Practical Points for Health Care Providers
Chaplain John Ehman (firstname.lastname@example.org)
4/20/07, revised 5/8/12
[For a printable PDF of this resource, click
Presented here are brief lists of points for health care providers to keep in mind when
caring for patients from a number of different religious traditions. These are not
comprehensive descriptions but rather practical items that may affect a patient, family,
and care team in the course of a hospitalization. For more information, and for resources to assist with any particular patient case, contact the chaplains of the Department of Pastoral Care.
Religious traditions tend to be as complex as they are long, and it is impossible to
predict how any one patient or family member may understand or apply them in the context
of health care. Therefore, providers should encourage patients and family members to
interpret how religious/cultural values may be pertinent to a hospital stay--regarding
personal needs, interaction with staff, and decisions about treatment.
The lists below address select points for the care of patients from
Buddhist Patients and Health Care:
Nine Practical Points for non-Buddhist Providers
- Buddhism places strong emphasis on "mindfulness," so patients may request peace and quiet
for the purpose of meditation, especially during crises.
- Some Buddhists may express strong, culturally-based concerns about modesty: for
instance, regarding treatment by someone of the opposite sex.
- Some Buddhists are strictly vegetarian in refusing to consume any meat or animal
by-product. For such patients, even medications that are produced using animals are likely to
- The importance of mindful awareness of all of life's experience may affect patients' or
family members' decisions about pain medications, out of worry that analgesics may unduly cloud
awareness. Clinicians should be very specific in discussion of the use of any drug that may affect
awareness, however it should be noted that moderate use of analgesics might actually enable a
patient who is struggling with pain to achieve greater concentration and "mindfulness" under
the circumstances. Non-pharmacological pain management options are often attractive. In some cases,
Buddhists may refuse analgesics, but this should not be assumed by staff to mean a desire for
suffering --in fact, Buddhism focuses on the relief of suffering, yet some patients may prefer
clarity of consciousness to drugs that may reduce mental alertness.
- Patients or families may pray or chant out loud repetitiously. This is often done
quietly, and any noise concerns in a hospital can usually be negotiated easily. Patients may use
a string of beads during prayer. Families sometimes wish to place a picture of the Buddha in the
patient's room. Requests to burn incense or candles can be handled by suggesting alternatives,
such as placing flowers in the room or setting up a small electric light.
- In end-of-life care, Buddhists may be very concerned about safeguarding their
awareness/consciousness. Clarification of the patient's wishes about the use of analgesics
in the days and hours before death is strategically important for developing an ethical pain
- As a patient approaches death, medical and nursing staff should minimize actions that
might disturb his/her concentration or meditation in preparation for dying. In Buddhist
tradition, death is conceived as a time of crucial "transition," with karmic implications.
Near the time of death, a Buddhist patient's family may appear quite emotionally reserved
and even keep their physical distance from the patient's bed --this is sometimes the custom for
the purpose supporting the patient's desire to concentrate without distraction on the experience
- After the patient has died, staff should try to keep the body as still as possible
and avoid jostling during transport. Buddhism teaches that the body is not immediately devoid
of the personís spirit after death, so there is continued concern about disturbing the body.
Such belief may also be an impediment to discussion of organ donation.
- Families may request that, after a patient has died, the patient's body be kept available
to them for a number of hours, for the purpose of religious rites. All such requests should be
negotiated carefully, maximizing the opportunity for accommodation in recognition of the
Catholic Patients and Health Care:
Eight Practical Points for non-Catholic Providers
- Sacraments and blessings by a Catholic priest are highly important, especially
before surgery or whenever there is a perceived risk of death. The sacramental requests most
often made by patients are for "Sacrament of the Sick" (what some Catholics may think of
as "Last Rites"), Confession, and Holy Communion (Eucharist) --the latter, however, does
not have to offered by a priest but may be offered by an authorized lay Catholic Eucharistic Minister.
