INTRODUCTION

Attitudes towards death

Death is unavoidably and irreversible experience and not within our control. It leaves the survivors in grief, distress, and sorrow (Sarbey, 2016). Though death is a universal phenomena, general public responses vary greatly about death, according to the situation and background of a person - such as a study report that nurses have a varied level of death fear depending on their experiences (Khader and others, 2010). Smith and Feldman (2005) report that differences in the attitude towards death varied according to the level of emergency medical technicians, EMTs (EMT basic/EMT intermediate, EMT-B/EMT-I versus EMT paramedics).

Religion and attitudes to death

The varied responses and perceptions of death among people may also be due to religions and faiths that portray death differently (Clark and Phillips, 2010).

According to scholars from different eras and religions, death has been considered a prime source of the origination of religion (Hayes and others, 2010). Further, different scholars reported different views about death, such as Strenski (2015) quotes Malinowski on religion, forebodings around death and immortality forms the nucleus of religious belief and practice (Kaberry, 1948).

Ricoeur defines the second na\'efvet\'e9 most succinctly as a creative interpretation of meaning, faithful to the impulsion, to the gift of meaning from the symbol, and faithful also to the philosopher s oath to seek understanding. In addition, Dezutter and others (2009) report that religious people may have very positive attitudes towards death since they often believe in life after death (hell and heaven). Evaluating the responses of followers of different religions of the world such as Greek, Hindu, Christian, Mesopotamian, Islam, and Egyptian revealed that religious belief systems interlink spiritual aspects with physical and psychological views of death (Byrne and Morgan, 2020; Dezutter and others, 2009). Religions have developed a belief system concerning the dead, their likely fate after death, strategies for caring for the corpse, giving the dead new status, finding ways to fill their vacated roles, reaffirming communal togetherness, and re-establishing and comforting the bereaved. Religious institutions and faiths often encourage believers to ponder death and develop knowledge about comprehending and coping with it. Religion established to the concept of salvation, reincarnation, heaven, hell, and rites to deal with death. Religion impacts people s attitudes regarding death-related topics such as euthanasia, suicide, and capital punishment, in addition to dealing with death (Kearl, 1989). Every religion has ideas around mortality and explanations of death that are firmly routed in teachings and pursuit of faith for a believer.

Christianity and death

Christianity is a monotheistic religion based on Jesus Christ s life and teachings, and the books of the Old and New Testament. There is a significant corpus of written material on faith, tradition, and ritual and the end of life due to the growth of the Christian faith and teaching over two millennia. The Ars Moriendi, or The Art of Dying Well, was issued by the Roman Catholic Church six centuries ago (Vogt, 2004).

The established association between mortality and religion is evident, according the fact that most Christian views associates the pursuit of eternal life with God at the centre of belief. The Ars Moriendi was published in the 1400s to guide Christian families in planning and creating a pleasant death. It warned against faithlessness, despair, impatience, vanity, and avarice as well as other temptations (Thornton and Phillips, 2009; Leget, 2007).

Islam and death

In Islam, the universality of death is emphasised in the Holy Qur an (Qur an 3:156, 3:185, 29:57, and 39:42), and one might infer from its teachings that the moment of death (al Maw\'e2t) is when the soul (al ru; sometimes used interchangeably with al nafs meaning self) is separated from the soulless body (al Maw\'e2t). However, neither the Qur an nor the Sunnah has a specific definition of death or a description of how to discern al ru s departure at al Maw\'e2t. Islam explains death as not the ultimate end but only the termination of physical life on earth and a beginning of everlasting life in Allah s realm. Significantly, present life is the only chance for better prospects after death (Miller and others, 2014).

Aims and objective

This paper investigates whether respondents religious affiliation affects their attitudes towards death. The following hypothesis were proposed.

H1: Religion affetcs individual attitudes towards death.

H2: Religion doesn t affect individual attitudes towards death.

METHODS

Selection criteria and samplings

A cross-sectional study was carried out in the cities of Erbil, Koya, and Sulaymaniyah, Iraq. Selected individuals should be in a good mental and physical health, must be a follower of either Islam or Christianity and must currently not be on medication or suffer any chronic medical condition. The exclusion criteria included followers of other religions and population with chronic disabilities, such as those suffering from mental health problems, substance abuse disorder, and chronic physical diseases.

