Death and Dying in the different religions

Janabel Said Clinical Oncology trainee Although the final outcome of death is the same for all humans, cultures vary in how they conceptualize death and what happens when a person dies. In some cultures, death is said to occur when there is total cessation of life, whilst other cultures and religions view death as a transition to another form of existence. The religious beliefs and customs of different cultures related to the care of the dying, death, organ donation and postmortems shall be discussed briefly below: Roman Catholicism The Roman Catholic church, the largest of the Christian churches, although present in all parts of the world, is identified as Roman because of its historical roots in Rome and because of the importance it attaches to the worldwide ministry of the bishop of Rome, the pope2. Catholicism is a religion based on the life and teachings of Jesus of Nazareth, Son of God, as presented in the New Testament3. One of the most important concepts is that of Jesus giving his life on the Cross (the Crucifixion) and rising from the dead on the third day (the Resurrection). Catholic belief teaches that one day in the future, Jesus shall return to earth in order to judge the living and the dead, which will complete creation by opening the kingdom of heaven4. When a Catholic is on his/her deathbed, a priest may be present to prepare them for death, administering the sacrament of the anointing of the sick and if so wished by the person, the sacrament of confession, this being done alone with the priest. Following death, a funeral is held within a week for friends and family to grieve for the person who has died and give thanks for their life. Nowadays a Christian may be either buried or cremated. For most of its history, the Roman Catholic Church had a ban against cremation5. It was seen as the most sacrilegious act towards Christians and God, physically declaring a disbelief in the resurrection of the body. In 1963, the Pope lifted the ban on cremation, and in 1966 allowed Catholic priests to officiate at cremation ceremonies. The Church still officially prefers the traditional internment of the deceased. Despite this preference, cremation is now permitted as long as it is not done to express a refusal to believe in the resurrection of the body. Until 1997, Church regulations used to stipulate that cremation has to take place after a funeral service. In 1997, the funeral rite was modified so that church funerals can take place when the body has already been cremated before the ashes are brought to the church. In such cases, the ashes are placed in an urn or another worthy vessel and brought into the church.

Pope John Paul II began his Address to 'The Society For Organ Sharing' by applauding the development of transplant surgery6, We should rejoice that medicine, in its service of life, has found in organ transplantation a new way of serving the human family, precisely by safeguarding that fundamental good of the person. There are no religious objections to post-mortem7.

Jehovahs Witness Jehovah's Witnesses are members of a Christian-based religious movement founded towards the end of the 19th century, under the leadership of Charles Taze Russell. There are 130,000 members in the UK. Although Christian-based, the group believes that the traditional Christian Churches have deviated from the true teachings of the Bible, and do not work in full harmony with God. They believe that the Bible is the Word of God and consider its 66 books to be divinely inspired and historically accurate. Jehovah's Witnesses believe death is a state of non-existence with no consciousness. No special rituals are carried out on a persons deathbed. A person would appreciate a visit from an elder of their own faith. Jehovahs witnesses are not in favour of organ donation except of bloodless organs such as the cornea. They also refuse blood products such as packed red cells, platelets or plasma. They do not have any objections with either burial or cremation. Post-mortems are a matter of individual choice for the family. Sikhism Sikhism was founded in the 16th century in the Punjab district of what is now India and Pakistan. It was founded by Guru Nanak. The most important thing in Sikhism is the internal religious state of the individual and to lead a good life buy keeping God in heart and mind at all times and helping others. Sikhs believe in re-incarnation but also believe that by living a life according to Gods plan, humans can end the cycle of rebirth already in this life and the soul may move on to meet the supreme soul, God. When death approaches, friends and relatives gather around the dying person and recite from the holy book, Guru Granth Sahib. Death is not looked upon as a sorrowful occasion and it is forbidden to cry. After someone dies, if the body is on a bed it should not be moved and no light should be placed next to it. Prayers are said which acknowledge that the

