Hospital Chaplaincy - the spiritual care of patients

The Patients Charter charges Trusts to respect the religious and cultural beliefs of patients, and each Trust should make provision for the spiritual needs of patients and staff.

The word religion has complex overtones. For example Jewish may indicate race, or national identity or religion. Moslem may mean religion, Arab culture etc. C of E may mean religion, cultural background, or a variety of Christian expressions.

These overtones cloud the real spiritual need of the human soul. For example the need of love, dignity, values and hopes. Every person has a need for a sense of security of self-worth and significance. So every person builds up a spiritual life consisting of their own mix of beliefs, religion, values and attitudes with cultural norms of behaviour, which should address these issues.

These are often expressed through a formal and recognised religion but also may be through, e.g. a political ideology, humanist philosophy, or social group, and if our nursing care is to be holistic it must take this aspect of patients very seriously.

We list here some of the main religious/spiritual expressions – a general survey of their historical and geographical development. Further help may be sought from the Chaplaincy.

Sources for the material in these notes are:

Religions in the UK A Multi-faith Directory
Published by the University of Derby and The Interfaith Network for the United Kingdom.
Religions and Culture
Published by Lothian Community Council
Spiritual Care for those who belong to cultural, religious and ethnic minority groups
Chaplaincy Department St Helens and Knowsley Hospitals
Our Ministry and Other Faiths
Published by the Hospital Chaplaincies Council
A Guide to Understanding Other Cultures, Their Beliefs and Customs
Chester and Ellesmere Port Community Health Council
Directory of Churches and Faith Communities in the Chester Area
Caring for Dying People of Different Faiths
by Rabbi Julia Neuberger
Mosby's Palliative Care Series
Operation World
WEC., OM Publishing

Other Contacts are:

Chester Council for Voluntary Service
63 Northgate Street, Chester CH1 2HQ. ‘phone: 01244 316587
The Ethnic Relations Officer for the North West
Manchester Community Health Council. ‘phone: 0161 832 8183.
Web Sites as indicated.

Review

These are notes hopefully to provide general guidelines for the wards.

If there are suggestions to improve them please contact one of the Chaplaincy team.

Revd J Arthur Roberts

May 2001

THE HOSPITAL CHAPLAINCY

The Chaplaincy exists to support patients, relatives and staff within the hospital. Members of the team are available at almost anytime. In line with the Health care Chaplaincy Standards, its key purpose is to enable individuals and groups in a health care setting to respond to spiritual and emotional need, and for the experiences of life and death, illness and injury, in the context of a faith or belief system.

The Chaplaincy Team: (See over for photographs of Team)

Senior Chaplain - The Rev J A Roberts
Deputy Chaplain - The Rev E T Davies
Free Church Chaplain - The Rev J Kingsley
Roman Catholic Chaplains - Brother Lawrence Pozzuoli and Brother Mark

Chaplains' Office telephone extension - 4024 (West Cheshire Hospital)

Answer machine - 4543 (Chapel Vestry)

Bleep - 2591 or Roman Catholic 2592

Support Lay Visitors:

Mrs Joy Adams, Mr Rod Smith, Mr Bob Jackson, Mrs Gill Hibbert, Mrs Janet Thorp, Mrs Val Powell

The Wards:

A programme of visiting the wards is in place whereby the members of the team try to meet people's needs, in addition to that which may have been detected by the nursing staff or expressed by the patient.

It helps if the patient's religious affiliation is detailed on admittance. This can be of important help to the Chaplaincy in meeting the needs and monitoring any trends.

The Chapel:

The Chapel is situated at the end of the first floor corridor, near to ‘the Bridge'. It is open at all times for quiet and personal prayer and reflection. There is some literature available and ‘Holy Books'. The Tree of Lights Book of Honour and Baby Memorial book are kept in the Chapel.

Prayer:

Prayer requests can be left in the Prayer Request Book kept in the Chapel.

Service:

There is a weekly service of Holy Communion every Sunday at 11.00am until 11.30am – it is open to all irrespective of denomination. Patients can be taken to and returned from this service.

[Index]

FORMAT OF EACH SECTION

There can, of course, be no substitute for a sympathetic understanding of the needs of each individual patient. Not all members of a particular faith will be equally practising or equally orthodox and so we can only offer here a general framework within which there will be much individual variation. These notes can therefore only be a very general guide, offering some clues to help you towards that understanding.

We live in a richly diverse multi-cultural society. The United Kingdom now has immigrant communities who have been resident here for decades. We also have ethnic groups who have arrived only recently. But for all of these, whether born here or newcomers, customs and practices, religious and otherwise are often passed on from one generation to the next.

In the interests of harmony these notes have been prepared to provide staff with a simple guide to some of the beliefs and customs which are particularly relevant in the context of their work. They are not a full account but seek to draw attention to some salient points.

Each Section generally takes the same form, ie

GENERAL

MARRIAGE AND FAMILY

Marriage
Family Planning
Pregnancy
Birth

MEDICAL CARE

General Attitudes
Blood Transfusion and Transplants
Ablutions and Toilet
Modesty
Diet -
Food
Fasting

DEATH AND DYING

FURTHER REFERENCE:

Holy Book
Festivals
Personnel
Contacts

[Index]

LANGUAGE

Differences in language can often hamper communication between staff and patients. Some of the most relevant spoken languages are:

Chinese: Cantonese, or Hakko
Bangladeshis: Bengali, Hindi or Urdu
Pakistanis: Punjabi, or Urdu
Sikhs, and Hindus from Punjab: Punjabi, or Hindi
Indians from Gujerat: Gujerati, or Hindi
Other Indians: Most will understand and speak some Hindi

When seeking help with interpretation, ask the patient's relatives or friends first – unless there is an emergency. Otherwise a member of staff who has a good command of both English and the patient's first language should be asked to interpret. Failing this, contact the relevant local minority community, the community relations council or any other organisation in your area which offers to arrange for interpreting.

In cases involving Mental Health it would be important to use a recognised impartial interpreter familiar with issues of the Mental Health Act.

NAMES

Most people in this country are accustomed to identifying themselves by their given (or Christian) names followed by their surnames, and to being indexed according to their surname. This is not universal practice, and confusion and even offence may arise when recording the names of Asian patients. Probably the best policy is to ask the patient for his or her family name and most used personal name , and use the family name as ‘surname' for recording purposes. Examples are given in the appropriate sections of this booklet.

Having decided which name will be used as the ‘surname', it should be made clear to the patient that this is the name by which he/she will be known in the medical records from then on.

[Index]

THE GOLDEN RULE

HINDUISM

‘This is the sum of duty: do naught to others which if done to thee would cause pain.'

The Mahabbarata

BUDDHISM

‘Hurt not others with that which pains yourself.'

Udana-Varqa

JUDAISM

‘What is hateful to you, do not to your fellow men. That is the entire law, all the rest is commentary.'

The Talmud

ZOROASTRIANISM

‘ That nature only is good when it shall not do unto another whatever is not good for its own self.'

Dadistan-I-Dinik

CHRISTIANITY

‘All things whatsoever ye would that I should do to you, do ye even so to them: for this is the law and the prophets.'

The Gospel of Matthew

ISLAM

‘No one of you is a believer until he desires for his brother that which he desires himself.'

Hadith

BAHA'I FAITH

‘He should not wish for others that which he doth not wish for himself, nor promise that which he doth not fulfil.'

Geanings

[Index]

HUMANIST AND ATHEIST (NON RELIGIOUS)

If a patient puts ‘None' against religion when coming into hospital it does not always mean he or she has no spiritual needs. Sometimes it means that they do not wish to be contacted by anyone or asked to make any commitment. It frequently happens that such patients are happy to talk with the chaplain if the initial approach is social. In this way a relationship may form which gives room for the patient to express feelings, fears and questionings of what they think is happening to them. This can be affirming and formative of their own interpretation of life.

‘Man is the measure of all things' is the keynote in humanistic philosophy, which believes that man himself can improve his own conditions without supernatural aid, and indeed has a duty to do so. A humanist has faith in man's intellect to bring knowledge and understanding into the world and to solve the moral problems of how to use that knowledge. Respect for one's fellow man, irrespective of class, colour or creed is fundamental together with the moral principles of freedom, tolerance, justice and happiness.

The close relationship between mind and body means it is inevitable, says the humanist, that when the body ceases to exist at death the whole life of man is finished. Thus there is no belief in immortality. In the words of Bertrand Russell, ‘I believe that when I die I shall rot, and nothing of my ego will survive', ( Why I am not a Christian, Allen & Unwin, 1975). Some feel that Cicero was the first humanist.

The humanist emphasis on achievement in this life leads to a concentration of effort in the solving of problems of pain, sickness and death, which limit that level of achievement.

There are no special religious requirements. But of course their human integrity and dignity, and personal values should be given the best respect.

[Index]

PRIMITIVE RELIGIONS
(such as SPIRITISM)

This represents a very general collection of answers to the primitive human need to find some sort of spiritual meaning and reference to the world. Expressions of spiritism are to be found in the most primitive of peoples as well as in civilised societies.

These include such things as traditional polytheistic religions, animism and spiritism – tribal religions, which may include voodooism and black magic, fetishism, ancestor worship etc. Local varieties of these would include Amerindian beliefs (American Indians), Aborigine, Shamanism (Where good and evil spirits are affected by the prayers of “Shamans”). Mostly these beliefs would be encountered in the underdeveloped world and would probably never be encountered in a western hospital.

However there maybe some modern equivalents in, for example the ‘Green' movement. Where there is a tendency to spiritualize and give some spiritual significance to growing things and inanimate objects, the sun and the moon etc. Some aspects of the New Age Movement refer back to some of these ancient features. No generic connection is assumed.

Nursing Care

Since the range of factors is so wide and individualistic it is impossible to systematize the material nor make any recommendations.

In the event of a patient holding such a faith system:

The patient and/or relative would need to be consulted.

The patient's views, integrity and dignity should of course be given as much respect as possible.

