1. Sikh Perspectives on Health Care, Dying and Death

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

4. 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

5. Who is a Sikh? The word Sikh means “disciple.”

6. 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)

7. 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

8. 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

9. Founding of Sikhism Founder of Sikhism, Guru Nanak Born in 1469 C.E. Nine human Gurus followed Guru Nanak

10. 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

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

12. 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

13. 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.

14. Panj Kakkars (5 Ks) Kesh (unshorn hair) -- acceptance of God’s will/design

15. Panj Kakkars (5 Ks) Kachhera/kachha (a knee-length garment normally worn under clothes) -- modesty, purity and sexual restraint

16. 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

17. 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

18. Types of Sikhs –Different Levels of Orthodoxy Amritdhari Keshdhari Sahajdhari

19. 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.

20. 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.

21. Turbans go With Hair

22. Some Women Wear Turbans

23. 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.

24. Views on Death Death is not the end, it is an inevitable part of life The soul does not die, only the body does Human life is a gift. It is the only opportunity we have to meet God

25. Views on Death We want to “die while alive”. Achieve the highest state of consciousness Eliminate duality between self/God/creation Eliminate Fear of death

26. Religious and Cultural Considerations in the Care of Sikh Patients

27. 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

28. 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

29. 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

30. Illness Behaviors Ardaas: Prayer of supplication Done at any time, particularly time of death or birth or other difficult times. Meditation

31. 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

32. 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

33. Community on Health Care Sanctity of life is an injunction, therefore: Assisted suicide and euthanasia not encouraged Therapeutic genetic engineering accepted

34. 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

35. Community on Healthcare Organ transplants and blood transfusions accepted; Sikh youth encouraged to donate Male infants not circumcised

36. 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.

37. 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

38. 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

39. 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

40. 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

41. Hospice care No contraindication to palliative care Patient might be very comforted bySikh hymns, prayers and meditation. Family or Gurdwara granthi can do this Be sensitive to officials of other religions doing prayers with patients

42. 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

43. Traditions at the Time of Death Family and Friends Gather, pay condolence calls Prayer services/reading of the scripture at home or at the Gurdwara Prayer service at the funeral home Cremation

44. 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

45. 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