Middle Eastern Family Religious Groups
Islam
General Notes
Much of the information that follows has been obtained from an Islamic
physician who wished to remain anonymous. Some issues addressed here are
virtually never discussed outside of the Islamic community.
It is sometimes difficult to separate religious and cultural understandings
in specific situations, due to the strong mutual influence and the development
of national and ethnic sects. The term “Muslim” is usually preferred to the
term “Moslem.” “Islamic” is preferred rather than the term “Mohammedan.”
Specific Religious Practices
There are no sacraments. There is no day considered “holy” but there are
days that are celebrated and observed. Exact dates are based on the lunar
rather than the solar calendar, and honor decisive events in the life of
Mohammed, his successors, or Islam in general. Ramadan is a month-long period
of fasting from food, drink, and sexual activities from sunrise to sundown.
Understanding of Healing
Faith healing is not acceptable unless the psychological condition of the
patient is deteriorating. Then it may be employed for morale. Sickness, death,
and healing are seen as part of the “will of Allah,” and it is offensive to
seek to avoid that will. At the same time, medical care is seen as part of what
Allah gives to humanity and it is expected that followers of Islam will make
appropriate use of medical care.
End of Life Issues/Terminal Care
Efforts to continue life are encouraged, even when quality is severely
compromised. The “right to die” is not recognized in Islam. Any attempt to
shorten the life-span or end it whether by suicide or another means is
prohibited. Euthanasia is not acceptable. Assisted suicide would also be
condemned. There is often great difficulty in accepting the concept of brain
death, based on viewing life as being present so long as there is the flow of
blood and breathing, even via mechanical ventilation.
One source has suggested that, when a situation arises in which the most
that realistically can be accomplished is the prolonging of dying, it may help
to reinterpret the situation. A strongly held rule of Islam is that a follower
of Islam may never be tortured or allowed to be tortured. It can be presented
that aggressive care without clear benefit to the patient can become, in
effect, a process of torturing and interfering with the will of Allah. It may
help if a Muslim physician is available to discuss the situation.
Locally, a representative of the Islamic faith did sign the Interfaith
Letter on Physician-Assisted Suicide.
Transplantation/Organ Donation
One source states that transplantation is acceptable for both donors and
recipients. However, at least in talking about organs removed after death,
donation would be considered the forbidden desecration of the body of a Muslim.
Reception of such an organ obtained under those circumstances would be opposed.
Removal or receipt of an organ from a non-Muslim would pose no problems. Based
on that duality, significant numbers of Muslims able to afford it have come to
the United States and other countries to receive transplants. Various medical
ethicists have raised questions about the appropriateness of that practice.
Autopsies/Care of the Body
Burial is mandatory. No coffin is required. Embalming is accepted if
required. There are several burial procedures as described below, but if the
body has been severely damaged any of the steps in the burial procedure may be
omitted, except for prayers and the burial itself.
As soon as possible after death there is a ritual washing of the body by
Muslims of the same sex, chosen for the honor on the basis of personal
holiness. Next the body is wrapped in a clean white cloth. Finally, there are
required special prayers for the deceased. The body should be readied and buried
as soon as possible, with the body precisely placed in the direction of Mecca.
A fetus is treated as discarded tissue before 130 days. After that it must
be treated as a fully developed human being.
Several issues should be noted in working with the family in the hospital
environment.
For staff, including Chaplains, there are several things that could be
viewed as “invasions” or intrusive familiarity with family members. There are
also acts that would be seen as dishonoring the person who died or violating
the body. The following could be suggested:
Never mention religion. Unless the family specifically and freely requests it, do not attempt to pray with the family. It would be accepted to say, “We should wish him (her) well where he (she)’s going. We have life and living to take care of. How can we help you to do that?” It’s very important to refer to the will of God, but never say “the Lord.” It is acceptable to refer to “Allah.”
The family will be waiting for and expecting to
hear the statement “It’s the will of God.” That statement helps the person
accept both the reality of the loss and the need to continue life. That
reminder is also later a part of the thrust of the funeral and burial service.
After the cathartic expression of grief, often with questioning why the death
happened, the family leader will signal the end of the process for those
present. He will say something like: “It’s the will of God. What you’re saying
is heresy and not acceptable in religion. What you’re saying is taboo. Don’t
say that or God will punish you.” The understanding in Islam is that God does
not have to explain or justify his actions. There is a sense that “Allah will
provide” whatever is needed.
The body can be touched by staff but only in
order to prepare it for the Funeral Home. It is helpful if the body is wrapped
in a white sheet, even if a plastic then covers that. If asked, it should be
stated that the body will be kept in the Morgue until the Funeral Home picks it
up. If asked, assure that it will be treated with respect. The family would
find it offensive if any unwrapped part of a woman’s body is touched by a male
staff member.
