Home

ISLAMIC MEDICAL EDUCATION RESOURCES01

9810-LIFE (AL HAYAT)

Lecture to 1st year medical students, Kulliyah of Medicine, International Islamic University, Kuantan on 31st October 1998 by Prof Dr Omar Hasan Kasule, Sr.

DEFINITION OF LIFE

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 border-line and require a clear definition. Both life and death are earthly events (7:25). Life can not be defined simply as the opposite of death. It is 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. The biological definition is not easy. 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.

 

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. Viruses make a very fine line between life and death. One of the signs of life is dynamic change. There is growth and development. There is also 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. Life could also be looked at in spiritual terms. Life without any spirituality is no life at all. Spiritual death could occur without biological death. Spiritual diseases could transform a human to be at the level of animals or even worse. We can conclude that life is a complex phenomenon with biological, chemical, and spiritual components.

 

Life can be described at various levels: ruh, the whole living organism, the organ,  the tissue or cell,  the molecule, and the atom. The highest level is that of the ruh about which we know very little. 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 in addition the ruh 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. 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 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). Life can be looked at in three stages: pre-uterine phase, uterine phase, the post-uterine phase, and the after death phase. The Qur'an has mentioned two lives and 2 deaths (40:11).  Life on earth is described as enjoyment, hayat akl 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).

 

NATURE OF LIFE

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 unravelled by scientific research and exploration.

 

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. 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.

 

There is a continuum in human life. The start is the state on non-existence (azal). Allah then created the souls and took an undertaking from them to worship him (al ‘ahad). Starting with Adam (PBUH) Allah created a physical body to house those souls during life on earth (hayat al duniyat). The physical part of existence on earth ends with death and the souls continue into eternity. Life in the integerrum (hayat al barzakh 23:100) is an intermediate stage between life on earth and life in the hereafter (hayat al akhirat). 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 in jannat while others will be in hell being punished for their transgressions on earth.

 

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 the time of the ajal is known by Allah alone. The Qur’an has taught the concept of a fixed time of death for every human (ajal al mawt) (p 1153 63:10-11; p 73 3:145, 6:60, 10:11, 14:44, 22:5, 39:432, 63:10-11). Only Allah knows this time; humans can not know it (jahl al insaan bi zaman al mawt, p 1155 31:34). 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 ar best an approximation. Death occurs immediately when the appointed hour strikes (buluugh al ajal). 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. 

 

Life can be a happy one (hayat said) or unhappy (hayat dhankat) (20:124). A good life is related to good deeds (p 382 16:97).

 

Life on earth is a test for humans (p 382 67:2). Those who pass the test succeed. Human life must be purposive to be meaningful. The first and most important purpose is worship of Allah (‘ibadat). 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 fulfil the trust of human vicegerancy on earth (amanat al istikhlaaf). 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.

 

QUALITY OF LIFE

The question whether life exists or has ceased to exist is a recent pre-occupation. For millenia 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. 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. Criteria of life are closely related to quality of life indices. A high quality of life will have more stringent criteria. Low quality life will have fewer criteria needed to define it. It is not possible to discuss criteria without taking quality into consideration.

 

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. 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 depend on quality of life assessment.

 

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. The new QOL indices are predictors of the goals. They are based 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. These indices are standardized but it must be remembered that each individual is unique.  The indices are used in clinical trials and clinical practice. In clinical trials QOL indices include survival duration, impairments (signs, self-reported disease, physiological measurements, tissue alterations, and diagnosis), and functional status (physical, psychological, and social)

 

The commonest scales of QOL used 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 (d) McMaster Health Index Questionaire: physical, social, and emotional parameters (e) Index of Health-related Quality of Life: physical, psychological, and social adjustment (f) Euroqol Quality Life Index: mobility, self-care, usual activities, pain/disconfort, anxiety/depression parameters (g) World Health Organisation Health-related Quality of Life (WHOQOL) is being developed.

 

QOL indices are used in the following special situations: cancer, rheumatoid arthritis, Parkinson's Disease, Asthma and Chronic obstructive pulmonary disease, hypertension, angina, psychiatry, and skin diseases. In cancer there are physical, psychosocial and general assessment. Physical performance status is assessed on the activities of daily living (ADL). In general the Sickness Impact Profile and the Quality of Well-being Index are used.

 

 START OF LIFE

Human life started with the stage of ruh when Allah took the convenant  '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. They were created from clay and became humans when the ruh was inserted. 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 DNA combine to give rise to the fetal DNA. The act is completed by insertion of the ruh during intra-uterine life. In a biological sense the continuity of life as not been interrupted from the time of Adam. There is therefore an unbroken continuity. It is 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. This is of practical and not an academic 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. Trauma or any other man-made cause of fetal death would be considered homicide only if it occurred after the defined start of life. 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. In all three cases the analysis is wrong. 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. We can therefore conclude that 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.

 

The issues of the start of life have not been studied by Muslims well. 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.

 

VALUE OF LIFE

Human life is a gift from Allah ,ni’imat al hayat (p 1236 16:78, 67:23). 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 fertlized ova do not grow into fetuses but are aborted early. 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). Humans must be grateful to Allah for the gift of life by worshipping Him (ibadat).

 

Each human has an inalienable right to life from Allah (haqq al hayat). This life can not be taken away or impaired by any human being except in cases of judicial execution after due process of the law.

 

Life is sacred. The sanctity of life (hurmat al hayat) is guaranteed by the Qur’an. 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.

 

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.

Professor Omar Hasan Kasule October 1998