Religion and End-of-Life Care

AMISH AMERICANS

  • Funerals are conducted in the home without a eulogy, flower decorations, or any other display; caskets are plain and simple, without adornment.
  • At death, a woman is usually buried in her bridal dress.
  • One is believed to live on after death, either with eternal reward in heaven or punished in hell.

BUDDHISM

  • A shrine to Buddha may be placed in the client’s room.
  • Time for meditation at the shrine is important and should be respected.
  • Client’s may refuse medications that may alter their awareness (such as opioids).
  • After death, a monk may recite a prayer for 1 hour (need not be done in the presence of the body).

CHRISTIANITY (Catholics and Orthodox religions)

  • A priest anoints the sick.
  • Other sacraments before death include reconciliation and holy communion.

CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS  (Mormons)

  • May administer a sacrament if the client requires.

JEHOVA’S WITNESS

  • Do not believe in sacraments.
  • Will be excommunicated if they receive a blood transfusion.

JUDAISM

  • Prolongation of life is important (a client on life support must remain so until death)
  • A dying person should not be left alone (a rabbi’s presence is desired).
  • Autopsy and cremation are forbidden.

HINDUISM

  • Rituals include tying a thread around the neck or wrist of dying person, sprinkling the person with special water, and placing a leaf of basil on their tongue.
  • After death, the sacred thread is not removed and the body is not washed.

ISLAM

  • Second degree male relatives such as cousins or uncles should be the contact person and determine whether the client or family should be given information about the client.
  • Client may choose to face Mecca (west or southwest in United States).
  • The head should be elevated above the body.
  • Discussions about death usually are not welcomed.
  • Stopping medical treatment is against the will of Allah (Arabic word for God).
  • Grief maybe expressed through slapping or hitting the body.
  • If possible, only a same-gender Muslim should handle the body after death; if not possible, non-muslim should wear gloves so as not to touch the body.

PROTESTANT

  • No last rites (anointing of the sick is accepted by some groups).
  • Prayers are given to offer comfort and support.

 

Religions and Dietary Practices

Buddhism

  • Alcohol is prohibited.
  • Many are lacto-ovo vegetarians.
  • Some eat fish and some avoid only beef.

Church of Jesus Christ of Latter-Day Saints (Mormons)

  • Alcohol, tea, and coffee are prohibited.
  • Consumption of meat is limited.
  • The first Sunday of the month is optional for fasting.

Eastern Orthodox

  • During Lent, all animal products, including dairy products are forbidden
  • Fasting occurs during Advent.
  • Exceptions from fasting includes illness and pregnancy.

Jehovah’s Witness

  • Any foods to which blood has been added are prohibited.
  • They can eat animal flesh that has been drained.

Judaism

  • Orthodox believers must adhere to dietary kosher laws: meats allowed include animals that are vegetable eaters, cloven-hoofed animals, and animals that are ritually slaughtered. fish that have scales and fins are allowed, any combination of meat and milk is prohibited.
  • During Yom Kippur, 24-hour fasting is observed.
  • Pregnant women and those are seriously ill are exempt from fasting.
  • During Passover, only unleavened bread is eaten.

Hinduism

  • Many are vegetarians. Those who eat meat do not eat beef or pork.
  • Fasting rituals vary.
  • Children are not allowed to participate in fasting.

Islam

  • Pork, birds of prey, alcohol, and any meat product not ritually slaughtered are prohibited.
  • During the month of Ramadan, fasting occurs during daytime.

Pentecostal

  • Alcohol is prohibited.
  • Members avoids consumption of anything to which blood has been added.
  • Some individuals avoid pork.

Roman Catholicism

  • They avoid meat on Ash Wednesday and Fridays of Lent.
  • They practice optional fasting during Lent season.
  • Children and the ill are exempt from fasting.

