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  • 1. Respecting religious and cultural beliefs a best practice guide for those involved in the welfare of patients
  • 2. Contents Introduction 1 Names and languages 2 Details on various religions/cultures 5 Interpreter policy 28 Acknowledgements 30 Index end
  • 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. 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. 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. 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. ATHEISM (Atheists) Religion & Culture Key points • Atheists do not profess any form of religious belief Care of the dying whatsoever and dismiss the idea of a supreme being, • Atheists are individuals and should be treated as such. God or gods of any kind. They are distinct from There will be a wide range of needs that patients have • There are no specific considerations. Agnostics, who are unsure about faith and belief in and they should be asked how their needs could be God. met during their stay in hospital. • They may be humanists (see “Humanism”) or they • Atheists may be wary of making their beliefs known may not wish to be described as belonging to any one so do not assume that their family will be aware of group of people. their beliefs. Food • No special 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 7
  • 8. • Founded in Persia in the mid 19th Century, by Key points Báhá’u’llah (means Glory of God) who is regarded as Care of the dying nd a Messenger of God. • There is a period of fasting each year, between 2 and 21st March, but invalids, children, elderly (over 70) • No particular points to note. and expectant/nursing mothers are exempted from • Jesus and Muhammad are acknowledged as prophets this. 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 • Báhá’is emphasise the unity of humanity and all necessary medically. 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 • Female Báhá’is do not usually have an objection to affairs. being examined by male clinicians. If a Báhá’i patient dies • Most Báhá’is follow a practice of daily prayer and an • The soul is believed to come into being at conception. annual period of fasting. Abortion is therefore strongly discouraged. • 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 • There are an estimated 5 million followers in the cover. Embalming is not allowed. 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 • No special requirements, except any food containing near as possible to the place of death and certainly alcohol is forbidden. Báhá’is are encouraged to be within an hours travel. vegetarian. • There is no usual objection to post mortems, provided the above stipulations can be met. 8
  • 9. THE BRETHREN (Brethren) Religion & Culture Key points Care of the dying • See the page on “Christianity”. • Ask the patient or carers if they would like the • A branch of Christianity with some specific presence of the hospital chaplain or their own local considerations regarding hospital care – which is why • Additionally, some Brethren only eat and drink with minister. this separate page is about them. other Brethren. They may therefore wish to eat alone behind closed curtains. • Brethren will try to maintain a 24 hour vigil when the • Brethren are fully part of the Christian Church but patient nears death. regard themselves as true Christians. They believe in • Women do not cut their hair and keep it covered in what they understand to be a more truly original public places. (A hospital may be considered a public pattern of the New Testament. 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 • There are no dietary requirements although some may control over the body and attend to washing and last avoid eating meat on Fridays. offices. • There will often be an objection to organ donation or post mortems, unless demanded by the coroner. • Either burial or cremation is acceptable. 9
  • 10. BUDDHISM (Buddhists) Religion & Culture Key points Care of the dying • Buddhism is more a way of life than a formalised • Buddhists would appreciate the use of an area for • A side ward would be appreciated. religion. peace and quiet to enable them to meditate and chant (side ward?). • Very full information will be sought from staff about • It is based on the teachings of Buddha (The any imminent death so that death will be approached Enlightened) who lived in India in the 5th/6th Century • Patient’s requirements in hospital may vary according in as clear a frame of mind and as positively as BC. to which branch of Buddhism they follow. possible. • Buddha is revered by Buddhists as the founder of • Visits from other Buddhists are very welcome. • Patients may wish to minimise or reduce the use of their Way of Life but not as a god. sedative drugs in an attempt to remain fully alert. • There is no conflict with modern medicine or • Buddhists hold no idea of a creator type of God, but techniques. instead believe that everything in life is inter- dependant. • There is no religious objection to blood transfusion. • There are 3 main schools – Theravada, Mahayana • Buddhist tradition condemns abortion