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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0103-LIFE, (HAYAT)

Lecture for 1st year students on 16th March 2001 by Professor Omar Hasan Kasule Sr.

OUTLINE

1.0 DEFINITION OF LIFE

A. Biological, Chemical, Physical, And Spiritual Life

B. Levels Of Life

C. Start Of Life

D. Stages Of Life

E. Ownership Of Life

 

2.0 THE QUR'ANIC CONCEPTS OF LIFE

A. Life Is From Allah

B. Physical Basis Of Life

C. Physical Processes Of Life

D. Spiritual Basis Of Life

E. Dynamism Of Life

 

3.0 NATURE OF LIFE

A. Continuum Of Life

B. Life Span

C. Life As A Test

D. Criteria Of Life

E. Success And Failure

 

4.0 QUALITY OF LIFE

A. Definition Of Quality Of Life

B. Quality Of Life And Biotechnology

C. Traditional Measures Of Quality Of Life

D. New Measures Of Quality Of Life

E. Toward An Islamic Qol Index

 

5.0 VALUE OF LIFE

A. Life As A Gift

B. The Right To Life

C. Sanctity Of Life

D. Material Worth Of Life

E. Moral Worth Of Life

 

1.0 DEFINITION OF LIFE

A. BIOLOGICAL, CHEMICAL, PHYSICAL, and SPIRITUAL LIFE

 

CONCEPTS

Life is a complex phenomenon with biological, chemical, and spiritual components. Human life is a unique combination of biology, chemistry, physics, chemistry, matter, energy, and spirit. All of us agree when we see a living thing that it is alive when it is breathing, moving, and eating. There are several situations that are borderline and require a clear definition. Life can not be defined simply as the opposite of death. It must be definable on its own. Life can be defined biologically, chemically, legally, and spiritually. It is not surprising that there is no one single definition of life; life is complex and its definition must be complex. Both life and death are earthly events (7:25). Life exists in the hereafter; but death does not. Humans share biological life with plants and animals. They share spiritual life with angels. No other creation of Allah resembles humans in having physical and spiritual life at the same time.

 

BIOLOGICAL LIFE

The biological definition of life is not straightforward. Phenomena of death occur on a continuous basis. On a daily basis cells die and are replaced. Some organs can die while the rest of the organism is still living. Even in situations in which the whole organism is considered dead by ordinary criteria, some parts of it could maintain manifestations of life for a long time. Organs of dead persons stay alive for a long time in transplantees. Human cells have been maintained in long-term culture for decades. There are several biological phenomena that are synonymous with life: reproduction, growth and development, innate purpose action, and change. One of the signs of life is dynamic change and cyclicity. Growth and development are followed by degeneration and death. The elements that make up the human body are recycled. The degenerate cells and tissues whether in life or after death break up and become part of the earth. They are later incorporated into new cells as food, water or air that is breathed in.

 

CHEMICAL LIFE

Life could also be defined in chemical terms as a series of chemical reactions in metabolism.  These reactions are not much different from inorganic reactions that occur between elements. The reactions associated with life are self-initiated, purposive and coordinated with one another. Viruses make a very fine line between life and death. They also make a fine distinction between the organic and the inorganic. They have some properties of what are normally living things. They however cannot carry out the whole range of metabolic processes associated with life and must be obligate parasites. Viruses can not on their own manufacture all the proteins they need. Viruses also have properties of non-living things like crystallization.

 

BIO-PHYSICAL LIFE

Living things have the ability of transforming one form of energy into another. This energy tranduction occurs among light, heat, chemical, and electric energy. There could be other forms of energy related to life that we do not yet know.

SPIRITUAL LIFE

Life can also be defined in spiritual terms. Life without any spirituality is not a full human life but is a life of animals. Spiritual death could occur without biological death. Spiritual diseases could transform a human to be at the level of animals or even worse (7:179).

