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Resources 16

  1. 1. Respecting religious and cultural beliefs a best practice guide for those involved in the welfare of patients
  2. 2. Contents Introduction 1 Names and languages 2 Details on various religions/cultures 5 Interpreter policy 28 Acknowledgements 30 Index end
  3. 3. A word of introduction The information presented in this booklet is intended as a guide only and simply covers the main essential points of differing religious and cultural beliefs. It must be remembered that in many parts of the world “religion” and “culture” are practically synonymous and there is no clear differentiation between the two terms. In the Western world that is far less true and we have now made a distinction between the two. It is possible to be fully integrated into our culture and not be “religious” in any sense. That would be unthinkable in other parts of the world. Whatever cultural or religious beliefs a patient has, individual and personal preferences may be expressed which may have an effect on the approach to care. For this reason, it is essential to always ask the patient and carers exactly what is required and what staff should be aware of. The chaplaincy department is always willing to give further advice as and when required and a list of local religious contacts is maintained by them. The chaplain is available continuously on call via the reception at St. Michael’s Hospital, telephone 01926 406789. If in doubt, please ask. Better that than risk offence.
  4. 4. Names and languages If you are used to having your first name(s) referred to as your “Christian” name(s), followed by your surname, be aware that this is a legacy of the predominantly Christian foundation of U.K. society. It may be deeply offensive to ask a person who is not a Christian for their Christian name. Probably the wisest policy is to ask for a patient’s personal name(s), and their family name. The family name can then be treated as the surname for recording purposes. Even then the matter might not be straightforward though! Asian cultures All Asian names have a religious significance. In practice they can vary a great deal, but in general they follow the format: Personal name - Religious name - Family name e.g. Davinder Kaur Bhuller (a Sikh name) Amjad Mohammed Hussein (a Muslim name) Arima Kumari Chopra (a Hindu name) The religious name for Sikhs is always Singh for a man and Kaur for a woman. Hindi women may often have simply a personal name and a family name.
  5. 5. So, when asking for a patient’s name, ask first for the family name and then their most used personal name. Use the family name as the ‘surname’ for recording purposes. If you cannot establish a family name, use the main personal name as the ‘surname’. Always try and make it clear to the patient how you are recording their names in the records. Vietnamese Similarly , Vietnamese names have three parts, but in Vietnam these are in reverse order i.e. Family name - Complimentary name - Personal name However, most Vietnamese in the U.K. have reversed this traditional order so that the family name comes last. A common family name is NGUYEN, and common complimentary names are VAN for men and THI for women. It is not always possible to distinguish the sex from any given personal name, and married women do not take their husband’s family name. Chinese Chinese names consist of three Chinese characters: Family name - Personal name - Personal name e.g Wong May Lin
  6. 6. Often the two personal names are run together e.g May Lin becomes Maylin. Married women add the husband’s name as a prefix. For example, if Wong May Lin married a Mr Cheung, she would be known as Cheung Wong May Lin. Common Chinese family names are Chang, Cheung, Ho, Lee and Wong. Sometimes Chinese people will add an English personal name and then put their family name last! If in doubt ask which is the family name. Language, too, often presents problems of its own. The trust has a policy on the use of interpreters (see the appendix). In general, you should not use a family member to communicate important clinical information to or from the patient. Interpreters are available locally and usually at short notice and these should be used in accordance with trust policy. Further details are given in the appendix. Some of the most usual spoken languages are: Chinese Cantonese, Hakka Bangladeshi Bengali, Hindi, Urdu Pakistani Urdu, Punjabi Sikhs, Hindus from Punjab Punjabi, Hindi Indians from Gujerat Gujerati, Hindi Other Indians Most would understand some Hindi
  7. 7. Religion & Culture • Atheists do not profess any form of religious belief whatsoever and dismiss the idea of a supreme being, God or gods of any kind. They are distinct from Agnostics, who are unsure about faith and belief in God. • They may be humanists (see “Humanism”) or they may not wish to be described as belonging to any one group of people. Key points • Atheists are individuals and should be treated as such. There will be a wide range of needs that patients have and they should be asked how their needs could be met during their stay in hospital. • Atheists may be wary of making their beliefs known so do not assume that their family will be aware of their beliefs. Food • No special considerations. Care of the dying • There are no specific considerations. If an Atheist patient dies • Normal post-death ward procedures may be carried out. • There are no specific teachings regarding organ transplantation/donation or post mortems. • Burial or cremation is dependent on the wishes of the deceased. Religion & Culture ATHEISM (Atheists) 7
  8. 8. Key points Care of the dying• Founded in Persia in the mid 19th Century, by Báhá’u’llah (means Glory of God) who is regarded as a Messenger of God. • There is a period of fasting each year, between 2nd and 21st March, but invalids, children, elderly (over 70) and expectant/nursing mothers are exempted from this. • No particular points to note. • Jesus and Muhammad are acknowledged as prophets but there is a belief that the nature of God must be re- taught by new prophets in each generation. • Normally abstain from alcohol & other harmful or habit forming drugs, although these are permitted if necessary medically. • Báhá’is emphasise the unity of humanity and all religions, the harmony of religion and science, equality of men and women and the abolition of prejudice. • There is no general objection to orthodox medical practices, rather Báhá’is are encouraged by their faith to trust and follow doctor’s recommendations. • Their ideal is for there to be one international community and one language in the world. • There is no religious objection to blood transfusion. • There are no clergy, instead elective administrative bodies known as “Spiritual Assemblies” handle their affairs. • Female Báhá’is do not usually have an objection to being examined by male clinicians. If a Báhá’i patient dies • The soul is believed to come into being at conception. Abortion is therefore strongly discouraged. • Most Báhá’is follow a practice of daily prayer and an annual period of fasting. • The body should at all times be treated with respect. • The majority of Báhá’is in Britain are of British origin. • Normal post-death ward procedures may be carried out and the body wrapped in a plain cotton or silk cover. Embalming is not allowed.• There are an estimated 5 million followers in the world. • There is usually no objection to organ donation – this is usually regarded as praiseworthy. Food • A Báhá’i is always buried and burial takes place as near as possible to the place of death and certainly within an hours travel. • No special requirements, except any food containing alcohol is forbidden. Báhá’is are encouraged to be vegetarian. • There is no usual objection to post mortems, provided the above stipulations can be met. 8