[Index]

BAHA'IS

GENERAL

The Bahá'i Faith originated in Iran in the middle of the nineteenth century. Founder is Bahá'ullah (Glory of God). He was exiled and persecuted, and finally sent to Akka in the Holy Land, where he passed away in 1892. The spiritual and administrative centre of the Faith is thus in the Holy Land.

Bahá'is believe in the oneness of mankind, and in one God, who has revealed His purpose progessively to mankind. There are followers in over 112,000 centres in the world, and over 130 national bodies. Bahá'is come from many diverse nationalities, cultures and backgrounds.

The Bahá'i Faith is an independent world religion, with its own laws and ordinances. Baha'is have great respect for physicians, and are exhorted to consult the best possible medical advice when ill. They are required to say an obligatory prayer each day and read from the scriptures of the faith each morning and evening. In illness, they are exempted from obligatory prayer.

Although there are significant numbers of Bahá'is in this country of Persian (Iranian) origin, the majority of members here are of British background and their cultural approach and needs are basically the same as those of other patients.

Language

The vast majority of members speak fluent English.

MARRIAGE AND FAMILY

The bearing of children is regarded as one of the main reasons for the institution of marriage, but the details and extent of contraceptive practice are left to the conscience of the couple. Many Bahá'is will not use the intra-uterine device for contraception as they regard it more as an abortifacient than as a contraceptive.

Contraception is according to personal preferences; however, methods which involve prevention of implantation of the fertilised ovum are improper, as Bahá'is believe that the soul comes into being at conception.

Termination of pregnancy is permitted only where there are strong medical grounds, such as risk to life and health of the mother. It is not regarded lightly, and is not permitted as a social or contraceptive measure.

Bahá'is have great respect for life. Each person has a soul, which progresses after death. The soul comes into being at conception. A child before birth has a soul; therefore, abortion is strongly discouraged. Sterilisation, in either sex, is unacceptable; however, appropriate medical advice is followed.

Birth

This is a happy time. It is personal preference whether the husband is present or not. There are no special traditions of initiation.

MEDICAL CARE

General Attitudes

While they believe in the power of prayer Bahá'is have no objection to orthodox medical practice, indeed have a great respect for medical opinion, seeing them as different aspects of the same God-given healing process. They are exhorted by their faith to trust and to follow the recommendations of the doctors treating them.

Blood Transfusions and Transplants

There is no objection to the giving or receiving of blood transfusions or of organ transplants; donation of organs after death for transplanting to others is regarded as praiseworthy.

Ablutions and Toilet

Usual respect given and dignity maintained.

Modesty

Bahá'is do not oppose being examined by male doctors.

Diet

Food

Bahá'is do not have any specific dietary prohibitions. Some Bahá'is may be vegetarians, but this is of their own choosing, and not a religious requirement.

Bahá'is do not use habit forming drugs (e.g. opiates, amphetamines), and do not drink alcohol, except when prescribed by a physician. Abstention extends to cooking, e.g. wine sauces, sherry trifle etc. Smoking is discouraged but not forbidden.

Fasting

The Bahá'i period of fasting is 2 – 21 March. It occurs at the same time in each year. The Bahá'is may not take food or drink between sunrise and sunset during this period. Fasting is not obligatory in sickness, pregnancy, menstruation, nursing mothers, people under the age of 15, and over 70.

DEATH AND DYING

Bahá'is believe that after death the body should be treated with respect. Bahá'is may not be cremated or embalmed. They may not be buried more than an hour's journey from the place of death. Further clarification in individual cases may be obtained from the Local Assembly of the Bahá'is in the area (see telephone directory). Bahá'is may leave their bodies to scientific research, or donate organs, according to their own personal wishes. Bahá'i relatives will wish to say prayers for the dead. The family will arrange a Bahá'i funeral, or it may be arranged by the Local Assembly.

FURTHER REFERENCE

Holy Book:
The Kitab-I-Iqan (The Book of Certitude)
and Kitab-I-Aqdas (Most Holy Book).

Festivals:
Feast of Naw-Ruz (20 or 21 March) – New Year
Feast of Ridwan – Lord of Feasts (21 April – 2 May)
Several others.

Personnel

The faith has no clergy and its affairs are in the hands of elected administrative bodies known as “Spiritual Assemblies”.

At present there are some 200 of these in the United Kingdom, and they can usually be found by referring to the telephone book under “Bahá'i Faith.”

If there is no entry then the address of the nearest Assembly or group can be obtained from the National Spiritual Assembly.

Contacts

The National Spiritual Assembly of the Bahá'is
Bahái Community of the United Kingdom
27 Rutland Gat
London SW7 1PD

[Index]

BUDDHISM

GENERAL

Buddhism was inaugurated by an Indian Prince (Siddartha Gantama) about 560 – 480 BC. As a rich ruler he was deeply troubled by the miseries of life for ordinary people. He relinquished his inheritance and began his search for truth which he felt would bring happiness and contentment. The beginning of his answer came in the form of four noble truths, which he discovered as he sat under a sacred fig tree by a river. It was from that point he was called Buddha, which means enlightened one.

By following a disciplined regime the Buddhist seeks Nirvana (spiritual perfection) by a process of rebirth and rebecoming. This is a much deeper and more complex idea than that of reincarnation, which “the West” has simplistically and erroneously called it.

Nirvana is not a place, like heaven, but rather a state or quality of mind. Buddhism involves a discipline of extreme rigour, beginning by following the eight-fold path of being and perceiving the world.

Four Noble Truths are at the heart of Buddhism. These truths are:

1 Unsatisfactoriness

2 The origin of unsatistisfactoriness

3 The cessation of unsatisfactoriness

4 The way leading to contentment.

Or put another way:-

Suffering is a part of life
Suffering is due to selfishness
Suffering will stop if selfishness is overcome
The way to bring suffering to an end is to follow the Eightfold Path.

BUDDHIST LIFE

The Five Precepts (or Panca Silani) are the basic rules of living for lay Buddhists. They express the intention to refrain from:

Harming living beings;

Taking what is not given;

Sexual misconduct and misuse of the senses;

Harmful speech;

Drink or drugs which cloud the mind.

Noble Eightfold Path: The eight aspects of the Path are traditionally grouped into three. The first two are concerned with wisdom, the next three with morality, and the final three with concentration and meditation. All aspects of the Eightfold Path are, however, interdependent.

i) Right Understanding: is the correct viewpoint, acquired through familiarity with the Buddhist teachings, that all life is impermanent.

ii) Right Intention: is the changed motivation which develops with corrected vision.

iii) Right Speech: emerges from right understanding and intention and causes no injury to oneself or others and thus avoids lying, abuse, slander and gossip.

iv) Right Action: consists of refraining from what is harmful and involves, among other things, cultivating the Five Precepts and practising what is beneficial for oneself and others.

v) Right Livelihood: includes right daily conduct and behaviour and not earning one's living in ways which are inconsistent with the Five Precepts and the Noble Eightfold Path.

vi) Right Effort: requires constant attentiveness and effort to sustain and generate good, as well as to refrain from what is harmful.

vii) Right Mindfulness: is rooted in the body and its activity; feelings; states of mind; and mental contents. Whatever enters a mind that is aware will be found to be subject to the Three Signs of Being (ie the first three Noble Truths.)

viii) Right Concentration: is nurtured through the practice of meditation.

In Summary:-

• Accept the Four Noble Truths

• Think in the right way which leads you to help others

• Be kind in speech, avoid boasting, gossip or lies

• Do what is right

• Earn your living in a way which is good

• Avoid evil thoughts and actions and work hard

• Learn to meditate

• Be at peace in your mind

The Buddhist faith centres on the Buddha, who is revered not in the sense of

Buddha as God but as an example to us of a way of life. The essence of Buddha, within ourselves and each of us has a part of Buddha within us. If we want to become Buddha we must realise Buddhahood within ourselves through prayers, purifications, retreats and virtuous conduct such as the practice of generosity.

Buddhism is unique in that it acknowledges no God as creator. It does however acknowledge many other lesser gods.

Different Forms of Buddhism:

A Theravada claims to follow the original teaching of the Buddha, but some say it is more rigid and less rich, and mainly presented in Sri Lanka, Burma, Cambodia, Thailand and South Vietnam.

B Mahayana which is a developed version of Buddhism.

• Tibetan

• Zen Buddhism, stresses sitting meditation and has influenced martial arts, flower arranging and the Japanese tea ceremony.
It has a very intellectual side, which has attracted many adherents in the West.

• Pureland Buddhism

4) Nicheren “

MARRIAGE AND FAMILY

Marriage

Buddhist parents help to arrange the marriage of their children into good families.

Family Planning

Buddhists believe that the size of one's family is dictated by one's destiny, and that this should not be interfered with. Accordingly all Buddhist traditions will disapprove of any method of family planning. If a couple do resort to one, it should be a method which safeguards the normal development of the baby if conceived. All Buddhist tradition will condemn abortion. Of the two, family planning and abortion, abortion is the much greater wrong.

Birth

A Royal or very high-class baby would have special ceremonies performed for him, but there are no special ceremonies for the babies of ordinary people.

As in most countries and religions, the birth of a child is a time of rejoicing. The parents may take a new-born baby to their local temple so that it may be given a Buddhist name. The baby is also sprinkled with water and blessed to ensure a happy future life. Finally, a candle of pure wax is burned so that the molten droplets fall into the bowl of pure water. This symbolises the coming together of earth, air, fire and water.

There is no urgency about this as their maybe for some Christians. In a Buddhist family, the child thinks of his parents as almost holy. The child knows that he has to look after his parents in their old age, to work for the good name of the family and look after its belongings. Buddhist parents try to keep their children from bad influences and try to give them a good education.

MEDICAL CARE

General Attitudes

Helping people is fundamental to Buddhist ideas, and so the patient will always respect the doctor and nurses for helping him.

Some Buddhists may be distressed by drugs which reduce consciousness, since importance is often placed upon the conscious state of mind, particularly at death, though this is unlikely to produce problems. Pain is accepted with as little complaint as possible.