 

B. LEVELS OF LIFE

Life can be described at various levels: ruh, the whole living organism, the organ,  the tissue, the cell, sub-cellular structures,  the molecule, and the atom. The highest level is that of the ruh about which we know very little (17:85). We however know that the ruh is the essence of human life and that it is eternal. Humans share with animals the biological nature of life but they have the ruh in addition which makes them special. The Qur'an mentions insertion of the ruh in case of Isa (PBUH) (p 515 4:171, 31:91, 66:12). The ruh is inserted in the fetus during intra-uterine life to give it human life, nafakh al ruh (p 516  15:29, 32:9, 38:72, p 1249 15:29, 21:91, 32:9, 38:72, 66:12). The body without the ruh has lost all the essence of a human being. On burial most of the human body decomposes and disappears within a short time and only bones persist for a longer time and they eventually also disappear. The Qur'an has mentioned the bones as a challenge to the unbelievers that He can indeed bring them back to life (p 281 17:49, 17:98, 23:35, 23:82, 37: 16, 37:53,  56:47, 75:3, 79:11). The main functions of blood circulation, respiration, nutrition, and metabolism require cooperation of various organs and tissue of the organism. The various organs of the body have a life and an individuality of their own and will bear witness against the human shahadat al a'adha (p 230 24:24). The cell is a basic unit of life. All life's complex functions and properties can be subsumed in the cell. Unicellular organisms are the simplest forms of life. Generally individual sub-cellular structures are not considered to have life if seen in isolation.

 

C. START OF LIFE

ADAM AND HAWA

Human life started with the stage of ruh when Allah took the covenant  'ahad al laah ila al bashar (p. 852 7:172-173, 36:60). This was life at a spiritual level. It became life in a material form with the creation of Adam and his wife Hawa in a physical form from the elements of the earth. They were created from clay and became full perfect humans when the ruh was inserted into them. Biologically the offspring of Adam and Hawa have continued transmitting the original biological material in the form of DNA all down the centuries from parent to offspring. The act of creation is repeated every time there is conception when maternal and paternal DNAs combine to give rise to the fetal DNA. The semi-conservative replication of DNA ensures that some atoms from the previous generation are part of the DNA of the next generation. The act of creation is completed by insertion of the ruh during intra-uterine life. In a biological sense the continuity of life has not been interrupted from the time of Adam. There is therefore an unbroken continuity that makes it pointless to try to define the exact moment when human life on earth is considered to start because of the concept of the continuum above.

 

MOTIVATION TO DEFINE START OF LIFE IN UTERO: 

The motivation to delineate the beginning of life is of practical materialistic and not academic or spiritual interest. Defining an exact moment in the intra-uterine phase for the start of life has legal implications in cases of contraception, abortion, inheritance, and homicide. We have to be careful about debates on the start of life. We need to ask ourselves what is the purpose behind the debates? There are social problems of an ethical nature that people want to solve by defining the start of life. The interest is therefore not only legal but is also ethical and moral. Once the point of start of life has been defined, then it is possible to legalize any medical procedures involving feticide provided they are done before the defined time. The main motivation for defining the start of life is to find is to escape moral and social dilemmas. Islamic law and teachings provide adequate measures for preventing these dilemmas rather than wait for them to occur and escape their consequences by abortion or feticide.

 

LEGAL CONSEQUENCES OF DEFINING START OF LIFE IN UTERO

Trauma or any other man-made cause of fetal death would be considered homicide only if it occurred after the defined start of life. Abortion before the defined start of life in utero would be considered legal. In a similar way, a fetus would have rights of inheritance from the father if the father died after the period of the defined start of life. The Islamic position is that life existed before and beyond conception. Feticide is committed in societies that want to allow sexual promiscuity unaccompanied by the responsibilities of child-bearing. Any aggression to the body of a pregnant woman is to be punished and should not be related to the life or non-life of the fetus. It is justice that any offspring of the deceased inherit to be able to have physical support.

