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Care of the dying in our multi cultural society There are very wide variations in the degree of adherence to religious practice and in the nature of that practice. There are many variations in attitudes within most of the major religions e.g. the difference between Orthodox and Reformed Judaism, or within Sikhism, or different Christian denominations. It is important therefore to consult closely with the individual or family concerned, as part of care planning. These guidelines are intended to help health care staff in unfamiliar situations, particularly where no immediate family members are available. • Always ask the patient/relative if they would like to see a Chaplain or make arrangements for their own priest/minister to visit, even if they have previously declined these services. Many patients change their minds in the final hours. • Involve the family in care, and last offices as much as possible. BUDDHISM BACKGROUND: Buddhism arose in the 6th Century BC in Nepal. Buddhism means the teachings of Buddha and Buddhist faith centres on Buddha who is revered not as a God but as the founder of a way of life. Buddhists believe in reincarnation and accept the responsibility for their actions, since the consequences may be seen in subsequent lives. RELIGIOUS NEEDS/SPECIAL CONSIDERATIONS Peace and quiet for meditation would be appreciated and they will also welcome visits from other Buddhists. Diet – may be vegetarian CARE OF THE DYING Buddhists would like to have very full information about their death to enable them to make preparation. They believe that the state of the mind at the time of death will influence the character of the rebirth. A visit from a fellow Buddhist for counselling or quiet for meditation would be valued. In order to approach death as clearly and consciously as possible, a Buddhist may wish, with close consultation with their doctors, to have a reduction in certain types of medication, such as sedatives and opiates. PROCEDURES AFTER DEATH: It would be appreciated if the body could be left for about an hour, so that the soul may depart undisturbed. POST MORTEM AND ORGAN TRANSPLANTS: There are unlikely to be any objections to these ROMAN CATHOLIC In addition to normal visits by the Chaplain often with Holy Communion, the sacrament of the sick with anointing is of particular importance. This is not only for the dying but for any who are sick, especially before an operation. CARE OF THE DYING PATIENTS Prayers may be said at the bedside and sometimes it will be appropriate for the patient to be anointed. After death some families may like to gather round the bed to give prayers of thanksgiving for the person’s life. The Catholic Priest must be called to the dying patient or to one who has just died and also to baptise infants in danger of death. POST MORTEMS AND TRANSPLANTS: No Religious objections PROCEDURES AFTER DEATH: No special requirements HINDUISM BACKGROUND: Hindus believe in one God who can be understood and worshipped in many different forms. They also believe in the theory of rebirth and the principle of action i.e. one has to face the consequences of actions in past lives. RELIGIOUS NEEDS OF PATIENTS/SPECIAL CONSIDERATIONS: Female patients prefer female doctors and consideration should be given to their modesty. Running water or a jug in the same room as a toilet is essential: if a bedpan is used, a bowl of water should be offered afterwards. Diet – many are vegetarian; and some are vegan. CARE OF THE DYING: Hindu patients, wherever possible, would like to die at home. Some Hindus would wish to lie on the floor. Readings from Hindu Holy Books, especially Bhagaved Gita are often requested. The Patient’s family may wish to call a Hindu priest for advice if the patient wishes it. The priest may tie a thread around the neck or wrist of the dying person. A small piece of Kusha grass may be put under the bed. A Hindu often has the leaves of sacred Tulsi plant and Ganges water put into his mouth before death. PROCEDURES AFTER DEATH: Do not wash the body as this is usually carried out be relatives later. Hindus prefer to be washed in water mixed with Ganges water. Jewellery, sacred threads and other religious objects should not be removed FUNERALS: Cremation preferred TRANSPLANTS AND POST-MORTEMS No objections to transplants. ISLAM (Muslim) BACKGROUND: The literal meaning of Islam is considered to be ‘Submission to the wills of Allah’. Makka (Mecca), Saudi Arabia is the place of pilgrimage and believed to be the birthplace of the prophet Mohammed, and the direction Muslims face when praying. Where possible, beds should also face that direction (South East). The Holy Qur’an is the Holy Book of the Muslins who believe it to be the Divine Revelation from Almighty Allah. RELIGIOUS NEEDS OF PATIENTS: Cleanliness: The provision of a jug/container of water in the toilet area for ablutions before prayer would be appreciated. Diet: Halal is the lawful food permitted to Muslims. Kosher meat or a vegetarian diet would usually be acceptable. No pork, alcohol or gelatine based products. Fasting: During the month of Ramadan food should be made available before dawn and after sunset for any patient wishing to fast. It is not compulsory for ill people or children to fast, but patients choosing to fast during Ramadan should have their wishes respected. Drugs: Essential drugs and medicines can