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Document No 76

1997        Page last updated: 13 August, 2005

University Hospitals Birmingham NHS Trust

Extracts from
"understanding and respecting religious and cultural needs: respect for privacy, dignity, religious and cultural beliefs"

BAHA'I

Although the Baha'i faith has its roots in Babism, a Muslim denomination, it is a separate religion. It's teachings centre on the unity of mankind, the harmony of religion and science, equality of men and women and universal peace.

It has no set doctrines, no priesthood, no formal public ritual and no authoritative scriptures. However a patient may wish to have a visitor from the Spiritual Assembly of Baha'i.

There are no unusual requirements for a Baha'i patient in hospital. S/he will accept usual routines and treatment.

Diet - Alcohol is not permitted - including alcohol in cooking.

Fasting - Members of the Baha'i faith fast for a period from 2nd March - 21st March.

The fast is from sunrise to sunset.

Children, expectant mothers and nursing mothers, the elderly and the sick are exempt from fasting.

If a patient is fasting, arrangements need to be made to make food available before dawn and after dusk.

Blood Transfusions - There is unlikely to be any objection.

Organ Transplantation - No objections to organ transplants.

8':1 Death - Baha'is believe in Afterlife and therefore they treat the body with great respect _ after death. Routine Last Rites are appropriate. Cremation is not permitted.

Burial should take place within an hour's journey from the place of death.

Post Mortem - No objections to Post Mortem.

Special Considerations - NAWRUZ - New Year, celebrated on 21st March each year.

BUDDHISM

Buddhist faith centres on the Buddha, who is revered, not as a god, but as an example of a way of life. Buddhists believe in re-incarnation and so accept responsibility for their actions. The chief doctrine is that of 'Karma', good or evil deeds resulting in an appropriate reward or punishment either in this life, or through reincarnation along a succession of lives.

From its very beginning, Buddhism has always been culturally adaptable, and as a result a variety of forms and movements have developed within the religion, each with different traditions. Ask the individual and/or family/friends what is required.

Diet - As Buddhism encourages its followers to practice non-violence, Buddhists will _ mostly be vegetarian. Meals will vary considerably depending upon their country of origin.

Family Planning - Buddhists believe that life begins at conception and so do not condemn contraception. However as abortion and active euthanasia are seen as taking life they are condemned.

Blood Transfusion - There is unlikely to be any objection.

Organ Transplantation - There is unlikely to be any objection.

Care of the Dying - Buddhists believe in rebirth after death. The state of mind of a person at the moment of death is important in determining the state of rebirth. They like to have full information about their imminent death to enable them to make preparation. Some

Buddhists may not wish to have sedatives or pain killing drugs administered at this time.

Peace and quiet for meditation and visits from other Buddhists will be appreciated. Some form of chanting may be used to influence the state of mind at death so that it may be peaceful.

Death - If other Buddhists are not in attendance, then a Buddhist minister should be informed of the death as soon as possible. Routine Last Rites are appropriate. Cremation is preferred.

Post Mortem - There is unlikely to be any objection.

Special Considerations - VESAK - a celebration of enlightenment of Buddha - held on full moon in May.

CHRISTIAN SCIENCE

Established in the United States of America in 1879

Christian Science teaches a reliance on God for healing, rather than on medicine or surgery. It will be unusual, therefore, for Christian Scientists to be patients in ordinary hospitals. They will usually seek nursing care at home or in a Christian Science Nursing Home. They may, however, be admitted to hospital following accidents, or during pregnancy and childbirth, and because of family or legal pressures. They will accept medical care for their children where the law requires them to do so. The Church does not attempt to control the actions of its members and the decision about whether to accept medical intervention lies with the individual.

A Christian Scientist will appreciate the normal care of the hospital if it is necessary for him/her to be admitted, but will normally wish to be totally free of drug treatment. S/he will probably wish to contact a Christian Science practitioner for treatment through prayer. The patient will appreciate privacy for prayer and access to the "holy" books of the Christian Science faith.

Diet - Alcohol and tobacco are not allowed. Strict Christian Scientists may not drink tea _ or coffee.

Blood Transfusion - It is not normally acceptable for adults, but parents usually consent _ to transfusion for their child if doctors consider it essential.

Organ Transplantation - It is not normally acceptable for adults to donate or to receive _ organs.

