Essex Cancer Network
Catching the concept of spiritual care This document is dedicated to Reverend Peter O'Driscoll a dear colleague and friend who spent many hours working to ensure spiritual care within health care remains high on the local agenda
Peter O'Driscoll 1949-2009
“Never forget you are unique, for you are Stardust” Contents
Welcome 4 Introduction 5 The Baha'i faith 7 Buddhism 8 Christianity 10 Hinduism 12 Jainism 14 Judaism 16 Islam 18 Spiritualism 20 Sikhism 22 Zoroastrainism 24 Chinese culture and religion 25 Christian Scientists 27 Jehovah’s Witnesses 29 Mormons / Latter-Day Saints 31 The society of Friends or Quakers 33 Rastafarianism 34 Romany Origin 36 Atheism 38 Information on Ramadan and 'Id-Ul-Fitr 40 Emergency Marriages in Hospital 45 Acknowledgments 47 Appendices A. Spiritual Assessment Tool 48 B. Spiritual, Religious, Pastoral & Cultural care guidelines 50 C. Spiritual Care Provider Contacts 56 References and Bibliography 57
Essex Cancer Network Catching the concept of spiritual care 3 Welcome
Welcome to this first Essex Cancer Network Not all persons who we care for in our edition of Catching the Concept of professional roles will have religious needs but will Spiritual Care. I hope that you, the user, will find have, to a varying degree, relative to the it both useful and valuable as a resource. Without diagnostic challenges they face, spiritual needs. doubt your experience of using it will assist in improving future editions. In 2004 NICE published “Improving Supportive and Palliative Care for Adults with Cancer - the “Your Guide to the NHS” (DOH 2000) makes this Manual.” This document recognises certain key commitment to patients: issues in delivering effective spiritual and existential support to people experiencing illness “NHS staff will respect your privacy and dignity. or treatment or who are approaching death. They will be sensitive to, and respect, your religious, spiritual and cultural needs at all times.” These are:
It is hoped that Catching the Concept of • Listening to the patient's experience and the Spiritual Care will assist all staff to deliver on this questions that may arise important aspect of holistic patient/client care. • Affirming the patient's humanity One misunderstanding that subverts the quality of spiritual / pastoral care provision is the equating • Protecting the patient's dignity, self worth and of religious and spiritual need. Nurse academic identity Nancy Goddard (2000) writing in “Journal of Advanced Nursing” states that: • Ensuring that spiritual care is offered as an integral part of an holistic approach to health, “Spirituality encompasses all aspects of human encompassing psychological, spiritual, social being and is a means of experiencing life. Faith, and emotional care, and within the framework on the other hand, is related to religious of the patient's beliefs or philosophy of life. expression and may or may not be a necessary component of spirituality.” (Salladay & McDonnell I hope that catching the Concept of Spiritual Care 1989). will assist all of us to address these key issues.
The distinction between spirituality and religiosity Peter O'Driscoll MA is an important consideration since its absence is Trust Coordinating Chaplain partially responsible for the conceptual confusion Basildon and Thurrock University Hospitals NHS and ambiguity that permeates discussion of these Foundation Trust concepts. Getting that distinction right is vitally and Member of the SECN NICE Spirituality Group. important.
4 Essex Cancer Network Catching the concept of spiritual care Essex Cancer Network Catching the concept of spiritual care 5 Introduction Spirituality and Religion
Reverend Peter O'Driscoll Whenever we are faced with the consideration of spirituality and religion we come up against This resource is designed to enable all problems of definition and understanding. Most staff to provide appropriate holistic care people who don't think too much about spirituality and religion confuse the two. for our patients and their relatives and / or significant others. We do care very In the “Journal of Family Practice”, Clayton well for the physical and emotional (1999) argues for an inclusive understanding of needs of our patients. spirituality, one that sees spirituality as a broader concept than religion. He states: “Religion may be one expression of spirituality, but certainly not However research has shown (O'Driscoll all spiritual persons are religious” (p.1-2). Clayton 2001) that nurses and clinical support goes on to quote Remen (1988) who suggests workers feel less knowledgeable and that the “spiritual is that realm of human experience to which religion attempts to connect skilled in providing for peoples spiritual us through doctrine, ritual and practice. needs. Sometimes it succeeds sometimes it fails. Religion is a bridge to the spiritual, but the spiritual lies This resource, together with the beyond religion.” Network's Catching the Concept of Fowler (1981) in his book “Stages of Faith” set Spiritual Care educational course, seeks out a paradigm of spiritual development across to address this. the life span from 3 to 84 years. Fowler (1981 p4) described faith as “not always religious in its content or context.” His view is that faith has to do with finding coherence in life, seeing oneself in relation to others “against a background of shared meaning and purpose.”
Hay and Nye (1998) offer a theory of spirituality that includes religion but is not limited to it. Their book is based on a three-year research project looking at Children's spirituality. They believe that spirituality is an inborn aspect of human nature and the result of evolutionary development.
6 Essex Cancer Network Catching the concept of spiritual care O'Murchu (2000) states, “Our spiritual story as a Rabbi Julia Neuberger (1998 p11) asserts “We are human species is at least 70,000 years old; by actually whole people and we need to be comparison, the formal religions have existed for recognised as whole people. Hence training, and a mere 4,500 years” (p. vii). Jaspers (1969) makes then practice, for health professionals should a similar point when he refers to the almost recognise that wholeness and respond to it, simultaneous emergence of religious systems in including recognising our need for spiritual care.” China, India, Persia, Palestine, and Greece. Dossey (1998 p37) writes, “We may specialise O'Murchu makes clear a distinction he wishes to and sub specialise, but our patients don't. They make between the worlds “official religious come to us a whole, not as a body cut off from systems”, e.g. Hinduism, Buddhism, Judaism, their soul and spirit. And it is the whole to which Christianity, Islam etc. He states, “Spirituality the nurse responds, if she deserves to be called a concerns an ancient and primal search for meaning nurse instead of a technician.” that is as old as humanity itself… and belongs - as an inherent energy - to the evolutionary unfolding Harold Koenig of Duke University (2000, p.1708) of creation itself” (p. vii). has written, “Patients want to be seen and Spirituality is a universal human experience, albeit treated as whole persons not as disease. A whole one that manifests at different stages of person is someone whose being has physical, development and sophistication. To be human is to emotional, and spiritual dimensions. Ignoring any be a spiritual being. However not all humans are of these aspects of humanity leaves the patient religious or have religious needs. In considering feeling incomplete and may even interfere with spirituality or spiritual care in a healthcare context it healing.” is important to bear this distinction in mind.
It is an obvious fact that not everyone who uses our services is religious or has religious needs. What perhaps has been less obvious to us is that everyone is a human and therefore spiritual being with spiritual need. When we recognise and respond to that spiritual need we are offering better holistic care.
Dossey & Keegan (1989 p.4) defined holism as “the view that an integrated whole has a reality independent of and greater than the sum of its parts.” This is echoed in Bradshaw (1994, xix) “A way of thinking, stressing that the whole is more than the sum of its parts and cannot be broken down into parts and analysed.”
Essex Cancer Network Catching the concept of spiritual care 7 The Bahá'í Faith
The Bahá'í Faith was founded by Bahá'u'lláh (1817-1892). The followers of the faith regard him as the most recent in the line of Messengers of God that stretches back beyond recorded time and include Abraham, Moses, Buddha, Zoroaster, Christ and Muhammad.
The central theme of Bahá'u'lláh's message is that humanity is one single race and that the day has come for its unification in one global society. God, Bahá'u'lláh said, has set in motion historical forces that are breaking down traditional barriers of race, class, creed, and nation and that will, in time, give birth to a universal civilisation. The principal challenge facing the peoples of the earth is to accept the fact of their oneness and to assist the processes of unification.
One of the purposes of the Baha'i Faith is to help make this possible. A worldwide community of some five million Baha'is, representative of most of the nations, races and cultures on earth, is working to give Bahá'u'lláh's teachings practical effect. “The way of life which Baha'is seek to cultivate is one that encourages personal development. Daily prayer and meditation free the soul from conditioned patterns and open it to new possibilities. Joining in projects with peoples of diverse backgrounds breaks down traditional prejudices.” The Temple of Bahá'í. Haifa, Israel
8 Essex Cancer Network Catching the concept of spiritual care Special Considerations Last Offices There are no special considerations to be taken Routine last offices are appropriate. into account in nursing a Baha'i patient. Post Mortems Blood Transfusion and Organ Donation The Baha'is have no objection to post mortem Both blood transfusion and organ donation are examination. acceptable and have been described by a Guardian of the faith as “a noble thing to do.” Followers of the Baha'i faith may not be cremated or embalmed. Diet They will not normally wish to be buried No special requirements, except that the use of more than an hour's journey from the place alcohol or narcotic drugs is avoided, except when of death. prescribed for medical reasons, because it is believed these substances eventually deaden the mind.
End of Life Care Baha'i relatives may wish to be present to pray for the dying/deceased person.
Essex Cancer Network Catching the concept of spiritual care 9 Buddhism
The founder of Buddhism in this world was Buddha Shakyamuni who lived and taught in India some two and a half thousand years ago. Since then millions of people (Buddhists) around the world have followed the pure spiritual path he revealed.
Buddhists today believe that way of life of peace, loving-kindness and wisdom is just as relevant today as it was in ancient India. Buddhists follow the teachings of the Buddha Shakyamuni who is revered not as a God but as the founder of a Way of Life.
Over the centuries Buddhism has spread widely, there are over 360 million Buddhists world-wide and there are many variations of Buddhism; ethnic Buddhists have been born into a Buddhist family or culture but many Buddhists in the UK have consciously converted to Buddhism.
Followers of Buddha seek to emulate his example of perfect morality, wisdom and compassion culminating in a transformation of consciousness known as enlightenment.
The Buddhist way of life involves a pursuit of morality and generosity, the keeping of special festivals and pilgrimages.
Buddhist sacred places and social responsibility. Buddhism is not dogmatic but through its long history has developed into many schools. It is important to ascertain which school of Buddhism the patient follows as this could influence their requirements in hospital. Buddest Temple
10 Essex Cancer Network Catching the concept of spiritual care Special Considerations Post mortem Buddhists have no conflicts with modern There are unlikely to be any objections. However medicine. many Buddhists may find the thought of post mortem distressing. It would be very helpful, if Peace and quiet for meditation and chanting possible, to reassure families that the body will be would be appreciated and they would also complete and repaired for burial or cremation. welcome visits from other Buddhists. After death the need to inform a fellow Buddhist Patients will need to wash their hands before is important. If there are family they may choose meditation. to do this but if unavailable then contacting a local chaplain may be appropriate. For advice Patients may wish to sleep on the floor. please contact the chaplaincy service either at the local acute trust hospital or local hospice.See Do not place any books or objects on top of their contact contact details are in the appendices Spiritual Writings; their Scriptures are to be attached to this document. treated with great respect. Last Offices The image of a Buddha would bring comfort as It is traditional for the body to be left undisturbed will flowers and an incense stick. These must be for some time to allow the soul to depart. There handled with great respect. is a strong tradition in Buddhism that consciousness remains with the body for up to Blood Transfusion and Organ Donation three days after death. Otherwise there is no There are no religious objections to the giving or prescribed ritual for the handling of the corpse of receiving of blood or organs. The Buddhists a Buddhist person; so customary laying out is believe that organ donation is a matter of appropriate. However a request might be made individual conscience. There is no written for a Buddhist monk or nun to be present. In this resolution on the issue; however, Reverend part of the country that would be difficult to Gyomay Masao, president and founder of the arrange. Generally cremation is preferred. Buddhist Temple of Chicago and a practicing minister says, "We honour those people who donate their bodies and organs to the advancement of medical science and to saving lives.”
