Sikh Perspectives on Health Care, Dying and Death

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Sikh Perspectives on Health Care, Dying and Death
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What is Sikhism?

• Sikhism is a monotheistic religion founded in the
  15th century in the region of northern India
  called Punjab.

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Sikh demographics

• Sikhism is the 5th largest religion in the world
• approximately 25 million Sikhs worldwide
• approximately 500,000 Sikhs in the United States
• several Gurdwaras (Sikh temples) in the Metro
  Detroit area
• 2 of Indian population 3 of Canadian

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Who is a Sikh?
The word Sikh means disciple.
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Basic Tenets of Sikhism

• Kirat karna -- To live an honest life, to be fair
  in all personal and professional dealings, to
  earn an honest living
• Naam japna -- To meditate on the Name of God
• Vand chakna -- To share wealth and do charitable
  work (seva)

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Basic Tenets of Sikhism

• There is one universal God and that God resides
  within God's creation
• The goal of human life is to lead a life of
  prayer meditation and service so our souls may
  merge with God
• The path to salvation does not lie in
  renunciation or celibacy, but leading the life of
  a householder

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Basic Tenets of Sikhism

• Sikhism condemns rituals and blind faith
• People of all races and religions are equal in
  the eyes of God, as are men and women

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Founding of Sikhism

• Founder of Sikhism, Guru Nanak
• Born in 1469 C.E.
• Nine human Gurus followed Guru Nanak

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Guru Granth Sahib
Compilation completed by 10th Guru, Guru Gobind
Singh in 1705 Written in Gurmukhi 1430
pages Contains the poetry of 6 Gurus and many
Muslim and Hindu saints/ scholars/poets
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Gurmukhi Script
The Guru Granth Sahib and small prayer books
(gutkas) are written in this script.
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Gutka

• If you see this at a patients bedside, please
• ask before moving
• wash hands before touching
• do not remove cloth if gutka is covered
• do not place on the floor or near patients feet

A gutka is a small book that contains the Nitnem
(the 5 daily prayers recited by Sikhs).
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What is the Khalsa?
The Khalsa (the Pure Ones) is an order of
baptized Sikhs who pledge to maintain the
distinct identity of the Khalsa and uphold the
Rahit Maryada.
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Panj Kakkars (5 Ks)

• Kesh (unshorn hair) -- acceptance of Gods
  will/design

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Panj Kakkars (5 Ks)

• Kachhera/kachha (a knee-length garment normally
  worn under clothes) -- modesty, purity and sexual
  restraint

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Panj Kakkars (5 Ks)

• Kangha (small comb worn in the hair) --
  cleanliness
• Kara (steel bracelet) -- unity and protecting
  oneself

Kangha a small comb worn in the hair
Kara steel bracelet
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Panj Kakkars (5 Ks)

• Kirpan (sword) -- responsibility to fight
  injustice

Gatra a strap that enables a kirpan to be
suspended near one's waist or tucked inside one's
belt
Kirpan ceremonial sword
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Types of Sikhs Different Levels of Orthodoxy

• Amritdhari
• Keshdhari
• Sahajdhari

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Amritdhari Sikhs
Amritdhari Sikhs have been baptized into the
Khalsa order according to the Amrit ceremony of
Guru Gobind Singh. All Amritdharis are required
to wear the 5 Ks, recite the daily prayers, and
live by the Sikh Rehat Maryada.
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Keshdhari Sikhs
Keshdhari Sikhs keep their hair, but may or may
not wear the other four Ks. You cannot usually
tell whether a Sikh is keshdhari or amritdhari
simply by looking.
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Turbans go With Hair
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Some Women Wear Turbans
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Sahajdhari Sikhs
Sahajdhari Sikhs believe in one God, the 10
Gurus, the Guru Granth Sahib, the importance of
the Khalsa baptism, and do not claim to be any
other religion. They do not necessarily keep
their hair, and may or may not wear any of the
other four Ks.
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Views on Death

• Death is not the end, it is an inevitable part of
  life
• The soul does not die, only the body does
• Human life is a gift. It is the only opportunity
  we have to meet God

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Views on Death

• We want to die while alive.
• Achieve the highest state of consciousness
• Eliminate duality between self/God/creation
• Eliminate Fear of death

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Religious and Cultural Considerations in the Care
of Sikh Patients
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Health-Seeking Beliefs

