Faith Traditions and Health Care (Revised, June 2003) This resource was developed as a handout for a panel discussion on the theme of "Spirituality and Medicine" which has been an annual component of the Professionalism and Humanism module of the University of Pennsylvania School of Medicine curriculum since 1997. Panel members--local representatives of various faith traditions--were asked to provide concise information on the following topics as they pertain to the beliefs and practices of the respective faith groups. These responses are offered as useful personal insights but are not intended as authoritative statements. Responses have been organized according to the following abbreviations: AAP: African American Protestant Bud: Buddhism CS: Christian Science Hin: Hinduism Isl: Islam JW: Jehovah's Witnesses Jud: Judaism RC: Roman Catholicism TOPICS: - BIRTH CONTROL - ABORTION - DIETARY REQUIREMENTS - USE OF BLOOD PRODUCTS - REFUSAL OR WITHDRAWAL OF RESPIRATOR, ETC. - SPECIAL GENDER CONSIDERATIONS IN HEALTH CARE - PATIENTS' MEDICAL DECISION MAKING - PRAYER FOR THE SICK - CRITICAL RITUALS OR SACRAMENTS - EUTHANASIA OR PHYSICIAN ASSISTED SUICIDE (PAS) - ORGAN DONATION - AUTOPSY - SPECIAL PRACTICES AFTER DEATH - LIFE AFTER DEATH - OTHER RELEVANT BELIEFS OR PRACTICES   BIRTH CONTROL AAP: Strongly promote. Bud: Buddhism does not comment on it, although the approval of birth control is implied because sex is not prohibited and abortion is not considered to be a viable birth control method. CS: Church members are not given any instructions by the Church on personal family issues such as birth control. Members are free to do whatever they feel is best. Members are morally guided by the Ten Commandments and the Sermon on the Mount, as well as by the writings of Mary Baker Eddy. It is important to remember that there are many more people practicing the healing system of Christian Science then there are members of the Church of Christ, Scientist. Therefore there are many levels of reliance on prayer. Hin: Strictly, sex is restricted for procreation within marriage, however, the majority of Hindus would use birth control. Most Western Krishna devotees do not use birth control except abstinence. Birth control is permissible if the prescribed method does not have any adverse impact on the health of either spouse and if it does not lead to permanent sterilization. JW: Decision is a personal one to be made by the couple involved. Jud: Most Jewish groups permit; Orthodox Jews may restrict types used, if permitted. RC: No artificial means may be used. Abstaining from intercourse during ovulation (rhythm method) permitted. ABORTION AAP: Not as a matter of birth control; only when the life of the mother is involved. Bud: Abortion is considered to be "killing," so it is to be avoided if at all possible. CS: See the response regarding Birth Control (above). Hin: Hindus believe that life begins at conception, so abortion is highly condemned. Isl: Abortions are strictly prohibited except in extreme cases, e.g., if the mother's health is in imminent danger. JW: Deliberately induced abortion simply to avoid the birth of an unwanted child is considered the willful taking of human life and hence is unacceptable to Jehovah's Witnesses. If (at the time of childbirth) a choice must be made between the life of the mother and that of the child, it is up to the individuals concerned to make that decision. Jud: Permitted to preserve the women's life or health. Some Jews are more liberal, but even the strictest view requires abortion to save the mother's life. RC: Never permitted. DIETARY REQUIREMENTS AAP: No restrictions. Bud: No restrictions as long as no killing is involved. The interpretation of this varies, so some Buddhists are vegetarians, while others are simply required not to participate actively in the death of an animal. CS: Christian Scientists are given no dietary requirements but strive to follow Jesus' words, "...take no thought, saying 'What shall we eat?' 'What shall we drink?...'" (Matthew 6:31). There is always the thought of balance and temperance, but there is no belief that food has power in itself to cure. Hin: No meat, fish, or eggs, and for the most strict no onion and garlic. Hindus who do eat meat will generally not eat beef. Isl: Dietary laws are followed by all orthodox members and include no pork or pork by-products; no alcohol or alcoholic by-products or intoxicants or anything else that alters thinking or behavior. JW: Jehovah's Witnesses believe that Christians are required to abstain from eating blood and the meat of animals from which blood has been drained (Acts 15:28-29). Jud: Many Jews observe a system of dietary requirements called Kashrut (keeping Kosher). Jewish law regulates how foods are prepared and which foods are allowable to eat (e.g., pork and shellfish are not allowed). During the holiday of Passover, many Jews abstain from eating leavened grain