The U.S. is often called a ‘melting pot’ as it amalgamates cultures around the world. The diversity of religion adds to the challenges in delivering culturally and religiously competent care.
Christianity
Modern Christianity originated when followers moved against what they believed to be problems and lacking in the Roman Catholic Church. Protestants put emphasis on salvation by grace and faith alone rather than works of man.
Beliefs
- Emphasis on community worship and the Church
- Base beliefs off of the Holy Bible and Scriptures and that Jesus Christ is the son of God.
- Two sacraments, namely, Baptism and Communion.
- Importance of daily prayer and scripture reading. Traditional Holidays observed.
Beliefs with Health Implications
Christian Protestant values have a loose grip on health practices and most Chrisitans are free to make health decisions based on their own needs. Below are some common health issues that clinical practitioners come across with religious individuals in the lens of Protestantism.
- Blood Products: individuals are free to accept or withhold from blood or blood products.
- Vaccinations: vaccinations are of individual choice
- Pregnancy: Infants are baptized in some denominations. Birth control and artificial insemination are individual choices, however, the support for these options vary by individual and denomination.
- End-of-life: Protestant physicians more likely to withhold treatment from terminally ill patients than other denominations. Protestant patients are more likely to desire life-prolonging treatment compared to non-fundamentalist counterparts.
- Death: Autopsy and organ donations are individual choices. Euthanaisia is generally not permitted.
Rituals with Health Implications
Food/Fasting: No restrictions
Judaism
Pronouncement of the covenant that God established with Israel’s descendants a big theme in Judaism. This religion includes practices, theological positions, texts, and organization forms.
Beliefs
- One omniscient God who is creator of the universe
- Commandements and duties that God communicated have importance over individual pleasures and rights.
- Sanctity of life is priority over religious commitments.
- Orthodox Jews: Strict interpretation of Torah, pray three times/day. Conservative Jews: modern and traditional religious observance accepted, daily prayers. Reform Jews: Choose which religious duties and freedom to interpret from Torah, open to multi-faith and bedside prayers.
Beliefs with Health Implications
Jewish people have more rules and regulations than Protestants in terms of what they can do with their bodies and health, but there are many levels of strictness and adherence to these rules. Below are some common health issues that clinical practitioners come across with religious individuals in the lens of Judaism.
- Blood Products: individuals are free to accept or withhold from blood or blood products.
- Vaccinations: vaccinations are encouraged.
- Pregnancy: abortion is allowed in order to save the mother. Birth control may not be permissible.
- End-of-life: May consult Rabbi about life-support and tube feeding, attitude depends on whether they are Orthodox or secular Jews. Orthodox Jews would want life-sustaining treatments. Religious Jewish physicians tend to be less likely to withdraw life-sustaining treatment.
- Death: Autopsy and organ donations are individual choices. Cremation is discouraged. Prayers and community for the sick are an important part of the faith.
Rituals with Health Implications
Food/Fasting: Kosher foods. Sick are exempt from fasting.
Amputation: Amputated limbs are to be saved to be buried in consecrated ground
Islamism
Islam is another common religion in the U.S. Followers are Muslims who believe in Allah and the prophets Adam, Abraham, David, Jesus, Moses, Noah, and God’s messenger Muhammad.
Beliefs
- One all-powerful God, Allah. Complete submission to Him.
- Judgment day, afterlife, importance of prayer 5 times/day. Death is in God’s plan.
- The Quran is the final revelation.
Beliefs with Health Implications
Muslims have many practices and beliefs that may affect their health. There are levels as to what extent the believers may go to, but basic beliefs encompass prayer, fasting, and pilgrimage. Other examples include the idea that female patients may require a female physician. Below are some common health issues that clinical practitioners come across with religious individuals in the lens of Islam.
- Blood Products: individuals are free to accept or withhold from blood or blood products.
- Vaccinations: not opposed, but certain considerations and socio-cultural reasons shape vaccine hesitancy (e.g., non-halal-based vaccine).
- Pregnancy: abortion is unacceptable except in cases of rape, incest, or when the mother’s life is endangered. A fetus is considered human after 25 weeks.
- End-of-life: dignity of patients was found to be important in decisions for physicians. Physicians may push DNRs in certain scenarios (e.g., dementia).
- Death: Confession of sins may occur before death. Autopsy for only legal or medical cases. Euthanasia is unacceptable. Organ donation is permissible. There is prayer for deceased 72 hours after death, so the death certificate must be signed quickly.