- If a patient is near death, there may be an urgent request for a Catholic priest to
offer "Sacrament of the Sick" (which some Catholics may call "Last Rites"). Even if the sacrament
has already been offered, there may still be a request for a priest to offer prayers and bless the
- Baptism: All requests for the sacrament of baptism should be relayed to a Catholic
priest, but in the case of an infant who is likely to die before a priest can arrive, such an
infant may be baptized by any person with proper intent --the person would say, "[name of infant],
I baptize you in the name of the Father, and of the Son, and of the Holy Spirit," pouring a small
amount of water over the infant's head three times. A report of such an emergency baptism should
be made to the local Catholic parish priest.
- Patients may request Holy Communion (Eucharist) prior to surgery. While a Catholic
priest or Eucharistic Minister would typically offer such a patient only a tiny portion of a
wafer, patents who are NPO (to have nothing by mouth) should have this request approved by the
care team as medically safe.
- Some patients may keep with them religious objects, such as a rosary (a loop of beads with
a crucifix, used for prayer), a scapula (a small cloth devotional pendant), or a religious medal.
If patients request that such an object remain with them during medical procedures, discuss the
option of placing the object in a sealed bag that can be kept on or near the patient. If an object
is metal and the patient is having a radiological procedure or test (like an MRI scan), ask the
patient or family if they can bring in a non-metal substitute.
- Interruption of religious practices, such as regular attendance at Mass or special
observance of special holy days, may be highly stressful to Catholic patients. Discuss
contacting clergy and/or a hospital chaplain.
- Patients may have moral questions about treatment decisions, often about the
withholding/withdrawing of life-sustaining treatment. Catholic teaching does not
generally require any treatment considered "extraordinary means," but a priest may offer
authoritative guidance in specific situations. Within families, there may be diverse
opinions about Catholic moral teaching, and differences sometimes fall along age cohort
lines because of the Second Vatican Council's many changes, occurring in the 1960s.
- Patients may request non-meat diets, especially during the late-winter time of Lent
(the 40 days before the festival of Easter).
Hindu Patients and Health Care:
Eight Practical Points for non-Hindu Providers
- Hindu patients may express strong, culturally-based concerns about modesty,
especially regarding treatment by someone of the opposite sex. Genital and urinary issues
are often not discussed with a spouse present.
- Hindus are often strictly vegetarian in refusing to consume any meat or animal
by-products. For such patients, even medications that are produced using animals are likely
to be problematic. Some Hindus may also refrain from eating certain vegetables, like onions
- Fasting is a common practice in Hinduism, and patients may wish to discuss the
implications here in light of the medical/dietary care plan.
- The act of washing is generally conceived as requiring running water, either from
a tap or (poured) from a pitcher. A patient may have a strong desire to wash his/her
hands after meals.
- For many Hindu patients, there is a cultural norm to use the right hand for "clean"
tasks like eating (often without utensils) and their left hand for "unclean" tasks like toileting.
Medical and nursing staff should consider this right-left significance before
hindering a patient's hand or arm movement in any way. Discuss options with the patient.
- Patients may wear jewelry or adornments that have strong cultural and religious
meaning, and staff should not remove these without discussing the matter with the patient or family.
- Hinduism teaches that death is a crucial "transition," with karmic implications.
There may be a strong desire that death occur in the home rather then in the hospital. Family
may wish a number of pre-death rituals (for example, tying a thread around the personís neck
or wrist), and after death they may request to wash the patient's body (done by family members
of the same sex as the patient).
- Family may request that there be constant attendance of the deceased's body, and a
family member or representative may wish to accompany the body constantly, even to the morgue
(where the person may sit outside any restricted area yet relatively near the body).
Jehovah's Witness Patients and Health Care:
Seven Practical Points for non-Jehovah's Witness Providers
- The most defining tenant for Jehovah's Witnesses in health care is the strict prohibition
(a scriptural injunction) against receiving blood (that is: red blood cells, white blood
cells, platelets, or plasma), be it by transfusion (even the transfusion
of a patient's stored blood), in medication containing or manufactured using blood products,
or in food.
- Some blood fractions (such as albumin, immunoglobulin, and hemophiliac preparations)
are allowed, but patients are guided by their own conscience.
- Organ donation and transplantation is allowed, but patients are guided by their own
- Jehovah's Witnesses are usually well prepared to work with health care providers to
seek all possible options for treatment that do not conflict with religious concerns. It is
very common for adults to carry at all times a card stating religiously-based directives for
treatment without blood.