Care of the Dying - There are no rituals to be performed.

Death - Routine

Last Rites are appropriate. A female body should be handled by female _ staff. Cremation is usually preferred.

Post Mortem - Christian Scientists object to post mortems, unless required by law.

Anglicans - Roman Catholics - Free Churches

Although the doctrines of Christian churches vary greatly both within and between countries, there are four features of Christianity that are nearly universal: initiation (baptism), worship, ministry and 'good works'. The sacred writings of Christian religion are in the Bible. A Christian's individual faith and religious practice will be influenced by the tradition of the church to which they belong as well as their own personal

relationship with God. Please record the individual's specific denomination in their notes.

Diet - There are no general dietary requirements. Some Christians observe Friday as a _ day when they do not eat meat. Some Christians may wish to abstain from food (fast) before receiving Holy Communion. Some abstain from alcohol.

Family Planning - Varies from Religion to Religion. Please refer to individual patient.

Blood Transfusion - No religious objections.

Organ Transplantation - No religious objections.

Death - Routine Last Rites are appropriate for all Christians.

Special Considerations ­

Baptism/Christening - There is no age limit for baptism. When babies or children are

very ill, baptism should be offered.

Roman Catholics - Baptism - A lay person may perform this ceremony if death is imminent.

In the absence of a Minister of Religion, anyone may perform a baptism. This is done by making the sign of the cross on a person's forehead. A little water is poured on the

forehead (or another accessible part of the body), with the words," ....................... (Name)..., I baptise

you in the name of the Father, and of the Son, and of the Holy Spirit. Amen".

The Chaplain should be informed as soon as possible.

If a child dies unbaptised the Chaplain will offer a Blessing and Naming service and a certificate to commemorate this will be given to the parents. This is particularly appropriate following a miscarriage or stillbirth.

Patients may wish to see a Chaplain, Priest or a Minister from the local church, especially before an operation or anything else which is of concern to them. They may wish to receive Holy Communion and be prayed with. They may request a Bible or wish to attend services in the hospital chapel.

Christmas and Easter are the most important festivals/celebrations. Christians will usually wish to receive Holy Communion at these times.

Post Mortem - No religious objection.

CHRISTIANITY

CHURCH OF ENGLAND (ANGLICAN)

Always ask the individual and/or family/friends if they would like to see a Chaplain or their local minister.

Prayers may be said at the bedside of the dying patient. Sometimes the family or the patient will ask to receive the "Sacrament of the Sick". This involves anointing with holy oil.

After death some families may like to offer prayers of thanksgiving for the person's life.

ROMAN CATHOLIC

The patient will probably wish to be visited by a Catholic Priest and to receive Holy Communion and the "Sacrament of the Sick". This is not only for the dying, but also for the sick, especially before an operation.

The Sacraments are very important. The Catholic Priest must be called to the dying patient and if the death is sudden, immediately afterwards.

FREE CHURCHES

Baptist

Independent churches and missions

Methodist

Moravian Brethren

Pentecostal

Plymouth Brethren Presbyterian

Salvation Army

The Religious Society of Friends (Quakers)

United Reformed Church

Free Church patients may like to receive a visit from a Minister, a member of their own church or the Free Church Chaplain. Ceremony/sacraments may not be observed as strictly as the Anglican and Catholic religions; however, they may welcome prayers being said with them.

ISLAM

The followers of the Islamic religion are called Muslims. The Holy Book for Muslims is the Holy Qu'ran. There are two main denominations: Sunni and Shi'ite.

The religious duties are summed up in 'five pillars':

Creed - God is one and only one supreme creator and Mohammed is the Prophet of God

Prayer five times a day facing Mecca (South-East) with ritual washing beforehand.

Alms giving

Fasting

A pilgrimage to Mecca once in life

Diet - Muslims are forbidden to eat any product from pigs. Other meat can be eaten but it has to be HALAL meat, Le. killed in a special manner stated in Islamic law. Fish and eggs are allowed but not if they are cooked near pork or non-halal food. Nurses should discuss dietary requirements with the patient. Alcohol is prohibited.

Fasting - During the month of Ramadan a Muslim fasts between sunrise and sunset. Those who are sick are not expected to fast. If, however, a patient wishes to do so, food should be made available before sunrise and after sunset. Essential drugs and medicines can be administered during Ramadan.