Rituals with Health Implications
- Food/Fasting: Ramadan–a one month fast of food, drink, and sexual intercourse during daylight. Children, women who are pregnant, and the ill may be exempt. Individuals must eat food that is clean, pure, nourishing, and wholesome (halal). Pork, shellfish, and alcohol are prohibited. Only vegetable oil is permitted.
- Migration: Pilgrimage to Mecca is required once in a lifetime.
- Same-sex physicians may be needed. Some women required to wear coverings.
Buddhism
Buddhism includes a diversity of spiritual and religious beliefs and traditions which originated from the teachings of Siddhartha Gautama—also known as the Buddha. Buddhism started 2,500 years ago in India and is considered another major religion in the U.S.
Beliefs
- Path to enlightenment by developing wisdom, morals, mediation.
- No “god”, but personal insight is first, with the study of laws of cause and effect, karma.
- Belief in Rebirth and that it is based on the actions of person and desire to bring freedom.
- “5 Lay Vows: no intentional killing, no stealing, no lying, no sexual misconduct, and no intoxicants.”
Beliefs with Health Implications
Buddhists have a range of personal expectations and rules they have for themselves. Although there is no “god” to observe their rights and wrongs, they have a strong moral code of conduct. Some of these may fall over into the medical field and affect health decisions. Below are some common health issues that clinical practitioners come across with religious individuals in the lens of Buddhism.
- Blood Products: Individuals are free to accept or withhold from blood or blood products.
- Vaccinations: Modern Buddhists will generally accept vaccines to protect their health. Debate is created if the vaccine is derived from any life form. But modern view stresses the importance of saving life through biomedical research.
- Pregnancy: Birth control and artificial insemination are permitted. Taking a life is unacceptable.
- End-of-life: Life-prolonging treatment favored if there is a higher chance of survival. Peaceful state of mind is of utmost importance.
- Death: Mind-altering drugs are avoided since state of mind at death influences rebirth. Buddhist representatives should be alerted in advance to preside over the care. SOme unexpected death may require rituals. Autopsy and organ donation is permitted.
Rituals with Health Implications
- Food/Fasting: Usually vegetarian. Stay away from alcohol, tobacco, and coffee.
Hinduism
As one of the oldest religions, Hinduism has customs and traditions dating back 4,000 years. In the U.S. it is one of the top religions and worldwide, there are nearly 1 billion followers. Hinduism stresses duties to God, parents, and teachers as well as a belief in karma and reincarnation.
Beliefs
- Pain and illness are a result of karma. Reincarnated life is influenced by how one faces this suffering or death.
- Goal is to escape an imperfect world and reunite with God.
- Multiple gods as Hindus view everything in the universe as god.
Beliefs with Health Implications
Similar to Buddhists, Hindus have a variety of personal regulations and duties they have for themselves. There are many Hindu-specific rules in the religion, so it is wise to watch out for these practices in the clinical setting. An important note is that the Father or Husband of the family is the primary spokesperson and women may not request special care. Below are some common health issues that clinical practitioners come across with religious individuals in the lens of Hinduism.
- Blood Products: Individuals are free to accept or withhold from blood or blood products.
- Vaccinations: There are no restrictions against vaccines. While cows are considered sacred, trace amounts of bovine components are not of concern.
- Pregnancy: Abortion is unacceptable unless it is for the life of the mother. Birth control and artificial insemination are acceptable. Exact time of birth is crucial.
- End-of-life: There are no restrictions on prolongation of life. Most Hindu physicians believe that DNR is allowed and many patients.
- Death: Euthanasia is not permitted. Hindus prefer to pass at home and the Gita or scripture is often read to provide comfort. Cremation is common the day of death and the body is typically not left unaccompanied until the cremation. Immediately after death, family may wash the body and a priest may pour water into mouth. Autopsy and organ donation are permissible.
Rituals with Health Implications
- Food/Fasting: Usually vegetarian and may avoid pork or beef. Fasting is important on holy days as well as certain days of the week representing deities.
- May require a supportive environment and privacy for daily practices.
*Information adapted from Swihart, et al., Chakraborty, et al.
Swihart, D. L., Yarrarapu, S. N. S., & Martin, R. L. (2023, January). Cultural religious competence in clinical practice. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/29630268/
Chakraborty, R., El-Jawahri, A. R., Litzow, M. R., Syrjala, K. L., Parnes, A. D., & Hashmi, S. K. (2017, January 19). A systematic review of religious beliefs about major end-of-life issues in the five major world religions: Palliative & Supportive Care. Cambridge Core. https://www.cambridge.org/core/journals/palliative-and-supportive-care/article/systematic-review-of-religious-beliefs-about-major-endoflife-issues-in-the-five-major-world-religions/31C31B331612050F02792FDA509B3D39