Growth hormone for slow grower, delayed menarche and legal obligation, precocious growth & sexual maturation,
genetic engineering, surgery for cosmetic reasons
The teaching of the prophet is that children should be ordered to pray at the age of 7 and punished for missing
prayer at the age of 10. Consideration may be made in these ages depending on whether the children are fast-growers or are
Children who are precocious growers need more food.
Children especially females who are precocious growers should cover their awrat and observe the etiquettes of adult
hijab earlier than normal because of earlier sexual maturation. Care should be taken not to marry off children growing quickly
because their cognitive and emotional development may lag behind their physical growth.
Children who grow rapidly could be allowed to undertake some transactions if their cognitive skills are judged
to be like those of adults.
Rapidly growing children may be tried and they may give evidence as adults. Slower-growing children may not be
treated as adults even if they reach the age of 15 years.
14.4.4 ADOLESCENCE AND YOUTH
A. ADOLESCENT GROWTH SPURT
Early and delayed puberty
C. BEHAVIORAL PROBLEMS
Adolescents acquire abstract thinking but they have little wisdom and experience with the result that they make
many mistakes. They are confused about their identity, are they children or are they adults? They resent parental control
yet they cannot live independently on their own. They are prone to addictions.
Causes of violence
Effects of violence
Prevention of violence
E. SEXUAL PROBLEMS
The adolescents are biologically mature and feel that they can have sex. They however do not have the emotional
and cognitive maturity needed for healthy sexual relations. They are not able to control their sexual instinct. They are influenced
by the media and the popular culture that teach sexual permissibility. The need for professional and career preparation results
in delay of marriage.
14.4.5 OLD AGE
THE CONCEPT OF HOEMOSTENOSIS:
Homeostasis is the state in which the body systems are in perfect harmony and balance. It is a dynamic concept
rather than a static one. There are always disturbances to the homeostatic order but the body has corrective mechanisms that
return it to the previous state almost instantly. This corrective ability declines gradually with age. The term homeostenosis
is used to describe the declining ability to maintain the homeostatic order as compensatory mechanisms become impaired.
CHANGES IN AGING.
Aging in accompanied by physical, psychological and social changes as well as challenges (3). There is no point
in time when development ceases and degeneration starts. The two processes are contemporaneous. In advanced age degeneration
becomes predominant. Normal aging is a gradual process of physical decline and degeneration. It affects the structure and
function of all organs. Old age because of its multiple incapacities is sometimes not a pleasant period. The Prophet (PBUH)
prayed not to live to advanced age al ta'awudh min ardhal al 'umr (16:70, 22:5,
Mukhtasar Sahih al Bukhari # 1750, KS 79). Some people with physical aging may
psychologically be young. The Prophet mentioned that some people stay young in 2 aspects: love of the world and long hopes
(Mukhtasar Sahih al Bukhari # 2096). Some of those who are physically young may
feel and behave like elderly people. There are social aspects in aging. The elderly lose their autonomy and are dependent
physically and emotionally.
Physical impairments: Old age is a period of limited work because of physical impairments (28:23). This is weakness
after the period of youthful strength and energy (30:54, 40:67). Physical decline starts from the age of 30. There is functional
decline in the performance of all organs of the body. The difference between the normal physiology of ageing and pathology
is very fine
Physiological and biochemical impairments: Biochemical homeostasis is impaired in the elderly. Control of serum
glucose is impaired. Serum sodium concentration rises and urine osmolality decline due to impaired osmo-regulation. Interpretation
of results of chemical pathology must take these changes into consideration.
QUALITY OF LIFE IN OLD AGE:
The issue of quality is relevant in discussions of longevity. As people age, the quality of their life deteriorates.
With increasing longevity new physical problems will appear that lower the quality of life.It is possible that with better understanding of the aging process, procedures will be available to maintain or even
improve quality of life in the elderly.. Epidemiological studies have shown that physical activity even in moderation reduces
morbidity, protects against neoplasia and aging. Prompt diagnosis and treatment of disease has a positive impact on the quality
of life. It is wrong to assume that such disease is normal and does not need treatment.
RIGHTS OF THE ELDERLY, HAQQ AL AL KABIR:
The elderly are dependent but very important members of society whose rights must be respected. It is a grave sin
to neglect these rights (KS 402). They have a right to be treated with extra care because of their dependent status. Children
are enjoined to treat their parents well in their old age, birr al waalidayn (KS
Rights and obligations: The legal rights and obligations of the elderly may be restricted because of their intellectual
impairment. The elderly experience confusional states that cloud their ability to make correct decisions about their person
and their wealth. However each case should be examined on its own merits. Some of the elderly remain intellectually competent
until the last.
ABUSE/MISTREATMENT OF THE ELDERLY:
materialistic societies do not respect elders because it is felt that they are unproductive and are a burden on
society. This is a major transgression (dhulm). They were productive at a time and the new generation was at that time dependent
ISLAMIC GUIDANCE ON THE ELDERLY:
Rights of the elderly: irfan haqq al kabir (KS 68). The elderly have a legal right of physical support by their
offspring (KS 576)
Balance: Geriatric medicine is a rapidly growing discipline due to the increasing longevity. A balance must be
established between what is considered the normal physiology of aging (requiring no intervention) and pathology in old age
(requiring intervention). The physician must make a judgment on whether diagnostic and therapeutic measures planned will not
make the prognosis worse. Care must be taken in prescriptions. The elderly are on several medications because of their multiple
pathologies and drug interactions are common. Adverse drug reactions may be more severe in the elderly. The elderly have altered
pharmacokinetics (absorption, metabolism, excretion).
