Nursing with Dignity Part 2: Buddhism

The followers of Buddha should be thought of as individuals as the religion has no single creed, authority or sacred book. They are united in their recognition of Siddhartha Gautama, an Indian prince who became the Buddha, or the ‘enlightened one’.

He lived about 2,500 years ago and renounced his inheritance, claiming no higher personal or spiritual status. However, he did teach freedom from ‘suffering’. In Buddhism, suffering is that which arises in our human form by our attachment and craving, and from which we can break free by choosing a path of wisdom, morality and mental culture (meditation).

Teachings

Buddhism is a chameleon religion that exists in many forms. These have sprung up as the central teachings of the Buddha have become amalgamated with the cultures and people that embrace it. There are millions of Buddhists around the world, with about 50,000 in the UK, and countless different groups and sects.

In the West, Buddhism creates a degree of consternation as it is a religion with no god. There is no supreme personal god or godhead, but the religion is based on a way of life that the Buddha commended.

Buddhism has no beliefs. Instead, it has teachings to guide one through daily life. These focus on individual effort and commend reflective practice.

Buddhists take refuge in the Buddha, his teachings and the community of Buddhists, and strive to live ‘skilfully’ and to abandon ‘unskilful actions’. Followers strive to achieve impersonal ultimate reality through a purifying life of ethical thinking and by carrying out good deeds.

The aim of the Buddhist is to achieve Nirvana. This is a state of liberation, which is characterised by freedom from suffering, death and rebirth.

The Buddha also commends mindfulness; being aware of the impact and effect of one’s behaviour so that it may be skilful. A skilful life is one that follows the precepts and divine abidings: a peaceful harmonious existence that values humility and makes few demands.

Individuality

Buddhists are as varied as the cultures, nations and people that embrace the religion. Some Buddhists chant teachings, practise silent meditation, chant meditative mantras (a spiritual symbol in sound), burn incense, light candles and try to sit in the lotus position. Others do all or none of these.

Like all patients, Buddhists should be cared for holistically and with sensitivity to their individual needs, and nurses should avoid making assumptions about any aspect of their lives. The accommodating nature that Buddhists should strive for usually means that it is easy to care for them, especially if you ask, rather than assume, from the outset.

However, in all traditions of Buddhism there are ordained monks and nuns who have taken specific vows and care should be taken to ensure that the requirements of these vows are met. It is usual for them to wear distinguishing robes, which may be of different styles and colours depending on the tradition they follow.

To ensure that you have the information you need to provide appropriate care, ask the patient, his or her family and loved ones, or a Buddhist chaplain, lay adviser or elder of the relevant Buddhist community.

There is a dedicated Buddhist prison chaplaincy of more than 40 visiting ‘ministers’ and an effective hospital chaplain should be able to locate local Buddhists or Buddhist groups to assist patients and staff.

Birth

There is no universal Buddhist baptism or initiation into the religion; you cannot ‘join’ but choose to enact the teachings voluntarily. There are no infant or childhood rituals, such as circumcision or head-shaving, but Buddhists may prefer a peaceful birth environment to allow a meditative state to arise.

Contraception

Most methods of birth control are not a great concern to Buddhists, who might practise any of the conventional methods. However, most would not consent to abortion on the grounds that it compromises the sanctity of living beings.

Gender/dignity

Most Buddhists have no additional needs other than those we all have - to be cared for respectfully with regard to our bodies. However, in accordance with their vows, ordained monks and nuns may be prohibited from being in the presence of a member of the opposite sex without a chaperone of their own gender. They may also have particular needs associated with their vows, so ask them.

Diet

Buddha commends a harmless life, and although it does not appear in the teachings many Buddhists prefer a vegetarian or vegan diet. Ordained and strict Buddhists may decline anything but a vegan diet and may refuse food after midday (unless for medicinal purposes), acknowledging that we often indulge a craving for food by eating more than we need.

The use of intoxicants, such as alcohol and psychotropic drugs, are likely to be resisted as they mar judgement. Buddhists are also likely to refuse opiates, sedatives and tranquillisers as these drugs may have an impact on their awareness and consciousness.