products. RC: On Fridays of Lent, abstain from meat if over 14 years of age. On Ash Wednesday and Good Friday, fast between meals if between the ages of 21 and 59. Neither applies if there is a medical emergency. Fast for one hour (except water) prior to receiving Communion. Fasting does not apply in a hospital setting. USE OF BLOOD PRODUCTS AAP: No restrictions. Bud: No restrictions. CS: The Church does not dictate the health care choices of its members. They are free to do whatever they feel is best. In general, however, Christian Scientists would prefer no (or at least minimal) medical intervention (such as drugs, surgery, or blood products). In general, Christian Scientists appreciate basic first aid and care, such as bathing and feeding. The important thing to remember is that each member should be given the opportunity to decide on his or her care in every situation. Hin: Most Hindus would use blood products if really needed, but they would likely have some concerns because of the "Karmic" obligation to repay the donor of the blood. Isl: Blood transfusions are permitted, including those from non-Muslims. JW: Blood transfusions are forbidden, but not the use of blood fractions such as albumin, immunoglobulin, and hemophiliac preparations. Jud: No restrictions. RC: Not required or prohibited. Considered acceptable the same way other medical interventions are evaluated as acceptable. REFUSAL OR WITHDRAWAL OF RESPIRATOR, DIALYSIS, FOOD, AND/OR HYDRATION AAP: Patient's choice. Where the patient is unable to choose, the family decides. Bud: No restrictions. It is the patient's choice or family's choice. CS: See the response regarding Euthanasia (below). Hin: No philosophical restrictions. Isl: It is not permissible to take one's life or intentionally do harm to one's life, therefore it is permissible to use life support to save and lengthen life. However, there is no obligation to continue these interventions just to prolong imminent death. The purpose of aggressive medical intervention is to maintain the process of life, not to avoid death. It is forbidden to cause harm to the patient with equipment and drugs when the futility of such procedures is established by the medical team. Under those circumstances it is permissible to discontinue life-support systems. JW: The decision to prolong or not to prolong life is a decision made by the individual and is pointed out on the power of attorney form. Jud: No restrictions for respirator or dialysis. Liberal opinions treat food and hydration as medication that can be discontinued, whereas more traditional opinions require food and hydration. This should be discussed with the patient, the family, and/or the rabbi. RC: Any treatment considered "extraordinary means" may be initiated or withdrawn if in keeping with the wishes of the patient. Personal choice (autonomy) is valued except in physician-assisted suicide, which is not permitted. SPECIAL GENDER CONSIDERATIONS IN HEALTH CARE AAP: None. Bud: None, except regarding a physician of the same gender for a Buddhist monk or nun. CS: --- Hin: Hindus are generally very modest and would probably prefer same-gender care, especially for women. Isl: Modesty and same-gender treatment (i.e., female physicians for female patients and male physicians for male patients) is preferred in order to safeguard the honor of both the patient and the physician under Islamic law. JW: None. Jud: Strictly orthodox patients may be concerned with inter-gender physical contact, but this is usually set aside when it is medically unavoidable. RC: Persons should have treatment available regardless of gender. Emphasis is on human dignity in general rather than gender. PATIENTS' FREEDOMS AND CONSTRAINTS IN MEDICAL DECISION MAKING AAP: The final decision is the patient's. Bud: The patient may make decisions with or without the family's input. CS: --- Hin: For Hindus from India, one should keep in mind that the family is emphasized over the individual. Even adult children generally follow their parents' instructions. This is less true of the Western-born generation. Isl: Islam is a very practical way of life, and Muslims strive to prepare their everyday life as if each day was their last day. JW: The patient should be fully informed about diagnosis, prognosis, and treatment, so that health care decisions can be made. Each Witness likely carries an Advance Medical Directive card. Friends and family should have copies of a four-page Power of Attorney form which contains, among other things, end-of-life decisions, names of health care agents, and directives for non-blood management. Jud: Individual freedom and the sanctity of human life are both central values in Judaism. Various movements within Judaism differ in approach as to how to best strike the delicate balance between autonomy/individual freedom-to-choose and the obligation to preserve life. RC: Abortion and assisted suicide are prohibited. All