Spiritual Care A multi-faith resource for healthcare staff

May 2021 Multi-faith resource for healthcare staff NHS Education for Scotland (NES) produced this booklet through its Spiritual Care and Chaplaincy Programme. It was prepared with input from Interfaith Scotland, individual faith and belief communities in Scotland and Hospital Chaplains. A copy of this resource can be found: Online at https://learn.nes.nhs.scot. Find it in the Person-centred Care Zone. Contents Spiritual Care

01 cotland is a religiously The main groups include: Jewish, should be careful and well-motivated and culturally diverse country Muslim, Christian, Bahai’, Sikh, to treat people appropriately whatever Buddhist, Hindu and Pagan. Other their cultural or religious situation. and this resource is designed belief groups such as the Humanist to assist NHS staff and Society of Scotland do not regard Ongoing volunteers to address some themselves as religious but are part of the spiritual care spectrum. of the spiritual and religious religious People who practice their faith or needs of people in their care. religion as part of their regular life and practice as part of their identity have a right to The Scottish Government has stated continue to express this identity while As far as is reasonably possible that spiritual care, which includes undergoing healthcare. a person should be allowed and but is not limited to religious care, is encouraged to continue to practice There is in fact a strong tradition within a necessary and integral part of the their religion, if they so wish, within most faiths of rituals or prayers or whole person care offered by the NHS a healthcare situation. The public other activities which are particularly in Scotland and must be provided in an nature of many hospitals and the for, or relevant to those suffering from equal and fair way for those of all faith numbers being dealt with can make ill health. The very purpose of most communities or none. this problematic, but attempts should religious traditions is in part to enable There are many religious faith be made to enable people to use such people to achieve as far as possible a traditions practised within Scottish religious resources they wish to express state of well-being in relation to God, society. While perhaps not as their faith. This might include rituals to self, to others, in caring relationships prevalent as in other parts of the UK such as prayer, reading holy texts and with the poor and with the whole of there is a rich variety of smaller faith short acts of worship or meditation. creation. The ideas of respect, patient communities alongside the generally It should normally be possible focus and equality and diversity, more numerous Christian groups. to arrange for a faith or belief leader all suggest very positively that the NHS Spiritual Care

02 or representative to visit if a patient of considerable help in the healing so wishes and to share such rites which process. Research shows that using are possible within the environment. a holistic approach of treating mind, Healthcare units should, as far as is body and spirit can aid the recovery possible, provide a quiet room which of a patient. can be used for the purpose. Different faiths and belief groups have particular needs to do with their Religion care. A proper needs analysis which includes a person’s faith or belief will and Health be more likely to result in appropriate and high-quality care. Practical Religious practice has a long history things like the wearing of articles of being linked to health matters. of faith, diet, washing facilities, ways In days when medical services were of addressing people – which name hardly existent, people turned to their to use, birth rites, death rites, modesty religion as a way of coping and to and communication issues are often seek healing. Religious practice is still important to religious people. important for many people. For some, The NHS in Scotland recognises that their understanding of their illness is the healthcare challenges faced by the related to their faith perspective. It can people it cares for may raise their need be that a certain religious perspective for spiritual and religious care and is can add to the anxiety of ill health, committed to addressing those needs. but it is far more common that the To enable this, most Health Boards have support of a religious community a Department of Spiritual and Religious and the practices of religion can be Care staffed by a chaplaincy team, who Spiritual Care

03 are a good source of knowledge and terminology. A faith or belief system experience on how to serve the needs or faith community can be a major of a multi-faith population. help in supporting people through Often the chaplaincy team will be the healing process. the first place people call when When considering the religious and seeking advice or help in finding the cultural needs of patients, please bear right care. Chaplaincy teams help to in mind that people from Black, Asian facilitate spiritual or religious care for and Minority Ethnic communities all, whatever their faith or life stance are more likely to be diagnosed happens to be. They will usually know with mental illness problems and more who to contact when a person asks likely to be admitted to hospital. They to see someone from a particular are also more likely to stop attending faith community. mainstream mental health services during or after treatment. A note on There is also some evidence that mental illness in such minority groups mental health sometimes goes unrecognised. There are many possible reasons for this—but Mental illness is but one of many cultural and religious factors may well diagnostic areas: it has therefore be involved. In these circumstances, not been picked out for special healthcare staff will need to be aware mention in the separate sections on of differences in culture and faith when individual faiths. However, sometimes assessing the mental illness and well a person’s mental illness is expressed being of patients, whatever their in a religious way or with religious background or community. Spiritual Care

04 Research into clinical outcomes has This booklet may not cover all faith shown that patients benefit when communities and relevant issues their care plans take account of their therefore it is essential to talk to faith, religious practices and other the patient about their health personal beliefs. needs. All NHS Boards should offer access to interpreting services and it is essential to use these services When in doubt, when a patient has difficulty ask the patient communicating their needs. When you know a person’s faith You can resolve many of the issues community or group, you should arising from caring for people from a be able to use this document to faith community or culture unfamiliar deal with the main areas which to you by simply asking the patient, may be relevant. or their visitors, how they wish to be looked after. It is polite, for example, NHS Chaplaincy to ask how a patient wishes to be addressed. This is important because and Spiritual not all cultures have a pre-name then a surname. When in doubt, ask. Care Services It is also worth noting that, in some cultures, it is not acceptable for men NHS chaplains are there for people and women to shake hands in greeting. of all faiths and none. Everyone, whether religious or not, needs support, especially in times of crisis. Spiritual Care

05 NHS Chaplains are available to patients in a number of different How do I find a chaplain? Are chaplains ways, to: Every Health Board has a spiritual available 24/7? • Support people at difficult times. care policy which will tell you the Whole-time chaplains will type of spiritual care service you can mainly work office hours. • Listen to their stories. expect in your hospital. Every Health Part-time chaplains will work • Work in one to one situations and Board will have a department of in a pattern which suits the understand relationships. spiritual care and the details of this hospital. However, chaplains • Help people (re-)connect with what should be easily available on the are usually available on an really matters to them in times intranet, notices, leaflets, through on-call rota providing 24-hour of illness in ways that promote the switchboard. cover. The areas they cover recovery and wellbeing. Every hospital should have a will vary from place to place chaplain. They may work whole or but this is usually for acute • Provide training to help you develop hospitals. Information should skills in spiritual care. part-time, but it is important you get to know them because you need to be clearly displayed if this • Provide information about different know who you are referring people service is available where faith and belief groups and about to or whose advice you are asking. you work. bereavement.

Sections of this text have been replicated from ‘Spiritual Care Matters’ by NHS Education for Scotland (2021) Are chaplains only a phone call away? Yes, each hospital will have its own referral system, and this is undergoing review in many areas, but the simplest way is always the best Telephone the chaplains’ office. Spiritual Care

06 Navigating this Communities document Baháʼí faith Hinduism Brahma Kumaris Humanism This document gives information, in the same order, for each of the Buddhism Islam communities listed on this page. Chinese faiths1 Jehovah’s Witnesses The format of each section on the communities follows the colour-coded Christianity Judaism infographic, also on this page, titled Paganism ‘Information areas’. Church of Jesus Christ of Latter-day Saints (Mormon) Sikhism 1 Although ‘Chinese’ does not represent a religious community, we decided to include a Chinese section as various religions are found in the Chinese Information areas community and there are particular practices that are specifically Chinese. Religious Blood transfusions, Key beliefs Birth Death practices transplants and customs customs organ donation

Attitudes to healthcare Fasting staff and illness Washing Ideas of modesty and toilet and dress Diet Family planning Spiritual Care

07 Baháʼí faith Spiritual Care

08 The Baháʼí faith is an Religious practices Key Baháʼí beliefs: independent world religion Baháʼís usually recite daily that originated in Persia • There is one God prayers—some may pray quietly, (now Iran) in the middle • Each person has a soul which some may chant. Although in comes into being at, and develops illness Baháʼís are exempt from of the 19th century. from, the time of conception and these prayers, some may still Its founder is called that lives on after death wish to recite them, and would Baha’u’llah (Glory of God). • All religions have a common therefore appreciate privacy. foundation Baha’u’llah announced that he Diet was a messenger from God sent • Men and women should have to help bring about a new age of equal opportunity Baháʼís have no specific dietary global civilisation which would be • Prejudice of all kinds should requirements. Some Baháʼís may characterised by unity and peace. be challenged be vegetarian, but this is a personal choice, not a religious requirement. Baha’u’llah was persecuted and • Extremes of wealth and poverty The use of alcohol and habit-forming finally exiled to Akka (Acre) in should be abolished drugs is strictly prohibited except Palestine where he died in 1892. when prescribed by a physician. The spiritual and administrative • Religious and cultural diversity centre of the Baháʼí faith is should be respected Smoking is discouraged. in present-day Israel.

