The Council on American-IslamicRelations is a non-profit, membershiporganization dedicated to presenting anIslamic perspective on public issues.

CAIR Research Center conducts researchon the American Muslim experience. Thecenter can be reached at: researchacair-net.org.

Dr. Mohamed Nimer is the director ofresearch and author of CAIR Guides toIslamic religious practices.

This publication has been written in con-sultation with:

• Mohamad Adam Elshiekh, Imam andDirector of the Islamic Society ofBaltimore, Maryland, and Member ofthe Fiqh Council of North America.

• Maher Hathout, Cardiologist, Duarte,California.

• Asma Mubin-Uddin, Pediatrician,Columbus, Ohio.

• Janan Najeeb, Diversity Trainer,Milwaukee, Wisconsin.

• Athar Shahid, Chair of Medical Ethics,Islamic Medical Association.

© Copyright 2005Council on American-Islamic Relations

A Health Care

Professional's

Guide to

Islamic

Religious

Practices

"There is a cure for every disease. Whenever an

illness is treated with its right remedy, it will, by

Allah's permission, be cured."

Saying of Prophet Muhammad

Call to prayer.God.A day of festivity and majorreligious holiday.Permissible by Islamic law.Clothing Muslim womenwear in public. It is general-ly loose-fitting and includesa head covering. Also calledkhimar.Prayer leader.Funeral.Friday (prayer).A cap worn by some Muslimmen.Islam's scripture.The month of fasting.Islamic law.Symbolic cleansing beforeprayer that does not requirewater.Ablution, or ritual washingbefore prayer.

Glossary of Muslim Terms

AdhanAllahEid

HalalHijab

ImamJanazahJum'ahKufi

Qur'anRamadanShari'aTayammum

Wudu

According to demographers, Islam isthe world's second largest faith,with more than a billion adherents.

Muslims are a dynamic segment of theAmerican population. This multi-ethnic,rapidly growing group adds a new factorin the increasingly diverse character ofpatients in the health care system. Theinformation in this booklet is designed toassist health care providers in formulatingand implementing policies and proce-dures aimed at the delivery of a more cul-turally competent care. It will also serve asa guide for the accommodation of reli-giously mandated practices of Muslimpatients.

Muslim View of Illness andTreatment

Muslims receive illness with patienceand prayers and consider it, like other lifeevents, a test from God. Death is part ofevery human's ultimate journey to the nextlife. Yet the Quran admonishes those witha fatalistic attitude towards life. TheProphet Muhammad taught that maintain-ing a healthy body is an individual's dutyand urged Muslims to seek treatmentwhenever needed. According to one say-ing of the Prophet, disease is part of fate,and so is its cure. There is a consensusamong Muslim jurists that preserving life isthe supreme objective of Shari'a, orIslamic law. Caring for the sick and theweak is a collective, societal responsibility.

U.S. Legal Protections of ReligiousFreedom

Prayer, fasting, pilgrimage, religiouscelebrations, and dietary and clothingrequirements are long standing practicesof members of the Muslim faith. Such reli-giously mandated expressions are protect-ed by the First Amendment to theConstitution, which protects the freedomto practice one's religion. Federal andstate laws prohibit discriminatory prac-tices on the basis of sex, race, religion,and national origin. Although religiouspractices of different faith traditions mayhave common elements, the details whichdefine what is proper religious practicemay differ from one religion to another.

Daily Prayer

Islam urges "God consciousness" in theindividual's life. To that end, Islam pre-scribes that believers perform prayer fivetimes each day. Each prayer takes five toten minutes offered any time during thefollowing periods:

1. Daybreak until just before sunrise.2. Midday until afternoon.3. Late afternoon until just before sun set.4. Sunset until darkness.5. From darkness until midnight.

Hospitalized patients and individualsin nursing homes may ask to be alerted inorder to fulfill this religious duty on time.During the act of worship, which include

specific recitations from the Qur'an, theMuslim will stand, bow and touch theforehead to the ground. Patients who can-not stand or kneel may pray using headmotions (or even eye motions, should thecondition require) in their beds. Patientsmay bring to the hospital a Quran andprayer rug. As an expression of respect,Muslims do not place anything on top ofthe Quran.

Washing

Before prayer, Muslims wash theirface, hands and feet with water. Thiswashing is performed as needed andcalled wudu, or ablution. In hospitals andnursing homes some patients may needassistance in washing. They will be grate-ful if their nurse knows of this need. Thewashing is normally performed in a restroom sink or other facility that has runningwater, and takes about two minutes. It maytake a little longer for some patients,depending on their mobility. Patients withno mobility may carry out tayammum, orsymbolic ablution, if there is no one avail-able to wash them. Also, taya mum canapply to areas of the body that, for med-ical reasons, cannot come in contact withwater (casts, bandages, etc.).