  9. 9. Key points Care of the dyingReligion & Culture • Ask the patient or carers if they would like the presence of the hospital chaplain or their own local minister. • See the page on “Christianity”. • A branch of Christianity with some specific considerations regarding hospital care – which is why this separate page is about them. • Additionally, some Brethren only eat and drink with other Brethren. They may therefore wish to eat alone behind closed curtains. • Brethren will try to maintain a 24 hour vigil when the patient nears death.• Brethren are fully part of the Christian Church but regard themselves as true Christians. They believe in what they understand to be a more truly original pattern of the New Testament. • Women do not cut their hair and keep it covered in public places. (A hospital may be considered a public place.) • Patients may have had little contact with the public media – T.V., radio. • There may well be religious objection to organ transplantation, although blood transfusion may be acceptable. • Brethren are strong anti-abortionists. If a Brethren patient dies Food • After death, the family will like to have complete control over the body and attend to washing and last offices. • There are no dietary requirements although some may avoid eating meat on Fridays. • There will often be an objection to organ donation or post mortems, unless demanded by the coroner. • Either burial or cremation is acceptable. 9 THE BRETHREN (Brethren)
  10. 10. Religion & Culture Key points Care of the dying • Buddhism is more a way of life than a formalised religion. • A side ward would be appreciated.• Buddhists would appreciate the use of an area for peace and quiet to enable them to meditate and chant (side ward?). • Very full information will be sought from staff about any imminent death so that death will be approached in as clear a frame of mind and as positively as possible. • It is based on the teachings of Buddha (The Enlightened) who lived in India in the 5th /6th Century BC. • Patient’s requirements in hospital may vary according to which branch of Buddhism they follow. • Buddha is revered by Buddhists as the founder of their Way of Life but not as a god. • Patients may wish to minimise or reduce the use of sedative drugs in an attempt to remain fully alert. • Visits from other Buddhists are very welcome. • There is no conflict with modern medicine or techniques.• Buddhists hold no idea of a creator type of God, but instead believe that everything in life is inter- dependant. • There is no religious objection to blood transfusion. • There are 3 main schools – Theravada, Mahayana (includes Zen Buddhism and is more liberal) and Tantric (which holds the Dalai Lama as a religious and political leader). • Buddhist tradition condemns abortion and all forms of contraception after conception. If a Buddhist patient dies• Active forms of euthanasia are also condemned. • Followers seek to emulate Buddha in perfect morality, wisdom and compassion culminating in a transformation of consciousness known as enlightenment. • There are no special rituals to be observed but a Buddhist priest should be informed as soon as possible. Contact either through the family or via the hospital chaplain.Food• The Way of Life involves living morally, being generous, keeping special festivals, pilgrimage to sacred places and social responsibility. • Normal post-death ward procedures may be carried out. • Many Buddhists are vegetarians because of their respect for all life. • There are over 310 million Buddhists in the world (some estimate 1000 million) and there are many variations of Buddhism. • There is usually no objection to organ donation or post mortems. Helping others is fundamental to Buddhist beliefs. • Many Buddhists in the U.K. are converts. Their number is growing. • Generally cremation is preferred, although bodies may be kept some time before actually being cremated. BUDDHISM (Buddhists) 10
  11. 11. Religion & Culture Key points Care of the dying • The Church of Christ, Scientist was founded by May Baker Eddy in 1879, who experienced personal healing after long ill health. • There are no last rites or rituals.• Patients will wish for minimal medical and drug therapy treatment. • A Bible may be requested. A copy should be found in bedside lockers.• There is a reliance on prayer alone for the healing of sickness and disease, which is believed to be in line with the healing practice of Jesus Christ. • Privacy for prayer and healing would be appreciated. • The church does not control the actions of its members - they are free agents. • There may be an objection to blood transfusion. • Usually Christian Scientist patients would go to a nursing home run by the church where the accent is on prayer alone. • The church does not rebuke those who do go to conventional hospitals. This may happen because of : If a Christian Scientist patient dies ⇒ Fractures following accidents ⇒ Childbirth • Female staff should handle a female body. ⇒ Lack of finance (cannot afford church nursing homes) • Normal post-death ward procedures may be carried out. Food⇒ Lack of faith (faith is not strong enough to believe cure can be obtained by prayer alone). • There is usually a strong objection to organ transplantation and/or donation. • Alcohol and tobacco are forbidden to Christian Scientists. • Post mortems are only allowed at the coroner’s insistence. • Cremation is usually preferred. THE CHURCH OF CHRIST, SCIENTIST (Christian Scientists) 11
  12. 12. Religion & Culture Key points Care of the dying • Christians believe that God became man in the person of Jesus Christ. He was crucified, rose from the dead and ascended into heaven. • Ask the patient or carers if they would like the presence of the hospital chaplain or their own local minister. • Patients may wish to see the hospital chaplain (especially so of Roman Catholics) or have a visit from their own minister. Contact should be made via St. Michael’s switchboard.