Attitudes to healthcare staff and illness Most Baháʼís have a positive attitude towards healthcare staff and are willing to seek medical help and advice when sick. Staff of either gender may care for Baháʼí patients. As well as taking prescribed medication, Baháʼís believe in the power of prayer in healing. In general, Baháʼís believe it is for

God alone to determine when a life should end, although it is recognised Spiritual Care and accepted that steps to ease suffering may, as a side effect, shorten life. 09 Washing and toilet Death customs Washing and toilet present Staff of either gender may care for the body. The Baháʼí faith has no clergy. At no unusual problems for the end of life, it would be hoped that family and loved ones would be present Baháʼís, although they prefer with the patient to provide comfort, support and prayer. Baháʼís believe the to have access to water for body has been “the temple of the spirit” and treat the body of a deceased ablutions before prayers. person with great dignity and respect. After death, the body is washed and wrapped in silk or cotton cloth and, for those over 15 years, a special burial ring is placed on the fnger. Relatives may wish to do this themselves or may Ideas of modesty and dress leave it to the funeral director. It is preferable that burial should take place as soon as possible, but no time limit is specifed. Baháʼí law prescribes that There are no particular points to be burial should take place at a distance of no more than one hour’s journey noted in this area and most Baháʼís from the place of death. The body should not be cremated or embalmed. would accept being examined by Funerals are normally arranged by the family of the deceased if available, doctors of the opposite sex. or on occasions by the Baháʼí Assembly (usually listed in the phone book). Autopsies and post-mortem examinations are acceptable if necessary, Fasting preferably in the hospital where the patient died so that the body will The Baháʼí fast takes place every be transported as little as possible. year from 2–20 March, prior to Naw- Because Baháʼís believe life begins at conception, a miscarriage is a great loss Ruz, the Baháʼí New Year. At this and the foetus should be treated with respect. Wherever possible the remains time Baháʼís may not take food or should be returned to the parents or local Baháʼí community for burial. drink from sunrise to sunset. Fasting is not obligatory during sickness or pregnancy, while breastfeeding or Birth customs menstruating, during hard physical labour, or on long journeys, and The birth of a child is a time of joy and Baháʼís may people under the age of 15 or over wish to express their gratitude to God with prayer; 70 are exempt from fasting. but they have no rituals associated with birth. Spiritual Care 10 Blood transfusions, transplants and organ donation Most Baháʼís would have no objection to blood transfusions and may receive transplants or donate organs for transplant. Organ donation after death has been described as being of “service to mankind in death” and “a noble thing to do”. On completion of the removal of organs for transplant, the donor’s remains should be buried in accordance with Baháʼí burial laws.

Family planning Family planning is left to the personal conscience of a Baháʼí, however, irreversible sterilisation in either sex is discouraged unless there is a medical condition relevant to the decision, in which case the individual would seek qualified medical advice. Abortion is permitted only where there are strong medical grounds such as risk to the mother’s life and health. Abortion is not regarded lightly and is not permitted as a contraceptive measure. Many Baháʼís will not use an intra-uterine device for contraception as they regard it more as

an abortive measure than a contraceptive. Spiritual Care

11 Brahma Kumaris Spiritual Care

12 Brahma Kumaris is a worldwide spiritual movement dedicated Attitudes to healthcare staff to personal transformation and illness Religious practices and world renewal. Most Brahma Kumaris have a The Brahma Kumaris practise meditation The Brahma Kumaris World Spiritual University positive attitude towards healthcare (BKWSU) was founded in 1937 in Hyderabad Sind staff and would be willing to seek regularly, health (then in India) by Brahma Baba, a businessman medical help and advice when permitting, especially in the and philanthropist. Brahma Baba had a vision sick. Decisions about where to seek early hours of the morning, of how people of all cultural backgrounds could advice and the type of treatment and it may be helpful for come together to rediscover and develop the are left to the individual. them to have access to spiritual dimension of their lives, and cultivate a quiet area for this. a deep, collective consciousness of peace and of the individual dignity of each soul. Diet Ideas of modesty The BKWSU (UK) teaches Raja Yoga as a way Brahma Kumaris are and dress of experiencing peace of mind and a positive encouraged to eat a lacto- As Brahma Kumaris approach to life. The University provides vegetarian diet (dairy teachers live a celibate opportunities for people from all religious products permitted) and life they may prefer and cultural backgrounds to explore their discouraged from using medical examinations own spirituality and learn skills of reflection alcohol, tobacco and other to be undertaken by and meditation derived from Raja Yoga, recreational drugs. Most someone of the same which will help develop inner calm, clear Brahma Kumaris do not use sex. Dedicated Brahma thinking and personal well-being. Across onions or garlic in cooking Kumaris women often the UK the BKWSU works with national and and prefer to have their dress fully in white if local organisations and community groups food cooked and blessed by officially representing in such areas as inter-religious dialogue, youth fellow Brahma Kumaris. the BKWSU. programmes, prison outreach, social work and women’s and men’s groups. BKWSU (UK) Spiritual Care was established as a UK charity in 1975. 13 Washing and toilet Death customs Brahma Kumaris take Brahma Kumaris favour a shower each morning cremation over burial. (showers are preferred to Dedicated Brahma baths wherever possible). Kumaris would prefer Brahma Kumaris also the body to be in special observe the discipline of white clothes although bathing or showering after a there is some flexibility in bowel movement and would this. Details of the funeral prefer to do this in hospital arrangements are always too, wherever possible. discussed with the family of the deceased so that Fasting the family’s wishes are honoured. There is no religious obligation for Brahma Kumaris to fast. Blood transfusions, transplants and organ Birth customs donation Dedicated Brahma Kumaris Brahma Kumaris would live a celibate life so it have no objection to blood would be unusual for transfusion or organ someone from the Brahma transplants. Decisions about Kumaris tradition to be the donation of organs are giving birth. left to the individual. Spiritual Care