Blood Transfusions and Transplants

For Buddhists there can be no objection to blood transfusions or transplants. Buddhists believe that most sickness is the result of previous lives; providing such treatment does not involve the destruction of life there can be no objection.

Ablutions and Toilet

There are no beliefs or practices stipulated in Buddhist scriptures. Buddhists from different parts of the world may follow various social customs in this area.

Many Buddhists share the prevailing British attitudes to their bodies while others share those of the Indian sub-continent, and will have strict rules of hygiene. Amongst these will be the requirement to wash before meditation, and washing after defecation and urination (the patient may need help to do this). This is somewhat curious in view of the prevailing Buddhist view of the body as a temporary vessel, but it is by no means uncommon, and those who care for Buddhists should be sensitive to the possibility of there being such attitudes in the person or family concerned.

Modesty

No unusual features.

Diet

Food

Diets vary according to the climate of the country involved. One can find both vegetarian and non-vegetarian Buddhists.

There are otherwise no dietary regulations. The patient or relatives need to be consulted.

Fasting

Most fasting days occur on New Moon and Full Moon days, but there are also other festival days such as Buddha's birthday, death day, his enlightenment, the first Sermon and others. On such days one is required to eat at the regular times, which means one should eat before 12 noon and not after.

DEATH AND DYING

All Buddhist tradition condemns active euthanasia. Buddhists may accept impending death easily, often preferring to know so that they can prepare themselves, and may look towards their next life with apparent equanimity. The Buddhist acceptance of death may in fact be more striking than the acceptance of pain. This can be difficult for caring staff to understand and work with.

As death approaches, the dying person needs peace and quiet to allow for meditation, as the monk or religious teacher chants passages of Buddhist scripture. A member of the family, another Buddhist, or a monk, if available, should be made to provide quietness for meditation, and to help the person achieve calmness, hopefulness and joy. There is usually no objection to post-mortem.

Immediately after death there are no special requirements relating to the care of the body. Buddhists from different cultures will have their own traditions regarding the care of the body. Local traditions also determine whether the body is buried or cremated. In the UK cremation or burial is equally acceptable. White or black may be worn by the mourners.

In Tibetan Buddhism it was sometimes the case that a body was kept 49 days whilst special daily prayers for the deceased took place. Normally the time before committal depends upon the lunar calendar and varies from 3 to 7 days.

The most important thing when a Buddhist dies is that a Buddhist

priest is informed as soon as possible and he preferably should be of the same school of Buddhism as the deceased. Most Buddhists would be quite happy to give a ‘who to contact' name and this might be done systematically when a patient enters hospital.

Ideally, a body should not be moved too much before the priest arrives. When he arrives the priest may do the necessary prayers, which could maybe take an hour or thereabouts, depending on the school. It is not always necessary for the officiating priest to recite the prayers actually in the presence of the corpse – they can be recited at a distance, in a temple for instance.

After a Buddhist has died there is usually a cremation. It is conducted by a member of the family or by a Buddhist bhikku or sister. It is important that the body is wrapped in a sheet without emblems in order not to upset the surviving relatives, since consciousness is thought at this stage to be just departing the body. There is a calmness and acceptance of death among Buddhists from which others of us could undeniably learn, but one needs to be careful of different traditions.

FURTHER REFERENCE

Holy Book
Extensive holy texts, but included are:-
The Three Baskets
The Lotus of the True Dharma
Flower Ornament Sutra

Festivals

There are full moon and new moon observances although there are others throughout the year which remember

Buddha's birth 8 April

His Death 15 February

His First Sermon July/August

Personnel

The community of monks is central in traditional Buddhism, though not essential.

Contacts

Chester Friends of the Western Buddhist order
Meditation Centre
Nr Corwen, Clwyd

Chester Zen Group
23 Hamilton Street
Hoole, Chester, CH2 3JG

Buddhist Society
58 Eccleston Square
London, SW1V 1PH 020 7834 5858

Web site BuddhaNet - www.buddhanet.net/

Mahayana Buddhism – www.geocities.com/Athens/

[Index]

CHRISTIANITY

GENERAL

In the UK Christianity is the largest and longest established of the world's religious traditions. It has helped shape the legal structures and public institutions as well as the culture of our country.

The common focus of Christianity is upon the historical figure of Jesus of Nazareth. Not just his teaching but even more his life, death and resurrection, which are of the heart of all the different interpretations of Christianity. Christians believe that Jesus fulfilled the Jewish expectations for the Messiah (the anointed one – a coming deliverer). They confessed him to be the Christ – the Greek word for Messiah.

Christians believe that there is one God who is the creator of all that is, but that his nature is unfathomable and came to be best expressed in the doctrine of the Trinity, God the Father, God the Son and God the Holy Spirit: not three gods but one: an expression of a dynamic inter-relationship of community, an interdependence and unity; expounded in highly complex language and at length as one might expect of such a mystery.

Christians believe that human beings have become flawed and in need of God's healing. Rather than cause the problems, Christians believe that God's love effects forgiveness and his grace restores wholeness to those who believe. It is the death of Jesus on the cross, which Christians believe is the pivotal event of history and the historical resurrection, which proves the last enemy of human life, has been conquered.

There are two ordinances, which Jesus initiated, which almost all Christians accept in one way or another.
They are: Baptism, by immersion in water or by the token sprinkling of water. This is the initiation event – signifying entry into the company of believers. Secondly, Holy Communion, sometimes called the Mass or the Eucharist, or the Lord's Supper. Where bread and wine are used to recall the crucifixion of Christ.

Globally, Christianity is regarded as having the most adherents (at least nominally) and these split into three historical categories: Orthodox, Roman Catholic and Protestant (Reformed).

In the very early days the Church grew and developed until differences of opinion resulted in the great schism in 1054 when the Roman Church separated itself from those that had associated with the other ancient centres of Jerusalem. Alexandria, Antioch and Constantinople.

Today the Orthodox Church is the family of ancient churches and traditions which now include Russian, Greek, Syrian, Armenian Coptic (Egypt). Their liturgy is rich and formal. The Catholic Church is associated mostly with the Latin-speaking peoples of the world – France, Spain, Italy, Portugal and colonies, and has its focus in Rome and the Papacy.

The Protestant Christians follow the division that occurred at the Reformation. Apart from the differences Henry VIII in England, and Martin Luther in Germany, had with the Pope, the main emphasis of the time was reformation to restore the supremacy and authority of scripture in matters of belief and church government, personal faith in Jesus, and holiness of living. The Protestant churches include the Lutheran, Reformed, Episcopal:- e.g. Church of England, Episcopal Church of Scotland, Church of Wales, Church of Ireland, and the worldwide churches of the Anglican tradition.

Also the Free churches, which include the Baptist, Salvation Army, United Reformed Church, Methodist Church, Presbyterian Church of Wales, Church of Christ, Pentecostal Churches, Presbyterian Church of Scotland, Assemblies of God, Brethren Congregational, Elim Pentecostal, Evangelical, Gospel Hall, Pentecostal traditions.

Most Christian churches share the idea of the local church being part of the larger, worldwide body of believers. The Orthodox, Roman Catholic and Anglican Churches give expression to this in that the local church communities, while being led by their local priest came under the pastoral supervision of the regional leader: the Bishop (and for Roman Catholics in the last resort, the Pope).

The Free churches on the other hand have for the most part a much more local focus. Their association with other churches is much more remote and their connection is a federal one.

MARRIAGE AND FAMILY

Christians have a very high view of marriage and see in it an expression of the love that God has for his people. It involves a lifelong commitment between one man and one woman. They believe at best it is the only setting for sex and the basis for stable personal relationships. Marriage and family life is considered the norm and to be desired and divorce is strongly discouraged – though not impossible.

Some Christians (particularly RC) strongly discourage (if not refuse) contraception though in practice some form is widely used and it has become a matter of personal choice.

Similarly abortion is strongly discouraged and only even considered when the life of the mother is considered more viable. It too is a matter of personal decision.

Birth is a time of celebration to which “Christening” is a declining feature. Some parents still feel happier if their baby is baptised if it seems to be in any danger. Chaplains will baptise in emergency situations but not otherwise, as this is the proper domain for the parishes and churches. The practice of Thanksgiving for the safe delivery of a child has almost disappeared. Though a request for blessing is always gladly met.

Baptists and some other Free Churches do not hold to the baptism of babies. Instead they will have a service of dedication, usually in a church.

MEDICAL CARE

General Attitude

Christianity has a great respect for the caring profession, indeed it has made significant contribution to its development over the centuries. In many cases pioneering research, health care, and professionalism. It still supports much pioneering charitable work. The culture of the UK has been so influenced by Christianity that it forms the norm of behaviour and standards of care.

Blood Transfusions and Transplants

There are no difficulties in this regard except for the personal choice of the individuals concerned.

Ablutions and Toilet

There are no religious rules about this except the concern with personal hygiene.

Modesty

Most people are fairly private and value their own space and strongly prefer to have single sex wards. Christianity as such has no objection as far as medical care is concerned.

Diet

Food

Christians regard the body as the temple of the Holy Spirit of God and as such should be treated with care and respect. At best their diet would be wholesome but it is much left to the individual. There are some who still only eat fish on Friday (and especially Good Friday) rather than meat.

Fasting

This is an entirely personal decision, although for some Christians a token fast during Lent (after Shrove Tuesday and before Good Friday) is practised.

DEATH AND DYING

Christianity believes in the resurrection of the body at some time and in some way which remains a mystery. For some this provides real hope and effects life and death.

As death draws near some Christians may ask to see a minister or priest. This request may come from the relatives and may include a request for anointing with holy oil. Prayers may be said and an act of fellowship and commendation made as appropriate.

Both the Roman Catholic and Orthodox Churches offer the sacrament of sick (sometimes known as the last rites) and can be very important, even for the family. It gives spiritual comfort and reassurance. The Anglican Church offers the same sacrament, but it is not requested as much. More common, along with other Protestant churches, is the saying of prayers and readings with maybe the laying on of hands.

