The Yale Journal for Humanities in Medicine
Ingrid Mattson, PhD
Published: July 17, 2002
Spirituality, Religious Wisdom, and the Care of the Patient
There is a great diversity of culture among the approximately 6 million Muslims who live in the United States. The cultural traditions of African-Americans, South Asians, Arabs, Turks, Eastern Europeans and others might influence the way in which any particular Muslim in the United States responds to illness and other life crises. Sacred texts and traditions, particularly the Qur’an and the Sunna-the example of the Prophet Muhammad-are the primary sources for a shared spiritual or religious response to illness among Muslims.
According to the Qur’an, all human beings (“children of Adam”) have been granted dignity by God: “We have dignified the children of Adam, and borne them over land and sea, and provided them with good and pure things for sustenance, and favored them far above a great part of Our creation (Qur’an 17:70).” The Prophet Muhammad is reported to have said that Adam was created in God’s image; dignity and nobility are part of each human’s birthright. Although the Qur’an recognizes that humans are easily tempted, it rejects the notion of original sin. In Islam, humans are not “essentially” sinners, rather, each human is born pure and is inclined towards goodness. In Islamic theology, society bears a heavy responsibility for suppressing and distorting the natural goodness of each human. In the end, however, every person should choose a life of goodness for themselves; this individual act of choice is the key to human dignity, and what raises humans above others of God’s creation.
Although Islam places great emphasis on each person’s individual responsibility to choose right over wrong, it does not recognize individualism in a sociological sense to be a good thing. A sense of responsibility for family, neighbors and community is highly emphasized in Islamic ethics and law. For example, adults are legally responsible in Islamic law for the economic support of their parents if they are in need. In most cases, the same responsibility entails for grown siblings. Muslims are therefore socialized with a strong belief that human society is only possible through mutual support and dependency. Shame is avoided by making assistance to the ill and needy a legal and moral responsibility of others, not an act of charity.
Many verses of the Qur’an, verses that are read and recited throughout the lives of Muslims, urge us to remember that all humans begin their lives helpless and end their lives helpless. As long as we do not deceive ourselves that we are the creators of our own lives, and as long as we remember that all power is a gift from God, we will not become devastated when we lose our strength. “It is God who created you in a state of weakness, then gave you strength after weakness, then after strength, gave you weakness and grey hair. He creates what He wills, and He is the all-knowing, all powerful (Qur’an 30:54).” Dignity is experienced by recognizing our dependence on God, not by projecting a false independence that inevitably will be lost.
In Islam, sickness can be an expiation for sins, an opportunity that God bestows upon those He loves. The Prophet Muhammad said, “Whenever God wills good for a person, He subjects him or her to adversity.” Islamic tradition reports the great suffering and adversity experienced by most prophets, including the Prophet Muhammad, who suffered in his final illness. Dignity, therefore, is not lost by acknowledging or expressing pain and suffering.
Muslims believe in life after death; consequently, a Muslim’s sense of self is not limited to identification with the physical body. Indeed, our identity is not limited even to our intelligence nor our spiritual awareness at the end of our lives-for many people lose control not only over their bodies, but even their minds in their final stages of illness. A Muslim is identified with the choices and actions he or she made throughout his or her life. The Prophet Muhammad taught that the choices we made freely in this life can continue to affect other people, animals, and even the earth as long as the world continues to exist. As we affect and influence earthly life, even after our physical deaths, it is clear that individual human identity can never be reduced to a feeble mind or body.
In addition to these theological positions, there are a number of Islamic practices that reinforces that reinforce the dignity of people who are suffering illness. First, it is not permitted to force any person to experience a treatment they do not want. Islamic tradition narrates that the Prophet Muhammad was angry at his family when they forced him to drink some medicine as he lay weak on his bed in the last days of his fatal illness. Indeed, when he regained some strength for a short time after that, he made his family drink the medicine themselves-to experience how humiliating it is to be forced to take a medicine one does not want.
Islamic law supports the dignity of those who are ill by recognizing their continuing obligation to remember God and worship Him as much as they are able. As long as they are conscious, even the bed-ridden must perform the five daily ritual prayers. If a Muslim is too weak to stand, he or she can sit. If a Muslim is too weak to sit, he or she can lie down. Even a paralyzed Muslim is required to pray by imagining the movements of prayer and moving his or her eyes in the proper direction, at the proper times. By requiring the continued performance of acts of worship, to the extent that a person is able, Islam refuses to allow ill adults to be reduced to the level of children, who lack such obligations. Adults are recognized as essentially competent, as long as they are lucid.
Physical modesty is an important part of Islamic ritual life and Muslim culture. It is very important for health care providers to respect the different norms of modesty Muslim patients may have, in order to preserve their dignity. Many people, not just Muslims, feel uncomfortable waiting in a hospital hallway on a stretcher, covered only by a thin sheet. For many Muslims, however, this degree of exposure is exceedingly abnormal and embarrassing. Allowing a Muslim woman extra time to put a scarf over her hair, or allowing a Muslim patient to use an extra sheet for better concealment of the body can help maintain these patients’ sense of dignity.