14 Buddhism Spiritual Care

15 The word ‘Buddha’ means ‘the awakened one’ and Buddhism Religious practices (which can be understood as both a religion and a philosophy Most Buddhists practise veneration with clear ethical foundations), stems from the teachings of the of the Buddha which can include honouring a Buddha fgure and historical Buddha, Siddhartha Gautama (lived 6ᵗʰ-5ᵗʰ century BCE1 making offerings to an image of the in present-day Nepal). Buddha, and it may be helpful to facilitate a space for a shrine. Most The Buddha was a human being, not a followers to develop wisdom and to have Buddhists also practice meditation, god, and is not worshipped as a god, but compassion towards all forms of life. and it may be helpful to offer access is revered as an inspiration of how people A Buddhist’s intention is to follow a path to a quiet area for this, or to allow can transform their lives and follow a of spiritual practice, including ethics, chanting of prayers or sacred texts. path of awakening, to end suffering. meditation and wisdom, which leads There are various Buddhist traditions. The to freedom from suffering, sometimes The Three Refuges ancient civilisations of India and China referred to as ‘Spiritual Awakening’, were profoundly affected by Buddhism ‘Enlightenment’ or ‘Nirvana’. This Following Enlightenment, and and today it remains deeply influential in path is known as “The Noble Eightfold shortly before his death, the Buddha Sri Lanka, Myanmar, Thailand, Vietnam, Path” and teaches eight principles brought together a group of his Korea, Japan and the countries of the to be understood and followed followers and founded a religious Himalaya (Tibet, Nepal and Bhutan); in daily life. order known as “The Sangha”— as well as many areas of India. There are Today Buddhism has spread across the which has remained both the over 500 million followers worldwide, globe and, as well as ethnic Buddhist guardian and the embodiment of around 8% of the world’s population. communities, there are a large number his teachings to this day. These The Buddha’s words were transmitted of convert communities practicing the three aspects, the Buddha, the orally through his followers and later essential Buddhist teachings in ways Dharma and the Sangha, are known formulated into teachings called the which are appropriate to the modern to Buddhists as the “Three Refuges” Dharma. These teachings were eventually westernised world, including being or “The Three Jewels” and for many written down and became more widely part of a Sangha. Buddhist they point to the practical available to anyone who wished to 1 Before the Common Era. This is often referred path of spiritual awakening. Spiritual Care hear them. Buddhism encourages its to as BC (before Christ). 16 Attitudes to healthcare staff and illness Family planning There are a range of Buddhist traditions and, similarly, There are a range of perspectives among Buddhists a range of perspectives around health issues. It is always around family planning. Most will involve consideration best practice to check with the patient and not presume of how to minimise harm and bring greatest beneft, an understanding on any particular issue. Most Buddhists individually and for the world. Celibacy, abstinence and/ have a positive attitude towards healthcare staff and or the use of contraception are all generally acceptable, are willing to seek medical help and advice when sick. and used as means of protection, by many Buddhists. Buddhists generally are willing to take any medicine that helps. Some Buddhists will be wary and will wish to know the effects of any drug that alters their emotional state or clarity of mind, because of the fifth precept. However, The Five Precepts the idea of the fifth precept is to prevent people carrying For people following Buddhism there are basic guidelines, out harmful acts while intoxicated, so they usually accept known as The Five Precepts. Each precept has a practice to prescribed medication that may be intoxicating but also abstain or refrain, and its opposite to cultivate. These are: heals or reduces suffering. Nevertheless, some Buddhists may favour alternative health remedies or may be Refrain from taking life Practice loving kindness reluctant to accept sedating medication. /reverence for life Refrain from taking that Practice generosity which is not given Ideas of modesty and dress Refrain from misuse of Practice stillness, There are no particular points to be noted in this area and the senses and sexual simplicity and contentment most Buddhists would not object to being examined by misconduct /true love doctors of the opposite sex. However, members of some Refrain from lying or using Practice truthful, kindly Buddhists Monastic communities may be uncomfortable false or harmful speech and helpful speech in settings alone with the opposite sex. Monastics observe modesty of dress, wearing full-length robes and Buddhist Refrain from taking Practice mindfulness and Spiritual Care monastics in many traditions also leave the right shoulder intoxicating drink or drugs clear comprehension and arm uncovered as a mark of respect. which cloud the mind 17 Fasting The Noble Eightfold Path If their health allows, some Buddhists fast on new moon and full moon days and on • Right view or right specific festival days such as the Buddha’s birth, his Enlightenment, his frst sermon, understanding his death and others. Some may also eat only one main meal a day (see below). • Right thought or right intent • Right actions or right conduct Death customs • Right speech The manner of consideration for the the body for its existence and it does dying will depend on the Buddhist not die at the time of physical death • Right livelihood group. If you need specific guidance but continues in an intermediate state • Right effort about a patient’s particular school of “bardo” (customarily assumed to • Right mindfulness of Buddhism, or want to arrange be around 7 weeks) before (generally) counselling from a fellow Buddhist taking rebirth into another body. Thus • Right meditation or practitioner, then you should find the time before and after physical right concentration out from the patient or family which death is a critical period for infuencing specific form or school of Buddhism the outcome of rebirth, into a higher the patient practises. You can then seek or lower form. out local contact details. Birth customs Buddhists may like to have full Generally, there are no guidelines, A person’s state of mind at the moment information about their imminent although Buddhists in some South of death is considered important across death, to enable them to make East Asian countries traditionally all Buddhist traditions. Practitioners in preparations, although this may vary. prepare a basket containing some Tibetan traditions believe that the state Nearing the time of death, the state tools for a baby boy, and a cradle of mind at the time of death infuences of mind should ideally be one of peace, containing needles and thread how they experience the intermediate so the patient may wish to meditate for a girl. Some may ask for the or ‘bardo’ states and thereafter the and ask for a quiet place. They may umbilical cord to be salted and character of rebirth. In these traditions, wish for a Buddha figure close by and placed in an earthenware pot. In the belief is that the body and mind, or may use a candle or incense stick. the UK some Buddhists may prefer consciousness, separate at the time of Spiritual Care to give birth at home. death—the mind is not dependent on 18 Continued from previous page. the patient and relatives if terminal into its own pure nature or to illness is diagnosed. positive rebirth. Some may ask for counselling from a fellow Buddhist, with recitation of For some Buddhists, after death the A Buddhist person’s body can be prayers or sacred texts. It is believed body should be left alone for 3 days to offered, after death, to any of the four that the mind of a person becomes enable the consciousness to separate elements (earth, air, fre and water)— powerful and sensitive before and after from the physical body. Failing this, the whichever is appropriate to the country death and can be clearly aware of what body should be disturbed as little as and people. Traditions vary as there is being done and said – remaining in a possible (particularly the lower part of are different schools of thought. positive and peaceful frame of mind is the body) and the head left uncovered. Ideally, the person’s end of life should thought to be of beneft to the patient. It is considered good if the lower part be discussed while they are still alive. of the body is not touched. If the body For some there may be a preference Ordained Buddhists or Lamas (Tibetan must be cleaned this should be done for a funeral to happen within three to and Nepali monks and nuns) may be as quickly and gently as possible. seven days of death. Some Buddhists called upon to do rituals to bless the The gender of staff caring for the body from other countries may wish their person’s mind/consciousness and is not an issue. body to be returned to their home guide it in a positive direction. Monks, country to be cared for according to nuns and Dharma teachers can also After death, an important Buddhist custom/tradition there. offer prayers for the person’s wellbeing. tradition is for the family to request Specifc prayers before, during and prayers from the sangha (usually Some patients and relatives may after death can be offered by fellow a monk, lama, nun, priest or order object to a postmortem due to the Buddhists—either at the bedside or member) of the appropriate school belief that the consciousness may from a distance. of Buddhism and to perform certain stay in/around the body for some time actions and dedicate them to the dead after the heart has stopped, and that Some Buddhists may express a person. For practitioners of Vajrayana interfering with internal organs may strong wish to die at home rather Buddhism/Tibetan traditions, an determine the optimal dissolution than in hospital. If possible, this experienced lama may perform the of consciousness. A postmortem may should be granted. Healthcare staff

special Buddhist practice of Phowa be less of an issue if three days have Spiritual Care should discuss in full the practical to free the deceased’s consciousness passed since death. implications of this decision with 19 Diet The principle of non-harm is an important consideration in a Buddhist’s diet and, if their health allows, many will be vegetarian or vegan. Some may follow a precept that involves eating only one main meal a day. This is usually eaten before midday. When their body may need additional sustenance, some Buddhists will eat non-vegetarian, or whatever is offered, as the Buddha encouraged gratitude for whatever was received.

Blood transfusions, transplants and organ donation There are no religious objections to blood transfusions or organ donation, since helping others is fundamental to Buddhist belief—and all consider blood and organ donation during life, acts of compassion.

Washing and toilet

Washing and toilet present no Spiritual Care unusual problems for Buddhists. 20 Chinese faiths Spiritual Care

21 Although there is a great variety Attitudes to healthcare staff and illness of Chinese belief systems (including Many Chinese are accepting of western medicine, however, this can Christianity and Islam), the most vary with age and upbringing. Traditional herbal remedies given prevalent influences are Buddhism by Chinese physicians are still used and you should check whether (see above), Confucianism, Taoism the patient is taking Chinese herbal medicine in combination with western medicine. Some prefer injections over pills in the belief and veneration of ancestors. that they are more effective. Confucianism was founded by K’ung Fu Tzu, who Chinese can be quiet, polite and unassertive and tend to suppress was born in 551 BCE3. Confucianism deals mainly feelings such as anxiety, fear, depression or pain. Recognising with individual morality, ethics and the proper non-verbal cues and their cultural meaning is important. exercise of political power. It emphasises respect Many Chinese are shy to ask the doctor questions about their for rules and authority. condition. Some feel embarrassment when they cannot communicate The founder of Taoism is believed to be Lao- well and can experience stress in a healthcare setting. Always ask if Tse (604-531 BCE). Taoism is broadly based an interpreter, not a family member, is needed during consultations. on the key concepts of yin and yang, ch’i and the five elements of matter (water, fire, earth, metal and wood). Religious practices Ideas of modesty and dress Confucianism, Taoism and Buddhism are Chinese religious practices Chinese women are generally often blended to form a set of complementary, vary according to modest and would probably peacefully co-existent religions. background and tradition (see the religious practice be more relaxed and content if In traditional Chinese families, sons and attended by female professionals. daughters must be dutiful towards older family section in Buddhism, Christianity and Islam for In practice, however, the great members, particularly their parents. Reverence majority of Chinese people today for ancestors is regarded as a matter of great guidance for Chinese patients from those backgrounds). are used to being treated by importance. Children are expected to carry out doctors of the opposite gender.

rituals and obligations in respect to the living and Spiritual Care the dead, however, religious scepticism among the younger generation of Chinese is common. 3Before the Common Era. This is often referred to as BC (before Christ) 22 Diet Washing and toilet The Chinese have definite customs concerning food, its preparation, its service, and the way Chinese cultures place great emphasis on it is eaten. The older generation often believe physical cleanliness. Most Chinese wash by that rice is the only form of staple food which pouring water over themselves or sponging. can give them energy and vitality. (Northern Showers are preferred rather than baths with Chinese eat little rice and more wheat, maize some worrying that baths could make them ill. and other cereals).

