Medical Ethics

Medical Ethics

How Hindu Dharma Addresses 25 Controversial Medical Issues Frequently Encountered by Physicians

INDU MEDICINE, KNOWN AS AYURVEDA, OR THE “SCIENCE of life,” has a highly developed system of practical ethics derived from the Hindu principles of nonhurtfulness, the sanctity of all life, the existence of the soul separate from the body and a willingness to accept life’s circumstances as defined by one’s karma and dharma.

In 1999, HINDUISM TODAY was approached by the Texas Medical Association to help them revise and expand a book on medical issues called Faith of Our Patients. When it was first published in 1978, the book dealt with the Catholic, Protestant and Jewish views of 14 “problem areas” most frequently encountered by physicians, including autopsy, abortion, artificial insemination, prolongation of life and organ transplants. The association had recently expanded its list and sought to include the views of Hinduism and Buddhism to accommodate increased religious diversity among their patients.

Responding to their request, HINDUISM TODAY enlisted the help of Swami Bua of New York; Swami Satchidananda of the Integral Yoga Institute; Swami Ranganathananda, president of the Ramakrishna Mission; Swami Chidananda Saraswati (Muniji); Swami Omkarananda; Swami Pragyanand; Swami Tejomayananda of Chinmaya Mission; Satguru Sivaya Subramuniyaswami, founder of HINDUISM TODAY, and his successor, Satguru Bodhinatha Veylanswami. We also consulted with Dr. Virendra Sodhi, a gifted ayurvedic and allopathic doctor in Washington, and Cromwell Crawford of the University of Hawaii, an Indian-born specialist in Hindu medical ethics. The assembled responses below represent the broad consensus of this group, with occasional differing opinions, though the precise wording has been crafted by HINDUISM TODAY.

Fortunately, as pointed out by Professor Crawford, the ancient codifiers of ayurveda, Sushruta and Charaka, carefully considered and documented the ethics of their profession and its medical procedures. They did so within the context of a Hindu view of man, which, as Swami Ranganathanananda put it, “is that his essential, real nature is the atman or Self, which is immortal, self-luminous, the source of all power, joy and glory. Everything that helps in the manifestation of the divinity of the soul is beneficial and moral, and everything that obstructs this inner unfoldment is harmful and immoral.”

With this over-arching principle in mind, it was the aim of the ayurvedic physician in ancient India (and remains so today) to preserve the well-being of the community through maintaining health and removing the threats to life of humans and nonhumans. The ancient healers held that pathogenesis, the development of disease, is not caused randomly or simplistically by external agents through infection or injury. Rather, the development of any disease is also an expression of karma: the results of one’s past actions. It is hoped that this compilation of Hindu medical ethics will provide a spiritual view of the medical concerns faced by all Hindus, one that will balance the prevailing humanistic view by presenting a traditional Hindu perspective from which to evaluate the important matters of healing, life, death and the beyond.

Matters of Birth

Hindus consider children a gift from God. Conception, development and birth of a child are sacred events, honored by a ceremony, or samskara, marking these rites of passage. Today’s medical technology has developed many means for conceiving children. Hindus have a general unwillingness to interfere with nature and a special aversion to abortion, based on the belief in reincarnation and the sanctity of marriage.
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Conception

From the Hindu point of view, conception connects a soul from the next world to this world, and the state of mind at the moment of conception—including the purity and spiritual intent of both partners—is a major factor in determining who is born into the family. Prospective parents often offer prayers at temples, perform spiritual disciplines and visit saints for their advice and blessings in their effort to conceive a worthy child. In Western thinking, no emphasis is placed on the state of mind of the parents at conception, and there is little understanding of the ways parents can affect the “quality” of the souls born to them.

Birth Control

While revering conception as a divine act, Hindus have little hesitation to practice birth control, and there are remedies specified in ayurveda both for facilitating and preventing conception. As Swami Bua reminded, restraint and moderation are important: “Hindu scriptures explain how to beget a child. They specify the days, time and methods. That means they would have known also how not to beget a child! But willful control of conception by external means was not advocated. The preferred control was through restraint, as wasting of life seeds was considered unhealthy and unethical. Birth control now is highlighted as a prime duty of every citizen to society and nation. But one fears that these open discussions are licensing society towards promiscuity, since weak minds take the shortest route to pleasures, however fleeting they may be, unmindful of consequences.”

Sterility Testing

While ostensibly harmless, sterility tests can cause serious social and emotional difficulty if one is deemed sterile, including inability to find a spouse, cancellation of proposals and the ruin of marriages once it is known who is to blame for the lack of children. “This should not be resorted to as a routine test,” cautioned Swami Bua. “Doubting the manliness of a man and femininity of a woman is degrading them. What will happen to those who fail the test? Will anybody come forward to marry them? Even though procreation is the main aim of a marriage, it is not the only aim. After a reasonable time following the marriage, if there has been no conception, and if a mature couple desire to get tested with a view to take corrective action, it may be done.” Dr. Sodhi pointed out that while ayurveda has no tests for sterility, the likelihood of children is one of the major considerations when evaluating a couple’s astrology prior to marriage.

