Religious Traditions in Health Care
A Primer for Health Care Providers
Keith F. Muccino, S.J., M.D.
Loyola University Chicago - Stritch School of Medicine
The Tradition
Perspectives on Health Care Issues
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The Tradition
God,The Cosmos & The
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Sources, Revelation,
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Organization: Hierarchy
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Calendar Time Line
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Prayer Ritual
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Views onThe
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One Supreme God called BRAHMAN Many forms and hence multiple Gods and Goddesses. Concept of Trinity: Brahma: Vishnu The protector Siva The destroyer
The Cosmos undergoes an endless cycle of birth and destruction. It acknowledges millions of universes. Humans are in a cycle of births and deaths called reincarnation, till they attain liberation called
Karma yoga or the path of duty Bhakti Yoga or the Raja Yoga or the path of penance Jnana Yoga or the path of wisdomHuman suffers or enjoys in this birth depending upon his/her previous birth good and bad deeds (Karma), And can be changed or modified by the present good or bad deeds.
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Non-founded religion. Many seers expounded the principles as revelations Religious scriptures are classified as the Sruti (that which is heard) and Smrti (that which is remembered)
Vedas are the ancient collections of hymns,rituals and prayers & forms the Sruti. 1.Rg Veda considered the oldest text book in any religion. 2.Yajur Veda 3.Sama Veda 4.Atharva Veda are followed by the Smrtis The latter includes the famous teachings, by Krishna an incarnation of God, called Gita or Song of Gods.
Religion and Medicine are intertwined.
Texts available for the practice of Medicine are – Atharva Veda (1500 b.c.e.) Caraka Samhita(100 c.e.) Sushruta Samhita (200 c.e.) And Ashtanga hridaya Samhita (700 c.e.)
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No central organization or hierarchy. Many different Gurus or teachers over the last >5000 years. There are Temples with Priests to facilitate the individuals prayer or Puja.
Social organization: Four classes or Varnas/castes: 1.Brahmin or priest 2.Kshatriya or Ruler/warrior 3.Vysya or businessman 4.Sudra or workers. Caste system (Portuguese for lineage) is outlawed now.
Concepts rapidly changing currently promoted by secularism.
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The Hindu calendar is based on 27 stars and based on lunar cycles.
The Lunar year is roughly seven days short of the Gregorian calendar. Made up every three years as an added short month. Concept of time is measured in Kalpas. Every Kalpa has 4.32 billion years and is divided into 4 Yugas. We are currently in the last Yuga – 195588597th year !
Personal rites or celebrations -Birth -Naming -First birthday -First feeding -First haircut -Initiation in studies -Home coming -Wedding -Funeral
Common : Many festivals through out the year based on lunar calendar. -Holi-spring festival -Janmashtami or Lord Krishna's birthday -Navarathri or nine nights for goddesses -Dussehra or Rama's win -Deepavali or festival of lights
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A congregation is not a must for worship. Prayer and worship at all levels are considered important. The Religion has Mantras for all occasions with rituals. Mantra itself is God. Every stage in life from birth to death has a Samskara or ritual associated with it. These rituals are an exercise in self-control as well celebration. As an object of focus and concentration for prayer, paintings and figures are used. Representative forms of God: -Pratika- Image -Linga - idol YantraDiagram Two types of prayers 1.External 2.Internal: The worshipper meditates and concentrates on his ishta-devata or personal choice of form of God. They are Japa is repetition of mantras. Mudra or gestures by hands Nyasa
Meditation is encouraged.
Four Obligations: 1.Salutations to ancestor once a month or once a year 2.Salutaions to Devas
3.Salutaions to community 4..Salutations to all living beings
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Four aims or goals in life: 1.DHARMA and obligations of person, a standard of conduct as a member of the community, as a member of the caste, and as person in a particular stage of life. Dharma laid down the rules and ordinances for actions in all situations. Always steering away from absolutes, always sensitive to context, the laws allow qualifications for time, place & exceptional circumstances
2. KAMA: Pleasure, usually understood as aesthetic pleasure of all kinds- art, music, dance, drama, literature, poetry and sex. All of this should be done, of course, within the realm of Dharma or in a virtuous manner
Working for and achieving success, in terms of both wealth and power.
Attempting to get released from the bondage of the cycles of births and deaths due to Karma by realizing the GOD within.
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Hinduism
Perspectives on Health Care Issues
Notions of
Physician – Patient Relationship
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Indiv. Autonomy Vs. Community
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Views on Rx: Transfusion
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Views on Sustaining vs.