Patients often ask relatives to bring in rice Death customs and other food when they visit. A traditional Chinese belief relating to diet in hospital Funeral and mourning customs vary widely in the Chinese concerns drinking soup that has been boiled for tradition, often dependent upon wealth and status, making a long time (six to seven hours). Many believe it very difficult to generalise for all Chinese. that consuming well-boiled soup will help clear In the case of adults, the body is often simply bathed and one’s system and promote a speedy recovery. covered in a white sheet, although some Chinese still follow the custom of clothing the body in white or traditional Chinese dress. Soya milk is often preferred to cow’s milk as some Chinese are dairy intolerant. In the case of a child some Chinese prefer things to be kept quiet and simple, with little or no fuss. In some instances, a coffin may Beef and cheese are the least preferred foods. not be used – simply a sheet. There is no formal funeral service for a child and many Chinese do not like to mention a child who Fasting has died at all, so counselling may be difficult. Chinese families There is no specific guidance on fasting for the do not like to be given back any of the child’s belongings as it Chinese community (see Buddhism, Christianity and is considered bad luck. On the death of a child, the burial takes Islam for Chinese patients from those backgrounds). place at once with no special ceremony. Buddhist and Taoist Chinese will often eat Muslim Chinese may object to a post mortem. a vegetarian diet before major festivals. Spiritual Care 23 Birth customs Family planning Often women eat a lot of root ginger before Generally, there are no problems with the birth, boiled with vinegar for several family planning although there is weeks. Eggs may be added to ‘cleanse’ often a certain reserve in talking about one’s insides. They may eat this mixture it, and it should not be mentioned in every day for a month after delivery. When the presence of other Chinese. Family- a child is born, relatives will visit and bring planning devices, sterilisation and presents such as chicken soup, clothing, abortion are acceptable. a cap and shoes for the baby, and eggs dyed red. Blood transfusions, transplants A Chinese woman may ask not to wash her and organ donation hair for one month after the delivery of a Most Chinese will agree to blood baby. This is an important tradition and she transfusion. Organ transplant can may be unwilling to go for a shower or sit in cause difficulty as traditionally the body a bath. She will take great care of her body should be buried whole, so they may be and will not take any form of exercise. reluctant to donate organs or tissue. Spiritual Care

24 Christianity Spiritual Care

25 Christianity was founded around 2000 years Attitudes to healthcare ago in the area of modern-day Israel and staff and illness Palestine. It is based on the teachings of Most Christians have a Jesus of Nazareth, known as Christ (the positive attitude towards Diet anointed one). healthcare staff and are There are no willing to seek medical universal Christian Christianity is a world-wide religion followed by people help and advice when sick. dietary regulations. of many different cultures and backgrounds. Although Christians hold much in common, there is a wide diversity Religious practices of beliefs, ethical standpoints and forms of worship among Family planning the many denominations and groups which make up the Key Christian Christian Church. practices (depending For many Christians, family planning is an individual The two major groups of Christians in Scotland are on denomination) choice. All Christian churches Protestants and Roman Catholics. Within the Protestant are Baptism, Holy uphold the sanctity of life group there are a number of distinct denominations Communion, and every effort is made to such as Church of Scotland, Baptist, Episcopalian, Confession, Absolution preserve life. Certain churches Methodist, Free Church of Scotland and many more. and the anointing of discourage their members These have a common core of beliefs but also a number the sick. The relevant from using artificial means of distinctive practices. hospital chaplain would be able to offer of contraception. Roman At the centre of Christian belief is Jesus, who is regarded these sacraments Catholics believe that every as the revelation of God. For many Christians this revelation to Christians on human being has a divine right is such that he is understood to be the incarnation of God. to live, and that life begins The Christian holy book is called the Bible and key Christian a hospital ward. Prayer at conception, so abortion is practices are baptism and Holy Communion (or Eucharist is also very important forbidden. Abortion is also or Lord’s Supper). Prayer and meditation are important to Christians and they strongly condemned in some to Christians in their daily life, and many Christians would appreciate other Christian denominations. are also involved with justice, peace and development some privacy for this. Spiritual Care issues, in common with adherents of other faiths. 26 Fasting Death customs There are no universal Christian Dying patients of all Christian denominations may wish the pastoral fasting regulations. Some support of their own faith leader or welcome the services of the Christians fast on particular days appropriate chaplain. It is important that, whenever possible, Roman and at particular times of the year. Catholic patients be offered the sacrament known as the Sacrament of the Some Christians give up certain Sick – this can usually be arranged by contacting your Chaplaincy Team. foods during Lent (a 40-day period If a baby is seriously ill, parents may wish to be offered a service of blessing between Ash Wednesday and or baptism for their baby. A chaplain or minister usually performs the Easter). Other Christians observe service, although a member of staff may perform an emergency baptism in Friday as a no-meat day or may fast their absence if requested. Some Christians do not practise infant baptism before receiving Holy Communion. and may prefer that sick or dying babies receive a blessing instead. If a baby is still born, or a child has died, many parents will also seek Birth customs a service of blessing or baptism. There are no specific or universal Many Unitarian Christians support the right to assisted dying and Christian customs relating to may decline certain treatments or have an ‘advance directive’ in place birth itself, although many declining some interventions. Christian traditions practise infant baptism. This may be significant for a new-born child Blood transfusions, transplants Ideas of modesty and dress who is dying, as the family may and organ donation request that the baby is baptised. There are no particular points Most Christians do not object to blood to be noted in this area and transfusions and may receive transplants most Christians would not or donate organs for transplant. Jehovah’s Washing and toilet object to being examined by Witnesses are an exception to this (see the doctors of the opposite sex. Washing and toilet present no relevant section for further details).

unusual problems for Christians. Spiritual Care

27 Church of Jesus Christ of Latter-day Saints Mormon Spiritual Care

28 The Church of Jesus Christ of Attitudes to healthcare staff and illness Latter-day Saints (LDS) was Most Latter-day Saints have a positive attitude towards healthcare founded in America in the early staff and are willing to seek medical help and advice when sick. 19th century by Joseph Smith. The Bible and Book of Mormon are essential scriptures for Ideas of modesty and dress Religious practices Latter-day Saints. Some Latter-day Saints will The sacrament of bread and wear special ‘endowment’ water (Latter-day Saints abstain The Church views the Holy Trinity (Father, undergarments (white knee from alcohol) equates to the Son and Holy Ghost) as three separate and length shorts). They believe these Eucharist of other Christians distinct members of a united Godhead. intensely private items to be and is performed each Sunday. Members believe in pre-existence: a spirit life sacred and will normally wear Although it may be taken in before birth that a person has no memory them day and night. They may be hospital, it is not regarded as of. They view life on earth as a period in removed by staff in an emergency essential for a sick patient. which to become worthy to return to live following an accident but must at The LDS Church administers in the presence of Jesus Christ and God. all times be treated with respect. spiritual healing to the sick. Family unity is of central importance Members don’t usually wear At the request of a patient two epitomised by a ‘sealing’ ceremony at a them while in hospital. members of the LDS priesthood Temple when man and wife are sealed may visit them. One would together for eternity. Children may be sealed anoint them with consecrated to their parents. Family members, already Washing and toilet oil and the second would place dead, who were not members of the Church, their hands on the patient’s Washing and toilet present may be baptised into the faith and sealed head and offer prayer. Some no unusual problems for to their families. privacy for this would be Latter-day Saints. The Church encourages reverence greatly appreciated.

and care for the body, and so counsels Spiritual Care against immoral practices and the use of illegal drugs. 29 Fasting Death customs Blood transfusions, All Latter-day Saints who are medically There are no special rituals associated transplants and fit to do so fast for 24 hours on (usually) with dying or death for any age group. organ donation the first Sunday of each month. Normally After death, a deceased member should be the fast would last from after the Most Latter-day Saints do not washed and dressed in a shroud according evening meal on Saturday until a meal object to blood transfusions to hospital protocol. An ‘endowed’ Latter- on Sunday late afternoon. They are and may receive transplants day Saint should be buried wearing encouraged to donate the money saved or donate organs for special undergarments (see above) and from missing two meals to help the poor. transplantation. other special clothes, and members of the Some Latter-day Saints in hospital may Church will dress the body before burial, feel well enough to continue with the by arrangement with the funeral director. Birth customs monthly fast. Generally, cremation is not encouraged, There are no specific although the family of the deceased must Latter-day Saint customs Diet decide on either burial or cremation. relating to birth itself. Church members live by a health code known as the Word of Wisdom. It warns against the use of Family planning stimulants and substances that are Although Latter-day Saints are not encouraged to use harmful to the body and promotes contraception, the Church does not explicitly teach that healthy eating. contraception is wrong and makes no doctrinal statement LDS patients will refuse tea, coffee, about it. Latter-day Saints condemn abortion on demand alcohol and tobacco. Water, milk, but permit it where there are strong medical grounds fruit juice, hot chocolate, Ovaltine such as risk to the life or health of the mother. The Church and other such drinks normally teaches that sterilisation should only be considered where available on hospital wards medical conditions jeopardise life or health. The husband or

are acceptable. wife must choose what is best for their family circumstances. Spiritual Care