• Eternal life is promised to those who believe. • Some patients, especially Roman Catholics, would expect the chaplain or their own minister to say special prayers prior to death. The patient may be anointed with oil on the forehead. • A Bible may be requested. A copy should be found in bedside lockers. • Most Christians are baptised as babies or when they are old enough to profess their own faith. • Patients may wish to attend church services in the hospital/unit during their stay. • Approximately 1/3 of the world’s population follows some form of Christianity. Many British people would call themselves Christians although they may not be active followers. Religious beliefs are more likely to be regarded as separate from culture than with many other religions. • After death, relatives may gather to give prayers of thanksgiving for the person’s life. • Patients may also request baptism or weddings whilst on the ward. Please contact the chaplain should this arise. • There are many different Christian churches with different structures, beliefs and rituals, but the understanding of God as Father, Son and Holy Spirit is common to all. • There is no religious objection to blood transfusion or organ transplantation. • Some Christians have strongly held beliefs against abortion and all kinds of euthanasia. • The most important festivals of the year are Christmas (the birth of Jesus) and Easter (his death and resurrection). • Seventh Day Adventists observe Saturday, not Sunday, as their holy day. The day extends from sunset Friday to sunset Saturday. If a Christian patient dies • Christian churches include Church of England (Anglican), Roman Catholic, Methodist, Baptist, Pentecostal, Salvation Army, United Reformed, Christadelphian, Seventh Day Adventist, Quakers (see separate page), Brethren (see separate page), Greek Orthodox, Russian Orthodox or Syrian Orthodox. Additionally, some Christians may describe themselves as Protestant, High Church, Chapel or Free Church. Food • Normal post-death ward procedures may be carried out.• There are no dietary requirements although some Christians may avoid eating meat on Fridays. • There is no religious objection to organ donation or post mortems.• Seventh Day Adventists abstain from eating certain animal meats esp. pig and offal. Many are vegetarians or vegans. They avoid alcohol and tobacco and may avoid tea and coffee. • Either burial or cremation is acceptable. CHRISTIANITY (Christians) 12
  13. 13. Religion & Culture Key points Care of the dying • Hinduism is the result of 5000 years of continuous cultural development. For the Hindu, religion and culture are inseparable. • It is crucial to Hindus that they are able to follow their religious practices in hospital. • Clothes, money etc. may be brought to the patient for him/her to touch. so that before death offerings can be made to the needy, religious people, or to the Temple. • Modesty is important to the Hindu. Female patients prefer a female doctor if possible. • Wherever possible, Hindus prefer to die at home.• There is no formal structure to the religion. • Hindus believe in one supreme spirit, from which the whole universe emanates. This spirit can be worshipped in many ways. • Dying patients may prefer to lie on the floor in order to be nearer to Mother Earth. • Provide running water or a jug/bowl of water in the same room as a toilet or bedpan. • There are no general religious objections to blood transfusion or organ transplantation/donation. • Married women wear red marks on their foreheads and nuptial threads/necklaces. Male adults wear a “sacred thread”. • There is a belief in an eternal soul (Atman) and in a law that determines in which form a person may be reincarnated (Karma). Everybody has to face the consequences of their actions in previous lives. • Patients may request a copy of the Bhagavad Gita. This can be obtained from the chaplain’s office. If a Hindu patient dies• There are many personal gods but the most important ones are Vishnu, Shiva and Kali or Shakti. • A rest for 40 days after giving birth is considered wise. The mother may not wish to be separated from her baby, however. • Do not touch the body before consulting the family (esp. eldest son) to ask if they wish to perform the last rites as distress may otherwise be caused. • The sacredness of the land of India and the caste system are central beliefs. • There is no Hindu objection to contraception. It is advisable to ask the woman if she would like her husband/relative to be present during discussions. • Every person has a duty to fulfil to society (Dharma). • If no family is available then follow these steps: ⇒ Wearing disposable gloves, close the eyes and straighten the limbs.• There is a great respect for all living things. Food ⇒ Do not remove jewellery, sacred threads or other religious objects.• Yoga is one of the six orthodox systems of Hindu philosophy, although it is also found in Buddhism. ⇒ Wrap the body in a plain sheet without any religious emblem. If in any doubt, do not wash the body as the family will wash it as part of the last rites with water from the Ganges, which is collected from the Temple. • Many Hindus are wary of consuming animal fat. It is best to consult individuals reagrding diet. However, there are some common points: • Two major festivals are Divali (Oct/Nov) which celebrates New Year, and Holi (Feb/Mar) which is a Spring festival. ⇒ Beef is forbidden and pork is usually unacceptable. ⇒ Many Hindus are vegetarians and do not eat eggs. • Post mortems are disliked but allowed if legally necessary. All organs must be returned to the body. Adult Hindus are always cremated (although children are buried). ⇒ Milk from cows is usually acceptable.• There are an estimated 500 million Hindus in the world. ⇒ Plates that have been used for non-vegetarian food are disliked. ⇒ Hindus do not smoke or drink alcohol. HINDUISM (Hindus) 13
  14. 14. Religion & Culture Key points Care of the dying • Humanists believe that humankind is able to improve its own condition without any form of supernatural aid and, in fact, has a duty to do so. • There are no special needs• Freedom of choice is important in humanism, especially in the main decisions regarding life and death. • Their “faith” is centred on human being’s intellect to bring knowledge and understanding into the world and our own ability to solve the moral problems we face. • There is a great respect amongst humanists for human life, regardless of creed, class or colour. • Humanist desire such things as freedom, tolerance, justice and happiness for all. If a Humanist patient dies • At death, the whole of life is finished and there is no belief in immortality. There are therefore no religious considerations in respect of those who have died. Food • There are no special dietary requirements • Often the funeral will be conducted by a Humanist official and cremation or burial is acceptable. • The British Humanist Association (020 7430 0908) can help to arrange humanist or non religious funerals. • The chaplaincy department has copies of an explanatory leaflet about humanist funerals, which is available on request. HUMANISTS 14