Seventh Day Adventist (Church of God)

  • Alcohol and caffeneted beverages are prohibited.
  • Many are lacto0ovo vegetarians; those who eat meat avoid pork.
  • Overeating is prohibited; 5 to 6 hours between meals without snacking is practiced.

 

Organ and Tissue Donation by Religious Affiliation Part 3

Islam

The Modern Religious council initially rejected organ donation by followers of Islam in 1983, but has reversed its position is provided that the donor’s consent is in writing in advance. The religion of Islam believes in the principle of saving human lives. According to A.Sachedina in his Transplantation Proceedings article, “Islamic Views on Organ Transplantation” “…the majority of the Muslims scholars belonging to various schools of Islamic law have invoked the principle of priority of saving human life and have permitted the organ transplant as a necessity to produce that noble end.”

Judaism

All four branches of Judaism (orthodox, conservative, reform, and re-constructionist) support and encourage donation. According to Orthodox Rabbi Moses Tendler, chairman of the Biology Department of the Yeshiva University in New York City and chairman of the Bioethics Commission of the Rabbinical Council f America, “If one is in the position to donate an organ to save another life, it’s obligatory to do so, even if the door never knows who the beneficiary will be. The basic principle of Jewish ethics–”the infinite worth of the human being–also includes donation of corneas, since eyesight restoration is considered a life-saving operation.” In 1991, the Rabbinical Council of America (Orthodox) approved organ donations as permissible, and even required, from brain-dead patients. Also, in Orthodox Judaism, where any part of the body is separated from the corpus, it requires burial. However, where an organ is to be transplanted to save the life of a patient or improve his health, then it is permitted.

The reform movement looks upon the transplant program favorably and Rabbi Richard Address, director of the Union of American Hebrew Congregations Bio-Ethics committee and Committee of Older Adults, states that “Judaic Response materials provide a positive approach and by the large North American Jewish community approves of transplantation.” Judaism teaches that saving a human life takes precedence over maintaining the sanctity of human body.

Shinto

In Shinto, the dead body is considered to be impure and dangerous, and thus quite powerful. “In folk belief context, injuring a dead body is a serious crime . . .,” according to E. Namihira in his article, Shinto Concept Concerning the Dead Human Body. ” To this day it is difficult to obtain consent fro bereaved families for organ donation or dissection for medical education or pathological anatomy . . .the Japanese regard them all in the sense of injuring a dead body.” Families are often concerned that they do not injure the itai, the relationship between the dead person and the bereaved people.

United Methodist

The United Methodist Church issued a policy statement regarding organ and tissue donation. In it, they state that, “The United Methodist Church recognizes the life giving benefits of organ and tissue donation, and thereby encourages all Christians to become organ and tissue donors by signing and carrying cards or driver’s licenses, attesting to their commitment of such organs upon their death, to those in need, as a part of their ministry to others in the name of Christ, who gave his life that we might have life in its fullness.” A 1992 resolution states, “Donation is to be encouraged, assuming appropriate safeguards against hastening death and determination of death by reliable criteria.” The resolution further states, “Pastoral-care persons should be willing to explore these options as a normal part of conversation with patients and their families.

Pentecostal

Pentecostals believe that the decision to donate should be left up to the individual.

Seventh Day Adventist

Donation and transplantation are strongly encourage by Seventh-day Adventist. They have many transplant hospitals, including Loma Linda in California. Loma Linda specializes in pediatric hearth transplantation. The individual and family have the right to receive or to donate those organs which will restore any of the senses or will prolong the life profitably.

United Church of Christ

Reverend Jay Lintner, director, Washington Office of the United Church of Christ Office for Church in Society, states, “United Church of Christ people, churches and agencies are extremely and overwhelmingly supportive of organ sharing. The general Synod has never spoken to this issue because, in general, the Synod speaks on more controversial issues, and there is no controversy about organ sharing, just as there is no controversy about blood donation in the denomination. While the General Synod has never spoken about blood donation, blood donation rooms have been set up at several general Synods. Similarly, any organized effort to get the General Synod delegates or individual churches to sign organ donation cards would meet with generally positive responses.”

