Hindu End of Life: Death, Dying, Suffering, and Karma

Susan Thrane, MSN, RN, OCN

Disclosures

Journal of Hospice and Palliative Nursing. 2010;12(6):337-342. 

In This Article

Hinduism 101

Hinduism is the oldest known religion, having been practiced over 8000 years as evidenced by ancient Hindu scriptures.[8] Table 1 highlights some basic Hindu beliefs. Several newer religions have roots in Hinduism including Jainism, originating around 3000 BCE; Buddhism, originating around 600 BCE; Sikhism originating around the 16th century; and Brahmoism, originating in the 18th century.[8] Hinduism is unique in that it has no founder, no beginning that we can point to, and no one holy book. The most holy Hindu text is called the Veda: a word that means wisdom. The Veda consists of four books and more than 100,000 verses.[3] Other holy texts are called the Upanishads and the Puranas.[8] The Bhagavad-Gita (song of God) is generally accepted by all and appears to be the most popular of Hindu sacred texts. According to Jeste and Vahia,[9] the Bhagavad-Gita is the most recent of the sacred texts and the most practical, giving devotees a more practical guide to Vedic wisdom.

One of the basic tenets of Hinduism is a belief in one God called Brahman. Brahman can take many forms, which means that there are literally thousands of gods and goddesses in Hinduism that each contains a part, or embodies a characteristic of Brahman. Many Hindus choose one god or goddess as their principal representation of Brahman, but may have many gods and goddesses that they worship or celebrate. Daily worship called puja includes lighting incense, prayer, and meditation and is often performed as a family in the morning before everyone starts their day.[10] Puja can be performed anywhere, but many families either have a room in their home dedicated to worship or at least an altar displaying statues or pictures of their chosen deity.

Reincarnation and Karma

Two important tenets of Hinduism that guide one's actions and influence suffering are karma and reincarnation. Reincarnation essentially means to be born again. The body is like a set of clothes that the soul removes before putting on new clothing. From a Hindu viewpoint, one can be born as a human, an animal, an insect, or even a plant.[11] What form the next incarnation takes depends on karma, and one can move up or down the hierarchy. If a person has lived a good life and performed more good deeds than bad, they are born into a more fortunate existence.

Karma guides how a Hindu lives, and each person's deeds both in current and past lifetimes determine what sort of rebirth they attain. Karma is a combination of cosmic and moral cause and effect that crosses lifetimes and life lessons learned for spiritual growth. There are three types of karma: karma from past lives that may or may not be experienced in the present lifetime, karma currently being created, and future karma or karmic experiences saved for a future lifetime.[12] A devout Hindu will be non-violent on every level including the practice of vegetarianism. The ultimate goal after living many lifetimes is to be released from rebirth or to achieve moksha; becoming one with Brahman.[13]

Caste System

A discussion of Indian culture and Hinduism would be incomplete without a mention of the caste system. For thousands of years, a strictly defined social structure existed in India. Each group or caste performed certain functions in society. The four main groups were the Brahman or priests; the kshatriyas, which were governors and administrators; the vaisya, who were the merchants and farmers; and the sudras, who performed menial tasks such as street sweeping and were considered spiritually unclean. The caste system was abolished in 1947, and while its influence is fading, some effects remain.

Spiritual Suffering

Suffering for the Hindu is highly related to the concept of karma, for example, "Belief in karma and reincarnation are strong forces at work in the Hindu mind."[14] (p29) Any good or bad thought or action leads to reward or punishment either in this life or a future existence. Hindus believe that there are certain life lessons to be learned before achieving moksha. Working through the karmic situation will resolve that karmic issue resulting in a lesson learned.

A Hindu who is getting older or who has a terminal illness will "tie up loose ends" by apologizing where needed, talking with family and friends to resolve conflicts, and generally fulfilling all known responsibility.[15] The goal of a well-lived lifetime therefore is to perform good deeds, to practice devotion to God, and to learn the karmic lessons encountered.

Spiritual suffering for a Hindu comes from knowing at the end of life responsibilities are left undone, karmic tasks are not completed, or bad thoughts and deeds predominated. The concept of karma conveys that suffering is part of life. Suffering is a result of past thoughts and actions either in this life or a previous life. By enduring suffering, a Hindu "pays for" or cancels past negative actions. "Suffering can be positive if it leads to progress on a spiritual path, …to be tested and learn from a difficult experience."[16] (p609) What may appear to be needless suffering to Western minds may be, in fact, a striving to meet death in a clear and conscious state and may be an attempt to atone for karmic debt.