  15. 15. Religion & Culture • Islam is an Arabic word which means peace, purity, acceptance and commitment. The literal religious meaning of Islam is “surrender to the will of God”. Followers of Islam are called Muslims. • Muslims believe in God alone as creator of the universe and they follow the revelations of the prophet Muhammed (peace and blessings be upon him). • Muhammed was born in Mecca in Saudi Arabia in 570 AD. The Holy Book of Islam is called the Qu’ran. • It is estimated that there are over 800 million Muslims in the world. There are over 1 million Muslims in the U.K There are two main sects – Sunni and Shi’a. • Worship is centred around a daily pattern of prayer and is conducted in a mosque by an Imam (prayer leader) in Arabic. There are no clergy as such. Attendance at a mosque is compulsory for men on Fridays. • Shariah law is a religious and moral law based upon the Qu’ran. • There are five crucial “pillars of Islam” which followers must observe: 1. Declaration of faith. 2. Five daily prayers (facing Mecca) 3. The fast of Ramadan between dawn and dusk in the ninth month of the Muslim calendar (late November/December). Ramadan ends with the festival of Eid. 4. The giving of alms to the poor. 5. Pilgrimage to Mecca (if able) at least once in a lifetime. Key points • Many Muslims would prefer to be attended by a member of the same sex. • Cleanliness is of great importance. A shower is preferred to a bath. After use of a bedpan, offer washing facilities. • Hands, feet & mouth are washed before prayer (if at all possible) • The whole body is washed after menstruation. • Modesty observed in dress (applies to both sexes). Hospital nightwear may not be acceptable. • If the patient has a copy of the Qu’ran in their locker, this should be kept on the highest shelf and nothing should be placed on top of it. • There may be a reluctance to receive blood transfusions although there is no specific religious law opposing it. • Boys are circumcised as soon as possible after birth. • Attitudes to contraception vary greatly. Food • It must be Halal (prepared in a special manner). Further, any food or preparation containing any kind of pig product is to be avoided. This extends beyond pork meat, ham and bacon to such things as gelatine and pig fat used in some soaps. • The consumption of alcohol is forbidden. Care of the dying • Patients may wish to sit or lie facing Mecca (South East). • Family or friends will wish to sit with the patient praying or reading the Qu’ran. If a Muslim patient dies • After death, the body is considered to be the property of Allah. • DO NOT WASH THE BODY. • Wear gloves to avoid direct contact with the body. The body should face Mecca (South East) and the head should be turned towards the right shoulder before rigor mortis. • You may comb hair, straighten limbs, remove equipment and cover the body in a white sheet, but the family will wish to do the washing of the body. • Post mortems are only permissible if the law requires it. ISLAM (Muslims) 15
  16. 16. 16 • The issue of organ donation is confused – the family may agree or not. • Muslims are always buried within 24 hours of the death. Religion & Culture • Based on the teachings of 24 founders, the main one being Mahavira, a contemporary of Buddha, who lived in the 6th century BC. • These founders (Tirthamkaras) have reached an ideal state of perfection and have untainted souls, unblemished by the world. Other Jains strive to emulate them. • For Jains, everything has a soul, therefore they insist on non-injury to all forms of life. This means they are very cautious in everything they do – for instance Jain monks wear cloths over their mouths to avoid killing anything by breathing it in. • Jainism recognises no supreme being as a creator God. • There are two main sects – Svetambaras wear white clothes, Digambaras traditionally go naked. Their ethics and philosophy are similar. • The main festival is Paryushanaparva (August/September) in which all Jains partcipate and request forgiveness of their wrongdoings. • There are over 3.5 million Jains world-wide, but most live in India. Key points • A Jain patient will be very particular about cleanliness, especially the floor in order to avoid stepping on any living creature. • Some Jains may prefer to fast between sunset and sunrise. • Female patients may prefer to be treated by female staff. • Some patients may appreciate a visit from the Brahman (priest) to say prayers. • Organ transplantation is dependent on the wishes of the patient and/or next of kin. Food • Jains are strict vegetarians although they may eat some dairy products like milk, curds or clarified butter. They may prefer to avoid garlic, onion and potatoes. There may be very particular dietary requirements - check with the patient or family. If in doubt treat as vegan. • Alcohol is prohibited. Care of the dying • The family may wish to be present and say prayers at the bedside. • Those who are considered to be very spiritually advanced are allowed by their religion to hasten their own death by fasting under specified circumstances. If a Jain patient dies • The family may provide a plain white gown or a shroud for the body. JAINISM (Jains)
  17. 17. • Post mortems are regarded as being disrespectful to the body, however this will depend on the degree of orthodoxy of the patient. • There are over 2 million followers in the world. In the U.K. there are over 120,000 Witnesses. • They do not smoke or use tobacco products. • Their places of worship are known as Kingdom Halls. • Organ donation is dependent on the wishes of the patient and the relatives. • Jehovah’s Witnesses refuse to obey any law that they see as being contrary to the will of God. This includes military service and receiving blood transfusions.Religion & Culture Care of the dyingKey points• Jehovah’s Witnesses were founded in the U.S.A. in late 19th Century. • There are no special rituals.• Blood represents life and on no account will they receive blood transfusions. They will be happy to co- operate with staff in alternative non-blood medical management. • God is seen as creator of the heavens and earth. • Dying patients will appreciate a visit from one of their elders. • Jesus Christ is accepted as the Son of God but regarded as man and not divine. They regard themselves as Christians, but are not accepted as such by the main Christian denominations who would stress Jesus as being both human and divine. • Life should not be prolonged artificially if death is imminent/unavoidable. • Children are not baptised. • They await the end of the present age, which will begin with the Battle of Armageddon. Jehovah and his true witnesses will be the only survivors. After Armageddon, there will be 1000 years of peace and life under “favourable conditions”. • They believe in making positive efforts to reach the public. The Watchtower is their publication which is freely distributed to households. • They have their own translation of the Bible. • The death of Christ is the only annual festival observed. They do not observe Christmas or birthdays. If a Jehovah’s Witness patient diesFood • Food containing blood is forbidden. JEHOVAH’S WITNESSES (Witnesses) 17