30 Hinduism Spiritual Care

31 Hinduism originated near the river Attitudes to healthcare Indus over 5,000 years ago, although staff and illness elements of the faith are much older. Most Hindu patients have a positive Religious practices The Hindu tradition has no founder attitude towards healthcare Many Hindus will make use and is best understood as a group of staff and are willing to seek of a shrine which can include medical help and advice when fgures of Hindu gods and it closely connected religious traditions sick. Many Hindu patients may be may be helpful to facilitate rather than a single religion. It using Ayurvedic medicine and, as a space for a shrine. Hindus represents a complete way of life this may involve the use of herbal will usually wish to pray twice and is practised by over 900 million remedies, it is important to find out. daily. Where possible they will burn incense and use followers. Eighty per cent of the Avoid unnecessary use of the left hand with Hindu patients holy books and prayer beads. population of India is Hindu. as this hand is regarded as unclean. Privacy would be appreciated for prayer times. Hindus believe in one God and worship that one God under many manifestations, deities or images. Examples of Hindu deities are Krishna, Ideas of modesty and dress Shiva, Rama and Durga. A Hindu woman will much prefer a female doctor when being Hindus believe that existence is a cycle of birth, examined or treated. Hindu women should only be accommodated death and rebirth, governed by karma (a complex in mixed wards in emergencies. A Hindu woman may find it belief in cause and effect). Hindus believe that all difficult to accept an X-ray gown because it is short. Jewellery may prayers addressed to any form or manifestation have religious signifcance and Hindu women may wear bangles will ultimately reach the one God. Hinduism does or a thread and you should not remove them without permission. not prescribe particular dogmas; rather it asks Some Hindus wear a red spot on their foreheads or scalp, which individuals to worship God according to their own again should not be removed or washed off without permission. belief. It therefore allows a great deal of freedom

in matters of faith and worship. Spiritual Care

32 Diet Washing and toilet Most Hindus are vegetarian. Most do not eat Hindus will require water for washing in the same room as pork or beef (the cow is viewed as a sacred the toilet itself. If there is no tap there, or if they have to use animal). Some Hindus will eat eggs, some will a bed-pan, they will be grateful to have a container of water not, and some will also refuse onion or garlic; provided. Hindu patients prefer to wash in free-flowing water, it is best to ask each individual. Dairy produce rather than sit in a bath. As Indian food is eaten using the is acceptable so long as it is free of animal fingers, hand washing before and after meals is customary. rennet, so for example the only cheese some Hindus will eat may be cottage cheese. It is important to remember that strict Death customs vegetarians will be unhappy about eating If possible, a Hindu should be allowed to die at home. If a Hindu vegetarian items if they are served from the patient is dying in hospital, relatives may wish to bring money and same plate or with the same utensils as meat. clothes for him or her to touch before they are given to the needy. They will wish to keep a bedside vigil – if the visitors are not allowed to go to the bedside themselves, they will be grateful if a nurse can Fasting do this for them while they wait. Some relatives will welcome an Fasting is a regular feature of the Hindu religion, opportunity to sit with the dying patient and read from a holy book. but few Hindus insist on fasting in hospital. After death the body should always be left covered. Sacred objects Fasting is commonly practised on new moon days should not be removed. Relatives will wish to wash the body and and during festivals such as Shivaratri, Saraswati put on new clothes before taking it from the hospital. Traditionally Puja and Durga Puja. Some fasts may only require the eldest son of the deceased should take a leading part in this, abstinence from certain foods. At the end of each however young he may be. period of fasting, visitors may bring in ‘prasad’4 so that the patient can join in the celebration. If a post-mortem is unavoidable, Hindus will wish all organs to be 4 Food that has been blessed. returned to the body before cremation (or burial for children under five years old). Spiritual Care

33 Birth customs Family planning Some Hindus consider it crucial to record the There is no objection to family time of birth (to the minute) so that a Hindu planning from the religious point of priest can cast the child’s horoscope accurately. view. However, there may be strong A Jatakarma ceremony welcomes the birth of a social pressures on women to go baby when the father places a small amount of on having babies, particularly if honey on the baby’s tongue, whispers the name no son has yet been born, and you of God in their right ear and chants mantas. should involve her husband in any discussion of family planning. If there is a need to separate mother and baby for any reason this should be done tactfully as she may prefer to keep the baby with her Blood transfusions, at all times. transplants and organ donation Relatives will want to make sure the mother has complete rest for 40 days after birth and Most Hindus have no objection they will be worried if she has to get up for a to blood transfusions and may bath within the first few days. This attitude receive transplants or donate is based on the belief that a woman is at her organs for transplant. weakest at this time and is very susceptible to chills, backache etc. Spiritual Care

34 Humanism Spiritual Care

35 Although humanism is not a faith, it does provide a moral Attitudes to healthcare staff framework for a life free from superstition and supernatural and illness beliefs. Humanism rejects any notions of a life after death, Humanists have a positive attitude believing that a person has only one life, and so humanists try towards healthcare staff and are to make it as worthwhile and happy as possible for everyone. comfortable seeking medical help and advice when sick. Humanists are atheists, agnostics or religious adherence that harms sceptics who either reject or at least or disadvantages others. Religious practices robustly question the idea of any god Humanists assert that morality Not relevant. However, registered or other power beyond the physical comes from our ability to see that humanist celebrants conduct non-religious world. However, humanism is more there is general benefit when we ceremonies to observe rites of passage—for than just a simple denial of religious behave well towards each other; birth, marriage and death. belief. Humanists base their moral an ability that is enhanced by principles on a rational approach to personal responsibility, a caring life, under-pinned by shared human and principled upbringing and Washing Ideas of modesty values and respect for others, with education that always insists that and toilet and dress the aim of improving the quality of we treat others with consideration No particular No particular life, making it more equitable for all. and unselfishness. Human rights requirements. requirements. Humanism focuses on human beings law is important to all humanist and offers an ethical approach to organisations throughout the world life, a belief in people’s ability to and they endorse the principles solve problems, recognising that of humanitarian ideals that are Diet much of what happens in our world enshrined in all such declarations, No particular requirements. Some is what people cause to happen. covenants and conventions as humanists are vegetarian or vegan, and To this end, humanists try to co- well as the universal initiatives many who eat meat will refuse it if it has operate with people of all faiths to promoted by the United Nations been slaughtered in a way they consider

achieve the shared aims of a caring for the peaceful co-habitation inhumane. Spiritual Care society, although they condemn of all the world’s populations. 36 Fasting There is no obligation Death customs for humanists to fast. Many Humanists will have a living will or advance directive. Birth customs Humanists favour cremation No particular or green burials and would requirements. want a humanist funeral. Many humanists endorse ‘death with dignity’ and would Family therefore favour legal voluntary planning euthanasia (with appropriate safeguards) for adults. Some may Humanists refuse treatment they regard as have always simply prolonging suffering. been strong advocates of Some Humanists may appreciate birth control the support of a fellow Humanist and for the or secular counsellor. right to choose Humanists may strongly resent in relation to the offer of prayer or discussion abortion. about faith or an afterlife.

Blood transfusions, transplants and organ donation Most humanists have no objection to blood transfusions and may receive transplants or donate organs for transplantation. Spiritual Care 37 Islam Spiritual Care

38 Islam is a world religion that The Five Pillars Ideas of modesty and dress originated in the Middle East of Islam: In Islam the free mixing of sexes is prohibited in the seventh century CE.5 To recite a specific • and there should be no physical contact between It is practised by about a fifth verse—their a woman and any man except her husband. declaration of of the world’s population. Generally, a Muslim woman is not allowed to be faith (Shahadah) Muslims believe there is only examined or surrounded by male members of one God (Allah) and that • To offer five specific medical staff. It is always preferable that a female prayers daily (Salat) member of the medical staff is present. In certain Muhammad is his prophet. • To give two-and-a- cases, a Muslim woman may not agree to be Although Muslims revere Muhammad half per cent of their examined or treated at all by a male staff member. they do not worship him. Islam views savings once a year to A Muslim woman may find it difficult to accept the Biblical Patriarchs as Prophets the poor (Zakat) an X-ray gown because it is short. Many Muslim and sees itself as a continuation and • To undertake a women wear a headscarf when out in public (the renewal of Judaism and Christianity. pilgrimage to Mecca, hijab) and some Muslim women will also choose Islam’s sacred texts include the Qur’an if they can afford to, to be fully covered with only their eyes and hands (the key source), the Gospels and the once in a lifetime (Hajj) showing (burka). You should show sensitivity to Hebrew Bible. the needs of Muslim women to dress appropriately. To fast during the Muslims believe that everything • month of Ramadan Muslims should only be accommodated and everyone depends on Allah. All (Sawm) in mixed wards in emergencies. Muslims of whatever race are members of one community known as the ummah. Muslims are guided to follow Allah’s will by obeying their holy book, Family planning the Qur’an, and also by following the Strictly speaking an orthodox Muslim would not approve of family-planning example set by Muhammad. devices. In practice individuals vary widely in their attitudes. Information