Organ and tissue donation

Most Buddhists would consider blood donation an excellent opportunity to give to another person. Equally, requests for organ and tissue donations are likely to be received favourably, but remember the individual nature of Buddhists and their families, who may have different spiritual views.

Mental health problems

Research presented to the 2001 annual conference of the Royal College of Psychiatrists found that using Vipassana (Buddhist meditation) as a therapy can benefit prisoners and people with mental health problems.

The US National Institute of Health is also funding a study to determine whether Vipassana can help patients with drug and alcohol addictions, and some US experts advocate ‘mindfulness’ as a way of reducing pain in patients with cancer, HIV and psoriasis.

Most Buddhists would recognise the organic cause of mental ill health and the need for the range of treatments available. However, they might see anxiety and phobic disorders as arising, in part, as a result of violating an ethical way of life through indulgent cravings and desire.

With regard to treatments, Buddhists are likely to favour cognitive approaches in conjunction with a balanced lifestyle, including a healthy diet, exercise, regular sleep times, and the avoidance of alcohol and tobacco coupled with meditation and relaxation techniques.

Buddhists recognise the value of equanimity, or mental composure, and the importance of a modest lifestyle. Regrettably, the pace of modern life and the competition and expectations it creates place unrealistic burdens on most people, which can give rise to mental ill health and stress-related problems.

Buddhists believe that ‘phenomenon and ignorance and attachment lead to suffering’. Those with mental health problems might want to meditate to help them search for the meaning of well-being. The practice of meditation produces calmness, peace, contentment, confidence and strength. This might lead them to bring about a change in self.

Euthanasia

Euthanasia is not countenanced in Buddhist teachings for two reasons. The first is that we all have past kamma or karma to work out, and death will achieve only a temporary alleviation of the suffering that arises from the ‘rewards’ of unskilful action. The second is that euthanasia, a ‘violent’ act by which life is extinguished, contravenes the Buddhist view of the sanctity of life.

This is not to say that other actions to alleviate suffering would not be acceptable, but active euthanasia such as suicide or self-harm would be considered ‘unskilful’ (the term preferred by Buddhist for acts that are not meritorious/good), and would attract ‘bad karma’.

Care of the dying

Resuscitation is an acceptable procedure for Buddhists, but some traditions have special needs as death approaches. To assist in the passage to the next rebirth, which is not the same as reincarnation, wholesome acts such as generosity, service, kindness or pleasant thoughts are recalled.

Dying Buddhists may request that a monk or nun be present to chant or assist in the passing from this life. Because rebirth is a fundamental part of Buddhism, the preparation for death prevails over the rituals associated with death. There is no one Buddhist death ritual, type of funeral or after-life requirement.

However, in some traditions, it is desirable for the body to remain at the place of death for up to seven days to allow rebirth to occur. This may be a problem, but again Buddhists are noted for their tolerance, equanimity and moderation, rather than for making demands, and usually a solution can be found.

Buddhists often opt for cremation as the body is considered a vehicle that is impermanent. In Tibetan tradition a ‘sky burial’ is still practised, in which the body is dismembered and scattered for vultures to eat. Niema Ash (1999) describes this practice of returning the flesh of the body to nature in a way that matches the rigours of living on mountains without soil or trees.

Conclusion

Caring for Buddhists means that health care professionals must address the issues of variability and difference. Like all patients, each Buddhist has individual needs. Nurses should remember to be ‘mindful’ of each person they care for, and to explore and try to meet their needs and wishes.

Buddhism has no commandments but a number of preferred and desired approaches that its followers will be pleased to share and may wish to follow in hospital.

USEFUL ADDRESSES AND WEBSITES

To find Buddhist groups in your area the best thing to do is ask the patient, or his or her friends and relatives. Alternatively, consult local newspapers or search the internet.

The Buddhist Hospice Trust, PO Box 123, Ashford, Kent TN24 9TF. Website: www.buddhisthospice.cjb.net/

The Buddhist Society, 58 Eccleston Square, London SW1V 1PH. Tel: 0207 834 5858. Website: www.thebuddhistsociety.org.uk/

Friends of the Western Buddhist Order, a global support network with centres around the world. Website: www.fwbo.org/

- This series has been endorsed by the Transcultural Nursing and Healthcare Association.