Artificial Insemination

Fertilization of the egg by mechanical introduction of sperm is universally acceptable when the sperm is provided by the woman’s husband. But questions arise with donated sperm from another man. Because conception creates a psychic bond between a man and a woman, even if they don’t meet physically, fertilization in this manner may have a similar karma as adultery. “In Sanatana Dharma initiation into married life is sanctified by sacred sacramental rites,” Swami Tejomayananda observed. “The offspring of such a union is blessed and protected by the holy mantras and rites. If there is some defect or obstruction in either partner, artificial insemination may be resorted to, but with the husband’s sperm only. If the procedure succeeds, it may be taken as the will of the Lord for that couple. Use of seeds from the sperm banks or from any living person other than the husband is not proper. It will amount to bearing a child outside holy wedlock.” However, as Professor Crawford pointed out, the Manu Dharma Shastra did allow a woman to conceive a child by another man, usually her husband’s brother. Swami Bua referenced this tradition also: “The Rig Veda and Atharva Veda prescribe the procedure called niyoga to enable a childless widow or the wife of an impotent man to raise progeny with his consent. But even with this, the attitude of an average Hindu woman considers the one who has given her a child as her respectful husband.” Satguru Bodhinatha Veylanswami observed that one has to consider the likely negative impact of artificial insemination on a marriage. The husband would not be the child’s true father, resulting in a weak relationship with the child and even with the wife who required another man to conceive.

In Vitro Fertilization

Even with present-day technology, the creation of “test-tube babies,” the fertilization of the egg outside the womb and its subsequent placement in the womb—is expensive and unreliable. As with artificial insemination, it is acceptable if the egg and sperm are from the husband and wife. Like other medical advances, in vitro fertilization introduces unknown factors that may bring unintended consequences, not necessarily positive or conducive to spiritual progress, which is life’s real purpose. Hindus regard the natural way of things as endowed with God’s infinite intelligence and often ask, “Are humans wise enough to tinker with the cosmic order of life?”

Abortion

Hindu scripture and tradition clearly prohibit abortion, except to save the life of the mother. It is considered an act against rita (universal order) and ahimsa (noninjury). In the words of Swami Omkarananda, “Imagine, through millions of abortions around the world, day in and day out, how many wonderful scientific and spiritual geniuses—doctors, men of excellence of every kind, sages, saints, benefactors of mankind, builders of a better culture and civilization—are destroyed even before they can take a breath of fresh air here on Earth!” Hindu ethics also do not justify aborting a fetus because of actual or potential deformity or mental retardation, for each birth, normal or not, is revered as having a divine purpose to be understood, not manipulated. Nevertheless, abortion is performed today by Hindus in India and elsewhere—particularly selective termination of female fetuses following ultrasound examination. Professor Crawford called that practice “a perverted use of modern science, a scarcely concealed form of female infanticide.” Sivaya Subramuniyaswami summarized in sutra 34 of Living with Siva, “Followers know abortion is, by Vedic injunction, a sinful act against dharma fraught with karmic repercussions. Scripture only allows it to prevent the mother’s death, for it is a greater sin for a child to kill the mother.” “In the modern context,” Swami Tejomayananda advised, “attention must be focused on the prevention of pregnancy by educating and creating awareness in the parents.” Abortion, should it occur, creates a karma to be faced in the future, but is not regarded as an unforgivable “sin.” A penance could mitigate the karma, such as adopting a baby who might otherwise have been aborted if no home was provided.

Selective Termination of Multiple Fetuses

Multiple births are rare, except when a couple is undergoing fertility treatments, which may result in multiple fetuses, creating a potentially dangerous condition for the mother. Under the principle that abortion is allowed to save the mother’s life, Dr. Sodhi offered that selective abortion is acceptable when a specific pregnancy poses such a threat. It is an unfortunate choice to have to make, and hopefully future technology will reliably produce only one fetus.

Pain-Relief Drugs for Newborns

Pain relief for children should be carefully chosen to not form, or lay the seeds for, a future addiction. Swami Bua counseled, “Some people think that the pains of a newborn baby are the consequences of its previous birth and that we should allow the baby to experience and sustain them so that remnants of the previous birth are left behind. But we should also realize that God has brought this baby to our hands expecting us to comfort it and protect it and help it to grow as a healthy and worthy human being. It is the duty of the parents and the people nearby to do whatever is possible to relieve the baby of any pain.” “According to ayurveda,” Dr. Sodhi added, “the baby has as sensitive a nervous system as an adult, just not as developed. So pain medicine is okay, if necessary. Morphine was used for thousands of years in the form of opium, applied on the baby’s skin for pain relief.”

Circumcision

Hindus consider the practice of circumcision for males unnecessary and do not practice it. Doctors should be alerted to Hindu views on this often-standard procedure. A circumcised Hindu boy could face ridicule and discrimination. Rarely, the procedure is required as a medical necessity for an adult, but kept secret.

