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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0306-HEALTH AND SICKNESS: THE PATIENT PERSPECTIVE

Lecture for 3rd year students on 10th June 2003 by Professor Omar Hasan Kasule sr.

1.0 HEALTH AS A BOUNTY, ni'imat al sihhat wa al ‘aafiyat

Good health is a gift from Allah, ni’mat al sihat wa al faragh[i]. Humans must be grateful to Allah for the gift of good health. This gratitude is in the form of worshipping Him and doing good things. Humans tend to take Allah’s gifts for granted and are therefore not grateful. They only understand the gifts when they are taken away. An ordinary person may not understand or appreciate the value of good health when in good health. On falling sick, the value of good health is understood and is appreciated but most often for a limited time. Everything is forgotten as soon as the illness is over.

 

2.0 ATTITUDE TO DEATH

The patient’s perspective of illness is colored by fear of death. It is known that illness precedes death.

 

Death and its occurrence are in the hands of Allah, taqdiir al mawt mina al llah[ii]. The believer surrenders all matters pertaining to death to the Lord.

 

The attitude to death varies according to the spiritual well being of those involved. The good people welcome death as a rite de passage to a better existence in the hereafter. They look forward to death, al shawq ila al mawt as a happy event. The Qur'an challenged the non-believers to wish for death if they were sure of a good life after death[iii]. The approach of death is an opportunity for repentance, tawbat[iv]. Death is an occasion for reminding and remembering the hereafter. It makes the good prepare better by doing more good deeds.

 

Humans are apprehensive about death, al hadhr mina al maw and often fear it, khawf al mawt[v]. This is basically the human fear of the unknown. It is useless to fear an event that is inevitable and over which a human has no control. Fear of inevetible death itself in illogical but anxiety about the manner and circumstances of death is reasonable and is expected from a normal human. Death may be feared because of leaving behind beloved ones.

 

Wishing for death, isti’ijaal al mawt, tamanni al mawt, in desperation with severe painful illness is discouraged. The wish for death, tamanni al mawt[vi] can be negative for the escapist who looks to death as a relief from present psychological or physical distress Committing suicide, qatl al nafs & intihar, is definitely forbidden and puts someone outside the fold of Islam.

 

Death is a trial, ibtila’a bi al mawt[vii] and is a calamity, musibat al mawt[viii]. This trial involves both the person dying and the relatives and friends left behind. Death is a calamity for the relatives, friends, and the society but not the deceased. If he is good he is going earlier to his Lord. If he is bad he has no more time to do bad; however he might have made tawbat and improved his situation had he lived longer. Death is a test for humans[ix]. The test for the

 

 

 

 

3.0 ATTITUDE TO DISEASE

 

In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. Falling ill may be Allah’s way of forcing the person to take a desired rest or care for the body before it can deteriorate further. Death from some diseases was said by the Prophet to be martyrdom, shahadat. The pain due to disease is a reminder of the punishment and suffering that the evildoers will suffer from in hell. Disease can be an opportunity for personal redemption by expiation/atonement for previous sins, al maradh kaffaarat ‘an ba’adhi al dhunuubi[x]. Disease may enable a person return to the due equilibrium in life. Falling sick may at times be Allah’s blessing in disguise that a person is incapacitated and thus is prevented from pursuits that could prove more dangerous for him. While a person is sick and is not busy with the routines of life he may have time to reflect and remember Allah.

 

The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness[xi]. Patience with chronic disease/disability is associated with high reward for example epilepsy[xii] and loss of sight[xiii]. Patience in the face of severe illness is a reason for entering paradise, jannat.

 

Some diseases are due to disobedience. Acts of disobedience may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship. The prophet taught that when communities commit inequities, Allah sends them diseases unknown in their ancestors. Many of the diseases of industrialized societies are related to lifestyle and may be Allah’s punishment for various transgressions.

 

Allah in recognition of the burden of disease and the need to give the body a chance to recuperate excused the sick from some physical religious obligations[xiv].