NB Please check that a patient (or their relatives) knows that a chaplain could be available (or their own local priest or minister) if that would help.

After death there are no special requirements more than that relatives expect dignity and integrity to be practised. Post mortems are usually accepted, but there are no religious rules. Funerals are usually arranged within one week (at the longest) of death.

FURTHER REFERENCE

Holy Book

The Bible.

Festivals

Good Friday and Easter (in the Spring) - which recalls the crucifixion and resurrection of Jesus. This is preceded by a 40-day period of fasting and prayer commencing on Ash Wednesday. Follows the lunar calendar.

Whit Sunday (late Spring) – the seventh Sunday after Easter - recalling the coming of the Holy Spirit and the birth of the Christian Church.

Christmas Day – recalling the birth of Jesus – 25 th December

Personnel

There is usually a Minister, Pastor or Priest attached to each place of worship who would be responsible for the church and its well being. These people would be ordained and recognised as such. Some Free Churches are so local however, that their minister will only be recognised by his/her own congregation or area.

There are others who have had some training and are licensed by their church to visit the sick on their behalf. They are permitted by the hospital to visit only those they know. They should not be permitted to visit bed to bed (although, of course general friendliness to clients is not prohibited). The hospital employs chaplains and trained helpers who are bound by the rules of the hospital and are given permission to act on behalf of the Chaplaincy around the wards as directed by the Chaplain.

[Index]

CHINESE

GENERAL

The Chinese culture in contemporary Hong Kong is different in many respects from the Chinese culture in Mainland China prior to the Communist Revolution in 1949, and in any case would be representative of only the Cantonese brand of Chinese culture. This is due to the fact that the largest element of the Chinese population in Hong Kong has come from the Chinese province Kwung Tung. Other elements in the urban population may include Hakka, Fukein, Hoklo Tanka and others.

The Chinese have a very rich and varied religious tradition and an extremely complex system of magical beliefs and practices. Amongst the older generation, especially the women, belief in the traditional religion is still strong in some cases but due to the growth of modern education and influences exerted by Westernisation religious scepticism amongst most of the younger generation has increased.

However, we must not ignore the fact that amongst the numerous Chinese immigrants in the UK there is a minority who still cling to their traditions and customs comparable to those of traditional China. They are the ones who will find it most difficult to adapt to the Western way of life, particularly under certain situations like hospitalisation.

Family Planning

Chinese accept family planning devices and even abortion. They now put more emphasis on the quality of the upbringing of their children. The idea of having a balance of male and female children is growing, though the preference for male descendants is still strong amongst more traditionally-minded parents.

Family planning matters should not be mentioned in the presence of other Chinese.

Birth

When a child is born the relatives pay visits, bringing presents such as eggs dyed red, chicken, soup and clothing, cap and shoes for the baby. The mother may be unwilling to go for a bath or a shower during these first few days after the birth; traditionally she should rest at this time, and in village conditions going to have a bath would have required considerable effort. About a month after the birth the baby's head is shaved.

MEDICAL CARE

General Attitudes

Due to Western influences over the last two or three decades Western medicine has become established in Hong Kong and it has been accepted by the majority of the Chinese as the most advanced form of treatment. However, there is a minority who are still accustomed to the traditional herbal remedies given by Chinese physicians when they fall ill. Most Chinese now feel it is possible to reconcile aspects of traditional and Western medicine.

Blood Transfusions and Transplants

Chinese have no objections to these.

Ablutions and Toilet

No special points.

Modesty

In general Chinese women have a comparatively shy and modest nature. They would probably be more contented and relaxed when they are being attended by a female professional. Reassurance and explanation by medical professionals on the various treatment procedures carried out on the patient is seen to be essential in order to gain their co-operation and trust. Fear on the part of the patient is often generated through ignorance of what is happening around him.

Diet

Food

The Chinese have very definite customs of their own concerning food, its preparation, its service, and the manner in which it is eaten. The older generation hold the belief that rice is the only form of staple food which can give them energy and vitality. Thus it is not uncommon to fine that Chinese patients appear to have lost their appetite during their stay in hospital, or complain about the meals served to them in the Western style. Although complaints are seldom made directly to the medical staff, the patient may indirectly request food and rice to be brought in to them by their relatives during their visits. This happens in Hong Kong too and reflects a strong preference for home cooking. A traditional Chinese belief relating to diet during hospitalisation concerns the consumption of soup, which has been boiled for a long time (6 – 7 hours). Many believe that the consumption of well boiled soup will help to clear one's system and promote speedy recovery, particularly after surgical operations.

DEATH AND DYING

Funeral and mourning customs vary very widely in the Chinese tradition making it very difficult to speak for all Chinese. The position and wealth or poverty of the family concerned are also factors to be considered in the performance of the rites. On the death of a child or infant, the burial takes place at one with no special ceremony. As for adults, the body is bathed. The custom was and still is for some Chinese to clothe the body in white or in old-fashioned Chinese clothing. Relatives and friends will wish to see the body before the coffin lid is closed.

Only Muslim Chinese will have any objection to post-mortems.

[Index]

HINDUISM

GENERAL

This is not one single religion but a collection of different forms of Indian religion.

Hindus believe that BRAHMAN is the single supreme spirit of all creation. It is perfect, unchanging and neither male nor female. Brahman created hundreds of gods and goddesses. In order to return to Brahman, the soul must be cleansed of earthly sins. This gives rise to the belief in re-incarnation, which may be in the form of an insect, animal or human being, depending upon the balance of good and bad deeds in this life and the performance of religious duties and rituals. Yoga, a form of deep meditation, which brings control over body and mind, is one commonly used aid to achieve this. With so much at stake, it is important that every effort is made to offer privacy and to comply with their requests.

Krishna worship is significant in the context that Mother Earth is symbolised by the cow, which is regarded as sacred. Feeding the cow is regarded as an act of worship. It is not known why the cow should be so respected, but in India they are permitted to go anywhere and eat anything.

The Stages of Hindu Life

Hinduism is taught from the cradle and is ingrained in its followers. In addition, Hindu customs and culture are deeply rooted in the religion. Hinduism provides each person a road map to follow through one's entire life. Some Hindus place great importance upon consulting with astrologists before important events, e.g. a surgical operation.

For Hindus, the purpose of human life is to make a conscious effort to communicate with the all-pervading reality – God. By living a moral and ethical life, serving his fellow men and creatures, man can realise God. To the extent he can live in tune with the universal law of righteousness, so does he progress; otherwise he is retarded. Hindus also believe that if they are not able to realise God in this particular life, they will be born again in this world to continue their pilgrimage. This process of rebirth continues until God is realised.

Hindus believe in divine reincarnations. God, in His infinite mercy and love for His creation, is born on this earth time and again whenever there is a need for it. In the long religious history of India they have ample proof of this – Rama, Krishna, Buddha and Nanak are some of the incarnations in Hindu tradition. Pious Hindus derive inspiration for their spiritual life from all or any of them.

Love for all sentient beings is practised by the Hindus as a means of serving the divinity dwelling in all. Care and concern for others is shown more through individual acts and by gradually extending into the community the natural love for one's own family, than by systematic organisation. Because the Hindu is shy of organisation, regarding it as often wasteful and showy, it

may not be obvious what is being done for the unfortunate in a Hindu community unless one lives in it. Every pious Hindu is expected to keep aside some food for the arrival of an unexpected guest – no one should be turned away hungry from his door. Guests invited or not should be treated like the Lord Himself. Because of the reverence for all life, ‘ahimsa' (non-injury) is cherished as one of the highest principles, and this makes Hindus reluctant to consume other creatures as food.

Worship can take place in a temple or at home. Images are used in worship, to personify divine qualities. These ‘gods and goddesses' are used as symbols of the Divine: the Hindu does not mistake the image for God. Depending on what a person wants to achieve, he worships that particular form as a facet of the One Reality-God.

Name

A Hindu patient is likely to have three names – personal name first, a complimentary name in the middle, then a family name e.g., Arima Kumari Chopra. For Gujerati men the middle name is the father's personal name plus an ending: e.g., Mohanda Karam(chand) Gandi. Women do not usually use their fathers' personal name as a middle name, so they have only personal and family names. Use the family surname for records.

Bindi

A coloured spot on the forehead is an indicator of married status. Usually a red spot identifies the lady is married. Young single girls usually use different colours to match an outfit. Black spot is worn by widows.

Married women nay wear a ‘nuptial thread' – a necklace which must be cut after death by the husband. This should be done prior to any autopsy. Male adults wear a ‘sacred thread' round the arm.

Great care should be taken not to remove these symbols, but if it is unavoidable then the patient's permission should be obtained. Then it is advisable to place these elsewhere on the body or nearby. These symbols must not be removed after death.

The male costume of the sub-continent is a long jacket with high collar and buttons down the front, worn over western-style trousers. Most men wear western-style clothes.

MARRIAGE AND FAMILY

Marriage

Most Hindu marriages are arranged by the parents and the marriage is seen as a time of unity of two families rather than two individuals. The marriage day and time is fixed by the priest after referring to astrology.

Family Planning

There is no objection to family planning from the religious point of view. However, there may be strong social pressures on the woman – particularly if no son has yet been born. It is advisable to include the husband in any discussion of contraception or sterilisation. There are strict controls over abortion and, in the event of a choice, the life of the mother takes precedence over that of the unborn child.

Pregnancy

At the first sign of pregnancy the child is blessed through the mother. On the tenth day after birth the child is named by a priest. At the onset of puberty the adolescent undergoes ‘the sacred thread' ceremony and makes solemn vows. This thread should not be removed or cut without the permission of the patient or next of kin. If the thread has to be cut and removed in a Casualty Dept. it should be retained and given to the patient later.

