Article Figures & Data
Tables
- Box 1.
Christians believe in the resurrection of the dead and everlasting communion with God and that a good death is part of this process
Clinicians should recognise that the cluster of traditions and denominations making up the Christian faith have some theologically grounded variations that may influence end-of-life decisions
Christians believe that life is a sacred gift from God and as such do not allow assisted suicide or euthanasia
Both Roman Catholics and Protestants who are dying may wish to be visited by a person from their church. Roman Catholics may wish to receive the Sacrament of the Sick with anointing (Last rites)
Christians recognise the medical benefits of organ donation (although for many, this should only follow full cardiorespiratory death not merely brainstem death) and do not regard their beliefs as being in opposition to post-mortem
Funerals themselves vary between the different churches and traditions; they typically involve readings from scripture, hymns and eulogies. They are, religiously speaking, celebrations of a person’s life, with thankfulness for the person’s faith and membership of God’s family
- Box 2.
Muslims pray only when ritually clean, and are not able to pray among bodily fluids or waste
Muslims will often wish to bury their dead as soon as possible. Therefore, timely release of the death certificate is vital
The Shariah does not recognise suicide; the right to die is not voluntary and it is forbidden to terminate life prematurely either actively or passively
Islam is not a monolithic religion or set of beliefs and due to a sociocultural variations, some patients will choose to defer to their own scholarly views
- Box 3.
Jewish law is specific, and may appear inflexible; however, rabbinic interpretations and an improved understanding of modern medicine demonstrate that there is flexibility when approaching end-of-life care
Rabbinic involvement in medical decision making is common and may challenge conventional patient autonomy, particularly at the end of life where the threshold for withholding life sustaining treatments in view of ‘futility’ may be higher than western trained physicians. However, this is not universal and careful explanation of treatments and prognosis is vital in allowing the family to make decisions together with rabbis
Patients may request medical interventions which the medical team may be uncomfortable with, as the Halacha requires a physician to do everything in their power to prolong life, but prohibits actions which prolong the act of dying or hasten death
Healthcare professionals should explore and establish the importance of prayer needs, Shabbat observance and the degree of involvement of the rabbi and family in decision making
Jews refrain from actions considered work on the Shabbat, such as writing, carrying, use of electrical devices or business transactions. Be mindful of this when treating patients observing Shabbat, for example when prescribing patient-controlled analgesia (PCA)
A dying patient should not be left alone and Jews will wish to fulfil their obligation of ‘Biqqur Cholim’ (visiting the sick)
Judaism prohibits prayer in the presence of bodily fluids. The dying patient can be incontinent, so if the patient cannot be continually cleansed the family/clinical team should seek rabbinical guidance to determine the correct course of action
- Box 4.
Attempting to generalise in the Hindu patient is difficult. There is no single central authority or compliance with a single doctrine and so practices and traditions will vary greatly
There appears to be a universal belief in reincarnation and karma. Life on earth is viewed as a transition between the previous life and the next one
The family have a duty to assist the dying and to perform the last rites. Additionally, families may wish to protect their loved ones from the prognosis of death
Suicide is frowned upon but some traditions state grounds for voluntary euthanasia to prevent extreme suffering; however, this is a controversial and poorly defined area
Unnecessarily prolonging life when the prognosis is poor is viewed as interfering with karma and reincarnation
Non-faith members are permitted to handle the body provided they are of the same gender
- Box 5.
Sikh beliefs towards end-of-life care are under-evaluated in the medical literature and further studies are required to explore attitudes and mainstream opinion
Sikhs have a strong tradition of accepting death, and believe in karma and reincarnation
The five K’s are of fundamental importance to Sikhs and are to be respected and not removed unless life threatening. Observance of these symbols may become particularly apparent at the end of life
Many Sikhs will forego unnecessary and invasive life-prolonging treatments when it is clear that it is futile
Sikhism is a social religion; therefore, a large number of community members may will wish to visit and offer support
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