Every Muslim must perform duties about facilities should be given, but no pressure exerted. Any discussion Spiritual Care known as the ‘five pillars of Islam’. should be in strict confidence, and never in front of visiting relatives or friends. 39 5 Common Era Washing and toilet Death customs Muslims attach great importance to cleanliness. They A dying Muslim will wish to lie on their right-side facing Mecca. must have running water (from a tap or poured from a Familiar people can give comfort by reading to the patient verses jug) in toilets, as they consider toilet paper inadequate. from the Qur’an. Where possible, a dying person will repeat a If a bedpan is used a container of clean water should declaration of faith (the Shahada) as their last utterance. accompany it. Muslims prefer to wash in free-flowing It is an important religious duty to visit the sick and dying, so a water, and cannot accept the idea of a bath. After large number of visitors may arrive at all hours. It is customary menstruation women must wash their whole bodies. among Pakistanis and Arabs to express their emotion freely It is regarded as unclean to eat or perform religious when a relative dies. Whenever possible you should give them ceremonies using the same hand that is used for privacy to do so, whilst explaining the need to avoid disturbing toileting purposes. other patients by their mourning. It is usual for the next of kin to want to ritually wash and wrap Religious practices the body in a white shroud before burial. If there are no relatives available to do this, staff should wear gloves when washing One of the most important religious practices for the body. The eyes should be closed and the lower jaw gently Muslims is fve daily prayers (Salat). The times are bound with cloth to the top of the head. The deceased is laid out broadly as follows: dawn (Fajar), just after noon (Zuhur), with their arms placed straight down the side of the body. afternoon/evening (Asr), following sunset (Maghrib), night time (Isha). In Islam the body must be buried as quickly as possible, Muslims welcome privacy/a quiet space during prayer preferably within 24 hours (cremation is forbidden). A post times, and they must face the Qibla (the sacred direction), mortem must be avoided if legally possible, as this is not the direction of the Kaaba shrine in Mecca (south-south allowed and causes considerable distress; organs should all be east in the UK). Ablution (if possible using free fowing buried with the body. water) before each prayer is necessary. They wash their Should a baby die at or after four months of pregnancy or soon hands, face, arms and feet, cleanse their mouth, nostrils after birth, he or she will be named, washed, shrouded and buried and ears, and run wet hands through the hair—each in the usual manner. If the foetus dies before four months of of these three times. Muslims will also wash before pregnancy, then it should be wrapped in a clean cloth and buried. Spiritual Care eating, and the Muslim holy day is Friday. 40 Blood transfusions, transplants and organ donation Diet There are no particular issues Muslims will eat only permitted food (halal) and will not eat or drink anything that relating to blood transfusions, but is considered forbidden (haram). Halal food requires that Allah’s name is invoked at although organ donation has been the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as permitted it is a complicated issue long as a Muslim kills them and offers a prayer. Fish and eggs are also halal but they for Muslims and will often be met must be kept strictly separate from meat during preparation. All products from pork, with reluctance. The decision would carrion and blood and all types of alcohol are forbidden. lie with the individual and their In the UK, Muslims buy their meat from a Muslim butcher whenever possible. family in consultation with their A Muslim does not eat generally available meat or food that contains animal fats, local religious leader. in case it contains pork fat or fat from other animals not ritually slaughtered. When away from home many Muslims will follow a vegetarian diet unless absolutely Birth customs sure that all food is halal. Some Muslim women will refuse to be examined Fasting Attitudes to internally before giving birth Muslims fast during the month of Ramadan (the date varies each healthcare staff and may be reluctant to be year). At this time Muslims will not eat or drink between dawn and illness attended by a male obstetrician and sunset. The sick, infirm or very old need not fast. Fasting is unless in an emergency. When a also excused during menstruation, for 40 days after childbirth, Most Muslim Muslim child is born, as soon as while breastfeeding or during a long journey. However, some patients have a possible a member of the family Muslims will choose to fast even if ill and you should try to positive attitude must recite in the baby’s ear accommodate this. This means providing adequate and towards healthcare a prayer that normally lasts a acceptable meals during the hours of darkness and, wherever staff and are willing minute or two (Azaan). A Muslim possible, adjusting medication to fit in with the fast. If the doctor to seek medical boy must be circumcised as says a patient should eat and drink more, you should explain help and advice soon as possible. It is not a to the patient that this is part of the medicine to assist recovery. when sick.

religious requirement for It is important to recognise that a decision to fast is based on Spiritual Care girls to be circumcised. different priorities, not on ignorance or being uncooperative. 41 Jehovah’s Witnesses Spiritual Care

42 Charles Taze Russell Attitudes to healthcare staff Religious founded the Jehovah’s and illness practices Witnesses in 1872, Most Jehovah’s Witnesses have a positive There are no although it did not attitude towards healthcare staff and specific religious become known officially are willing to seek medical help and practices that Washing advice when sick. They may be keen to as such until 1931. would affect a and toilet make sure that medical staff are aware Jehovah’s Witness Washing and Jehovah’s Witnesses view they would reject blood transfusions. while in hospital. toilet present themselves as Christian and no unusual regard Jesus Christ as the Son of problems for God, but not in the sense of being Diet Death customs Jehovah’s equal with God or one with God. Jehovah’s Witnesses Jehovah’s Witnesses do not Witnesses. Jehovah’s Witnesses consider reject foods have special rituals for the their religion to be a restoration containing blood sick or the dying. You should of original first-century but have no other make every reasonable effort Ideas of modesty Christianity. They accept both the special dietary to provide medical assistance and dress Old and New Testaments of the requirements. and comfort. Spiritual care will Bible as inspired by God. They do Some Jehovah’s be provided by local Witnesses There are no not, however, use the symbol of Witnesses may be (friends, family and elders). particular points to the cross because they believe vegetarian, and be noted in this area. it to be of Pagan origin. others may abstain Fasting Jehovah’s Witnesses refuse blood from alcohol, but transfusions and take a non- this is a personal Jehovah’s Witnesses are not Birth customs negotiable stance on this matter. choice. Jehovah’s required to fast for religious reasons There are no specific Witnesses do not but must not consume blood (for Jehovah’s Witness smoke or use other example in blood sausage or

customs relating Spiritual Care tobacco products. in animal meat if the blood has to birth itself. not been properly drained). 43 Family planning Blood transfusions, transplants and organ donation Jehovah’s Witnesses believe that Jehovah’s Witnesses carry on their person an advance medical the Bible is the inspired word directive/release that states they must not receive blood of God or Jehovah. As the Bible transfusions under any circumstances, while releasing medical does not directly discuss birth practitioners and hospitals from responsibility for any damage control, birth control is seen as that may be caused by their refusal of blood. When entering a personal decision and is left the hospital, they should sign consent/release forms that to the individual’s conscience. reiterate this and specify the hospital care needed. Jehovah’s Jehovah’s Witnesses believe that Witnesses’ religious principles do not absolutely prohibit the use human life begins at conception of minor blood components such as albumin, immuno globulins and do not therefore approve of and haemophiliac preparations. Each Witness must decide abortion. If the termination of a individually whether he or she can accept these. pregnancy is the only means of While forbidden to take blood, Jehovah’s Witnesses are saving a mother’s life, the choice not specifically forbidden to take in tissue or bone from is up to each individual. Witnesses another human. Jehovah’s Witnesses currently accept organ are strictly politically neutral and transplants, although any surgery would have to be performed do not get involved in any debates on a bloodless basis. Some Jehovah’s Witnesses may not wish to or demonstrations on this issue. donate their organs because someone else’s blood would then flow through them. In the case of organs that do not involve blood flow, for example corneas, they would have no religious grounds to object to donation. Therefore, whether to accept an organ transplant or donate organs is a personal decision. Spiritual Care