and all forms of (includes Zen Buddhism and is more liberal) and contraception after conception. Tantric (which holds the Dalai Lama as a religious and political leader). • Active forms of euthanasia are also condemned. If a Buddhist patient dies • Followers seek to emulate Buddha in perfect morality, wisdom and compassion culminating in a • There are no special rituals to be observed but a transformation of consciousness known as Buddhist priest should be informed as soon as enlightenment. possible. Contact either through the family or via the • The Way of Life involves living morally, being Food hospital chaplain. generous, keeping special festivals, pilgrimage to • Many Buddhists are vegetarians because of their • Normal post-death ward procedures may be carried sacred places and social responsibility. respect for all life. out. • There are over 310 million Buddhists in the world • There is usually no objection to organ donation or (some estimate 1000 million) and there are many post mortems. Helping others is fundamental to variations of Buddhism. Buddhist beliefs. • Many Buddhists in the U.K. are converts. Their • Generally cremation is preferred, although bodies may number is growing. be kept some time before actually being cremated. 10
  • 11. THE CHURCH OF CHRIST, SCIENTIST (Christian Scientists) Religion & Culture Key points Care of the dying • The Church of Christ, Scientist was founded by May • Patients will wish for minimal medical and drug • There are no last rites or rituals. Baker Eddy in 1879, who experienced personal therapy treatment. healing after long ill health. • A Bible may be requested. A copy should be found in • There is a reliance on prayer alone for the healing of bedside lockers. 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 • There may be an objection to blood transfusion. members - they are free agents. • 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 ⇒ Lack of faith (faith is not strong enough to believe Food out. cure can be obtained by prayer alone). • There is usually a strong objection to organ • Alcohol and tobacco are forbidden to Christian transplantation and/or donation. Scientists. • Post mortems are only allowed at the coroner’s insistence. • Cremation is usually preferred. 11
  • 12. CHRISTIANITY (Christians) 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 • Patients may wish to see the hospital chaplain • Ask the patient or carers if they would like the and ascended into heaven. (especially so of Roman Catholics) or have a visit presence of the hospital chaplain or their own local from their own minister. Contact should be made via minister. • Eternal life is promised to those who believe. St. Michael’s switchboard. • Some patients, especially Roman Catholics, would • Most Christians are baptised as babies or when they • A Bible may be requested. A copy should be found in expect the chaplain or their own minister to say are old enough to profess their own faith. bedside lockers. special prayers prior to death. The patient may be anointed with oil on the forehead. • Approximately 1/3 of the world’s population follows • Patients may wish to attend church services in the some form of Christianity. Many British people hospital/unit during their stay. • After death, relatives may gather to give prayers of would call themselves Christians although they may thanksgiving for the person’s life. not be active followers. Religious beliefs are more • Patients may also request baptism or weddings whilst likely to be regarded as separate from culture than on the ward. Please contact the chaplain should this with many other religions. arise. • There are many different Christian churches with • There is no religious objection to blood transfusion or different structures, beliefs and rituals, but the organ transplantation. understanding of God as Father, Son and Holy Spirit is common to all. • 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 • Seventh Day Adventists observe Saturday, not resurrection). 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, Food • Normal post-death ward procedures may be carried Christadelphian, Seventh Day Adventist, Quakers (see out. separate page), Brethren (see separate page), Greek • There are no dietary requirements although some Orthodox, Russian Orthodox or Syrian Orthodox. Christians may avoid eating meat on Fridays. • There is no religious objection to organ donation or Additionally, some Christians may describe post mortems. themselves as Protestant, High Church, Chapel or • Seventh Day Adventists abstain from eating certain Free Church. animal meats esp. pig and offal. Many are vegetarians or vegans. They avoid alcohol and tobacco and may • Either burial or cremation is acceptable. avoid tea and coffee. 12