  18. 18. Food• The living body is dedicated to God but once dead the body has no particular significance. Normal ward practices can be followed. • There are about 15 million Jews in the world and a significant number of communities in the U.K. • Many Jews will request Kosher food (specially prepared meat). Only lamb, beef or chicken is allowable and only true fish (with scales and fins). • There are no religious objections to organ donation or post mortems. • Some Jews will not take milk and meat products at the same meal, or use crockery that has had meat on it previously. It is advisable to check with the patient. • Witnesses may be buried or cremated. Key points Religion & Culture Care of the dying• Most Jewish people who are hospitalised will expect no particular considerations other than dietary requirements (see below). • Jews believe in one spiritual God who cannot be represented in any shape or form. • Dying patients must not be left alone; therefore many families will wish to sit with their relatives during the last few hours/days.• There is no specific religious objection in Judaism to blood transfusion. • God created heavens and earth and ordained Jewish people to be inheritors of a special relationship with him, established through a covenant with Abraham. • A Rabbi (Jewish minister) or a relative may recite special prayers.• Ultra-orthodox Jews may have the following requirements:• Their stories are found in the Hebrew Bible (the Old Testament). • Organ transplantation is allowed in order to save lives.1. Women may not want others to look at their hair and may usually wear a wig.• The family is very important in Jewish culture, as is observance of the Sabbath (see under Key points) 2. Men may not touch women (including nurses) other than their wives without appearing immodest.• There is a wide variation in Jewish patterns of life and worship, ranging from the ultra-orthodox to “reform” and “liberal” movements. 3. Some orthodox Jews observe the Sabbath, which begins at sunset on Friday and last until sunset on Saturday and will prefer to do no work, writing or travelling during the Sabbath. They may ask nursing staff to operate the bedside light. If a Jewish patient dies • If the death occurs on the Sabbath (sunset Friday – sunset Saturday) leave the body and contact the family, otherwise proceed as below. • Although authority is vested in Rabbi’s (Jewish ministers) who would normally conduct collective worship in synagogues, much religious observance is done at home. 4. A reluctance to accept family planning. • Boys are circumcised on the 8th day after birth if healthy. A room may be requested for this to happen and the ceremony is conducted usually by a trained medically certified functionary called a “Mohel”. • The eyes should be closed, the body covered and left untouched. Either family members or associates of the same sex will prepare the body for funeral. • There are many festivals in the Jewish calendar, but the most important and holiest one is Yom Kippur (day of atonement and fasting) which occurs in late September/early October. JUDAISM (Jews) 18
  19. 19. • Burial should take place as soon as possible, preferably within 24 hours of death. It is delayed only for the Sabbath. • If the death has to be notified to the coroner or if the attending doctor is unable to complete the certificate, the family should be informed and asked to contact their undertaker who will liaise with the coroner’s office. Key points Care of the dying Religion & Culture • There are no specific considerations• Moonies hold positive views concerning Western medicine.• Founded by Sun Myung Moon in South Korea in 1954. • There are no cultural or religious objections to blood transfusions or organ transplantation.• Followers (Moonies) are intent on unifying the world and all its religion in a state of perfect harmony, hence the name of the Unification Church. • To achieve this their “divine principle” would have to be instituted. This claims that a sinless man could save the world and create the Kingdom of God on earth. Whether this is Sun Myung Moon himself is unclear. • There are 3 million followers in the world. • Strict codes of behaviour and discipline are followed and there has been much controversy about the sect allegedly brainwashing recruits and breaking up families. Food If a Moonie patient dies • There are no specific dietary requirements. 19 UNIFICATION CHURCH (Moonies)
  20. 20. • Mormons try to take care of their body, take proper rest and eat healthily. • Normal ward procedures may be followed although it would be advisable firstly to check if the family have any specific requirements. • Missionary work is usually conducted by pairs of young people working full time without pay visiting homes and the general community. • Many Mormons will eat meat sparingly, avoiding meats with a lot of blood in them.• Moonies are usually buried rather than cremated. • There are 7 million Mormons world-wide and over 150,000 in the U.K. • They are wary of stimulants and avoid coffee, tea, alcohol and tobacco. • In hospital, milk or fruit juice will be acceptable. Religion & Culture Key points Care of the dying• The Church of Jeus Christ of Latter Day Saints was founded in the early 19th Century. • Some Mormons who have undergone a special ceremony wear a sacred undergarment. This is an intensely private item and is worn throughout life and in death. It may be removed for hygiene purposes and laundering and operations but must be treated with due respect. • Death is regarded as a blessing and spiritual contact with other Mormons is important during the dying process. An active Mormon will know how to contact the local bishop and a representative (home teacher) may call in to see the patient. • Their headquarters are in Salt Lake City in the U.S.A. • The church has an elaborate hierarchy and associated rituals. • Mormons believe that God, Christ and the Holy Ghost are separate persons although united in purpose. • There is no objection to blood transfusions or organ donations. • They believe that there is a living prophet who receives revelations from God and directs their church. • Children are not baptised. • They also believe that we are living in a time just before the second coming of Christ and there is an urgency to spread the gospel. • Honouring and upholding the law is important, as is being of service in the community. There is often a strict control exerted over the lives of members. Food If a Mormon patient dies CHURCH OF JESUS CHRIST OF LATTER DAY SAINTS (Mormons) 20
  21. 21. • Seek the views of the family, although usually there is no specific ritual and normal ward procedures may be followed, except that the sacred garment (if worn) must be replaced on the body after last offices. Food • Likely to be vegetarian or vegan. • Burial is usually preferred to cremation. • There is no objection to post mortems. Religion & Culture Key points Care of the dying• People who are New Age followers are not part of a cohesive religion or ideology but are part of a loose and flexible movement. • New Age followers are likely to hold a holistic view of healing. • Needs will be highly individualistic, but are likely to involve access to other followers with similar beliefs. • Organ transplantation or blood transfusions are unlikely to cause any predicament.• Followers are highly individualistic in their attitudes and place a high value on freedom, ecology and women’s rights. • New Age spirituality draws its beliefs from many other religions, especially Eastern religions like Taoism, Hinduism and Buddhism but also embraces science and other philosophies such as astrology, reincarnation theories and crystals. • There is therefore a strong belief in the powers of meditation and contemplation as a means of approaching the fundamental questions of life. NEW AGE 21
