1. ISLAMIC MEDICAL EDUCATION RESOURCES029912-LIFE, al hayatLecture for 1st year students at the Kulliyah of Medicine, International Islamic University, Kuantan on 18th December 1999OUTLINE1.0 DEFINITION OF LIFEA. Biological, Chemical, Physical, And Spiritual LifeB. Levels Of LifeC. Start Of LifeD. Stages Of LifeE. Ownership Of Life 2.0 THE QUR'ANIC CONCEPTS OF LIFEA. Life Is From AllahB. Physical Basis Of LifeC. Spiritual Basis Of LifeD. Ruh As The Permanent Essence Of LifeE. Life Is Dynamic: Constant Change 3.0 NATURE OF LIFEA. Continuum Of LifeB. Life SpanC. Life As A TestD. Criteria Of LifeE. Success And Failure 4.0 QUALITY OF LIFEA. Concept Of Quality Of LifeB. Quality Of Life And BiorechnologyC. Measures Of Quality Of LifeD. Uses Of QOL IndicesE. Toward An Islamic QOL Index 5.0 VALUE OF LIFEA. Life As A GiftB. The Right To LifeC. Sanctity Of LifeD. Material Worth Of LifeE. Moral Worth Of Life1.0 DEFINITION OF LIFEA. BIOLOGICAL, CHEMICAL, PHYSICAL, and SPIRITUAL LIFECONCEPTSLife is a complex phenomenon with biological, chemical, and spiritual components. Human life is a unique combination of biology, chemistry, physics, chemistry, matter, energy, and spirit. 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 borderline and require a clear definition. 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. Both life and death are earthly events (7:25). Life exists in the hereafter; but death does not. Humans share biological life with plants and animals. They share spiritual life with angels. BIOLOGICAL LIFEThe biological definition is not straight-forward. 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. There are several biological phenomena that are synonymous with life: reproduction, growth and development, innate purpose action, and change. One of the signs of life is dynamic change and cyclicity. 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 CHEMICAL LIFELife 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. The reactions associated with life are self-initiated, purposive and coordinated with one another. Viruses make a very fine line between life and death. They also make a fine distinction between the organic and the inorganic. They have some properties of what are normally living things. They however can not carry out the whole range of metabolic processes associated with life and must be obligate parasites. Viruses can not on their own manufacture all the proteins they need. Viruses also have properties of non-living things like crystallization. BIO-PHYSICAL LIFELiving things have the ability of transforming one form of energy into another. This energy transduction occurs among light, heat, chemical, and electric energy. There could be other forms of energy related to life that we do not yet know. SPIRITUAL LIFELife 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. B. LEVELS OF LIFELife can be described at various levels: ruh, the whole living organism, the organ, the tissue, the cell, sub-cellular structures, 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 the ruh in addition 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 for a longer time and they eventually also disappear. 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 main functions of blood circulation, respiration, nutrition, and metabolism require cooperations of various organs and tissue of the organism. The various organs of the body have a life and an individuality of their own and will bear witness against the humanshahadat al a'adha (p 230 24:24). The cell is a basic unit of life. All life's complex functions and properties can be subsumed in the cell. Unicellular organisms are the simplest forms of life. Generally individual sub-cellular structures are not considered to have life if considered in isolation. C. START OF LIFEADAM AND HAWAHuman 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 in a physical form from the elements of the earth. They were created from clay and became humans when the ruh was inserted into them. 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 semi-conservative replication of DNA ensures that some atoms from the previous generation are part of the DNA of the next generation. 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. MOTIVATION TO DEFINE START OF LIFE IN UTERO: The motivation is of practical materialistic and not academic or spiritual 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. 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 rather than wait for them to occur and escape their consequences by abortion or feticide. LEGAL CONSEQUENCES OF DEFINING START OF LIFE IN UTEROTrauma or any other man-made cause of fetal death would be considered homicide only if it occurred after the defined start of life. Abortion before the defined start of life in utero would be considered legal. 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. The Islamic position is that 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. RESEARCH CHALLENGESThe issues of the start of life have not been studied by Muslims well. The aim of such research should be detailed understanding of early life and not defining the exact moment of its start. 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 living organic and non-living organic material. 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. D. STAGES OF LIFELife can be looked at in three stages: pre-uterine phase, uterine phase, the post-uterine phase, and the after death phase. The post-uterine phase has in return got two stages: life on earth, hayat al duniyat, and life in the hereafter,hayat al akhirat. All these are stages of biological life. The Qur'an has mentioned two lives and 2 deaths (40:11). The biological interpretation of this verse is still a challenge. The two lives could be life on earth on earth and life in the hereafter. We know of only one death on earth. Allah knows best what the other death is. Life on earth is described as enjoyment, hayat al 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). 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 unraveled by scientific research and exploration. E. OWNERSHIP OF LIFELife 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 enjoined to take good care of it. 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. 2.0 THE QUR'ANIC CONCEPTS OF LIFEA. LIFE IS FROM ALLAH3:1567:1588:4215:2323:8025:330:4040:7140:6845:2650:4353:4457:227:2 B. PHYSICAL BASIS OF LIFEThe complex molecules of the human body are from a few basic elements that are most abundant in nature: hydrogen, oxygen, carbon, calcium, and phosphorus. 