Journal of Preventive Medicine and Care
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Research Article | Open Access
  • Available online freely | Peer Reviewed
  • “Prevention of Death Anxiety by Familiarity with the Concept of Death”

    Minoo Asadzandi 1      

    1Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

    Abstract

    Objectives

    Death is the only definitive phenomenon in life, and everyone is sure that it will happen in the future. Based on the philosophical perspective, the concept of death differs in different cultures. The purpose of this study was “explaining the difference between the concept of death from the perspective of theology and empirical science”.

    Methods

    In this qualitative evolutionary study, a targeted review was conducted to answer the question “what is the difference between the concept of death from the perspective of theology and empirical science?” Articles published between 1990 and 2018 were extracted from the PubMed, science direct, google scholar, SID, and Cochrane databases. At the same time, Islamic religious evidence (Quran and Hadiths) was investigated for understanding the concept of the death in Islam. The “Shia Seminary” research methodology was used to avoid interpretations of the Quran verses and to ensure the authenticity of the Hadiths.

    Findings

    Empirical sciences consider death as a biological phenomenon, which results from irreversible damage to cerebral hemispheres and brain stem (brain death) that causes grief process, fear, anxiety, and sadness. From the perspective of Islam, death is an existential phenomenon, the transfer of the soul from one world to another. Death is the complete reception of the soul from the body by the angels and the beginning of another life, in the "world of grief.

    Conclusion

    Given that in Islam, death does not mean destruction. It is imperative that the spiritual counselors teach the patient and the family about the life after death and the blessings of paradise. In pastoral care at the end of life, reducing patients’ anxiety and fear of death, with hope in God's mercy is necessary.

    Received 15 Jun 2019; Accepted 16 Jul 2019; Published 18 Jul 2019;

    Academic Editor:Shuai Li, Department of Engineering University of Cambridge UK.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright©  2019 Minoo Asadzandi

    License
    Creative Commons License    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Minoo Asadzandi (2019) “Prevention of Death Anxiety by Familiarity with the Concept of Death”. Journal of Preventive Medicine And Care - 2(4):23-29.
    Download as RIS, BibTeX, Text (Include abstract )
    DOI10.14302/issn.2474-3585.jpmc-19-2947

    Introduction

    When prevention of death is impossible and the long term, medical treatment is not helpful, the palliative treatment staff try to help the patient with more comfort and pain relief 1. The goal of end-of-life care is to provide the possibility of death with dignity and tranquility for the patient in order to make the family more relaxed 2. Patient and family must spend their last days of life without fear, anxiety, grief and with less suffering 3. Palliative treatment staff are obliged to recognize the concept of death. They should be able to listen with sympathy without judgment 4. They must be aware of anxiety and fear of death and correct their point of view about death in accordance with the patients’ social culture and beliefs and reduce fear, anxiety of death 5.

    From the scientific point of view, death is an irreversible stop in life and vital signs 6. Whenever the body fails to adapt itself to the new conditions and vital activities are not possible, death occurs 7. Some scholars consider death as a process, not a sudden occurrence, which begins with processes of "burnout." In this definition, there is no clear boundary between death and life, and it's very difficult to determine the exact time of death. This group says that death occurs when the whole organism cannot act as an intact whole 8. Life is meaningful when human beings have the power of cognition and consciousness. So life without these criteria is inevitable. They introduce death as a complete ignorance of external stimuli and internal needs and the lack of complete response to them 9.

    For centuries, death was a puzzle 8. It was thought that the only definitive sign of the death of a human being should be "corruption of the corpse". In the late 18th century, in Europe, there were places for holding the dead person for two to three days. Hence, with the delay in burying the dead persons, they examined the signs of corrupting corpses 10. Until the middle of the 19th century, physicians did not officially play a role in determining death. The first law of mandatory confirmation of death by medical graduates in England passed by the Parliament in 1836, and centers of death certificate were established. In 1901, an examination by a physician or a surgeon was legally mandatory for a death certificate, in the United States, and other parts of Europe. In 1918, the law for using the death test was approved in France 11.

    With the recognition of the circulatory system and the identification of respiratory physiology, the importance of perfusion and tissue oxygenation was determined 12. In the early years of the twentieth century, cardiopulmonary arrest was a standard indication of death 13. With the advancement of medical technology such as defibrillator-pacemaker-ventilator and advances in resuscitation methods, thousands of re-life cases were reported in patients with cardiopulmonary arrest 14. These findings showed that stopping heart or breathing is not the end point of life. The human is alive, as long as its brain cells are alive. Therefore, brain death was defined as the "main criterion" of the end of life 15.

    In 1959, “Mora let” and colleagues expressed an irreversible coma as “Coma DE passé”. In 1968, a special committee at the Harvard Medical School, provided definitions and criteria for brain death 16. In 1981, World Criteria for Brain Death were announced by the National Institutes of Health in the United States and the Advisory Group, the High Commission on Medical Ethics 17. These criteria are currently recognized in most of the Americans and European countries. In the above mentioned laws, brain death is defined as the irreversible damage to cerebral hemispheres and brain stem 18, 19.

