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Home , Chinese folk religion, Last offices

Factsheet 15: Culture and Religious Practices in Healthcare, and Bereavement

Key considerations for reviewers • Were the persons cultural and religious practices considered according to their wishes? • It might be useful to ask the question “Do you or your relative/ friend have any religious practices or customs that you would like us to be aware of?” The sensitive use of questions will be more helpful than an assumption.

Introduction It is important to consider different cultural aspects and practices during healthcare, death and bereavement. In particular, people who are members of a may wish to practise some elements of their religion in relation to their treatment, up to their death and after their death. However, it is important to never assume how a person’s cultural background will dictate their needs and practices. The person and their family should always be consulted about what is appropriate for them. Please find below a list of (in alphabetical order) summarising some of their religious and practices.

Baha’i Most Baha’is have a positive attitude towards healthcare staff and are willing to seek medical help and advice when sick. As well as taking prescribed medication, Baha’is believe in the power of in healing. The use of habit-forming drugs is strictly prohibited except when prescribed by a physician. In death Baha’is treat the body of a deceased person with great respect. Autopsies and post mortem examinations are acceptable if necessary. Wherever possible the remains should be returned to the parents or local Baha’i community for burial. Most Baha’is would have no objection to blood transfusions and may receive transplants or donate organs for transplant. Examinations are acceptable if necessary. Kumaris Most Brahma Kumaris have a positive attitude towards healthcare staff and would be willing to seek medical help and advice when sick. Brahma Kumaris teachers live a celibate life and may prefer medical examinations to be undertaken by someone of the same sex. They would have no objection to blood transfusion or organ transplants. Dedicated Brahma Kumaris would prefer the body to be in special white clothes and all favour cremation over burial. Buddhists will normally wish to be as conscious as possible when death approaches, and it is important to negotiate issues of medication at this time. Some Buddhists may express a strong wish to die at home rather than in hospital. Healthcare staff should discuss in full the practical implications of this decision with the person and relatives if terminal illness is diagnosed. They may ask their spiritual teacher to be with This was correct as of 29/7/2019 LeDeR Programme Fact Sheet 15. V 5-0

them, to chant passages of Buddhist scripture. Some believe that the spirit may remain associated with the body (and may continue to meditate) for some time after ‘physical’ death, so the body should not be disturbed during this time until the spiritual teacher advises when the body can be moved. Objections may be made to post mortems, due to the that the mind may stay in the body for some time after the heart has stopped, and interfering with internal organs may undermine the optimal dissolution of consciousness, therefore the body should not be moved for 72 hours. Chinese (Shendao, Shenism, Shenxianiam) Traditional Chinese religion is a diverse mixture of beliefs and practices. Different are carried out in different parts of , and many contemporary carry out according to various religious faiths such as Buddhism or . Throughout known Chinese history ancestors have been worshipped by their descendants and satisfying the needs of departed relatives is a constant concern within . A of traditions broadly associated with Chinese folk religion consists of different rites depending on the age of the deceased, the cause of death, and the marital and social status of the deceased. Respect is given to elders and there are often elaborate funeral preparations in these cases. For those not considered elders (children and unmarried/ childless adults) there may be no special ceremony and many Chinese do not like to mention a child who has died, so counselling may be difficult. Chinese families may not want to be given back any of the child’s belongings as it is considered bad luck. Most Chinese people believe that burial brings peace to the person who has died although there are other accepted ways of disposing of bodies. Post-mortems may be refused as they are seen as invasive and particularly so for Muslim Chinese. Organ transplant can cause difficulty as traditionally the body should be buried whole, so they may be reluctant to donate organs or tissue. Chinese people may want to use Traditional Chinese Medicine (TCM) in conjunction with or instead of western medicine. TCM and western medicine are practised side by side in Chinese hospitals. According to many Chinese, acute illnesses and those requiring surgery are best treated by western medicine while conditions with prolonged symptoms are better treated with TCM. Chinese patients may have been taught to respect medical professionals highly and not to ask questions or challenge opinions. Where language barriers exist, it is advised that professional interpreters are used instead of relatives. Diet and is very important in TCM. Many ethnic Chinese are lactose intolerant. Christianity Most Christians have a positive attitude towards healthcare and are willing to seek medical help and advice when needed. They usually do not object to blood transfusions, transplants or donating organs. Church of England, Church in Wales, Scottish Episcopalian Church & Anglican Some Anglicans will want the Chaplain or other minister to be with them as they approach death. If this is requested, the priest will treat it as an emergency and should be called regardless of the time of day. The relatives may want to see a priest after the person has died. Catholic, Roman Catholic and Ukrainian Catholic Some Catholics (especially older people) may abstain from meat on Fridays, and observe dietary discipline during Lent. Some Catholics may wish to receive Holy Communion, make their confessions to a priest and receive the Sacrament of the Sick or ‘Last Rites’ prior to their death. If this is requested, the priest will treat it as an emergency and should be called regardless of the time of day. Many Catholic families will want to see a priest after a death. After death, routine last offices are appropriate.

