Guidelines for healthcare providers interacting with Sikh patients

The more medical staff knows about a patient's background, the more dignified and successful the treatment can be. Photo: Unsplash

Religious literacy helps ensuring a dignified treatment of patients

The following article offers guidance for doctors, nurses, and other healthcare professionals caring for Sikh patients. It provides insights on topics such as hygiene, dietary, religious considerations, and handling existential experiences like death. In general, we recommend taking the time to ask about individual needs, habits, and current life situations, as this helps avoiding a stereotypical and one-size-fits-all approach.

Introduction to the Sikhi way of life

Sikhi (Sikh religion, Sikhism), the journey of life-long learning, evolved in the Panjab region from the 15th century onwards. This young world religion has unique traditions, including its own poetic script-language (Gurmukhi), naming conventions, and devotional recitation style. Sikhi draws on timeless spiritual wisdom (Gurmat) revealed to over 30 Enlightened Ones, which has been preserved until today (Gurbani). It inspires around 25 million Sikhs worldwide. Sikhi views all sentient beings as part of one family. Its wisdom helps reflecting upon childhood imprints all forms of mental impurity. Gurmat thus paves the way to distinguish natural needs from desires, embrace a cyclical worldview, transcend the diaspora of ephemerality, heal, and return to the common spiritual homeland of all life - while living a dignified, ethical, healthy, and spiritual life in harmony with nature and the Divine.

Clarifying Needs

First of all, it is helpful if medical staff members ask what they should take into account and what personal wishes the patent has. It is especially important to inquire about specific considerations for patient care. If language barriers arise, we suggest involving a knowledgeable individual who understands both the language and religious background. In some cities, the local interfaith council may provide assistance in finding a suitable person. Additionally, online translation tools can facilitate basic communication.

Privacy

Many Sikhs, especially those originating from Panjab, often have a strong sense of shame. Therefore, it is essential to be particularly mindful of their privacy during any medical or nursing care. In shared hospital rooms, it is important to ensure that curtains are drawn during visits and examinations. Sikhs from the Panjab region may prefer care from same-gender staff members.

Hygiene

Sikhs value a healthy lifestyle and hygiene. Sikhs usually wash their hands before meals. Smoking, alcohol, or drug consumption should be avoided in their presence and during food preparation. Sikhs mostly prefer to wash under running water and therefore opt for showers over baths. After using the restroom, they usually cleanse themselves with water, rather than using only toilet paper. It is therefore helpful to have a bowl or bottle ready in the bathroom.

Diet

It is recommendable inquiring on a case-by-case basis about prevailing dietary habits. Some Sikhs are vegetarians, avoiding all types of meat and fish. Some Sikhs may also abstain from eggs. Sikhs traditionally avoid consuming Halal meat in principle and any other form of preparation where the animal suffers.

In the Sikh religious community center (Gurdwara), a specially prepared sweet offering called Parshad is distributed after the closing of recitations. It may happen that a small portion of this and other food from the community center is brought by family members. From a holistic perspective, it may be meaningful for patients, even with dietary restrictions, to taste some of the food unless there are compelling medical reasons not to do so.

Religious considerations

For Sikhs, it is crucial to have the opportunity to practice their way of life during a hospital stay. Sikhs typically engage in regular recitations, usually in the morning and evening. Sikhs generally wash their hands and rinse their mouths before recitations, and some may also wash their feet. Bedridden patients should be provided with a small washbasin. Some Sikhs recite verses entirely from their heart, while others may use a small collection of the preserved spiritual wisdom (Gutka). Nowadays, smartphone and tablet apps and audio recordings are also used.

Sikh patients who are able to move around would likely appreciate access to a separate, quiet (multifaith) prayer room. This room should be clean, unadorned, and smoke-free. It is advisable to have comfortable seating arrangements on the floor with carpets.

Exemplary and wise Sikhs who have been initiated into the Khalsa order through the Khande Di Pahul ceremony traditionally carry five articles known as Panj Kakar (5Ks). These include a small sword, an iron bangle, cotton shorts, a wooden comb, and uncut hair with a head covering. Initiated Sikhs usually remove these articles only when necessary, such as for X-rays or MRI scans. Since the hair is preserved uncut from birth onwards, cutting it is emotionally challenging for Sikhs. Therefore, it should only be done for urgent medical reasons. Timely and thorough counseling on the necessity of such a procedure is crucial, and consent should be taken by all means.

