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A Time for Listening and CaringSpirituality and the Care of the Chronically Ill and

Christina M. Puchalski

Print publication date: 2006

Print ISBN-13: 9780195146820

Published to Oxford Scholarship Online: November 2011

DOI: 10.1093/acprof:oso/9780195146820.001.0001

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(p.387) B Religious Beliefs and Practices

(p.387) B Religious Beliefs and Practices

A Time for Listening and Caring
Oxford University Press


General Information. Buddhism is a religion and a philosophical system of beliefs followed by 300 million people. It is based on the teachings of Siddhartha Gautama Buddha, born in Nepal in 6th century Be, who focused on living ethically in this world and achieving enlightenment. The focus on the search for awareness and attainment of unconditional compassion is encouraged. Spiritual practices such as meditation, contemplation, Yoga, and chanting provide guidance, comfort, and meaning. Relief of suffering can be achieved by following the Noble Enlightened Path.

Suffering. In Buddhism, it is believed that life is suffering, which originates in attachments and in avoiding pain. One can end suffering by letting go of attachments. Suffering results in ignorance, selfish desires, and attachments to illusions.

Diet. Different branches of Buddhism have different dietary regulations.

Death. In Buddhism, there is a belief in reincarnation, but not in immortality of both body and soul. No underlying self migrates to the next reincarnation. The dying person's state of mind is important. To help patients achieve peace of mind, family, friends, and monks read religious texts and repeat mantras to the dying person. After death, the body is washed, dressed in burial clothes, and cremated. Some Buddhists believe the dead person's conscious soul remains around or in the body for several days, so monks are invited to chant sacred texts to assist the dead person's passing to the spiritual world.

Ethical Issues. Buddhists believe that it is good to continue living, but when the mind is no longer alert or the person is in excessive pain, a natural death is preferable. Allowing a person to die a natural and peaceful death is essential.

(p.388) Christianity

General Information. Christianity is a religion followed by 1.8billion people. It is based on the life and teachings of Jesus Christ, who is God incarnate, fully divine and fully human. In Christianity, there is a belief in humanity and the need to develop selfless and unconditional love for God and other people, following God's example of his love for humankind. Christians believe in the doctrine of the Trinity, which affirms that God is three in one being (Father, Son, and Holy Spirit). Guidance and inspiration comes from the Bible. It is believed that Jesus died so that man's sins are atoned for. The Scriptures and the Ten Commandments describe the righteous life. Spiritual practices such as prayer, sacraments, rituals, meditation, and religious service offer comfort and meaning.

Suffering. Some Christians believe suffering is caused by sin; others see suffering as an unexplainable part of living or a result of alienation from God. Suffering is relieved by surrender to God's will for the person and acceptance of God's will.

Diet. In Christianity, diet varies with tradition. Some people choose to fast on particular religious days. Catholic Christians abstain from eating meat on Ash Wednesday and the Fridays of lent (hospitalized or ill patients are excused).

Death. In Christianity, death is seen as a natural part of life. It is believed that each person has a soul that is unique and immortal. Some Christians welcome dying as a way to a full union with God and believe that in life one prepares for dying and for that union with God. Many Christians believe death results in a temporary separation of body and soul; full union will occur after Christ's second coming. Many Christians also believe that after death, the soul is judged and either remains in heaven or hell. Family, friends, priests, or ministers pray or sing at the bedside of the dying person. For Catholic Christians, the sacrament of the Anointing of the Sick (formerly known as last Rites) or prayer ritual, called Viaticum, bring peace and comfort. Christian funeral practices vary from simple observance to elaborate rituals.

Ethical Issues. End-of-life care organ donation decisions vary. Most Christians put emphasis on respect and value of life but also view quality of life and dignity of the human person as central to decision making.

(p.389) Hinduism

General Information. Hinduism is a religion of 700 million people, an amalgam of many traditions, rituals, devotions, and philosophical beliefs developed over the past 4,000 years. Polytheism (worshiping of or believing in more than one deity) is the basis of Hindu worship, although Hindus believe in the essential oneness of ultimate reality, called Brahman (God), Spiritual practices, such as Yoga, focus on developing selflessness and transforming awareness and finding meaning. Devotional prayer and Hindu scriptures provide comfort and insight.

Suffering. There are thee main causes of suffering in Hinduism:

Physical and psychosocial pain: This can be alleviated with medication.

Ignorance: This can be alleviated with education and increased insight.

Restricted sense of being: This can be alleviated by realizing that an eternal self (Atman) underlies the human self, which is part of the ultimate reality.

Diet. Vegetarianism is recommended.

Death. In Hinduism, death is considered natural and unavoidable, but not real. Only Brahman and Atman are ultimately real. Hindus believe in an eternal soul that transgresses from one reincarnation, to another. Religious rites and ceremonies provide support to the dying person and family members. A son or relative puts water from the Ganges River in the person's mouth to bring peace. Family members and friends sing devotional prayers, read Hindu scriptures, and chant. After the death, the body is washed, anointed, and dressed in new clothes. The hair and beard of the person are trimmed. Cremation offers the best way for the soul to begin its journey.