Care for the elderly: Routine screening of the elderly is very useful to discover problems early and deal with
them. Rehabilitation is a multi-disciplinary effort involving physicians, nurses, physiotherapists, social workers, and psychologists.
Members of the family must be an integral part of the team that cares for the elderly. There is a debate between home care
vs institutionalisation. Home care would be the best because it gives the elderly more feeling of dignity and personal worth.
MUSCULO-SKELETAL MOTOR DYSFUNCTION
The Qur'an describes old age as the age of weak bones (19:4). The elderly have various degrees of immobility due
to muscular, joint and bone degeneration. Their limited mobility is also associated with instability. The elderly are prone
to falling and other accidents because of blurred vision and loss of balance (poor propioception, vestibular lesions).
Acts of physical worship (Ibadat): The elderly, like the sick, are exempted from fulfilling all the acts and conditions
of the physical acts of ibadat, salat, saum, and hajj. The elderly can pray sitting down (KS 310). If the sitting down posture is difficult they can pray lying
on the side (KS 310). Abdullah Ibn Omar did not complete some acts of prayer because of a disability in his foot (KS 367)
In sickness permission is given to omit circumbulation of the kaaba (KS 352). Circumbulation can be performed on
another persons's back or a vehicle like a wheel chair. The prophet did circumbulate on an animal (KS 352). It is offensive,
makruh, to circumbulate on an animal for no valid excuse.
Jihad: The elderly are exempted from the obligation of jihad because of their physical impairment. If the elderly
have only one son to look after them, they are entitled to deny him permission to go to jihad
C. NEUROLOGICAL DYSFUNCTION
Autonomic dyfunction: Functional impairments in many organs occur due to imbalances in the autonomic nervous system.
The elderly may suffer from urinary or fecal incontinence. They may also suffer from urinary or fecal retention. Postural
hypotension occurs limiting their ability to stand up for prolonged periods or to walk. Impaired thermoregulation makes them
very vulnerable to sudden changes in environmental temperature.
Taharat: Urinary incontinence and fecal incontinence may make it difficult for the elderly to maintain a state
of ritual purity, wudhu, for long enough to complete the prayers. They are allowed to wear a diaper or urinary retainer, make
wudhu, and pray immediately. They do not have to repeat the prayer because of any incontinence that they may experience.
D. PSYCHO-SOCIAL DYSFUNCTION
The sleep patterns are altered with insomnia being common. The elderly cannot sleep in the early hours of the morning
probably due to depression.
Description of impairments: The elderly may suffer from various types and degrees of intellectual impairment. Alzheimer's
disease is the commonest cause of intellectual decline. This manifests as cognitive impairment, memory loss, and reduced or
distorted environmental sensory input. The cognitive impairment is due to decline of speed of information processing. This
reduces fluid intelligence, the ability to solve new problems. Memory loss is more pronounced for recent than for long-term
memory. The experience and accumulated knowledge of the elderly sometimes more than compensates for the cognitive decline.
Many elderly are functioning very well intellectually well into their 90s.
Ibadat:The elderly may not be able to fulfil all the conditions of prayer on account of their mental impairments.
Munakahaat: In extremes of age the pronouncements of the elderly on marriage contracts and divorce may be due to
Muamalaat: restriction on the elderly in transactions
Jinayaat: reliability of evidence of the elderly. Criminal liability for actions.
Psycho-social: Old age is a period of psychological stress because of the dependency status it engenders. Loss
of independence is felt keenly by previously active and self-directed individuals. There is loss of self-esteem. Socially
the elders suffer from the stress of reduced social interaction and loss of income. In many communities the elderly live in
poverty. On the other hand there are a few elderly who enjoy their last years of life. These are generally in good health
or have accepted their physical impairments. They usually feel they have accomplished their mission in life. In a stage of
actualisation, they have no more ambitions or challenges to face and there do not feel the frustrations and stresses of the
Sexual function: Old age is looked at for both males and females as a period of declining reproductive ability
11:72). Their sexual function is reduced due to anatomical changes or autonomic dysfunction. Reduction of sexual function
may not be accompanied by reduction of sexual desire. In old age males may suffer from impotence due to erectile difficulties.
Vaginitis in females due to deficient estrogens making sexual intercourse painful.
Eye accommodation is impaired leading to presbyopia. This is due to decreasing elasticity of the lens capsule and
the thickening of the lens. Decline in the ears results in loss of high frequency hearing (presbyacusis). Bone loss starts
from the age of 35 years and osteoporosis increases with age.
Nutrition: Elderly malnutrition is common. The nutritional intake is lower because of poverty, inability to prepare
and consume food or just loss of appetite. Nutritional deficiencies are also common due to unbalanced diets. An elderly person
is exempted from fasting if it will hurt good health (KS 334).
PREGNANCY and DELIVERY
Rulings on pre-natal diagnosis
Naming of newborns with indeterminate gender
Circumcision of newborns with bleeding disorders
Neo-natal screening for genetic and metabolic disorders
Rulings on milk banks
Formula for computation of the level of nafaqat
Rulings on child abuse: physical, psychological, and sexual
Rulings on obligation of immunization
Rulings on use of hormones for slow growers
Legal obligations for pubertal signs delayed beyond the age of 15
Rulings on legal obligations for children with precocious growth
Rulings on minimum age at marriage for children growing precociously
Ruling on transactions by children below the age of majority
Court trial of quick-growing children as adults
1. Rulings on sex education for adolescents
Abuse of the elderly
Ruling on offspring to provide physical support for the parents
Salat, hajj, and jihad obligations for the elderly
Wudhu and salat with fecal and urinary incontinence