Diet Many are vegetarians because of their respect for all life.
A side room would be appreciated where possible.
End of Life Care Buddhists would like to be fully informed about their imminent death to enable them to make their preparation for it. Buddhists recognise that death is the ultimate barrier or fear for most people. Because Buddhists believe the state of mind of dying patients will influence their rebirth they place considerable importance on a state of conscious and focused peace as the best preparation for death. This may mean a reduction of certain drugs that reduce consciousness.
Essex Cancer Network Catching the concept of spiritual care 11 Christianity
There are many different Christian churches with differing structures and beliefs, but all Christians are followers of Jesus of Nazareth and worship one God, revealed as Father, Son and Holy Spirit. Easter and Christmas are the most important Feast Days.
Jesus lived in what is now Israel and Palestine in the 1st century CE (Christian Era). He was an itinerant preacher who taught people about the need to love God and one another. Jesus was crucified by the authorities, and Christians believe that on the third day he was raised from the dead and is present with his followers today.
All the churches believe the Bible (the Christian Scriptures) to be the word of God and so hold it in great reverence. The churches differ as to how it is interpreted.
The main Christian traditions in England include:
• The Church of England (the Anglican Church)
• The Roman Catholic Church (often called the Catholic Church)
• The Orthodox Churches (Greek, Russian and others)
• The Methodist Church
• The United Reformed Church
• The Baptist Union
• The Salvation Army
• The Pentecostal churches
There are many other smaller Christian churches and groups.
The Church of the Nativity door, Bethlehem, West Bank, Palestine, Israel
12 Essex Cancer Network Catching the concept of spiritual care Special Considerations End of Life Care Patients may wish to see a chaplain, especially before and after an operation, and some may wish Anglican to be prayed for, or receive Holy Communion or Prayers may be said at the bedside of the dying, anointing. and sometimes there may be the request that the patient be anointed. This is not only for the dying They may request a Bible, or to visit the Multi- but for all those who are sick, especially at Faith Prayer Room. The chaplains consider it their stressful times such e.g. before an operation. The duty to make sure that as many people as chaplain should be called to patients as early as possible are visited whilst they, are in hospital, possible so that they can get to know the patient and are available to visit on request at all times of and their family. The family / significant others the day, and at night if appropriate. may welcome the support of a chaplain after the patient has died and may wish for prayers to be While many Christian patients will welcome a visit said at the bedside. They may also wish for from any chaplain, Catholic patients especially arrangements to be made for their local priest to may wish to see the Roman Catholic Chaplain, visit. and Orthodox patients may request to have an Orthodox priest visit. Baptism for babies and young children may also be offered. Blood Transfusion and Organ Donation There are no religious objections to the giving or Roman Catholic receiving of blood or organs, nor the donation of In addition to what is written above about the body for teaching or research. Many churches Anglican patients, catholic patients may want to do not forbid the termination of pregnancy for be visited by the priest with Holy Communion; serious medical reasons. the Sacrament of Anointing is of particular importance. The chaplain should be called as early Diet as possible, especially if the patient has not been There are no restrictions as to diet, although some seen before. The baptism of infants in danger of may like to fast before receiving Holy dying is also important. Communion. Free Churches Some patients may prefer to avoid eating meat Free Church patients may often welcome the on Fridays and at other Religious festival times in opportunity to pray with a chaplain, but will not the year. normally expect a sacramental ministry. They may also like the opportunity to have a Bible available for use.
Last Offices These procedures are appropriate for all Christians.
Portrait of Mary, Joseph and baby Jesus, Nativity Church, Bethlehem, West Bank, Palestine, Israel
Essex Cancer Network Catching the concept of spiritual care 13 Hinduism
Hinduism is not a religion with a formal structure, it is the result of 5,000 years of continuous cultural development. It includes a number of extremely diverse, traditional and cultural beliefs and practices.
Hindus believe in the theory of re birth and the principle of action i.e. one has to face the consequences of actions in past lives.
It is extremely important to the Hindu patient that he is allowed to practice his religion in hospital.
Married women and children may wear red markings on their forehead. Married women may also wear a nuptial thread/necklace and male adults a “sacred thread”.
Special Considerations Blood Transfusion and Organ Donation Female patients prefer a female doctor if possible There are no objections on religious grounds to and consideration should be given to their modesty. blood transfusion.
Hindus are accustomed to having running water Hindus are not prohibited by religious law from or a jug in the same room as the toilet and if a donating their organs. bed pan is used a bowl of water must be offered afterwards. Ablutions are important. This act is an individual's decision. H.L. Trivedi, in “Transplantation Proceedings” stated that, The patient may want to lie on the floor (close to "Hindu mythology has stories in which the parts mother earth). of the human body are used for the benefit of other humans and society. There is nothing in the Avoid using the left hand unnecessarily with Hindu religion indicating that parts of humans, patients because this hand is regarded as unclean. dead or alive, cannot be used to alleviate the suffering of other humans." The family may wish to stay with the patient all the time. Hindu Temple, Neasden, North London
14 Essex Cancer Network Catching the concept of spiritual care Diet If no family member is available the following The eating of beef is forbidden and pork is not procedure should be followed: usually acceptable. Many are vegetarians and do Wearing disposable gloves close the eyes. not eat eggs and dislike plates that have been Jewellery, sacred threads and other religious used for non-vegetarian food. However, milk objects should not be removed. from cows is acceptable to most Hindus. Wrap the body in a plain sheet without religious There will be a need to rinse the mouth after emblems. In most cases it should not be washed eating. as this is part of the funeral rites and will usually be carried out by relatives later using Ganges End of Life Care water, which is collected from the Temple.
Before death a Hindu may desire to offer food Post mortems and other articles of use to the needy, religious Are disliked but are accepted if required by law. persons or to the Temple. As the body should be complete when cremated (or buried in the case of a child under five) These gifts will be brought by the relatives for the families may be concerned that all organs are patient to touch. returned to the body.
A Hindu would like to have the leaves of the Coping with the unfamiliar organisational side of sacred Tulsi plant and Ganges water placed in his death in Britain can be extremely distressing to mouth by relatives before death. Therefore warn bereaved relatives. Careful explanation and the relatives if death is imminent. Offering a calf practical help may be needed. If a Hindu (female) is symbolised by placing "Kusha" grass representative is required, please contact your under the bed. local chaplaincy team (see appendices).
Hindu patients wherever possible would like to die at home. Stone carved sculpture of elephant god Ganesha in Khajuraho temple, Madhya Last Offices Pradesh, India Consult the family asking if they wish to perform the last rites. It must be understood that some Hindu families can be very sensitive about who touches the body after death. All handling should be done wearing disposable gloves.
Staff also need to be sensitive and aware that the washing of the body after death is a traditional part of the rituals carried out by close family members.
Relatives may request that you inform the Hindu priest (Brahmin).
If unavailable, relatives may wish to read from the Bhagavad-Gita or make a request that staff read extracts during the last offices. The family may wish to stay with the patient during last offices. If possible, the eldest son should be present.
Do not cut nails or trim beards without family consent. The hands should be placed on the chest with the palms together and the fingers placed just under the chin, in the traditional Hindu sign of greeting. Essex Cancer Network Catching the concept of spiritual care 15 Jainism
As with many Eastern Religions, Jains believe that the soul is eternal and experiences many consecutive births in order to work toward complete enlightenment which ultimately leads to moksa or liberation. The path to moksa for Jains however, is different from that of Hindus and Buddhists. For Jains, the path to moksa begins with ahimsa or non-harming. This means for the layity, not harming any two to five sensed beings and for the ascetics, complete ahimsa for all creatures.
The goal of the Jain religion is to achieve liberation from the cycle of birth and death. Jains believe that an immortal and indestructible soul resides within every living being. Under the influence of passions such as greed and hatred, the soul comes under a complex web of karma, or the past deeds of the soul, and suffers repeated birth and death. The effects of karma can only be overcome when the soul achieves liberation.
The Three Jewels While every Jain should seek liberation, the path to liberation is a very demanding one that is achieved by only a few. The ideal for most Jains is therefore to live a good life in this world, by practice of the Three Jewels:
1. Right knowledge: understanding how karma binds the soul
2. Right faith: belief in the essentials of Jainism
3. Right conduct: adherence to the five vows
Jain Tirthankar, Lord Mahavira's Statue in meditation, at Dadabadi, Delhi, India.
16 Essex Cancer Network Catching the concept of spiritual care The Five Vows The most important is the morning prayer. Some Jains believe that to attain spiritual advancement Jains will also perform the morning and evening one must follow the five vows: ritual of 'penitential retreat', which lasts for 48 minutes. During this time the person will not 1. Non-violence: (Ahimsa) not giving any harm to respond to others. There are issues around the any creature - Jains are strict vegetarians use of antibiotics though if necessary they will accept them with regret. 2. Truthfulness: this includes avoiding saying what would be painful to others Blood Transfusion and Organ Donation Blood transfusion is acceptable. There is no 3. Non-stealing: this includes avoiding greed and religious objection to organ donation or exploitation transplantation. Jains may consider that the chance to save the life of another human being 4. Chastity: celibate monks and nuns are given as the greatest gift they can give. great respect in the Jain tradition Diet 5. Detachment: since the pleasures of this world Jains are vegetarians and do not eat meat, fish or are viewed as illusion, Jains try to limit their eggs or anything made from, or containing them. attachment to them Though most drink milk they will avoid butter and cheese because of the micro-organisms they Ahimsa: non-violence contain. They avoid alcohol and will not eat This central teaching of Jainism was made famous honey because it deprives the bees and may also in recent times by Mahatma Gandhi, who was contain micro-organisms. Many devout Jains will greatly influenced by Jain ideas. He made ahimsa avoid root vegetables, including onions, garlic, the guiding principle of his struggle for social potatoes and carrots. Some eat a vegan diet. It freedom and equality. Ahimsa means more than should be understood that Jains who break the not hurting others, it means not intending to dietary laws are likely to feel revolted and also cause harm, physical, mental or spiritual, to any spiritually polluted. Jains only eat during daylight part of nature, for, in the words of Mahavira: hours. “You are that which you wish to harm.” End of Life Care A Jain who is critically ill or dying may receive Compassion comfort from meditation, prayer, prayer beads This is the positive aspect of non-violence, to and recordings of chanting and prayers. A Jain practice an attitude of compassion towards all patient may ask for certain people to visit in order life. Jains pray that forgiveness and friendliness to seek forgiveness for any conscious or may reign throughout the world and that all living unconscious harm they may have done. beings may cherish each other. Obviously privacy and time for this process will be greatly appreciated. As death approaches many Interdependence Jain families would consider it very important to This ancient Jain principle teaches that all of be able to be present with their loved one. nature is bound together, and says that if one does not care for nature one does not care for Last Offices oneself. Routine last offices are appropriate. It is possible that family members may wish to help wash the Self-restraint body. The arms are placed alongside the body. An important Jain principle is not to waste the gifts This should then be wrapped in a plain sheet of nature, and even to reduce one's needs as far as without any religious symbols. Jains are cremated possible. As Gandhi said, “There is enough in this as soon as possible after death, within 24 -48 world for human needs, but not for human wants.” hours.