  • 13. HINDUISM (Hindus) Religion & Culture Key points Care of the dying • Hinduism is the result of 5000 years of continuous • It is crucial to Hindus that they are able to follow their • Clothes, money etc. may be brought to the patient for cultural development. For the Hindu, religion and religious practices in hospital. him/her to touch. so that before death offerings can be culture are inseparable. made to the needy, religious people, or to the Temple. • Modesty is important to the Hindu. Female patients • There is no formal structure to the religion. prefer a female doctor if possible. • Wherever possible, Hindus prefer to die at home. • Hindus believe in one supreme spirit, from which the • Provide running water or a jug/bowl of water in the • Dying patients may prefer to lie on the floor in order whole universe emanates. This spirit can be same room as a toilet or bedpan. to be nearer to Mother Earth. worshipped in many ways. • Married women wear red marks on their foreheads • There are no general religious objections to blood • There is a belief in an eternal soul (Atman) and in a and nuptial threads/necklaces. Male adults wear a transfusion or organ transplantation/donation. law that determines in which form a person may be “sacred thread”. 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. • There are many personal gods but the most important If a Hindu patient dies 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 • Do not touch the body before consulting the family • The sacredness of the land of India and the caste her baby, however. (esp. eldest son) to ask if they wish to perform the system are central beliefs. last rites as distress may otherwise be caused. • There is no Hindu objection to contraception. It is • Every person has a duty to fulfil to society (Dharma). advisable to ask the woman if she would like her • If no family is available then follow these steps: husband/relative to be present during discussions. ⇒ Wearing disposable gloves, close the eyes and • There is a great respect for all living things. straighten the limbs. • Yoga is one of the six orthodox systems of Hindu Food ⇒ Do not remove jewellery, sacred threads or other religious objects. philosophy, although it is also found in Buddhism. ⇒ Wrap the body in a plain sheet without any religious • Many Hindus are wary of consuming animal fat. It is best to consult individuals reagrding diet. However, emblem. If in any doubt, do not wash the body as the • Two major festivals are Divali (Oct/Nov) which family will wash it as part of the last rites with water celebrates New Year, and Holi (Feb/Mar) which is a there are some common points: from the Ganges, which is collected from the Temple. 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 • There are an estimated 500 million Hindus in the ⇒ Milk from cows is usually acceptable. necessary. All organs must be returned to the body. world. ⇒ Plates that have been used for non-vegetarian food are Adult Hindus are always cremated (although children disliked. are buried). ⇒ Hindus do not smoke or drink alcohol. 13
  • 14. HUMANISTS Religion & Culture Key points Care of the dying • Humanists believe that humankind is able to improve its own condition without any form of supernatural • Freedom of choice is important in humanism, • There are no special needs aid and, in fact, has a duty to do so. 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 Food considerations in respect of those who have died. • 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. 14
  • 15. ISLAM (Muslims) November/December). Ramadan ends with the of pig product is to be avoided. This extends beyond festival of Eid. pork meat, ham and bacon to such things as gelatine Religion & Culture 4. The giving of alms to the poor. and pig fat used in some soaps. 5. Pilgrimage to Mecca (if able) at least once in a • Islam is an Arabic word which means peace, purity, lifetime. • The consumption of alcohol is forbidden. acceptance and commitment. The literal religious Key points Care of the dying meaning of Islam is “surrender to the will of God”. Followers of Islam are called Muslims. • Many Muslims would prefer to be attended by a • Patients may wish to sit or lie facing Mecca (South member of the same sex. East). • Muslims believe in God alone as creator of the universe and they follow the revelations of the • Cleanliness is of great importance. A shower is • Family or friends will wish to sit with the patient prophet Muhammed (peace and blessings be upon preferred to a bath. After use of a bedpan, offer praying or reading the Qu’ran. him). washing facilities. • Muhammed was born in Mecca in Saudi Arabia in • Hands, feet & mouth are washed before prayer (if at 570 AD. The Holy Book of Islam is called the all possible) Qu’ran. • The whole body is washed after menstruation. • It is estimated that there are over 800 million Muslims in the world. There are over 1 million Muslims in the • Modesty observed in dress (applies to both sexes). If a Muslim patient dies U.K There are two main sects – Sunni and Shi’a. Hospital nightwear may not be acceptable. • After death, the body is considered to be the property • Worship is centred around a daily pattern of prayer of Allah. • If the patient has a copy of the Qu’ran in their locker, and is conducted in a mosque by an Imam (prayer this should be kept on the highest shelf and nothing leader) in Arabic. There are no clergy as such. • DO NOT WASH THE BODY. should be placed on top of it. Attendance at a mosque is compulsory for men on Fridays. • Wear gloves to avoid direct contact with the body. • There may be a reluctance to receive blood The body should face Mecca (South East) and the transfusions although there is no specific religious law • Shariah law is a religious and moral law based upon head should be turned towards the right shoulder opposing it. the Qu’ran. before rigor mortis. • Boys are circumcised as soon as possible after birth. • There are five crucial “pillars of Islam” which • You may comb hair, straighten limbs, remove followers must observe: equipment and cover the body in a white sheet, but • Attitudes to contraception vary greatly. 