  22. 22. If a New Age patient dies Food• Some Pagans follow their own inspirations but others are trained in various disciplines such as the Craft (or Witchcraft for which some prefer the name Wicca), Druidry (but not all Druids are pagan – some understand themselves to be Christian), Odinism, Shamanism, Women’s Traditions & Men’s Traditions. • Normal ward procedures may be followed in the absence of other specific requests. • May well be vegetarian, vegan or wish to eat raw food. • There may be a desire for the body to be buried in a natural woodland site using bio-degradable materials. • There is unlikely to be any objection to either post- mortems or organ donation. Key pointsReligion & Culture Care of the dying • Because of the diverse traditions within Paganism, patients should be asked how their needs could be met during their stay in hospital. • Paganism is probably one of the oldest surviving religious forms. • Pagans will wish to know that they are dying so that they can prepare positively for death. • There are many different practices of paganism but certain aspects are common to all: • Most Pagans would prefer to die at home or in a place special to them rather than in hospital. • Many Pagans are wary of making their beliefs known so do not assume that their family will be aware of their beliefs. ⇒ Feminism is a strong influence and Women’s sprituality is much respected. • Patients will appreciate a visit from their own spiritual advisers (they should have the contact number) rather than the hospital chaplain.⇒ The “Goddess” is the primary focus for worship but has many different names. However, most pagans acknowledge a masculine God too. ⇒ Pagans believe that everything a person does will return to him/her amplified. ⇒ There is a strong emphasis on having a harmonious relationship with nature. All things have a spirit (including inanimate objects such as rocks) and must be respected. ⇒ There is a belief in destiny. ⇒ Pagans believe that all things feed their energy back to Earth through decay and the release of the “life- force” when they die. PAGANISM (Pagans) 22
  23. 23. Food If a Pagan patient dies • No special considerations. • Normal post-death ward procedures may be carried out. • There are no specific teachings regarding organ transplantation/donation or post mortems. • Burial or cremation is dependent on the wishes of the deceased. Key pointsReligion & Culture Care of the dying• A Quaker patient may wish to be visited by another Quaker. • Quakers are a branch of the Christian Church and believe the whole of life is sacred and the experience of God to be available to everyone. • There are no special rites or rituals for the dying. • Patients will appreciate a visit from an Elder or other Quaker, who may sit in silent worship• Followers adhere to a way of life rather than a dogma or creed. By looking into their inmost hearts they believe people can have a direct communication with their Creator. • The movement started in the mid 17th century. • Followers may call themselves “Friends”. • There are no ministers or priests but elders or overseers are appointed to be concerned with the spiritual and pastoral welfare of Quakers and their meetings. • Quakers do not sing hymns or use set prayers but wait on God in silence punctuated occasionally by a member speaking briefly, praying or reading from the Bible. THE RELIGIOUS SOCIETY OF FRIENDS (Quakers) 23
  24. 24. If a Quaker patient dies • There is a rejection of Western culture and Christian churches. • Many will not accept family planning. • Normal post-death ward procedures may be carried out. Food• Natural methods of childbirth are preferred and a time of separation and purification may be observed after the birth.• There are no religious objections to organ transplantation/donation or post mortems. • Any pig meat is forbidden and some fish are unacceptable e.g. herring and sardines. • Many Rastafarians are converts to the religion. • Burial or cremation is dependent on the wishes of the deceased. • Many Rastafarians are vegetarian. • Orthodox Rastafarians do not take any stimulants, i.e. alcohol, tobacco or caffeine. Marijuana is the sacramental herb. Religion & Culture Key points Care of the dying • Rastafarianism began in the 1930’s in the West Indies among the descendants of slave families who had originally come from Africa. • Members have a distinctive hairstyle - dreadlocks (locks) are a symbol of faith and a source of black pride. Orthodox members may not permit their hair to be cut. • There are no special rites or rituals for the dying. • Identification with Africa is central to Rastafarian doctrine and the movement is linked to the roots of resistance to slavery. • Rastafarian women dress modestly at all times. They do not wear second hand clothes and may therefore be unwilling to wear hospital garments which have been worn by others.• Ras means prince, so Ras-Tafari becomes Prince Tafari, who became the Emperor of Ethiopia (Haile Selassie I) in 1930. He is considered to be a divine being who will eventually lead all black people to freedom. • Rastafarians may be unwilling to receive any treatment which might contaminate the body and may reject some Western style treatments. Alternative therapies may be preferred. • The Old and New Testaments are regarded as scriptures, but Rastafarians do not consider themselves as Christians. For them, Christ’s spirit has been reborn in Ras Tafari. • Visiting the sick is important and may be done in large groups which may cause its own problems in the ward. • Rastafarianism is a personal religion. There are no church buildings, set services or official clergy. • Blood transfusions may be refused because of fear of contamination of the body. RASTAFARIANISM (Rastafarians) 24
  25. 25. If a Rastafarian patient dies Food• Normal post-death ward procedures may be carried out. • There are no dietary requirements. • There are strong objections to organ transplantation/donation or post mortems, based on fear of contamination of the body. Post mortems would only be allowed under coroner’s orders. • Burial is usually preferred to cremation. Care of the dying Key pointsReligion & Culture • Visiting the dying is important and family/friends may travel from around the country to visit the patient. Large numbers may be involved. • Clothes are not washed in a bowl used for vegetable or food preparation. • Includes Irish, Welsh, Scottish and English Travellers, those who live on a permanent site, those in transit and those settled in houses (a Traveller may have given up wandering without relinquishing his/her ethnic identity). • A separate bowl is kept for washing face and hands etc. • It is immodest to undress in front of others and also rude to keep legs and feet uncovered. • Many are Christians. • Travellers often have difficulties in accessing health services. Treatment is often akin to “temporary resident status” where notes are not retained by any GP • Older people may refuse to wash their hair. It is considered that the hair will clean itself naturally. Cleanliness may be aided by using hedgehog oil. • Older people may also use bacon fat as a moisturiser. • Patients may wish to see a chaplain and/or request a Bible. If a Traveller patient dies• There is no religious/cultural objection to blood transfusions. 25 ROMANY ORIGIN (Travellers)