44 Judaism Spiritual Care

45 Judaism is an ancient religion that Ideas of modesty and dress has been practised for over 5,000 For the older generations and more Orthodox Jews, one usually years and is based on the belief in one exposes the body only in the privacy of the home and to a spouse. universal, omnipotent God. The Jews A Jewish woman may be reluctant to have any intimate physical believe that God is omniscient and will examination, especially during menstruation. Women will probably reward the righteous and punish the wish to keep their arms and their legs above the knee covered at all times, or expose only those parts of their body that are to be examined. wicked at the end of time when there For Orthodox patients, wherever possible the examiner should be will be a resurrection of all the dead. of the same sex as the patient. However, if the only person available to do an examination is of the opposite sex, this is acceptable as a Jews live according to values based on love of one’s neighbour and tolerance of one’s fellow last resort. Both sexes may wish to keep their hair covered (Orthodox human beings. Judaism requires its followers Jewish women may wear a wig, hat, scarf or snood and Orthodox to live their lives in accordance with 613 Jewish men a skull cap called a yarmulke, kipah or kappel). If the Commandments (mitzvoth) covering all aspects examination is to include the head, then discuss the removal of head of life. Judaism does not believe non-Jews are coverings sensitively, and where appropriate offer an alternative obliged to live by the same rules. (a theatre cap, for example). The religious aspects of Judaism are based on relationships: the relationship of God and humanity, and the relationships between Birth customs humans based on principles of fairness and After birth, 40 days of rest is required for the mother by custom. If a equality. Religious observance is a means of baby boy is still in hospital by the 8th day the family may request the publicly displaying subservience to the will of God. ritual of circumcision to be performed by a trained and medically Orthodox Jews are more traditional and certified religious functionary (although this must be delayed for a observant of the religious/dietary laws than premature or unhealthy baby). A small room may be requested, and Progressive/Liberal/Reform Jews. Given the huge others of the family will attend. Traditionally, a baby boy’s name is diversity of Jewish practice, patients appreciate kept secret until the circumcision. Traditionally a baby girl is named Spiritual Care being asked about what is important to them. in the synagogue, often on the Sabbath following the birth. 46 Death customs Attitudes to There are specific Jewish laws might place a feather over • All external catheters healthcare and customs for dealing with the the mouth and nose and and medical equipment staff and dead. It is important to contact watch for signs of breathing. attached to the body should illness the family and the appropriate • Do not wash the body be removed. All incisions Most Jewish Burial Society/Committee as (clean crevices if required etc should be dressed. patients have soon as possible. No mutilation to preserve the dignity of • Cover the body with a plain a positive of the body is allowed unless the deceased). Washing the white sheet without emblems. attitude there is a legal requirement body is part of Jewish ritual towards for a post mortem. Some families will want to healthcare performed by the Burial ensure that someone from the Jewish law forbids Jews to do Society/Committee whose staff and are Jewish community remains to willing to anything to hasten a person’s members undertake to wash sit with the body. Psalms may death and at the same time and shroud the dead and seek medical be recited during this time. help and requires everything possible to to sit with them until burial While Orthodox Jews are buried, be done to comfort the dying. takes place. advice not cremated, Reform and when sick. Some Jews would not touch a • Do not remove false teeth Liberal Jews may choose either dying person for fear that the or other prostheses. method of disposal of the body. slightest touch might hasten Immediately after death, close their death, so the range of • Close the eyes (a relative may want to do this). The mouth relatives may make a tear in one what you can or cannot do for a of their garments. dying person may vary and you is held in position by placing should consult a trusted rabbi a cloth under the chin and If a child dies, the body should acceptable to the family. tying it above the head. be treated in the same way as • Straighten the body out, an adult. Jewish law requires When a Jewish person dies, the burial of miscarried the following guidelines apply: laying it flat with the feet together and arms by the foetuses, which should be • Do not touch the body until side, hands open. delivered to the family or Spiritual Care 20 minutes after death. Some Burial Society Committee. 47 Religious practices Family planning One of the most important has enough time to get home Jewish practices is Sabbath before dusk. Similarly, some Contraception is not banned in the Jewish observance. The Jewish Sabbath Jews will not travel to hospital religion, but there are guidelines that need to (Shabbat) begins at dusk for admission on the Sabbath be followed as to when and how it is appropriate. on Friday and ends with full except in an emergency, and if Couples may wish to consult their chosen rabbi, darkness on Saturday night, discharged on a Sabbath will together with guidance from medical staff, before a period of approximately 25 wait in hospital until nightfall making a decision. hours. It is a day of rest and before travelling home. Jews believe that until the head of a baby has left begins and ends with ceremonies Many Jews pray three times the womb of its mother, it does not gain full status in the home. Before dusk on a day in the morning, afternoon as a living person. This means that where the mother Friday candles are lit, and a and evening, and would may die if the pregnancy continues, Jewish law prayer of blessing is said over appreciate privacy for this. permits a therapeutic abortion to save the life of the wine and bread before a festive Men will wrap themselves in mother at the expense of the child. In cases of rape meal. After dark on Saturday a prayer shawl, and during or where the mental health of the mother is at risk night, a prayer of farewell is said weekday morning prayers will if the pregnancy continues, the mother may wish over a candle, wine and spices. If wear phylacteries (leather boxes to discuss the medical advice with her rabbi before at all possible, you should make containing scriptural passages) making a decision. arrangements to enable Jewish strapped to their head and arm. patients to observe these rituals. Any room or area provided for Blood transfusions, transplants On the Sabbath creative work prayer should be clean and and organ donation is prohibited, and this includes contain no religious items Jewish law approves of blood transfusion in order things such as travelling. If you on display which may offend to achieve the desired medical outcomes. Jewish are arranging travel for a Friday or distract them in their act law permits organ donation from dead bodies discharge, make sure you leave of worship. It would be helpful where there is a high chance of success for the adequate time for all discharge to indicate which way is east. specific recipient. Relatives of a potential donor will

procedures, such as collecting Spiritual Care Many Jews will wash and say wish to consult an appropriate rabbi before making prescriptions, so that the patient a brief blessing before eating. a decision, and this should obviously be facilitated. 48 Diet Washing and toilet Judaism lays down strict guidelines like jelly or yoghurts can be a problem On waking, orthodox Jews concerning some aspects of their for Jewish patients as they can contain will want to wash their diet. Acceptable food is called kosher. gelatine, which is of animal derivation. hands as they may not eat Continuing to eat a kosher diet while Since most cheese contains rennet, cheese or drink before doing so. in hospital or on a medically restricted must display a rabbinical seal of approval. A brief blessing is recited diet poses a major problem for Jewish Many Jews will not eat cheese which is before eating any food, and people. However, as there is a wide range described as vegetarian. While most Jews Orthodox Jews will want to of religious practice by Jewish people, will take regular milk, some religious Jews wash before eating bread. observance of the dietary laws will vary will only use supervised milk. Fish without Some Orthodox Jews do from patient to patient and patients scales or fns are also forbidden. not bathe or shower during should be consulted about their level The Festival of Passover, which occurs major festivals or Shabbat of dietary observance. in the spring, is a time when there are and some men prefer to be It is important that staff ensure that additional dietary stringencies and food bearded or will only use an Jewish patients are given meals bearing is strictly ‘unleavened’. The label on the electric razor (a modern the word kosher. Religious Jews will kosher hospital meals must indicate circumvention of a ruling not wish to use hospital crockery and that they are specifically approved for against shaving). should be served the Kosher meal in its Passover. In particular, no leavened bread original wrapping, together with plastic or cakes are permitted, and instead, cutlery. If help is required to open the unleavened bread called matzah is eaten. container, it should be done in full At this time, Jewish patients may wish to view of the patient. eat and drink only products approved for Milk should not be offered to Jewish Passover. They may require to store food patients along with a meal of meat or in their locker or in a refrigerator. Some chicken. Most Jews observe a period of patients may only take food and drink brought in by relatives and every effort

at least three hours before having milk or Spiritual Care products that contain milk. Simple items should be made to accommodate them. 49 Fasting Yom Kippur (late September/early October) is the most important holy day of the year for most Jews. Many Jews who do not observe any other Jewish custom will fast during Yom Kippur. It is a 25-hour fast beginning before sunset on the evening before and ending after nightfall. These restrictions can be lifted where a threat to life or health is involved. Children under the age of nine and women in childbirth (from the time labour begins until three days after birth) are not permitted to fast, even if they want to. Older children and women from the third to the seventh day after childbirth are permitted to fast but are allowed to break the fast if they feel the need to do so. People with other illnesses would consult a physician and rabbi for advice. There are five further fasts, four of them minor, that last from dawn to nightfall, and a person is permitted to eat breakfast if up before sunrise. There is a great deal of leniency in the minor fasts for people who have medical conditions or other difficulties with fasting. The fifth fast is Tisha B’Av, a fast that takes

place in July or August and begins in the Spiritual Care evening at sunset and finishes at nightfall. 50 Paganism Spiritual Care

51 Paganism has its roots in the indigenous, pre-Christian Attitudes to healthcare staff and illness religions of Europe and derives its meaning from the Most Pagans have a positive attitude towards Latin “paganus” (country dweller) and “pagus” (the healthcare staff and are willing to seek land). The name referred to a follower of the ‘old religion’ medical help and advice when sick. or ‘earth spirituality’. Its re-emergence in Scotland parallels that in other western countries, where it has Washing Ideas of modesty been growing rapidly since the 1950s. Neo-paganism and toilet and dress covers a wide range of beliefs including Wicca, Druidry, Washing There are no particular Odinism and Witchcraft. Pagans practice a life-affirming, and toilet points to be noted in this earth-respecting and nature orientated belief path. present no area and few Pagans unusual would object to being The social infrastructure of aspect in Paganism and the earth problems examined by doctors Paganism reflects the value the itself being the primary Goddess. for Pagans. of the opposite sex. Pagan community places on Pagans believe that nature unity in diversity; it consists of a is sacred and that the natural Fasting network of inter-related traditions cycles of birth, growth and death There are no organised fast days, but some and local groups served by observed in the world around Pagans choose to fast in preparation for several larger organisations. In us carry profoundly spiritual Ostara (Spring Equinox). Scotland the Pagan Federation meanings. Human beings are acts as an educational and seen as part of nature, along representative body. with other animals, trees, Diet Pagans understand the divine stones, plants and everything For ethical reasons, most Pagans strongly to be manifest within nature else that is of this earth. Most prefer foods derived from organic farming and recognise divinity as taking Pagans believe in some form of and free range livestock rearing, while many many forms, finding expression in reincarnation, viewing death as

are vegetarian or vegan. Spiritual Care goddesses as well as gods, with a transition within a continuing goddess worship being a central process of existence. 52 Birth customs Wheel of the Year events: As Paganism celebrates life, birth is • Samhain (Oct 31) • Beltane (Apr 30–May 1) viewed as sacred and empowering. • Midwinter/Yule (Dec 21) • Midsummer (Jun 21) Pagan women will wish to make their own informed decisions regarding • Imbolc (Feb 2) • Laghnasadh/Lammas (Aug 1) prenatal and neonatal care. • Spring Equinox/Ostara (Mar 21) • Autumn Equinox (Sep 21)