1. Declaration of faith. the family will wish to do the washing of the body. 2. Five daily prayers (facing Mecca) Food 3. The fast of Ramadan between dawn and dusk in the • Post mortems are only permissible if the law requires ninth month of the Muslim calendar (late • It must be Halal (prepared in a special manner). it. Further, any food or preparation containing any kind 15
  • 16. • The issue of organ donation is confused – the family requirements - check with the patient or family. If in may agree or not. doubt treat as vegan. JAINISM (Jains) • Muslims are always buried within 24 hours of the • Alcohol is prohibited. death. Religion & Culture Key points Care of the dying • Based on the teachings of 24 founders, the main one • A Jain patient will be very particular about being Mahavira, a contemporary of Buddha, who cleanliness, especially the floor in order to avoid • The family may wish to be present and say prayers at lived in the 6th century BC. stepping on any living creature. the bedside. • These founders (Tirthamkaras) have reached an ideal • Some Jains may prefer to fast between sunset and • Those who are considered to be very spiritually state of perfection and have untainted souls, sunrise. advanced are allowed by their religion to hasten their unblemished by the world. Other Jains strive to own death by fasting under specified circumstances. emulate them. • Female patients may prefer to be treated by female staff. • For Jains, everything has a soul, therefore they insist on non-injury to all forms of life. This means they are • Some patients may appreciate a visit from the very cautious in everything they do – for instance Jain Brahman (priest) to say prayers. monks wear cloths over their mouths to avoid killing anything by breathing it in. • Organ transplantation is dependent on the wishes of the patient and/or next of kin. • 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. Food If a Jain patient dies • Jains are strict vegetarians although they may eat • There are over 3.5 million Jains world-wide, but most • The family may provide a plain white gown or a some dairy products like milk, curds or clarified live in India. shroud for the body. butter. They may prefer to avoid garlic, onion and potatoes. There may be very particular dietary 16
  • 17. • Post mortems are regarded as being disrespectful to • There are over 2 million followers in the world. In the body, however this will depend on the degree of the U.K. there are over 120,000 Witnesses. • They do not smoke or use tobacco products. orthodoxy of the patient. • Their places of worship are known as Kingdom Halls. • Organ donation is dependent on the wishes of the patient and the relatives. JEHOVAH’SWitnesses refuse to obey any law that they • Jehovah’s WITNESSES (Witnesses) see as being contrary to the will of God. This includes military service and receiving blood Religion & Culture transfusions. Key points Care of the dying • 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- • God is seen as creator of the heavens and earth. • Dying patients will appreciate a visit from one of their operate with staff in alternative non-blood medical management. elders. • Jesus Christ is accepted as the Son of God but regarded as man and not divine. They regard • • Children are not baptised. Life should not be prolonged artificially if death is themselves as Christians, but are not accepted as such imminent/unavoidable. by the main Christian denominations who would stress Jesus as being both human and divine. • 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. Food If a Jehovah’s Witness patient dies • Food containing blood is forbidden. 17
  • 18. • The living body is dedicated to God but once dead the Food body has no particular significance. Normal ward • There are about 15 million Jews in the world and a practices can be followed. significant number of communities in the U.K. • Many Jews will request Kosher food (specially prepared meat). Only lamb, beef or chicken is • There are no religious objections to organ donation or allowable and only true fish (with scales and fins). post mortems. • Witnesses may be buried or cremated. JUDAISM (Jews) • 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. Key points Religion & Culture Care of the dying • Most Jewish people who are hospitalised will expect • Jews believe in one spiritual God who cannot be no particular considerations other than dietary requirements (see below). • Dying patients must not be left alone; therefore many represented in any shape or form. families will wish to sit with their relatives during the • There is no specific religious objection in Judaism to last few hours/days. • God created heavens and earth and ordained Jewish people to be inheritors of a special relationship with blood transfusion. • A Rabbi (Jewish minister) or a relative may recite him, established through a covenant with Abraham. • Ultra-orthodox Jews may have the following special prayers. • Their stories are found in the Hebrew Bible (the Old requirements: • Organ transplantation is allowed in order to save Testament). 