An important part of being a nurse is understanding many ethnic, cultural, and religious groups and their practices. Nurses should not stereotype their patients, rather they should ask what groups they associate themselves with. The nurse can then perform care that is appropriate for the ethnic, cultural, or religious group they are a part of. When caring for a hospice patient who associates with the religion Buddhism, one should know the history, customs for symptom management, what is considered acceptable or taboo, and the rituals and customs performed for the deceased.
Buddhism first began in North West India about 2,500 years ago (Buddhist Funerals, n.d.). It was first taught by Siddhartha Gautama, who is known as Buddha, also called the Awakened One (The life of the Buddha, n.d.). He taught how to live right and use life’s sufferings to reach enlightenment. His teachings are known as Dharma and have spread from India to China, Tibet, Japan, Thailand, Sri Lanka, United States, and many other places (Buddhist Funerals, n.d.). Those that practice Buddhism in the additional countries follow the general practices of the religion; however, they have made changes and accommodations and essentially have created subtypes of the religion. For example, there is Theravada Buddhism and Thai Forest Tradition in Thailand, Tibetan Buddhism in Tibet, Chan and Zen Buddhism in China, Nichiren Buddhism in Japan, and Buddhism of Sri Lanka (One Mind Dharma, 2017). Knowing the history of Buddhism will help one understand the differences in beliefs and its impact on the treatment and care of the dying.
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Buddhists believe in reincarnation, the rebirth of a life, and karma, the belief that good and righteous actions will provide one happiness and bad and obscene actions will bring him or her suffering. They also believe in compassion. Many Buddhists in hospice or palliative care state that the goal is to be as comfortable as possible, reduce any suffering, and have a peaceful death. In the article, Buddhist Ethics and End-of-Life Care Decisions, it is stated that some Buddhists will refuse medical intervention and will perform various forms of meditation (McCormick, 2013, p. 222). A few may even refuse pain medication. The article also states that many will accept the reality of death to help prepare themselves for their upcoming death (McCormick, 2013, p. 222). It is believed that suffering can help a person reach enlightenment.
There are many different medical interventions that Buddhists find acceptable and some that are taboo. When it comes to life-sustaining treatment, Buddhists believe in the natural process of dying. Therefore, they believe that tube feedings are appropriate when they are not considered a medical treatment but instead a human need (McCormick, 2013, p. 216). However, if the tube feedings are used to prolong the life of a dying person, then it is unacceptable (McCormick, 2013, p. 217). Buddhists understand that delaying the death of a dying life may cause anger and frustration in that person and eventually cause them to suffer. Furthermore, they will not be able to die peacefully. Buddhists also do not believe in intentionally ending one’s life as in, but not limited to, euthanasia and assisted suicide. Once life-sustaining treatment such as tube feedings or mechanical ventilation is started, withdrawing treatment is allowed if it is done compassionately and to reduce suffering (McCormick, 2013, p. 217). It could potentially return the patient to the natural process of dying. Although somewhat adverse to the natural dying process, Buddhists are allowed to donate their organs (McCormick, 2013, p. 215). It is believed that this action is a form of compassion and accumulates good karma since the donor is giving life to others in need.
Buddhists’ goal for the dying is to help a person make an easy transition to the afterlife. From a Buddhists’ perspective, when a person dies, they are reborn and sent to the Pure Land. According to the article, Buddhist Realities Concerning Death, it is stated that Buddhists should die in a calm state, surrounded by loved ones, and saying their goodbyes (Rosenblatt, 2016). For these reasons, it is difficult if a Buddhist dies unexpectedly such as in a car crash or other serious accident. Once someone is dead, Buddhists believe that their soul stays close to the body for a couple of hours (Fowler, 2017). Many families ask that the body not be moved during those hours to give the soul time to detach and be reborn. Although, if the person who has passed away did not give up their attachments to people, things, or symbols, then it is harder for the person’s consciousness to move on (Rosenblatt, 2016). Before one dies, the family can help the person give up their attachments so they can have a peaceful death and move to the Pure Land faster. A monk or nun may also be sought out to chant from the Buddhists scriptures to help the dying person be in the right place spiritually (Roberson, Smith, & Davidson, 2018).
Once someone has passed away, the monk will suggest that the body be taken to the temple (Fowler, 2017). Buddhists’ funerals vary between each subtype of the religion and can last a couple of hours. Some funerals will consist of a short and straightforward service held at a crematorium or chapel and performed by monks who may chant scriptures. Offerings performed by family or other mourners that transfer worthiness and value to the deceased may be completed if a monk cannot be contacted (Buddhist Funeral Service Rituals, n.d.). Other funerals, such as traditional Buddhist funerals, may consist of the family wearing white or a white cloth, chanting or singing prayers, bringing fruit or flowers as offerings, burning incense, and ringing gongs or bells (Buddhist Funeral Service Rituals, n.d.). The body may either be cremated or buried but cremation is preferred. If the body is not cremated, there will be an open casket. If a burial has been chosen for the funeral, a monk will perform the last rites before closing and sealing the casket (Buddhist Funeral Service Rituals, n.d.).
The Buddhist religion’s goal is for a person to reach enlightenment. Buddhism helps people live a life full of compassion and selflessness, and as a result, provides an opportunity for a peaceful death. Healthcare providers, especially those who work in hospice, need to follow the customs of the different ethnic, cultural, and religious groups. Following these practices and rituals, especially in the process of dying and death, will provide the patient and his or her family a fulfillment of their beliefs.
Buddhist funerals. (n.d.). Retrieved August 5, 2018, from https://www.thebuddhistsociety.org/page/buddhist-funerals/
Buddhist funeral service rituals. (n.d.). Retrieved August 05, 2018, from https://www.funeralwise.com/customs/buddhist/
Fowler, J. (2017). From staff nurse to nurse consultant: Spiritual care part 3: Buddhism. British Journal of Nursing, 26(12), 710.
McCormick, A. J. (2013). Buddhist ethics and end-of-life care decisions. Journal of Social Work in End-of-Life & Palliative Care, 9(2-3), 209-225. doi:10.1080/15524256.2013.794060
One Mind Dharma. (2017, December 09). Understanding the different types of buddhism. Retrieved August 05, 2018, from https://oneminddharma.com/types-of-buddhism/#respond
Roberson, K., Smith, T., & Davidson, W. (2018). Understanding death rituals. International Journal of Childbirth Education, 33(3), 22-24.
Rosenblatt, P. C. (2016). Buddhist realities concerning death. Death Studies, 40(10), 648-650.
The life of the buddha. (n.d.). Retrieved August 05, 2018, from https://www.diamondway-buddhism.org/buddhism/buddha/
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