Other Medical Concerns

Our reflections move on to ethical considerations regarding organ transplants, blood transfusions, faith healing and dietary laws.
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Organ Transplants

Hindus generally believe that the recipient of a major organ, such as the heart, lung, liver or kidney, takes on some of the karmas of the donor. Evidence of this can be found in documented cases where the organ recipients took on the interests, emotions, food preferences, etc., of the donor, especially after a heart transplant. Transplants apparently create psychic connections with the donor, whether living or dead. Also, the fact that part of a deceased donor’s physical body still “lives” may interfere with his reincarnation pattern, keeping him close to the physical plane and to the recipient. Swami Tejomayananda offered, “The Hindu way of life is to accept the inevitable, to go through the karma, exhaust it and be free to take on new life to evolve further spiritually.” Swami Bua voiced a different view: “Let us encourage and support the scientists and medical men and women who are working with pure intentions towards a painless, diseaseless society. We should only guard against unscrupulous traders in human organs.” Swami Chidanand Saraswati opined that it is “important to donate organs” in the Hindu spirit of giving and sacrifice. Dr. Sodhi offered: “Some transplants, such as the cornea, are okay, but not the heart, which is the seat of the soul according to ayurveda. If the quality of life is going to be very good after the transplant, I might not have a problem, but if they have to be on harsh drugs all the time, maybe transplanting is not the best idea.” Swami Satchidananda chided, “What are we doing by transplanting organs?” By replacing organs in a body that is clearly dying, we are not allowing the soul to fulfill its karma in this life by dying at the proper time and getting a new body. The trend of science seems to want to keep the soul indefinitely in the same old body with repaired parts. This is not the correct thing to do.”

Blood Donations/Transfusions

“In early times there were some hesitations, on the basis of caste and religion, for blood transfusion,” observed Swami Bua, “but now, considering the necessity of blood transfusion during any surgery, people are accepting it.” Blood transfusions differ from organ donations in that the recipient’s body soon completely replaces the foreign blood.

Religious or Faith Healings

Hindus make use of all means of healing, be they medical, astrological or metaphysical. The latter includes mantras and yoga, seeking the guidance of a guru and performing temple ceremonies for the direct blessing and intervention of God, Gods and devas. “A Hindu has an ardent faith in the powers of prayers and in the Supreme God,” said Swami Bua, “The patient will go to the doctor—ayurvedic or allopathic—all the while praying to God for recovery.” Swami Pragya-nand noted, “Healing with mantras was very popular in ancient times. Even now it is being practiced for various ailments.” Swami Tejomayananda added, “In healing by prayers, Divine Grace comes in. If the karma is nearing exhaustion, or it is only a weak karma, or the healing will help the person in his spiritual pursuit, or if the Higher Power has some work to be done through the person, then a cure may be effected.” Dr. Sodhi added, “In ayurveda, specific pujas, or ceremonies to the Gods, are sometimes prescribed for patients.”

Dietary Ethics

Vegetarianism is a central aspect of Hinduism, and of even broader import is the ayurvedic wisdom that health is directly dependent upon diet. A Hindu vegetarian who is hospitalized will need to coordinate with care-givers to be served proper food unless he can have family or friends bring his meals. The ayurvedic prerogative is: when healthy, eat a diet that prevents disease and enhances spiritual life. When ill, a drastic change in diet may be the best cure, as seen in the improvement of heart patients put on a vegetarian diet. “The scriptures recognize that fact that food has a great influence on the mind,” shared Swami Tejomayananda, “‘When food is pure, mind is pure,’ state the Upanishads. Mothers prepare food with love in the heart for the children. These positive vibrations are absorbed, and the persons who partake of the food imbibe them. Eating is an act of worship.”

End-of-Life Issues

Hindus regard death as a most exalted human experience, the migration of the soul from one dimension of consciousness to another, a transition we have all experienced many times. Death is not to be feared, neither unnecessarily accelerated nor relentlessly delayed. In considering the following end-of-life issues, the Hindu seeks to preserve the natural timing of death, while humanely comforting and being present for the patient in a spiritual environment.
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Assisted Suicide

Hindu philosophy does not support assisted suicide, which is deliberately causing the death of a patient at the patient’s own request by drugs, overdose of painkillers or other lethal means. In extreme circumstances of unbearable agony where others turn to euthanasia or mercy killing, Hindus know the sufferer may refuse food and water.

Suicide

Hindus believe that life is sacred—God’s grace—and therefore it is not ours to end. Suicide only postpones and intensifies the karma one seeks escape from, requiring several lives to return to the evolutionary point that existed at the moment of suicide; thus it is a spiritual step backwards. In cases of terminal illness, under strict community regulation, tradition does allow prayopavesha, self-willed religious death by fasting. Sivaya Subramuniyaswami taught, “The Vedic rishis gave the anguished embodied soul a way to systematically, nobly and acceptably, even to loved ones, release itself from embodiment through fasting. The person making such a decision declares it publicly, which allows for community regulation and distinguishes the act from suicide committed privately in traumatic emotional states of anguish and despair. Ancient lawgivers cited various stipulations for prayopavesha: inability to perform normal bodily purification, death appears imminent, or the condition is so bad that life’s pleasures are nil. The gradual nature of prayopavesha is the key factor in distinguishing it from sudden suicide, for it allows time for the individual to settle all differences with others, to ponder life and draw close to God.” It also gives the person time to reflect and reconsider his decision.