1. Women may not want others to look at their hair lives. • The family is very important in Jewish culture, as is and may usually wear a wig. observance of the Sabbath (see under Key points) 2. Men may not touch women (including nurses) other than their wives without appearing • There is a wide variation in Jewish patterns of life and immodest. worship, ranging from the ultra-orthodox to “reform” 3. Some orthodox Jews observe the Sabbath, which and “liberal” movements. begins at sunset on Friday and last until sunset on If a Jewish patient dies Saturday and will prefer to do no work, writing or • Although authority is vested in Rabbi’s (Jewish travelling during the Sabbath. They may ask • If the death occurs on the Sabbath (sunset Friday – ministers) who would normally conduct collective nursing staff to operate the bedside light. sunset Saturday) leave the body and contact the worship in synagogues, much religious observance is 4. A reluctance to accept family planning. family, otherwise proceed as below. done at home. • Boys are circumcised on the 8th day after birth if • The eyes should be closed, the body covered and left • There are many festivals in the Jewish calendar, but healthy. A room may be requested for this to happen untouched. Either family members or associates of the most important and holiest one is Yom Kippur and the ceremony is conducted usually by a trained the same sex will prepare the body for funeral. (day of atonement and fasting) which occurs in late medically certified functionary called a “Mohel”. September/early October. 18
  • 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. UNIFICATION CHURCH (Moonies) Key points Care of the dying Religion & Culture • Moonies hold positive views concerning Western • There are no specific considerations • Founded by Sun Myung Moon in South Korea in medicine. 1954. • There are no cultural or religious objections to blood • Followers (Moonies) are intent on unifying the world transfusions or organ transplantation. 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
  • 20. • Normal ward procedures may be followed although it • Missionary work is usually conducted by pairs of • Mormons try to take care of their body, take proper would be advisable firstly to check if the family have young people working full time without pay visiting rest and eat healthily. any specific requirements. homes and the general community. • Many Mormons will eat meat sparingly, avoiding • Moonies are usually buried rather than cremated. • There are 7 million Mormons world-wide and over meats with a lot of blood in them. 150,000 in the U.K. • They are wary of stimulants and avoid coffee, tea, alcohol and tobacco. CHURCH OF JESUS CHRIST OF LATTER DAY SAINTS (Mormons) • In hospital, milk or fruit juice will be acceptable. Religion & Culture • The Church of Jeus Christ of Latter Day Saints was Key points Care of the dying founded in the early 19th Century. • Some Mormons who have undergone a special • Death is regarded as a blessing and spiritual contact • Their headquarters are in Salt Lake City in the U.S.A. ceremony wear a sacred undergarment. This is an with other Mormons is important during the dying intensely private item and is worn throughout life and process. An active Mormon will know how to contact • The church has an elaborate hierarchy and associated in death. It may be removed for hygiene purposes and the local bishop and a representative (home teacher) rituals. laundering and operations but must be treated with may call in to see the patient. due respect. • 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 • Children are not baptised. church. • 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 20
  • 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) Food must be replaced on the body after last offices. • Likely to be vegetarian or vegan. • Burial is usually preferred to cremation. • There is no objection to post mortems. NEW AGE Religion & Culture Key points • People who are New Age followers are not part of a • New Age followers are likely to hold a holistic view Care of the dying cohesive religion or ideology but are part of a loose of healing. and flexible movement. • Needs will be highly individualistic, but are likely to involve access to other followers with similar beliefs. • Organ transplantation or blood transfusions are • Followers are highly individualistic in their attitudes unlikely to cause any predicament. 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. 21