- Contrary to some popular misconceptions, faith-healing is not a part of Jehovah's Witness
tradition. Prayers are often said for comfort and endurance.
- Jehovah's Witness tradition does not teach that those who die experience an immediate
afterlife. It would be inappropriate to say to the family of a deceased patient anything
like, "He's in a better place now."
- Jehovah's Witnesses do not celebrate birthdays or Christian "popular holidays."
Jewish Patients and Health Care:
Eleven Practical Points for non-Jewish Providers
- Some Jewish patients may strictly observe a rule not to "work" on the Sabbath
(from sundown on Friday until sundown on Saturday) or on religious holidays. If so, this
religious injunction against "work" -- which includes prohibitions against using certain tools
or engaging in tasks such as those that initiate the flow of electricity -- would be problematic to
tasks like writing, flipping a light switch, or pushing buttons to call a nurse, adjust a motorized
bed, or operate a patient-controlled analgesia (PCA) pump. Also, the tearing of paper may be
considered "work," so roll toilet paper should be replaced with an opened box of individual
sheets.Medical procedures should not be scheduled
during the Sabbath or religious holidays (unless they are life-saving), nor should hospital
discharges be planned during such times without the consent of the patient. While these
restrictions on "work" are generally associated with Orthodox Judaism, it is possible that
they may be important for any Jewish patient.
- Jewish holidays are usually highly significant for patients, especially Passover
in the spring and Rosh Hashannah and Yom Kippur in the fall. These holidays may affect the
scheduling of medical procedures and may involve dietary changes (related to a need for
special food or to a desire to fast). All Jewish holidays run sundown-to-sundown.
- Jewish patients often request a special "Kosher" diet, in accordance with
religious laws that govern the methods of preparation of certain foods (for example, beef)
and prohibit certain foods (for example, pork or gelatin) and combinations (for example, beef served
with dairy products). During the holiday of Passover, an important distinction is made
between food that is merely "Kosher" and that which is specifically "Kosher for Passover."
Hand washing before eating may have a religious significance.
- Some Jewish patients may have culturally-based concerns about modesty, especially
regarding treatment by someone of the opposite sex. However, Jewish tradition holds the
expertise of medical practitioners in high regard, and this fact may assuage concerns about
treatment by the opposite sex.
- Questions about the withholding or withdrawing of life-sustaining therapy are
deeply debated within Judaism, and some patients or families are strongly opposed to the
idea. Family members often wish to consult with a rabbi about the specific circumstances
and decisions regarding end-of-life care.
- After a patient has died, Jewish tradition directs that burial happen quickly and
that there be no autopsy (though there is acceptance when autopsy is deemed necessary,
such as by a mandate from the Medical Examiner). Also, the family may request that a
family member or representative constantly accompany the body in the hospital,
even to the morgue (where the person may sit outside any restricted area yet relatively
near the body), to say prayers and read psalms.
- There may be a request that amputated limbs be made available for burial. Details
should be arranged through the patientís/familyís funeral home.
- Jewish religious laws pose a complex set of restrictions that can affect medical
decisions, and patients or family members may request to speak with a rabbi to determine
the moral propriety of any particular decision. Exceptions are often made to the normal
application of the religious laws when an action is understood in terms of "saving a life,"
such as with emergency surgery during the Sabbath or (potentially) in the case of organ donation.
The value of "saving a life" is held in extremely high regard in Jewish tradition.
- It is common for Jewish patients to a yarmulke or kippah (skull cap), especially for
prayer,, but some people may wish to keep them on at all times. Patients
or family members may also wear prayer shawls and use phylacteries (two small
boxes containing scriptural verses and having leather straps, worn on the forehead
and forearm during prayer). There may be a request that at least ten people (a minyan)
be allowed in the patientís room for prayer.
- A Jewish person need not be religious to be "Jewish," and such non-religious patients may
observe Jewish religious traditions for cultural reasons.
- The word "Jew" is commonly used within Jewish culture, but non-Jews should be
mindful of its complex historical connotations by which it can sometimes carry a harsh tone
when spoken by non-Jews.