Prolongation of Life

Ayurveda classifies disease as eithersadhya, those that can be effectively treated and cured, or asadhya, those that cannot. It further classifies untreatable diseases as those which can be managed for an acceptable quality of life, such as diabetes, and those which cannot, such as terminal cancer. If treatment cannot provide the patient a quality life, then it is considered better to give no treatment beyond palliative measures.

The Right to Die

It is the law in many parts of America that a hospital must do everything it can to keep a patient alive as long as possible, no matter what his state of consciousness, or the prognosis for a useful existence. If the patient’s financial resources are exhausted, then the state must pay. To avoid being kept alive against his own wishes, he must make a “living will” in advance, to specify under what conditions he declines further treatment, and assign a person to make that decision for him if he cannot. A living will can preserve the resources of a family, avoiding costly and ineffective heroic treatment. Hindus accept the natural timing of life and of death, and do not strain to gain a few months of struggle-filled life at great effort and expense.

Do-Not-Resuscitate Orders

Part of a living will deals with “Do-not-resuscitate” orders. These instructions tell the doctors when they should not use cardiopulmonary resuscitation (CPR) or other measures to revive a person if his heart or breathing has stopped. Again, the decision centers around the likely quality of a life so revived. A drowning or heart-attack victim may, after resuscitation, go on to a full recovery. But for terminally ill patients, resuscitation may only delay the inevitable, prolong the suffering and interfere with the natural timing of death. Sivaya Subramuniysawami counseled, “To make heroic medical attempts that interfere with the process of the patient’s departure is a grave responsibility, similar to not letting a traveler board a plane flight he has a reservation for, to keep him stranded in the airport with a profusion of tears and useless conversation. To prolong life in the debilitated physical body past the point that the natural will of the person has sustained is to incarcerate, to jail, to place that person in prison. The prison is the hospital. The guards are the life-support machines and the tranquilizing drugs.”

Removal of Life Support

A critical and closely related issue any living will should address is the removal of life support. Modern machines can keep patients alive when they are unable to breathe or take nourishment, and when organs cease to function, including the heart. Life-support patients may be in near-normal consciousness, semi-conscious, comatose or brain dead, with no brain wave activity at all. Even common kidney dialysis machines and ventilators qualify as life support, for if turned off patients would die. A much discussed issue is whether turning off a life support machine is killing the patient or letting him die. The issue is further complicated by rapidly advancing technology whereby ever more seriously ill or injured patients can be kept alive.

In Dr. Sodhi’s opinion, removal of life support would be justified in a case where there is no brain-wave activity, for “according to ayurveda, that person is dead. Sustaining his condition is more like the torture of the soul, and ayurveda prohibits it.” While ancient Hindu medicine did not anticipate many of the abilities of today’s complex machines, it did discuss the issue of nourishment, which is a part of any life-support system. Hindu scripture allows for the termination of food and water at the request of a terminally ill patient who chooses a self-willed death by fasting. The patient can specify in advance in his living will under what conditions nourishment, hydration or other life support should be withheld. Knowing his intentions would alleviate the karmic burden of the doctors and family. The ideal, as Sivaya Subramuniyaswami counseled his devotees, is to not be put on a life support machine in the first place when there is little chance of recovery.

Preparation for Death

“With our strong conviction that all our actions in the present life will be the cause for the effects in our future life,” noted Swami Bua, “a wise Hindu facing death goes into introspection of all his deeds during the present life and sincerely tries to make amends for the wrong deeds. Wherever it is beyond correction, he repents and wholeheartedly prays for forgiveness in the form of chanting mantras. He plans to visit holy places and temples, health permitting. When and if he becomes immobile due to physical conditions, and the indications are that he is nearing his end, his children assemble around him and give him holy water from the Ganges. They sing bhajanas and chant mantras, often in a 24-hour-a-day vigil.” Sivaya Subramuniyaswami wrote, “Blessed with the knowledge of impending transition, we settle affairs and take refuge in japa, worship, scripture and yoga—seeking the highest realizations as we consciously, joyously release the world. Our soul never dies; only the physical body dies. We simply step out of the physical body and are in our astral body, going on in the mind as usual. For Hindus, death is nobly referred to as mahaprasthana, ‘the great journey.’ The awareness, will, memory and intelligence which we think of as ourselves continue to exist in the soul body. We approach death as a sadhana, as a spiritual opportunity. To leave the body in the right frame of mind, in the right consciousness, through the highest possible chakra, is a key to spiritual progress.”

