Caring for Dying People of Different Faiths

Rabbi Julia Neuberger

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781857759457
• eBook ISBN: 9781315358420
• Edition: 3
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

'This book is a tribute to expert nursing. It should be seen as a celebration of all that is good in nursing. It also sets out the path for nursing that is centred on relationships - the essence of person-centred nursing is based on the quality of relationships both between nurse the client and others and also between nurses their colleagues and peers. Increasingly it is a challenge for nurses to hold on to humanistic care when we practice in a world of healthcare which is performance and fiscally driven. The concept of partnership and reciprocity runs through the book like a golden thread gleaming in a rich tapestry of person-centred practice expressed via the perspectives of the contributors. Expert practitioners working with people who have dementia have led the way in the development of person centred practice.' Pauline Ford Advisor in Gerontological Nursing Royal College of Nursing 'This book is a compendium of contemporary dementia care practice. It provides knowledge that is the foundation for a clear path to successful care outcomes. It clearly leaves no room for the ignorance that produced the uncertainty and inconsistency of past practices. If dementia can be likened to a journey of highs and lows this book shows us how to eliminate the negatives and accentuate the positives.' Bob Price Director Alzheimer Education Australia

1

Introduction to caring for dying people of different faiths

There is a real problem for many of us who are called upon to look after patients whose religion and customs are different from ours. It used to be easy. Britain was primarily a Christian society; in some ways it still is, but now many people in Britain are from totally different religious backgrounds, with quite different practices and beliefs. There are also many people who have no specific religion or religious and cultural tradition which might give them comfort, help and succour in the last days, weeks or months of their lives, or the lives of those they love. They are often the people who have most difficulty in knowing how to behave at the very end, for there is no very obvious ritual for them to follow, and that can be exacerbated for family and friends who are left behind if they too are not sure how to behave and what to do.

Finding out about the patient’s beliefs

It is often tempting for carers, especially those with religious convictions, to assume that those who profess to a religion on a hospital form are in fact what they have stated, that is to say, for example, a practising and believing Muslim, Hindu or Jew. It cannot be stressed too often that this is no more likely to be true than if someone puts ‘Church of England’ down on the same form. It is quite likely to be merely a matter of labelling, of saying – in an increasingly diverse society that nevertheless recognises communities – that this is the community to which I belong.

Nevertheless, labels are important. It is not uncommon to find people who would describe themselves as agnostic Jews, Hindus or Muslims. This is because, for many people from the Indian sub-continent or those who have lived as minorities in Europe for centuries, the issue is not a straightforwardly religious one. It is to some extent anthropological; it is about ways of living lives, grouping ourselves within a community, marking the life-cycle occasions of births, marriages and deaths, and of distancing ourselves from other groups. Community is often defined by religious affiliation: one is a Muslim, Sikh, Hindu, Jew, Christian or whatever because of one’s roots (very often because of one’s name alone), regardless of beliefs or current religious practice. The distinguishing marks are often to do with what one eats and how one disposes of the dead and so on.

While the labels need to be respected, and food that is forbidden in one religion or another should not be served, it often requires a great deal more sensitivity than just reading the form to find out what the patient’s religion is. Often the person concerned will volunteer information if asked in the right way: ‘Well, you know, I’m not too bothered whether or not I see a priest … I’m not really religious. Sometimes the family will make it very clear: ‘Well, we’re Jews, you know, but we don’t practise much … I shouldn’t bother unduly’. The opposite may also manifest itself. The patient may become agitated and be comforted only by seeing a priest or by performing some ritual on his own in order to assuage some guilt or confusion. The family may tell the staff that the patient is deeply religious and often help the staff to provide the best possible care for the individual concerned. However, sometimes it turns out that it is the family that wants all the rituals, rather than the individual himself.