Hygiene/Cleanliness - Hands, feet and mouth are always washed before prayer.

Hand washing is considered essential before eating.

Water for washing is needed in the same room as the WC itself, Le. patients should be

provided with bowls/jugs of water/bidet etc. If a bedpan has to be used, bowls/jugs of water should also be provided. Patients prefer to wash in free flowing water e.g. a shower, as baths are considered unhygienic. If a shower is not available, ask the patient if they would like to use a jug in the bath.

Modesty - Women prefer to be treated by female staff where appropriate.

Dress/Jewellery - A locket containing religious writing is sometimes worn around the

neck in a small leather bag. These are kept for protection and strength and therefore should never be removed.

Family Planning - Strictly speaking orthodox Muslims do not approve of contraception, in practice, individuals vary widely in their approach.

Abortion is frowned upon, but is often tolerated if it is for medical reasons.

Childbirth - 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 short prayer.

A Muslim boy is required to be circumcised as soon as possible.

Organ Transplantation - No specific rulings prohibiting transplantation. However, strict Muslims will not agree to organ transplants.

Care of the Dying - The dying Muslim may wish to sit or lie with his/her face towards

Mecca. Moving the bed to make this possible will be appreciated. The family may recite prayers around the bed. If no family are available, any practising Muslim can help.

The patient may wish the IMAM (religious leader) to visit.

Death - After death the body should not be touched by non-Muslims. Health workers _ who need to touch the body should wear disposable gloves.

The body should be prepared according to the wishes of the family. If family are not available, the following procedure should be followed:

Turn the head towards the right shoulder before rigor mortis begins. This is so that the body can be buried with the face towards Mecca.

Do not wash the body, nor cut hair or nails.

Wrap the body in a plain white sheet.

Muslims believe in the resurrection of the body after death, therefore Muslims are always buried, never cremated. The body will be ritually washed by the family and Muslim undertakers before burial. Muslim funerals take place as soon as practicable, as delay can cause distress. If a delay is unavoidable explain the reasons carefully to the relatives.

If the death has to be reported to the Coroner s/he should be informed that the patient was a Muslim and be asked if the procedures can take place as soon as possible.

If the family wish to view the body, staff should ask the Mortician to ensure that the room is free of any religious "symbols".

Post Mortem - Post Mortems are forbidden unless ordered by the coroner, in which case _ the reasons for it must be clearly explained to the family. The family may request that organs removed should be returned to the body after examination.

Special Considerations - There are many Muslim festivals, all calculated by the lunar calendar. Ask the patient or family if any important occasions for their faith occur during their stay in hospital. The most important is the month of Ramadan during which Muslims practice self-discipline in order to achieve tolerance, love, sacrifice and equality.

JEHOVAH'S WITNESSES

Jehovah's Witnesses try to live their lives according to the commands of God as written in the Old and New Testaments. They regard Jesus Christ as the Son of God, but not in the sense of being equal with God or one with God.

Diet - Food containing blood or blood products is not acceptable. 1:8 Jehovah's Witnesses do not smoke.

Blood Transfusions - Jehovah's Witnesses have religious views that taking blood into one's body is morally wrong and is therefore prohibited. This includes whole blood or its components, such as packed red cells, plasma, white cells and platelets. Jehovah's Witnesses can choose whether to accept products such as albumin, immunoglobins or clotting factors.

Blood samples may be taken for pathological testing providing any unused blood is disposed of.

Dialysis will usually be accepted.

Jehovah's Witnesses will accept medical treatment in all other respects apart from those involving the use of blood or blood components.

Organ Transplantation - Generally not permitted. Components where blood is not involved, e.g. corneas, are more likely to be acceptable. Jehovah's Witnesses are not likely to be willing either to donate or receive an organ through which blood flows. They will want reassurance that blood will not be used against their wishes.

Care of the Dying - There are no special rituals for the dying but they will usually appreciate a visit from one of the Elders of their Faith. (There are no separate clergy),

Death - Routine Last Rites are NOT appropriate.

Post Mortem - This is a matter of individual choice for the family.

Special Considerations - Jehovah's Witnesses do not usually celebrate birthdays or Christmas. The only festival celebrated is the annual memorial of the death of Christ.