From a nursing perspective, karma and spiritual suffering can have several ramifications. Hindus who feel they need to diminish or alleviate past karma may wish to endure suffering. This may involve fasting, doing penance such as intense prayer or worship, or enduring pain even when medication is available. Fasting can have several forms. The patient may wish to avoid only certain foods or not eat certain meals or at certain times of the day. Other forms of atoning for bad thoughts or deeds can include confession to a guru or priest, repentance either public or private, sacrifice such as shaving the head, religious ceremonies, gift giving to the poor or to the temple, and pilgrimages to sacred spots.[17] Obviously, participation in these activities depends on whether the patient is at home or in a healthcare facility and whether he/she is ambulatory or near death. Assisting the patient and family to be able to complete religious ceremonies, prayer, or penance may be very important to their spiritual well-being. Assisting the patient and family does not necessarily mean participating; it can mean helping them find the materials or just assuring them that they will not be disturbed. Allowing private time and space for these activities will be helpful.

Suffering in Death and Dying Practices

Fearing death is natural and results from a fear of the unknown. According to Hinduism Today, a person with a terminal illness should tell family and friends so they can prepare for their loved one's death and be happy for them.[18] Death is the fulfillment of this life and a chance for a better reincarnation, a chance to learn new karmic lessons and to move closer to moksha.

Hindus believe that death must come naturally at the proper time. Life should not be prolonged by aggressive medical means unless it will result in a good quality of life. Prolonging life artificially would result in the soul remaining on earth past its natural time "tethered to a lower astral region rather than being released into higher astral/mental levels."[14] (p32) Hindus will often forgo aggressive treatment when an illness is terminal or there is no hope of recovery. If the patient is a parent of young children, more aggressive treatments are often sought in the hope of prolonging life to provide for the children. Nor should life be cut short willfully. Speeding up death by artificial means would result in a large karmic debt. Suicide would result in many lesser rebirths to "make up" for the karmic debt of ending one's life unnaturally.[19] Thoughts at the moment of death will result in a greater or lesser rebirth. (See Table 2 for a summary of palliative and end-of-life issues.)

Hindus may endure pain or uncomfortable symptoms to face death with a clear mind. They may use medication to control symptoms, but may avoid using so much that it reduces their consciousness. Rabindrnath Tagore,[20] a Hindu philosopher, once said "let me not beg for the stilling of my pain but for the heart to conquer it." Hindus will, if at all possible, be thinking of Brahman at the moment of death and therefore experience a higher state of consciousness and a higher astral plane after death. Intentionally bringing all one's attention and energy to the top of the head and thinking thoughts of Brahman help the soul leave the body in the highest possible state.

Ideally, a Hindu should die at home surrounded by family and friends who will sing sacred hymns and say prayers or chant the dying person's mantra in his/her right ear if he/she is unconscious. As death approaches, the bed should be turned so the head faces east. Hindus with a terminal illness or certain other disabling conditions are allowed to choose a "self-willed death by fasting"[19] but must tell their family and community. This is an acceptable method of ending suffering.

Case Discussion Continued

Mrs S. was extubated per her family's wishes. Friends of the family brought a CD player and played some traditional music. The temple priest was called and brought Tulsi leaves and sacred water. Mrs S. was given medication to relieve her pain and comfort measures including cool cloths, and positioning with pillows. Family, friends, and the temple priest stayed with Mrs S., reading from holy texts and praying. Her youngest son chanted her mantra into her right ear. The priest applied holy ash to Mrs S.'s forehead and placed a few drops of sacred water and a Tulsi leaf into her mouth for purity and a peaceful death moments before she died.[21,22]

Postdeath Rituals

After death, all the pictures of deities in the household are turned to face the wall. The body is placed in the home's entryway with the head facing south "reflecting a return to the lap of Mother Earth."[15] (p170) If a patient dies outside the home, the family may want to bring the body home for ritual bathing, dressing, and for friends and family to say goodbye. If necessary, these rituals can take place in a mortuary.

Bodies are always cremated, never embalmed, although they can be frozen for up to 3 days so relatives can attend the funeral rites. The family may wish to witness the cremation and even start the cremation fire. The family may return to collect the ashes directly from the crematorium. After the family returns from the crematorium, everyone bathes, and the entire house is cleaned. The ashes are scattered in an ocean or a river or are sent to India to be scattered in the Ganges River. Infants and young children are the exception to the cremation rule: since they have not accumulated bad karma and are considered pure, infants and young children may be buried.[23] (See Table 3 for a summary of postdeath practices.)

The period immediately following death is considered a time of impurity. A pot of water is set in the entryway and is changed every day for 31 days. On the third, fifth, seventh, and ninth days, a meal of the deceased's favorite foods is prepared, and a portion is put in front of a photograph of the deceased. The time of impurity can last from several days to a year. The length of the time of impurity is traditionally determined by caste: the lower the caste, the longer the time of impurity.[24] During this time, the family lives in seclusion and does not participate in festivals, celebrations, or temple observances.

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