Subjects of both groups have an unbiased and equal probability of being chosen and representing the population. Muslims who participated in this study were Sunnis and followers of the Imam Al-Shafi i doctrine, and the Christians were all Assyrians.

Mental health assessment

The mental status of the participant was assessed by the trained psychologists. According to the standard procedure, individuals were assessed for anxiety symptoms such as fear of dying, hand trembling, and cold/hot sweats using Beck s Depression Inventory.

Death attitude

The Death Attitude Profile-Revised (DAP-R)is a 32-item scale, a self-reported scale that uses a seven-point Likert scale to measure respondents attitudes towards death. This questionnaire is assigned in five dimensions: Fear of death, d eath avoidance, neutral acceptance, approach acceptance, escape acceptance . Questions were offered in two languages: English (since some of the participants studied in English and had lived in English-speaking countries), and Kurdish, and were validated by three experts in the concerned field.

The scale, questions, and calculation

The scale consists of 32 questions that can be divided into five subscales to determine respondents fear of death(negative thoughts and feelings about death, questions 1, 2, 7, 18, 20, 21, and 32), death avoidance(avoiding thoughts of death as much as possible, questions 3, 10, 12, 19, and 26), neutral acceptance(death is neither welcomed nor feared, questions 6, 14, 17, 24, and 30), approach acceptance(death is viewed as a passageway to a happy afterlife, questions 4, 8, 13, 15, 16, 22, 25, 27, 28, and 31), and escape acceptance(deathis viewed as an escape from a painful existence, questions of 5, 9, 11, 23, and 29).

Answers to questions are scored based on a Likert scale from 1 (strongly disagree) to 4 (undecided), to 7 (strongly agree).

The average score of each section is used for evaluation.

Statistical analysis

With the help of SPSS Version 20, the central tendency was used to compare the attitudes of Muslims and Christians to analyse the overall relationships between religion and attitudes towards death. Pearson correlation tests were applied to assess the relationship between individual variables.

RESULTS

After screening 150 individuals, a total of 100 (52 Muslims and 48 Christians) individuals were selected for the current study to enable group matching of the above-mentioned demographic variables.

Table 3 provides the comparison of subscales of the death attitude profile between Muslims and Christians, statistical descriptions includes ranges, means, and standard deviations normalised by the number of questions in individual subdimensions. The mean value shows the central tendency of the variables and standard deviation.The deviation is a measure of how dispersed data is in relation to the mean.

After normalising for the number of question per dimension (division by the number of questions per dimension) the following averages resulted: mean value (M) and standard deviation (SD) for the variable fear of death (FD) in Christians (M=4.14, SD=2.85) and Muslim (M=3.22, Std. D=0.93), approach acceptance (AA) Christians (M=3.36, Std. D=1.44) and Muslim (M=3.24, SD=1.02), escape acceptance (EA) Christian (M=4.32, SD=3.88) and Muslim (M=3.47, SD=1.59) neutral acceptance (NA) Christian (M=3.10, SD=0.89) and Muslim (M=4.68, Std. D=2.741), death avoidance(DA) Christian (M=4.68, SD=0.99) and Muslim (M=2.67, SD=1.53). None of the variables were significantly different between different religions (p>0.1).

DISCUSSION

The topic of the present study is unique and has never been studied in Iraq or anywhere else in the Middle East. A cross-sectional survey was conducted among the Muslim and Christian participants to assess the attitudes towards death by religion.