In all of these situations the burden on staff in the hospital, community or hospice is considerable. This has not been recognised until comparatively recently, because in a rather absurd way it was always believed that the hospital chaplain or the patient’s own spiritual adviser could handle any problems. That time is now past. Hospital chaplains are often vastly overburdened and cannot cope with all the cases they see. In the case of faiths other than Christianity, moreover, chaplains and official hospital visitors are often themselves very part-time. So nowadays carers themselves need the ability to handle such problems, in order to give proper and full care to seriously ill patients, for whom these religious and socio-religious concerns are of great importance.

Recognising the patient’s needs

A great degree of comfort can be brought to a seriously ill or dying patient by the recognition of what their needs might possibly be. The fact that someone has bothered to ask whether it would be helpful to have a Bhagavad Gita or a pair of Jewish Sabbath candlesticks, or a Koran or a few drops of Ganges water brought in, makes all the difference to the individual who feels he is in unfamiliar surroundings and is often in pain or discomfort. Suddenly, here is someone who knows what might be required, who has taken the trouble to find out something about the individual patient’s religion and culture, and who is offering to make special provision for the individual. It can make the difference between the patient regarding himself as just another person on the hospital conveyor belt or as someone whose individuality is being taken seriously. It can be enormously helpful, transforming the attitude of the patient concerned who may suddenly become more co-operative in treatment. The patient’s relationship to the staff will also be enhanced with those who have shown such interest.

However, the converse can also be true. Some patients may describe themselves as Jews, Hindus or Muslims yet become quite angry when any offer of spiritual help is made. When nurses ask about their level of religious practice some patients may regard this as ‘nosy and inquisitive’. The sensitivity required in this area is enormous; it is all too easy to upset a patient by forcing, or seeming to force, his own religion upon him. What has to be developed is a sensitivity towards the possible requirements of an individual patient, with some knowledge of the religious tradition from which he comes, rather than imposing an abandoned, half-forgotten, religious tradition upon him.

Recognising the different forms of each religion

Once a nurse has established that there is a need for, an interest in, or a willingness to find out what is available, she must be very careful to recognise all the different sects of every religion, for by no means all believers in a particular religion share the same degree of observance or the same theological beliefs. Indeed, many people who argue that they are from the same religion turn out to have less in common with each other than with people who hold the same intellectual position in other religious groupings. A classic example of this is the similarity, in some aspects, between Christian fundamentalists, the people who believe that there is no human element in the story of the Gospels and who argue for a strong belief in Hell, and orthodox Jews who believe quite literally that God gave the Torah, the Five Books of Moses, to Moses on Mount Sinai. Those intellectual positions, undoubting and uncritical, have in some ways more in common with each other than either does with the more liberal view in their own religion.

In most, but not all, religions, there is an orthodox and a progressive or liberal wing. There are also variations in types of the religion, as distinct from intellectual position, often due to the country or area of origin. Thus there are Shi’ite and Sunni Muslims, Ismaili Muslims, followers of the Aga Khan, as well as Ahmaddiya who are a rather different group. There are Sephardi and Ashkenazi Jews, who may be orthodox, conservative, reform or liberal by grouping. There are Roman Catholics and various types of Christians from the Protestant traditions, from the established to the free churches. There are Hindus of a wide variety of beliefs and there are more and less fundamentalist Sikhs. There are Chinese Christians and Chinese Buddhists, who nevertheless share a great deal in respect for ancestors, and there are Shintoists and Buddhists from Japan, again linked by ancestor respect.

All these variations and shades of view need to be borne in mind by anyone caring for people belonging to religious, cultural and ethnic groups with which the nurse is less than familiar. However, it is not all that difficult. The truth of the matter is that usually the patient or the patient’s family is so delighted that any interest is being taken in their religious or cultural life that they will pour out information and detail, and in fact leave the nurse who asked the original question feeling that she has opened up an important and sensitive area. Nurses can learn much from this experience. It can also be immensely exciting. Nevertheless, before the learning process can begin properly, it is as well to have in mind where the main differences in attitudes tend to lie.