 

4.0 TALKING WITH THE PATIENT

The Prophet gave us guidance on what can be said and what should not be said in the presence of the patient[xv]. Positive words encourage while negative ones discourage the patient and indirectly affect response to treatment mediated by psycho-immune mechanisms. The good word is charity, al kalimat al laytinat sadaqat[xvi]. The following are enjoined: asking about the patient’s feelings, sua'al anhu, doing good/pleasing things for the patient, ihsaan, making the patient happy, tatyiib nafs al maiidh, and encouraging the patient to be patient, tashjiu al mariidh[xvii]. The patient should be discouraged from wishing for death wishing death, tamanni al mawt[xviii].The caregivers should use the opportunity of interaction with the patient to give them nasiihat because religion is sincere advice, al ddiin al nasiihat[xix]. Special emphasis should be placed on remembering Allah because the Prophet remembered Allah at all times, dhikr al llaah ‘ala kulli al ahyaan[xx].  

 

The physician should behave with the patient as if he is visiting him at home with all the respect and considerations that are due. This covers getting permission, isti idhaan[xxi] and manner of conversation. It is for example prohibited for the caregivers to engage in secret discussion, najwa, that does not involve the patient[xxii]. The physician should appreciate and understand the psychology of the patient who is deprived of the bounty of good health and is likely to be depressed. The prophet said many people are deprived of two bounties, health and relaxation, ni’mataan maghbuun fiihina kathiir min al naas al sihat wa al ‘aafiyat[xxiii].

 

5.0 ETIQUETTE OF THE PATIENT

Gratitude: The patient should always express gratitude to those taking care of him or her even if there is no marked physical improvement. The patient should complain only to draw attention to problems that need attention. Complaints for other purposes should be minimal

 

Patience: The patient should be patient in the knowledge that illness is kaffaarat[xxiv]. Allah may afflict someone when He desires good for him, man yurid al llahu bihi khayran yaswibu minhu[xxv].

 

Dua: The patient should make dua for himself and others. The dua of the patient has a special position with Allah  (  ). The patient should never hesitate to make dua for a visitor who asks for it.


[i] (KS106 Bukhari K81 B1, Tirmidhi K34 B1, Ibn Majah K37 B15, Darimi K20 B2)

[ii] (2:243, 2:258, 3:273, 3:27, 3:145, 3:156, 6:95, 6:162, 7:158, 9:116, 10:31, 10:56, 15:23, 22:66, 23:80, 25:3, 26:81, 30:19, 30:40, 39:42, 40:11, 40:68, 44:8, 45:26, 53:44, 56:60, 57:2, 67:2, 76:28)

[iii] 2:94

[iv] (p1158 4:18, 23:99)

[v]  (p1155 2:19, 2:243)

[vi] (p1154 2:94-95, 3:143, 19:23, 62:6-7)

[vii] (p1153 21:35, 77:2)

[viii] (5:106)

[ix] (p382 67:2)

[x] (KS503-504 Bukhari K75 B1, Bukhari K75 B2, Bukhari K75 B3, Bukhari K75 B13, Bukhari K75 B14, Bukhari K75 B16, Muslim K45 H45, Muslim K45 H46, Muslim K45 H47, Muslim K45 H48, Muslim K45 H49, Muslim K45 H50, Muslim K45 H51, Muslim K45 H52, Muslim K45 H53, Abudaud K20 B1, Tirmidhi K8 B1, Ibn Majah K31 B18, Darimi K20 B56, Darimi K20 B57, Muwatta K50 H6, Muwatta K50 H8, Ibn Sa’ad J2 Q2 p11-13, Zaid H346, Ahmad 1:11, Ahmad 1:172, Ahmad 1:173, Ahmad 1:180, Ahmad 1:185, Ahmad 1:195, Ahmad 1:196, Ahmad 1:201, Ahmad 1:381, Ahmad 1:441, Ahmad 1:455, Ahmad 2: 194, Ahmad 2:198, Ahmad 2:203, Ahmad 2:205, Ahmad 2:248, Ahmad 2:287, Ahmad 2:303, Ahmad 2:335, Ahmad 2:388, Ahmad 2:402, Ahmad 2:450, Ahmad 2:500, Ahmad 3: 4, Ahmad 3:18, Ahmad 3:23, Ahmad 3:24, Ahmad 3:38, Ahmad 3:48, Ahmad 3:61, Ahmad 3:81, Ahmad 3:238, Ahmad 3:258, Ahmad 3:316, Ahmad 3:346, Ahmad 3:386, Ahmad 3:400, Ahmad 4:56, Ahmad 4:70, Ahmad 4:123, Ahmad 5:198, Ahmad 5:199, Ahmad 5:316, Ahmad 5:329, Ahmad 5:330, Ahmad 5:412, Ahmad 6:39, Ahmad 6:42, Ahmad 6:53, Ahmad 6:88, Ahmad 6:113, Ahmad 6:120, Ahmad 6:157, Ahmad 6:159, Ahmad 6:167, Ahmad 6:173, Ahmad 6:175, Ahmad 6:203, Ahmad 6:215, Ahmad 6:218, Ahmad 6:247, Ahmad 6:254, Ahmad 6:257, Ahmad 6:261, Ahmad 6:278, Ahmad 6:279, Ahmad 6:309, Ahmad 6:448, Tayalisi H227, Tayalisi H370, Tayalisi H1380, Tayalisi H1447, Tayalisi H1584, Tayalisi H1773, MB1949)