Post Mortems Special Considerations For Jains there is no religious prohibition against Most Jains will want to pray three times a day, in post mortems. the morning, around noon and just before sunset.
Essex Cancer Network Catching the concept of spiritual care 17 Judaism
The foundations of Judaism and the earliest stories of the Jewish people are found in the Hebrew Bible. The essential belief is that there is One spiritual God who cannot be represented in any shape or form. The family has great importance in Jewish life. In Britain today there is a wide spectrum of observance among Jews, from Reform and Liberal to Orthodox communities, whose daily lives are guided by the code of laws contained in the Five Books of Moses, which through rabbinic interpretation govern the lifestyle of Jews in their daily lives.
Jew praying at the Western Wall in Jerusalem.
18 Essex Cancer Network Catching the concept of spiritual care Special Considerations End of Life Care It is considered immodest for men to touch According to Jewish law and tradition a dying women other than their wives, therefore person should not be left alone and many families consideration about what contact is necessary will wish to sit with their relatives during the last between nurse and patient should be given. days/hours. When dying they may wish to hear Orthodox Jews will wish to observe the Sabbath, or recite special psalms and a special prayer which begins just before sunset on Friday and (Shema) and may appreciate being able to hold lasts until complete darkness on the Saturday. the page on which it is written. These prayers During this time they will not write, travel or can be said on their behalf by a relative or a switch on electrical appliances; therefore they Rabbi but it is stressed that a Rabbi is not would appreciate such things as having the bed essential and that if these prayers are not said light switched on or off for them. nothing untoward has occurred.
Many orthodox Jewish women may not wish Last Offices others to look at their hair and may wear a wig. Eight minutes are required to elapse before the In hospital, they may prefer to keep their head body is touched. covered with a head scarf. Usually relatives will straighten the body, but nursing staff are permitted to perform any Blood Transfusion and Organ Donation procedure for preserving dignity and honour. There is no religious objection to blood Nurse may: transfusion. 1. Close the eyes. 2. Tie up the jaw. 3. Put the arms parallel and close to the side of All four branches of Judaism (Orthodox, the body leaving the hands open. and Conservative, Reform, and Reconstructionist) straighten the patient's legs. support and encourage donation. According to 4. Remove tubes and instruments (unless Orthodox Rabbi Moses Tendler, Chairman of the contaminated). Biology Department of Yeshiva University in New York City and chairman of the Bioethics Patients must not be washed (unless a relative Commission of the Rabbinical Council of America, state otherwise), but may be dressed in a plain "If one is in the position to donate an organ to shroud. The body would usually be washed by a save another's life, it's obligatory to do so, even if nominated group. the donor never knows who the beneficiary will be. The basic principle of Jewish ethics - 'the Relatives may wish to keep vigil over the body. infinite worth of the human being' - also includes donation of corneas, since eyesight restoration is If death happens during the Sabbath (between considered a life-saving operation." sunset on Friday and sunset on Saturday), the body should be left. Seek advice from relatives. Diet Many will ask for Kosher food. In essence this Burial ideally should take place as soon as means that meat must be specially prepared by practicable preferably within 24 hours of death Jews, meat being lamb, beef or poultry, but and will be delayed only for the Sabbath and NEVER pig meat or rabbit. Fish must have fins major Festivals. The immediate family will set the and scales (excluding e.g. shellfish, eel). Meat ritual proceedings in motion. The local coroner and milk products may not be mixed. Some will and registrar have special arrangements in place order Kosher hospital meals, or may request pure for this. vegetarian diets. The patient should obviously be consulted over his/her level of dietary observance.
Essex Cancer Network Catching the concept of spiritual care 19 Islam
Islam is Arabic and means peace, purity, acceptance and commitment. The literal religious meaning of Islam is surrender to the will of God. A Muslim is one who follows Islam, there are approximately 200 million people who profess Islam, they are scattered from the Adriatic to Malaysia, North Africa, Bangladesh and Pakistan and throughout the Western world. Muslims believe in God's last prophet Mohammed (peace and blessings be upon him). He was born in Makkah (Mecca) in Saudi Arabia in 570 AD. The Holy Book of Islam is the Qur'an. This may be translated as the Quoran or the Koran and is believed to be the last revealed Word of God.
Muslims are required to follow the Five Pillars of Islam:
1. Faith. The most important pillar is the 2. Prayer. Salat is the name for the obligatory testimony of faith, called the Shahada: “La prayers said five times a day. The Islamic faith ilaha illa Allah, Muhammadun rasoolu Allah,” believes that individuals have a direct meaning “There is no true god but God relationship with God, and the prayers (Allah), and Mohammed is the Messenger represent the direct link between the (Prophet) of God.” This simple statement worshipper and God. The mandatory five daily expresses a Muslim's full commitment to the prayers are said at dawn, noon, mid teachings of Islam. afternoon, sunset and nightfall, with the worshippers facing Mecca.
Muslim Children Praying
20 Essex Cancer Network Catching the concept of spiritual care 3. Alms. Zakah refers to the financial obligations Blood Transfusion and Organ Donation required of adherents. A key principle of Islam There are no religious objections to blood is that everything belongs to God, and that transfusion or organ donation. In 1995, the wealth is only held by human beings in trust. Muslim Law Council UK issued a directive in The word zakah means both "purification" support of organ donation and transplantation. and "growth." Each year a Muslim calculates his or her own zakah. Adherents use a Diet benchmark of 2 .5 % of an individual's Halal food is available from the catering capital, given annually to the needy or for department (it is food prepared in a special way). religious purposes. Religious belief forbids pork, bacon, ham and alcohol. During Ramadan it is incumbent that all 4. The Fast. Every year in the month of Muslims fast but ill patients are exempt from this. Ramadan, (ninth month of the Muslim Food should be made available for any Muslim calendar) all Muslims fast from first light to patient before dawn and after sunset. The taking sunset, abstaining from food, drink and sexual of medication during a fast may cause difficulties relations. The fast is used as a method of self- to the patient; no undue pressure should be purification. By forgoing worldly comforts the applied. Patients may wish to sit or lie facing fasting person seeks to gain a clearer Mecca (South East). Family or friends may sit perception of God and a heightened sensitivity with the patient reading the Holy Qur'an and to the suffering of the poor. making supplication.
5. The Hajj. This pilgrimage to Mecca - the Hajj - End of Life Care is considered the most significant manifestation Procedure at death of Islamic faith and unity. It is an obligation for Do not wash the body those who are physically and financially able to perform it at least once in their lifetime. Last Offices Family members will probably want to perform Special Considerations the last offices. Where no relatives are available, Muslims attach great importance to cleanliness. staff should wear gloves to avoid direct contact with the body. The body should face Mecca and • Hands, feet and mouth are always washed the head should be turned towards the right before prayer. shoulder before rigor mortis begins. The body can be made respectable in the usual way, i.e. • After menstruation the whole of the body is combing hair and straightening limbs BUT the washed. family will ritually wash the body before burial. Burial normally occurs within 24 hours of death. • A shower is preferred to a bath. The local coroner and registrar have special arrangements in place for this. • Offer washing facilities after using a bedpan. Post Mortem • Muslims of both sexes are modest in their dress Only allowed if required by law. and outlook and due consideration should be given to this important factor during hospital Further helpful information on the care of procedures and routines. Please note: patients Islamic patients can be found at the back of may be reluctant to wear western style night this manual. gowns.
• Termination of pregnancy is not allowed.
• Following spontaneous abortion, tissue is treated as non-living matter if before 130 days gestation. After this period it is classed as a fully developed human being and must receive a funeral ceremony.
Essex Cancer Network Catching the concept of spiritual care 21 Spiritualism
Most of the psychic phenomena associated with the Spiritualist movement are as old as man himself. Throughout the ages, man has been aware of the existence of discarnate beings. For many cultures, ancestor-worship became a form of religion, where the wise men of the tribe, who were possessed of psychic powers, the equivalent to modern mediums, would testify to the presence of the spirits, and develop methods to communicate with them.
Modern Spiritualism is considered to date from events which occurred at Hydesville, New York State, USA, in 1848, when the Fox sisters established intelligent communication with a spirit entity. The public interest, and numerous investigations, allowed mediumship to come out into the open. Many Spiritualist societies were formed in America, based not merely on psychic phenomena, but also on the religious implications which lay behind teachings received from spirit.
The turning point for Spiritualism in the UK came in 1951, with the passing of the Fraudulent Mediums Act, which removed genuine mediums from the provisions of the Witchcraft Act 1735 and the Vagrancy Act 1824, thereby allowing Spiritualists to openly, and legally, practice their religion.
Spiritualists generally believe that the early Christian Church was founded on the basis of mediumship, Jesus being considered to have been an exceptionally gifted psychic and medium, as illustrated by reports of his healing powers, inspired teachings, physical mediumship, and so called miracles.
spiritualism a woman is praying to god
22 Essex Cancer Network Catching the concept of spiritual care There are Seven Principles of Spiritualism, which Spiritualists believe that they have communicated form the basis of the religion, and the religious with the dead through mediums. In most cases philosophy of the Spiritualist National Union. the act of dying, of being released from the body, and the spirit moving to a different dimension in 1. The Fatherhood of God. the spirit world, is reported as being a joyous 2. The Brotherhood of Man. experience. Spiritualists do not therefore, generally, fear physical death. For many, where 3. The Communion of Spirits and the the physical body is in constant pain, or is unable Ministry of Angels. to provide the sustenance that the soul requires 4. The continuous existence of the human for its progression, then death will be welcomed. soul. When close to death, most Spiritualists believe 5. Personal Responsibility. that they will become aware of relatives, or 6. Compensation and retribution hereafter friends, from the spirit world, who will gather to for all the good and evil deeds done on help their transition. They should be encouraged earth. to relate these experiences, which should be 7. Eternal progress open to every human treated with respect, and not subject to ridicule. soul. People with clairvoyant, or clairaudient, abilities may also claim to see or hear spirit entities Spiritualism does not provide direction to its around them. Again this should be considered to followers, instead it allows all to exercise freewill be perfectly normal for these gifted individuals. It within the framework offered by the preceding is thought that as the physical brain becomes less Seven Principles. active close to death, then these psychic experiences become more common. Blood Transfusion and Organ Donation There are no religious objections to Last Offices transplantations. Organ donation is believed to be Routine last offices are appropriate. an individual decision. Post Mortem Diet Is acceptable but generally undesirable, unless No special requirements. required by law.
End of Life Care Information: There are no special rituals or practices for the For further information, and contact details, dying. please visit www.snu.org.uk or www.nfsh.org.uk Spiritual Healing is a major belief within Spiritualism. Most spiritualists believe we all have the power to heal, through thought, touch and the demonstration of compassion. Spiritual Healing is not in this context directed at physical healing, but the healing of mind and spirit, and helping the patient to face the future without fear.