Prayer Space

Worship may be performed in anyquiet, dry, clean place. During the prayers,the worshiper will face toward Mecca

(generally northeast in America, except inHawaii and western Alaska whereMuslims face northwest). Total privacy isnot required. However, others should notwalk in front of or interrupt the worshiperduring the prayer. He or she may notrespond to a ringing telephone or conver-sation. Doctors and nurses should wait toaddress the patient until the the end of theprayer. However, in case of emergency,the Muslim will respond to an announce-ment by stopping the prayer immediately.

Relatives and friends visiting patientsaround evening prayer time would appre-ciate it if health care providers informthem about the nearest chapel where theycan offer their prayer. Chapels that canaccommodate Muslim needs must haveadequate space. Also, they must be clearof images of living creatures. Muslim wor-shippers stand in line, bow and touch theforehead to the ground.

Friday Congregational Prayer

Friday is the day for congregationalworship in Islam, called Jum'ah. It lastsabout forty-five to ninety minutes andtakes place at the mosque (a house of wor-ship) during the noontime prayer andincludes a sermon. Sick people do nothave to attend the congregational prayer.However, seniors in nursing homes wouldappreciate any assistance in traveling tothe nearest mosque. Mosque administra-tors may be willing to help arrange thetransportation and accommodation of dis-

abled persons wishing to attend mosqueservices.

Fasting

Islamic holy days and festivals followthe lunar calendar. Like the solar calendar,it has twelve months. However, a lunarmonth, which is marked by the rise of anew crescent on the horizon, may lastonly twenty-nine days. Thus a lunar year isabout eleven days shorter than the solaryear, causing the Islamic holy days tomove forward about eleven days eachyear.

The month of Ramadan, the ninthmonth of the Islamic lunar calendar, is thetime in which Muslims are to fast.Observing Ramadan means refrainingfrom eating, drinking (and smoking) andsexual activity from dawn to sunset.Ramadan is a period of personal restraintand a time of focus on proper conduct. Itis also time to empathize with those whoare less fortunate and to appreciate whatone has.

Fasting is prescribed for those who arementally and physically fit. Those exempt-ed from fasting include children under theage of puberty, those who are too old tofast, nursing mothers, pregnant women,those who are menstruating, and the sick.

Sick persons can defer fasting andmake up the missed days at a later time.Emergency medical care can be givenwithout reservation. In non-emergency sit-

uations, fasting Muslims will usually agreeto medical testing but not to nutritionalintravenous injection. Still, the observanceof the fast may require the postponementof some medical procedures. Medicaltests and drugs can be administered aftersundown or after the Ramadan fast ends ifpossible. Fasting Muslims can have dropsput in the eyes or ears. These decisionsmust be made by the patient in consulta-tion with hislher doctor.

Muslim Holidays

There are several days in the Muslimcalendar with special religious signifi-cance. However, Muslims celebrate Eid (aday of festivity and major religious holi-day) twice a year. The first is celebrated onthe three days after the month of Ramadanends. The second is celebrated on thetenth through the thirteenth days of thetwelfth Islamic month. The feasts includecongregational prayer, family visitationsand gift exchanges. A typical greeting onthese occasions is "Eid Mubarak," orBlessed Eid (pronounced "eed moo-BAR-ak). Eid days are devoted exclusively tofamily and community. Elective medicaltests and procedures should be scheduledaround the holidays. Hospital administra-tors should add Muslim holidays to theircalendars. Local Islamic centers would beable to furnish such information in a time-ly manner.

Dietary Requirements

The Qur'an prohibits the consumptionof alcohol and pork. Therefore, practicingMuslims are careful about the food theyconsume and how it is prepared. Muslimsfollow certain standards—called halal(permissible)—of slaughter and prepara-tion of meat and poultry. Some objection-able food items include:

• Pepperoni, sausage, and hot dogs con-taining pork.

• Bacon—alone or in soups, quiche, etc.• Animal shortening—in breads, pud-

ding, cookies, cakes, donuts, etc.Vegetable shortening is acceptable.

• Gelatin—in Jello, desserts, candies,marshmallows, chocolates, etc.

• Lard—in any product.• Food ingredients containing alcohol,

such as vanilla extract and Dijon mus-tard.

Health care centers can order Muslimspecial meals from certified halal foodproviders. If this is not possible, patientsmust be given choices that meet Muslimdietary requirement (such as vegetable,egg, milk and fish). Some patients mayobject to fish without scales, for instance,catfish.

Physicians should avoid prescribingmedical pills coated with pork-extractedgelatin. Also, some types of medications,such as cough syrups, often contain alco-hol. If available, alternatives to these med-ications should be prescribed. For

instance, the pediatric formulations ofmost cough syrups do not contain alcoholand can be given to adult patients after thedose is adjusted.

