Sikh Perspectives - Raman Singh

Sikh Perspectives on
Health Care, Dying and
What is Sikhism?
Sikhism is a monotheistic religion founded
in the 15th century in the region of
northern India called Punjab.
Sikh demographics
• Sikhism is the 5th largest religion in the world
• approximately 25 million Sikhs worldwide
• approximately 500,000 Sikhs in the United
• several Gurdwaras (Sikh temples) in the
Metro Detroit area
• 2% of Indian population 3% of Canadian
Who is a Sikh?
The word Sikh means “disciple.”
Basic Tenets of Sikhism
• Kirat karna -- To live an honest life, to
be fair in all personal and professional
dealings, to earn an honest living
• Naam japna -- To meditate on the
Name of God
• Vand chakna -- To share wealth and
do charitable work (seva)
Basic Tenets of Sikhism
• There is one universal God and that God
resides within God's creation
• The goal of human life is to lead a life of
prayer meditation and service so our souls
may merge with God
• The path to salvation does not lie in
renunciation or celibacy, but leading the life
of a householder
Basic Tenets of Sikhism
• Sikhism condemns rituals and
blind faith
• People of all races and religions
are equal in the eyes of God, as
are men and women
Founding of Sikhism
Founder of Sikhism, Guru Nanak
Born in 1469 C.E.
Nine human Gurus followed Guru
Guru Granth Sahib
completed by 10th
Guru, Guru Gobind
Singh in 1705
Written in Gurmukhi
1430 pages
Contains the poetry
of 6 Gurus and many
Muslim and Hindu
Gurmukhi Script
The Guru Granth
Sahib and small
prayer books
(gutkas) are
written in this
If you see this at a
patient’s bedside,
• ask before moving
• wash hands before
A gutka is a small book that
contains the Nitnem (the 5 daily
prayers recited by Sikhs).
• do not remove cloth if
gutka is covered
• do not place on the
floor or near patient’s
What is the Khalsa?
The Khalsa (the Pure Ones) is an order of
baptized Sikhs who pledge to maintain the
distinct identity of the Khalsa and uphold the
Rahit Maryada.
Panj Kakkars (5 Ks)
• Kesh (unshorn hair) -- acceptance of God’s
Panj Kakkars (5 Ks)
• Kachhera/kachha (a knee-length garment
normally worn under clothes) -- modesty,
purity and sexual restraint
Panj Kakkars (5 Ks)
• Kangha (small comb worn in the hair) -cleanliness
• Kara (steel bracelet) -- unity and protecting
Kangha: a
small comb
worn in
the hair
Kara: steel
Panj Kakkars (5 Ks)
• Kirpan (sword) -- responsibility to fight
Kirpan: ceremonial sword
Gatra: a strap that enables a
kirpan to be suspended near
one's waist or tucked inside
one's belt
Types of Sikhs –Different Levels of
• Amritdhari
• Keshdhari
• Sahajdhari
Amritdhari Sikhs
Amritdhari Sikhs have been baptized
into the Khalsa order according to the
Amrit ceremony of Guru Gobind Singh.
All Amritdharis are required to wear
the 5 Ks, recite the daily prayers, and
live by the Sikh Rehat Maryada.
Keshdhari Sikhs
Keshdhari Sikhs keep their hair, but
may or may not wear the other four
Ks. You cannot usually tell whether a
Sikh is keshdhari or amritdhari simply
by looking.
Turbans go With Hair
Some Women Wear Turbans
Sahajdhari Sikhs
Sahajdhari Sikhs believe in one God, the
10 Gurus, the Guru Granth Sahib, the
importance of the Khalsa baptism, and do
not claim to be any other religion. They
do not necessarily keep their hair, and
may or may not wear any of the other
four Ks.
Views on Death
Death is not the end, it is an inevitable part
of life
The soul does not die, only the body does
Human life is a gift. It is the only
opportunity we have to meet God
Views on Death
We want to “die while alive”.
