Evidence-Based Complementary and Alternative Medicine as permissible in cases of chronic illness and an obligation in cases of emergency in which loss of life would occur if the person was not treated [15]. Pain relief by analgesic, including morphine, to prevent suﬀering is allowed and recommended, even if it hastens death, since actions are judged by their intention. The Muslim believes that pain expunges sins, but pain must be treated because God opposes human suﬀering; (see Jotkowitz and Zivotofsky [25] for an extended discussion of the varying, though similar, Jewish approaches to pain relief). 3. Thinking about Death A second foundational aspect of the palliative approach is that death is not the enemy. In Islam, death is inevitable and occurs only with a command from God: “Every soul shall have a taste of death: in the end to Us shall you be brought back” [34] (29 : 57). It also states, “Wherever you are, death will ﬁnd you out, even if you are in towers built up strong and high” [34] (4 : 78). “From it (the earth) did We create you, and into it shall We return you, and from it shall We make you appear once again” [34] (20 : 55), referring to life after death. Death should not be resisted or fought against, but rather it is something to be accepted as part of the overall divine plan [35]. “It is God who creates you and takes your souls at death” [34] (16 : 70). When death is approaching, believers should pronounce the Faith of Testimony (Shahada): “There is no god but Allah, and Muhammad is the messenger of Allah.” This short, important ritual consolidates the dying person’s expectation that death is not the end, and that he or she is now entering the world of the divine with the proper attitude. Death is the will of God: “It is not possible for a soul to die except with the permission of God at a term set down on record” [34] (3 : 139). The only guarantee that comes along with birth is death. “To God we belong and to Him is our return” [34] (2 : 156). Death is unpredictable and can happen at any time and as such Muslims should always be prepared for the inevitable and for what is about to occur. “When their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour” [34] (16 : 61). Death is but a gateway from this short but mortal existence to a life of immortality in the afterlife. The Quran always aﬃrms the unlimited mercy and forgiveness of God, but links future life to performance in the present life, from birth to death [36]. The earth is described as a resting place for the purpose of worshipping God and doing good deeds [34] (2 : 20-21). In Judaism, there are sharply contrasting views of how to think about death. Very common is the belief articulated well by Rabbi Lord Immanuel Jacobovits, the late chief rabbi of England and founder of the modern study of Jewish medical ethics, who writes that the parallelism in Deuteronomy 30 : 15—“behold, I set before you this day life and good and death and evil”—indicates that death is evil. Without discounting that prevalent view, we would like to round out the picture by examining two sources from the Jewish tradition that endorse the belief that death is not the enemy. Rather, in this view, life is a wonderful gift. It 3 is an opportunity to serve the Creator and, for this reason, we do our best to preserve life. “And G-d saw all that He had made, and behold it was very good” (Genesis 1). In the teachings of Rabbi Meir they found written: “And behold it was very good”—behold how good is death.” (Midrash Genesis Rabbah 9 : 5). The beginning of Genesis describes the creation on each of the ﬁrst ﬁve days; at the end of each day, God looks at what He has created and declares that “it was good.” Yet at the end of the sixth day of Creation, the text is slightly but signiﬁcantly diﬀerent—God declares that “it was very good.” What is the signiﬁcance of the extra word, very? Rabbi Meir teaches that there is something additional, not explicitly mentioned in the text, which is also good. Perhaps, surprisingly, he teaches that this “hidden” ﬁnal good element of creation is death itself. Another source explains, in greater detail, how it is it that the fact of death’s existence is actually something positive: “(The angels) said to the Master of the Universe, “It is better for you to give the Torah to the heavens, since we are holy and pure, and the Torah is holy and pure, and we live (eternally), and the Torah is the tree of life, it’s better that it should be given to us!” He said to them, “It cannot be fulﬁlled in the heavens, as it is written, “It is not found in the land of [eternal] life” (Job 28). Rabbi Nehemia said in the name of Rabbi Yehuda, “Draw a parable to a man who had a son who lacked one ﬁnger, and he took him to learn the arts. There was one art which requires all the ﬁngers. After some time his father came to see him and found that he had not learned that art. He asked his teacher, “Why have not you taught him this art?!” He replied, “This art requires all the ﬁngers. Your son is lacking one ﬁnger, and you are asking for him to learn this art?” So too God said to the angels, “You cannot fulﬁll the Torah, for you do not reproduce, you do not have impurity or death or sickness, rather you are all holy!” (Midrash Psalms 8). Let us closely examine this text. The Torah is the collective body of God’s teachings in general, often used to mean the Five Books of Moses in particular. This text teaches that man is able to fulﬁll God’s commands better than the angels, immortal and perfectly pure, ever could. The very fact of our mortality and our experience with impurity enhances mankind’s ability to serve God. In Judaism, impurity is generally a function of contact with the world of the souls (contact with a dead body, giving birth, the unfertilized life ending in menstruation) or, in eﬀect, of contact with death. The angels, who live forever, are actually in this sense lesser beings than mankind, who have contact with death, because one grows as a person as a result of living with the reality of death. This takes shape in numerous diﬀerent ways. The reality of death provides us with the fundamental attitude of gratitude for our very lives. The fact that our time might run out at any moment provides us with motivation to live our lives well, every single day. Many of our patients report how the experience of illness has taught them valuable lessons, such as self-respect and the willingness to admit that we are not in complete control, and helped them to grow as a person. The same can hold true for friends or family members of someone who is ill. In this view, the creation of death as a part of our world is, in fact, “very good.”