JUDAISM

In Judaism, religion and culture are entwined. It is based on the worship of one God; carrying out the ten commandments; and the practice of charity and tolerance towards one's fellow human beings.

There are different groups within Judaism:­

Orthodox Jews - Are usually more traditional and observant of the religious/dietary laws.

Non - Orthodox Jews (includes Conservative/Liberal/Reform) - Make their religious observance fit into modern society.

Diet - Many Jews will ask for KOSHER food, i.e. meat that has been prepared in a special way according to Jewish law.

Shellfish, pork, rabbit and their derivatives are strictly prohibited (treifu). Milk and meat products are not eaten at the same meal. This means that they do not have milk in their drinks or cream with their desserts after their meat meal and do not use butter on meat sandwiches.

The patient should be consulted over his/her level of dietary observance and the necessary arrangements made.

Orthodox Jews may not be happy to take non-Kosher medication.

Fasting - See special occasions below. If fasting would be a danger, even Orthodox patients will accept medical advice.

Modesty - Orthodox Jewish women prefer to have their bodies and limbs covered.

They may also prefer to keep their hair covered with a head scarf. Orthodox men keep their head covered with a hat or skull cap (Kappel).

Family Planning - Some Orthodox Jews forbid contraception or family planning unless the woman's health is at risk.

Birth - Nearly all Jewish boys are circumcised, usually eight days after birth. This is performed by a trained and medically certificated religious functionary called a Mohel. If there is doubt about the child's health the circumcision is delayed.

Organ Transplantation - There is no objection to organ transplants.

Care of the Dying - The patient may wish to recite or hear special psalms or prayers, especially Psalm 23 (The Lord is My Shepherd), and may appreciate being able to hold the page on which it is written.

Prayers may be said by the relatives and they may wish a Rabbi to be called to help the dying person with their formal confession and to bring comfort.

The body should be handled as little as possible by non-Jews.

Depending on the sex of the patient a fellow male or female washes and prepares the body for burial. Usually three members of the community are present. Traditional Jews will arrange for this to be done by the Jewish Burial Society.

If, however, members of the family are not present, most non Orthodox Jews would accept the usual washing and last rites performed by hospital staff.

The body should be covered with a clean white sheet.

The family may wish for the body to be placed with the feet pointing towards the doorway and to light a candle.

Some Orthodox Jewish groups may wish to appoint someone to stay with the body from the time of death to the burial, which usually takes place within 24 hours. This person is called a "watcher" and he or she may need to stay with the body throughout the night.

In the above instance or if the family wish to view the body, staff should ask the Mortician to ensure that the room is free from any religious "symbols".

If the death has to be reported to the Coroner, s/he should be informed that the patient was Jewish and be asked if the procedures can take place as soon as possible.

Orthodox Jews are always buried but non Orthodox Jews allow cremation. The funeral has to take place as soon as possible.

Post Mortem - Post Mortems are not permitted unless legally required.

Special Considerations - The Sabbath (Shabbat) begins at sunset on Friday and lasts until sunset on Saturday. On the Sabbath 'work' is prohibited and this includes things such as writing, travelling and switching on lights or electrical appliances.

Passover (in March or April) is when special foods may be required by some Jewish patients.

Day of Atonement or Yom Kippur (in September or October). This is a special day of fasting. A Jewish patient will normally wish to keep that day to pray and be quiet. It is the holiest day of the Jewish Calendar and is considered to set the path for the year to follow. Orthodox patients must be offered alternatives to oral medication, such as injections or suppositories.

MORMONS

The Mormon Church is also known as the Church of Jesus of Latter-Day Saints. It began in America in 1830.

Mormons follow a very strict health code, known as the Word of Wisdom which advises against the use of tea, coffee, alcohol, tobacco etc. and advocates healthy living.

Family unity has great importance for Mormons.

Diet - Mormons eat sparingly and avoid products which contain a lot of blood.

Tea and coffee are avoided and some Mormons will avoid all hot drinks. Milk, water and

fruit juice are acceptable.

Blood Transfusions - Generally no objections.

Organ Transplantation - There is no objection to organ transplants.

Care of the Dying - There are no rituals for the dying, but spiritual contact is important. The church has "home teachers" who offer support and care by visiting church members in hospital.