As a Chaplain in a death situation you should never
touch the body, whether male or female. The safest guideline is also to never
touch a family member. The best advice for viewing the body after death would
be to escort the family in and then stand off to the side, out of the line of
sight. You are there to help if needed, not pretend to be part of the family.
Try to identify who is the effective leader within the family. That person
should be the one approached with practical details, rather than presuming that
it would be the next of kin.
Special
Treatment Issues (Blood, drugs, dietary, etc.)
Pork is prohibited. If used as the base for
medicine or a treatment (such as insulin) that should be communicated to the
patient if other alternatives are not available. The principle is that usual
restrictions are waived for medical necessity, but the information should still
be disclosed. Intoxicants would fall into the same category.
Fasting by every adult Muslin is required during the month of Ramadan. Exempted from fasting are: pregnant women, nursing mothers, the aged, and anyone who a physician recommends not fast because of a physical condition.
The left hand is used for some “profane” actions
and the right hand reserved for “sacred” actions. Toileting activities are done
with the left hand, and there is a ritual washing before prayer five times per
day, and before eating.
Notes for Pastoral Care
The physician is viewed as “the right hand of
God” and highly respected. The nurse is seen as the physician’s “helper” and
shares in that respect as a result. Chaplains, Social Workers, etc., do not fit
into the Muslim understanding and may cause confusion. One suggestion is for
the Chaplain to present that role as helping in the process of communication
and understanding, and to help assure that the patient’s religious
understandings and concerns are honored. The ministerial role is respected, but
there may be concern that there will be an attempt to convert or challenge the
patient’s religious identity. That is especially important to remember during
times of crisis, such as immediately after death.
A difficult subject to raise is the place of
women in Muslim society. It is hard to say how much of what follows is a
general characteristic or a description of a particular cultural pattern. It is
also unclear how much acculturation or resistance to it influences the
patterns. The source for the following comments, however, felt the description
to be important for Chaplains in understanding and working with Muslims.
A woman is viewed as an extension of the most
important man to whom she’s related. A woman without such a relationship is an
anomaly. Such things as being required to ask permission to even leave the
house and being chaperoned in doing so are common. Life can easily become
dismal and oppressive.
Chronic depression is common, leading to
functional physical symptoms. It was also suggested that there is an unusually
intense denial of the abuse of women and children. It is considered a subject
never to be discussed, even by health care professionals.
In situations where a husband dies, especially
if the relationship was supportive, the wife may fear a loss of freedom. It is
suggested that one fear at times is that the husband’s brothers, in taking over
leadership of the family, may remove the children or unjustly use their
inheritance. Remarriage is uncommon, and a desire to remarry is taken as an
insult to the dead husband.
Female circumcision is common in some countries
that are predominantly Islamic, and that practice may be carried with a family
to the United States. The circumcision may range from drawing blood by cutting
the clitoris to extensive mutilation of the entire area. Please see
Circumcision (Male and Female) later in this text.
Membership
I didn’t find information about membership in the United States.
Judaism (General)
General
Notes
What is stated here would apply to Orthodox
Judaism. Conservative and Reformed Judaism would follow some of what is
described, but not all.
Specific
Religious Practices
Sabbath is observed from Friday 18 minutes
before sunset until Saturday 42 minutes past sunset. There are various feasts
and celebrations, based on the lunar calendar.
Unless there is a life-threatening situation,
major procedures should not be performed on the Sabbath or on major festivals.
If it is medically necessary to eat on a fast day a patient may do so. If a patient
does want to fast he should be allowed to do so.
The preservation of life is the most important
criteria in determining the need for medical or surgical treatment. If a
patient refuses necessary treatment on the Sabbath or holy day he should be urged
to accept it.
When a patient is about to die, there is a
special confession rite called “Vidui” that is recited by all present.
Circumcision is practiced as a religious
procedure. A Jewish male is circumcised by a Mohel (ritual circumciser who uses
modern sterile technique) on the eighth day following birth. The circumcision
may be delayed for strong medical reasons. The rite also includes prayer,
blessings, and naming the child. Please see Circumcision (Male and Female)
later in this text.
Understanding
of Healing
Jewish law demands that a person who is sick
seek medical care. Prayer and hope for recovery are encouraged. There are a
number of specific prayers for the sick.
Reproductive
Issues
Birth control is permitted for valid medical reasons,
hesitantly. Vasectomy or the use of a condom is not permitted for birth
control. For sterility testing, other measures are preferred, but a condom
without spermicide is permitted. Artificial insemination must use the husband’s
sperm. One source says it is not permitted.
Abortion
Abortion is permitted only in the case of grave
psychiatric or physical danger to the mother. It is viewed as a situation of
saving the life of the mother.
End of
Life Issues/Terminal Care
Euthanasia is prohibited. A doctor is not
permitted to shorten life even for a second, but medical treatment that is
ineffective need not be continued. Prolonging of dying is not supported.
