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. 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. 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. 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. 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. 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. 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. 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. 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. 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
• 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. • 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. 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. • 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. • 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. • 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. 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. 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. 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. 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. • 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. 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. • 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. • 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. • 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