• Whoever is born will eventually die
• Physical body is perishable, but soul is eternal
• The soul is a part of the One Universal Creative
  Force and yearns for reunion
• Liberation from the cycle of birth and death,
  from millions of life forms ? Human life is
  valuable

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Health-Seeking Beliefs

• Concept of hukam (Gods will)/kismat (fate or
  destiny) -- acceptance of illness
• Fighting spirit/martial tradition of the Sikhs --
  active role in illness
• Generally, Sikhs will accept their physical
  state, but will also try to improve it

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Illness Behaviors

• Illness may be in the hukam, but ones effort is
  required in recovery
• Meditation or recitation of Gurbani by patient or
  visitors
• Shabad Kirtan Singing of poetry from the Guru
  Granth Sahib by patient or visitors, CD, tape,
  DVD, Mp3, phone
• Cultural practice Family and family friends

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Illness Behaviors

• Ardaas Prayer of supplication
• Done at any time, particularly time of death or
  birth or other difficult times.
• Meditation

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Modesty

• Cultural issue
• Head coverings
• Rehat Maryada specifies that Khalsa Sikhs must
  always wear kachhera
• Most women would prefer to keep themselves as
  covered as possible

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Diet

• Meat is not served at langar
• Rehat Maryada states that Sikhs cannot eat
  ritually slaughtered meat
• Some Sikhs are vegetarian and some are not
• Sikhs do not fast for any reason

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Community on Health Care

• Sanctity of life is an injunction, therefore
• Assisted suicide and euthanasia not encouraged
• Therapeutic genetic engineering accepted

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Community on Healthcare

• Pregnancy and birth are celebratory events
  cultural biases against females
• Reproductive assistance only within marriage
• Therapeutic abortions accepted (injunction
  against female infanticide in Gurus writings and
  the Rehat Maryada)
• No postpartum rituals

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Community on Healthcare

• Organ transplants and blood transfusions
  accepted Sikh youth encouraged to donate
• Male infants not circumcised

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Your Approach

• Family important in decision making
• Respect modesty and privacy
• Vegetarian choices
• Familiar food is an issue for older Sikh patients
  
• We encourage hospitals and long term care
  facilities to have Sikh chaplain on list.

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Your Approach

• Avoid interrupting prayer or meditation for
  routine patient care
• Sensitivity to 5 Ks particularly turban for men
• Consult patient and family before procedures
  requiring removal of hair

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Nursing Home/Assisted Living Care

• Culturally, nursing home are usually considered
  acceptable for temporary or rehabilitation care.
• Most families will bring elders home if at all
  possible.
• Providing advice on elder care

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Advance Directives

• Advance directives are individual choices
• Maintaining a terminal patient on artificial life
  support for a prolonged period in a vegetative
  state is not encouraged, so most Sikhs will
  probably specify a period of time during which
  they would prefer to be kept on life support
  because mind is not alive anymore

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End of Life Care

• No contraindication to autopsies
• Consult patient, family and Sikh scholar
• Have relatives and Sikh granthi nearby to recite
  Shabad Kirtan
• Death is viewed as a part of life, not to be
  feared

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Hospice care

• No contraindication to palliative care
• Patient might be very comforted bySikh hymns,
  prayers and meditation.
• Family or Gurdwara granthi can do this
• Be sensitive to officials of other religions
  doing prayers with patients

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End of Life Care

• Allow family and granthi to follow traditions to
  prepare body for cremation
• Body to be cremated expediently, unless waiting
  for relatives to arrive

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Traditions at the Time of Death

• Family and Friends Gather, pay condolence calls
• Prayer services/reading of the scripture at home
  or at the Gurdwara
• Prayer service at the funeral home
• Cremation

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Philosophy Surrounding Death

• End of body, not soul
• Soul is meeting with great soul
• Ardaas/supplication is that God take the departed
  back to the true home

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Resources
Sikh Patients Protocol for Health Care
Providers, www.sikhwomen.com/health/care/index.htm
The Sikhism Home Page, www.sikhs.org Shiromani
Gurdwara Parbandhak Committee, www.sgpc.net Gatewa
y to Sikhism, www.allaboutsikhs.com The Sikh
Coalition, www.sikhcoalition.org Sikh-Seek (Sikh
search engine), www.sikhseek.com