  • 22. If a New Age patient dies • Some Pagans follow their own inspirations but others Food are trained in various disciplines such as the Craft (or Witchcraft for which some prefer the name Wicca), • Normal ward procedures may be followed in the Druidry (but not all Druids are pagan – some • May well be vegetarian, vegan or wish to eat raw absence of other specific requests. understand themselves to be Christian), Odinism, food. Shamanism, Women’s Traditions & Men’s • There may be a desire for the body to be buried in a Traditions. natural woodland site using bio-degradable materials. • There is unlikely to be any objection to either post- mortems or organ donation. PAGANISM (Pagans) Religion & Culture Key points Care of the dying • Because of the diverse traditions within Paganism, • Paganism is probably one of the oldest surviving • Pagans will wish to know that they are dying so that patients should be asked how their needs could be met religious forms. they can prepare positively for death. during their stay in hospital. • There are many different practices of paganism but • Most Pagans would prefer to die at home or in a place • Many Pagans are wary of making their beliefs known certain aspects are common to all: special to them rather than in hospital. so do not assume that their family will be aware of their beliefs. ⇒ Feminism is a strong influence and Women’s • Patients will appreciate a visit from their own spiritual sprituality is much respected. advisers (they should have the contact number) rather ⇒ The “Goddess” is the primary focus for worship but than the hospital chaplain. 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. 22
  • 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. THE RELIGIOUS SOCIETY OF FRIENDS (Quakers) Religion & Culture Key points • A Quaker patient may wish to be visited by another Care of the dying • Quakers are a branch of the Christian Church and believe the whole of life is sacred and the experience Quaker. • There are no special rites or rituals for the dying. of God to be available to everyone. • Patients will appreciate a visit from an Elder or other • Followers adhere to a way of life rather than a dogma Quaker, who may sit in silent worship 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. 23
  • 24. If a Quaker patient dies • There is a rejection of Western culture and Christian • Many will not accept family planning. churches. • Normal post-death ward procedures may be carried out. • Natural methods of childbirth are preferred and a time Food of separation and purification may be observed after • There are no religious objections to organ the birth. • Any pig meat is forbidden and some fish are transplantation/donation or post mortems. unacceptable e.g. herring and sardines. • Many Rastafarians are converts to the religion. • Burial or cremation is dependent on the wishes of the • Many Rastafarians are vegetarian. deceased. • RASTAFARIANISM (Rastafarians) Orthodoxtobacco or caffeine. Marijuanastimulants, i.e. alcohol, Rastafarians do not take any is the sacramental herb. Religion & Culture Key points Care of the dying • Rastafarianism began in the 1930’s in the West Indies • Members have a distinctive hairstyle - dreadlocks among the descendants of slave families who had (locks) are a symbol of faith and a source of black • There are no special rites or rituals for the dying. originally come from Africa. pride. Orthodox members may not permit their hair to be cut. • Identification with Africa is central to Rastafarian doctrine and the movement is linked to the roots of • Rastafarian women dress modestly at all times. They resistance to slavery. do not wear second hand clothes and may therefore be unwilling to wear hospital garments which have been • Ras means prince, so Ras-Tafari becomes Prince worn by others. Tafari, who became the Emperor of Ethiopia (Haile Selassie I) in 1930. He is considered to be a divine • Rastafarians may be unwilling to receive any being who will eventually lead all black people to treatment which might contaminate the body and may freedom. reject some Western style treatments. Alternative therapies may be preferred. • The Old and New Testaments are regarded as scriptures, but Rastafarians do not consider • Visiting the sick is important and may be done in themselves as Christians. For them, Christ’s spirit has large groups which may cause its own problems in the been reborn in Ras Tafari. ward. • Rastafarianism is a personal religion. There are no • Blood transfusions may be refused because of fear of church buildings, set services or official clergy. contamination of the body. 24