Birth

Relatives will be anxious to visit the mother and child as soon as possible after the birth. This is a time of great rejoicing, with distribution of sweets to celebrate – particularly if the baby is a boy. Relatives will be anxious that the mother has complete rest for forty days after birth – they will be very worried if she has to get up for a bath within the first few days, for example. This attitude is based on the belief that a woman is at her weakest at this time and very susceptible to chills, backaches, etc. On the other hand it may require considerable tact and gentle persuasion to reconcile the mother to her baby being placed in a separate room, if the hospital's procedures require this. Visiting relatives will sometimes have to be persuaded to leave gifts of new clothing for the baby at the bedside, rather than putting them on straight away.

When a baby is born in a Hindu family, the priest is informed of the date and exact time of the child's birth. From this information, the baby's horoscope is prepared. Hindus accord great significance to astrology, at the important stages of their lives. The priest will then suggest suitable syllables from which the parents select a name for the baby. This is one of the main reasons why Hindus in western countries do not register the name of their baby immediately.

Childhood

Many boys go through a ceremony when they have their first haircut. Their head is completely shaved. The symbolic meaning of this ceremony is that bad impressions of the previous life are to be removed.

Upanayana

This is one of the important ceremonies when a Hindu boy is given a thread with three strands which he wears on his second birth when he starts to learn from his Guru (teacher). These three threads mark the duties to God, parents and teachers and of the world.

MEDICAL CARE

General Attitudes

Generally speaking, Hindu patients will willingly accept the authority of the professional, whether male or female. They may tend to favour home remedies for ailments such as coughs, and be slow to seek professional attention.

Blood Transfusions and Transplants

There are no problems in respect to blood transfusions or organ transplants.

Ablutions and Toilet

Like most Asians, Hindus attach great importance to personal cleanliness. It has important religious significance. They prefer showers to baths. Washing hands in free-flowing water before meals and before prayers is essential. Mouthwashes may be requested after meals.

Toilet paper on its own is not considered hygienic; therefore there is a need for water to be available in the toilet. Washing hand after the use of a bedpan, etc, is a must. The right hand is usually used for 'clean' tasks, the left for 'unclean' tasks.

Hindus will need water for washing in the same room as the WC itself. If there is no tap there, or if a bedpan has to be used, they will be grateful to have a container of water provided. Hindu patients much prefer to wash in free flowing water, rather than sitting in a bath.

Modesty

In hospital, men will usually wear a long shirt over pyjamas.

NB The older female population prefers to be examined by a female doctor. Medical care takes priority over the availability of a female doctor in an emergency. They should be accommodated in mixed wards only in emergency situations.

The female national costume of the country is a sari, which is worn over a short blouse and an underskirt. The midriff is usually left bare. Women prefer to wear long gowns and night-dresses as they find exposing their legs embarrassing.

The body and hair are particularly important to Hindu women and a married woman may refuse to have her hair cut without her husband's permission. They may be reluctant, or refuse to undress in front of a male nurse or doctor. Hindu women do not like to expose themselves in short, open-back gowns such as operation or x-ray gowns. Longer, closed gowns should be used.

Diet

Food

Although some do, most Hindus do not eat beef, since reverence for the cow is also a symbol of reverence for all animals. Some will eat eggs, some not: it is best to ask each individual. Dairy produce is acceptable, so long as it is free of animal fat; some Hindus will eat only cottage cheese – again, the best thing to do is to check with the individual. It is important to remember that strict vegetarians will be unhappy about eating even vegetarian items if they are served from the same plate or with the same utensils as meat.

It is not enough simply to remove meat from a plate when the patient points out that he or she is a vegetarian. Apart from practices based on religious beliefs, some Indians may have strongly held traditional ideas about taking certain foods at particular times – for example, it is considered unwise to take milk or any citrus fruit when suffering from a cough.

There is a positive conviction concerning the effect of food upon human development, especially for those who practise spiritual disciplines. Milk, yoghurt, butter, ghee (clarified butter) and fruits are usually acceptable because no killing has taken place and they are considered to be foods which promote purity and harmony.

When preparing their own food, many Hindus offer their food to a deity before eating it, and keep aside a portion for animals. Products which have been cooked in, or contain, by-products from slaughtered animals would not be acceptable to strict Hindu vegetarians. For example, neither conventional ice cream (which may contain animal fats) nor cheese which contains rennet (extracted from the pancreas of the cow), nor chips which have been cooked in animal fats, would be acceptable. Hindus may also refrain from intoxicating drinks such as alcohol, and in some cases from tea and coffee too.

Fasting

Many Hindus (and especially women) observe fasts or vrats (vows) as devotion to a deity and on behalf of the well being of themselves and their family. These vows entail the avoidance of certain foods at certain times, such as on particular days of the week of the lunar month, and of the year.

Very few Hindus would insist on fasting when in hospital; and even then would take hot milk, fruit tea, and salad without salt. At the end of a period of fasting visitors may bring in ‘prasad' so that the patient can join in the celebration. This will be in the form of a small quantity of food, perhaps sweets, which has been offered to God in thanksgiving and is now shared amongst those present.

DEATH AND DYING

The dying person is read passages from the Holy Book, the Gita, and prayers are said. Thread with three strands, similar to that worn by young children may be tied around the wrist. The forehead is marked with a holy paste. It is believed that after death, the soul immediately leaves the body to start its new life and as it is the hope of every Hindu not to be reborn but to achieve unity with God, His name is repeated into the ears of the dying person. Relations may wish to bring money and clothes for the patient to touch before they are distributed to the needy.

Grief is openly expressed, so it may help if a dying person can be moved to a side room, or the relatives given a private place to grieve.

Hindus believe that a body without a soul is a carcass, which must return to nature, thus they are cremated. Because of the strong belief in this, occasionally, a dying person may request to be placed on the ground during the final few breaths. If the body is to be left in a room over-night, a light or candle must be left burning throughout the dark hours. The body to be left in a North/South aspect (ie the head in line with the earth's magnetic field).

Hindus prefer to cremate the body before the next sunset, so every effort should be made to complete documents as soon as possible. Locum doctors should be asked to attend to this before leaving the hospital.

Permission for post-mortem is only given if legally required. It may be seen as abhorrent, a feeling which should be respected. If autopsy is carried out, all organs must be replaced, as Hindus believe that otherwise the soul of the deceased will not find peace in the afterlife. Relatives will wish to wash the body and put on new clothes before taking it from the hospital. Traditionally the eldest son of the deceased should take a leading part in this, however young he may be.

NB Children under five years are normally buried.

Relatives will fully participate in the making of all arrangements, but may need guidance on death certificates, registration, etc, as usual.

After the cremation ceremony, ashes are collected and scattered over running water, ie a river or sea, and the wish of most Hindus will be to have their ashes scattered over the River Ganges – ‘The Holy River'. Mourners usually wear white or a pale colour and mourning periods vary from a few days to several months.

FURTHER REFERENCE

Holy Book

For Hindus sacred texts are essentially spoken rather than written. The texts that are used are treated with great respect. The Bhagavad Gita is one of the most important for many Hindus.

Festivals

There are several festivals - almost monthly. They follow a lunar calendar.

Personnel

Domestic worship is widespread.

Where possible many Hindus attend public places of worship. In such places there may be priests whose function in the temple worship others perform the life cycle rituals. Priests can be male or female.

Contacts

National Council of Hindu Temples
C/o Shree Sanatin Mandir
Weymouth Street
Off Catherine Street
Leicester LE4 6FP

Hindu Council for the UK
C/o 150 Penn Road
Wolverhampton
West Midlands WV3 0EN Tel: 01902 334331

Local Temple:
Lord Rama Krishna Temple
7 Haydock Street
WARRINGTON
Cheshire. Tel: 01925 572 0420

Websites: The Hindu www.webpage.com/hindu/

Hare Krishna www.iskon.org/

The Hindu Universe www-hindunet.org/home.shtml

God in Hindu Dharma and Temples http//hindunet.org/god/

[Index]

JUDAISM

GENERAL

Very few of the Jews coming into hospital were born outside Britain, although many will have relatives abroad, especially in Europe, USA and Israel.

Almost all will be English-speaking. However, prayers are usually said in Hebrew.

Judaism is very traditional, but most of those Jewish families who have been in Britain for two generations or more have become assimilated. They have developed a culture which takes from Judaism, Christianity and secular ideas and values.

Jews believe in one God, creator of the Universe. Jewish teaching requires that followers love God and all people and hope for a united human race, living in peace.

There are two main groups of Jews:

Orthodox: who follow the religious laws very closely.

Non-orthodox: who believe the laws can be adapted to help Jews cope with modern living.

The latter group may describe themselves as Reformed, Progressive or Liberal.

Unless instructed to the contrary it should be assumed that a Jewish patient is ‘Orthodox' and wishes to observe the religious customs. However, every effort should be made to determine the patient's earlier allegiance to his faith and the nature of his involvement.

NB. Remember, a number of Jews came to Britain after fearful times in other countries ie Germany. Many unpleasant memories from their past may return when they are admitted to hospital.

On the Sabbath (Saturday) no ‘Constructive' work should be done using money, writing, telephoning, travelling or switching “on” and “off” lights. It is, therefore, best not to discharge patients on or immediately before a Sabbath. However, it is permissible to move furniture, sweep floors, wash-up, read, make beds and fully participate in meetings.

Most wear western clothes, although Orthodox women often have their heads shaved and wear a scarf or a wig in public. Men will normally cover their heads to pray.

MARRIAGE AND FAMILY

Judaism encourages Jews to marry within the Jewish community. Although weddings do not have to be performed in synagogues, most of them are. It is hoped that every marriage will result in the birth of children, for they are considered a very important link between the generations. Orthodox Jewish parents may arrange a marriage for their children.

Family Planning

While mechanical methods of contraception are not strictly permitted, today almost all Jew will use some method of family limitation. The pill is very widely used.

Jewish Law distinguishes between different types of device, and oral contraception is the least objectionable. In artificial insemination the only permitted donor is the husband. Sterilization is not permissible for Orthodox Jews. Note that in all cases the Reform synagogues are more accepting than Orthodox or Conservative ones.

Abortion

Abortion is usually only sanctioned if the life of the mother is at risk, though some permit early abortion of an embryo, which is demonstrably abnormal. Many permit abortion for strictly medical reasons.