Death - Routine Last Rites are appropriate.

The sacred garment, if worn, (see Special Considerations), must be replaced on the body following the last rites.

Church burial is preferred, although cremation is not forbidden."

Post Mortem - There are no religious objections. It is a decision for the individual family.

Special Considerations - Some Mormons who have been through a special temple ceremony wear a sacred undergarment. It is an intensely private item and is worn at all times. It is only removed for hygiene purposes. It may be removed for surgical operations but it must at all times be considered private and be treated with respect.

RASTAFARIANISM

Rastafarians are followers of a movement which began in the 1930s in the West Indies, among the descendants of slave families who had come from Africa.

The Old and New Testaments are still regarded as scriptures, but Rastafarians do not consider themselves to be Christian.

Rastafarianism is a personal religion. It places emphasis on personal dignity and a deep love of God. There are no churches, services or official clergy.

For some, legal marriage is unnecessary and thus extended families may be complex.

Diet - All forms of pork and shellfish are forbidden. Some Rastafarians are completely vegetarian. Some do not drink milk or coffee.

Modesty - Rastafarian women dress modestly. There is a taboo on wearing second hand clothing, and therefore the patient may be unwilling to wear hospital garments which have been worn by others. A disposable theatre gown may be preferred.

Family Planning - The majority of Rastafarians do not believe in contraception.

Blood Transfusion - There will probably be anxieties about this because of concerns about contamination of the body. Assurance will need to be given.

Organ Transplantation _ This is not generally acceptable.

Care of the Dying - Amongst Rastafarians, visiting the sick is important. Visits are often made in groups. Family members may wish to pray at the bedside. Apart from this there are no rites or rituals, before or after death.

Death - Routine Last Rites are appropriate. Burial is preferred.

Post Mortem - A post mortem will only be agreed to if ordered by the Coroner.

Special Considerations - Rastafarians will be unwilling to receive any treatment that will contaminate the body. They will prefer alternative therapies such as herbal ism or acupuncture. However, those who seek the advice of doctors are likely to accept some conventional treatment.

The distinctive hairstyles (dreadlocks or locks), are a symbol of the Rastafarian faith. Orthodox members may not permit their hair to be cut.

SIKHISM

Sikhs, as an act of faith, wear the 5 signs of Sikhism, known as the 5 K's. Kesh - uncut hair, kept under a turban

Kangha - small comb worn in the hair Kara - steel wrist band or bangle (or ring)

Kirpan - sword/dagger

Kaccha - white shorts worn as an under garment

These symbols should be not disturbed unless it is absolutely necessary, in which case the necessity should be explained to the patient and/or his/her family.

Diet - Many Sikhs are vegetarian. Some may not eat eggs or fish. A few Sikhs who eat meat will not eat beef. It is helpful to explain to patients the ingredients of dishes with unfamiliar names, e.g. "Hot pot".

Sikhs do not smoke and alcohol is forbidden.

Names - Most Sikhs have three names: a first name, a religious middle name and a _ family name. The religious middle name is always SINGH for men, and KAUR for women. Some Sikhs just use this religious title, e.g. Mr Singh. The wife of "Mr Singh" is never "Mrs Singh" but "Mrs Kaur" and vice versa.

Family Planning - Contraception can be used but is not openly spoken about.

Blood Transfusion - Generally no objections.

Organ Transplantation - Generally no objections.

Care of the Dying - A dying Sikh may receive comfort from reciting hymns from the Guru

Granth Sahab, the Sikh holy book. The family or any practising Sikh may help with this.

Death - Generally Sikhs are happy for non-Sikhs to attend to the body. However, many families will wish to wash and layout the body themselves.

If members of the family are not available, in addition to the normal Last Rites, the following procedure should be followed:

Special regard should be given to the 5K's. These should be respected and should be left intact.

- Do not trim the hair or beard.

If the family wish to view the body, staff should ask the mortician to ensure that the room is free from all religious "symbols".

Apart from Stillbirths and Neonates, who may be buried, Sikhs are always cremated. This should take place as soon as possible.

Post Mortem - No objections to post mortem examinations.

Special Considerations - Sikhs do not have a specific holy day: British Sikhs have adopted Sunday as the holy day. Prayers are read up to five times daily.

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