Organ and Tissue Donation by Religious Affiliation Part 2

Greek Orthodox

According to Reverend Dr. Milton Efthimiou, Director of the Department of Church and Society for the Greek Orthodox Church of North and South America, ” The Greek Orthodox Church is not opposed to organ donation as long as the organs and tissue in question are used to better human life, i.e., for transplantation or for research that will lead to improvements in the treatment and prevention of disease.” Organ donation is the individual decision of each member.

Gypsies

Gypsies are a people of different ethnic groups without a formalized religion. They share common folk beliefs and tend to be opposed to organ donation. Their is connected with their beliefs about the afterlife. Traditional beliefs contends that for one year after death the soul retraces its steps. Thus the must remain intact because the soul maintains its physical shape.

Hinduism

According to the Hindu Temple Society of North America, Hindus are now prohibited by religious law from donating their organs. This act is an individuals decision. H. L. Travedi, in Transplantation Proceedings, stated that, “Hindu mythology has stories in which the arts of the human body are used for the benefit of other humans and society. there is nothing in the Hindi religion indicating that parts of humans, dead or alive, cannot be used to alleviate suffering of other humans.”

Independent Conservative Evangelical

Generally, Evangelicals has no opposition to organ and tissue donation. Each church is autonomous and leaves the decision to donate up to individual.

Jehovah’s Witnesses

According to the Watch Tower Society, Jehovah Witnesses believe donation is a matter of individual decision. Jehovah’s Witnesses are often assumed to be opposed to donation because of their belief against blood transfusion. However, this merely means hat all blood must be removed from the organs and tissues before being transplanted.

Lutheran

In 1984, the Lutheran Church in America passed a resolution stating that donation contributes to the well being of the humanity and can be “…an expression of sacrificial llove for a neighbor in the end.” They call on members to consider donating organs and to make any necessary family and legal arrangements, including the use of a signed donor card, The ability to transplant organs from a deceased to a living person is considered a genuine medical advance.

Mennonite

Mennonites have no formal position on donation, but are not opposed to it. They believe the decision to donate is up to the individual and his or her family.

Society of Friends (Quakers)

Organ and tissue donation is believed to be an individual decision. The society of Friends do not have an official position on donation.

Unitarian Universalist

Organ and tissue donation is widely supported by Unitarian Universalist. They view it as an act of love and selfless giving.

Moravian

The Moravian Church has made no statement addressing organ and tissue donation or transplantation. Robert E. Sawyer, President, Provincial Elders Conference, Moravian Church of America, Southern Province, states, “There is nothing in our doctrine or policy that would prevent a Moravian pastor from assisting a family in making a decision to donate or not to donate an organ.” It is, therefore, a matter of individual choice.

Mormon (Church of Jesus Christ of Latter-day Saints)

The question of whether one should will his bodily organs to be used as transplants or for research after death must be answered from deep within the conscience of the individual involved. Those who seek counsel from the Church on the subject are encourage to review the advantages and disadvantages of doing so, to implore the Lord if inspiration and guidance, and then to take the course of action which would give them a feeling of peace and comfort.

Organ and Tissue Donation by Religious Affiliation Part 1

AME & AME Zion (African Methodist Episcopal)

Organ and Tissue donation is viewed as an act of neighborly love and charity by these denominations. They encourage all members to support donations as a way of helping others.

Amish

The Amish will consent to transplantation if they know that it is for the  health and welfare of the recipient. They would be reluctant to donate their organs if the outcome was known to be questionable; however, nothing in the Amish Understanding of the Bible forbids them from using modern medical services, including surgery, hospitalization, dental work, anesthesia, blood transfusions, or immunizations. John Hostetler, world renowned authority on Amish religion and professor of anthropology at Temple University in Philadelphia, says in his book, Amish Society, “The Amish believed that since God created the human body, it is God who heals.”