  26. 26. • The family will request that the person be laid out in their choice of clothing. Food • The family will want the body of the deceased returned home in order that they can maintain an overnight vigil with the body and to give opportunity for family and friends to pay their last respects. • Again, the personal requirements of individuals should be attended to as much as possible. • Personal items are often placed in the coffin e.g. jewellery, photographs etc. • There is no religious/cultural objection to organ transplantation/donation. Care of the dying Key points• Burial is usually preferred to cremation. Religion & Culture • No specific considerations. • Much of what has been written about Chinese culture (see under Taoism and Confucianism) is relevant to Shintoism also. • Japanese culture finds its main religious expression in a mixture of Shintoism and Buddhism. • Even though Shintoism is no longer Japan’s state religion, there are devotees of Shintoism in Japan, and according to some reports, it has recently risen in popularity. • Shintoism originated in Japan over 2000 years ago • “Shinto” means “Way of the Kami”. It used to be the state religion of Japan until 1945. • The chances of encountering a Kami patient are very slim and the best course of action is to try and attend to whatever needs the particular individual expresses. • There is no scripture, only mythology based on 2 texts. • High standards of behaviour are expected of Kami and there are many rituals that are followed. • In practice, many people follow Shinto but feel free to choose Buddhist rites for funerals etc. • There are reputed to be 8 million followers, or Kami, world wide, but there are very few in the U.K. SHINTOISM (Kami) (Japanese) 26
  27. 27. If a Kami patient dies ⇒ Kara - a steel bracelet or ring worn on the right wrist. • Beef and pork are not normally eaten by Sikhs and many will not accept fish, eggs and meat.⇒ Kaccha - a special type of underwear. ⇒ Kirpaan - a sword symbolically worn by baptised Sikhs. • In this unlikely event, seek the guidance of the family. • If in any doubt, it is best to follow the points made under the corresponding section on the page dealing with Taoism/Confucianism. Care of the dyingKey points • The family will wish to be present and say prayers at the bedside. Religion & Culture • Female patients would prefer to be seen by a female doctor, if possible. • Sikhs believe in one God, and many cycles of rebirth. • The five K’s (see opposite) worn by men should not be disturbed. If it is necessary to disturb them (e.g. cutting hair) then the need for this should be carefully explained to the patient and family. • They respect equality of all people, regardless of cast, creed, colour or sex. • Sikhism originated in Punjab, India. • Most Sikhs are accustomed to having water in the same room as the toilet, therefore a bowl of water should be provided when a bedpan has been used. • There are approximately 300,000 Sikhs in the U.K. There is a large local community in Leamington Spa. • There are no objections to blood transfusions or organ transplantation. • Sikhs believe that God is the only reality and that spiritual release can be obtained by taming the ego through devotional singing, recitation of sacred texts, meditation and service. Prayers are read five times a day. • Contraception may be used but is not openly spoken about. • All men are given the name Singh (meaning lion). Women receive the name Kaur (princess). • Mothers are encouraged to rest for 40 days after giving birth. Mothers may not wish to be separated from their babies. If a Sikh patient dies • Sikhs wear, as an act of faith: • Normal ward procedures may be followed, BUT DO NOT DISTURB THE FIVE K’s (see under Culture opposite). Food⇒ Kesh (means hair) - long hair kept under a turban. ⇒ Kangha - a small comb worn in the hair at all times. SIKHISM (Sikhs) 27
  28. 28. • The body should be released as soon as possible to enable the funeral to take place. • When a child is born, the mother may be unwilling to bathe for a few days, tradition saying she should rest at this time. The baby’s head may be shaved at 1 month old.• There is no religious/cultural objection to organ donation or post mortems. • Sikhs are always cremated. Religion & Culture • Many Vietnamese and Chinese people will follow a mixture of Taoism, Confucianism and Buddhism. (Although a significant number of Vietnamese and Chinese are Christian). • Taoism & Confucianism are both philosophies and religions. Often followers will draw from both philosophies and also Buddhism. • The Tao is thought of as the absolute basis and source of all things. It is the underlying state of emptiness which is the base of all creation. Strip away all our thoughts, senses and all the changing phenomena that we see around us and what you have left is Tao. • Taoism has been long associated with a search for immortality and it is believed that longevity can be encouraged by holding together the yin (the principle of rest, or what is dormant) and the yang (the active principle, or what is creative). • Matter and spirit are regarded as being the same thing. There is no distinction between the two. • Confucianism emphasises respect for authority. Law is essential in order to make life possible. Key points • Family life is very important and ties are very strong. • Some female patients (especially older women) would prefer to be seen by a female doctor. • A soak in the bath is believed to be bad for the body in later life, therefore a shower is preferred. • There are no specific religious or cultural objections to blood transfusion or organ transplantation. • Ethnic Vietnamese/Chinese are likely to prefer Western medicine to any form of traditional ethnic remedies, although there may be some suspicion of Western medicine by a minority of older Chinese patients. Food • In order to be healthy, an equilibrium between “hot” and “cold” needs must be maintained and this relates to food, herbs and medicines. (This has nothing to do with temperature!) Foods are therefore defined as hot or cold and so, to restore balance, a strict diet may be observed. • Hot foods include most pulses, spices, eggs, nuts, honey, onions, lamb, tea, coffee. Cold foods include cereals, rice, wheat, fruit, potatoes, white sugar, green vegetables, milk. • Many people prefer to have home cooked food brought into them. Older Chinese may cling to the belief that the only form of food which can give them energy and vitality is rice. Care of the dying • No specific considerations. If a patient dies • Wherever possible a Vietnamese or Chinese person will wish to die at home in the presence of relatives. Chinese people will wish to return to the community of their birth to die, if possible. • If death occurs in hospital, contact the family first before carrying out normal procedures. If no family can be contacted then the body is bathed and, in the case of traditional Chinese, is clothed in white or traditional Chinese clothing. • Relatives and friends will wish to see the body. • Funeral arrangements and mourning varies widely. TAOISM & CONFUCIANISM (mainly Chinese/Vietnamese) 28
