Cultural Competency - Multicultural Health Generalizations: Death and Dying Customs
African Americans and Death & Dying
- Faith or spirituality can play an important role in the life and death of many African Americans.
- One reason why some African Americans might be resistant to completing written advanced directives is historical mistreatment, and thus mistrust of the medical system.
- Among the younger generations of African Americans, some are giving more consideration to hospice.
- Palliative care is an option acceptable among some African Americans.
- A dying African American patient or family member might request the presence of a spiritual leader at the bedside.
- Many African Americans and their friends may have a desire to mourn together at the death of a loved one.
Sources:
1. Edwards, G. (2006). Program for Multicultural Health, University of Michigan Health System.
2. Andrews, J.D. (2005). African Americans. Cultural, Ethnic, and Religious Reference Manual for Health Care Providers. (3rd edition). JAMARDA Resources, Inc. Winston-Salem, NC.
3. Barrett R.K., Heller K.S. (2001). "Death and dying in the black experience: An interview with Ronald K. Barrett." Innovations in End-of-Life Care. 3(5), http://www.edc.org/lastacts (accessed 2/2006)
4. Crawley, L., Payne, R., Bolden, J., Payne, T., Washington, P., & Willaims, S. (2000). "Palliative and End-of-Life Care in the African American Community" JAMA. 284(19):2518-2521
Muslims and Death & Dying
Death and dying can be extremely important spiritual times for Muslim patients. Some Muslims may prefer to face Mecca (approximately northeast from Ann Arbor) and may appreciate the company of family and friends who recite prayers and verses from the Qur'an (the Muslim holy book). After a Muslim patient dies, burial should take place as soon as possible. Family and/or community members may want to prepare the body by washing it and then wrapping the body in unsewn white cloth. Post-mortem examinations are discouraged - unless required by law. Most scholars, however, approve of the transplantation of organs from the deceased - with family permission.
Source: Sheikh, A. and Gatrad, A.R. (2000). Caring for Muslim Patient. Radcliff Medical Press: Abingdon, Oxon.
Traditional Judaic Dying Customs
In traditional Judaism, the spirit leaves the body at the time of death. If possible, the dying person is encouraged to recite the confessional or the affirmation of faith (shema) before death. A family member may wish to perform this ritual if the dying person is unable to do so. By religious law, someone should stay with the dying person so the soul will not feel alone. Judaic law also requires the body not be left alone after death. If death occurs on the Sabbath, the family may request he body not travel until the Sabbath is over. The entire body is then prepared as soon as possible, preferably within 24 hours, for burial. The body may be ritually washed after death by members of the Ritual Burial Society; the son or nearest relative may desire to close the eyes and mouth of the deceased; and arms and hands are extended at the sides of the body, incisions covered, and the body draped with a sheet. Beginning with a 7-day mourning period called shiva, mourning extends over one year and includes practices that influences all aspects of life.
Source: Dunn, Cindy MS, RD, LDN, PA-S "Cultural and Religious Beliefs that Shape Health Care Choices" LeMoyne College Physician Assistant Program Religious Studies. Spring, 2000
http://wwwdev.lemoyne.edu/pa_students/Judaism.htm#Healt (disabled)
Alternate source:
http://www.jewish-funerals.org
Japanese Beliefs of Brain Death
- Some Japanese patients approach death with quiet restraint based on Buddhist tradition.
- Unlike members of Western society, some Japanese people believe that the body is as holy as the mind.
- Japanese tradition views the mind and body as one. This belief has led to a reluctance to accept the concept of brain death.
- Although the brain may have irreversibly lost its function, some Japanese people may be hesitant to believe that a person is completely dead when the body shows obvious signs of life.
- Pronouncing such a person as "dead" could be viewed as disrespectful to a future ancestor.