Pain Control

Hindus regard pain management as an important duty of care-givers. “If an individual opts to undergo the pains, he or she should be left alone,” Swami Bua advised. “Otherwise, it is the duty of the people around to help reduce his suffering. If a person is relieved of pain, his thoughts become sublime, with gratitude and the feelings of amity, affection and love. Nobody should be allowed to die with feelings of bitterness, feelings of wanting or feelings of unfulfilled duties. We should do everything possible to keep the dying person comfortable till his end, which is determined by Him.” Opiates and other drugs have been used for this purpose in Hindu medicine for thousands of years, according to Dr. Sodhi. However, he explained, “Practitioners try not to administer so much pain-killer as to alter or cause loss of consciousness.” Excessive pain-killers can dull awareness and inhibit a conscious transition, which is the Hindu ideal.

Definition of Death

“When the physical body dies, this automatically severs the silver cord that connects the astral and physical bodies,” Sivaya Subramuniyaswami explained. Metaphysically, this is the point of death. Physically, death can be defined as the cessation of breath, heartbeat and brainwave activity, in that order. Even then, it may be possible to revive a person, and the patient may report a “near-death experience” of beginning the transition to the next world but being pulled back. Decay of the body is the definitive sign of death.

Autopsies

Autopsies are the examination of a dead body to learn the cause of death. Hindus believe that autopsies are disturbing to the still-aware soul which has just separated from the body and should therefore be avoided unless required by law. Similarly, embalming, which replaces the blood with a preservative fluid, is ill-advised.

Use of the Body After Death

In ancient times, doctors around the world used dead bodies to understand anatomy and practice surgery. In India, the bodies used for this purpose were those unclaimed by relatives or friends. According to Swami Bua, “In the Vedic Age, dissection and mutilation of body were considered detrimental to the fulfillment of life. Yet, if we consider that once the spirit leaves the body, the lifeless body has no karmic obligations, then it may be okay.” Swami Pragyanand pointed out that autopsy and dissection were practiced by Sushruta, an early pioneer of ayurveda. Swami Tejomayananda offered, “The body of the deceased is treated with reverence. The feelings and sentiments of the family also do not favor dissection. People have some fear that the astral body may be hurt by these intrusions or some harm may come to the family.” Sivaya Subramuniyaswami similarly held that what happens to the dead physical body is disturbing to the soul, and did not advise his devotees to donate their bodies to science.

Burial and Cremation Practices

Cremation, ideally held within 24 hours, is the traditional Hindu system of disposing of dead bodies. It has the benefit of releasing the soul most quickly from any lingering attachment to the earth plane. Should it be necessary to preserve the body a few days to allow time for distant relatives to arrive, refrigeration or use of dry ice is recommended, rather than embalming. Hindus do not bury their dead, except infant children and godly saints.

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There remain several areas of medical ethics to be addressed, including genetic engineering, stem-cell research, cloning and animal to human transplants. If you have insights or comments, feel free to email them to us at letters@hindu.org.

A Health-Care Providers’ Handbook on

Hindu Patients

Excerpts from a new booklet by Queensland Health, Australia

SKILLED MEDICAL GROUP IN AUSTRALIA HAS produced an impressively accurate and comprehensive 24­page booklet that is packed with vital, insightful information for health care providers. Put together in 2011 by the Queensland Health Multicultural Services (multicultural@health.qld.gov.au), it is entitled Health Care Providers’ Handbook on Hindu Patients. The first half of the booklet, guidelines for health services, covers a wide gamut of subjects: including communication issues, religious observances, dietary needs, astrological beliefs, decision making, traditional medicines and remedies, medicines of animal origin, maternity services, home visits, rehabilitation and end of life issues. The second half is devoted to Hindu beliefs that relate to health care. It includes cogent sections on food, karma, holy days, fasting, abortion and more. The text as written is in a terse summary form meant for easy access by care givers and we share it unedited, believing that its sensitive wisdom will guide health­care providers all over the world looking after the needs of Hindu patients. On the advisory committee, ensuring depth and authenticity, was a host of persons of Indian origin: Shyam Das, Kermeen Kansara, Vinita Khushal, Balaji Motamarri, Rajni Nair, Pt. Sanat Pandey, Surendra Prasad, Sarva­Daman Singh and Krimesh Shukla.

Introduction

Queensland is a culturally and religiously diverse state—in 2006 nearly one in five Queenslanders (17.9 per cent) was born overseas, 7.8 per cent of the population spoke a language other than English at home, and more than 129,000 people followed a religion other than Christianity. Between 2001 and 2006, one of the fastest growing religions in Queensland was Hinduism. Figures from the 2006 census show there are more than 14,000 Hindus living in Queensland [total population 4.5 million]. This figure is now likely to be higher, as between 2007–08 and 2009–10, permanent migration to Australia from Southern Asia (which includes India, Sri Lanka, Bangladesh and Nepal) was second only to permanent migration from Europe. The increasing cultural, linguistic and religious diversity in the Queensland population means that to be safe, health services need to be culturally appropriate and responsive. Research indicates a strong link between low cultural competence and poor quality health outcomes, and significant risks.