  • 25. If a Rastafarian patient dies • Normal post-death ward procedures may be carried Food 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. ROMANY ORIGIN (Travellers) Care of the dying Religion & Culture Key points • Visiting the dying is important and family/friends may • Clothes are not washed in a bowl used for vegetable travel from around the country to visit the patient. • Includes Irish, Welsh, Scottish and English Travellers, or food preparation. Large numbers may be involved. those who live on a permanent site, those in transit and those settled in houses (a Traveller may have • A separate bowl is kept for washing face and hands given up wandering without relinquishing his/her etc. ethnic identity). • It is immodest to undress in front of others and also • Many are Christians. rude to keep legs and feet uncovered. • Travellers often have difficulties in accessing health • Older people may refuse to wash their hair. It is services. Treatment is often akin to “temporary considered that the hair will clean itself naturally. resident status” where notes are not retained by any Cleanliness may be aided by using hedgehog oil. GP • Older people may also use bacon fat as a moisturiser. • Patients may wish to see a chaplain and/or request a Bible. • There is no religious/cultural objection to blood If a Traveller patient dies transfusions. 25
  • 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 • Again, the personal requirements of individuals overnight vigil with the body and to give opportunity should be attended to as much as possible. for family and friends to pay their last respects. • Personal items are often placed in the coffin e.g. jewellery, photographs etc. • There is no religious/cultural objection to organ transplantation/donation. SHINTOISM (Kami) (Japanese) Care of the dying • Burial is usually preferred to cremation. Key points Religion & Culture • No specific considerations. • Much of what has been written about Chinese culture • Japanese culture finds its main religious expression in (see under Taoism and Confucianism) is relevant to a mixture of Shintoism and Buddhism. Shintoism also. • Shintoism originated in Japan over 2000 years ago • Even though Shintoism is no longer Japan’s state religion, there are devotees of Shintoism in Japan, and • “Shinto” means “Way of the Kami”. It used to be the according to some reports, it has recently risen in state religion of Japan until 1945. popularity. • There is no scripture, only mythology based on 2 • The chances of encountering a Kami patient are very texts. slim and the best course of action is to try and attend to whatever needs the particular individual expresses. • 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. 26
  • 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 ⇒ Kaccha - a special type of underwear. many will not accept fish, eggs and meat. ⇒ Kirpaan - a sword symbolically worn by baptised • In this unlikely event, seek the guidance of the family. Sikhs. • If in any doubt, it is best to follow the points made under the corresponding section on the page dealing with Taoism/Confucianism. SIKHISM (Sikhs) Care of the dying Key points • The family will wish to be present and say prayers at Religion & Culture • Female patients would prefer to be seen by a female the bedside. doctor, if possible. • Sikhs believe in one God, and many cycles of rebirth. • The five K’s (see opposite) worn by men should not • They respect equality of all people, regardless of cast, be disturbed. If it is necessary to disturb them (e.g. creed, colour or sex. cutting hair) then the need for this should be carefully explained to the patient and family. • Sikhism originated in Punjab, India. • Most Sikhs are accustomed to having water in the • There are approximately 300,000 Sikhs in the U.K. same room as the toilet, therefore a bowl of water There is a large local community in Leamington Spa. should be provided when a bedpan has been used. • Sikhs believe that God is the only reality and that • There are no objections to blood transfusions or organ spiritual release can be obtained by taming the ego transplantation. through devotional singing, recitation of sacred texts, meditation and service. Prayers are read five times a • Contraception may be used but is not openly spoken day. about. • All men are given the name Singh (meaning lion). • Mothers are encouraged to rest for 40 days after Women receive the name Kaur (princess). 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 ⇒ Kesh (means hair) - long hair kept under a turban. Food NOT DISTURB THE FIVE K’s (see under Culture ⇒ Kangha - a small comb worn in the hair at all times. opposite). 27
  • 28. cereals, rice, wheat, fruit, potatoes, white sugar, green • The body should be released as soon as possible to • When a child is born, the mother may be unwilling to vegetables, milk. enable the funeral to take place. bathe for a few days, tradition saying she should rest at this time. The baby’s head may be shaved at 1 • Many people prefer to have home cooked food • There is no religious/cultural objection to organ month old. brought into them. Older Chinese may cling to the donation or post mortems. belief that the only form of food which can give them energy and vitality is rice. • TAOISM & CONFUCIANISM (mainly Chinese/Vietnamese) Sikhs are always cremated. Care of the dying Key points • No specific considerations. Religion & Culture • Family life is very important and ties are very strong. • Many Vietnamese and Chinese people will follow a • Some female patients (especially older women) would mixture of Taoism, Confucianism and Buddhism. prefer to be seen by a female doctor. (Although a significant