Muslim customs surrounding death, bereavement, postmortem examinations, and organ transplantsBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6953.521 (Published 20 August 1994) Cite this as: BMJ 1994;309:521
Muslims are always buried, never cremated. It is a religious requirement that the body be ritually washed and draped before burial, which should be as soon as possible after death. Those carrying out this duty should be immunised against hepatitis B and be aware of the hazards of AIDS. Muslim women never attend burials and it is rare for funeral directors to be involved. Muslim jurists from the Arab world can justify organ transplantation, but those from the Indian subcontinent are against it. They are united in the belief of the sacredness of the human body and thus deplore postmortem examinations.
There are over 1.5 million Muslims in the United Kingdom,1 of whom well over 600 000 are from Pakistan and Bangladesh.2 Most of the rest are from India. Muslims from the largest non-Christian religious group in the United Kingdom, encompassing 43% of the Asian population from the Indian subcontinent.3 Behaviour surrounding death as expected by the Muslim faith is generally adhered to in Britain. Most of the customs followed have been laid down in the Shari'ah (Muslim laws) which are derived from the Hadith (practices and sayings of the prophet Mohammed) rather than the Koran.
Although Islam recognises no intermediary between humans and God, such as a clergy, there are special committees in the Indian subcontinent that decide on matters such as the burial in sacred ground of a person who has committed suicide. Ulamas (high ranking Muslim jurists) guide the Muslim world on the interpretation of the Koran and the Hadith.
Muslims prefer to die in their own homes. They believe in the day of judgment and the life hereafter, and that on approaching one's death it is important to ask for forgiveness of violations against humans before asking for forgiveness from God for sins committed.
It is a religious recommendation that an ill person, whether an acquaintance or a stranger, be visited. This is considered a form of worship and “mercy” is showered on the visitor. Thus a Muslim dying in hospital will have many visitors. When death is near relatives give holy water (zam zam) to drink, and verses from the Koran are read. The dying person is encouraged to recite and redeclare his or her faith.
Prolongation of life by artificial means (such as a life support machine) is strongly disapproved of unless there was evidence that a reasonable quality of life would result.4 In hospital a great deal of anxiety may be created by certain beliefs - for example, if a baby has died in utero and if no immediate delivery is effected the mother may believe that she herself is going to die.
When a Muslim dies in hospital a great deal of anxiety may follow as a result of medical attendants being unfamiliar with Muslim rites. Ideally, the face of the person who has died should be turned towards Mecca,5 but in hospital turning the face towards the right should be sufficient. The arms and legs should be straightened and the mouth and eyes closed. All clothes should be removed by a person of the same sex and the body covered with a sheet. A baby dying at or before birth has to have a name. When a Muslim patient dies it is a religious requirement that the corpse be ritually bathed before burial. A stillborn baby will not require a full funeral service and in theory does not necessarily have to be buried in a cemetery. Neither the ritual wash nor the usual shrouding is required in such cases. For practical purposes in British hospitals stillbirths can be dealt with as live births.
If a postmortem examination has to be performed or death has occurred just before the weekend greater distress is caused because of the extra waiting. Postmortems are not allowed by religion - this is because the body is sacred and belongs to God6 - but when the law of the country demands it there is no alternative. Generally, religious opinion is against dissection of bodies for learning and anatomy.4, 7 For the following reasons attempts should be made to release the body to the relatives as soon as possible.
Firstly, it is a religious requirement that the body be buried as quickly as possible.1 Secondly, it is felt that any person who died was obviously loved by his or her family and if decay sets in, then that loved one could become repulsive (Muslim bodies are not embalmed.). This is particularly important in the hot countries from which most Muslims in the United Kingdom come. Thirdly, Muslim communities are so closely knit that 200-300 people may visit the home of the deceased, often from long distances - many of them eating and sleeping there. (Within a few hours of the death of a Muslim most of the community of that town and indeed of other towns will become aware of this, through relatives and announcements in mosques.) Thus, the longer the body remains unburied the greater the burden and distress to the family.
Finally, as a mark of respect the immediate relatives may not eat until after the funeral.
Washing and shrouding
It may take up to an hour to wash and drape the body in a simple white cloth, which is in three pieces. This cloth may have been prepared by the deceased during his or her lifetime. Usually two people are needed for this procedure, which is carried out by those of the same sex as the deceased, except for a child up to the age of 8 years. Private parts are covered with a sheet and never exposed during the wash. Gloves are usually worn and a sponge used.
The washing and draping of the body is carried out by respected elders experienced in rules of Muslim burial. It would seem prudent to protect them from hepatitis B by active immunisation. This would be particularly relevant if death had resulted from an accident and signs of blood were evident on the body.
Strictly speaking, only the wife, husband, mother, brother, sister, father, grandparents, children, and grandchildren are allowed to see the face of the deceased, which should not be exposed after shrouding. In reality these rules are not strictly adhered to.
Muslims are always buried, never cremated.8 Often the members of a funeral committee collect death certificates and make arrangements for funerals in order to take the worry off the immediate family members. The caskets in which the burials are to be carried out are kept by the community and are simple wooden boxes with no decorations. Many purpose built mosques in the United Kingdom have a “cold storage” room to preserve the body. Short term storage may be in the home of the deceased where the relatives pray, seated around the coffin, which faces Mecca. Though burial in the United Kingdom is usually in a wooden coffin, according to religion, Muslims prefer to bury their dead without this. Some local authorities in the United Kingdom (Batley and Dewsbury, for example) allow this practice.