Birth and Naming

The birth of a baby is a joyous occasion for Sikhs, as they are typically family oriented. Relatives will regularly visit the mother and bring fresh meals. Newborns are usually not named immediately after birth. The first name is traditionally chosen from the preserved timeless spiritual wisdom (Gurbani) in the central Sikh scripture, known today as the Guru Granth Sahib. It traditionally consists of an inspirational word from the divine scriptures. Girls are given the common surname Kaur (princess), and boys the name Singh (lion). It is important to consider the particularities of Sikh tradition in handling birth and naming procedures. Depending on nationality and relevant regulations, there may be complications with the authorities, so it is advisable to familiarize yourself with applicable naming rules well in advance of the birth.

Accompanying the seriously ill

Recitations provide strength and trust. Especially in existential situations. Seriously ill Sikhs who are no longer able to recite verses themselves are grateful when relatives or friends do so. It can also be helpful if recitations or interpretations of verses are played on a smartphone. A selection of recitations can be found here and on our YouTube channel. Further recitations can be found by searching the internet using the keywords "Kirtan Hazuri Ragi". Further recitations can be found, for example, by searching the Internet using the keywords “Kirtan Hazuri Ragi”. If there is no internet connection, it is recommended to download recitations, for example here.

Life-Prolonging Measures and End-of-Life Care

In the event that Sikh patients are terminally ill or in a coma with little chance of recovery, life-sustaining equipment can de discontinued from a religious perspective, as prolonging the physical life is not considered meaningful. It is important to talk to Sikhs who have a serious illness as early as possible about how to deal with life-prolonging measures and to obtain the relevant authorizations. It is also advisable to draw up a living will in good time.

Blood and Organ Donation

From a religious perspective, there is no objection to blood transfusions or organ and blood donations. Indeed, service to humanity is highly regarded in Sikhi. Nonetheless, consent should be taken well in advance. An organ donor card is recommended.

Death and Autopsy

Sikhs endeavor to accept physical death as a natural progression, similar to birth (Hukam). Sikhs regard death to be the state where the body is no longer infused with a spiritual consciousness. Therefore, deceased bodies have limited significance for Sikhs. They are usually cremated. When the body is cared for by nursing staff, it is important to ensure that the five characteristics of initiated Sikhs of the Khalsa (Kakar) are not removed if possible. This includes treating the uncut hair and turban with respect. The body is washed, traditionally clothed in white, and handled as is customary. While there may be personal objections to an autopsy, there are no religious concerns regarding it.

Cremation

When it comes to cremation, the laws of the country must always be considered. Sikhs are traditionally cremated, and the ashes are returned to nature, either through scattering in a forest or river. Relatives, friends, and acquaintances usually gather immediately to recite spiritual wisdom (including the recitations of Sohila), and provide moral support.

Recommended Reading

The Council of Religions Frankfurt has published the guide "Interreligious Soul Care” (Seelsorge Interreligiös). Additionally, the following publications, developed with the participation of Sikhs, offer valuable insights into the care of Sikh patients, and are based on the information provided here:

1. Evangelical Church Rhineland: "The Most Important Religions and Worldviews. A Guide for Staff in Hospitals, Elderly Care Facilities, and Hospices.

   Evangelische Kirche Rheinland. “Die wichtigsten Religionen und Weltanschauungen. Ein Leitfaden für Mitarbeitende in Krankenhaus, Einrichtungen der Altenhilfe und Hospiz.”

2. Elke Urban: "Transcultural End-of-Life Care - Caring for the Dying and Dealing with the Deceased from Various Religions and Cultures." Published by Kohlhammer Verlag.

   Elke Urban. “Transkulturelle Pflege am Lebensende - Die Pflege Sterbender und den Umgang mit Verstorbenen unterschiedlicher Religionen und Kulturen". Kohlhammer Verlag.

Note

This text can be publicly displayed with attribution to the source "SikhiCouncil, www.sikhi.eu."