Access to a Healer should be granted if requested.
Essex Cancer Network Catching the concept of spiritual care 23 Sikhism
Sikhs believe in one God, and in many cycles of rebirth. They respect equality of all people, regardless of caste, colour, creed or sex. The birth place of Sikhism was in the Punjab, India and there are approximately 300,000 Sikhs in the UK.
Sikhs believe that God is the only reality and that spiritual release can be obtained by taming the ego through devotional singing, recitation of the divine name, meditation and service. Prayers are read five times daily. Sikhs do not smoke and adultery is forbidden.
To indicate equality all men are given the name Singh (which means lion). Women receive the name Kaur (princess).
Sikhism People meditating at the golden temple.
24 Essex Cancer Network Catching the concept of spiritual care Special Considerations Most Sikhs are accustomed to having water in Sikhs who have undergone the Khalsa baptism the same room as the toilet, therefore a bowl of ceremony adhere to the Khalsa Code of Conduct water should always be provided when a bedpan which defines social practices, ethical rules of has been used. conduct, acceptance of the teachings of the Gurus, and wearing of five physical articles of Blood Transfusion and Organ Donation faith which are as follows: Blood transfusions and organ donation are acceptable Kes (also may be referred to as kesh, kais, kesa) - uncut hair, including body and facial hair. Hair on Diet the head is worn in a topknot. Not all Sikhs, Sikhs are basically lacto vegetarian. A lacto particularly in Western countries, adhere to this vegetarian does not eat meat, fish, poultry or practice. eggs, but includes dairy products in their diet. They will eat milk, ice cream (that does not Kangha - a comb carried as a symbol of hygiene, include eggs), yogurt and cheese. They would to keep the hair neat and to hold the topknot in avoid ice creams, baked goods, pancakes and place. However, bald Sikhs also wear a kangha. veggie burgers that contain eggs.
Kara - a steel or iron bangle worn on the right wrist as a sign of loyalty to the Guru and as a End of Life Care reminder to the wearer to restrain his or her Health care providers, including nurses, physicians actions and to remember God at all times. and chaplains should comfort the terminally ill patient, making sure he / she is pain-free, have his Kirpan - a sword, often a short one / her relatives and friends nearby, and have access approximately four inches in length or a smaller to a Sikh Granthi (a Sikh), who can recite Gurbani steel replica. The kirpan is often worn (writings of the Gurus) and perform Sikh prayers. underneath the clothing and symbolises defence At the departure of their loved ones, Sikhs for all that is just. console themselves with the recitation of their sacred hymns. Kaccha - knee-length pants tied with a drawstring, generally worn as an undergarment, Last Offices symbolising sexual restraint. Family members, (especially the eldest son) and friends will be present if they are able. The family Men who are members of the Khalsa must wear usually takes responsibility for the last offices, but a turban. However, the turban is not one of the nursing staff may be asked to close the patient's five Ks. The turban is a method of keeping the eyes, straighten the body and wrap it in a plain hair neat and tidy. It consists of a lengthy piece white sheet. of cloth and is generally tied as an inverted V over the forehead. The turban cannot be covered by Do not remove the five 'Ks', which are personal any other headgear or replaced by a cap or hat. objects sacred to Sikhs. With minimum delay, the The turban is mandatory for Sikh men and body is to be removed to the funeral home for optional for Sikh women. expeditious cremation, unless the family is waiting for a close relative to arrive. The body should be MRI scans may not be performed unless patient covered with clean linens and shrouded. agrees to remove their KARA.
The Kara should only be removed if surgery or x Post Mortem ray is to be performed on the right wrist or arm. Is acceptable but generally not desirable unless For other operative procedures, seal with tape. required by law.
If for any reason the patient's KACHA (special Sikhs are always cremated. shorts underwear) are removed, they should be Stillborns and neonates may be buried. replaced by another pair. Consult the patient for method of removal and replacement. There is a Sikh Gurdwara (Temple) located in Grays. Sikhs prefer running water to wash in before meals. Essex Cancer Network Catching the concept of spiritual care 25 Zoroastrianism (also known as Parsees)
One of the great religions in world history, Zoroastrianism became the state religion of the Persian Empire. It is in this ancient tradition that Noruz is now celebrated in Iran, though in that country it is a secular holiday. (It is estimated today there are currently between 150,000 and 200,000 followers of Zoroastrianism worldwide, most of them in India and Iran.)
Zarathustra's teachings were strongly dualistic. He said that life is governed by good and evil, "two primal Spirits" who are "twins renowned to be in conflict." Because of this, he is said to have invented the notion of Satan as an evil entity in distinct opposition to God.
He said that, "In thought and word, in act they are two: the better and the bad. And those who act well have chosen rightly between these two, not so the evildoers." In doing so, Zarathustra created the first world religion to make ethical demands on people.
Zarathustra taught that "the aim of life is to lead a happy and joyful existence," according to Dr. Khosro Khazai, president of the European Centre for Zoroastrian Studies. "Individual happiness depends on the happiness of society, and society cannot be happy if all beings in that society, including animals and plants, cannot lead a peaceful and a fulfiled existence."
Zoroastrianism Masjed-i Jame' Mosque in Yazd, Iran
26 Essex Cancer Network Catching the concept of spiritual care Equality between all men and women is frequently mentioned in the central Zoroastrian text known as the Avesta. The Avesta strongly condemns oppression; in Zoroastrian thought, everyone should take it upon himself to relieve others of oppression. Fittingly, it was as a Zoroastrian that Cyrus the Great, who ruled the Persian Empire in the 6th century B.C., made what has been described as the first human rights declaration. On a clay cylinder now preserved at the British Museum, he wrote, "I have granted to all humans the liberty to worship their own gods and ordered that no-one could ill-treat them for this. I ordered that no house should be destroyed. I guaranteed peace and tranquillity for all humans. I recognised the right of everyone to live in peace in the country of his choice..." Indeed, in his "History of Zoroastrian Philosophy", Paul du Breuil claims that thanks to Zoroastrian government reforms, "Persian women enjoyed unprecedented liberty through the whole of Antiquity."
Another Zoroastrian concept was the "Kingdom of God" or "chosen government," which held that all virtuous people should be free and be able to choose leaders for their righteousness.
Blood Transfusion and Organ Donation Blood transfusions and organ donation are acceptable
Last Offices Customary last offices are often acceptable to Zoroastrian families, who may want to be present during or participate in the preparation of the body of the deceased.
After washing, the two sacred garments are required: the Sadra is placed next to the skin under the sheet, and the Kusti is replaced. Relatives may cover the deceased's head with a white cap or scarf. It is important the funeral take place as soon as possible after death.
Essex Cancer Network Catching the concept of spiritual care 27 Chinese Culture and Religion Harmonious relationships are stressed among nature and other individuals.
The five primary religions of China are Taoism, Confucianism, Buddhism, Islam, and Christianity. Taoism has the least amount of followers. Christianity is viewed as being partially responsible for the introduction of the Western culture into China.
Taoism and Confucianism are religions that originated in China.
Taoism probably took form as a religion during the second century, originating from sorcery, the pursuit of immortality and other supernatural beliefs in ancient China. Taoists take the philosopher Lao Zi as their teacher, and his work, the Dao De Jing (The Classic of the Way and It's Power), as their “holy book”. Sublimating the philosophical concept of “Dao” or “Tao” (the Way) as described in the Dao De Jing. Taoists believe that man can become one with the “Tao” through self-cultivation, and achieve immortality. Today, China has more than 1,500 Taoist temples, and over 25,000 Taoist monks and nuns.
Confucianism is more a philosophy than a religion. Confucian codes of conduct and clearly defined patterns of obedience became inextricably linked in Chinese culture. The family is the basic unit of society. Age is esteemed and the young respect their elders. Strict codes of obedience are held together by the concept of filial piety, the desire not to lose face and a form of ancestor worship.
Pagoda of the Chinese gardens in Singapore
28 Essex Cancer Network Catching the concept of spiritual care Buddhism was introduced to China from India in approximately the first century A.D. Tibetan Buddhism, or Lamaism as it is sometimes called, is found primarily in Tibet and Inner Mongolia. China has more than 13,000 Buddhist temples, with about 200,000 monks and nuns. Islam probably first reached China in the mid-seventh century. Arab and Persian merchants of the Islamic faith came overland through Central Asia to northwest China and by sea to the coastal cities in south eastern China, bringing with them the Islamic faith. Now China has more than 30,000 mosques and more than 40,000 imams.
Christianity reached China after the seventh century. There are about four million Catholic believers, 4,000 clergy and more than 4,600 churches and meeting places in China.
Please refer to the relevant religion's listing in this document
Many Chinese feel shame and embarrassment when they cannot communicate well. Therefore, they may experience a great amount of stress in the health care environment.
Many feel embarrassed to ask questions when health care workers do not speak their language. Therefore, it would be appropriate to have a translator available when discussing important matters in the patient's health care.
Chinese people tend to be quiet, polite, and unassertive and tend to suppress feelings such as anxiety, fear, depression or pain. It is important to recognise nonverbal cues and their cultural meanings to develop culturally appropriate care.
Encourage and elicit Chinese patients to verbalise their feelings and ask questions. A more detailed information resource is available via the internet by searching Google with keywords 'Chinese Religion and Culture or by typing the following address into the URL window: www.uh.edu/~fyang/china.htm
Essex Cancer Network Catching the concept of spiritual care 29 Christian Scientists Not to be confused with the Church of Scientology
Founded by Mary Baker Eddy in 1875, who suffered a great deal of ill health, and experienced personal healing after reading of the healing power of Jesus Christ in the New Testament, The Church of Christian Scientists aim to reinstate primitive Christianity and its lost element of healing. It is probably best known for its reliance on prayer alone for the healing of sickness and disease. This is believed to be in line with the healing practiced by Jesus Christ and is seen as an integral part of the ministry of Christianity. Christian Scientists are free moral agents and the Church does not control the actions of its members.
It is unusual for Christian Scientists to be patients in ordinary hospitals. Instead they would seek help from a nursing home run by the church, where the accent is on healing by prayer alone. However, the church does not rebuke those who defer to the family or legal pressures to undergo conventional medical treatment.
Christian Scientists may be admitted to hospital for the following reasons:
• Following accidents, a surgeon is allowed to set bones.
• Childbirth, when a midwife is required by law to attend the woman.
• Lack of finance if they can no longer afford care in their own hospital, even though the church does give substantial financial support. Church Christ the Scientist in • Lack of faith; when faith is not Boston, USA. strong enough to believe cure can be affected by spiritual means.
30 Essex Cancer Network Catching the concept of spiritual care Special Considerations End of Life Care The Christian Scientist, if in hospital voluntarily, is likely to accept minimal medical treatment. What to do after death Worship is kept free from ritual and there are no They may also ask for drug therapy to be kept to last rites. a minimum. Last Offices They may wish to contact a Christian Science Routine last offices are appropriate. However a practitioner to ask for treatment through prayer. female body should be handled by female staff. Cremation is usually preferred, but this is a matter Access to the Bible and Christian Science for family choice. published works would be appreciated. Post Mortem Privacy for prayer and healing would also be Christian Scientists wish to be free from post appreciated. mortems unless required by law.