[xi] (MB1948, MB1951)

[xii] (MB1954)

[xiii] (MB1955)

[xiv] (2:10, 48:17, 2:184, 2:185, 2:196, 4:43, 4:102, 5:6, 9:9, 73:20)

[xv] (KS505 Bukhari K75 B10, Ibn Majah K31 B14, Ibn Majah K31 B20, Tirmidhi K26 B35, Ahmad 1:76, Ahmad 2:172, Ahmad 3:267, Ahmad 6:109, Ahmad 6:114, Ahmad 6:126, Ahmad 6:127, Ahmad 6:131, Ahmad 6:278)

[xvi] (KS462 Ahmad 2:312)

[xvii] (KS505 Tirmidhi K26 B35) (KS505 Tirmidhi K26 B35)

[xviii] (KS524 Bukhari K75 B19, Bukhari K80 B30, Bukhari K81 B7, Bukhari K94 B6, Muslim K48 H10, Muslim K48 H11, Muslim K48 H12, Muslim K48 H13, Abudaud K20 B9, Tirmidhi K20 B3, Nisai K21 B1, Nisai K21 B2, Ibn Majah K37 B13, Ibn Majah K37 B31, Darimi K20 B45, Ibn Sa’ad J4 Q1 p15, Ibn Sa’ad J4 Q2 p61, Ahmad 2:263, Ahmad 2:309, Ahmad 2:316, Ahmad 2:350, Ahmad 2:514, Ahmad 3:100, Ahmad 3:104, Ahmad 3:163, Ahmad 3:171, Ahmad 3:195, Ahmad 3:208, Ahmad 3:247, Ahmad 3:258, Ahmad 3:281, Ahmad 3:332, Ahmad 3:494, Ahmad 5:109, Ahmad 5:110, Ahmad 5:111, Ahmad 5:112, Ahmad 5:266, Ahmad 6:339, Ahmad 6:395)

[xix] (KS237 Abudaud K40 B59. Nisai K39 B22, Tirmidhi K25 B17, Darimi K20 B41, Ahmad 1:351, Ahmad 2:297, Ahmad 4:102)

[xx] (KS241 Muslim K3 H115, Abudaud K1 B9, Tirmidhi K45 B9, Ibn Majah K1 B11)

[xxi] (p84 24:27-29, 24:58-59, 33:53)

[xxii] (p 84 58:9)

[xxiii] (KS106 Bukhari K81 B1, Tirmidhi K34 B1, Ibn Majah K37 B15, Darimi K20 B2)