Personal level of adherence

Hinduism is the world’s oldest living faith and third largest religion. It is practiced in many countries around the world, including by large populations in Southern and Southeast Asia, Europe, Africa, North America and Australia.

There is much diversity in the beliefs and practices of Hindus, with hundreds of diverse sects and no central doctrinal authority. As Hinduism grants individuals complete freedom to practice his or her religion as they choose, there are personal and cultural variations that make it difficult to provide definitive rules and regulations that apply to all Hindu patients. Because of these personal variations, it is important that health care providers consult the patient about their personal level of religious observance and practice.

However, Hindu patients should not be regarded as a “special” group that require additional attention from health care providers. Due to the common Hindu beliefs of karma (the belief that every action has a consequence which is experienced in this or future lives) and reincarnation, Hindu patients may display acceptance of difficult circumstances and be inclined to comply with the instructions of health care providers.

Section I: Religious Observance

Hinduism grants individuals complete freedom to practice his or her religion as they choose. As a result, it is important that health care providers discuss religious observance needs with each patient. Some topics that health care providers may wish to discuss with their patients include prayer and meditation, bathing and cleanliness, dietary needs and astrological beliefs.

Prayer and Meditation

• Prayer and meditation are important to many Hindus.

• There are no set times for prayers; however, most Hindus prefer to pray in the morning.

• Prayer can take place in any location, including in bed or in hospital prayer rooms.

• Hindu patients may wish to have religious statues or icons close by when in hospital.

Bathing and Cleanliness

• The concept of purity is important to Hindu life, and some Hindus may be quite meticulous about bathing and cleanliness.

• Most Hindus have a ritual of cleanliness and prayer each morning which includes brushing the teeth immediately upon waking, followed by bathing, prayer and then eating.

• A delay in eating to follow this ritual should not be interpreted as a refusal to eat.

• Washing of hands prior to eating is important as many Hindus eat with their hands.

• Washing with running water is important to Hindus and most will prefer a shower rather than a bath.

• Women may be considered impure or unclean when menstruating or following childbirth.

Dietary Needs

• Many Hindus are strict vegetarians, abstaining from all meat, fish and eggs. Vegetarian Hindus do consume dairy products.

• Hindus who choose to follow a vegetarian diet do so because of a belief in nonviolence which extends to animals, and a belief that nonvegetarian food impedes spiritual development.

• Some Hindus choose to eat meat and do not follow a vegetarian diet.

• Most nonvegetarian Hindus do not eat beef or pork, as cows are considered sacred and pigs are considered unclean.

• Many nonvegetarian Hindus may choose to abstain from eating meat on particular days of the week. For example, a strict vegetarian diet may be observed on Mondays.

• Some strict vegetarian Hindus will not eat from plates or use utensils that have previously been used to serve meat.

• Most Hindus will eat only with the right hand. Some may not eat food which has been passed to them with the left hand.

• Fasting is common for Hindus and can vary from complete abstinence to only avoiding certain types of foods.

• Fasting on a particular day of the week is also a common practice.

Astrological beliefs

• Many Hindus hold strong astrological beliefs and may believe the movement of the planets has a strong influence on health and wellbeing.

• Patients may wish to schedule appointments or surgeries according to these beliefs.

Decision-making

Hinduism views the needs of the individual in the greater context of family, culture and environment. As a result, family members, especially elders, can have a strong influence on decision-making related to health matters, including informed consent. Hindus may wish for family members to be responsible for making treatment decisions.

Administration of medicines

Traditional Medicines and Remedies

Hindus may use a variety of ayurvedic medicines, home remedies and spiritual remedies, often in conjunction with Australian medicine. It is important for health care providers to be aware of their patient’s preferences. Ayurveda is a holistic system of medicine practiced by many Hindus around the world. It is a highly valued and respected health science in India. Ayurveda is practiced by many Hindus in Australia, and ayurvedic medicines are regulated by the Therapeutic Goods Administration (TGA). As a discipline, ayurveda sits alongside Traditional Chinese Medicine in the TGA classification of complementary medicines.

Based on ayurvedic principles, Hindus believe that all illnesses, whether physical or mental, have a biological, psychological and spiritual element. Ayurveda seeks to maintain a balance between the body’s three elemental energies (humors). Good and bad health is related to the level of balance of these three energies. Many Hindus also use traditional home remedies which are based on ayurvedic medicine and are easily available from Indian grocery stores.

One of the most common Hindu spiritual remedies is vibhuti, or holy ash. Vibhuti is commonly used in Hindu religious worship and is believed to contain protective, purifying and healing properties when applied on the skin (particularly on the forehead), consumed in small quantities, or carried on the person in a small packet.

Medicines of Animal Origin

Some medicines may not be suitable for Hindu patients because they are derived from cows, pigs or other animals. The Queensland Health Guideline on Medicines/Pharmaceutical Products of Animal Origin states that health care providers should inform patients about the origins of their proposed medication if it is derived from animals and no suitable synthetic alternative exists. Patients should be encouraged to make informed decisions regarding their treatment.