Assembly of God

The church has no official policy regarding organ and tissue donation. The decision to donate is left up to the individual. Donation is highly supported by the denomination.

Baptist

Though Baptists generally believe that organ and tissue donation and transplantation are ultimately matters of personal conscience, the nations largest Protestant denomination, the Southern Baptist Convention, adopted a resolution in 1988 encouraging physicians to requests organ donation in appropriate circumstances and to “….encourage voluntarism regarding organ donations in the spirit of stewardship,compassion for the needs of others and alleviating suffering.” Other Baptist groups have support the organ and tissue donation as an act of charity and leave the decision to donate up to the individual. A transplant as an end in itself is not approved. It must offer the possibility of physical improvement and extension of human life.

Brethren

While no official position has been taken by the Brethren denominations, according to Pastor Mike Smith, there is a consensus among the national fellowship of Grace Brethren that organ and tissue donations is a charitable ac so long as it does not impede the life or hasten the death of the donor or does not come from an unborn child.

Buddhism

Buddhist believe that organ and tissue donation is a matter of individual consequence and place high value on acts of compassion. Reverend Gyomay Masao, president and founder of the Buddhist Temple of Chicago says, “We honor those people who donate their bodies and organs to the advancement of medical science and to saving life.” The importance of letting loved ones know your wishes is stressed.

Catholicism

Catholics view organ and tissue donation as an act of charity, fraternal love and self sacrifice. Transplant and morally and ethically acceptable to the Vatican. According to Father Leroy Wickowski, Director of the Office of Health Affairs of the Archdiocese of Chicago, “We encourage donation as an act of charity. It is something good that can result from tragedy and a way for families to find comfort by helping others.” Pope John Paul II has stated, “The Catholic Church would promote the fact that there is a need for organ donors and that Christians should accept this as a ‘challenge to their generosity and fraternal love so long as ethical principles are followed.”

Church of Christ (Independent)

Organ transplant should not be a religious problem.

Presbyterian

Presbyterians encourage and endorse organ donation. they respect individuals conscience and a person’s right to make decisions regarding his own body.

Christian Church (Disciples of Christ)

The Christian Church encourages organ and tissue donation, stating that we were created for God’s glory and for sharing God’s love. A 1985 resolution adopted by the General Assembly encourages”… members of the Christian Church (Disciples of Christ) to enroll as organ donors and prayerfully support those who have received an organ transplant.”

Christian Scientists

The Church of Christian Scientist takes no specific position on transplants or organ donation as distinct from other medical or surgical procedures. Members are free to choose whatever form of medical treatment they desire, including a transplant. Organ donation is the individual decision of each member.

Ethical Issues and Genetic Science

The advances in scientific expertise bring with them moral dilemmas. Genetic research offers great promise; we may soon be able to cure many of the genetically determined diseases and predispositions to disease. We may even be able to improve upon Mother Nature. The question is to whether humankind has the wisdom to utilize this knowledge for good without violating moral rules. Only time will tell. Genetic screening will allow  parents to know whether their offspring will be afflicted with disease, but in some cases this does nothing more than begin the misery sooner. Prenatal genetic testing will give parents the choice to terminate pregnancies that will lead to defective infants. Genetic testing may also justify discrimination in the minds of many. Eugenics as a state of policy is unlikely and will make such proposals. The human genome project will rank among humankind’s greatest achievements once it is completed, and by itself presents no real moral difficulty; but the applications of the knowledge may be more than human wisdom can handle. Recombinant DNA maybe the most dangerous as it puts us in the position of creators of whole species that may or may not coexist with humanity and the rest of natural world. In spite of dangers, we will proceed, as we should. We may not turn away from the pursuit of knowledge even if some would misuse it.