  29. 29. • When a family member dies the body may be taken home for up to three days to allow friends and relatives to pay their respects. • There are no religious/cultural objections to post mortems or organ donation. Key points ZOROASTRIANISM (Parsis) Care of the dying Religion & Culture • The family may wish to be present and say prayers at the bedside. • There should be no problem with normal hospital routines regarding washing etc. • Based on the teachings of Zoroaster (Zarathustra), who lived in Iran in the 6th century BC. • There is no religious objection to blood transfusions. • Zoroastrianism remained the main religion of Persia until the Muslim conquest of the 7th century AD. • Daily prayers are necessary which involve untying and tying the sacred girdle. Patients may need help to do this. • Today Parsis form a well educated, articulate minority mainly centred in India. • There are relatively few Parsis in the world and this limits the availability of suitable marriage partners. There is a subsequent proneness to conditions with a hereditary aspect e.g. Rh negative blood group, diabetes, cancer and coronary problems. • Followers have a dualist view of the world – the world is a battleground between good and evil. If a Parsis patient dies• The sacred literature is the Avesta. • Fire plays a major role in the rituals and haoma, a drink, is also important. • The body must be washed before being dressed in white clothing. • There is a significant community in London • The family may wish the head to be covered with a cap or scarf. • Today, one can only be a Parsis by birth. • Parsis hold that the soul is earthbound for 3 days after death and so it is important to commence prayers for the deceased as quickly as possible after death. Food • There is no religious/cultural objection to organ transplantation/donation.• There are no religious dietary requirements. • Either burial or cremation is acceptable. 29
  30. 30. • Post mortems may only be held if requested by the coroner. Appendix - Interpreter Policy If a patient’s ability to communicate effectively in English is limited and affects their understanding and ability to be fully involved in their care planning, they will need the services of an interpreter. Specialist interpreting services (e.g. signing) may be required by certain patients. Additionally, interpreting services may also be required by some staff in some circumstances e.g. during IPR and training sessions where individual’s command of English is limited. The Trust’s policy states that facilities must be made available to access an interpreting service for use with patients, clients, residents, carers and staff. There are certain principles employed in this policy, namely, • All users should be able to communicate with health workers in a language with which they feel comfortable. • Information must be provided to service users and their carers in an accessible format to enable them to make informed decisions. • When a patient/user requires interpreting services, the assessment of needs and service response should be documented in the patient’s notes. In order for the policy to be followed properly: • Language should be recorded on admission. • Where it is necessary to obtain consent for treatment, the assessment and explanation must be culturally sensitive, in an appropriate language and format and the circumstances fully documented in the patient’s notes. Additionally, • Family members and friends must not be used as interpreters in clinical dialogue with the patient. • Trust staff and other volunteers who are used to provide interpreting services must have received training regarding confidentiality and other relevant specific information. 30
  31. 31. Procedure Authority to use interpreters should be obtained from the senior staff member of the department concerned e.g. ward manager. Interpreters can be contacted through a number of sources. Interpreters may be found in the following ways. 1. There are various members of the trust’s staff who are able to act as interpreters on a voluntary basis. Their availability obviously cannot be guaranteed. A full list is given on a separate memo accompanying this document. 2. Warwickshire County Council Social Services Department on 01926 412532 are able to supply interpreters for any language on a fee basis. They are usually able to respond fairly quickly. 3. The National Register of Public Service Interpreters can be accessed in office hours through the Nursing and Quality Department at Governor’s House or, out of hours, at Campion Ward, RLSRH, (01926 317700). A charge is involved. 4. Coventry & Warwickshire Sign Language Interpreting Services offers a signing service, again on a fee-paying basis. Their telephone number is 024 7652 0378, fax 024 7622 9667. 31
  32. 32. Acknowledgements The information presented in this directory has been compiled using a number of sources. We are particularly indebted to: “Religious and cultural beliefs in the provision of healthcare” – Chesterfield and North Derbyshire Royal Hospital NHS Trust, 1995. “Faith communities in Bristol” – issued by the chaplaincy department of the United Bristol Healthcare NHS Trust, 1999. “Understanding and respecting religious and cultural needs” – University Hospital Birmingham NHS Trust, 1997. “Religions and cultures” – Lothian Racial Equality Council, 1992. The Oxford Dictionary of World Religions, 1997. “Our ministry and other faiths” – Hospital Chaplaincies Council, 1993. “Concise guide to customs of minority ethnic religions” – Coventry Diocese, 1992 32
  33. 33. Index A Church of England · 10 Agnostic · 5 "Cold" foods · 26Allah · 13 Confucianism · 26Anglican · 10 Crystals · 19Armageddon · 15 astrology · 19 Atheists · 5 DAtman · 11 Avesta · 27 Dalai Lama · 8 Dharma · 11 B Digambaras · 14 Divali · 11 Báhá’i · 6 Báhá’u’llah · 6 EBaptist · 10 Bhagavad Gita · 11 Bible · 9, 10, 15, 16, 21, 23 Easter · 10 Brahman · 14 Eid · 13 Brethren · 7, 10 Buddha · 8, 14 FBuddhism · 8, 11, 19, 24, 26 Buddhist · 8 Free Church · 10 Friends · 21 C GChapel · 10 Chinese · 3, 4, 24, 26 Christadelphian · 10 Goddess · 20 Christian · 10, 26 Greek Orthodox · 10 Christian Scientist · 9 Christianity · 7, 10 Christians · 23 Christmas · 10 33
  34. 34. H M Halal · 13 Mahavira · 14 High Church · 10 Mahayana · 8 Hindu · 2, 11 Marijuana · 22 Hinduism · 11, 19 Mecca · 13 Holi · 11 Methodist · 10 "Hot" foods · 26 Mohel · 16 Humanist · 5, 12 Moonies · 17 Mormons · 18 Muhammed · 13 I Muslims · 13 Islam · 13 NInterpreters · 28-29 New Age · 19 J PJainism · 14 Jains · 14 Japanese · 24 Paganism · 20 Jehovah’s Witnesses · 15 Pagans · 20 Jews · 16 Parsis · 27 Judaism · 16 Paryushanaparva · 14 Pentecostal · 10 Pillars of Islam · 13 K Protestant · 10 Punjab · 25 Kaccha · 25 Kali · 11 QKami · 24 Kangha · 25 Kara · 25 Qu’ran · 13 Karma · 11 Quakers · 10, 21 Kesh · 25 Kingdom Halls · 15 RKirpaan · 25 Kosher · 16 Rabbi · 16 Rastafarianism · 22 34
  35. 35. Rastafarians · 22 Roman Catholic · 10 Russian Orthodox · 10 S Sabbath · 16 Salvation Army · 10 Seventh Day Adventist · 10 Shakti · 11 Shariah law · 13 Shi’a · 13 Shinto · 24 Shintoism · 24 Shiva · 11 Sikhism · 25 Sikhs · 2, 4, 25 Sun Myung Moon · 17 Sunni · 13 Svetambaras · 14 Syrian Orthodox · 10 T Tantric · 8 Tao · 26 Taoism · 19, 26 The Church of Christ, Scientist · 9 The Church of Jeus Christ of Latter Day Saints · 18 The Watchtower · 15 Theravada · 8 Tirthamkaras · 14 Travellers · 23 U United Reformed · 10 V Vietnamese · 3, 26 Vishnu · 11 W Witnesses · 15 Y yang · 26 yin · 26 Yoga · 11 Yom Kippur · 16 Z Zarathustra · 27 Zen Buddhism · 8 Zoroaster · 27 Zoroastrianism · 27 35

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