Birth

When Jewish children are born they are given both an ordinary name and a Hebrew name. The ordinary name may be chosen from among those which are popular at the time, and the Hebrew name has a Jewish historical meaning. A boy is given his name during a circumcision ceremony, which is a very important and ancient rite. It is important that it takes place on the eighth day after birth. Only illness can delay the ceremony. It is performed by a Moehl, who is not necessarily a doctor or a Rabbi, but is always a specially trained religious Jew.

Most Jewish children attend a religious school in addition to their ordinary daytime school. Boys must be able to read Hebrew by the age of thirteen as this marks their entry to manhood when they are expected to understand their religion and observe the Jewish Laws.

MEDICAL CARE

General Attitude

Even for the least religious Jew there is a strong sense of the value of being human and that God created us in His own image. Doctors and other healthcare workers are thus immensely respected by Jews, as those who preserve human life. It also means that religious rules can be broken if necessary in favour of preserving life. Judaism could be described as the most “this life” affirming religion.

Blood Transfusion and Transplants

Transplant surgery: the preservation of life is the important guiding principle which may over-ride things otherwise not permitted. Therefore, though mutilation of a corpse is not permitted, there is no objection in principle to corneal grafts or other organ transplants. However, Jewish law insists, firstly, that no vital organ be removed from a donor until death is definitely established by the complete cessation of all spontaneous life functions and not merely be what is termed “clinical death”, such as irreversible brain damage, and, secondly, that such operations must not be continued unless they have passed the purely experimental stage and offer recipients a reasonably hopeful prognosis.'

(From a paper on ‘Jewish Medical Ethics' given by Dr Immanuel Jakobovits, Chief Rabbi at the Royal Free Hospital, 1980).

This can be important when chaplains are offering support to families who have been asked to consider donating organs of a relative following a road traffic accident. The medical profession is treated with great respect in Judaism, although there is little mystique attached to medicine, and the Jew is likely to be an aware and a questioning patient.

Ablutions and Toilet

No special requirements

Modesty

No special requirements

Diet

Food

Food is immensely important in Jewish life and non-Jews may feel it is worried about to an outrageous extent. Jews eat only meat which is killed by their own religious-trained personnel in a humanitarian way; this ensures that as much blood as possible is drained from the meat before it is prepared by soaking and salting, then cooked. The pig is a totally forbidden animal, and it would be extremely unusual for a Jewish patient to eat pork in any form. Jews who are observant will not take milk and meat at the same meal, and prefer at least a three-hour wait between these kinds of foods.

A Kosher household will keep meat and milk utensils, crockery and cutlery rigidly separate. The very orthodox are prepared to avoid any suspect food, and an item such as cheddar cheese may be refused because it contains animal rennet from a non-kosher animal; the same applies to jellies containing gelatine. Jews will eat eggs and white fish; but there are prohibitions on shellfish and on fish lacking fins and scales.

The teachings of the religion do stress that to avoid a deterioration in health some laxity may be allowed: a Jew who would not eat out in a café or restaurant, because of the risk of inadvertently eating from plates which have contained forbidden foods or which have been part of a mixed washing-up, will take a cup of tea or a plate of cereal in order to avoid undue health risk.

Observant Jews may request a vegetarian hospital diet, as this avoids the need to make special requests in order to avoid eating non-kosher meat. However, deep-frozen kosher meals are available through the hospital service.

Fasting

There are several minor fasts in the religious calendar but the prominent fast which almost every Jew observes is Yom-Kippur, the day of atonement, a 24 hour fast, usually falling in late September/October. If his health permits a Jew would prefer to keep that day and also to pray and to be quiet and penitential. It is the holiest day of the Jewish calendar, one that is considered to set the path for the year to follow.

DEATH AND DYING

Euthanasia

Any deliberate act to hasten death, with or without the patient's consent, is incompatible with Jewish understanding of the sanctity of life. Jewish law brands active euthanasia as murder. This does not mean that a doctor is required to prolong the agony, and permits the withdrawal of treatment in hopeless cases. Similarly it is wrong to subject people, even with their informed consent, to possibly hazardous medical experiments unless these patients may themselves derive benefit.

Dying

This grip on life often makes Jews less than good at dealing with dying patients. Strangely, it is not the uncertainty about the afterlife which causes the problem, but the emphasis put on the here and now. Although Judaism is extremely good at looking after the bereaved and gives them support and comfort, the dying person can seem somewhat neglected. Attitudes vary.

Often a dying Jew does ask to see a rabbi. There are no last rites in Judaism, and it is not essential; but if a rabbi is required the nurse should ask whether, for instance, the family is orthodox, and the orthodox rabbi should be called, or if they are reform or liberal, when a reform or liberal rabbi should be called. Often, if it really is near the end, the rabbi will say some prayers with the patient, and try to get the patient to say the first line of a prayer called the Shema, ‘Hear O Israel, the Lord is our God, the Lord is one'.

There is the chance too for a private confession – not out loud to the rabbi – and the last words the patient speaks might well be that line of prayer. Very often, the family is much comforted by the presence of a rabbi, partly because it seems appropriate, but partly also because there are a lot of things to be done at the time of a death, and they want to make sure that they have got it right.

GUIDELINES FOR DEALING WITH DYING & DECEASED JEWISH PATIENTS

• If a Jewish patient is seen to be approaching death, the next of kin should be informed. If no relative is available, contact should be made with the Minister of the patient's Synagogue.

• In case of death, inform the above if this was not possible before death.

• The body of the deceased should remain untouched for a period of 20 minutes.

• If, after this period has elapsed, no member of the family or Jewish Community capable of dealing with the body has arrived, the following procedure should be carried out by the Hospital staff: (Use disposable gloves).

a) The eyes and mouth should be closed. The mouth should be held in a closed position by placing a cloth under the chin and tying it above the head.

• The fingers of each hand should be straightened and the hands and arms should be placed parallel to the body. Similarly, the

legs and feet should be straightened.

• Any tubes etc, or artificial limbs should be removed and any incisions plugged so as to prevent or stem the flow of blood.

• Any excess dirt should be wiped away and washed off.

• The body, still fully clothed, should be wrapped in a sheet and placed in the hospital mortuary where it shall remain untouched pending the arrival of the authorised Jewish undertaker who will be able to attend to the body.

5 The washing and preparation of the body for burial are intrinsic parts of Jewish ritual, which should remain the prerogative of the Jewish Burial Society.

• It would be helpful if the body of the deceased could be labelled

with the word “Jewish”.

• Jewish Law requires a body to remain totally intact after death

and regards the carrying out of a post-mortem as a desecration

of the body. Care should be taken to ensure that relatives of Jewish patients are not asked to consent to a post-mortem not required by law and ordered by a Coroner, as this is likely to cause offence and distress.

• Jewish Law necessitates the carrying out of a funeral, as soon as possible after death. It is therefore important to assist in the provision of a Death Certificate at the earliest possible opportunity, thereby enabling the funeral arrangements to be commenced.

• Similarly, Jewish Law insists on burial rather than cremation and any suggestion to carry out cremation would also cause offence and distress.

• Occasionally, a request may be received for members of the family to remain with the deceased either at the bedside or after the body has been removed to the mortuary. This request is in keeping with Jewish tradition and should be treated favourably wherever possible.

• In the event of a death taking place where the deceased has no next of kin and is not associated with any Synagogue Burial Society, contact should be made during normal working hours, (including Sundays, from 10.00am to 1.00pm) with the Jewish Communal Burial Board (Tel: 0151-733-2292).

DEATH

Jewish tradition demands that funerals and burials must take place as soon as possible after death, ideally within twenty-four hours and usually within three days. The body is washed and shrouded by the family members. Relatives will fully participate in making all arrangements but will need the usual guidance regarding death certificates, registration, etc. Funeral services are always simple and the use of flowers is not encouraged. Cremation is not allowed among Orthodox Jews, but it is common in the Progressive groups.

Every effort should be made to complete documents as soon as possible after the death if burial is to follow and locum doctors should be asked to attend to this before leaving the hospital.

Permission for post-mortem may only be given by Orthodox Jews if legally required.

FURTHER REFERENCE

Holy Book

The Torah and the writings of the Rabbis

Festivals

Shabbat: The Sabbath each week from Sundown, Friday night until Sundown on Saturday night.

Pesach: The Passover - around Easter. (Follows a lunar calendar).

Rosh Hashanah: Jewish New Year (with Day of Atonement - around September/October

There are others.

Personnel

Rabbi: teacher and leader attached to a local Synagogue.

Contacts

Religious Matters:

Senior Rabbi to the Merseyside Community

Rabbi Lionel Cofnas
Childwall Hebrew Congregation
Synagogue Chambers
Dunbabin Road
Liverpool L15 6XL
Tel: 0151 722 2079

Other Matters:

Honorary Secretary
Merseyside Jewish Representative Council
Shifrin House
433 Smithdown Road
Liverpool L15 3JL

Local:

Chester Jewish Group
1 Stephens Gardens
Little Sutton, S Wirral CH66 4QA

Web Sites: Guide to Judaism www.judaism.miningco.com/

The Utimale Jewish / Israel Link Launcher //ucsu.colorado.edu/-jsu / launcher.html

[Index]

MUSLIM

GENERAL

Islam is an Arabic word and connotes submission to the will of God. The other literal meaning of Islam is ‘Peace'. Islam is established on two principal bases of faith:

1 There is no other God worth worshipping except Allah (The entire Universe was created by God whom Islam calls Allah and who is the Lord, the Sovereign of the Universe. He is one and has no associate with Him in divinity).

2 Mohammed (peace be upon him) is the prophet sent by God to all humanity.

Therefore whoever honestly believes in and professes faith in the Unity of God and the prophethood of Mohammed (peace be upon him) joins the fold of Islam and is a Muslim. The holy book Qu'uran is the revealed book of Allah. Islam is based on five fundamental principles which should be completely practised by every Muslim:

1 To bear witness that there is no one worthy of worship but Allah and that Mohammed (peace be upon him) is Allah's servant and Apostle for all humanity at large.