15:26 Humans created from clay and dust16:4 Humans created from nutfat22:5 Stages of creation starting with the soul, then the nutfat then the clot then the flesh23:12-14 Stages of creation: soul then nutfat then 'alaqat25:54 Creation from water30:20-21 Creation from dust32:7-9 Creation from dust35:11 Stages of creation soul then nutfat38:71 Creation from twiin77:20-23 Semen C. SPIRITUAL BASIS OF LIFEHuman life is a combination of the physical elements and the ruh. The physical part is created first followed by the insertion of the soul, nafakh al ruh. The nature of the insertion of the ruh is not known for certain to us. It may be a purely spiritual phenomenon or may have some biological and physical aspects. The Qur'an has described the spiritual component of life in the verses 15:29, 32:9, and 38:72 D. RUH AS THE PERMANENT ESSENCE OF LIFE E. LIFE IS DYNAMIC: CONSTANT CHANGEThe Qur'an has described dynamic changes in human life (4:28, 16:70, 22:5, 30:54, 36:68, 95:4-5). Dynamic changes are also found in animals and the physical world. What is unique about humans is that their dynamism is purposive and is directed because they have a will and an intellect. 3.0 NATURE OF LIFEA. CONTINUUM OF LIFEThere is a continuum in human life. The start is the state on non-existence, 'adam. Allah then created the souls and took an undertaking from them to worship him. This undertaking is called the covenant, 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 physical death and the souls continue existing into eternity. Life in the interregum, hayat al barzakh (23:100) is an intermediate stage between life on earth, hayat al duniyat, 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 paradise, jannat, while others will be in hell, jahannam, being punished for their transgressions on earth. B. LIFE SPANHuman 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 timing of the ajal is known by Allah alone. The Qur’an has taught the concept of a fixed time of death for every human, tahdiid ajal al mawt (p 1153 63:10-11; p 73 145, 6:60, 10:11, 14:44, 22:5, 39:432, 63:10-11). Only Allah knows this time. Human ignorance of this time,jahl al insaan bi zaman al mawt ( p 1155 31:34) is one of the limitations of human knowledge of the absolute unseen, ghaib mutlaq. 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. C. LIFE AS A TESTLife on earth is a test for humans (p 382 67:2). Those who pass the test succeed. The most important test is to know and fulfil the purpose of life. 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. D. CRITERIA OF LIFEThe 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. E. SUCCESS and FAILURELife can be a happy one, hayat saidat, or unhappy, hayat dhankat (20:124). A good life is related to good deeds (p 382 16:97). Success and failure are experienced both on earth and in the hereafter. 4.0 QUALITY OF LIFEA. CONCEPT OF QUALITY OF LIFEHuman 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. 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. 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. QUALITY OF LIFE and BIOTECHNOLOGYIssues 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. C. MEASURES OF QUALITY OF LIFETraditional 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. Their interpretation is often subjective. The new QOL indices are predictors of the goals. They are based on 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 Questionnaire: 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. D. USES OF QOL INDICESQOL 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. E. TOWARD AN ISLAMIC QOL INDEXThe definition and use of QOL indices reflects the cultural and philosophical background as well as the world view of the judeo-christian and greco-roman traditions. Islam being a separate civilization has its own world view and this affects the formulation of QOL indices. Unfortunately Muslims have not yet worked on defining QOL from the Islamic context. 5.0 VALUE OF LIFEA. LIFE AS A GIFTHuman life is a gift from Allah ,ni’imat al hayat (p 1236 16:78, 67:23). This can be appreciated from several vantage points: statistical probability, good health, sustenance, and social. Humans must be grateful to Allah for the gift of life by worshipping Him (ibadat). Statistical probability: 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 fertilized ova do not grow into fetuses but are aborted early. Good health: The prophet said that health, sihhat, and afiyat are two bounties that many people do not enjoy. Few people are healthy in all their organs and at all times. Sustenance, rizq: Allah gives humans the gift of life and also gives them sustenance. Sustenance is a manifestation of the continuation of rububiyat. Social aspect: Social aspects of life as a given can be visualized in the form of offspring, relatives and spouses. 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). Relatives in the extended family are a source of psychological support. Spouses give both psychological and physical comfort. B. THE RIGHT TO LIFEEach 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. C. SANCTITY OF LIFELife 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. Because of its importance some jurists have put it in the first position above hifdh al diin because diin can not survive in the absence of life. D. MATERIAL WORTH OF LIFENo material value can be put on human life. Legal compensation for bodily damage or homcide is replacement of lost earnings and not paying for the value of life. The compensation is a legal provision to provide sustenance to surviving relatives in case of death. It also provides sustenance to the person whose organ was severed and therefore can not work to support himself. E. MORAL WORTH OF LIFEDestroying the life of one person is equivalent to destroying the life of all humans DISCUSSION1. What is the essential difference between animal and plant life?2. What is the essential difference between human and animal life?3. How does life of a single cell relate to the life of the whole organism?4. Describe what you understand by sleep being a type of death5. Define spiritual death6. What do you understand by the statement that Allah gives and takes away life7. What is ajal; how would this concept apply to parts of the body © Professor Omar Hasan Kasule Sr. December 1999