This week we were really privileged to have taken part in a training day for Imams and faith teachers at The London Muslim Centre. The East London Mosque & London Muslim Centre is in the heart of Tower Hamlets and one of the main aims of the Mosque is to focus on the needs of the diverse Muslim community whilst ensuring services are open to all. They are doing some really fantastic work around this!

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The day was chaired by Muhammad Sadiqur Rahman and Rayhan Uddin and was organised as part of the Mosques Faith in Health programme. Faith in Health is a partnership with NHS Tower Hamlets and aims to create awareness in the community of the health services to the 45 mosques in Tower Hamlets. Working in partnership with the Association of Islamic Teachers, Faith in Health runs training sessions for Imams and Islamic teachers on different health issues such as diabetes, healthy living and heart disease; issues that are prevalent in the community, allowing the Imams and teachers to serve their communities more effectively.

Looking at resources

We started with an overview of Advance Decisions and Health and Personal Welfare Lasting Power of Attorney. As some of the audience did not have English as a first language Rayhan helped translate some of our key messages. I then used an overview of a case study that was covered in Radio 4’s Inside the Ethics Committee ‘End of Life and Islam’ programme as a framework for discussion and to consolidate understanding.

The case study was about a 75 year old Muslim man who had lost capacity. He did not have an Advance Decision or Health and Personal Welfare Lasting Power of Attorney and his life was being sustained artificially for nearly six months in intensive care. The medical team felt that it was in Mr Khans best interest to limit treatment, but the family disagreed as they felt that they were best placed to judge what their father would want. The family found it very difficult to get sound advice about what was in the best interests of Mr Khan, a man who was critically ill but also a devout Muslim. When they spoke to Islamic Scholars  there wasn’t enough information about when a line should be drawn. In the Quran it is taught that for every life that is saved, the whole of mankind is saved but if you take away life it is as if you have killed all of mankind. Without any additional specialist advice this presented a incredibly heavy burden on the family. So, as devout Muslims, they continued to do what they thought was the right thing – by asking the doctors to continue treatment. In this case the doctors did follow the family’s wishes, but it was emphasised to the group that in the absence of an Advance Decision or Health and Personal Welfare Lasting Power of Attorney the final decision would always be taken by the healthcare team.

There was a really thoughtful and insightful discussion around the case study – participants shared that many Muslims believe that everything should be done to preserve life and then it should be left in God’s hands to see if these treatments succeed and fail. Many also believe that pain is given in this world to take away suffering in the next. However, within the group there were several different views with some individuals stating that if an individual is ‘brain dead’ then treatment should be withdrawn. It was agreed that if in doubt, individuals should consult their local Imams for advice. However, as Mr Khan’s family discovered, is sometimes difficult to have access to the correct information and sometimes the Imam may not be qualified to the level that is required. There are not many people who have training in this area from the Muslim faith and so it was not surprising that Mr Khans family were not able to find a clear cut answer.

We also discussed the thoughts of Mufti Mohammed Zubair Butt a scholar at Leeds teaching Hospital and Community Chaplain who talked about three different ‘treatment means’ in the programme:

  • ‘Definitive’ meaning adopting  treatment such as artificial food and water and antibiotics that will always help sustain life – he recommends that it is accepted by those of Muslim faith.
  • ‘Presumptive’ meaning adopting treatment that does not always have a desired outcome – he states that because of this, it is not mandatory to consent to this in the Muslim faith.
  • ‘Speculative’ meaning if there is no hope of recovery then the treatment should not be adopted and the individuals should trust in the will of God. For example, if the heart stopped naturally, then it is God’s wish and so it would be acceptable not to intervene.

In Mr Khans case there was no hope of recovery from the additional treatment offered. Mufti Mohammed Zubair Butt’s view was that to continue to pursue this medical intervention was not mandatory, ‘at best it could be speculative’ and so the Muslim faith would support the doctor’s view to limit treatment apart from food and water and antibiotics – therefore supporting the healthcare teams views.

The Imams shared that most of the individuals in their community were not aware of Advance Decisions and Health and Personal Welfare Lasting Power of Attorney, and inspite of their faith believed that ‘Doctor knows best’ It was agreed that it was important that families are made aware that it is very important to communicate with their healthcare team if they have been given a diagnosis and  to find out as much as possible about their illness trajectory. If they have strong views about what sort of medical treatment they would  and would not want, it would be advisable to put their wishes down in writing, should they lose capacity.

At the end of the training we heard a bit about the history of the Mosque. I found out that it accommodates over 7,000 worshipers for congregational prayers and it’s centre is the largest of its kind in Western Europe! The beautiful geometric Girih tiles used on the facade of the building carry a huge amount of symbolism, the acquisition of knowledge being part of this. We very much hope that we will continue to work alongside its members to ensure that they can develop knowledge around their rights and choices and ensure that individuals have the care and support that is right for them at the end of life.

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