Blood Transfusion and Organ Donation Transfusion and organ transplantation these are regarded as material methods of treatment and neither donation nor reception would usually be acceptable for adults. Children will fall under the Children Act (1989) and therefore the patient's parents are unable to object if doctors feel it essential.
Diet The only dietary prohibitions are for alcohol and tobacco.
Essex Cancer Network Catching the concept of spiritual care 31 Jehovah's Witnesses
Jehovah's Witnesses believe in Almighty God, Jehovah, Creator of the Heavens and Earth. They do regard Jesus Christ as the Son of God and declare themselves to be Christians. There are about 117,000 Witnesses in the UK.
Jehovah's Witnesses await the end of the present world system which they believe will begin with the Battle of Armageddon. Jehovah and his true witnesses will be the only survivors, his true witnesses being their sect. After Armageddon there will be 1000 years of peace and life under “favourable conditions”.
Jehovah's Witnesses believe in making a positive effort to reach the public, just as Jesus did when "he went journeying from city to city and from village to village, preaching and declaring the good news of the Kingdom of God". Scriptures are offered to householders as well as Bibles and literature, if desired. Witnesses conduct meetings in Kingdom Halls on a weekly basis and also assemble in private homes for Bible Studies each week.
The only festival celebrated is the annual memorial of the death of Christ, the date of which varies, being calculated according to the biblical formula.
32 Essex Cancer Network Catching the concept of spiritual care Special Considerations Last Offices Jehovah's Witnesses are deeply religious people There are no special recommendations, however who have sincerely held Bible based views that relatives may wish to be present during last taking blood into one's body is morally wrong. offices, either to pray or read from the bible. The family will inform staff should there be any special They believe medical treatment is a matter of requirements, which may vary depending upon informed consent of the individual. Jehovah's country of origin. Witnesses will not accept treatment involving use of blood or blood components, but will be Post Mortems pleased to co operate with medical and nursing There are no religious objections. staff in alternative non blood medical management. Jehovah's Witnesses may be either buried or cremated, depending on personal or family Parents of children needing blood transfusions preferences and local circumstances. There are no may object on religious grounds. However specific funeral rites, though a simple, personal children are protected under the Children Act service will likely be held at the deceased's (1989) and as such doctors may, if essential, Kingdom Hall, or at the graveside or override the parent's objections, or apply to the crematorium. courts to make a decision in the child's best interests.
They have strong views about termination of pregnancy and are totally against it with the possible exception of an ectopic pregnancy.
Jehovah's Witnesses do not object to modem medicine, but to them blood represents life itself and must be handled with respect.
Blood Transfusion and Organ Donation For blood transfusion please see above. Organ and bone marrow donation and transplantation is acceptable.
Diet Jehovah's Witnesses reject food containing blood. They do not smoke or use tobacco products.
End of Life Care
There are no special rituals or practices for the dying, but patients who are very ill will appreciate a pastoral visit from one of their elders.
They do not support euthanasia, but accept that if someone is in the terminal phase of their existence life should not be prolonged artificially.
The living body is dedicated to God, but the body has no particular religious significance once the breath of life has passed from it.
Essex Cancer Network Catching the concept of spiritual care 33 Mormon / Latter-Day Saints
The Mormon Church arose in America in the early 19th Century. It has a growing membership of over 11,000,000 worldwide with a slight majority outside the United States.
Mormons believe that God, Christ and the Holy Ghost are separate entities although united in purpose. They believe in continuing Revelation and that there is a living prophet, a man who received revelations from God and directs their churches here on earth. They also believe that we are living in a time just before the Second Coming of Christ, and that the Gospel should be taken through Missionary Work to the whole of the world. They believe in self sufficiency in honouring, upholding and sustaining the Law and in being of service in the community.
Missionary work is mainly done by young people between the ages of 19 and 22 who travel in pairs serving full time without pay. They spread the word of the Mormon Church visiting homes and the Community.
The Mormon Churches Temple Square in Salt Lake City, Utah
34 Essex Cancer Network Catching the concept of spiritual care Blood Transfusion and Organ Donation Last Offices Blood transfusion there is no religious objection, Routine last offices are appropriate. There are no the church encourages blood donation and makes special requirements, but relatives may wish to be its meeting houses available for this purpose. present. Relatives will advise staff if the patient wears a one or two piece sacred undergarment. There are no religious objections to organ If this is the case relatives will dress the patient in transplantations or donations following death. these items. Members are counselled that the decision is one for the individual and the family to make. Post Mortems There are no religious objections to post mortems Diet or organ transplantations or donations following Mormons try to take care of their body, take death. proper rest and exercise and eat a healthy diet. They are not usually vegetarians but will eat meat Burial is preferred although cremation is not sparingly avoiding products with much blood (i.e. forbidden. black pudding). There is concern over the effects of stimulants including caffeine and tea.
Mormons drink neither tea nor coffee. Some will avoid all hot drinks. In hospital, water, milk or fruit juice will be acceptable. Alcohol and tobacco are forbidden.
Some Mormons who have undergone a special Temple ceremony wear a sacred undergarment. This intensely private item will normally be worn at all times, in life and death. It may be removed for hygiene purposes and laundering and for surgical operations, but it must at all times be considered private and treated with respect.
End of Life Care
Death, if inevitable, is regarded as a blessing and a purposeful part of eternal existence.
There are no rituals for dying but spiritual contact is important and active members of the church will know how to contact their Bishop. The church has home teachers who assist caring by offering home support and by visiting church Members in hospital.
Essex Cancer Network Catching the concept of spiritual care 35 The Society of Friends or Quakers
Quakers believe the whole of life is sacred and the experience of God available to everyone.
Quakers have found corporately that the Spirit, if rightly followed, will lead them into truth, unity and love: all their testimonies grow from this leading. These insights, attitudes and practices form a way of life, rather than a dogma or creed. Although their spiritual experience cannot ultimately be expressed in words, Quakers base their whole lives on it.
The Religious Society of Friends (Quakers) arose in the mid 17th Century. Its members call themselves Friends of Truth, or simply, Friends. There are no ministers or pastors. Elders and Overseers are appointed to oversee the spiritual and pastoral well being of Quaker meetings and their members. In meetings for worship, Quakers do not sing hymns or use set prayers, but wait together on God in silence, with a member on occasion speaking briefly, perhaps praying, or reading from the Bible or other religious work.
While in hospital or hospice a Quaker may like to be visited by another Quaker.
36 Essex Cancer Network Catching the concept of spiritual care Blood Transfusion and Organ Donation There are no religious objections to transplantations. Organ and tissue donation is believed to be an individual decision.
Diet No special considerations, some Quakers are vegetarian and a few are vegan.
End of Life Care
There are no special rituals or practices for the dying. Patients will appreciate a visit from an Elder or other Quakers who may sit in silent worship.
Last Offices Routine last offices are appropriate. A number of people are appointed to support and advise families after a death and to assist with practical arrangements.
Post Mortems There are no objections on religious grounds.
Essex Cancer Network Catching the concept of spiritual care 37 Rastafarianism
Rastafarians are followers of a movement which began in the 1930s in the West Indies, mainly in Jamaica and Dominica among the descendants of slave families who had come from Africa. Identification with Africa is central to the Rastafarian doctrine and the movement is linked to the roots of resistance to slavery. "The Back to Africa" movement led by Marcus Garvey raised black consciousness and self respect and has inspired faith.
The accession of Ras (Prince) Tafari as the Emperor of Ethiopia (Haile Selassie 1) in 1930 is central to Rastafarian belief. He is considered to be a divine being, the Messiah of the human race who will ultimately lead all black people to freedom. Rasta man in traditional dress.
Various groups have contributed to the Rastafarian Movement which has in many ways rejected both Jamaican - European culture and the Christian Revivalist Religion predominant in Jamaica. This has resulted in a distinct entity. The Old and New Testaments are still regarded as scriptures, but Rastafarians do not consider themselves to be Christians. For them Christ's spirit has been reborn in Ras Tafai, the New Messiah. They believe they are the true Jews who will eventually be redeemed by repatriation to Africa, their true home and heaven on earth. Rastafarianism is a personal religion; there are no church buildings, set services or official clergy. All members share in the religious aspects and have a deep love of God.
38 Essex Cancer Network Catching the concept of spiritual care Special Considerations Diet Many Rastafarians are converts to the religion, All forms of pig meat are forbidden. Some feel and members of the faith are readily identified by that all meat is unnecessary and follow a their distinctive hairstyle. Dreadlocks or “locks” vegetarian diet. Certain fish are regarded as are a symbol of faith and a sign of black pride. unwholesome, herring and sardines in particular are not acceptable. Only natural food is eaten, Orthodox members may not permit their hair to canned or chemical food is not eaten. Orthodox be cut. Rastafarian women dress modestly at all Rastafarians do not take stimulants, i.e. alcohol, times and this must be respected in hospital. caffeine or tobacco. There is a taboo on the wearing of second hand clothing, therefore they may be unwilling to wear hospital garments which have been worn by End of Life Care others. Disposable theatre gowns may be preferred. Family members may pray at the bedside of the dying person, but there are no rites or rituals Rastafarians will be unwilling to receive any before or after death. treatment which might contaminate the body and some may reject western style treatments. Some Last Offices will prefer to try alternative therapies such as Following death routine last offices are herbalism, homeopathy or acupuncture. appropriate.
For some a legal marriage is unnecessary and thus Post Mortems extended families may be complex. These would be extremely distasteful to most Visiting the sick is important and visits are often Rastafarians. Few would agree to a post mortem made in groups, which is sometimes frowned on except where it is ordered by the Coroner. by hospital staff. Rastafarian visitors therefore Burial is preferred but cremation is not forbidden. often feel they are made unwelcome in the hospital environment.
Blood Transfusion and Organ Donation There is also a belief that blood transfusion interferes with God's plan for mankind. Organ donation and reception to and from other members of the family may be considered.
The fear of contamination of the body will influence the attitude to transfusion and transplantation; therefore assurance would be needed that no disease would be transmitted.
Parents of children needing blood transfusions may object on religious grounds. However children are protected under the Children Act (1989) and as such doctors may, if essential, override the parent's objections, or apply to the courts to make a decision in the child's best interests.
Essex Cancer Network Catching the concept of spiritual care 39 Romany Origin
Includes English, Irish, Scottish and Welsh travellers and those who live on a permanent site, those in transit and travellers who are settled in houses.Although a traveller may have relinquished their nomadic lifestyle, this does not mean the loss of their ethnic identity.
Many people of Romany origin are Christians. Travellers often experience difficulties in seeing a GP and when this happens will present themselves at Accident & Emergency Departments as this is their only means of gaining the health care needed.
Romanes (the Romany language) is still spoken today. However, the majority of travellers speak English, but may need assistance with filling in forms.