2 To establish daily five stated prayers (Salat). First early in the morning

before sunrise, second at noon, third midway between noon and sunset, fourth at sunset, fifth at night. There is a set ritual. Privacy for this is appreciated. Before prayer hands must be washed in a prescribed way.

3 Fasting in the month of Ramadan requires abstaining from food and drink and sexual contact from dawn to sunset.

4 Regular Charity (Zabat) – charity to the poor is obligatory and binding.

5 Pilgrimage to Mecca – it is an incumbent duty to be performed once a lifetime if one can afford it.

A Muslim also believes in the Divine Books as revealed by Allah to his Apostles for the guidance of mankind, such as the Torah revealed to Moses, the Gospel revealed to Jesus, the Psalms revealed to David and the Qu'uran revealed to Mohammed (peace be upon him); and in the last day of resurrection, which is the day when Allah will call together all mankind (from first to last) in order to carry out his just account with them.

In Britain the majority of Muslims are permanently settled from India, Pakistan and Bangladesh, or visitors and students from Africa and the Arab countries, but there are Muslims to be found all over the world.

Friday is the Holy Day. Prayers are said using a special prayer mat and facing Mecca (South East) – (see map in the Introduction).

The Chapel can be used and Christian symbols etc temporarily removed if required.

ISMAILIS are SHIA IMAMI MUSLIMS and therefore essentially conform to the Muslim traditions. There are substantial Ismali communities settled in Western Europe and North America who have adapted themselves to the way of life in these countries especially with regards to hygiene, general dietary habits (with notable exceptions), their attitudes to medical treatment etc.

Patients should in general be consulted as regards personal preferences since the older generation is likely to be more conservative in their attitudes. In cases of difficulty contact the local community leaders who will be only too happy to be of assistance.

As with other Asian patients, confusion may arise when recording names. A Muslim may have several personal or religious names and sometimes also a family name for example, Amjad Mohammed Hussein. If there is a family name use it for the records, if not, establish the main personal name and use it.

The vast majority of Arabs are Muslim, either Sunni or less often Sh'ite. However, many westernised Arabs do not practice their religion very much in this country. ‘Muslim' may be more a political statement than a religious declaration. A small number of Arabs are Christian.

Islam is growing through the conversion of British men and women, so do not assume those records, which state that ‘John Smith' is a Muslim, are incorrect. Not all Muslims are black, ie Arab, Asian, or Afro-Caribbean, or born outside the UK. Islamic converts are likely to follow the rules of their faith very strictly.

MARRIAGE AND FAMILY

Marriage

In Islam, a happy family life is regarded as the foundation of a healthy society. The Qur'an encourages Muslims to marry and have children. It also emphasises that sexual relationships outside marriage are always wrong. Marriages between Muslims are often arranged by the parents and marrying within the family, ie first cousins is encouraged. Muslim men are allowed to marry up to four wives, but it is very rare for most ordinary Muslims to have more than one wife. Muslims do however think that it is good to be able to take a second wife if the first is unable to have children.

Family Planning

Strictly speaking an orthodox Muslim would not approve of family planning devices. In practice individuals will vary widely in their attitudes; information about facilities available should be given, and any discussion allowed but no pressure exerted. Any discussion should be in strict confidence, and never in front of visiting relatives or friends.

The basic ethical text for most Arabic physicians was the Hippocratic Oath. To this was added the Adab at-tabib. However, whereas the Hippocratic Oath would prohibit abortion, the pharmaceutical textbooks include many abortifacient drugs. Orthodox Islam still follows the older ethical code. Modern medicine in Islamic countries, which have come under western influence, tends to follow western patterns.

Birth

Some women may refuse to be examined internally before giving birth. When a Muslim child is born it is required that as soon as possible a member of the family recites in the baby's ear a prayer which normally will last a minute or two. A male Muslim child is also required to have circumcision done as soon as possible. Since this is not provided within the NHS the family must make their own private arrangements.

When Muslims become parents, they have a special responsibility to ensure that their children grow up understanding the faith. The very first thing a Muslim baby hears on coming into the world is the ‘Shamadah' (the profession of faith). The birth of a child, especially a boy, is a time of rejoicing.

Naming a child has a religious significance, therefore, names cannot be chosen before the birth of a baby.

MEDICAL CARE

General Attitudes

A Muslim believes that whatever takes place, good or bad, can only take place with the consent of Allah and according to his judgement and distinction, as nothing can happen in his dominion against his Will. In adversity and calamity a Muslim is forbidden to despair and is required to be patient, seeking help through prayers and remembrance of Allah.

Drugs derived from pork are strictly forbidden. Generally Muslims try to persevere with pain, believing it to be God's will.

Blood Transfusions and Transplants

In strictly orthodox terms these can only be accepted with reluctance. However the decision lies with the individual and his family, who if they wish can consult local religious leaders.

Ablutions and Toilet

Muslims attach great importance to cleanliness. Ablution before each prayer is necessary. The worshiper washes his hands, rinses his mouth, washes his hands up to the elbows and feet up to ankles. After menstruation women are required to wash their whole bodies, and the use of a shower rather than a bath would be preferred by Muslims.

Modesty

The Islamic religion teaches high moral values, which includes:

• The separation of men and women in public places.

• Women to keep their bodies covered, apart from their face at all times, especially in public places.

• Since clothes have a religious significance, some women will be reluctant to wear hospital nighties or pyjamas and examination gowns. omen wear a headscarf and men wear a brimless hat and may wish to continue doing so while in hospital.

• Women may refuse to be examined by a male doctor.

Generally a Muslim woman is not allowed to be examined or be surrounded by male members of medical staff. It is always preferable that a female member of the medical staff is present. In certain cases a Muslim woman may not agree at all to being examined or treated by a male member of the medical staff. In Islam free mixing of sexes is prohibited and women are required to cover their head and chest to maintain modesty and moral standards.

Muslims should be accommodated in mixed wards only in emergency situations. This is an area in which an open-minded and helpful approach by staff could be particularly helpful – for example when a female patient finds it difficult to accept an X-ray gown because of its shortness.

NB This culture is so strong that male spiritual leaders will not be likely to minister to female Muslims.

Diet

Food

Lamb, beef, goat, chicken and rabbit, buck deer etc are allowed provided these are killed by a Muslim with a religious prayer (Halal food). Pakistanis are particularly strict about eating non-Jalal meat. Pork meat, carrion and blood are forbidden, also all types of wines and alcohol. In Britain a Muslim buys his meat from a Muslim butcher who is available according to Islamic injunctions, because meat or food generally available in the shops usually contains animal fats. Fish and eggs are allowed, but if these are cooked where pork or other meat is cooked then they are not permissible. Both Pakistanis and Arabs like their food well seasoned and spiced. Bland hospital food may seem unacceptable, or even make them vomit.

Fasting

During the month of Ramadan a Muslim eats before observing his fast, that is 1½ hours before sunrise, and is allowed to eat and drink all lawful things after sunset. Fasting is excused during menstruation and after a recent childbirth. Those who are sick, on a journey or breastfeeding their babies are not asked to fast, but they should make up for this later.

If the doctor feels it is important that the patient should eat and drink more, it is useful to explain that this is part of the ‘medicine' to assist recovery.

DEATH AND DYING

For the Muslim, death is a transition from this world to eternity. The purpose of life, according to the Qur'an, is to prepare for eternal life, for every soul shall taste death. In the Islamic faith there is a belief in the Day of Judgement and the stages of life, death and resurrection have no meaning until one completes the full cycle.

As death approaches, family members and other Muslims join the dying person and together they recite verses from the Qur'an. The dying person may ask to be positioned so as to have his or her body facing towards Mecca (in this country, towards the south-east). When death is imminent, the ‘Declaration of Faith' is said and the dying person responds, if possible, with ‘I bear witness that there is no God but God and Muhammed is his prophet'.

Grief is expressed very openly and publicly. If possible, a dying patient should be moved to a side room and/or relatives offered a private place to grieve. A firm but gentle request may have to be made to avoid disturbing other patients.

Following death, the body is washed and wrapped in a shroud, turned towards Mecca (South East) and a funeral prayer is said. The relatives will do this if asked.

The body should be left untouched except that the body is straightened, the eyes and mouth closed and the big toes fastened together, and the head turned towards the right shoulder (ie Mecca) ready for burial. Always wear disposable gloves to avoid defiling the deceased.

If it is necessary to remove the body to the mortuary it should not be uncovered, except for washing which must only be carried out by another Muslim of the same sex. The Janaza prayers, which follow a death, are preferably said at the Mosque. For these reasons the body should be released to the undertakers as quickly as possible.

It needs to be realised that many Muslims have a dread that their bodies may be mutilated for experimental, or other purposes after death, and there is a need for reassurance on these grounds.

Muslims believe in the resurrection of the body so they are buried, never cremated. Permission for post-mortem will only be given if legally required. Since burial must take place as quickly as possible, it is appreciated if the documents can be completed immediately after the death, enabling the registration and funeral to be arranged without delay. Locum doctors should be asked to attend to this before leaving the hospital.

FURTHER REFERENCE

Holy Book

The Qur'an.

Festivals

There are several festivals which follow the lunar calendar (and consequently are not relative to the modern calendar).

Ramadam: is the best known. It is the ninth month and during this time Muslims fast from before dawn to sunset daily.

Eid al – Fitre: a major festival at the conclusion of the fast of Ramadam.

Eid al – Adha: Marks the end of the Jajj. In Muslim countries all families who can afford to sacrifice an animal as Abraham did in place of his son Ishmail. In the UK this is usually carried out by the community.

Personnel

Individual mosques are generally controlled by an annually elected

committee which also appoints the leader of the congregation ie the Imam, who can also be a local community spokesman.

There is no hierarchy of ordained clergy.

