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

Professional Care Issues

Healthcare decisions in Hindu families will likely be made by the most senior member of the patient's family or the eldest son.[25] Hindu culture believes in "human interdependence and interconnectedness, which is understood to be the foundation of well-being."[10] (p28) In other words, Hindus do not have the same concept of individuality and autonomy that Westerners prize so highly; family and community are more important. Other cultural differences may or may not be relevant, depending on the acculturation of the family, and are directly contradictory to Western views. For example, addressing the head of the family first shows respect in Indian culture, while maintaining eye contact with a head of family or elder shows disrespect. The best course is to tread lightly and be aware until discernment can be made of individual preferences.

Accepting the end of life is part of Hindu philosophy. Artificially prolonging life is generally thought of as interfering with karma. Interventions such as intubation, artificial feeding, or very aggressive care in the face of a terminal illness would go against traditional Hindu thinking. Palliative and comfort care are in line with Hindu thoughts on karma and reincarnation, concepts that Western caregivers need to be aware of.

Two other issues that relate to end of life include organ donation and autopsy. Autopsy is avoided unless required by law. Hindus believe that disturbing the body of the deceased is disturbing to their soul and inhibits the soul from moving onward.[19] Organ transplantation is another practice that is conditionally discouraged. From the donor perspective, a part of the body lives on and interferes with reincarnation. From the recipient perspective, part of the donor's karma is transferred along with the organ especially a major organ such as the heart, liver, or kidney.[19] Depending on the views of the family, donation of an organ other than the heart, liver, or kidney may be permissible.

Spirituality and culture go hand in hand for Hindus, and Western medicine is beginning to acknowledge the importance of spirituality in healthcare. Spiritual issues are now being addressed for patients, especially at end of life. In a study of 560 nurses who cared for dying patients in Ethiopia, Kenya, India, and the United States, nurses from all four countries identified spiritual interventions such as praying with or praying for the patient and reading from holy texts as helpful or important to patients and families.[22] The similarities between cultures speak more loudly than the differences. Nurses from all four cultures stressed compassion, respect, and individualizing care based on patients' needs. Specific culturally based interventions mentioned by the nurses from India included allowing family member to offer Tulsi leaves (a type of basil) for purity and water from the Ganges River for a peaceful death.[21,22]

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