1st draft for

WRITING MANUAL OF STANDARD OPERATING PROCEDURES FOR

HEALTHCARE PROFESSIONAL TO HASTEN THE IMPLEMENTATION
OF
SHARIAH
COMPLIANT
HOSPITAL
CONCEPT
AT
THE
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA TEACHING
HOSPITAL

Introduction
Spiritual care is recognized as an integral component of comprehensive
palliative care
Palliative care is resorted to when clinical evidence indicates that
there is no net benefit from life support or conventional treatment.
A motivation for improving palliative care is the concept of good
death.
Death in inevitable, much can be done to make the death process as
comfortable as possible.
The comfort may be physical involving pain relief and general
tender loving care. The comfort may also be psychological involving
allaying anxieties and fear of death among the terminally ill.
Terminally patients experience fear and loneliness during serious
illness most of the time, which generates spiritual crisis that
requires special care.
Spiritual care can play an important role when cure is not possible.
Religious care is given in the context of the shared-religious beliefs
values, liturgies and life style of a faith community.
SC is usually given in a one-to-one relationship, person-centred, and
be non-judgemental towards patients personal conviction or life
orientation.
SC encompasses quality of life, patient decision making methods
and achievement life goals.
Cultural background may play an important role is shaping response
to difficult situations.
Health care should adopt cultural competence and sensible
awareness when caring for Muslim patient and family. A holistic
approach to care needs understanding of Islamic belief (internal and
external), religious practise, spiritual beliefs, cultural more and
social background.
Ensuring a better quality of life for both acute or terminally ill
Muslim patients and their families.

Issue in spiritual care in terminally ill patients.

Based on literature reviews:
1. Islam and medical ethics
Based on ethical principles: nonmaleficient, justice, autonomy and
beneficience.

Concept of nonmaleficience and justice are more prioritized.

Reason:
1. Avoidance of inflicting harm takes priority over doing good
(primum non nocere)
2. Relieve of one patientss suffering should not cause another to
experience an equal or greater suffering.
Right to accept and refuse intervention.
Withdrawal and withhold medical treatment issue.
Given the centrality of the family, considering informing family of
medical information, and to be involved in the decision-making
process.
Requests for assisted death should be refused.
Privacy and confidentiality have to be maintained.
Caregivers must respect the patients autonomy as long as he is
competent.
If the patient is not competent to make decisions, his guardian, wali,
will make decisions that the caregivers are bound to respect.

2. Cleanliness
Cloth and body of the patient cleanliness for ritual and health
purpose.
Refer to figh ibadah (Subhi)
3. Modesty
Ideally to have a healthcare provider of the same gender.
Permitted if it is difficult to fulfil.
Must have chaperon if different gender.
Body part should be optimally exposed.
4. Social aspects
Visiting the sick and welcoming the visitor
A member of the family may wish to remain with the patient at all
times, in line with medical arrangements as necessary.
Islam encourage believers to have their will written and regularly
updated throughout life.
With the diagnosis of a terminal illness, patient become more
serious about having a written will in place.
Valid will need the patient to be mentally competent and the will
should be witnessed by two mentally competent adults.
5. Prayers
Obligation to perform prayer despite of being sick except when
cognitively impaired.
Compensation for the lost prayers.
Modification of the format to perform prayer.
Good and comfortable environment provision.
6. Truth telling

Great sin to tell lies according to Islamic faith.

Telling the whole truth to the patient requires judgment and
balancing benefits and harm.
Hadith of hypocrisy
Healthcare professional role on breaking bad news.
Professional truth-telling techniques.
Good communication-develop and maintain trust.

7. The use of opioids and sedatives.

Use of stated drugs as it affects sensorium.
Islam prohibits any substance that disturbs mind.
Permissibility of necessity to reduce pain.
Explanation to the patient and family of possible side effects e.g.
drowsiness.
In Islamic perspective, medication-related sedation could be looked
at two different angles.
1. Alleviation of the suffering of a human being is considered
very righteous.
2. Maintaining a level of consciousness as close as to normal as
possible is of great importance to allow for observance of the
worship rites for the longer period possible before death
8. Dietary consideration.
Exemption from Ramadhan fasting during sickness.
Need for compensation.
Patients with advanced incurable disease are requested to feed a
poor person each day of Ramadhan not fasted.
Need for timing readjustment for medication and meals if patients
insist on fasting.
The prophet Muhammad discouraged forcing the sick to take food
or drink. Associated with malignancy; anorexia/cachexia syndrome.
Terminally ill patient close to death, it is prudent to maintain
minimal amount of nutrition.
If deteriorating, resort to alternative nutrition administration such as
by subcutaneous hydration.
Reason for the approach is to prevent the potential feeling of guilt
and sorrow experienced by the family if the nutritional support is
withdrawn or withheld completely.
9. Longevity of a terminally ill patient
Family more comfortable with less definitive answers about the
patients prognosis.
It is good to practise to response like this is in Allahs (God) hands
and we can never predict this accurately.
The longevity of every person is only known by Allah.

10.

However, it is recommended to continually keep the patient and

family informed about progression of the patients condition and
wheather death is becoming imminent.
So as to alert the family to be prepared during this period for funeral
rites.
Religious practices around death
Terminally ill Muslim patients experience fear and loneliness during
serious illness most of the time, generates spiritual crisis requiring
special care
A spiritual care giver or a person of wisdom will usually remind a
dying person of the great generosity of Allah and will encourage him
to look forward to Allahs blessings and forgiveness.
Prophet Muhammad said, None of you should die without having
good expectations in Allah. He also visited a young man who was
dying and asked him, How do you feel? The man replied, By
Allah, O Messenger of Allah, I have hope in Allah and I fear my sins.
The Messenger said: These two qualities do not dwell together in
a persons heart in this situation (of dying) but Allah will grant him
what he hopes, and save him from what he fears.
Families prompt the patient with the Shahadah (bearing withness
that there is no tru God but Allah and Muhammad is verily His
Servant and His Messenger) as a final statement of faith.
Reciting chapters of the Noble Quran at the bedside of the patient or
play Quranic audio cassettes instead.
The severely ill patient who might be distracted by his pain, greatly
appreciates a companion who can read the Quran to him and
remind him of God. A family member may wish to remain with the
patient at all times, if medically appropriate.

Conclusion
Patients at the end of life more vulnerable and sensitive to care provision;
they desire holistic care constitutes of controlling pain and physical
symptoms, social, psychological and spiritual components.