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CAREGIVING IN DIFFERENT RELIGIONS AND CULTURES By Amira G. Eltaliawi, MD Consultant of Geriatrics and Gerentology Introduction • For thousands of years care giving for the elderly has been an integral part of different religions and traditions all over the world. Various religious establishments have given care for elderly with dementia and many of today’s formal care giving institutions have developed from these establishments. • Religion and different traditions also, ever since the dawn of man, have inspired caregivers for the elderly and motivated them as well as helped relieve their psychological and spiritual stress. Objectives • The aim of this review is to explore the value of care giving in different religions and traditions with a special focus on religions of the region (Judaism, Christianity and Islam). • The perspective of three different caregivers; one Muslim, one Christian and one Jewish will be presented. Questions • How have your religious values affected your care-giving • • • • of a dementia patient? Can religion be a burden in care-giving? Autonomy vs. beneficence? Special religious laws vs. modern laws? End of life issues; how has religion influenced decisions and affected coping in this phase? Judaism "Honor your father and your mother “(Exodus 20:12) • Historically speaking, the Jewish community has tended to demonstrate a care for the aged that is often taken to be exemplary translated into a pattern of institutions caring for their needs. • Jewish sources mandate that children tend personally for their parents' physical and psychological needs. Maimonides adds one caveat referred to in the article below: Those who are extremely disturbed by their parents' dementia may arrange to have someone else care for their parent. • Care is instructed to carried out in a proper attitude :"A man may feed his father on fattened chickens and inherit Hell [as his reward], and another may put his father to work in a mill and inherit Paradise. • “Do not stand idly by the blood of your neighbor.” Leviticus 19:16 . Jewish law requires every sick Jew to seek medical treatment. Christianity Yes, honoring aged parents includes protecting them and providing for them materially when they are not in a position to care for themselves. ( John 19:25-27) • Paul says: “their first responsibility is to show godliness at home and repay their parents by taking care of them.” Timothy 5:3–4 • Churches have historically speaking had great role in the development of nursing homes. • Life is a gift from God, “we are the Lord’s” (14:8) Islam "Show gratitude to Me and to thy parents: to Me is (thy final) Goal. (Luqman 31: 14) • In Islam, parents' rights are the most venerable rights after those of God. • The mother ranks before the father in Islam as far as their children are concerned. Prophet Muhammad (peace be upon him) said: "Paradise lies under the feet of the mother.“ • Retirement homes giving basic maintenance needs for the aged and infirm who lacked a family to care for them were present in Muslim Spain • For Muslims, life is sacred because God is its origin and its destiny. Death does not happen except by God’s permission, as dictated in the Qur’an How have your religious values affected your care-giving of a dementia patient? “ Jewish families are some of the closest knit and bonded families. Judaism inspires its followers to go the extra mile to ensure giving their elderly the care they need. They themselves would actually take leave of their jobs, get to more detailed planning to ensure elderly get the care they deserve. • “Serving is a big part of Christian teachings; worship is not just about going to church to pray. Jesus taught us to show our faith thru deeds. Another inspiration was the decision of love in my life”. • • “I believe that when we do good to others, God repays us in our life and I have personally sensed this. Religion has helped me in caregiving because I smile to my patients like Prophet Mohamed ordered us and this makes patients more responsive . Also prayers have helped to calm my patients at the end of life”. Can religion be a burden in care-giving? “Yes, religion can bring on guilt and I see it all the time and increases caregiver stress. Also because of having to make certain religious observances like observing Sabbath.” • “Personally I had no guilt feeling although sometimes people have a sense of resentment; why me? I don’t believe it is wrong to seek help and I had that in mind when I started my project. I was aware of this burden”. • “I personally had no guilt because religion only commands us to do what is in our means. I dream and strive to give all what I think is due to my patients; but when I can’t , I am not stressed”. • Autonomy vs. Beneficence • • • “In Jewish tradition, elderly have a very sacred level of respect and obedience to them is valued and that doesn’t change even with dementia. A mother could be 25% competent but she will have her way”. “I believe that we were born free and we inform our parents and let them take the decisions”. “I believe that the benefit of the patients health supersedes autonomy, but I would try to convince my patient rather than force it upon her”. Modern law vs. Religious laws • The Talmud laid down the rule for Jews in all the ages of exile: dino d'malkuto dino, “the law of the land is our law.” But still Jews tend to honor their religious laws when they can like Sabbath and speedy burial of their dead. • “We have no specific laws and I haven’t faced any problems with Egyptian laws”. • “I find no discrepancy between my vision of Sharia law and and Egyptian laws”. End of life issues “Belief in Judaism gives caregivers a certain acceptance of death, and I have seen it with a lot of Jewish families; they accept what’s coming on to them. As to end of life decisions; Judaism doesn’t force us to live every single minute if we are at the end of life. DNR orders and refusal of tube feeding and other options have not been a problem with the families I’ve worked with”. • “I know that when a person dies he is joined with his creator and thus the day of death is day of happiness. This acceptance of death has led me choose hospice care for my mother. As to end of life decisions, I am not aware of any Christian teachings that guide these decisions”. • “Submission to fate of coarse alleviates the pain of seeing a loved one dying. Also knowing that death is not a bad thing nor is it the end has helped me cope with seeing a patient in the end of life and difficult decisions”. • Buddhism • In South Asia, caregiving responsibilities are framed by the concept of Karma, the Buddhistbelief that good acts will lead to good consequences. • Caregiving for elder is accepted as an integral task of a family member. African Traditions • Traditionally in Africa, the main source of support has been the household and family, supplemented in many cases by other informal mechanisms, such as kinship networks and mutual aid. • The elders provided care to the children who in turn provided care to them in their old age, hence the Shona saying, “Look after it and it will look after you”. Conclusions Religious values can play a role in both formal and informal care giving as well as provide spiritual and psychological support and much needed sense of reward for care givers. Recommendations • Exploration of ways to enhance faith as a support to caregivers. • Studies need to be done to explore the role of faith in caregiving. THANK YOU