Oral Hygiene

• Oral hygiene is very important to most Hindus, especially those who practice ayurvedic principles.

• Many Hindus prefer to brush their teeth immediately after waking in the morning and some may also scrape their tongue with a metal tongue scraper. This is done to avoid the ingestion of impurities that may have built up in the mouth during sleep.

• Hindu patients may also wish to brush their teeth immediately after waking from general anesthesia or surgery for the same reason.

• Health care providers should explain the benefits of also brushing the teeth after eating.

• Many Hindus use home remedies for oral hygiene and health purposes, including chewing mint leaves, cloves or fennel seeds.

• Oral health examinations and treatments are usually not regarded as invasive by Hindu patients.

Maternity Services

• A small number of Hindu ceremonies accompany pregnancy and childbirth.

• While most of these ceremonies are completed in private, there are some which may be completed while the mother and infant are in hospital care.

• After childbirth, a Hindu father may wish to perform the jatakarma ceremony to welcome the infant into the world. As part of the ceremony, the father touches and smells the infant and whispers mantras (religious verses) into the infant’s ears.

• Another rite which is performed shortly after birth involves drawing a small dot (often in the shape of an Om) behind the infant’s ear. The Om symbol may also be placed on a chain around the infant’s neck or placed in the cot.

• A family member may also wish to write the Om symbol on the infant’s tongue with jaggery (unrefined whole cane sugar) dipped in ghee or honey.

• Health care providers should advise parents that feeding honey to infants below the age of 12 months is not recommended in Australia due to the risk of infant botulism.

• The sixth day after birth is considered the most auspicious in a person’s life. On this day, a fragile white cotton thread is ceremoniously tied around the infant’s wrist, ankle or neck. A pen and blank piece of paper may also be placed in the infant’s cot, as it is believed that on this day Saraswati (Goddess of Learning) charts the child’s future.

• Some Hindus may wish to bury the umbilical cord on the sixth day after birth. If there are clinical reasons for not providing the umbilical cord to the parents, this should be explained.

• The naming ceremony (namakarana) usually occurs at the infant’s home after birth.

• Depending on family customs, the ceremony may be delayed if the infant requires extended hospital care.

• Some Hindu women may wish to express colostrum before feeding their baby for the first time.

• Health professionals should inform women of the benefits of feeding their infant colostrum.

Community health services

Home Visits

• Hindus may prefer for shoes to be removed when entering a home.

• If this is not possible for Workplace Health and Safety reasons, alternatives should be explored (e.g., wearing plastic shoe covers).

• Health care providers should avoid taking meat products into the homes of vegetarian Hindus.

Rehabilitation Issues

• Self care practices involving eating or drinking are ideally performed with the right hand.

• Health care providers should be aware that where a patient has lost the ability to use their right hand, sensitivity may be required.

• Similarly, loss of function in the left hand may affect the patient’s comfort with bathing and washing habits.

Visiting Arrangements

• Visiting the sick is an important responsibility for Hindus.

• Hindu patients may have large numbers of visitors, including those from outside their immediate family.

• Health care providers should discuss with the patient, or their family, the impact a large number of visitors may have on rest or care requirements, and other patients.

• Patients may wish for family members to stay in the hospital overnight. This should be accommodated if possible.

Care of Family and Older Persons

• Hinduism encourages family members to take a role in the care of family members.

• Hinduism especially emphasizes respect for all older people, with children having a special responsibility towards their parents.

• It is considered a family obligation to care for the elderly and the sick.

• Health care providers should take this into account when developing care plans or suggesting nursing or residential care.

End of life issues

• The sanctity of life is central to Hindu teachings.

• Hindus believe that all living beings possess a soul which passes through successive cycles of birth and rebirth.

• Hindu patients may wish to die at home, as this has particular religious significance.

• The patient’s eldest son is expected to be present before, during and after death, even if the son is a small child.

• Other family members may wish to be present and to participate in the care of the patient.

• Family members may request that patients not be told about a terminal diagnosis directly.

• A Hindu patient may wish for a pandit (priest) to be present to perform certain rituals, including: tying a sacred thread around the neck or wrist, placing a few drops of water from the River Ganges into the patient’s mouth, placing a sacred tulsi leaf (holy basil) in the patient’s mouth.

• A Hindu patient, especially a Hare Krishna follower, may wear sacred tulsi beads (a string of small wooden prayer beads) around their neck. It is important that these be on the body at the time of death.

• If it is necessary to remove these beads, they should be retied around the wrist (preferably right).

• Patients may wish to read or recite religious chants and prayers. However, some patients may prefer to listen on a personal media player or small radio.

• Hindu chaplaincy services are available in many Queensland Health facilities.

Deceased Patients

• A deceased Hindu’s body is usually washed by close family members, with the eldest son taking a leading role.

• The family may wish to light a small lamp or burn incense near the body.

• If possible, all jewelry, sacred threads and religious objects should be left in place.

• Health care providers should advise family members if it is necessary to remove these items.

• The deceased patient’s family may have a preference for the position of the body after death.

• Hindus are usually cremated as soon as possible after death.