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Who's at the Bedside – Spiritual Care
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Concept of holistic medicine (Vaidya) or physician should be -Knowledgeable -experienced -friendly -compassionate -Virtuous -Devoted to learning -rational -ready to act -clean Patient should be -endowed with good memory -must follow directions -Provide all relevant information without fear.
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Concern for both -Meaning of selfhood, "I"ness or Godliness encased in a body -sense of continuity in all eventualities and all life tasks -Material self (Ahamkara) human, public, negative and worldly / private -Transcendent self (Atman) positive, nearer to and more like God -self as witness, untouched by birth and death -Godly SELF is the only true reality. Physician should charge depending on the capability of the patient. -Free care to poor is part of Dharma.
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No contraindication to transfusion -No impediment to transplantation (described in epic Mahabharata) -No restriction of organ donation (described in Siva Purana) -cremation is recommended -No hurdles for autopsy (described in Sushruta Samhita), except time. Cremation is recommended by sundown if person dies during day and by next sundown if one dies during night.
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Suffering is considered part of ones Karma but it is okay to get relief. -Death is opposite of birth and not of life and Hindu concept denies death's finality. -since rebirth is almost certain; death is just a passage to next life. -Pain medications can be given in adequate doses to control pain, but should not diminish patient's alertness or thinking capabilities. -Withdrawal of life support is not contraindicated. In fact artificial or mechanically sustained life is held to be of little value. -Individual's choice and self-willed death be allowed in very elderly, suffering from incurable disease, great calamity etc. In these situations euthanasia could be classified as a self willed death. -Currently suicide and euthanasia are illegal in India. Brain death as well as PVS is valid for withdrawal of life support. Withdrawal of food is permitted. Fasting is indeed a form of self willed death and hence not contraindicated.
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Death is private. Only close relatives stay at the bedside. -Most people prefer to die in their own bed/home. -to attain better next life spiritual readings or special mantras by self or others is encouraged -Visiting the sick is only by patient's request.
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The Tradition
God,The Cosmos & The
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Sources,
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Organization:
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Calendar
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Prayer
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Views onThe
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God the merciful,& compassionate
God the Creator of the
Everything submits (aslama) to God, and will taste death, will be resurrected and judged
Humans are born with moral sense. They are perfectible, if they heed to the call of prophets, who have been sent to guide them.
Humans are not born in sin, but they are forgetful about the goal of their life. They need constant reminders through God's revelation
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The Qur'an, the holy book of Muslims – God's revelation to Prophet Muhammed
Muhammed's life is a perfect model for his followers, known as Sunna (tradition)
Sunna recorded in books of Hadith (narratives describing the patterns of prophetic behavior.
Most important collection of Hadith:
Sahih Bukhari
Usul al-Kafi for Shiite Muslims.
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No hierarchy;
Mosque = Simply a place of Worship
Ulema = Scholars of Islamic law and theology, also recognized as leaders.
Imam = Religious leader, functions as a pastor to the community, performs marriages and presides over funerals.
In Shiite Islam after the Prophet, Imam is a rightful successor
Ayatollah = Surpreme legal authority emulated by believers in matters of faith and practice
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Muslim calendar =lunar (355 days) rotates in all seasons
No new year celebrations
Two feasts known as:
Id al-Fitr (marking end of Ramadan, fasting month),
Id al-Adha (marking the annual pilgrimage to Mecca)
Shiites commemorate Ashura (Tenth day of the first month), a day of mourning for the Prophet's grandson, Husayn, killed in 680 CE
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Sala t= Daily prayers
Five times: Before sunrise,
Jumu'a
Wudu = prayers
Ghusul = Ritual bath after sexual intercourse, and following menstruation and child-birth for women
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Life=
Justice, truth and compassion
Human relationship is core of one's religious commitment
Rights in relation to obligations
Kindness to fellow humans as expression of obedience to God
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Islam
Perspectives on Health Care Issues
Notions of
Physician – Patient Relationship
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Individual Autonomy Vs. Community
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Views on Rx: Transfusion
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Views on Sustaining vs.
