Compassion over Correctness
In a nutshell, when caring for a Muslim (or any)
patient…

15. THANK YOU
chaplainsakinah@gmail.com

16. George Fitchett’s 7x7 Model

17. Communal Rituals for
Hospital Staff