Parenteral therapy and oxygen should not be discontinued. Machines are to be
continued, but new treatments need not be started.
Locally, a representative of the Michigan Board
of Rabbis did sign the Interfaith Letter on Physician-Assisted Suicide.
Transplantation/Organ
Donation
Brain death is not accepted. Death is defined as
the ending of breathing and circulation for a period that would make
resuscitation impossible. Donation of a vital organ must follow those criteria.
A vital organ may not be received by a Jewish patient unless the donor met the
Jewish requirement for death.
Autopsies/Care
of the Body
The body is prepared in a ritual washing by
members of the Chevra Kadisha (Ritual Burial Society). The washing is
ordinarily done at the funeral home.
The body is to be buried as soon as possible
after death. A fetus is also buried. Cremation is not in keeping with Jewish
law.
A limb that is amputated must be buried. Jewish
law requires that the entire body of a person be returned to the earth.
Autopsy is allowed only when required by law, or
for compelling reasons. It should be limited to the minimum necessary. All body
parts or organs are to be returned for burial.
Special
Treatment Issues (Blood, drugs, dietary, etc.)
“Kashruth” (laws regarding food) are observed.
Kosher food should be made available for patients requesting it. In a hospital
setting the full requirements may not be possible, but much of it could still
be honored. Disposable plates and eating utensils could be used. No pork or
prohibited types of fish such as shellfish, lobster, or shrimp should be
offered. No food should be prepared with or served with any type of pork
product. No milk or daily product should be served along with any form of meat.
One practical option if a patient is concerned about whether meat was prepared
in a waythat was fully kosher would be to use
commercially available kosher TV dinners.
Notes for Pastoral Care
Attendance at the actual funeral and burial is
limited to close family members of the person who died. Unless directly and
specifically invited to attend, don’t. Instead, there is a custom of a formal
grieving called “sitting shiva” for seven days at the home. The family uses
that time to receive those who would like to pay their respects. It would be
appropriate to visit at that time, and it would be seen as an act of kindness
and respect for the person who died, as well as a sign of respect for the
family. There may be unfamiliar customs and patterns of grieving for someone
who’s non-Jewish. The family and other visitors will understand that and make
allowances.
Union of American Hebrew Congregations (Reform)
One of the oldest congregations in America was
the Sephardic congregation, Beth Elohim, in Charleston. In the 1820s, some of
its younger members wanted some English added for those who spoke no Hebrew.
Rejected, they withdrew and in 1824 organized the Reform Society of Israelites.
Reform was already a powerful movement in
Germany, where educated Jews sought to reconcile their learning and religious
heritage by modernizing Jewish thought and life. Ceremonial laws and many
practices such as covering the head during worship were discarded. An openness
to the general religious community was advocated.
The leader around whom the various reform
efforts coalesced was Rabbi Isaac Wise who came to the US in 1846. In 1857 he published
his revised prayer book in both Hebrew and German.
In 1875, Wise founded the Union of American
Hebrew Congregations with headquarters in Cincinnati. Two years later its
education center, Hebrew Union College, was established. In 1889 the rabbinical
structure, the Central Conference of American Rabbis, with Wise as president,
was formed.
Membership
In 1980, membership in the United States was
estimated at 1,200,000.
Union of Orthodox Jewish Congregations of America
The earliest divisions in American Judaism were
linguistic. They came about as various national groups settled in America.
Orthodox Jews are distinctive within the Jewish community in their Old World
practices: strict keeping of the Sabbath, kosher food laws and special
attention to tradition, the keeping of the exact forms of their elders. The
learning and use of Hebrew is emphasized.
In the process of Americanization and with the
importation of German-based Reform Judaism, Orthodoxy arose as a
tradition-affirming segment of Judaism. Orthodoxy only formalized as an
organization at the end of the nineteenth century.
In 1902, the Union of Orthodox Rabbis was formed
by the Eastern European rabbis. In 1935, the English-speaking rabbis formed the
Rabbinical Council of America. Thus Orthodox Jews are served by one
congregational and two rabbinical associations.
Orthodox Jewish congregations are independent
and autonomous, and both rabbis and congregations freely associate in the
various associations.
Membership
In 1980, membership in the United States was
estimated at 1,000,000.
The United Synagogues of Conservative Judaism
As Reform and Orthodox conflict began to
polarize the Jewish community, there arose a middle group that advocated an
allegiance to traditional Judaism, but without strict attention to all the
Orthodox ways. After a controversy at the graduation of the first class at
Hebrew Union College, several men opposed to Reform Judaism formed the Jewish
Theological Seminary Association. The establishment of Conservative synagogues
followed.
The Conservative synagogue uses English as well
as Hebrew in services, does not separate men and women, and emphasizes modern
education. However, many orthodox practices during worship are retained such as
covered heads.
Membership
In 1995, membership in the United States was
1,500,000.
Page was last updated on 08/14/00