Romany primitive the front part of caravan
40 Essex Cancer Network Catching the concept of spiritual care Special Considerations The family will also want to take the person who Romanies do not believe in washing clothes in the has died back with them in order to sit up all same bowl that vegetables or food is prepared in. night with them allowing family and friends to A separate bowl is kept for washing face and pay their last respects before the funeral the next hands etc many feel it is mochardi (unclean) to day. do otherwise. Burial is preferred since the majority of Romanies From the age of eleven and throughout do not believe in cremation, although cremation adulthood people of Romany origin do not like is not forbidden. undressing in front of others (out of modesty). In addition to this they prefer to keep legs and feet Without prejudice to the above be aware covered it is considered to be rude to do that some gypsies / travellers of Eastern otherwise. European / North African origin may be Muslims. Older Romany people will not wash their hair it is clean from its own natural process and cleanliness is aided by the use of hedgehog oil. Older people often use bacon fat as a moisturiser, particularly on their arms.
Patients may wish to see a Chaplain and / or request a Bible.
Catholicism does forbid the termination of pregnancy and indeed many Travellers (irrespective of religion) do not agree with abortion other than on medical grounds.
Blood Transfusion and Organ Donation There is no religious / cultural objection to the giving or receiving of blood or organs.
Diet There are no general dietary requirements.
End of Life Care
If a Traveller is dying then his / her family and friends from around the country will visit, wanting and needing to see and be with the person before they die. This often means that there will be a large number of people visiting.
Last Offices Routine last offices are appropriate. After the death the family may request that the person be laid out in clothing of their choice.
Family and friends will often place items in the coffin these will be things that the person who has died was fond of e.g. jewellery, photographs, and children's toys.
Essex Cancer Network Catching the concept of spiritual care 41 Atheism
Atheists do not believe in God or a higher being. However by virtue of being human they have a spiritual dimension and experience spiritual need. Agnosticism
An atheist, like a Christian, holds that we can know whether or not there is a God. The Christian holds that we can know there is a God; the atheist, that we can know there is not. The Agnostic suspends judgment, saying that there are not sufficient grounds either for affirmation or for denial.INFORMATION ON RAMADAN AND 'ID-UL-FITR Thoughts on the Spirituality of Atheism C. George Boeree
I am an atheist. This may not seem to particularly qualify me to talk about spiritual matters. I believe it does, and uniquely: I see atheism as a sort of minimalist spiritual perspective, one that has stripped away so much of what we usually think of as spiritual - the supernatural - that the essence of spirituality can be seen more clearly.
People will ask me: Don't you believe in God? No, I don't. Jesus? Buddha? I believe that both were men of great charisma and insight - but neither was a god. Don't you believe in anything? Of course I do. I believe in two things above all: Nature and love. Nature is all-powerful. Love is how I understand the good. It might have been nice to believe in God, often defined as all- powerful and good, but combining the two like that has always posed too much of a contradiction for my poor mind to believe in.
It's the old problem of evil: If he's all-powerful and all-loving, why does he then permit evil? If you want to get specific, why does he allow innocent children to suffer (and they do suffer, don't they?). Me, I have nature, which I hold in great esteem, but which is clearly not loving - and love - which is good but clearly not all-powerful.
What about an afterlife? No, I don't believe in that either. You mean you think we just die and that's it? Yes, that's right. So how can you stand
42 Essex Cancer Network Catching the concept of spiritual care to live? Life is enough. It has to be, it's all there is. lot of a people all by themselves. But we aren't all But then what's the meaning of life? The by ourselves. meaning of life is in the living of it. We aren't as alone as we think we are, each of us Our lives are such small things. Sometimes we locked away in some soul-walnut. I believe that think we need something grand to make them consciousness is only occasionally restricted to worthwhile -- like eternal life in paradise, or great one person's mind. Most of the time, it lies success, or intense experiences. Or we feel we somewhere between us. need a grand philosophy or religion to give our lives meaning. But that's just not true. It's the If you are playing pool with a friend, and you are little happiness's of life that give it meaning. really concentrating on the game, for a little while Some laughter, some conversation, good food the two of you are actually sharing consciousness, and a little sex, satisfaction at a job well done, a he sees what you see and you see what he sees. walk on the beach, making a difference, even if When you make love with someone, you become its a small difference, seeing your children lost in each other, lost in the passion of the become happy, healthy, productive adults, moment, and share consciousness. When you washing your car, a game of cards, a good movie, raise your children, you pass on your values and a beer.... God (if you'll pardon the expression) is dreams and quirks, and every now and then they in the details. So just lay back and enjoy life - will see the world through your eyes, and you sounds pretty hedonistic! Perhaps, if your idea of through theirs. I'm not talking about e.s.p. or hedonism includes doing your best and loving psychic phenomena here. I'm just suggesting that others. Then what's the difference between an we never lived in such separate egos in the first ordinary life and meaningful life? Attitude! place. We all learn to believe we are isolated, but we aren't. The world is so incredibly rich, so incredibly complex, that it can overwhelm us. That's how love works: To love means to realise that you and the other person aren't entirely We retreat from the richness of life and love into separate, that his or her needs and feelings are the semi-conscious state of the workaday world. yours. It is looking in someone's eyes and seeing We retreat into roles and rituals and habits and yourself. And that provides us with one more defensiveness and alcohol and television.... We source of meaning! sleep-walk through life, and miss the good stuff. and life is hard. Very hard for many people. Okay. So you have some meaning in your life. But you don't have ultimate meaning, do you? No. Nature is what it is, does what it does, whether Ultimately, as far as nature is concerned, my poor we enjoy it or not. And people, while capable of atheist philosophy says it makes no difference if love, often don't show it. So we close our eyes we shut out both good and bad or experience and hearts to protect ourselves. Perhaps we even both good and bad fully, six of one, half a dozen grow a thick layer of callus over our inner-most of the other. Love or don't love? It doesn't matter selves. But if we close our eyes and hearts, again to nature. But with open eyes and hearts we do we miss the good stuff. This is why we need to find meaning, even if it isn't glorified with the face our problems instead of hiding from them, title of "ultimate." accept anxiety and sadness and even pain as inevitable parts of life, rather than pretending I have no desire to convert anyone to atheism. It that we can only be happy when life is perfect. seems rather absurd to try to convert someone to nothing! But I do think that, even if we put away If we shut down when unhappiness comes our our various and complex religious belief systems, way, we may not feel as much pain, but we are the possibility for a fulfiling life remains. Perhaps no longer open to the small, good things of life the possibility is even enhanced. that make it meaningful. So we just have to buck up and deal? In a way it does all come down to that. You can't do it alone, you need God's help! That would be nice, but that kind of help doesn't seem forthcoming! It seems like you are asking a
Essex Cancer Network Catching the concept of spiritual care 43 Background
Ramadan is the month of fasting when the Qur'an (Muslim Holy Book) was revealed to the Prophet Mohammed (peace and blessings be upon him). For Muslims it is a special month of spiritual reflection and revitalisation, when they try to spend as much time as possible in prayer and other ritualistic exercises.
Fasting Prayers
• During Ramadan fasting is compulsory for all • Alongside the customary and obligatory adult Muslims and they must refrain from prayers, which are said five times a day, there drinking and eating during daylight hours. are additional prayers and other spiritual • Fasting lasts from dawn to sunset This may exercises, which are mostly carried out at night. have implications for staff and patients. If you In addition, during the last ten days of the fast require further information on what types of there are further prayers and spiritual exercises food patients may need to observe and break to be held. their fast Imam would be pleased to offer • For the purpose of prayer, water for ritual advice. ablution may be required. • Although people in poor health, the very • Some patients may ask for a prayer mat, a elderly, pregnant women or mothers who are copy of the Qur'an or a Ramadan prayer- breast-feeding are exempt from the obligation, timetable. some may nevertheless insist on fasting. • As a result, the nursing and medical staff may 'Id-ul-Fitr have to discuss the administration of The end of the month is marked by the medicines. celebration of 'Id-ul-Fitr. This is one of the most important festivals in the religious calendar. It is Those fasting need a meal before the break of also a great social and family occasion that begins dawn and another after sunset. with a compulsory congregational prayer in a mosque or any other suitable place
44 Essex Cancer Network Catching the concept of spiritual care FAQ's on health issues whilst fasting In light of this, one needs to be more practical in the advice that is given to the patient.
The following are frequently asked Questions by If the patient and the child are healthy and fasting Muslim patients who are fasting and when they will not have any adverse medical effects on themselves are not sure of the answers. either, then one should allow the patient to fast along with explaining the safest way of doing so. 1. Blood Tests Q: If blood is taken out of the body, does this If the patient or the child is not healthy or fasting break the fast? will have adverse medical effects on either, then A: Taking out blood during fasting does not explain to the patient why they should not fast. invalidate the fast.
2. Flu Jab Answers have been provided by Imam Yunus Q: Can one get a Flu Jab whilst Fasting? Dudhwala, Imam/Multifaith Manager of Newham A: Yes, it is permissible. It will not Healthcare NHS Trust, Chaplaincy Department. invalidate the fast Any other questions can be forwarded to Imam 3. Injections Yunus Dudhwala via e-mail Q: Is it permissible to take an injection while [email protected] or on fasting and does that nullify the fast? ext. 8053 A: It is permissible to take an injection during fasting. The injection does not nullify the fast.
Q: While fasting, I went for a CT scan. I was informed that I will not have to take anything orally for this procedure. However, I was given some medicine through IV. Did this invalidate my fast? A: The fast is still valid.
4. Pregnancy Q: I am a midwife and see many Muslim Patients who during their pregnancy in the month of Ramadan are fasting, despite being advised not to. Is there any Islamic advice I can use to convince these patients? A: First of all, one needs to understand the concept of fasting in the month of Ramadan for a Muslim.
• Ramadan is a very special spiritual month. • Fasting is one of the five pillars of Islam. • Fasting lasts from dawn to dusk (approx. 11-12 hours in 2003). • If a person is ill, and not well enough to fast, the person is exempt from fasting, but will have to make up the missed fast after recovering from the illness. Due to the above, Muslims will fast as long as they are physically able to do so; no matter what advice they are given. Essex Cancer Network Catching the concept of spiritual care 45 Fasting and medicines in Ramadan It is not part of the Muslim religion to cause self- (Information for Health Care Professionals) harm by altering medication taken and illness is the one occasion when Muslims are allowed to Introduction break the practice of fasting. The table attached During the Muslim holy month of Ramadan there gives guidance on patients in whom it may be are likely to be queries about medication and how it safe to fast and those who should be advised can be taken when people are fasting. Until against fasting. recently little was known of medication compliance during Ramadan but last year a project was If you require any further advice, please contact undertaken, at Bart's and the London NHS Trust, to the Medicines and determine medication usage in the Tower Hamlets Prescribing Team on 020 8271 1322 Muslim population during Ramadan. Dietary Advice Project results There are three stages to the fast during The results were quite alarming. It was found Ramadan. Firstly there is the pre-dawn breakfast, that 23% of patients did not take their which should consist of a light meal and water. medication at all during the holy month, and a The fasting period runs from dawn to sunset. At further 48% doubled their evening dose to sunset the fast is broken with a small snack and compensate for medicines normally taken twice a dinner is eaten in the evening. There is no need day. Doubling the dose of twice-daily medication for excess. All patients must maintain a balanced or omitting a dose all together could in some diet consisting of items from the following five cases cause severe adverse effects and is an groups, that is, meat or bean, bread or cereal, important point to note when prescribing or milk, vegetable and fruit. The following advice is counselling this group of patients especially when particularly useful: acute therapy is prescribed during this time. • Encourage fluids, especially water, to prevent Action dehydration. (Break the fast with fruit and As healthcare professionals we can advise patients water). if it is safe for them to fast in the first instance • Consume sufficient vegetables at mealtimes. and advise on safe ways to fast, if they still wish • Avoid caffeine-containing beverages such as to do so. Figure 1 lists groups of patients who tea, coffee and cola etc. (Reduce the quantity should not fast consumed before Ramadan to prevent headache, irritability and mood swings.) Figure 1 • Avoid intake of refined sugar (table sugar, Fasting is not obligatory upon the following sucrose) in food such as sweets or other forms. • Avoid spicy foods. • Children under 12 years (i.e. under the age of puberty). • Persons incapable of fasting due to: a) old age (these patients will be required to offer compensation (fidya), refer to local imam) b) incurable disease i.e. HIV infection (these patients will be required to offer compensation (fidya), refer to local imam) c) chronic disease i.e. diabetes, COPD (these patients will be required to offer compensation (fidya), refer to local imam). • Pregnant or nursing mothers (can make up days missed at an alternative time). • Menstruating women or women with post- partum bleeding (can make up days missed at an alternative time).