Clothing

Islam prescribes that both men andwomen behave and dress modestly.Muslims believe that an emphasis onmodesty encourages society to value indi-viduals for their wisdom, skills and contri-bution to the community, rather than fortheir physical attributes. There are a num-ber of ways in which Muslim men andwomen express such teachings.

Men and boys are always to be cov-ered from the navel to the knee. Also,some Muslim men wear a small head cov-ering, called a kufi. When in public, manyMuslim women wear loose-fitting, non-revealing clothing, known as hijab, or khi-mar. This attire, which may vary in style,includes a head covering. Female patientsmay wish to maintain this head coveringthroughout hospitalization (even in bed),or may ask staff to hang a "Please knocksign on the door so they may cover theirheads before a non-relative enters theroom.

Doctors and nurses should notdemand the removal of any piece of cloth-ing unless there is a clear need for it. Also,if possible, males—except the husband—should not be allowed in the room.

Touching

For those who have reached puberty,Islam prescribes certain parameters forrelations between the sexes. For example,many Muslims are reluctant to shakehands with the opposite sex. This shouldnot be taken as an insult, but as a sign ofpersonal modesty. Patients may ask for asame sex nurse and doctor.

Birth and Circumcision

Following Prophetic tradition, Muslimparents whisper the adhan (call to prayer)close to the right ear of a newly born baby.This ensures that among the first words aMuslim infant hears is an invitation to fol-low God. Circumcision is required only ofmale babies and usually takes place with-in the first seven days of life. Should therebe any medical reason, it can be per-formed during later childhood years.

Death

It is essential that family members (orthe local mosque if family members can-not be reached) know immediately whena patient is dying. Many would like to bepresent during the last days to hold specialprayers with the person. If family can notcome soon, the imam (prayer leader) oncall can counsel the patient.

In accordance with Islamic tradition,family or community members wash thebody of the dead and bury himlher quick-ly. Cremation is not permissible and

embalming should not be performedunless required by law. The imam on callor the local mosque must be notifiedimmediately to accommodate Janaza(funeral) service. Patients may have in theirwill requests specifying where they shouldbe buried and who should handle theirfuneral and burial. Such requests shouldbe accommodated. Hospital staff may askabout such a will and may encouragepatients to put all their requests in writing.

On Call Chaplains

Hospitals should designate imams, orMuslim chaplains, to serve their Muslimpatients. They can advertise to inviteapplicants or contact the nearest Islamiccenter to ask for recommendations andcontact information. CAIR's websiteincludes information that can help findthe nearest Islamic center (See the backcover for CAIR's internet address).

Autopsy

Islam prohibits the mutilation of deadbodies because it shows lack of respect forthe dead. Unless required by the police inconnection with an investigation, anautopsy should not be performed.However, autopsy for medical researchmay be acceptable if respect for the bodycan be guaranteed. Providers should care-fully explain the need for the procedurewith the patients and/or their relatives.

Assisted Suicide and Euthanasia

The Quran teaches that God is thegiver and taker of life. ProphetMuhammad taught that suicide is a gravesin. Assisted suicide and euthanasia arenot permitted.

Abortion and Stillborns

Muslims do not generally approve ofabortion, although many would welcomeother birth control measures. Still, abor-tion is permissible to save the life of themother. Burial of stillborns is a very sensi-tive matter. Many Muslim patients wouldstrongly oppose treating miscarried fetusesas "medical waste" and would insist on aproper funeral and burial. Health careproviders must carefully consult with theparents on this issue.

Other Medical Procedures

• Blood transfusions are permissible.Some patients may prefer directedblood donations (from relatives) toanonymous ones.

• Maintaining a terminal patient on arti-ficial life support for a prolonged peri-od in vegetative state is not encour-aged.

• Transplantation is generally allowedafter consultation with the patient orhislher guardians.

• Organ donation is permissible if thereis a will or if the family permits it.

• Artificial reproductive technology,including surrogate motherhood,sperm and embryo donation, is notpermitted except between husbandand wife during the span of an intactmarriage.

Civil Rights Reports1996 - The Price of Ignorance

1997 - Unveiling Prejudice

1998 - Patterns of Discrimination

2001 - Accommodating Diversity

2002 - Stereotypes & Civil Liberties

2003 - Guilt by Association

2004 - Unpatriotic Acts

GuidesEmployer's Guide to Islamic Religious Practices

Educator's Guide to...

Health-Care Provider's Guide to...

Correctional Institution's Guide to...

Law Enforcement Official's Guide to...

Know Your Rights Pocket Guide

Voter Registration Guide (groups, orgs, etc.)

Muslim Community Safety Kit

Other PublicationsU.S. Congress Handbook (full color)

American Muslims One Year After 9/11 (special)

Media Relations Handbook

The American Mosque - Mosque Study Project

A Rush to Judgment

The Usual Suspects

A Model for School District Religious Policy

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Mosque Open House pamphlet

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