Transcultural Health

It is important for health care providers to be sensitive to these transcultural differences among our patient population as they affect how willing the patient is to comply with our regimes or even whether the patient is willing to risk entry into our strange system.

Example of this is in United States which is in a period of dynamic social change in which hundreds of thousands immigrants from China, India, Cambodia, Mexico, Haiti, South America, the Middle East, Philippines, and Eastern Europe are flocking on it. Along with their hopes, aspirations, personal problems, talents and dreams, these new immigrants bring with them their views of health, illness, and appropriate practices. Although a review of traditional practices within the diverse homelands of these immigrants reveals the existence of meaningful health care traditions different from those practice in the west, their is a reluctance of many health care providers to see the benefits or to be willing to accept these differences.

Health care practice in the West is based on scientific reasoning and high technology. Western health care is a system of marvels: organs can be replaced, the blind can be made to see, and the dead can be revived. On the surface it would seem that modern medicine as taught and practice in the West should be embraced by all. What can one truly take from a health care traditions that is not built upon an understanding of germ theory.

Some patients do not seem able to follow prescriptions given, will not show up for appointments, do not comply with treatment regimes, and are not even willing to access the system until they are in severe distress and leave quickly as possible. Under current practice, something is being missed in regard to these patients and the system is failing them. Is it because the patients and practitioners have different views regarding health , illness, and appropriate practice? Can it be that the patients often believe that the care offered would make them sicker or is incompatible with their illness? In some sense what the patient believes is not as important as whether the provider is sensitive to the facts surrounding the belief system of the patient and is willing to respect the differences. It is important to come to understand how patients understand illness and their relationship to it and also what motivates them to seek  medical assistance and then to follow the advice given. There is an ethical and professional imperative to build the bridges of understanding that allows for successful practice among those with different view of health, illness, and appropriate practice.

Genetics as Social Policy

Ethical issues arise when we consider the possibility of turning genetic testing into social policy. Some suggest that all parents be tested for genetic diseases in order to avoid the social and personal costs of genetic impairment. Others worry that this will lead to a coercive policy of abortion or of preventing parents from having children. Such policies raise still further issues when they are directed to certain ends, as they are with eugenics. Eugenics is the practice of manipulating the genes of offspring through either breeding or genetics alteration.  Should we attempt to eliminate some or all genetic abnormalities? Should we attempt to improve the race of human being by increasing intelligence through genetic selection?

Scientist are not only involved with genetic testing, they are also engage in an enterprise called “the human genome project”  The task is to ‘map’ the 100,000 genes that make up the 46 chromosomes, which altogether comprise the ‘human genome’. The genome is the blueprint contained in each cell that guides the development of of human being. The ethical worries regarding this issue is more vague; they have as much as to do with the idea of human possessing such “God-like” knowledge as they have to do with application of knowledge. From certain theological points of view, the mere possession of such profound knowledge is immoral; only God should have such knowledge. The idea is that the attempt to gain such knowledge is hubris or excessive pride. It is suggested that we leave such knowledge to God and concern ourselves with more mundane task.

Ethical Issues of AIDS

I remember that weekend when no patient in the intensive care unit was over the age of forty. i remember the intern who tearfully refused to come to the emergency room to see the fourth AIDS patient I had admitted to her in as many hours. She never did meet him; he died before she calmed down.

Abigail Zuger, M.D.,1986

Hundreds of thousands of lost lives later, the initial impact is over. The thunderbolt of AIDS are starting to become a fact of life. Some sense of continuity with the rest of history has become possible.  AIDS continues to be a source of uniquely complex medical, legal, and social dilemmas; nonetheless, it has evolved into an entity provoking fewer immediate panicked reactions and more measured, mature analysis.

Abigail Zuger, M.D.,1993

 Acquired  Immune Deficiency Syndrome (AIDS) continues to grow as a worldwide epidemic. The disease, which at one time was centered within certain high-risk groups, has now spread into all segments of the population. The study of high-risk groups is no longer the best way to identify those at risk for the disease; rather, risk should be measured through the observance of certain high-risk behaviors.