46 Essex Cancer Network Catching the concept of spiritual care References 4. Athar, S. "Medical aspects of Islamic fasting." 1. Athar, S. "Health Concerns for Believers; httD://www.islam-usa.com/im15.html contemporary issues." httD://www.islam- 5. Aprilawati, L. (translated by Green, C.) usa.com/h8.htm "Fasting for Muslims with AIDS" (1998) 2. Nomani, M.Z.A. "Diet during Ramadan." PROCARE. httD://www.labs.neUaims/i99ar1.htm httD://www.essentialdruqs.orq/Droqrams/Drovc 3. Azizi, F. and Behnam, S. "Ramadan fasting aare-hma and diabetes mellitus." (1998) Int. Journ. Ramadan. Fasting Res. 2:8-17. httD://www/labs.neUains/i98ar2.htm
Disease state advice Chronic respiratory disease COPD safe way to fast Emphysema Severe asthma Bronchitis Diabetic patients Exempt from fasting (these patients will be Type 1 required to offer compensation (fidya), Type 2 refer to local imam), but those who do fast Type 1 and Type 2 insulin dependant and experience shortness of breath or diabetic patients should not fast, especially worsening of breath or have an asthma if less than 20 years or pregnant (these attack must immediately break the fast patients will be required to offer and take the required medication or seek compensation (fidya), refer to local imam). medical attention if appropriate. Unsafe • Most patients will insist on fasting, but should Inhalers cannot be used during fasting only do so if the diabetes is controlled. therefore asthmatic patients who are not • Should only be undertaken if the diabetes is well controlled on preventative inhalers controlled. and who are using relief inhalers more • Patients must maintain their normal diet i.e. frequently should consider not fasting, as low fat and low sugar diet, when breaking the using inhalers will break the fast. fast and maintain their normal daily activity.
• Patients must also drink sufficient water in the Chronic heart disease hours before and after the fasting period to Coronary artery disease prevent dehydration (please see Diabetes and Severe uncontrolled hypertension Ramadhan leaflet). Exempt from fasting (these patients will be • All patients must be counselled of the warning required to offer compensation (fidya), signs of dehydration or hypoglycaemia. If either refer to local imam), but those who do fast occurs they must break the fast immediately. and experience severe illness must immediately break the fast and take the required medication or seek medical Diabetic patients attention if appropriate. Type 2 Unsafe a) Diet controlled In controlled hypertension with no other b) Oral medication co-existing cardiovascular disease patients can fast, but must continue all regular a) Diet controlled diabetic patients can fast safely. medication. It may be a good opportunity b) Patients taking oral hypoglycaemic agents to review current treatment and use longer should not fast unless their diabetes is controlled. acting alternatives to encourage better compliance.
Essex Cancer Network Catching the concept of spiritual care 47 Chronic renal disease Renal dialysis Renal transplant Nephrotic syndrome It is not safe to fast if the patient has co- existing disease such as coronary artery disease, severe uncontrolled hypertension or is at risk of dehydration (these patients will be required to offer compensation (fidya), refer to local imam).
If dehydration occurs they must break the fast immediately. If there are no other co-existing diseases or all are controlled the patient can fast if they adhere to their normal diet and receive counselling so they are aware of the signs of dehydration.
48 Essex Cancer Network Catching the concept of spiritual care Emergenct Marriages in Hospital (a) The couple must genuinely desire a wedding Church of England Guidance according to the rites and ceremonies of the Church of England; 1. In speaking of emergency marriages in hospital, the distinction needs to be drawn (b) At least one party should be baptised; between: (c) Neither party can be divorced with a former partner living; (a) Cases where a patient is not expected to (d) The families of the couple should recover or to be able to leave hospital, support the intended marriage. but is not in immediate danger of dying; and Applications should be submitted on the (b) Cases where there is an expectation or prescribed form, copies of which are available risk of death within a short time. from the Faculty Office.
2. So far as category (a) is concerned, it is 6. In connection with applications for Special possible for an Anglican hospital chaplain to Marriage Licences certain documentation is solemnise a marriage in the hospital according required. to the rites of the Church of England on the authority of a Superintendent Registrar's (a) A letter from the chaplain setting out the Certificate. However, the statutory couple's circumstances and the requirements for the marriage of a "house- background to the application. bound" person will need to be complied with, (b) A letter from the doctor in attendance including the normal requirement that the which states that "the patient is certificate cannot be issued until 15 days after seriously ill, is unlikely to recover, cannot notice has been given to the Superintendent be moved to a place registered for a Registrar. This procedure is therefore not marriage and understands the nature of appropriate for cases in category (b). marriage". (c) A note of authorisation from the hospital 3. The only way in which a marriage according to management. the rites of the Church of England can be arranged at short notice in cases within 7. Finally, I am sure you will be very much aware category (b) is by applying for an Archbishop's that one of the reasons why a couple Special Marriage Licence. For a civil ceremony sometimes request marriage in such a Registrar General's Licence must be applied circumstances is to ensure that the survivor for, which again allows a marriage to take inherits the property of the person who is not place without the usual notice period, but expected to recover. Whether a chaplain which cannot be used to authorise a marriage thinks the case is an appropriate one for an according to the rites of the Church of "emergency" marriage is of course a pastoral England. Where a couple marry after the issue matter but it is clear that in some cases the of Registrar General's Licence it is of course couple's concerns could be met by a will made open to them to have a service of blessing on the basis of proper legal advice. Even afterwards. where the marriage does take place it is not a substitute for making a satisfactory will. 4. Superintendent Registrar's Certificates and Registrar General's Licences are obtained from S E Turner local Register Offices, and chaplains should of Clerk to the Faculty Office course ensure that they have the relevant March 2002 contact details to hand.
5. Archbishop's Special Licences are issued from the Faculty Office at 1 The Sanctuary, London SW1P 3JT.For further information please discuss with your local chaplaincy service :
Essex Cancer Network Catching the concept of spiritual care 49 Acknowledgements
This manual has been adapted by the NICE Spirituality Group 2005– 2009 from an original work by Peter O'Driscoll, Head of Chaplaincy Services Basildon NHS Acute Trust.
The NICE Spirituality group comprises of:
Carolyn Doyle Community Macmillan Palliative Care Team Leader (East)
Debbie Hickey Head of Nursing St Luke's Hospice
Angie Cliverd Community Clinical Nurse Specialist
Sharon Quinn Team Leader Basildon Hospital Palliative Care Team
Dawn Patience Ward Sister Basildon Hospital
Karen Chittick Community Clinical Nurse Specialist
Adrian Roberts Representative of South Essex Cancer User Partnership
Katy Hacker Hughes Chaplain Farleigh Hospice Chelmsford
Mark Ambrose Chaplaincy services St Helena Colchester
Ivor Moody Chaplain Anglia Ruskin University
Carol O Leary Nurse Director Essex Cancer Network
Spiritual Assessment Tool adapted from original work by Katy Hacker-Hughes and Mark Ambrose
50 Essex Cancer Network Catching the concept of spiritual care Appendix
Essex Cancer Network Catching the concept of spiritual care 51 Appendix A Support What or who has helped you through difficult SpiritualIity Assessment tool adapted times in the past? Is that still the case? At this time are there relationships or experiences you are thankful for, or that are bothering you?
Patient details Goals, Hopes and dreams Is there anything that gives you positive feelings about the future, or that you still hope to Aim: achieve? To give patients the opportunity to explore their spirituality and enable them to come to a place of Our Chaplain is available to support you in any spiritual rest / peace. way regardless of what you may or may not believe Care objectives: To give the patient appropriate time, with good active listening, allowing them to share their “journey” - their thoughts, feelings, experiences Need identified Yes No and beliefs. • •
Dates / times Referral made •Yes •No Details: Signed
Meaning and purpose: Further information Who are the important people in your life and Review of Spiritual Needs what things are really precious to you? What gives you inspiration or peace? Dates / times
Faith and Beliefs: Do you consider yourself to have any spiritual or Signed religious belief? Is there anything spiritual or religious that has either helped you or been difficult for you in the past? Notes:
Implications for Care: Is there anything you would like to tell us about your beliefs and how you put them into practice that would help us when planning your care? What can we do to help?
Dates / times
Signed
52 Essex Cancer Network Catching the concept of spiritual care Spiritual, Religious, Pastoral and Cultural Care Guidelines
'Spiritual care is not a luxury for the few; it is the essential right of every human being, as essential as political liberty, medical assistance and equality of opportunity. A real democratic ideal would include knowledgeable spiritual care for everyone as one of its most essential truths.'
Sogyal Rinpoche Buddhist Teacher
Spiritual Care Guidelines
Purpose: The Purpose of this guideline is to ensure that patients spiritual, religious, and cultural identity is recognised and valued throughout the patient care pathway.
Statement: The Essex Cancer Network is committed to ensuring that the spiritual, religious and cultural needs of patients (and their carers) are identified and incorporated into patient care plans in order to ensure that the patient is looked at holistically and experiences care in an 'environment that actively encompasses respect for individual values, beliefs and personal relationships'1; a care that is mindful of the patient's social, spiritual and emotional needs.
Main Imperatives of All staff must
The Guidance: • maintain an awareness that patients have spiritual and/or religious needs • these needs can change through the patient journey • ensure a basic spiritual needs assessment at admission • ensure, where the patient consents, that religious affiliation and spiritual needs are communicated with locality based chaplaincy teams.