be administered during Ramadan. MODESTY: Both male and female Muslims are modest in dress and outlook. A female Muslim may wish to have the curtains drawn around her bed during times of public access (i.e. visiting) and to request that her husband is present during medical examination. CARE OF THE DYING PATIENT: The opportunity to make a will and settle affairs where necessary is important. Patients may wish to sit or lie facing Mecca, moving the bed, to make this possible, would be appreciated. “Muhammad is the messenger of Allah” should be the last words spoken into the ear of the dying patient. If no Muslim relative or visitor is available these words may be said by a non-Muslim carer. PROCEDURE AT DEATH: Usually, all the Islamic requirements are undertaken by the family and Muslim undertakers. The body should be left untouched. If for any reason non-Muslim health workers need to touch the body they should wear disposable gloves. Do not wash the body or cut nails or hair. Cover the deceased with a plain white sheet which covers all of the body. POST MORTEMS AND TRANSPLANTS: In Islam the body is considered to belong to God. Post mortems are therefore forbidden unless ordered by the Coroner in which case the reasons for it must be clearly explained to the family. Strict Muslims will not agree to transplants and the subject should not be raised unless the family initiates the discussion. FUNERALS: Immediate burial (next day) is preferred. The coroner’s officer should be informed that the patient was a Muslim and for the death certificate to be issued as soon as possible. JUDAISM BACKGROUND: The foundation of Judaism and the earliest stories of the Jewish people are found in the Jewish Bible. Orthodox Jews follow a strict religious lifestyle based on a traditional interpretation of the scriptures. Progressive (also called Liberal or Reformed Jews) adapt their religious observance to a more modern way of life. RELIGIOUS NEEDS OF PATIENTS: Diet - Some Jews will ask for kosher foods, i.e. specially prepared meat – no pork, milk and meat products. The extent of dietary observance can vary greatly, so consult with each patient about their needs. Sabbath: The Sabbath begins at sunset on Friday and continues until sunset on Sunday. Some Jews may refrain from every day tasks like writing, switching on lights etc. Clothing: Some Jewish men will need to keep their heads covered at all times, some while they are praying, and others not at all. Some women may wish to keep their arms covered and may wear a wig. CARE OF THE DYING PATIENT: Many families will wish to sit with their relatives throughout the last days/hours. A dying Jew may wish to hear special psalms, particularly Psalm 23, and traditionally should have the opportunity of saying a special prayer or confession, and to receive the Affirmation of Faith (Shema). These prayers may be said on their behalf by a relative or a Rabbi, but it is not essential that a Rabbi is present. PROCEDURE AT DEATH: The eyes and mouth should be closed soon after death and the arms extended by the side. In some cases the son or nearest relative may wish to do this. The body should be covered and handled as little as possible by others. Some Orthodox Jews will wish the body to remain where it is until their funeral director can come and take it away, but most will be happy for the body to be taken to the hospital mortuary until it can be collected. This will be necessary if a patient dies on the Sabbath. FUNERALS: Immediate burial (next day) is preferred. The coroner’s officer should be informed that the patient was Jewish and for the death certificate to be issued as soon as possible. POST MORTEMS AND TRANSPLANTS: The preservation of life is an important principle in Judaism. Therefore, although mutilation of a corpse is not permitted there is no objection to organ transplants. SIKHISM BACKGROUND: Sikhs (disciples) are members of a religious faith which originated in the Punjab in Northern India as a reformist movement of Hinduism. The Gurdwara (Sikh Temple) is the meeting place for public worship. The Guru Grant Sahab (Sikh Holy Book) is the focal point of the Gurdwara. Sikhs, as an act of faith, wear the “5 k’s” 1 Kesh: (means hair) long hair is kept under a turban 2 Kangha: small comb which is worn in the hair at all times 3 Karak: Sikh steel bracelet worn on the right wrist 4 Kachha: breeches – a special type of underwear 5 Kirpaan: sword – baptised Sikhs wear a short sword. RELIGIOUS NEEDS OF PATIENTS/SPECIAL CONSIDERATIONS: Female doctors preferred for female patients. The turban should be treated with great respect at all times and only removed after asking permission, if it is absolutely essential. The Kara (bracelet) should not be removed. A bowl/jug of water should be provided for washing in the toilet area. Diet: Many Sikhs, especially women, are vegetarian, and some are vegan. THE CARE OF THE DYING: The dying Sikh may receive comfort from reading hymns from Guru Grant Sahab. POST MORTEMS AND ORGAN TRANSPLANTS: There are no religious objections to this. PROCEDURES AT DEATH: The family may wish to wash and lay out the body themselves, but generally Sikhs are happy for others to do this for them. Routine procedures may be carried out but do not remove the ‘5 K’s’. Do not trim beards or remove turbans. If Kachha (breeches/shorts) have been removed they should be replaced. FUNERALS: Cremation, as soon as possible.