Ethical Issues. Mercy killing, assisted suicide, and suicide are disapproved of, but letting nature take its course is acceptable. Having a living will and organ donation are both individual choices.


General Information. Islam is a religion of approximately 970 million people that is based on the teachings of the Prophet Muhammed. Muslims believe in one God who is all-powerful, compassionate, and immortal. After death, the soul is judged by God, and remains in either heaven or hell. Guidance and comfort are provided by the Koran, prayer, rituals, and fasting. Muslims believe that the Five Pillars of Islam, the Ten Commandments, and the Golden Rule describe the righteous life.

(p.390) Suffering. According to Islamic belief, suffering is caused by alienation from the will of Allah and relieved by total surrender to His will, as embodied in the Koran.

Diet. Most Muslims follow rigid dietary guidelines (no pork, no alcohol) and are required to wash specific parts of the body before each of the required daily periods of prayer. Assisting with daily prayer and dietary and hygiene requirements is important for spiritual care of Muslims.

Death. In Islam, creation, death, and resurrection are linked. Life is viewed as a time of preparation for the soul to pass into life after death. To struggle against death is viewed as resisting the will of Allah. Muslims who are dying usually want to lie toward Mecca. When a Muslim person is dying, family members repeat prayers, read Islamic scripture, and encourage the patient to repeat the statement of faith. After death, the unwashed body is wrapped in a plain sheet, the feet are tied together and the face is bandaged to keep the mouth and eyes closed. At the mosque or at the person's home, the body is bathed, perfumed, wrapped in white cotton, and buried as soon as possible.

Ethical Issues. It is permissible to use life support to save and lengthen life. The purpose of oppressive medical intervention is to maintain the process of life but not to postpone death. While it is not permissible to disconnect life support, because that will cause death, it is also not permissible to cause harm to the patient with equipment and drugs when the futility of such treatment is established by the medical team. Physician-assisted suicide is prohibited.


General Information. Judaism is a religion of 17 million people, which is based on the belief of one eternal God who is omnipotent and all-knowing. Followers rely on the Hebrew Bible, including the Ten Commandments, for spiritual authority on righteous living. Scriptures, religious rituals, family relationships, and their history as a people provide comfort, identity, and meaning.

Suffering. In Judaism, suffering results from the disobedience of God's laws as described in the Torah. Suffering is relieved by asking for God's forgiveness, living in accordance with God's divine will, and living in a righteous way for the good of the whole.

Diet. Many Jews observe a kosher diet.

(p.391) Death. There is a wide range of beliefs in Judaism concerning the afterlife, from no specific belief to immortality of the soul. Death is viewed as a necessary part of God's creation, not a punishment for sin. Some Jews believe in hope for personal salvation and the coming of a Messiah. Others view salvation as an assurance of the continued existence of the whole of creation rather than eternal life for an individual. The Jewish tradition is to focus primarily on how life is lived on earth rather than on events after death. There is a belief that dying patients should be attended to constantly. Family, the rabbi, and friends read from specific religious texts and recite psalms. The dying are encouraged to pray for forgiveness. After death, the body is washed and prepared for burial, which is done within 24 hours. The Kaddish (mourner's prayer) is recited after the funeral service. A7-day period of mourning is observed.

Ethical Issues. The importance of life is fundamental to all decision making, but the belief that dying must also be done with dignity also imparts decisions. There are many different views on removing life support. It's important to consult the family and the rabbi in each circumstance.

Native American Spirituality

General Information. Many followers of Native American spirituality regard their beliefs and practice as an integral part of their being, not so much as a religion. Because of the wide range of habitats in North America, different tribes evolved different spiritual beliefs and practices to match the lifestyle and needs of the individual tribe. Many Native Americans follow other religious traditions, such as Christianity, yet also retain their traditional beliefs and practices. Many tribes have complex forms of sacred forms of writing; others have passed on their spiritual beliefs as an oral tradition. Native Americans may believe in a Deity; some believe in a dual divinity—a Creator responsible for creation, who is recognized in ritual and prayers, and a mystical individual who teaches culture and behavior. There are also spirits who control the weather, inhabit the underworld, and interact with humans. Shamans are healers whose bodies are occupied by spirits during ceremonies.

Suffering. According to Native American beliefs, everything physical has a spiritual counterpart that is more important. Everything and everyone has an inherent purpose. A person has a spiritual definition; when that spiritual definition is not recognized in others or in oneself, suffering occurs.

Diet. Varies.

(p.392) Death. In general, native religions have no-precise belief about life after death. Some believe in reincarnation. Others believe that humans return as spirits, and others may believe that nothing can definitely be known about life after death. Dying at old age is a blessed event, a time to celebrate the prosperity of the community; the life of the deceased is commemorated and placed in etermity. An untimely death at a young age may be seen as a sign of trouble ahead.

Ethical Issues. Most Native Americans view death as natural. However, for specific preferences for treatment at the end-of-life, one needs to discuss that with each person, family, and/or shaman, as beliefs and values can vary.