Due to the frightening consequences of the disease and its relative newness, the public has reacted very negatively toward those infected. Victims of the disease have been stigmatized, exposed to humiliation,  and have experienced loss of work, insurance, and housing. The issue of confidentiality and the attempts to sustain a level of privacy beyond that provided for other diseases often create problems for the patient and health care provider. AIDS is the only disease about which there is any question as to whether health care providers should be told the diagnosis of their patients.

Ethical issues involved with this disease include confidentiality, the duty to treat infected individuals, the need for universal screening, the duty of infected health care providers to warn patients , and the need for equitable distribution of medical care and research dollars. It is clear that the resources that will be needed to care for these patients threatens to overwhelm an already burdened health care delivery system.

None of these issues has yet been satisfactorily addressed. How we finally addressed  and resolve this problems will speak either well or ill of the ethical foundations of the American health care system. Because of the scope of the ethical problems associated with the AIDS epidemic, our actions in response to it will leave either a proud or a shameful heritage for future health care providers.

Abortion

There has been little information with regard to the health provider’s role in abortion. The reason for this is that the abortion issue is not essentially a health issue but rather a social issue that take place in the health care arena. Abortion, in most instances where it is performed, is legal. The American Association in it’s Code of Medical Ethics, Current Opinions document, 2.01 states

The Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.

One’s attitude toward abortion is often very intense, close, and personal. As a matter of professional autonomy, it would seem that health care providers with deeply held beliefs with regard to this matter would not be required to participate in the process. However, this may require that the provider ascertain the philosophical view of the institution where he desires employment prior to accepting duty there. Its make very little sense to look at only the salary and fringe benefits of a hospital and then find yourself working at an institution where the daily practice of abortion creates for you severe moral distress.

Health care providers, regardless of their personal feelings concerning abortion, cannot ignore the social realities of our time., such as the liberation of women and the problems of teenage mothers. There is very little indication that the abortion controversy will end anytime soon. As a matter of role duty, we must come to understand that people of intellect and honor have come to very different decisions regarding the issue. As health care providers, we do not have the luxury of treating patients with whom we have formed a patient/provider relationship with anything but the highest level of professional concern , regardless how we may feel about their decisions on this issue.

Abortion is an extremely emotional issue in that it makes us consider some very important and deep moral concepts, such as person-hood and the value of human life. While it is important to understand the facts of fetal development, there is no getting around the problem of philosophical disagreement over fundamentals. Noe can we ignore important social realities such as the liberation of women and the problem of teenage mothers. Abortion also requires that we review our moral intuitions. We discussed various analogies in order to determine whether our intuitions can yield a consistent moral position on abortion.

whatever your view of abortion, it should be clear that issue is a difficult one that reaches to the depths of our most profound thoughts on what is important in life. Nothing indicates that the controversy will end anytime soon, so how is a sensitive person to regard her opponents on the issue? If one imagines that a fetus is a baby, how much effort on it’s behalf is rational? An adult who rushes into the street to save a toddler who has entered the pathway of an onrushing car would be considered hero. What, then, is so extraordinary about blocking a doorway or lying down in front of an abortion clinic, if what you see yourself doing is saving babies? If, on other hand , your view of a fetus is that of a piece of tissue–even one with remarkable potential, but still only a piece of tissue–jumping in front of cars or blocking doorways is a very strange behavior indeed.

Perhaps what is missing in the debate is a level of tolerance and civility that considers the opposing view to be wrong but perhaps rational. The pro-choice advocates began to call the pro-life advocates”terrorist” while the pro-life movement continued to cast the pro choice side as “baby killers”. It is not likely that “baby killers” and “terrorist” are the kinds of people who will be able to sit down and reason together. Confrontations have become increasingly violent and costly as one town after another becomes a battleground.