[xxiv] (KS503 Bukhari K75 B1, Bukhari K75 B2, Bukhari K75 B3, Bukhari K75 B13, Bukhari K75 B14, Bukhari K75 B16, Muslim K45 H45, Muslim K45 H46, Muslim K45 H47, Muslim K45 H48, Muslim K45 H49, Muslim K45 H50, Muslim K45 H51, Muslim K45 H52, Muslim K45 H53, Abudaud K20 B1, Tirmidhi K8 B1, Ibn Majah K31 B18, Darimi K20 B56, Darimi K20 B57, Muwatta K50 H6, Muwatta K50 H8, Ibn Sa’ad J2 Q2 p11-13, Zaid H346, Ahmad 1:11, Ahmad 1:172, Ahmad 1:173, Ahmad 1:180, Ahmad 1:381, Ahmad 1:441, Ahmad 1:455, Ahmad 2:194, Ahmad 2:198, Ahmad 2:203, Ahmad 2:205, Ahmad 2:248, Ahmad 2:287, Ahmad 2:303, Ahmad 2:335, Ahmad 2:388, Ahmad 2:402, Ahmad 2:450, Ahmad 2:500, Ahmad 3:4, Ahmad 2:18, Ahmad 2:23, Ahmad 2:24, Ahmad 2:38, Ahmad 2:48, Ahmad 2:61, Ahmad 2:81, Ahmad 2:238, Ahmad 2:258, Ahmad 2:316, Ahmad 2:346, Ahmad 2:386, Ahmad 2:400, Ahmad 4:56, Ahmad 4:70, Ahmad 4:123, Ahmad 5:198, Ahmad 5:199, Ahmad 5:316, Ahmad 5:329, Ahmad 5:330, Ahmad 5:412, Ahmad 6:39, Ahmad 6:42, Ahmad 6:53, Ahmad 6:88, Ahmad 6:113, Ahmad 6:120, Ahmad 6:157, Ahmad 6:159, Ahmad 6:167, Ahmad 6:173, Ahmad 6:175, Ahmad 6:203, Ahmad 6:215, Ahmad 6:218, Ahmad 6:247, Ahmad 6:254, Ahmad 6:257, Ahmad 6:261, Ahmad 6:278, Ahmad 6:279, Ahmad 6:309, Ahmad 6:448, Tayalisi H227, Tayalisi H370, Tayalisi H1380, Tayalisi H1447, Tayalisi H1584, Tayalisi H1773) (KS503 Bukhari K75 B1, Bukhari K75 B2, Bukhari K75 B3, Bukhari K75 B13, Bukhari K75 B14, Bukhari K75 B16, Muslim K45 H45, Muslim K45 H46, Muslim K45 H47, Muslim K45 H48, Muslim K45 H49, Muslim K45 H50, Muslim K45 H51, Muslim K45 H52, Muslim K45 H53, Abudaud K20 B1, Tirmidhi K8 B1, Ibn Majah K31 B18, Darimi K20 B56, Darimi K20 B57, Muwatta K50 H6, Muwatta K50 H8, Ibn Sa’ad J2 Q2 p11-13, Zaid H346, Ahmad 1:11, Ahmad 1:172, Ahmad 1:173, Ahmad 1:180, Ahmad 1:381, Ahmad 1:441, Ahmad 1:455, Ahmad 2:194, Ahmad 2:198, Ahmad 2:203, Ahmad 2:205, Ahmad 2:248, Ahmad 2:287, Ahmad 2:303, Ahmad 2:335, Ahmad 2:388, Ahmad 2:402, Ahmad 2:450, Ahmad 2:500, Ahmad 3:4, Ahmad 2:18, Ahmad 2:23, Ahmad 2:24, Ahmad 2:38, Ahmad 2:48, Ahmad 2:61, Ahmad 2:81, Ahmad 2:238, Ahmad 2:258, Ahmad 2:316, Ahmad 2:346, Ahmad 2:386, Ahmad 2:400, Ahmad 4:56, Ahmad 4:70, Ahmad 4:123, Ahmad 5:198, Ahmad 5:199, Ahmad 5:316, Ahmad 5:329, Ahmad 5:330, Ahmad 5:412, Ahmad 6:39, Ahmad 6:42, Ahmad 6:53, Ahmad 6:88, Ahmad 6:113, Ahmad 6:120, Ahmad 6:157, Ahmad 6:159, Ahmad 6:167, Ahmad 6:173, Ahmad 6:175, Ahmad 6:203, Ahmad 6:215, Ahmad 6:218, Ahmad 6:247, Ahmad 6:254, Ahmad 6:257, Ahmad 6:261, Ahmad 6:278, Ahmad 6:279, Ahmad 6:309, Ahmad 6:448, Tayalisi H227, Tayalisi H370, Tayalisi H1380, Tayalisi H1447, Tayalisi H1584, Tayalisi H1773)

[xxv] (KS504 Bukhari K75 B1, Ibn Majah K31 B18, Muwatta K50 H7, Ahmad 2:159, Ahmad 2:237, Ahmad 2:440, Ahmad 3:148, Ahmad 4:195, Ahmad 4:196, Ahmad 5:240, Ahmad 5:248, Ahmad 5:272, Ahmad 5:427, Ahmad 5:428, Ahmad 5:429, Tayalisi H347). There is a lot of reward for the patient who surrenders to Allah, ajr al marridh al mustaslim (KS505 Muslim K45 H54, Muwatta K50 H5)

Professor Omar Hasan Kasule Sr.