Both groups had a reasonable attitude toward death, as indicated by mean scores around 4, in other words, undecided. Both religions followers mean value and standard division were around 4, in other words, undecided for the variable fear of death (FD), indicating that neither Muslims nor Christians are extremely afraid of death. Meanwhile, both Muslims and Christians were slightly opposed to approach acceptance (AA). Individuals with higher scores in AA may consider death to be a bridge toward a joyful life as a result of the individual s belief in life after death and rewards in the afterlife and may have a positive relationship with psychological well-being and a negative relationship with depression. When people think about death, they may seek a healthy way to cope and adapt themselves to the fear of dying or thinking about death (Menzies, Sharpe, and Dar-Nimrod, 2019). Considering that both groups were opposed to the ideals of escape acceptance (EA), both followers have no way of escaping death and vice versa. However, both Muslim and Christian values were against the variable of death avoidance (AD), which means that neither group is avoiding the truth of death, also AD refers to the strategies people utilise to avoid speaking and thinking about death in an effort to decrease death anxiety (Nozari and Dousti, 2013). According to the current study s findings, both Muslims and Christians share the same or similar attitudes regarding death. This finding is congruent with the results of Wong and others (2015), who concluded that religion has little effect on people s attitudes and behaviours regarding death (Wong, 2015).

The relationship between a person s attitudes towards death is significantly related to their attitudes towards life. The theories suggests a strong relationship between death attitudes, fulfilment in life, and the ability to accept one s past as meaningful. Moreover, research has shown evidence supporting these theories (Parker, 2013). Though it is widely expected that religiosity plays a vital role in making a difference in individuals attitudes towards death (Dezutter and others, 2009), the data in the present study indicates no significant difference in death attitudes among both religious faiths. One study suggested that age has a greater influence on death anxiety and fear, which changes attitudes towards death (Thorson and others, 1997). Therefore, the alternative hypothesis is rejected on the basis of this result which stated that religion affects a person s attitude toward death, while on the other hand the null hypothesis was accepted that states that religion does not have any effect on the individual attitude towards death.

Furthermore, no obvious pattern of association between religious belief and death dread has been identified. It interacts with various circumstances, including religion, cultural history, and situational setting. Almostadi (2018) suggests that vulnerable individuals, like people diagnosed with cancer and their loved ones, emphasise the significance of a comprehensive therapeutic approach that includes a spiritual component. Nurses, who spend more time with cancer patients and other healthcare workers, understand the importance of this comprehensive approach. Nurses can provide much-needed education and emotional support to patients and families and make the necessary referrals by proactively discussing common topics around death and grief with patients.

Regardless of religious belief, death anxiety appears to be a practically universal feeling among cancer patients. Besides this, Afolabi (2014) suggests that culture, hospices, medications, death education, psychotherapy, philosophical belief system, and a suitable environment with proper infrastructure are all used to alleviate or lessen the fear of death. Religion is primarily recommended in this study as a tool for adults to meet several fundamental psychological requirements, such as facing impending mortality, finding and maintaining a sense of meaning and value in life, and accepting the unavoidable losses of old age. But Morris and McAdie (2009) suggested that religion does not affect five personality factors (dominance, liveliness, warmth, apprehension, and sensitivity), general well-being, and death anxiety ().

LIMITATION AND RECOMMENDATION

This study cannot be overgeneralised for all Muslims and Christians because it has focused mainly on Iraqi society. But studies report that culture may influence death anxiety (Hui and Fung, 2008). Therefore, the culture of the individual may affect the religious affiliation and attitudes to death. In addition to this, it should also be noted that followers of different beliefs might internalise or interpret the same religious concepts very differently. Therefore, future studies should test whether these findings are generalised to other groups. Further studies should include a larger sample size and should also be conducted within different religious groups and subgroups and should include diverse cultures and beliefs to expand the results and broaden the research into attitudes towards death.

CONCLUSION

Investigating death attitudes is helpful to examine people s level of resilience, self-care, and the way of coping with life. The current study concluded that the individual s religion does not change a person s attitudes towards death.

Acknowledgments

I would like to convey my appreciation to the participants and my colleagues who gave their time to support this research, as well as to Professor Reinhard Heun for his constructive comments.

Conflict of interest:

The author has no conflict of interest to disclose.

Funding disclosures:

I certify that no funding has been received for the conduct of this study.

Guarantor of submission:

The corresponding author is the guarantor of submission.

Ethical approval:

An ethical committee has approved the present study from Kscien Organization for Scientific Research for conduction in Iraq-Erbil.

Informed consent:

The author received written consent from the participants to participate in this study.

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