Areas for examination

The first requirement for anyone caring for a patient and wishing to recognise his spiritual and cultural needs is to know something of the basic beliefs of the religion concerned. In each of the succeeding chapters, a very brief and therefore necessarily simplistic summary of beliefs has been given. These range from belief in God or gods to concepts of the afterlife and immortality of the soul, from the nature of human life to the idea of sacred texts. When dealing with the dying patient, it is very important to have some idea of his beliefs about immortality of the soul and the afterlife – for obvious reasons. However, those are not the only areas of interest and a more general knowledge can be very helpful.

One basic and practical consideration is whether there are last rites – whether there are rules about who can touch the body, questions about confession, about prayers, about leaving the dead person alone and so on. These are listed in no specific order, just as they occur in the course of the nurse’s duties. One of the reasons for writing the first edition of this book nearly 20 years ago was to try and order the thinking about these issues, and to see how prohibitions and taboos in various religions link in with the basic structure of their beliefs. For instance, it is impossible to understand laws and prohibitions about not leaving human bodies alone after death without having some idea of what that particular religion or philosophy has to say about the nature of human life and its value. Without that, the most common response is for the nurse to try to impose her own views – for want of anything ‘better’ to do. This is rarely done out of arrogance or a desire to effect a bedside conversion, but merely out of a lack of understanding and sympathy.

In each case, questions need to be asked about the value of human life. These need to be expanded into questions about the nature of human life in the here and now, as against any future life or spiritual immortality. Then there is the whole area of what it is permissible to do with or to the body – what parts can be replaced in transplants or whether that has any effect on the nature of individual immortality. What is the attitude to pain relieving drugs which can, arguably, shorten life? How firmly held are beliefs in this area? The questions are endless and by no means easy to answer, but a nurse who wants to give comprehensive care to patients who hold views different from her own at least needs to grapple with the questions, even if she does not know the answers. More than that, she needs to think out her own views on these subjects, because only with a secure basis to one’s own thinking can one really learn and understand other people’s.

Once attitudes to human life itself have been thought out, other issues have to be considered. For instance, what does that particular religion say about last rites? Some religious groupings, notably Roman Catholics, regard them as essential. In others, there are no such things. In some religions, it would be normal and right for a person to be told if he were dying, if he did not already know. In others, this would be anathema, for he might then not make the effort at recovery and lose the will to fight which might give him a little longer of this life here on earth.

All these are issues which need to be explored, for they may materially affect the way the patient is treated. They may also help the nurse to understand the patient she is caring for in the last stages of life. Many people have a real need for spiritual care and comfort in these last stages, but they are not always available from chaplains and visitors, nor indeed are these always the only appropriate people to give them.

Obviously, we are dealing here with some fundamental questions about the nature of nursing, and the extent to which nursing care covers the spiritual aspect of life. Twenty years ago this was a subject barely touched upon in nursing training and education, or in debates about what was properly part of nursing care. Now, however, books are written, articles published in learned and professional journals, conferences are over-subscribed and short courses over-booked, such is the interest in spiritual care in nursing, long overdue though it is. Nevertheless, for practical purposes, all nurses need some basic knowledge and the life, in those last days, weeks and months, of many dying patients will be immeasurably improved if nurses have some awareness of their spiritual needs, and try, very unobtrusively, to minister to them.

Two last points need to be made.

•  Nurses themselves should not underestimate just how stressful dealing with dying patients and their families can be. It can often make the whole process much easier if the nurse herself knows something of what the expectations of the patient and the family are likely to be.

•  This book is just a beginning; it tries to set some of the boundaries and to introduce the caring nurse to some of the philosophies, religions and ways of life her patients may have.

Anyone who wants a thorough knowledge of the subject or subjects, however, would be well advised to read, study and discuss these issues in greater depth, and some titles which might be helpful can be found in the bibliography at the end of this book.

2

Judaism

Story of the Jewish people and their faith

Judaism is a religion largely of a people, the Jews. Whilst by no means distinguishable by ethnicity (there are black, brown and white Jews of a variety of different racial types), there is a strong sense of people-hood amongst the Jews and a sense of group loyalty and support for each other. The old adage used to be that Jews looked after their own’ but, although that is true in some circumstances, it is by no means universal and Jews suffer a great deal from the fragmentation of families found throughout British society.