death is an act of God8. Once deceased, the person is clothed in clean clothes and placed in a coffin ornamented with flowers and wreaths. Preferably, this should be done by a relative. The five symbols, which represent a Sikhs faith, should remain untouched: kesh (unclipped hair), karra (iron bracelet), kachera (a special type of undergarment), kirpan (sword) and kangha (comb). Cremation is the accepted form of disposal of the body. They have no objections to organ donation or post-mortem. Judaism Judaism is the original of the three Abrahamic faiths, which also includes Christianity and Islam. It originated in the Middle East over 3500 years ago and was founded by Moses, although Jews trace their history back to Abraham. Jews believe that there is only one God with whom they have a covenant. Jews believe that God appointed the Jews to be his chosen people in order to set an example of holiness and ethical behaviour to the world. When terminally ill, a Jewish patient may wish to recite or hear special psalms or prayers, especially Psalm 23 by relatives and a Rabbi. The Rabbi may also be called to help the dying person with their formal confession and to bring comfort. Jewish law prohibits any active intervention that would hasten the death of a terminal patient9. The patient should be kept as comfortable as possible. It is not permitted to move a dying patient as this may hasten death. Where this is thought to be necessary, a Rabbi should be consulted. Once death occurs, a Rabbi should be contacted as soon as possible. The eyes and mouth should be closed, preferably by a family member. The body should be handled as little as possible by non-Jews. It is essential that the body is laid flat with hands open, arms parallel and close to the body and legs stretched out straight. The body should then be completed covered (including the head) in a white sheet, and where possible should not be unattended after death. Some families will request that the body be placed on the floor for a short time. Jewish law requires burial to take place as soon as possible after death, and any unnecessary delay must be avoided. Cremation is not permitted in Orthodox Jewish law, while Reform and Progressive communities allow it. Post-mortem examinations are not permitted in Jewish law except in cases of emergency, or where civil law absolutely requires an autopsy. In cases of queries a Rabbi should be consulted.

Jews support and encourage organ donation in order to save lives. This principle can sometimes override the strong objections to any unnecessary interference with the body after death and the requirement for immediate burial of the complete body. Jews require consultation with a competent rabbinic authority before consent is granted. If an organ is needed for a specific, immediate transplant then it could be considered a great honour for a Jew to donate organs to save another person's life. However, if the organs were being donated into an organ bank, or for medical research, then this may be looked on less favourably. Islam The word Islam means 'submission to the will of God'. Muslims believe that Islam was revealed in Mecca, Arabia. According to Muslims, God sent prophets, Jesus, Moses and Abraham, to mankind to teach them how to live according to His law. When a Muslim is near death, those around him or her are called upon to give comfort. They may recite verses from the Qur'an (the Muslims Holy Book), give physical comfort, and encourage the dying one to recite words of remembrance and prayer. If at all possible, a Muslim's last words should be the declaration of faith: "I bear witness that there is no god but Allah."10 The dying Muslim may wish to sit or lie with their face towards Mecca, which may mean even moving the bed to make this possible. If no family are available, any practising Muslim can help. The patient may wish the IMAM (religious leader) to visit. Once deceased, the family or other members of the Muslim community prepare the deceased for the burial, which should preferably take place within 24 hours. The deceased will be washed respectfully, with clean and scented water, in a manner similar to how Muslims make ablutions for prayer. Male relatives will wash male bodies and female relatives will wash female bodies. The deceased is placed with their head facing the Muslim holy city of Mecca. Muslims believe in the resurrection of the body after death, therefore Muslims are always buried, never cremated. Post mortems are forbidden unless ordered by the Coroner, in which case the reasons for it must be clearly explained to the family. The family may request that organs removed should be returned to the body after examination. Muslims are not against organ donation. One of the basic aims of the Muslim faith is the saving of life11. Violating the human body, whether living or dead, is normally forbidden in Islam except in cases of necessity and in saving another person's life. Hinduism

Hinduism is the predominant religious tradition of the Indian subcontinent. Hinduism is a social system as well as a religion, with customs and practices being closely interwoven. Unlike most other religions, Hinduism has no single founder, no single scripture, and no commonly agreed set of teachings. Most Hindus revere a body of texts as sacred scripture known as the Veda, and most Hindus draw on a common system of values known as dharma. Hindus believe that existence is a cycle of birth, death, and rebirth, governed by Karma. Hindus believe that the soul passes through a cycle of successive lives and its next incarnation is always dependent on how the previous life was lived. When death approaches, the sick person will be lifted out of their bed and laid on the floor with their head towards the north. Relatives gather around the dying person, dip a leaf of sweet basil, tulsi, in water from the Ganges and place this on the lips of the dying person while they sing holy songs and read holy texts. The patients family may wish to call in a Hindu priest to read from the Hindu holy books and to perform holy rites. To enter death with all of ones senses alive is considered ideal, and many Hindus will refrain from taking medication when they feel that their time is up. After death, the dead person is ritually washed by family members, and wrapped in white cloth on the floor, but with the face uncovered. The eyes are closed and the limbs straightened; jewellery, sacred threads and other religious objects are not removed. If a body is to be left in a room overnight a light or candle is left burning throughout the night. Cremation is the accepted form of disposal of the adult body. Only children under 8 years of age are buried. Post Mortems are generally disliked but not prohibited if requested by the Coroner. Hindus have no objections to organ transplantation. Life after death is a strong belief of Hindus and is an ongoing process of rebirth. This could be seen as reflecting positively on the concept of organ donation and transplantation. Decisions about organ donation and transplantation are left to individuals to make, but there are many references that support the concept of organ donation in Hindu scriptures. Therefore, it is right to donate organs, only if the act of donating an organ has beneficial results. Buddhism Buddhism is a spiritual tradition that focuses on personal spiritual development and the attainment of a deep insight into the true nature of life. Buddhism teaches that all life is interconnected. There is no belief in a personal God. It is not centred on the relationship between humanity and God. Buddhists believe that the dead are reborn at higher or lower planes of existence, depending on merits they have built up in this life and former lives.

