End of Life Care for Patients of Main Faiths and Cultures

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1 Correspondence address End Of Life Care Holme Valley Memorial Hospital Huddersfield Road Holmfirth HD9 3TS Helen Green: Kirsty Stubbings: Julie Williams: End of Life Care for Patients of Main Faiths and Cultures Locala Community Partnerships Freepost plus RSTJ-EYJA-UCTB Beckside Court, Bradford Road, Batley WF17 5PW Customer Liaison: This leaflet is available in other languages and can be made available in large print, Braille or on audiotape Follow us on facebook Locala Community Partnerships is always looking for ways to improve services. Please tell us about your experience, either positive or negative, by visiting the Patient Opinion website. We will always respond to your comments.

2 The Golden Rule is to ask the patient in advance and their family/carers what they would like doing in the event of death. Below are some general guidelines: Contact details are also available on Chaplaincy Webpage, and the Trust Chaplains can be contacted via Switchboard for further information:--

3 Baha i If an illness is incurable, Bahá ís can accept palliative treatment if they wish, details of which can be discussed with the appropriate medical professionals as well as with the spiritual caregivers. Whenever possible it is up to the patient to decide, in co-operation with his or her doctors, what course of action to take. If the patient is unable to take decisions on his or her own behalf, the family should consult with the medical professionals. Bahá ís recognize death as a transition to a further stage of life akin to the transition made when a baby is born. It is not for one person actively to end the life of another, so euthanasia is not permitted, although it is recognized that steps to ease suffering may, as a side effect, shorten life and this is accepted. There may come a time in the life of the patient when it becomes appropriate to withhold treatment, other than the palliation of suffering; the family will wish to discuss this with the relevant medical professionals. Of course, Bahá ís and their families are just as prone to fear death, or at least the bereavement that death brings, as anyone else. An important part of the role of the spiritual care giver at this

4 stage will be to lovingly remind the Bahá í patient of Bahá u lláh s teachings about the joy that he or she will experience in the next life and to help the patient, through prayer and love, to accept the transition. The spiritual care giver may also offer comfort to the bereaved family. The body of the deceased is treated with respect and should be buried, not cremated, within an hour s journey of the place of death. A Bahá í who is near death does not require the intervention of a spiritual care giver or chaplain, but clearly they will want to have their loved ones around them at that time. There is no ritual or sacrament associated with death. If there is time to prepare for death, it is very much up to the individual and those close to him or her to choose how to approach this.

5 arrive. The body should be covered with clean linens and shrouded. If a Sikh representative is required, please contact the Chaplaincy Department, or contact the person listed on the webpage for Contacts. Buddhism A side room would be appreciated where possible. Buddhists would like to be fully informed about their imminent death to enable them to make their preparation for it. Buddhists recognise that death is the ultimate barrier or fear for most people. Because Buddhists believe the state of mind of dying patient will influence their rebirth they therefore place considerable importance on a state of conscious and focused peace as the best preparation for death. This may mean a reduction of certain drugs that reduce consciousness. Post Mortem There are unlikely to be any objections. However many Buddhists may find the thought of post mortem distressing. It would be very helpful, if possible, to reassure families that the body will be complete and repaired for burial or cremation. After death the need to inform a fellow Buddhist is important. The family may do this but if unavailable the chaplain may fulfil this function.

6 It is traditional for the body to be left undisturbed for some time to allow any remaining consciousness to depart. There is a strong tradition in some strands of Buddhism that consciousness remains unattached to the body for several days after death ( bardo ), so it is desirable that an atmosphere of peace surround the deceased, and prayers and chanting is performed and so a request might be made for a Buddhist monk or nun to be present. Otherwise there is no prescribed ritual for the handling of the corpse of a Buddhist person; so customary laying out is appropriate. Generally cremation is preferred. If a Buddhist representative is requested please see the adjoining contact list. Sikhism Health care providers, including nurses, physicians and chaplains should comfort the terminally ill patient, making sure he/she is painfree, have his/her relatives and friends nearby, and have access to a Sikh Granthi (a Sikh), who can recite Gurbani (writings of the Gurus) and perform Sikh prayers. At the departure of their loved ones, Sikhs console themselves with the recitation of their sacred hymns. Family members, (especially the eldest son) and friends will be present if they are able. The family usually takes responsibility for the last offices, but nursing staff may be asked to close the patient s eyes, straighten the body and wrap it in a plain white sheet. Do not remove the five 5Ks (hair, comb, bangle, sword and shorts see main webpage), which are personal objects sacred to Sikhs. With minimum delay, the body is to be removed to the funeral home for expeditious cremation, unless the family is waiting for a close relative to