This information was correct as of 29/7/2019 LeDeR Programme Fact Sheet 15. V 5-0

Orthodox (Eastern, Greek, Russian, Serbian & Coptic) Many Orthodox Christians will observe a discipline of fasting during Lent, and some during Advent. It should be noted that the Orthodox Church observes a different calendar from that used by Western Christians - Christmas and Easter are about 12-13 days after the ‘Western’ date. The person may request the presence of the as death approaches. If this is requested, the priest will treat it as an emergency and should be called regardless of the time of day. The family may wish to see a member of the clergy after death. After death, routine last offices are appropriate. Methodist, Baptist, Quaker, Presbyterian (Church of Scotland), United Reformed Church, Salvationist ( Army), Free/ Independent Church & Other Christian Some people from some denominations may wish to receive Holy Communion and may ask the Chaplain or members of their own church to pray with them from time to time. A person may sometimes wish a minister or other Christian friends to be with them as they approach death. After death, routine last offices are appropriate. In Hinduism, it is forbidden to eat beef and many also avoid pig meat. They may wish to have statues or pictures of the with them. These should be treated with utmost care and respect. Ritual cleanliness can be very important, and a Hindu person may wish to wash in running water (i.. a shower) before meditating. Modesty is also important; they may wish to be examined only by a doctor of the same gender. Most Hindu people will wish to die at home, if at all possible. A dying person will be visited by their family, and may ask to see a Hindu priest. After death, the family should be consulted before anyone touches the body. The family will usually want to wash the body at home. If staff have to attend to this, disposable gloves should be worn; the dead person’s limbs should be straightened and their eyes closed; jewellery, threads, and other religious items should not be removed; and the body should be wrapped in a plain white sheet. Cremation should follow as quickly as possible after death. Humanist, Agnostic and Atheist No special arrangements. After death, routine last offices are appropriate. The option of a non-religious funeral should be given, which may have to be asserted with funeral directors. Jehovah’s Witnesses Witnesses adhere strongly to the New Testament prohibition on ingesting blood or blood products, and meat from animals which have been strangled. Blood and blood products are usually not acceptable in medical treatment, and the person will often have a very clear idea of their own moral boundaries in this matter. This should be clearly documented in the case notes and on any form which the person is asked to sign. After death, routine last offices are appropriate. Jewish Jewish people may follow a kosher diet to a greater or lesser extent. The most commonly followed prohibitions are pig meat (and any other animal that hasn’t cloven hooves and chews the cud – so beef could be kosher but rabbit not), shellfish (only seafood with a fin and a tail should be eaten) and meat and dairy should not be mixed. A strict Orthodox kosher diet would require that all meat and dairy comes from animals slaughtered in a prescribed way and that meat and dairy are prepared in separate kitchens. Jewish communities traditionally accord high status to those in the medical professions and generally view medical treatment positively. distinguishes between acts that shorten life and those which prevent

This information was correct as of 29/7/2019 LeDeR Programme Fact Sheet 15. V 5-0