The state of mind of a person at the moment of death is important in determining the state of rebirth. They like to have full information about their imminent death to be spiritually prepared. Some Buddhists may not wish to have sedatives or analgesics that may blur the conscious mind. Peace and quiet for meditation and visits from other Buddhists would be appreciated. Some form of chanting may be used to influence the state of mind at death so that it may be peaceful. After death, a Buddhist minister is informed if other Buddhists are not in attendance. The death process of an individual is viewed as very important, and a body should be treated with respect. Some Buddhists, including those who are followers of Tibetan Buddhism, believe the consciousness may stay in the body for some time after the breath has stopped. Until the consciousness leaves the body it is important the body remains undisturbed, so Tibetan Buddhists may have some concerns that an operation so soon after death may damage their consciousness and cause harm to their future lives. The deceased may be cremated or buried, depending on the wishes of the family. They have no objections to post-mortem. There are no rules in Buddhism for or against organ donation, but central to Buddhism is a wish to relieve suffering. There may also be occasions when organ donation may be seen as an act of charity. In Buddhism the decision for or against organ donation relies very much on an individual's decision. People may decide for or against it, without one choice being seen as right and the other wrong. Services in Dundee Roman Catholicism - Chaplains are available in Ninewells Hospital and visit wards regularly. The Hospital Chapel is on Level 7, at the entrance to South Block. If the chapel is closed for any reason, staff at the Main Reception Desk will open it on request. Jehovahs Witness - Kingdom Hall Of Jehovahs Witness, Court Street, Dundee, Angus, DD3 7QQ Tel: 01382 826757. Judaism - Dundee Hebrew Congregation, 9 St Mary Place, Dundee, DD1 5RB, Tel: 0141 638 6411. Hinduism - Tayside Hindu Cultural and Community Centre, 10 - 12 Taylor's Lane, Dundee DD2 1AQ, Tel: 01382 669652 Islam - 6 Milne Street, Dundee DD1 5BZ, Scotland, United Kingdom 01382 228374 www.dundeeislamicsociety.co.uk, www.dundeecentralmosque.org.uk Sikhism - The Sikh Temple, 10 Taylors Lane, Dundee, Tel: (0382) 645770.

Buddhism - Samye Dzong, 51 Reform Street, Dundee DD1 1SL, Tel: 01382 872020 http://dundee.samye.org References 1. W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler, editors. Online Readings in Psychology and Culture. Washington: Centre for Cross-Cultural Research; 2002 2. http://mb-soft.com/believe/txc/rcatholi.htm 3. http://www.bbc.co.uk/religion/religions/ 4. http://www.khm.uio.no/utstillinger/farvel/christian.html 5. Church Handbook of Instructions, Book 1. Utah: The Church of Jesus Christ of Latter-day Saints; 2006 6. Cullen PJ. Organ Donation: A Catholic Perspective. Catholic Medical Quarterly. 1998 7. http://www.e-radiography.net/nickspdf/Handbook%20on %20beliefs.pdf 8. http://www.staffspasttrack.org.uk/exhibit/ilm/Mourining%20and %20Remembrance/Types%20of%20funerals/Sikh%20Funerals.htm 9. http://www.jvisit.org.uk/hospital/caring-terminal.htm 10. http://islam.about.com/cs/elderly/a/funerals.htm 11. http://www.organdonation.nhs.uk/ukt/how_to_become_a_donor/religi ous_perspectives/leaflets/islam_and_organ_donation.jsp 12.