(1Essence of Care: Privacy & Dignity Factor 2)
Essex Cancer Network Catching the concept of spiritual care 53 Definitions Hay and Nye (1998) offer a theory of spirituality that includes religion but is not limited to it. Their What is spirituality? book is based on three-year research project looking at spirituality of children aged six to ten in The palaeontologist and Jesuit priest, Pierre two primary schools, one in Norwich and the Teilhard de Chardin wrote other in Birmingham. They believe that spirituality is an inborn aspect of human nature and the "We are not human beings having a spiritual result of evolutionary development. experience, we are spiritual beings having a human experience." Priest & Psychotherapist Dirmuid O Murchu wrote (de Chardin) in 2000 that: "Our spiritual story as a human species is at • Every human being, religious or not, possesses least 70,000 years old; by comparison, the spirituality. formal religions have existed for a mere 4,500 years" (O'Murchu 2000). • Spirituality encompasses the purpose and meaning of an individual's existence. A number of definitions of spirituality have been • Spirituality involves relationships with, and offered. These are only useful in so far as they perceptions of, people and all other things and point, imperfectly, to what it is. events. • Spirituality is unique to each person. “A quality that goes beyond religious • Spirituality can be founded in cultural, religious affiliation that strives for inspiration, and family traditions, and is modified by life reverence, awe, meaning and purpose. Even experiences. in those who do not believe in any god. The • Spirituality is the basis for an individual's spiritual dimension tries to be in harmony attitudes, values, beliefs, and actions; for people with the universe, and strives for answers with religious faith, spirituality is usually about the infinite, and comes into focus when encompassed within their religion. the person faces emotional stress, physical illness or death.” (Murray R. and Zentner, J & B 1989). In considering Religion & Belief in a healthcare context it is crucial to keep in mind the distinction “The human propensity to find meaning in that must be made between spirituality and life through self-transcendence; it is evident in religion. perspectives and behaviours that express a sense of relatedness to a transcendent “Spirituality encompasses all aspects of dimension or to something greater than self, human being and is a means of experiencing and may or may not include formal religious life. Faith, on the other hand, is related to participation” religious expression and may or may not be a (Reed P 1991).. necessary component of spirituality (Salladay & McDonnell 1989). The distinction (emphasis added) between spirituality and religiosity is an important consideration since its absence is partially responsible for the conceptual confusion and ambiguity that permeates discussion of these concepts.” (Goddard 2000)
continued
54 Essex Cancer Network Catching the concept of spiritual care What is Religion? 1. Scope of the Spiritual & Pastoral Care Guideline Religion can be defined as: This guideline may be used as a precursor to the "...a system of faith and worship which formation of spirituality policies across the Essex expresses an underlying spirituality. This faith Cancer Network. is frequently interpreted in terms of particular rules, regulations, customs and practices as well as the belief content of the named 2. Responsibilities religion. There is clear acknowledgement of a Coordinating Chaplaincy Teams power other than self, usually described as 'God" To ensure that this guideline is used to influence (Speck 1998). policy making, and is subject to regular review and is cascaded appropriately throughout the Or relevant organisations.
“Religion is any specific system of belief about 3. Objective of Guidelines deity, often involving rituals, a code of ethics, a philosophy of life, and a worldview.æ” To ensure that the patient is looked at holistically (www.religioustolerance.org/rel_defn.htm). and experiences care in an environment that actively encompasses respect for individual values, beliefs The Nine Major World Religions present in the UK and personal relationships. This guideline aims to Religious belief and practice manifest in a rich ensure that the spiritual, religious, pastoral and variety of ways. The Department of Health cultural needs are identified and incorporated into recognises nine major world religions that have a care planning, and, where appropriate, significant presence in the UK. In alphabetical communicated in a timely manner to the local order these are: chaplaincy / Department of Spiritual & Pastoral Care.
Baha'i 4. Principles Buddhism Christianity 4.1 The following basic principles should Islam underpin all spiritual care services in the NHS/ Hinduism voluntary sector. It should: Jainism Judaism Be impartial, accessible and available to Sikhism persons of all faith communities and those Zoroastrian of no faith.
Within the locality covered by the Essex Cancer Function on the basis of respect for the wide Network (ECN) the World religions with a range of beliefs, lifestyles and cultural significant presence in the community are (in backgrounds found in the NHS today. descending order of numerical strength): Value such diversity Christianity Islam Be a significant organizational resource in an Hinduism increasingly multicultural society. Sikhism Judaism Be a unifying and encouraging presence in Buddhism the organisation.
This local order of numerical strength mirrors Never be imposed or used to proselytise; (i.e. reality nationwide. to try to persuade someone to change their religious or political beliefs or their way of living to your own).
Essex Cancer Network Catching the concept of spiritual care 55 Be characterised by openness, sensitivity, & religious needs assessment form integrity, compassion and the capacity (see Appendix A). to make and maintain attentive, helping, supportive and caring relationships. 5.5 Staff should be mindful that a patient's declared religious affiliation is also important Affirm and secure the rights of patients to be in ensuring appropriate and sensitive cultural visited (or not visited) by any chaplain, care. If a patient is Buddhist, Jewish, religious leader or spiritual caregiver. Hindu, Muslim or Sikh this will have dietary consequences. Indeed this underlines why a Be carried out in consultation with other NHS timely spiritual & religious needs assessment / voluntary sector staff. should be carried out on a patient's admission if the organisation is to comply Acknowledge that spiritual care across the with the appropriate Essence of Care ECN is given by many members of staff and benchmark and the National Institute for by carers and patients, as well as by qualified Clinical Excellence's Spiritual Care Service staff specially appointed for that purpose. Configuration and Delivery' guidelines. (Based on Scottish Executive HLD (2002) 76) 5.6 Staff should recognise that spiritual needs are likely to change with time and circumstances. 4.2 Failure to attend to a patient's spiritual and (For example, a patient might indicate that on religious needs could render an NHS / admission for investigative procedures that voluntary sector / organisation liable under The they have little or no spiritual/religious issues. Human Rights Act 1998, should a patient However, it is probable that this would claim that s/he was denied the right enshrined change very significantly, should the patient in Article 9 of the European Convention receive a challenging diagnosis.) on Human Rights to manifest his or her religion, in worship, teaching, practice and 5.7 A patient's family and other carers may be observance. important components of spiritual care. This can be especially true of those patients who 5. Process come from particular religious and ethnic minorities. Where this is the case staff should 5.1 Each organisation will have a spirituality policy support them in doing so. in place. 5.8 Secondary care and Hospices only across the 5.2 Each organisation will ensure that patients network have professionally trained staffed and carers are offered information about the within their chaplaincy or Spiritual and resources available for spiritual care and how Pastoral Care departments. This group of staff to access specialist spiritual help and support. are qualified, authorised and appointed spiritual caregivers functioning at a high level 5.3 All points of admission will ensure an of competence and capable of offering accurate and timely assessment of a patient's spiritual care in an open and flexible way. religious and spiritual need. They are available as a resource to patients and carers. They are also available to all staff 5.4 This assessment should include teams. a) asking the patient if they have a specific religious affiliation. 5.9 Notwithstanding 5.8 the network believes b) asking if they consent to this information that spiritual care should be seen as the being passed to the local health & social care responsibility of the whole team, while teams including local chaplaincy teams. recognising the role of the professional c) asking if they would like to be visited by spiritual caregiver for ensuring its provision. their own religious representative.
In the case of a) & b) the patient's consent should be noted. This should be done using a spiritual
56 Essex Cancer Network Catching the concept of spiritual care Appendix C Spiritual Care Provider Contact Sheet (to be completed locally)
Fair Havens Hospice and Little Havens Hospice Name Role Spiritual support Contact Comments
St Luke's Hospice Name Role Spiritual support Contact Comments
Farleigh Hospice Name Role Spiritual support Contact Comments
St Helena Hospice Name Role Spiritual support Contact Comments
St Francis Hospice Name Role Spiritual support Contact Comments
Southend University Hospital Name Role Spiritual support Contact Comments
Broomfield Hospital Name Role Spiritual support Contact Comments
Colchester General Hospital Name Role Spiritual support Contact Comments
Basildon and Thurrock University Hospitals Name Role Spiritual support Contact Comments
Please note For community patients please contact their named spiritual care provider or contact the oncall Chaplain at the local acute trust.
Essex Cancer Network Catching the concept of spiritual care 57 References & Bibliography Remen, RN (1988) On Defining Spirit. Noetic Sciences Review Autumn, 65 cited in Salladay, S. Clayton, T (1999) Inclusive Spirituality, The A., & McDonnell, M. M. (1989). Spiritual care, Journal of Family Practice Vol. 48(2), February ethical choices, and patient advocacy. Nursing 1999, pp 96-97 Clinics of North America, 24(2), 543-549.
Cherub, (2001) The Spirituality of My Nipple Ring accessed 20.35 December 15th 2001 @ Goddard, N (2000) A response to Dawson's www.bme.freeq.com/pierce/08- critical analysis of 'spirituality as "integrative nipple/A10409/nipthesp.html energy."' Journal of Advanced Nursing Volume 31(4) April 2000 pp 968-979 Dossey, BM and Dossey L BODY-MIND-SPIRIT: Attending to Holistic Care, American Journal of Human Rights Act, HMSO, London 1998 Nursing Vol. 98(8), August 1998 pp 35-38 Murray R. and Zentner, J & B (1989) Nursing Fowler, James W.(1995) Stages of Faith: the Concepts for Health Promotion. Prentice Hall, Psychology of Human Development and the Quest London for Meaning Harper San Francisco 1995 O'Murchu, D (1997) Reclaiming Spirituality Goddard, N (2000) A response to Dawson's Dublin, Gateway Publishing (Gill & Macmillan Ltd.) critical analysis of 'spirituality as "integrative energy."' Journal of Advanced Nursing Volume Reed P (1991) Spirituality and Mental Health in 31(4) April 2000 pp 968-979 Older Adults: extant knowledge for nursing. Family & Community Health 14(2): 15-25 Hay, D & Nye, R 1998 The Spirit of the Child, London, Fount (HarperCollins) 1998 Supportive and Palliative Care Manual for Adults with Cancer, NICE, London, March 2004 Jaspers K (1969) Way to Wisdom , London, Yale University Press. Peter Speck, 'The meaning of Spirituality in Illness' in Mark Cobb and Vanessa Robshaw, Koenig, H (2000) Religion, Spirituality and The Spiritual Challenge of Health Care (Churchill medicine: Application to Clinical Practice, JAMA, Livingstone, 1998) October 4 2000, vol 284, no 13, page 1708 Scottish Executive Health Department, McSherry, W (1997) A Descriptive Survey of Spiritual Care In NHS Scotland, Scottish Executive, Nurses' Perception of Spirituality and Spiritual Edinburgh 2002 Care, submitted as a Thesis for the Degree Master of Philosophy, University of Hull, 1997 Your Guide to the NHS, Department of Health, London 2001 Neuberger J (1998) “Spiritual care, health care: what's the difference?” in Cobb, M and Robshaw V, The Spiritual Challenge of Health Care Bibliography/Further Reading Edinburgh, Churchill Livingstone. Henley, A & Schott J (1999) Culture, Religion O'Murchu, D (1997) Reclaiming Spirituality and Patient Care in a Multi-Ethnic Society, Age Dublin, Gateway Publishing (Gill & Macmillan Ltd.) Concern Books, London, 1999.
O'Driscoll, P (2001) A Study of the Perceptions http://www.bahai.org/article-1-2-0-3.html and Understanding of the Spirituality and Spiritual http://www.arcworld.org/faiths.asp?pageID=46 Care of the Nurses of the Basildon & Thurrock http://www.geocities.com/Athens/Oracle/3211/oth General Hospitals Trust , submitted as a erfaiths1.html dissertation for the Degree Master of Arts, School www.omsakthi.org/religions.html of Healthcare Studies, University of Leeds, 2001. www.religioustolerance.org/rel_info.htm
58 Essex Cancer Network Catching the concept of spiritual care
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