other medical decisions should be made with attention to the values of autonomy, justice, and benefit/burden. PRAYER FOR THE SICK AAP: Strongly support. Bud: There are no required prayers for the sick. The patient should keep in mind that illness is part of life, and nothing is certain. CS: --- Hin: There are no specific prayers for the sick. Various prayers may be used. Isl: It is incumbent for believers to offer prayers, to visit the sick, and to offer assistance to the family. JW: Prayer on behalf of the sick to comfort them and help them to endure their medical problems. Witnesses do not believe in modern-day faith healing. Jud: "Mi Sheberakh" is the prayer for the sick said by a rabbi, but appropriate prayers or psalms can be said by anyone, not only by a rabbi. RC: It is appropriate to pray for the sick, and it may have a beneficial effect on their recovery. CRITICAL RITUALS OR SACRAMENTS AAP: No rituals; just a pastoral presence. Bud: No rituals. CS: Christian Scientists most often rely on treatment (prayer) for healing. A member may want to be in touch with a Christian Science practitioner. A listing of practitioners can be obtained at Christian Science reading rooms, which are listed in the Yellow Pages. Some practitioners may be listed in the Yellow Pages. There are no physical rituals or sacraments in Christian Science. Hin: Hindus may wear beads from the sacred Tulasi plant around their neck as a religious article; they would prefer this not be removed, if possible. Health care providers may also find marks on their bodies which have been made with clay: these should not be washed off, unless necessary. Isl: When death approaches the sick, it is customary that the recitation of "the declaration of faith" is offered. Also, a sick person should be turned on his/her right side. JW: Jehovah's Witnesses do not have special rituals to be performed for the sick or for those dying. Every reasonable effort should be made to provide medical assistance, comfort, and spiritual care needed by the sick patient. Jud: A prayer of confession made be made by or on behalf of a gravely ill person. However, it is not required, nor is it the equivalent of a "last rite." RC: Baptism is required for membership in the Church; it is said to "remove" original sin, and introduce God's grace (salvation). If a newborn or child is not baptized and is in danger of death, anyone could and should baptize at the parent's request by doing the following: ordinary water is poured over the forehead with the words, "I baptize you, in the name of the Father, and of the Son, and of the Holy Spirit." The baptism is considered valid if the one baptizing has the intention of the Church and the parents in mind, even when that person is not a baptized Christian. Anointing of the Sick: A sacramental ritual which serves as a sign of God's presence (grace) for and in the sick person. Anyone with an acute or chronic illness may request that this sacrament be administered. It is administered only by an ordained priest. Commendation of the Dying: At the time of dying or death, special prayers are said which speak to immediate preparation for death and comfort to the mourners. This is commonly--and incorrectly--called "last rites." These prayers have a powerful cultural as well as religious meaning to many and should be administered for pastoral reasons on the request of the individual or family members. Most Catholic parishes will send a priest, day or night, for the emergency administration of the Sacrament of Anointing of the Sick and/or commendation of the dying. Prayers for commendation of the dying do not have to be said by a priest. EUTHANASIA OR PHYSICIAN ASSISTED SUICIDE (PAS) AAP: No doctrinal stance. Bud: Highly condemned. One renowned teacher was asked whether killing a deer that had been mortally injured by a car was compassionate, and he answered, "No," that it was still killing and that you would be tampering with the life stream of that being. CS: In general, Christian Scientists would expect healing, even if the medical prognosis is that the patient will soon die. Because of this, it would be rare for a Christian Scientist to desire to die, even though he or she may refuse medical treatment. Hin: Opposed. Isl: This practice is prohibited. It is against the tenets of Islam. Mercy killing is not the norm under the daily decisions that are made when practicing Islam. JW: Life is precious, and the willful taking of life is wrong. Jud: Active euthanasia or physician assisted suicide is not allowed; pain relief--even if it slows respiration, etc.