Source:
Sichina, E. S. (2000, Jul. 18). Japanese culture: Religious influences on health beliefs. (Online). University of North Carolina, Greensboro. http://www.uncg.edu/phe/immigrant/japanese/japanreligion.html (disabled) (2002, Feb. 13).
Alternate source: Yoshida, Masayuki, BA, MA, PhD. Reconsidering the Japanese Negative Attitude Toward Brain Death and Organ Transplantation. Eubios Journal of Asian and International Bioethics 14 (2004), 91-95. (Online). http://www.biol.tsukuba.ac.jp/~macer/EJ143/ej143f.htm (disabled) Redirected to: http://www.lifestudies.org/japanese.html
Asian Indian End-of-Life Beliefs and Practices
The cultural background of many Asian Indian elders often influences end-of-life care beliefs and practices. For instance, older Asian Indian patients are more likely to practice family-centered decision making rather than making healthcare decisions alone. Sometimes family members may ask the physician not to tell patients their diagnosis or other important information. Many patients believe that suffering is due to karma (law of cause and effect), which is inevitable. Some Asian Indian patients prefer to die at home, and hold rituals and practices specific to their cultural beliefs. For example, a dying patient may wish to be moved to the floor with an idea of being closer to the Mother Earth. Furthermore, when close to death, family members are often present in large numbers. With these cultural beliefs and practices in mind, providing privacy to the patient and family during end of life would allow for the rituals to be performed.
Source: Alagiakrishnan, K., and Chopra, A. Health and health care of Asian Indian American elders. (Online). Stanford University. http://www.stanford.edu/group/ethnoger/asianindian.html (2002, Jun. 27)
Chinese Buddhist Beliefs about Death and Dying
- According to Chinese Buddhist beliefs, death is not always a one-way passage but sometimes a revolving door. Death may be considered a revolving door through which the consciousness departs from one's life and begins the journey to another new life.
- Another Chinese Buddhist belief is that human life is concurrent and inseparable from two factors: consciousness and warmth. Dying is a gradual process whereby the consciousness gradually separates from the body. Death occurs when the body has completely lost its consciousness and warmth.
- A dying Chinese Buddhist should stay in a peaceful and comfortable environment, preferably accompanied by the chanting of Amitabha, which may be sung by people or played by audio tapes.
- When a person's pulse and brain waves have ceased, traditional U.S. practice is to pronounce the person dead. However, the Buddhist belief is that the person is still actively dying; the consciousness is still in the process of separating from the body.
- During active dying, it is very important to avoid movement of the body or abrupt environmental changes. Therefore, it is preferred to not disturb the body in any way for at least eight additional hours, preferably until the body is cold all over.
Source: Lin, Y. (1995, Jun. 17). Crossing the Gate of Death in Chinese Buddhist Culture. (Online). Buddhist Yogi C. M. Chen's Homepage. http://www.yogichen.org/efiles/mbk16.html
Mexican-American Death Rituals
Mexican-Americans' death rituals are primarily an adaptation of their religion practiced, most commonly Catholicism. Mexican-Americans may often have a calm acceptance of illness or dying and view death as a natural part of life (Heusinkveld, 1993, as cited in Purnell, L. D., & Paulanka, B. J. 1998). Family members may arrive in large numbers at the hospital or home in times of illness or an approaching death. When a person dies, relatives and friends may gather for a velorio (a festive watch over the body of the deceased person before burial). Many Mexican-Americans bury the body within 24 hours, which is required by law in Mexico. More traditional Mexican-Americans may continue their native practice of erecting altars in their homes to honor deceased relatives on the anniversary of their deaths. The dead are [especially] honored [every November 2nd], with candles, decorations, and by bringing the deceased's favorite meal to a picnic at the grave site [where family members may spend the night praying and singing] (Heusinkveld, 1993, as cited in Purnell, L. D., & Paulanka, B. J. 1998). This celebration is known as el Día de los Muertos (the day of the dead).
Source: Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach . Philadelphia, PA: F. A. Davis Company.
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