10 Nursing Considerations for Cultural Variations at the End of Life Religious beliefs and rituals often bring comfort and hope to patients at the end of their lives. Religious and cultural customs are often intertwined and can be manifested by different families in many different ways. Thus, it is crucial to clarify with the patient and family which beliefs and rituals are important and meaningful for them. Likewise, it is important to note that not all individuals who follow a particular religion will accept all of its precepts, so clarifying which aspects of a religion have meaning for each patient is critical in delivering culturally appropriate care. With these caveats noted, this chapter provides an overview of several widely recognized religious traditions, with a particular emphasis on how these religious perspectives may influence patient and family wishes at the end of life. After reading this chapter, you will be able to: ■ Identify how religious traditions can be used to promote comfort for terminally ill patients and their families ■ Discuss key points of five major world religions ■ Provide examples of common end-of-life practices within various faith traditions OVERVIEW OF MAJOR WORLD RELIGIONS Buddhism The central beliefs of Buddhism are rooted in the enlightened teaching of Siddhartha Gautama and offer instruction on how to free oneself from suffering and live in a state of contentedness (Bruce, 2012). Buddhism is a flexible and moderate religion; its practices are often influenced by and evolve with changing cultural traditions (Bülow et al., 2008). Buddhism teaches: ■ Birth and death occur in a cycle. ■ Reincarnation does not necessarily mean that one will return in human form. Rather, one may return in any number of living forms. ■ The circumstances of one’s life and death contribute to the circumstances of one’s rebirth. Thus, it is important to create the conditions for a “good death.” Creating opportunities for a “good death” entails providing an environment in which the dying person can cultivate a calm mental state even as death approaches (Bruce, 2012; Webb & Stouffer, 2014). Creating a peaceful environment may involve: ■ Minimizing interventions ■ Lowering lighting ■ Playing music that the patient and family find soothing Fast Facts in a Nutshell The family may provide an image of the Buddha or create an altar near the patient’s bedside and prayers may be said to comfort the patient (Bruce, 2012). Buddhists believe that after death, it may take several days for one to fully disconnect from the body. Thus, it is best to allow the body to be undisturbed for as long as possible. In the past, some Buddhists were opposed to organ donation because of this belief (Webb & Stouffer, 2014), but these attitudes are shifting, and organ donation is becoming acceptable to some Buddhists (Bülow et al., 2008). Christianity Christianity is a religion rooted in the teachings of Jesus Christ, which are contained primarily in the New Testament of the Bible. Like most other religions, Christians can be considered conservative, moderate, or liberal. There are many branches of the Christian faith, including Catholic, Protestant, Orthodox, and independent churches. Often, when patients identify as part of the Christian faith, they will specify a branch such as “Roman Catholic,” or state that they are, for example “Methodist” or “Episcopalian,” which are branches of Protestantism. Fast Facts in a Nutshell Religious rituals, such as the Eucharist (when bread and wine are shared) and baptism (when a person is washed of sins and welcomed into the faith), have their basis in the religious scriptures. Most Christians incorporate both the Old and New Testaments of the Bible into their spiritual practices, but emphasis is placed on the New Testament, particularly the acts and words of Jesus. The key point in Christianity is the notion that Jesus died and rose from the dead. Based on this critical doctrine, most Christians believe in an afterlife and follow certain tenets of the religion to ensure that they will be acceptable to God at the time of death. Many Christians request special clerical blessings during illness or at the time of death. The practice of confession is common, particularly among Catholics, and involves stating one’s sins to a priest and then receiving a blessing of forgiveness. This may be particularly important for patients in the last weeks and days of life. Practices that may be comforting to Christian patients nearing death include: ■ Reading sections of the Bible ■ Arranging a visit from a patient’s spiritual leader, often called a “priest” or “minister” ■ Arranging for sacraments such as communion (Eucharist) Fast Facts in a Nutshell Christian families may place religious objects such as crosses, medals, or beads near or on the patient. Holy water or oils may also be used to bless the patient. At the time of death, there is no prohibition against removing these objects from the body. However, these articles should be offered back to the family and never discarded. Tending to the sick is a key element of the Christian faith; Christians believe that what is done to one who is sick or in need is done to Jesus himself (Soskice, 2012). Therefore, it is very important to provide space and privacy for family members to be involved in care and to be present with their loved ones as death approaches. Christianity does not include any prescribed rituals for preparing the body; this is left to the preference of the family (Kemp & Bhungalia, 2002). The religion teaches that those who die are in the care of the Lord and extended grief rituals are not largely recognized. In fact, Christians have historically been expected to move on quickly after a loss. However, Western culture has advanced current understandings of grief and mourning and Christian families may increasingly seek counseling or support after the loss of a loved one (Kemp & Bhungalia, 2002). Hinduism The term “Hindu” refers to those who are from a specific area in India (Flood, 1996). Many traditions and beliefs are incorporated within Hinduism; it is a religious tradition without rigid doctrine (Rambachan, 2012). Yet, even though there is not one central leader or set of required beliefs, most Hindus are familiar with the religion’s foundational texts: ■ The Vedas ■ The Bhagavad Gita ■ The Mahabharata ■ The Ramayana ■ The Bhagavata Purana Fast Facts in a Nutshell
(Bruce, 2012; Webb & Stouffer, 2014)
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