 

RESEARCH  CHALLENGES

Muslims have not studied the issues of the start of life well. The aim of such research should be detailed understanding of early life and not defining the exact moment of its start. Study of sub-cellular structures may reveal new relations and explanations. Such studies also will clarify the boundary between the inorganic and organic parts of the body and the relation between life and the organic. The boundary between the world of the seen, alam al shahadat, and the world of the unseen, aalam al ghaib, needs to be elucidated in biological systems.

 

D. STAGES OF LIFE

Biological life can be looked at in three stages: pre-uterine, uterine, the post-uterine phases. The post-uterine phase has in return got two stages: life on earth, hayat al duniyat, and life in the hereafter, hayat al akhirat. The Qur'an has mentioned two lives and 2 deaths (40:11). The biological interpretation of this verse is still a challenge. The two lives could be life on earth on earth and life in the hereafter. We know of only one death on earth. Allah knows best what the other death is. Life on earth is described as enjoyment, hayat al duniya matau (p 430 3:14, 3:185, 4:77, 6:32, 7:32, 9:38, 9:69, 10:23-24, 10:70, 10:98, 11:15, 13:62, 20:131, 23:33, 28:60-61, 28:77, 29:64, 33:28, 40:49, 42:20, 42:36, 43:32, 43:35, 46:20, 47:36, 57:20). Humans have a blind love for life on earth and its enjoyment (p 382 2:96). Life in the hereafter starts with resurrection (p 19 6:6:36, 7:29, 7:57, 10:4, 10:34, 11:7, 16:38, 17:49-52, 17:99, 18:48, 21:104, 22:7, 23:100, 28:85, 29:19-20, 30:11, 30:25-27, 30:50, 30:56, 31:28, 32:10-11, 34:7, 36:12, 36:32-36, 36:51-52, 36:27-83, 37:16-21, 46:33, 56:47-50, 58:6, 71:3-4, 83:4-6, 86:8-10). As far as we know human life exists only on our planet. The possibility of human life on other planets is possible and was referred to indirectly by the Qur’an (42:29). The details will have to be unraveled by scientific research and exploration.

 

E. OWNERSHIP OF LIFE

Life belongs to Allah and not the human (p 382 3:156, 7:158, 8:42, 15:23, 23:80, 30:40, 4);11, 40:68, 45:26, 50:43, 53:44, 57:2, 67:3).  Allah gives and takes away life (2:96, 3:156, 7:25, 7:158, 15:23, 23:80, 30:40, 40:43, 40:68, 45:26, 50:43, 44:53:44, 57:2, 67:2). Humans do not own their life but are temporary custodians of life enjoined to take good care of it. Humans have no control over life or death (25:3). Death and life are in Allah’s hands (p 382 25:3). Humans therefore have no right to destroy their life or that of any other human. Doing so is one of the greatest transgressions.

 

2.0 THE QUR'ANIC CONCEPTS OF LIFE

A. LIFE IS FROM ALLAH

Allah gives life and takes it away (p 382 3:156, 7:158, 15:23, 23:80, 30:40, 40:11, 40:68, 45:26, 50:34, 53:44, 57:2, 67:2). Nobody else has control over life (p 382 25:3).

 

B. PHYSICAL BASIS OF LIFE

The complex molecules of the human body are from a few basic elements that are most abundant in nature: hydrogen, oxygen, carbon, calcium, and phosphorus. Humans created from the basic elements of earth (15:26, 30:20-21, 32:7-9, 38:71) and water (25:54). They result from semen (77:20-23) and the union of male and female gametes, nutfat (16:4). The Qur’an has in many verses described the stages of creation starting with the soul, then the nutfat then the clot then the flesh (22:5); soul then nutfat then 'alaqat (23:12-14).