Jews regard Abraham as the founder of Judaism. In terms of the Bible stories, Abraham was the first of the three patriarchs who together are regarded as the founding fathers of the people of Israel. Jacob, Abraham’s grandson, had the name Israel conferred upon him and his descendants at the end of a nightlong struggle with a mysterious stranger. According to the Bible, the two wrestled until dawn. The stranger then asked to be released. Jacob refused to do so without a blessing. The stranger asked his name and, when told, said:

You shall no longer be called Jacob, but Israel, for you have striven with God and with Man and have prevailed.

The name ‘Israel’ that attaches to the Jewish people and later to the Jewish state means ‘one who wrestles with God’.

The history of Judaism is more complicated, however. Whatever the historical truth of the journey from Ur of the Chaldees to the land of Canaan, with Abraham following a divine call, Judaism as a religion regards itself as the product of two journeys. The first is Abraham’s, with Lot, of the early stories in the book of Genesis. They went from Mesopotamia to the land of Canaan and Abraham settled there and made it his tribal home. Then, three generations later, there was a famine in the land and they journeyed to Egypt to get food, where they encountered Joseph who had been sold into slavery by his brothers who could neither stand his arrogance nor their father’s favouritism towards him. Joseph became vizier to one of the Pharaohs and was in charge of food supplies. He recognised his brothers and eventually invited them all down to Egypt, where they lived happily for some time. Then there came a Pharaoh ‘who knew not Joseph’ and who started treating the Israelites as slaves. From that point, things became worse and worse until, led by Moses, they left Egypt (the Exodus) and journeyed for 40 years in the wilderness before reaching the promised land.

To what extent this is actually true, in that it can be proved historically, is a matter of considerable debate. What can be said, however, is that the folk memory of journeying from slavery to freedom became one of the most important motifs in Jewish thought. The reminders are constant – in one version of the Ten Commandments, for instance, the reason for observing the Sabbath is given as having been slaves in Egypt. The implications are twofold: firstly, that you know what it is to have no rest, and secondly, that you should give your servants and animals rest, precisely because you know what it is to be a slave.

Because this is such a strong motif in Judaism, the Egypt experience, as one might describe it, figures large. The Sabbath, for those who are religious, is of great importance. The festival of Passover, despite not being as important a festival as the New Year and the Day of Atonement (jointly termed the High Holy Days), is of great sentimental and emotional value to even the most disaffected Jews. They regard themselves as if they had been there, as if they had been freed from Egyptian slavery.

During the journey through the wilderness, the children of Israel were given the Torah or the Pentateuch and became governed by the rule of law. Orthodox Jews believe that the Torah was handed down literally by God to Moses on Mount Sinai. Progressive (conservative, reform and liberal) Jews believe that it was divinely inspired, but written down by human beings at different times, and that there are contradictions within it and elements which are human rather than divine. The extent to which Jews stick to the letter of the law varies considerably. Their degree of adherence to Jewish law can only be found out by asking them.

Though practice varies, most Jews, however unobservant, would understand the expression ‘performing a mitzvah’. Literally this means performing a commandment, but has come to mean doing a good turn. Jews who hold no religious beliefs themselves would often feel sufficiently Jewish to be offended by crucifixes hung all over the walls, or by being asked to kneel for prayers which Jews never do.

It is worth mentioning perhaps th...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Acknowledgements
• 1 Introduction to caring for dying people of different faiths
• 2 Judaism
• 3 Christianity
• 4 African and Afro-Caribbean beliefs and customs
• 5 Islam
• 6 Hinduism
• 7 Sikhism
• 8 Buddhism
• 9 Chinese beliefs and customs
• 10 Japanese beliefs and customs
• 11 Humanism
• 12 People as individuals
• General information and bibliography
• Index