Muslim Patients and Health Care:
Twelve Practical Points for non-Muslim Providers
- Muslim patients may express strong, religiously/culturally-based concerns about modesty,
especially regarding treatment by someone of the opposite sex. A Muslim woman may need to cover
her body completely and should always be given time and opportunity to do so before anyone enters
her room. Women may also request that a family member be present during an exam and may desire
to keep on her clothes during an exam if at all possible. Muslim men may find examination by a
woman to be extremely challenging. Nudity is emphatically discouraged. There should be no casual
physical contact by non-family members of the opposite sex (such as shaking hands). Some Muslims
may avoid eye-contact as a function of modesty.
- Muslims may specifically request a diet in accordance with religious laws for "Halal"
food, though many Muslims simply opt for a vegetarian diet as a quiet way to avoid religious
prohibitions against such things as pork products or gelatin. ("Halal" is not the same
as "Kosher" --the latter refers to Jewish tradition.) Forbidden foods are referred to as "Haraam."
- Muslim dietary regulation can affect patients' use of medications, especially
drugs that have porcine origins or that contain gelatin or alcohol. The dietary prohibition against
alcohol has occasionally
raised questions about Muslims' use of alcohol-based handrubs in the hospital, but such handrubs
should not ultimately prove problematic, because they do not have an intoxicating effect and
are used for potentially life-saving hygiene --nevertheless, a patient or family member's
concern about this should be addressed thoroughly and sensitively, perhaps with the input of an imam.
- The act of washing is generally conceived as requiring running water, either
from a tap or (poured) from a pitcher. As a result, Muslim patients typically do not feel truly
cleaned by a sponge bath. Also, it is generally important that Muslims wash--with running
water--both before and after meals, and also before prayers.
- Muslim prayers are conducted five times a day. Patients may desire to pray by kneeling and
bending to the floor, but Islamic tradition recognizes circumstances when this is not medically
advisable. If patients are disturbed by their inability to pray on the floor, advice should be
encouraged from an imam.
- Muslim patients may take suffering with emotional reserve and may hesitate to
express the need for pain management. Some may even refuse pain medication if they understand
the experience of their pain to be spiritually enriching.
- There may be a request that amputated limbs be made available for burial. Details
should be arranged through the patientís/familyís funeral home.
- Muslim tradition generally discourages the withholding or withdrawing of life-sustaining
therapy. However since decisions on this subject turn on the particular circumstances of
the patient and the complexities of medical treatments, family members who are morally conflicted
may wish to bring an experienced imam into their discussion with physicians.
- A family member may request to be present with a dying person, so as to be able
to whisper a proclamation of faith in the patient's ear right before death. (Similarly, a
husband may request to be present at a birth in order to whisper a proclamation of faith in
the ear of the newborn.)
- After a death, the family may request to wash the patient and to position his/her
bed to face Mecca. The patient's head should rest on a pillow.
- Burial is usually accomplished as soon as possible. Muslim families rarely allow
for autopsy apart from an order by a Medical Examiner. Some Muslims may consider organ donation,
especially with a sense of "saving life," but the subject is open to a great difference of opinion
within Islamic circles.
- During the thirty-day month of Ramadan, Muslims refrain from food and drink from
dawn until sundown. Physicians should explore with patients whether it is medically appropriate
to fast while in the hospital, and if so, investigate options for pre-dawn meals, for providing
patients with dates and spring water in the late afternoon (--a traditional way to break the
daily fast), and for delaying dinner until after sunset. While anyone who is ill
is not obligated to fast, the Ramadan observance can be powerfully meaningful to patients
if they can participate. The month of Ramadan shifts according to a lunar calendar, and
when it occurs during the summertime, longer days can make the fast more physically stressful.
Pentecostal Patients and Health Care:
Four Practical Points for non-Pentecostal Providers
- Pentecostal patients may pray exuberantly. Noise concerns in a hospital can sometimes
present a problem in this regard, but simply shutting the door to the patient's room can usually
provide an adequate solution.
- Pentecostals may pray by "speaking in tongues" (also called "glossolalia") --expression
that is seemingly unintelligible to an objective hearer, but which holds very deep religious
significance for worshippers.
- Patients or families may request that relatively large numbers of people be allowed in the
patient's room for prayer.
- Patients or families may express strong belief in miraculous healing.