    All scientific findings over the years are related to the human body. The main criterion for determining death is the death of the heart, lung and brain. But among followers of the Abrahamic religions there is a belief in the existence of the soul and life after death 20. This belief has been neglected in scientific terms. So the question is:

    What happens to the soul during the death?

    What is the fate of "human soul" when he is dead?

    Methods

    This Evolutionary Study has Focused on this Question:“what is the difference between the concept of death from the perspective of theology and empirical science?” the following stages were carried out to promote and complete the available knowledge by using a systematic, scientific and justifiable process as follow 21:

    Reviewing the Religious Evidences

    Religious evidences were taken from the verses related to death and dying time by using Book Al-Mu'ajm, authentic Shia commentary books, related reliable Hadiths based on Rejal and Derayeh (The science of identifying narrators of the hadiths of Shiite Imams and their accuracy in narrative). Behar-ol-anvar, Kofi, resurrection and human destiny books.

    “Shia Seminary” research methodology was used to avoid interpretations of the Quran verses and to ensure the authenticity of the Hadiths.

    Reviewing the Scientific Evidences

    Articles published between 1990 and 2018 were extracted in the PubMed, science direct, google scholar, SID, and Cochrane databases. Content analysis were used as research methodology.

    Inclusion Criteria for Selecting Evidences and Articles Included

    Articles that focus on death, brain death and dying time.

    Articles have to be written in 1990 to 2018.

    Essay based on evidence-based pyramid priorities.

    Verses interpretations should have been collected from the authentic reference books.

    Findings

    Empirical sciences consider death as a biological phenomenon, which results from irreversible damage to cerebral hemispheres and brain stem (brain death).

    Clinical Criteria for Brain Death

    1. Deep Coma (GCS = 3), which is characterized by lack of self-movement, lack of eye opening, lack of speech and motor response to painful stimuli.

    2. The patient's coma is not due to reversible causes such as:

    Hypothermia (body temperature below 32.2 ° C).

    Drug use or drug poisoning (Nervous system drugs)

    Metabolic disorders, Endocrine disorders

    Hypoglycemia or hyperglycemia

    3. Lack of brain stem response.

    Lack of pupil light reflexes

    Lack of corneal reflex

    Lack of gag reflex

    Lack of coughing, swallowing, sneezing reflexes

    Lack of reflexes related to eye movements

    Dolls eye reaction

    The absence of an Calorie reaction

    4. Absence of spontaneous breathing by apnea test

    Para Clinical Tests for Brain Death

    Angiography of the brain vascular by injecting the contrast agent: confirmation of the absence of blood supply results in the diagnosis of brain death (in this case, it is not necessary to pass the waiting time).

    Electroencephalography twice in 6 hours intervals: The iso-electricity of waves is an indication of the loss of cortical function (this test does not indicate the activity or lack of brain stem and in cases of suspected coma, has no diagnostic value)

    Angiography with intravenous injection of radioisotope materials and brain imaging.

    Based on Quran Verses

    In the Perspective of Islam, Death is an Existential Phenomenon, the Transfer of the Soul from one World to Another

    The soul is the source of life, from the unseen world, beyond the universe of matter.

    Power, intelligence, discretion, and decision are due to the ability of soul.

    "Living things" have a degree of soul, are able to perceive, feel, and move with the help of their Spirit.

    Death happens with the permission of God (Surah Malek / verse 20) (Surah Baqara / I 258) by the angel of death.

    Death is the complete reception of the soul from the body by the angels and the beginning of another life, in the world of grief (Surah al-Zumar / Verse 42).

    At the time of death, the soul is retrieved and delivered by the angel who receives the ghosts (Hazrat "Azrael”, peace be upon him) and the spirit is transmitted to another world (Surah al-Zumar / Verse 42).

    Death is a divine destiny (Surah al-Rahman / verses 26-27, Surah al-Anbiya / Verse 35). It is not such that God has given a permanent life to man, but destructive factors overcome the will of God (Surah Vaghea / verse 60)

    Death is made by divine permission (Surah Malek, verse 2), at a specified time, and in a specific place, although for many people, time, place, and mode of dead occurrence are unknown.

    In various traditions: "Death is joyful, for believers.

    Clinical Criteria for Death in Islam

    The separation of the soul from the body produces signs (Surah Day of Judgment / verses 26-30)

    As long as the heart beats and the body is warm, "the soul understands and perceives."

    The complete removal of the soul from the body by irreversible cooling from the legs to the head.

    Exodus of the soul is from the larynx area (Sura of the Incident / Verses 83-87).