the unnecessary delay of death – the latter is permitted. Respect for the dead body is a matter of paramount importance. After a person dies, their eyes are closed, their body is covered (exposing a body is considered disrespectful) and candles may be lit. The body should not be left alone and eating or drinking in the presence of the body is considered disrespectful because the dead can no longer do these things. Most communities have a voluntary organisation to care for the dead, known as the chevra kaddisha (the holy society). A male chevra prepares the men and a female chevra the women. In preparation for the burial, the chevra thoroughly cleans the body and wraps it in a plain shroud. The dress of the body and the coffin should be simple, so that a poor person would not receive less honour in death than a rich person. The body is not embalmed, and no organs or fluids may be removed. Autopsies/ post mortems in general are discouraged as desecration of the body but permitted where it may save a life or where local law requires it. When autopsies must be performed, they should be minimally intrusive. Organ donation may be permitted, because the subsequent burial of the donee can satisfy the requirement of burying the entire body. In , the body must be buried as quickly as possible and not cremated however cremation is increasingly permitted in . Coffins are not required, but if they are used, they must have holes drilled in them so the body comes in contact with the earth. In Judaism, death is a natural process and not a tragedy, even when it occurs early in life or through unfortunate circumstances. An afterlife, where those who have lived a worthy life will be rewarded, is part of the belief system. Mourning practices in Judaism are extensive and have two purposes: to show respect for the dead and to comfort the living. Mormon All who are medically fit, fast for 24 hours on (usually) the first Sunday of each month. Normally these fasts would last from after the evening meal on Saturday until a meal on Sunday late afternoon. Those in hospital may feel well enough to continue with this monthly fast. Stimulants are forbidden, most notably caffeine (coffee, tea, cola drinks), alcohol, and tobacco. Caffeine and alcohol are, however, accepted as ingredients in medicines. Most Latter-day Saints do not object to blood transfusions and may receive transplants or donate organs for transplantation. Meat is eaten sparingly or not at all. The person’s family will normally inform the local Mormon Church, and may invite ministers to pray with them. After death, routine last offices are appropriate. However, some Mormons who have undergone a special Ceremony wear a sacred undergarment, which must be replaced on the body after washing. Muslim Pig-meat is forbidden, as is alcohol and any meat should be halal. Ramadan is an important month of fasting (from before sunrise until after sunset each day), which does not occur at the same time each ‘Western’ year, however rules on fasting are often relaxed for ill people. Muslims will wish to observe segregation of the sexes. A person of the same gender should carry out medical examinations wherever possible. As death approaches, members of the person’s family may wish to gather to recite and passages from the Qur’an with them. The person should be positioned so that they are facing the city of Mecca. After death, the body should be treated with great sensitivity: the remains associated with the body for some time, and some Muslims believe that during this time, the body can still feel pain. Staff should not wash the body, and if possible should avoid touching the body. If staff need to remove IV tubes, catheters, etc., they should wear gloves to prevent direct contact with the body. The family will wish to prepare the body for burial. The preparation will be carried out by family members of the same gender. If this is not possible, then staff wearing disposable gloves should straighten the dead person’s limbs and turn the head

This information was correct as of 29/7/2019 LeDeR Programme Fact Sheet 15. V 5-0

towards the right shoulder. If the body has to be removed to the Mortuary, it should not be uncovered. The burial should take place within 24 hours: the family will make the necessary arrangements, and the Registrar will usually do everything possible to facilitate this. Post mortems are not usually agreed to, unless required by the Coroner. It is considered normal and praiseworthy for Muslims to express their emotions freely at the death of a relative. They should be allowed the space and time to do this, and should be offered privacy. Rituals and prayer are very important to many Pagans, and their needs in this area should be respected. Many have a strong belief in complementary therapies such as herbalism, spiritual healing, and crystal healing. Pagan beliefs about death vary. Most believe in the immortality of the soul, and many believe in . For any special requirements, the person’s relatives should be consulted. After death, routine last offices are appropriate. Sikhs believe in reincarnation, so death may be less threatening to them than it might otherwise be. When a Sikh person is near death, they may be visited by many members of their community (not just their family), who will read to them from the Guru Granth Sahib. This spiritual care of the dying is an important community activity and should be facilitated as far as possible. After death, the religious symbols must not be removed from the body. The family should be consulted regarding last offices. Death is followed by cremation as soon as possible. Their beliefs give many Spiritualists a strong confidence in the face of death: it is merely the transition from this world to the spirit world. Some may ask people to pray for them as they prepare to make the transition. After death, routine last offices are appropriate.

Additional sources of information Religion or belief: a practical guide for the NHS (2009): http://www.clatterbridgecc.nhs.uk/application/files/7214/3445/0178/ReligionorbeliefApracticalguideforth eNHS.pdf A multi-faith resource for healthcare staff: http://hcfbg.org.uk/wp- content/uploads/2013/09/multifaithresourceforhealthcarechaplains.pdf

This information was correct as of 29/7/2019 LeDeR Programme Fact Sheet 15. V 5-0