--is allowed. RC: Neither is permitted. This is different from the secondary effect of medications which are used for comfort (e.g., decreased respiration with the use of morphine). Comfort care measures are recommended to support human dignity and decrease suffering. ORGAN DONATION AAP: Support. Bud: Some Buddhist traditions recommend against it, because they believe it will alter the natural process of death (which continues after the Western determination of death) and rebirth, but many Buddhist traditions view it as a beneficial act of compassion. CS: In general, Christian Scientists would not participate in organ donation programs. Hin: Because Hindus believe in reincarnation, they would not want to donate organs, as this would implicate the donor and recipient in a future birth. Isl: This is not permitted. We ask the medical society to respect that we do not wish to have our organs taken or transplanted. JW: This is a personal medical decision. Jud: Encouraged by most Jewish groups, especially when there is a specific recipient. RC: Organ donation is allowed; donation and reception of organs should be evaluated according to ethical issues. AUTOPSY AAP: Support. Bud: No prohibition. It is an individual decision. CS: --- Hin: No prohibition. However, it is desired that cremation occur as soon as possible after death in order to free the soul. Isl: This is a most displeasing practice, seen essentially as a dismembering of a deceased body. Islam prohibits this practice, because the soul of the deceased is still connected with the physical body. JW: We generally prefer not to be subjected to a postmortem dissection. Jud: Discouraged traditionally unless required by law or to gain life-saving information (e.g., genetic information for a family member). RC: Permissible, if respect for the deceased is maintained. SPECIAL PRACTICES AFTER DEATH AAP: None. Bud: The spent body is nothing special after death. Cremation or burial is the decision of the individual. CS: --- Hin: Hindus would probably want a priest to sprinkle holy water (from the Ganges or Yamuna Rivers) on the body, and place Tulasi leaves on the tongue. Cremation is the practice for the disposal of the body. Isl: Saying: "From Allah we come, to Allah we'll return." Closing the eyes, preparing/washing the body (Ghusl), saying good things about the deceased. JW: This would be either a funeral or memorial service that might involve burial or cremation. Jud: The body should be treated with respect, covered promptly, and traditionally "guarded" by volunteers. The funeral takes place within 24-48 hours. RC: Respect for the body is maintained. Burial in consecrated ground is required (land which is set aside or blessed at time of burial). If a person has an amputation of a limb, the practice is to provide burial out of respect for the body. LIFE AFTER DEATH AAP: Strongly believe in. Bud: Buddhism believes in reincarnation. Subsequent lives are determined by the good or bad actions ("karma") of the person. One goal is to transcend reincarnation and end the circle of birth and death, although in many traditions there are vows that commit the individual to be reborn so they can help others. The goal here in not necessarily to transcend reincarnation but to transcend confusion. CS: --- Hin: Belief in reincarnation: the next life is determined by the consciousness at the time of death, according to the good or bad deeds/actions of the person. The goal is to transcend reincarnation and end the cycle of birth/death. Isl: Muslims believe in life after death, therefore it is essential that we constantly strive to live righteously in accord with the Word of Allah. JW: The dead go back to the dust and are neither in heaven nor a place of torment. Jud: Most Jews believe in the continuity of the soul, and many have more extensive beliefs. The emphasis is on life in this world. RC: Through the resurrection of Jesus, persons are given the gift of life eternal. There is life beyond human life in which we will be judged for our lives and receive eternal reward or punishment. OTHER RELEVANT BELIEFS OR PRACTICES AAP: Medicine and its practice are sacred. God is the ultimate source and reference when it comes to life and its quality. Bud: Illness is part of life. We seek help from medicine and its practices in the normal nature of a human being. CS: --- Hin: --- Isl: At the birth of a child, we require the placenta. Also, we practice the tradition of the Prophet in manners and beliefs. JW: We believe the only hope for the dead living again is by a resurrection under God's government of a paradise on earth that He proposed in mankind's beginning. Jud: Some Jews observe the rules of Sabbath (e.g., requiring abstaining from workday activities, such as writing or turning on a light). However, the preservation of human life takes precedence over nearly all other Jewish laws, including the rules of Sabbath. RC: Many persons seek and receive great comfort from the reception of Sacraments at the time of illness. This may include the reception of Communion and the practice of private devotions. Physicians may add to the support of patients by asking if the patients' spiritual needs and practices are being cared for at the time of an illness or during a time of extreme stress or loss.