 

C. PHYSICAL PROCESSES OF LIFE

The Qur’an describes processes of life after birth. These may be basic necessities of life, dharurat, that humans get by permission of Allah such as eating (26:79, 67:15, 80:24-32, 6:14, 32:27, 106:4), drinking (16:10, 16:69), reproduction (35:11, 41:47) and defecation (4:43, 5:6). The processes may also be needs, haajiyaat, that make life more meaningful for example vision (16:78, 23:78, 46:26, 67:23, 76:2), hearing (16:78, 23:78, 46:26, 67:23, 76:2), and speech (6:111, 13:31). The processes may also be tahsiinaat such as the intellect, ‘aql (2:118), consciousness, shu’uur (2:49), and the qalb (22:46).

 

D. SPIRITUAL BASIS OF LIFE

Human life is a combination of the physical elements and the ruh. The physical part is created first followed by the insertion of the soul, nafakh al ruh. The nature of the insertion of the ruh is not known for certain to us. It may be a purely spiritual phenomenon or may have some biological and physical aspects. The ruh is the permanent essence of life. The righteouses live a life of faith, hayaat iimaniyat (p 383 6:122, 8:24). The evildoers live the life of animals.

 

E. DYNAMISM OF LIFE

The Qur'an has described dynamic changes in human life (4:28, 16:70, 22:5, 30:54, 36:68, 95:4-5). Dynamic changes are also found in animals and the physical world. What is unique about humans is that their dynamism is purposive and is directed because they have a will and an intellect.

 

3.0 NATURE OF LIFE

A. CONTINUUM OF LIFE

There is a continuum in human life. The start is the state on non-existence, 'adam. Allah then created the souls and took an undertaking from them to worship him. This undertaking is called the covenant, al ‘ahad (p 852 7:172-173, 36:60). Starting with Adam (PBUH) Allah created a physical body to house those souls during life on earth, hayat al duniyat (p 430 2:204, 6:29, 7:152, 9:55, 9:85, 18:104, 23:37, 45:24). The physical part of existence on earth ends with physical death and the souls continue existing into eternity. Life in the integerrum, hayat al barzakh (23:100) is an intermediate stage between life on earth, hayat al duniyat, and life in the hereafter, hayat al akhirat (9:38, 14:3, 14:27, 16:107, 29:64, 40:39). In the hereafter human life will re-assume its physical form with the resurrection, al ba’ath. Life in the hereafter will be eternal. The fortunes of people will vary; some will be enjoying the bounties of Allah in paradise, jannat, while others will be in hell,  jahannam,  being punished for their transgressions on earth.

 

B. LIFE SPAN

Human life on earth has a definite time span, ajal (p 73 6:2, 6:128, 11:3, 13:38). No human endeavor including the most advanced medical procedures can shorten or extend this time span. The whole purpose of medicine is to exert maximum efforts to improve the quality of remaining life since Allah alone knows the timing of the ajal. The Qur’an has taught the concept of a fixed time of death for every human,  tahdiid ajal al mawt (p 1153 63:10-11; p 73 145, 6:60, 10:11, 14:44, 22:5, 39:432, 63:10-11). Only Allah knows this time. Human ignorance of this time, jahl al insaan bi zaman al mawt ( p 1155 31:34) is one of the limitations of human knowledge of the absolute unseen, ghaib mutlaq. Humans have no means of foretelling in a certain way the moment of death (p 1258 31:34). They can predict or extrapolate from their empirical observations and experience but this remains at best an approximation. Death occurs immediately when the appointed hour strikes, majiu al ajal & buluugh al ajal (63:11). The hour of death is fixed ajal musamma, ajal ma’aluum (p 1153 35:45). It can not be advanced or forwarded (p 1153 15:4, 16:61, 71:4, 63:10-11). Humans naturally want to live for long (2:96). This may be because they want to enjoy the earth as long as possible or for fear of the unknown after death. Some humans desire a long life to be able to make a maximum contribution to improving themselves and the earth on which they live. 