Contacts (please see also “Modesty” in MEDICAL CARE notes)

Chester Islamic Society
Westlorne Street
CHESTER CH1 4AF

Shahjalal Mosque
45 Egerton Street
CHESTER CH1 3NP
Tel: 316356 or 313424

Bangladeshi & Asian Community Development Project
Mr S Ahmed
Ffolliott House
53 Northgate Street
Chester CH1 2HQ
Tel: 343570

Islamic Cultural Centre
29 – 31 Hatherley Street
Liverpool
Tel: 0151 709 2560

Shahjalal Mosque
309 Borough Road
Birkenhead
0151 666 2089

Shahjalal Mosque
Islamic Cultural Centre
Regents Park
London
NW8 7RG
Tel: 0207 724 3363

Imams and Mosques Council
12-22 Creffield Road
London W53 RP
Tel: 0208 992 6636

Web Sites: Islamic Studies, Islam, Arabic and Religion www.arches.edu/-godlas/

[Index]

SIKHISM

GENERAL

The Sikh religion was founded by Guru Nanak, born in Talvandi in 1469, Guru Nanak envisaged a society in which every member would work for the common good. ‘Sikh means ‘disciple'. He and the nine other Gurus who followed him sought to set an example in the way of living spiritually while at the same time taking an active part in the world.

Guru Nanak was opposed to religious practices taking the form of superstitions and ritual acts, which he saw as barriers rather than aids to worship. He spoke against the caste system, against customs of ‘purdah' (veiling) and ‘sati' (widow burning), and gave women not only equal but rather higher status than men. He emphasised the One-ness of God and his omni-presence; and he stressed the virtues of truthfulness, kindness and generosity, and the equality of men.

His teachings were followed by nine more Sikh Gurus over a period of two hundred years. The tenth Guru, Gobind Singh, knit the Sikhs into a saint and soldier nation with a common loyalty and a common purpose, and at the same time introduced a more democratic form of organisation with less reliance on a single man; He introduced Sikh baptism in 1699: all baptised adopted the same family names of ‘Singh (lion) for men and ‘Kaur' (Princess for women, and the men and women all wore five symbols of brotherhood. Sikhism is as much a way of life as a religion. Referred to as the five K's because of their Punjabi names which begin with that letter. They are:

Kesh - Uncut hair

Kangha - Comb used to keep the hair tidy. (Sikh men wear a turban to keep their hair in place).

Kara - Metal bangle

Kaccha - Special shorts

Kirpin - Dagger/sword.

(The sixth must be prepared to defend his religion and people at all times. There is a strict emphasis on physical fitness)

The Guru also instructed the Sikhs to rise early and say prayers in the morning, at sunset and before returning to bed.

The main ideals that influence the way of life for Sikhs are based on the following:

1 Equality:

All human beings are equal because God is contained in every heart. The distinction of caste, colour and creed only serve to perpetuate the inequalities, which are created by selfish human beings.

2 Worship of God:

Sikhs believe God to be present everywhere; therefore prayers can be said anywhere at any time. However, the best times for prayers are considered to be before dawn, at dusk and before going to bed.

3 Dignity of Labour:

Sikhism condemns idleness or a tendency to live off others. For Sikhs, there is dignity in labour in any job provided it is legal and ethical. Use of dishonest means is regarded as a sin.

4 Giving Charity:

Living and sharing is shown in the concern for needs of the poor. By giving one tenth of their income to religious purposes or for the needy in the community.

Voluntary Service:

This plays an important part in the Sikh way of life.

The Sikh code of conduct

• Sikhs are forbidden to cut their hair.

• Sikhs are forbidden to commit adultery.

• Sikhs are forbidden to smoke or chew tobacco. Drugs and alcohol will only be taken in moderation.

• Sikhs are forbidden to eat Halal or Kosher meat. Many Sikhs do not eat beef because of the Hindu influence and many are vegetarians out of choice.

Names

Sikhs have three names: a personal name, then a title (Singh for all men, Kaur for all women), then the family name: e.g. Harbans Singh Gill; Davinder Kaur Bhuller. Sikhs usually prefer to be called by their first name, or by their first name and the honorific title. However, to avoid confusion in the records it is best to obtain the family name of possible and use it thus: Gill, H S (man); Bhuller, D K (woman). The husband of Mrs Kaur will be Mr Singh. The wife of Mr Sing is never Mrs Singh but Mrs Kaur.

MARRIAGE AND FAMILY

Marriage

Marriage is particularly important for Sikhs as it is the basis for bringing up children in the Sikh faith. Marriage involves not just the couple, but also their families and because of this, the choice of a marriage partner is made with the advice and assistance of the families. Sikhs regard marriage as a sacred bond of mutual dependence between a man and a woman.

Sikh families, like most Indian families have a tradition of extended or joint family. This tradition is not possible to continue in Britain as the houses are not large enough to accommodate an extended family. Sikhs maintain a strong and supportive family structure.

Family Planning

Sikhs have no objections to family planning.

Birth

On the other hand it may require considerable tact and gentle persuasion to reconcile the mother to her baby being placed in a separate room, if the hospital's procedures require this. Visiting relatives will sometimes have to be persuaded to leave gifts of new clothing for the baby at the bedside, rather than putting them on straight away.

The desire for a son for some is often misunderstood as a disappointment at the birth of a daughter. Sons are seen as security, especially as the boys are expected to look after their ageing parents.

Soon after the birth of a child, the parents visit the Temple to pray and decide on a name for their child. This is done by opening the Holy Book, Guri – Granth Sahib, at random and the first letter of the hymn letter of the child's personal name. For this reason, parents are unable to choose a name before birth.

First name is common to both sexes, the second name usually is Singh for a boy and Kaur for a girl, followed by a surname.

MEDICAL CARE

General Attitudes

Generally speaking, Sikh patients will willingly accept the authority of the professional, whether male or female. They may tend to favour home remedies for ailments such as coughs, and be slow to seek professional attention.

Blood Transfusions and Transplants

Sikhs have no objections to these.

Ablutions and Toilet

As with other Asian patients, Sikhs prefer to wash in free flowing water rather than sitting in a bath; and they will appreciate having water provided in the same room as the WC or with a bedpan when one has to be used. They will want to wash their hands and rinse their mouths before meals.

Like most Asians, Sikhs attach great importance to cleanliness. They prefer showers to baths. Washing hands in free-flowing water before meals, prayers and after visiting a toilet is a must.

Modesty

Women prefer to be examined by female doctors, but in the case of emergencies they do not mind being examined by male doctors provided there is a female member of staff present. Likewise, they should be accommodated in mixed wards only in emergency situations. Staff can help avoid embarrassment by being helpful and understanding – for example, when a patient has difficulty in accepting an X-ray gown because of its shortness.

Sikh men are expected to wear a turban, which clearly identifies their religion, but not all do due to social difficulties. It is an insult to try and remove a person's turban. Sikhs do not cut their hair and take great pride in keeping the hair clean and tidy. Young boys have their hair plaited until they are old enough to tie a turban.

Women dress modestly, but can wear a range of clothing. Traditionally, they wear loose trousers and a long tunic with a long scarf as the Pakistani women. Some wear a sari. Young girls are encouraged to keep their legs covered when they reach their teens. Sikh women wear loose trousers under a long tunic and a long scarf called ‘shunni'. Going out alone to parties and discos is discouraged, especially for girls.

The older female population prefer to be examined by female doctors. Medical care takes priority over the availability of male/female doctors.

Diet

Food

Most Sikhs do not eat beef. While some will accept other meats, others will not eat meat of any kind. It is helpful to explain to patients whether dishes contain beef, park or lamb: they may not be familiar with such names as ‘Irish stew,' or ‘Scotch broth'.

Fasting

Some Sikhs may wish to fast when there is a full moon, but this is by no means universal.

DEATH AND DYING

The Sikh belief is that it is part of God's purpose that we all die. Death is regarded as similar to sleep and of short duration. Individual existence is considered to be the result of a repeated sequence of birth, death and rebirth as the soul seeks spiritual enlightenment. For the Sikh, God is all pervading and is the source of life. It is believed that a dead person's virtuous deeds constitute a link with those still alive and, together with his words, stand as his true memorial. This is why there is a complete prohibition of any kind of memorial. Prayers for the dead form no part of the Sikh religion.

Relations will advise but usually a dying Sikh will appreciate passages of the holy book, “Adi-Granth” being read to him by a presence of his family or local Sikh community. Following death, the room in which the body is laid must have a light switched on until it is removed. Grief is openly and publicly expressed so it may be advisable to move a dying patient into a side room or for the relatives to be given a private place to grieve.

The dying person may receive comfort by reciting hymns from the Sikh holy book. A relative or any other practising Sikh may share in the reciting of the hymns. It is important that the person should die while speaking the name of God (Wonderful Lord). Some may ask for holy water to be put into the mouth.

Traditionally, the funeral takes place before the next sunset. At Sikh funerals, families say goodbye to their dead relatives. The prayer said before going to sleep is used at funerals, symbolising that death is similar to sleep and should not be mourned. The body is cremated and the ashes scattered in running water, ie a river or sea.

Every effort should be made to complete documents as soon as possible after the

	Home \| News \| Bulletins \| About MFGHC \| Council \| Resources \| Links \| Forum \| Index
	Multi-Faith Group for Healthcare Chaplaincy
	*.....advancing multi-faith healthcare chaplaincy.*

.....advancing multi-faith healthcare chaplaincy.

THE HOSPITAL CHAPLAINCY

FORMAT OF EACH SECTION

THE GOLDEN RULE

HINDUISM

BUDDHISM

JUDAISM

ZOROASTRIANISM

CHRISTIANITY

ISLAM

BAHA'I FAITH

HUMANIST AND ATHEIST (NON RELIGIOUS)

PRIMITIVE RELIGIONS (such as SPIRITISM)

Nursing Care

BAHA'IS

BUDDHISM

Marriage

Birth

General Attitudes

Blood Transfusions and Transplants

Modesty

CHRISTIANITY

CHINESE

HINDUISM

JUDAISM

MUSLIM

SIKHISM

PRIMITIVE RELIGIONS
(such as SPIRITISM)