Social Work Engagement With a Dying Muslim Patient

Introduction and Initial Engagement

The first practical challenge in this case is getting past Mr. Fahza's son in order to reach his father. Securing the son's agreement is essential because it enables a smooth start to the engagement process. His cooperation would encourage discussion under the right conditions and set a constructive tone for everything that follows.

Legal and Cultural Context for End-of-Life Disclosure

According to the Patient Self-Determination Act (PSDA) of 1990, Mr. Fahza has the right to be informed about his own clinical condition in order to make a decision about whether to continue with chemotherapy or to enter hospice and die peacefully. This reflects the standard approach of the Western healthcare system.

The religion of Islam, like Christianity, holds beliefs in the death and resurrection of the body and soul, and it teaches believers how to prepare for death when its imminence becomes clear. Statistics show that a vast majority of American men would want to know about the eventuality of dying from a fatal illness in its final stage. As a male Shi'a Muslim in his late eighties, Mr. Fahza is very likely to feel relieved — and even grateful — to be told that he could go home and prepare for his end, given that medicine can no longer alter its course.

Chemotherapy is a long, strenuous, and very painful treatment. An 87-year-old patient in the last stage of cancer is more likely to be willing to forgo it once he understands that his illness is terminal. It must be kept in mind that informing a patient about his condition is entirely different from euthanasia. The preliminary discussion with the son should establish this distinction clearly. The social worker will not introduce that word into the conversation, but will help the son gradually reach this understanding on his own terms.

Gathering Patient Background and Avoiding Stereotyping

As the literature indicates, it is very important that the social worker understands the meaning of death for a Shi'a Muslim originally from Iran, as well as the attitudes toward death prevalent in his community. The patient's origins and his American experience are both relevant. Furthermore, the patient's son is at his father's bedside, which adds an emotional dimension to the situation that must be handled carefully.

Social workers are required to approach their patients with a foundational principle: patients are individuals. Statistics are useful only up to a point. Firsthand information is more valuable than statistical generalizations because it helps the social worker form an accurate picture of a specific person in a specific circumstance. As individuals, patients have a personal history. It would be helpful for the social worker to learn — perhaps from the son, or from Mr. Fahza himself — how long the patient has been living in the United States. Since the patient does not speak English, the social worker can reasonably infer that acculturation has occurred only to a limited degree. The social worker should also seek to understand the patient's level of education, his occupation, his living situation, and the rest of his family network.

After gathering the necessary information to address this matter of life and death, the social worker must take care not to stereotype or fall into miscommunication. Questions related to the kind of support the patient might need from care providers in view of his imminent death are important for building his trust that the social worker is on the right track. Information about decision-making patterns within Mr. Fahza's family, and about other significant people in his life, is also relevant to the case.

Koenig and Gates-Williams (1995) warn against the dangers of stereotyping. Once the social worker has gathered enough information about a patient's personal life, she must carefully analyze it and refrain from making assumptions based on what the majority of similar cases might suggest. Comparing is only productive when paired with contrasting in social work practice. These authors emphasize that studies, research results, and statistics are useful tools, provided the social worker never loses sight of the fact that the person she is speaking with is an individual human being confronting an extreme situation.

In this case, the views of the patient and his son may differ significantly regarding placement in a home hospice setting. The son may have various reasons for not wanting his father to die at home. It is important to explore why the son insists on his father remaining in the hospital — even if that means continuing chemotherapy. Beyond the possibility that he is in denial about his father's dying, there may be other factors at play. The social worker must be aware of any divergence of opinion between the two and work toward the best possible solution for the patient.

References

Kagawa-Singer, M., & Backhall, L. (2001). Negotiating cross-cultural issues at end of life. Journal of the American Medical Association, 286(3001), 2993–3001.

Koenig, B. A., & Gates-Williams, J. (1995). Understanding cultural difference in caring for dying patients. Western Journal of Medicine, 163(3), 244–249.

Coolen, P. R. (2012). Cultural relevance in end-of-life care. EthnoMed.

Rizvi, S. M. What you should do just before death. Islam.org.

Peveto, C. A. (2005). Cultural changes in attitudes toward death, dying, and bereavement. Springer Publishing Company.

Searight, H. R., & Gafford, J. (2005). Cultural diversity at the end of life: Issues and guidelines for family physicians. American Family Physician, 71(3), 515–522.