Autopsy

• Hindus generally regard autopsies as unacceptable. However, autopsy is permitted if required under Queensland statutory laws.

• Hindus are usually cremated as soon as possible after death, and autopsy may affect this practice.

• Health care providers should consult with the family of a deceased Hindu patient before proceeding with an autopsy.

Section II: Hindu Beliefs Affecting Health Care

Food beliefs

Hindu dietary practices can vary depending on the individual’s beliefs and customs. Most Hindus do not eat beef or pork and many follow a vegetarian diet. Fasting is common among Hindus, but there are no set rules, and the decision to fast is up to the individual. Many Hindus follow ayurvedic dietary practices. Under this system, certain foods are classified as hot or cold and can adversely or positively affect health conditions and emotions. The classification of foods as hot or cold is unrelated to temperature. Hot foods are generally those foods which are salty, sour or high in animal protein, while cold foods are generally sweet or bitter. Some strict Hindus do not consume garlic or onion, as the properties of these foods disturb spiritual practices such as meditation.

Karma

• A central belief of Hinduism is the doctrine of karma, the law of cause and effect.

• Hindus believe that every thought, word and action accumulates karma, which can affect current and future lives.

• Hindus believe in reincarnation. Actions from a past life can affect events in the current life, including health and well­being.

• Health care providers should be aware that a strong belief in karma can affect decision­making regarding health care.

Holy days

Hindus do not observe a specific day of worship, although some days of the week may be associated with particular Deities. Hindus do observe a number of holy days and festivals which can have an impact on health care due to associated fasts. Most Hindu holy days are based on the lunar calendar, and the dates can vary from year to year. Some festivals can occur over an extended period, with celebrations lasting for days or weeks.

Fasting

Fasting is an integral part of Hinduism and is seen as a means of purifying the body and the soul, encouraging self­discipline and gaining emotional balance. Fasting may be practiced on specific days of the week, during festivals or on holy days, or in conjunction with special prayers. It is not considered obligatory for a Hindu patient to fast during hospitalization. However, some patients may wish to fast while in hospital. There is no specified way to fast, but individuals may choose to abstain completely from all food and drink or only abstain from certain foods.

Dress

While there is no religious requirement for modest dress, many Hindus choose to dress modestly and may be reluctant to be examined by health care providers of the opposite sex. Hindu women may wear a sacred thread or gold chain around their necks, and Hindu men and boys may wear a sacred thread across the chest. These items should not be removed during examination. If it is necessary to remove an item, permission should be sought prior to removal.

Hare Krishna followers, and some other Hindus, may wear sacred tulsi beads around the neck. If it is necessary to remove these beads, they should be retied around the wrist (preferably right). In addition, some jewelry worn by Hindus may have a sacred meaning, and patients should be consulted before removal.

Mental health and/or cognitive Dysfunction

Hindus believe that all illnesses, whether physical or mental, have a biological, psychological and spiritual element. Treatments which do not address all three causes may not be considered effective by a Hindu patient.

Many Hindus attach a stigma to mental illness and cognitive dysfunction. Many have a strong belief in the concept of the evil eye and may believe this to be a cause of mental illness. In addition, all illness, including mental illness, may be seen as the result of karma from this life or a previous life.

Transplants and Organ Donation

Hinduism supports the donation and transplantation of organs. The decision to donate or receive organs is left to the individual.

Contraception

There is no official Hindu position on contraception.

Abortion

Beliefs about abortion may vary depending on cultural or religious interpretations. Many Hindus believe that the moment of conception marks the rebirth of an individual, which may make abortion unacceptable, except in emergencies.

Assisted Reproductive Technologies

There is no official Hindu position on assisted reproductive technologies.

Pain Management

Hinduism encourages the acceptance of pain and suffering as part of the consequences of karma. It is not seen as a punishment, but as a natural consequence of past negative behavior and is often seen as an opportunity to progress spiritually. This may affect triaging or the monitoring of pain levels as Hindu patients may not be forthcoming about pain and may prefer to accept it as a means of progressing spiritually. However, this behavior may be less prevalent in Australia, especially among young people.

Death and Dying

Hindus believe that the time of death is determined by one’s destiny and accept death and illness as part of life. As a result, treatment is not required to be provided to a Hindu patient if it merely prolongs the final stages of a terminal illness. Under these circumstances, it is permitted to disconnect life supporting systems. However, suicide and euthanasia are forbidden in Hinduism.

Web Resources

The booklet, in its fullness (including a list of appropriate Hindu vegetarian foods at the back), can be seen here:

www.health.qld.gov.au/multicultural/health_workers/hbook­hindu.asp

A religious calendar that includes Hindu holy days may be found at: www.health.qld.gov.au/multicultural/support_tools/mcsr.asp

Health Care Providers’ Handbook on Hindu Patients is licensed under a Creative Commons Attribution, Non­Commercial, Share Alike 2.5 Australia licence. To view a copy of this license, visit:

www.creativecommons.org/licenses/by­nc­sa/2.5/au/deed.en