number of Vietnamese and Chinese are Christian). • A soak in the bath is believed to be bad for the body in later life, therefore a shower is preferred. • Taoism & Confucianism are both philosophies and religions. Often followers will draw from both • There are no specific religious or cultural objections philosophies and also Buddhism. to blood transfusion or organ transplantation. If a patient dies • The Tao is thought of as the absolute basis and source • Ethnic Vietnamese/Chinese are likely to prefer of all things. It is the underlying state of emptiness Western medicine to any form of traditional ethnic • Wherever possible a Vietnamese or Chinese person which is the base of all creation. Strip away all our remedies, although there may be some suspicion of will wish to die at home in the presence of relatives. thoughts, senses and all the changing phenomena that Western medicine by a minority of older Chinese Chinese people will wish to return to the community we see around us and what you have left is Tao. patients. of their birth to die, if possible. • Taoism has been long associated with a search for Food • If death occurs in hospital, contact the family first immortality and it is believed that longevity can be before carrying out normal procedures. If no family encouraged by holding together the yin (the principle • In order to be healthy, an equilibrium between “hot” can be contacted then the body is bathed and, in the of rest, or what is dormant) and the yang (the active and “cold” needs must be maintained and this relates case of traditional Chinese, is clothed in white or principle, or what is creative). to food, herbs and medicines. (This has nothing to do traditional Chinese clothing. with temperature!) Foods are therefore defined as • Matter and spirit are regarded as being the same thing. hot or cold and so, to restore balance, a strict diet may be observed. • Relatives and friends will wish to see the body. There is no distinction between the two. • • Funeral arrangements and mourning varies widely. • Confucianism emphasises respect for authority. Law Hot foods include most pulses, spices, eggs, nuts, is essential in order to make life possible. honey, onions, lamb, tea, coffee. Cold foods include 28
  • 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. ZOROASTRIANISM (Parsis) • There are no religious/cultural objections to post Key points Care of the dying mortems or organ donation. Religion & Culture • There should be no problem with normal hospital • The family may wish to be present and say prayers at routines regarding washing etc. the bedside. • 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 • Daily prayers are necessary which involve untying until the Muslim conquest of the 7th century AD. 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. • Followers have a dualist view of the world – the There is a subsequent proneness to conditions with a world is a battleground between good and evil. hereditary aspect e.g. Rh negative blood group, diabetes, cancer and coronary problems. • The sacred literature is the Avesta. If a Parsis patient dies • Fire plays a major role in the rituals and haoma, a • The body must be washed before being dressed in drink, is also important. 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 • There are no religious dietary requirements. transplantation/donation. • Either burial or cremation is acceptable. 29
  • 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. 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. 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. Index A Church of England · 10 Agnostic · 5 Allah · 13 "Cold" foods · 26 Anglican · 10 Confucianism · 26 Armageddon · 15 Crystals · 19 astrology · 19 Atheists · 5 Atman · 11 D Avesta · 27 Dalai Lama · 8 Dharma · 11 B Digambaras · 14 Divali · 11 Báhá’i · 6 Báhá’u’llah · 6 Baptist · 10 E Bhagavad Gita · 11 Bible · 9, 10, 15, 16, 21, 23 Easter · 10 Brahman · 14 Eid · 13 Brethren · 7, 10 Buddha · 8, 14 Buddhism · 8, 11, 19, 24, 26 F Buddhist · 8 Free Church · 10 Friends · 21 C Chapel · 10 G 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. 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 Interpreters · 28-29 N New Age · 19 J Jainism · 14 P 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 Kami · 24 Q Kangha · 25 Kara · 25 Qu’ran · 13 Karma · 11 Quakers · 10, 21 Kesh · 25 Kingdom Halls · 15 Kirpaan · 25 R Kosher · 16 Rabbi · 16 Rastafarianism · 22 34
  • 35. Rastafarians · 22 Roman Catholic · 10 U Russian Orthodox · 10 United Reformed · 10 S V Sabbath · 16 Salvation Army · 10 Vietnamese · 3, 26 Seventh Day Adventist · 10 Vishnu · 11 Shakti · 11 Shariah law · 13 Shi’a · 13 W Shinto · 24 Shintoism · 24 Witnesses · 15 Shiva · 11 Sikhism · 25 Sikhs · 2, 4, 25 Y Sun Myung Moon · 17 Sunni · 13 yang · 26 Svetambaras · 14 yin · 26 Syrian Orthodox · 10 Yoga · 11 Yom Kippur · 16 T Z Tantric · 8 Tao · 26 Zarathustra · 27 Taoism · 19, 26 Zen Buddhism · 8 The Church of Christ, Scientist · 9 Zoroaster · 27 The Church of Jeus Christ of Latter Day Saints · 18 Zoroastrianism · 27 The Watchtower · 15 Theravada · 8 Tirthamkaras · 14 Travellers · 23 35