 

C. LIFE AS A TEST

Life on earth is a test for humans (p 382 67:2). Those who pass the test succeed. The most important test is to know and fulfill the purpose of life. Human life must be purposive to be meaningful. The first and most important purpose is worship of Allah, ‘ibadat (51:56). Life devoid of 'ibadat has lost its purpose. 'Ibadat is a continuous undertaking as long as life continues (p 382 19:31). ‘Ibadat is here considered in its comprehensive sense. All good and well-intentioned human activity is ibadat and has a reward. It is part of ibadat to fulfill the trust of human vicegerancy on earth, amanat al istikhlaaf (p 161 2:30-34, 6:165, 7:69, 7:74, 10:14, 10:73, 27:62, 33:72, 35:39). Humans must improve the earth and leave it better than they found it. They must improve themselves socially and spiritually. They have to play a positive role in preserving the stability of the eco-system and the food chain for their good and that of existing generations and generation not yet born.

 

D. CRITERIA OF LIFE

The question whether life exists or has ceased to exist is a recent pre-occupation. For millennia humans did not bother to answer the question since the answer had no practical value. When a person was seriously ill all they did was to wait. If there was some life the patient could revive else he would not. In the absence of technological intervention death occurred quickly and rapidly. Death was easily defined in terms of irreversibility. There was no hurry to ascertain death. Modern technology has complicated the picture by introducing methods of keeping some functions of life like breathing or blood circulation beyond the point at which traditionally people would have been considered in a state of irreversible decline to death. It is therefore now important to be able to define the moment of death to guide decisions on whether to apply or stop the advanced technology life support. The definition of death will require first establishing criteria of life.

 

E. SUCCESS and FAILURE

Life can be a happy one, hayat saidat/hayat taibbat (p 382 16:97), or unhappy, hayat dhankat (20:124). A good life is related to good deeds (p 382 16:97). Success and failure are experienced both on earth and in the hereafter.

 

4.0 QUALITY OF LIFE

A. DEFINITION OF QUALITY OF LIFE

Human life must have some quality. It is not enough to eat and breathe or maintain the vegetative functions only. A human can not live like a plant or an animal. The quality of life can be defined in physical, mental, or spiritual dimensions. The physical criteria are: absence of disease, comfortable environment, and basic necessities. The mental criteria are: calmness, absence of neurosis and anxiety,  and purposive life. The spiritual criteria are mainly correct relation with the creator.

 

B. QUALITY OF LIFE and BIOTECHNOLOGY

Issues of quality of life have been raised in the recent past because of advances in terminal disease care and the stresses of technological development. Many patients who used to die of cancer and other debilitating diseases can now survive. Both the disease and its treatment cause considerable changes to their lifestyle. The life under these debilitating conditions is of low quality. Both the original disease and the treatment contribute to this low quality; the treatment in some cases has a more contribution. Specialized methods have been developed to be able to assess the quality of this life empirically. These indices take into considerations performance status on physical tasks in addition to social or psychological parameters. Industrial society has given rise to environmental pollution and mental stress that affect the quality of life. Decision-making on allocation of health care resources depends on quality of life assessment.

 

C. TRADITIONAL MEASURES OF QUALITY OF LIFE

Traditional measures of the quality of life use anatomical, chemical, and physiological indices. They indicate general goals and are not good measures of actual quality of life. Their interpretation is often subjective. In cancer patients physical, psychosocial and general assessments are made with reference to activities of daily living (ADL). Among traditional indices used are: survival duration, impairments (signs, self-reported disease, physiological measurements, tissue alterations, and diagnosis), and functional status (physical, psychological, and social).

 

D. NEW MEASURES OF QUALITY OF LIFE

 The new QOL indices are predictors of the goals. They are based on instruments that are validated and whose reliability is tested empirically.  Some are general whereas others are specific. Assessment of QOL may be by indices or by profiles; indices being more popular.

