Background and beliefs
Islam is the religion of Muslims, an Abrahamic monotheistic faith believed to be revealed to Mu:hammad as the prophet of Allah (God in Arabic) by the arch-angel Gabriel. The two branches, Sunni and Shi'a, consider their scripture (the Qur'an) to be the final revelation of Allah. Islam acknowledges all previous prophets including Adam, Noah, Abraham, Moses and Jesus. The two branches Sunni and Shi'a differ in the way they express their religion. They agree on the five pillars of Islam; testimony (shahadah); prayer (salat); charity (zakat); fasting (sawm); and pilgrimage (Hajj). There are no major differences between the two branches in relation to advance care planning.
Believing that Allah is the ultimate judge with the absolute justice, it is believed that it is up to Allah on judgement day to forgive whomever He wishes or not”.
Muslims do accept absolute terminal prognosis. Whilst death is subject to the will of Allah, Allah gives life and death and he is the one who grants joy. It is important to focus on positive aspects and offer hope.
Disclosure of medical prognosis and language
Discussion around medical prognosis is acceptable in Islam (after diagnosis is confirmed thoroughly), as long as it is done with respect, dignity, care, sensitivity and compassion. The person should be granted time to reflect upon the information from the health care professionals.
In Islam, illness or any suffering that is undergone is a form of purification and leads to forgiveness and mercy from the Creator. The word 'death' is not taboo from a religious point of view. The word 'cancer' can culturally be taboo and should be used sensitively.
It is best to ask the person how much information they would like to know with regards to health prognosis. Religious leaders have suggested that for most Muslims, there may be some cultural differences in disclosure and the role family members play in the disclosure process. News should always be disclosed in a gentle and slow manner.
Who should be involved?
It is important to ask the individual who they would like to have involved in the advance care planning discussion. Generally selected family/next of kin would be involved with permission from the person involved in advance care planning. Depending on cultural background, there might be strong involvement of family, especially elders and male members.
Religious leaders have stated that a more active role in decision making may be played by males (either husbands, sons or family elders/community leaders) in consultation with the females concerned. Families that have settled in Australia longer or of european origin may preference family discussions.
It is always best to give the option of also involving an imam or other religious elder to assist with theological questions/dilemmas, to support the person in decision making.
Advice on having the ACP conversation
Open-ended questions are useful to gather information, understand rituals and cultural/religious beliefs of individuals and their needs. Religious leaders have provided guidance to ease into the conversation rather than starting abruptly. They have emphasised that respect, dignity, sensitivity and compassion are important.
Questions that may be asked:
Do you consider yourself religious?
Do you have an imam?
Have you ever thought about what your wishes might be should you not be able to make decisions anymore?
Is there any specific religious requirements you require, like a prayer room?
The level of religiosity may impact advance care planning conversations so it is important to be aware of whether the person is a strong believer or non-practicing.
Most traditionally, religious people of Islamic faith prefer same gender interactions (especially women) and might be uncomfortable with mixed gender. Depending on cultural background, it may be inappropriate to shake hands with a person of the opposite gender.
Rituals and practices
Muslims are encouraged to invite an imam or a knowledgeable Muslim to guide the religious rituals. This is intended to help relieve their suffering.
Religious leaders have emphasised that Turkish Cypriots don't traditionally invite an imam as it might be viewed as a negative sign.
Festivals and special dates
The main religious festivals in Islam are at the end of the month of fasting, Ramadan (Eid al-Fitr) on the first day of the tenth lunar month, and the end of Hajj, the pilgrimage to Mecca (Eid al-Adha / Bakri-Eid / the festival of sacrifice) on the tenth day of the twelfth lunar month. These do not have a fixed date and local names for these festivities may vary. For local festival dates it is best to check with the person or family. Generally festivals are times of joy, happiness and time spent with one's family. Local festivals might also be celebrated, such as for Shi'a the Ashura (the day AlHussain – grandson of Prophet Mu:hammad – was martyred) and the Nowruz (Persian/Iranian New Year) in Afghanistan and the Persian region.
Friday is a special day for all Muslims, it is considered the weekly 'Eid. A midday sermon takes place in every mosque. With regards to advance care planning conversations held on this day, Islam and Muslims have no issue where this is concerned. Only males are obliged to attend the Friday prayers.
"We’re encouraged to remember death every day." - Islamic Leader
"We have a huge variety of Muslims from extreme practicing to not extreme practicing and you need to take that into consideration." - Islamic Leader
"It’s just something to think about, death, it’s not inappropriate. In our religion we know death is inevitable and we’re all going to go down that path." - Islamic Leader
"At the end of the day our life, our health, is all in the hands of the Creator." - Islamic Leader