Achieve the highest state of
Eliminate duality between
Eliminate Fear of death
Religious and Cultural
Considerations in the
Care of Sikh Patients
Health-Seeking Beliefs
• Whoever is born will eventually die
• Physical body is perishable, but soul is
• The soul is a part of the One Universal
Creative Force and yearns for reunion
• Liberation from the cycle of birth and death,
from millions of life forms  Human life is
Health-Seeking Beliefs
• Concept of hukam (God’s will)/kismat (fate
or destiny) -- acceptance of illness
• Fighting spirit/martial tradition of the Sikhs
-- active role in illness
• Generally, Sikhs will accept their physical
state, but will also try to improve it
Illness Behaviors
• Illness may be in the hukam, but one’s
effort is required in recovery
• Meditation or recitation of Gurbani by
patient or visitors
• Shabad Kirtan: Singing of poetry from the
Guru Granth Sahib by patient or visitors,
CD, tape, DVD, Mp3, phone
• Cultural practice: Family and family friends
Illness Behaviors
• Ardaas: Prayer of supplication
• Done at any time, particularly time of death or
birth or other difficult times.
• Meditation
• Cultural issue
• Head coverings
• Rehat Maryada specifies that Khalsa Sikhs
must always wear kachhera
• Most women would prefer to keep
themselves as covered as possible
• Meat is not served at langar
• Rehat Maryada states that Sikhs cannot eat
ritually slaughtered meat
• Some Sikhs are vegetarian and some are
• Sikhs do not fast for any reason
Community on Health Care
• Sanctity of life is an injunction,
• Assisted suicide and euthanasia not
• Therapeutic genetic engineering
Community on Healthcare
• Pregnancy and birth are celebratory
events; cultural biases against females
• Reproductive assistance only within
• Therapeutic abortions accepted (injunction
against female infanticide in Gurus’
writings and the Rehat Maryada)
• No postpartum rituals
Community on Healthcare
• Organ transplants and blood
transfusions accepted; Sikh youth
encouraged to donate
• Male infants not circumcised
Your Approach
Family important in decision making
Respect modesty and privacy
Vegetarian choices
Familiar food is an issue for older Sikh patients
• We encourage hospitals and long term care
facilities to have Sikh “chaplain” on list.
Your Approach
• Avoid interrupting prayer or
meditation for routine patient care
• Sensitivity to 5 K’s particularly turban
for men
• Consult patient and family before
procedures requiring removal of hair
Nursing Home/Assisted Living Care
• Culturally, nursing home are usually
considered acceptable for temporary or
rehabilitation care.
• Most families will bring elders home if at
all possible.
• Providing advice on elder care
Advance Directives
• Advance directives are individual choices
• Maintaining a terminal patient on artificial
life support for a prolonged period in a
vegetative state is not encouraged, so
most Sikhs will probably specify a period
of time during which they would prefer to
be kept on life support – because mind is
not alive anymore
End of Life Care
• No contraindication to autopsies
• Consult patient, family and Sikh
• Have relatives and Sikh granthi
nearby to recite Shabad Kirtan
• Death is viewed as a part of life,
not to be feared
Hospice care
No contraindication to palliative care
Patient might be very comforted bySikh
hymns, prayers and meditation.
Family or Gurdwara granthi can do this
Be sensitive to officials of other
religions doing prayers with patients
End of Life Care
• Allow family and granthi to follow
traditions to prepare body for
• Body to be cremated expediently,
unless waiting for relatives to
Traditions at the Time of Death
Family and Friends Gather, pay condolence
Prayer services/reading of the scripture at
home or at the Gurdwara
Prayer service at the funeral home
Philosophy Surrounding Death
- End of body, not soul
- Soul is meeting with great soul
- Ardaas/supplication is that God take the
departed back to the true home
Sikh Patient’s Protocol for Health Care Providers,
The Sikhism Home Page,
Shiromani Gurdwara Parbandhak Committee,
Gateway to Sikhism,
The Sikh Coalition,
Sikh-Seek (Sikh search engine),