    Discussion

    The unknown causes fear. People who are unaware of the death have anxiety and fear 22. While from the perspective of Islam death is the "journey of the soul" to the heaven house, moving towards the God kindness 23. Death doesn’t mean destruction. Death is complete reception of the soul from the body and transferring it to another world. So, we will not die with death, but we will begin a new life 24.Death is moving from a home to another 25, it is a bridge that brings the believers to the paradise and disbelievers into hell 26, it is like taking off dirty clothes and unlocking the heavy chains and putting on the finest clothes and the best perfumes 27, it is passing through the darkness and losses, it is going to the eternal blessings, it is smelling the best flowers and end for all pains and suffering 28.

    Some Scholars Argue

    “this belief in Islamic medicine which the human heart is the place of the soul" is based on "Greek medicine" and based on the theory of Socrates. The advancement of medical science, the invention of modern medical equipment, the proof of the cells theory and diseases etiology recognition, has been the end of credit for the Socrates theory. On the other hand, the recognition of the circulatory system, the science of tissue anatomy, the discovery of the gradual death of members, the distinction between human death and body death by biochemical science, the successful transplantation of the heart, all of them, reject the unconvincing belief in placing the soul in the human heart.  The heart pumping blood and delivering blood to other parts of the body 29.

    The close connection of the soul with physical heart in Islamic medicine is based on Hekmat No. 108, Nahj al-Balaghah. Imam Ali (peace be upon him) states: “Definitely there is a part in the human chest that is hanged on a special vein. The strangest parts of the human being are the "heart". This is a remarkable thing due to the features that are contained of Wisdom and anti-wisdom” ignorance (“Therefore, if extreme wishes appear in heart, then it will become greedy. Greed brings humiliation. Too much greed corrupts the heart”) 30. Here's the concept of heart in the al-Mizana commentary: The heart is the first member to which the soul belongs. Because of anesthesia and so on, human consciousness and intelligence are out of work, but the heart rate and pulse are still alive. If his heart fails, life will not remain for him. So the source of life in man is his heart. At first soul belongs to heart and then goes to the other members. Surely feelings, wisdom and will, sadness, fear, hope and anxiety…., all of them are heart-related. It means that when the soul perceives these emotions, its effects appear in the heart and bloodstream. 31.

    Many physicians believe that they should not attempt to maintain "vegetative state in patients" because there is no definite human personality with "brain death"32. The patient has neither movement power nor sensation, not the ability to think, to recognize to speak, and he/she will never be able to live and originate in activities and works. What is left of him is just some of the signs of life. Such an inventory, not only has no company in society, but also is no longer a member of his own family, due to brain death 33. While brain death patient is still alive in Islam. According to Shi'a jurisprudents, in patients with "brain death",

    if the donation of the patient's body organ causes to "speed up his death", the physician will not be allowed to do so.

    The patient should be anesthetized in the operating room for donation.

    Only members can be donated, which will not speed up the death.

    The patient's body should not be "piece-piece" in any way.

    After the organ donation surgery, the patient should be nursed in hospital 34.

    Answer Three Questions of this Article

    What Happens to the Soul During the Death?

    "Based on "revelation epistemology" death is a sign of the God wisdom and power, an existential phenomenon, the complete reception of the soul from the body by the angels. Which occurs through the complete separation of the soul from the body. "Allah takes the souls at the time of their death, and those that do not die He takes during their sleep. Then He keeps those for which He has decreed death and releases the others for a specified term. Indeed in that are signs for a people who give thought.” (Surah al-Zumar verse 42) 35.

    What is the Fate of "Human Soul" When he is Dead?

    The soul transfer from one world to the unseen world and begins another life, in the "world of grief 36.”And behind them is a barrier until the Day they are resurrected ". (Surah Mu'minoon verse 100). According to the verses of the Qur'an other than the Day of Judgment, where there is a general account of the people, there is another world between this world and the world of resurrection, which call "the world of grief. It means mediator, the universe that lies between this world and the Day of Judgment 37. After death, although the general account of the people has not been investigated and should be considered on the Day of Judgment, the "status of people's lives" is different. Some of them are "happy and blissful, and some of them are in sorrow 38. It is said: The grave universe for man is a garden of heaven gardens or a pit through the pits of hell.

    What is the Difference Between the Concept of Death from the Perspective of theology and Empirical Science?”

    In terms of empirical sciences, death means brain death and the destruction of the body. In terms of the religions, death is rebirth, spiritual journey and the beginning of a new life. “And never think of those who have been killed in the cause of Allah as dead. Rather, they are alive with their Lord, receiving provision”, (Verse 169 of Surah Al-Imran) 39.

    Conclusion

    Having a sound heart is the source of happiness in this world and salvation on the Day of Judgment. Sound heart owners are free from fear, anxiety and sadness 40. They live and die under the protection of God's love. For them death does not mean destruction, it is the beginning of life after death and the blessings of paradise. In pastoral care at the end of life, reduce patients’ anxiety and fear of death, with hope in God's mercy is necessary.

    Ethical Approval

    “For this type of study formal consent is not required.”

    Acknowledgements

    I appreciate those who taught me.

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