 

The indices are standardized but it must be remembered that each individual is unique.  The indices used in clinical trials and clinical practice include. Other indices include: (a) McMaster Health Index Questionnaire: physical, social, and emotional parameters (b) Index of Health-related Quality of Life: physical, psychological, and social adjustment (c) Euroqol Quality Life Index: mobility, self-care, usual activities, pain/discomfort, anxiety/depression parameters (d) World Health Organization Health-related Quality of Life (WHOQOL) is being developed.

 

The commonest profiles of QOL used in clinical practice are: (a) Quality of Well-being Index: combines morbidity and mortality parameters (b) Sickness Impact Profile: physical and psychological dimensions (c) Nottingham Health Profile: perceived health status with no direct questions on health

 

E. TOWARD AN ISLAMIC QOL INDEX

The definition and use of QOL indices reflects the cultural and philosophical background as well as the worldview of the Judeo-Christian and Greco-roman traditions. Islam being a separate civilization has its own world view and this affects the formulation of QOL indices. Unfortunately Muslims have not yet worked on defining QOL from the Islamic context.

 

5.0  VALUE OF LIFE

A. LIFE AS A GIFT

Human life is a gift from Allah, ni’imat al hayat (p 1236 16:78, 67:23). Humans must be grateful to Allah for the gift of life by worshipping Him, ibadat (p 1241 2:21-22) The gift of life can be appreciated from several vantage points: statistical probability, good health, sustenance, and social relations. The statistical probability of being alive is low. Those who have life are a select few. A fertilized ovum that eventually grows into a human being is a very small statistical probability. One male ejaculate has millions of sperms and only one of them succeeds in fertilizing the female ovum. In many cases fertilized ova do not grow into fetuses but are aborted early. The prophet said that good health, sihhat, and afiyat are two bounties that many people do not enjoy (KS106). Few people are healthy in all their organs and at all times. Allah gives humans the gift of life and also gives them Sustenance, rizq. Sustenance is a manifestation of the continuation of rububiyat. Social aspects of life as a gift can be visualized in the form of offspring, relatives and spouses. Children are a bounty to parents,  ni'mat al dhurtiyat (p 1239 3;38, 6:84, 14:39, 19:5-7, 19:19, 21:72, 21:90, 25:74, 29:27, 38:30, 42:49). Relatives in the extended family are a source of psychological support. Spouses give both psychological and physical comfort (7:189, 30:21).

 

B. THE RIGHT TO LIFE

Each human has an inalienable right to life from Allah, haqq al hayat. This life cannot be taken away or impaired by any human being except in cases of judicial execution after due process of the law. The laws of marriage ensure that every child is born in a family in order to get physical protection. Nafaqat is compulsory for a pregnant and nursing woman even if divorced to ensure proper nutrition for the fetus and later infant. Breast-feeding is obligatory for the first 2 years of life. Feticide, infanticide, and homicide are prohibited to protect life.

 

C. SANCTITY OF LIFE

Life is sacred. The sanctity of life, hurmat al nafs is guaranteed by the Qur’an (p 1254 2:84-85, 4:29, 5:32, 6:151, 17:33, 18:74, 25:68). The life of each single individual whatever be his or her age, social status or state of health is important and is as equally important as the life of any other human (p 382 5:32). Protection of life, ‘ismat al hayat/hifdh al nafs,  is the second most important purpose of the shariat coming second only to the protection of the diin. It has priority over any other mundane consideration. Because of its importance some jurists have put it in the first position above hifdh al diin because diin can not survive in the absence of life.

 

D. MATERIAL WORTH OF LIFE

No material value can be put on human life. Legal compensation for bodily damage or homicide is replacement of lost earnings and not paying for the value of life. The compensation is a legal provision to provide sustenance to surviving relatives in case of death. It also provides sustenance to the person whose organ was severed and therefore cannot work to support himself.

 

E. MORAL WORTH OF LIFE

Every life is as important as any other life. Destroying the life of one person is equivalent to destroying the life of all humans (p 382 5:32).

Professor Omar Hasan Kasule Sr. March 2001