Religious law does not allow Muslim women to attend burials,9 and they do not in practice, even if a female relative or a baby has died. This is as a result of the belief that women are of “faint heart” and will easily break down. Some visit the grave at other times in spite of this practice being religiously “reprehensible.”5 Although graves are dug by grave diggers, the filling in with earth is carried out by the relatives. Graves are dug in such a way that the face of the deceased faces Mecca.
As the body is sacred it should not be abandoned by members of the dead person's family and therefore it is rare for undertakers to be involved in Muslim funerals. Usually a family car or van is used to carry the body to the cemetery. Shiites, though a small minority compared with Sunni Muslims in Britain, are well organised and have their own “hearse” (and have negotiated burials over weekends in Birmingham). Religious customs surrounding death are similar in Shiite and Sunni Muslims.
As it is not always possible in Britain to comply strictly with all the Islamic rules for burial, some families (particularly Pakistanis) take the dead back to their homelands, in which case the bodies are embalmed by funeral directors. This practice is deprecated by religious leaders in Britain and Muslims are encouraged to bury the dead locally. Sending bodies entails much bureaucratic delay, which adds further distress to the relatives. If local authorities in Britain would allow compliance with Islamic rules (for example, burial without the box) burial in Muslim homelands would certainly diminish.
Attendants at funerals cover their heads with a cap or hat as a mark of respect. Muslims are buried in a separate area designated for them in the common cemetery of a town or city in the United Kingdom. Those attending the funeral form a double line facing each other and the bier is passed on the shoulders along this line towards the grave. In the case of a child, the bier is carried in the arms of a relative. After the funeral, a “wake” is held for both the men and the women, usually on the same day, in the form of a meal for all those attending the funeral.
If Muslims die in circumstances where they do not have relatives or friends, the elders of the Muslim community of the town will arrange for the ritual washing and also the funeral at their own expense.
The initial bereavement period lasts for three days, during which prayers in the home are recited almost continuously. Public rites are for men only. According to religious laws a Muslim wife is expected to stay in her home for up to 4 1/2 months after the death of her husband or, if she is pregnant, until pregnancy ends. This is important in establishing that pregnancy was progressing before death of the husband. Most Muslim women in the United Kingdom follow this unless they are, or have now become, breadwinners, in which case there is a religious dispensation.
Shoes are taken off before entering the house of the bereaved, and it is customary to cover one's head when talking about the person who has died. People often sit on the carpet to pass on their condolences. Traditionally, black clothes or veils are not worn during bereavement - most people wear plain simple clothes with no make up or jewellery. It is not customary to send wreaths or flowers. No collection is made or donations given.
The extended family network provides a great deal of support for the bereaved. Because of the physical proximity of family members and the custom of talking through the experience a feeling of loneliness and isolation is less common. Most Muslims have religious explanations for a person's death, particularly that of a child. Guilt is a common component of bereavement10 and is incorporated into the grieving process, which is dealt with openly. Religion encourages sharing of grief and provides the means for absolving it. This should be appreciated before any counselling is attempted.
As organ transplantation has not been explicitly dealt with in the Koran or the Hadith, there is a difference of opinion among the ulamas. Those from Arab countries consider it permissible, but those from the Indian subcontinent11 believe that organ transplantation is not permissible because human life is sacred; the human body is entrusted to an individual and thus does not belong to him or her; and transplantation can lead to illegal trade in organs and the poor would suffer.
In 1967, when Razur Rahman was director of the Islamic Research Institute of Pakistan, he sanctioned “eye” transplants on the principle that “the needs of living humans have priority over dead ones.”4 Leading ulamas questioned this and did not agree. The Muslim community in general, however, has had a positive attitude despite the ulamas' disapproval.
Although, in the words of the prophet Mohammed, “the breaking of a bone of a dead person is equal in sin to doing this while he was alive,”7 as far back as 1952 the supreme head of the Islamic School of Jurisprudence in Egypt stated that if anything was of “good” for mankind then “necessity allows what is prohibited.” Such rulings allow transplants of organs as long as the following conditions are satisfied11: a transplant is the only form of treatment available; the likelihood of success of the transplant is high; the consent of the donor or next of kin is obtained; death of the donor has been fully established by a Muslim doctor of repute, or there is no imminent danger to the life of a living donor; and the recipient has been informed of the operation and its implications. Donation to a Muslim should only be to save his or her life 12, 13; and organs are accepted from a non-Muslim only if not available from a Muslim.
Donation of organs is a theoretical issue in Muslim countries as they generally have a very basic medical service, with transplants taking a very low priority. High ranking Muslim jurists in Pakistan have advised that donation of organs is not allowed (M Y Sacha, personal communication). With sympathetic and informed counselling, however, the objections can often be overcome - “no organs” are donated during a bone marrow transplant, for example.
Discussions concerning organ transplantation should be initiated by the transplant team: other professionals have in the past relayed conflicting advice to parents and this has resulted in the patient not being treated. This team should include a liaison officer who works in the Asian community providing advice and support to families of patients needing organ transplantation and also those families whose children have undergone a transplant operation. In Birmingham, parents of children who have had an organ transplant help the team in discussions with prospective transplant families. Emergency blood transfusions are allowed by Islamic law.6
I have highlighted some events surrounding death of Muslim patients who in the United Kingdom predominantly come from India, Pakistan, and Bangladesh. There will be some differences with Muslims from the Arab world, largely concerning bereavement and organ transplantation; the other issues are strictly adhered to throughout the Muslim world.
Sincere thanks to the Waterval Islamic Institute, Johannesburg, South Africa, without whose help and guidance it would have not been possible to prepare this manuscript.