7 Put the arms parallel and close the side of the body leaving the hands open. Straighten the patient s legs. Remove tubes and instruments (unless contaminated). Patients must not be washed (unless relative state otherwise), but may be dressed in a plain shroud. The body would usually be washed by a nominated group. Relatives may wish to keep vigil over the body. If death happens during the Sabbath (Between sunset on Friday and sunset on Saturday), the body should be left. Seek advice of relatives. Burial ideally should take place as soon as practicable preferably within 24 hours of death and will be delayed only for the Sabbath and major Festivals. The immediate family will set the ritual proceedings in motion. Guidance is available in an absolute emergency using the contact details given on these webpages. Christian Some Christian patients may especially value prayer and anointing of the sick before an operation or approaching death. The family/significant others may also welcome the support of a chaplain at the time of a patient s dying or death. Many patients committed to a particular church or denomination will already be receiving support from their own faith community. In addition to this, a Roman Catholic / Orthodox patient and their family may request to be visited by the priest with Holy Communion and the Sacrament of Anointing (the last rites ) especially as death approaches. This may include making a confession of sins. The priest should be called as early as possible, especially if the patient has not been seen before. Following death, there are no specific care requirements, but that the body is treated with dignity and respect. If the patient or their family practiced the Christian faith, it should be asked whether prayers of commendation of the patient to God s care and keeping are required. Post-mortems are usually acceptable.

8 If a Christian chaplain is required, please contact Switchboard for the chaplain on duty (Church of England / Free Church {i.e. Methodist, Baptist, United Reform, Pentecostal} - both during the day and out of hours), or request the Roman Catholic priest. For those of other Christian denominations, please contact the Church of England / Free Church chaplain on duty for assistance. Judaism According to Jewish law and tradition a dying person should not be left alone and many families will wish to sit with their relatives during the last days/hours. A dying Jew may wish to hear or recite special psalms and a special prayer (shema) and may appreciate being able to hold the page on which it is written. These prayers can be said on their behalf by a relative or a Rabbi but it is stressed that a Rabbi is not essential and that if these prayers are not said nothing untoward has occurred. On death Eight minutes are required to elapse before the body is touched. Usually relatives will straighten the body, but nursing staff are permitted to perform any procedure for preserving dignity and honour. Nurse may: Close the eyes. Tie up the jaw.

9 Islam / Muslim Procedure at death do not wash the body. Ideally the body should be untouched by non- Muslims. Family members will probably want to perform the last offices. Where no relatives are available, staff should wear gloves to avoid direct contact with the body. The body should face Mecca and the head should be turned towards the right shoulder before rigor mortis begins. The body can be made respectable in the usual way i.e. combing hair and straightening limbs BUT the family will ritually wash the body before burial. Burial normally occurs within 24 hours of death. The local coroner and registrar have special arrangements in place for this. Post-mortem only permitted if required by law. If a Muslim representative is required, please contact the Chaplaincy Department, or contact the chaplain / spiritual adviser listed on the webpage for Contacts. End of Life Care Hinduism Before death a Hindu desires to offer food and other articles of use to the needy, religious persons or to the Temple. These gifts will be brought by the relatives for the patient to touch. A Hindu would like to have the leaves of the sacred Tulsi plant and Ganges water placed in his mouth by relatives before death. Therefore warn the relatives if death is imminent. Offering a calf (female) is symbolised by placing "Kusha" grass under the bed. Hindu patients would like to die at home wherever possible. On Death Consult the family asking if they wish to perform the last rites. It must be understood that some Hindu families can be very sensitive about who touches the body after death. All handling should be done wearing disposable gloves. Staff need also to be sensitive and aware of the fact that the washing of the body after death is a traditional part of the rituals carried out by close family members. If required by relatives, inform the Hindu

10 priest (Brahmin). If unavailable,relatives may wish to read from the Bhagavad Gita or make a request that staff read extracts during the last offices. The family may wish to stay with the patient during last offices. Do not cut nails or trim beards without family consent. The hands should be placed on the chest with the palms together and the fingers placed just under the chin, in the traditional Hindu sign of greeting. under five) families may be concerned that all organs are returned to the body. Coping with the unfamiliar organisational side of death in Britain can be extremely distressing to bereaved relatives. Careful explanation and practical help may be needed. If a Hindu representative is required, please contact the Chaplaincy Department, or contact the person listed on the webpage for Contacts. If no family member is available the following procedure should be followed: Wearing disposable gloves, close the eyes and straighten the limbs. Jewelry, sacred threads and other religious objects should not be removed. Wrap the body in a plain sheet without religious emblems. In most cases it should not be washed as this is part of the funeral rites and will usually be carried out by relatives later using Ganges water, which is collected from the Temple. Post mortems are disliked but are accepted if required by law. As the body should be complete when cremated (or buried in the case of a child