Blood Religious practices Death customs transfusions, Most Pagans worship the old pre-Christian gods Most Pagans believe in some form transplants and and goddesses through seasonal festivals and other of reincarnation, viewing death as a organ donation ceremonies. The seasonal festivals are known as the transition within a continuing process Most Pagans would Wheel of the Year. of existence. Pagans accept death as have no objection to a natural part of life and will wish to Observance of these festivals is very important to Pagans, blood transfusions know when they are dying so that they and those in hospital will generally wish to celebrate them and may receive may consciously prepare for it. Most in some form. Some Pagans may wish to have a small transplants or Pagans would not welcome prayer at white candle or a small figure of a goddess on their locker. donate organs the bedside at the time of death. for transplant. Ritual jewellery is very common and may have deep personal religious signifcance. In some traditions the wearing of a ring, which symbolises the person’s adherence Family planning to Paganism or a particular Pagan path, is common. The Pagans will generally plan pregnancies and use contraception removal of such a ring may cause considerable distress as appropriate. Paganism emphasises women’s control As there are many diverse traditions within Paganism, over their own bodies, and the weighty decisions relating you should ask individual patients if they have any to abortion are seen as a personal matter for the woman special requirements. Most Pagans will be offended concerned, who will be supported in the choices she makes. if their faith is recorded ‘none’. Spiritual Care

53 Sikhism Spiritual Care

54 The Sikh faith is a distinct religion revealed through the The ‘Five Ks’: teachings of ten Gurus (messengers of God), the first of whom • Kesh: uncut hair—symbolising was Guru Nanak Dev Ji who was born in 1469 CE6 in the Punjab, the importance of living in India. In 1708 the tenth and the last human Guru, Guru Gobind harmony with nature Singh Ji, vested spiritual authority in the Holy Sikh Scriptures • Kangha: a small wooden (Guru Granth Sahib Ji) and temporal authority in the community comb—to manage their of baptised Sikhs (Khalsa Panth). hair and symbolising the importance of controlling Sikhs strictly believe that there is one Sikhs who choose to go through the one’s thoughts god, who is both transcendent and initiation rite of baptism wear five articles • Kara: an iron/steel bangle immanent (present in all things and of faith, commonly known as the ‘Five Ks’. —as a reminder to do everyone). Although above human Each of these articles have deep spiritual good deeds comprehension, God can be realised and moral significance, forming part of and experienced through prayer, the Sikh Code of Ethics and Discipline. • Kirpan: a short sword—as a contemplation and service. The object of The articles of faith must not be removed. reminder to fght for justice a Sikh’s life is to develop consciousness of Sikhism is a very community oriented • Kacchera: special shorts God and to receive God’s grace through faith with a deeply devotional, poetic —to maintain modesty truthful living and selfless service in base, combined with a strong emphasis the context of a family life. Sikhs seek on service and social action within the equality of all people regardless the community. of caste, colour, creed or sex. Attitudes to healthcare A Sikh is likely to have a personal name staff and illness A Sikh’s way of life is guided by the (common to both sexes), a middle name Most Sikhs have a following principles; remembering and (‘Singh’ for all males and ‘Kaur’ for all positive attitude towards praying to God at all times, earning a females), followed by a family name. healthcare staff and are living by honest means, sharing with the Sikhs may use the term Sikhi, rather poor and needy, selfless service to God willing to seek medical

than Sikhism, to describe their faith. Spiritual Care and His Creation, treating all human help and advice when sick. 6 Common Era beings as equal. 55 Religious practices Ideas of modesty and dress Sikhs pray in the early morning, at sunset, and before bed. They are also Some Sikh women would prefer a female doctor when being examined expected to recite hymns whenever or treated. Sikh women should only be accommodated in mixed wards in they have time in the day. Some emergencies. A Sikh woman may find it difficult to accept an X-ray gown privacy for prayers will be appreciated. because it is short. Although not one of the Five K’s, As mentioned above, ideally the five articles of the Sikh faith should not the dastaar (turban) is often worn be removed. If the Kacchera (shorts) need to be removed they should be to maintain the sanctity of the hair replaced by another pair. The patient should be consulted on the method and is treated with utmost respect. of removal and replacement. Baptised Sikh men always have their uncut hair in a turban, and Washing and toilet baptised Sikh women will also cover their hair. You should be particularly sensitive about removing the turban, as it is worn to maintain the Sikhs prefer to wash in free-flowing sanctity of Kesh (hair) and is treated with the utmost respect. Sikh water, rather than sitting in a bath; women wear a long Punjabi scarf (chunni) for the same purpose. and they will appreciate having water provided in the same room as the toilet, or with a bedpan Blood transfusions, transplants when they have to use one. Sikhs Birth customs and organ donation will want to wash their hands and The birth of a baby is a happy Most Sikhs would have no objection to blood rinse their mouth before meals. occasion. The baby may not be transfusions and may receive transplants or The uncut hair is kept clean named for several days as the donate organs for transplantation. However, and neat by washing regularly initial for the name is obtained with regard to transplants, especially the and combing, normally twice from the Guru Granth Sahib Ji donation of organs, the decision rests with a day. If the patient is not well (the Sikh Scriptures). The family the individual or their family, or both. In the enough, nursing staff may assist may also have Amrit (holy water) absence of close relatives, a medical officer in washing and combing, and placed on the tongue by a family in charge may take whatever action he or she Spiritual Care such help will be welcome. member or baptised Sikh. considers necessary to save the patient’s life. 56 Family Diet planning Practising Sikhs will refrain from alcohol, tobacco and other intoxicants. The use of tobacco Sikhs have or alcohol in any form is strictly forbidden to Sikhs who have taken Amrit (are baptised). no objection Many baptised Sikhs are vegetarians. They will exclude eggs, fish and any ingredients with to family animal derivatives or cooked in animal fat from their diet. Dairy produce is acceptable planning. providing it is free from animal fat e.g. cheese made from non-animal rennet. It is essential to avoid contamination with meat at all stages of preparation, storage and serving. Some Sikhs Fasting will only eat food prepared by their own families. Non-vegetarian Sikhs will only eat meat that has been slaughtered according to their own rites (jhatka) and not halal or kosher rites. Sikhs do not fast.

Death customs In the final stages of illness a Sikh patient will be comforted by reciting hymns from the Sikh Holy Scriptures. A Giani (priest) from the local Gurudwara (Sikh place of worship) or another practising Sikh may do this with the patient. The family will normally be present. Nursing staff must ensure that none of the five articles of faith on the body of a Sikh is disturbed. It is also important not to trim the hair or beard, and the hair on the head should be kept covered. After death, the eyes and mouth should be closed, and limbs straightened with arms placed straight beside the body and the body should be covered with a plain white sheet or shroud. Typically the body will be washed and dressed in clean clothes by members of the family. Most Sikhs are cremated as soon as possible after death although babies who are stillborn or die around the time of birth may be buried. The body of a stillborn baby should be given to the parents to perform the funeral rites. The child should simply be wrapped in a plain white sheet to await the arrival of a relative who will perform the Last Offices.

Sikhs do not like the idea of a post mortem but will accept it if it is legally unavoidable. Spiritual Care

57 Appendices Spiritual Care

58 Sources

The sources listed below have been used in preparing this document and may be of further interest.

BBC Religion The Mental Health Foundation: Executive Briefing—Spirituality and Mental Health https://www.bbc.co.uk/religion/religions https://www.mentalhealth.org.uk/sites/ Essex Cancer Network: Catching default/fles/spirituality_mental_health the concept of spiritual care _briefng.pdf https://eput.nhs.uk/wp-content/uploads/ 2014/02/Catching-the-Concept-of-Spiritual- Merseyside and Cheshire Cancer Network: Opening the Spiritual Gate Care-Booklet.pdf https://www.openingthespiritualgate.net Greater Manchester Mental Health NHS: /all-faiths Respecting the Religious and Cultural needs of patients Religion Media Centre—Fact Sheets https://www.gmmh.nhs.uk/download. (various) cfm?doc=docm93jijm4n901 https://religionmediacentre.org.uk/factsheets

Interfaith Scotland: A Guide to Faith West Lothian Faith Group: Faith Communities in Scotland Handbook (Updated 2017) https://interfaithscotland.org/wp- https://interfaithscotland.org/wp-content/ content/uploads/2018/07/Guide-to-Faith- uploads/2018/08/West_Lothian_Faith_ Communities-in-Scotland-2014.pdf Handbook_October_2017.pdf Spiritual Care 59 Thanks

Thanks to the following groups and individuals for their input to this resource. • Baptist Union of Scotland • Muslim Council of Scotland • Brahma Kumaris, Inner Space, • NHS Fife Spiritual Care Edinburgh • NHS Lothian Spiritual Care • Church of Jesus Christ of Latterday • NHS Orkney Spiritual Care Saints • OneSpirit Interfaith Foundation • Church of Scotland • Quakers • Confucius Institute for Scotland • Salvation Army • Kagyu Samyeling Ling Tibetan Monastery, Langholm • Scottish Council of Jewish Communities • Interfaith Scotland • Scottish Unitarian Association • International Society for Krishna Consciousness • Sikh Council of Scotland • Methodist Church in Scotland Spiritual Care

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