Sikh Perspectives on Health Care, Dying

and Death

What is Sikhism?

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

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

Who is a Sikh?

The word Sikh means “disciple.”

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)

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

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

Founding of Sikhism

Founder of Sikhism, Guru Nanak Born in 1469 C.E.

Nine human Gurus followed Guru Nanak

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

Gurmukhi Script

The Guru Granth Sahib and small prayer books (gutkas) are written in this script.

Gutka

A gutka is a small book that contains the Nitnem (the 5 daily prayers recited by Sikhs).

If you see this at a patient’s 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 patient’s feet

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.

Panj Kakkars (5 Ks)

• Kesh (unshorn hair) -- acceptance of God’s will/design

Panj Kakkars (5 Ks)

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

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

Panj Kakkars (5 Ks)

• Kirpan (sword) -- responsibility to fight injustice

Kirpan: ceremonial sword

Gatra: a strap that enables a kirpan to be suspended near one's waist or tucked inside one's belt

Types of Sikhs –Different Levels of Orthodoxy

• Amritdhari• Keshdhari• Sahajdhari

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.

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.

Turbans go With Hair

Some Women Wear Turbans

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.

Views on Death

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

Views on Death

We want to “die while alive”. Achieve the highest state of consciousnessEliminate duality between self/God/creationEliminate Fear of death

Religious and Cultural

Considerations in the Care of Sikh

Patients

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

Health-Seeking Beliefs

• Concept of hukam (God’s 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

Illness Behaviors

• Illness may be in the hukam, but one’s 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

Illness Behaviors

• Ardaas: Prayer of supplication• Done at any time, particularly time of

death or birth or other difficult times.

• Meditation

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

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

Community on Health Care

• Sanctity of life is an injunction, therefore:• Assisted suicide and

euthanasia not encouraged• Therapeutic genetic

engineering accepted

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

Community on Healthcare

• Organ transplants and blood transfusions accepted; Sikh youth encouraged to donate

• Male infants not circumcised

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.

Your Approach

• Avoid interrupting prayer or meditation for routine patient care

• Sensitivity to 5 K’s particularly turban for men

• Consult patient and family before procedures requiring removal of hair

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

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

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

Hospice care

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

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

Traditions at the Time of Death

Family and Friends Gather, pay condolence callsPrayer services/reading of the scripture at home or at the GurdwaraPrayer service at the funeral homeCremation

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

Resources

Sikh Patient’s 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

Gateway to Sikhism, www.allaboutsikhs.com

The Sikh Coalition, www.sikhcoalition.org

Sikh-Seek (Sikh search engine), www.sikhseek.com