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Who's at the Bedside – Spiritual Care
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NAFS = "person"
RUH = "spirit"
God loves human beings and requires them to care for their total being
Human body a "trust" from God, to be cared for
Health = total well-being, health care is to be holistic in approach
Ailments = Psychosomatic reasons and not simply physical
God the Healer, but human, as God's vice-regent on earth responsible to fulfill divine Will in matters of total well-being of society
Physician responsible for restoring health, patient responsible for carrying out plans to improve health
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Individual life seeks meaning in relation to others in family and society
Autonomy respected as long as collective interests are also taken seriously
Islamic ethics incline towards community, but does not ignore individual concerns of autonomy
Allocation of limited resources must take into consideration poverty and beneficence of individual and immediate family
Health care not a right but an obligation
Humans must not cause harm or injury to themselves
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LEGITIMATE MEANS of saving life are recognized
Blood transfusion -- permissible
Organ donation/transplant is permissible if conditions permit and if consent available, even from surrogate decision-maker
Postmortem exam: (autopsy) allowed to determine causes of illness to improve methods of curing
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Suffering not evil, educational, purifier of human spirit, test from God to purify
Pain killers allowed to treat pain, even if they lead to shortening of life
God gives life and determines death
Euthanasia and assisted suicide ar e prohibited
Withdrawal of life-support permissible if medical experts determine futility of extraordinary intervention
Obligation of medical professional is to cure not to prolong imminent death
Patient has right to refuse treatment that causes harm.
Brain death criteria are valid/acceptable
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Prayers are encouraged at all times: God is the HEALER
Pastoral Care permitted if family members allow
Special care needed for Muslim women whose privacy must be protected at all time
Family and community participate in last moments of life
Patient is made to face Mecca
Visiting sick is like visiting God, highly meritorious
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The Tradition
God,
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Sources,
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Organization:
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Calendar
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Prayer
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Views on the Moral Life
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God is both transcendent and immanent.
God's primary attitude toward humanity is grace and forgiveness.
The world is created by God and is good: embodiment is good. (Celibacy is not valued)
While humans are "sinners", God's grace overcomes sin.
We do not earn salvation but receive it as a gift.
Our task is to be channels of the divine love we have received from God.
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Primary document is the Holy Bible whose authority is viewed variously.
Most see scripture as revealing both God and human inspiration, although some see scripture as a human document while others view it as infallible.
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Various- from bishop-led, to lay-centered leadership.
No one form of leadership or polity.
Forms range from congregation in style Baptists, Disciples, United Church of Christ to more connectional Episcopal Methodist
Different from Catholicism no special spiritual status is given to clergy.
Clergy/bishops are considered as part of the "priesthood of believers."
Impossible for any human to claim infallibility: To do so is to be idolatrous.
Focus on conscience in matters of faith, along with the authority of scripture and tradition.
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Varies. Some follow traditional cycle of Christian seasons (Advent, Lent, etc.) while others follow the secular calendar, with few holidays (merely Christmas and Easter
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Various, primarily congregational – both informal and formal.
Focus on personal experience of God.
Personal prayer is important
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Worship of God in everyday life.
We worship God in our secular professions as well as in our ordained.
Both loose and strict constructionist in terms of Biblical authority.
Our moral life gives glory to God.
Various views on abortion, euthanasia, etc. (Strict pro-life and pro-choice positions are idolatrous.
Neither suffering nor death are the greatest evils.
Morality must be updated to respond to the times.
Interplay of absolutes and concrete moral situations.
The Church is constantly reforming.
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Protestantism
Perspectives on Health Care Issues
Notions of Body & Spirit
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Individual Autonomy vs
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Views on Rx: Transfusion
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Views on Sustaining vs.
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Who's at the Spiritual Care
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Covenant oriented.
Love oriented ethic.
Living in the style of Jesus as model: Embracing God's suffering and redemption.
Care for the poor.
Holistic spirituality, embracing body, mind, spirit, and relationships.
As we give to the poor, we give to God.
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Polar and complementary.
We are individuals in community.
Health care is a social as well as a personal issue.
Ethics are communal as well as individual.
Concern for the poor.
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No prohibition to any of these provided that they reflect personal choice.
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Suffering is meaningful, may be a source of spiritual growth.
Palliation is always appropriate.
Various views on euthanasia, suicide… Strong prohibition by some…others see freely chosen euthanasia as a reflection of God's compassion and God's will in certain situations.
God may be the supreme relativist in the concrete expression of love.
Brain death valid for withdrawal of live support
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Good dying embraces body, mind, spirit, and relationships.
Pastoral and medical care should complement each other.
Openness among some to alternative healers.
Death as communal as well as individual.
Strong support for hospice movement as human care of the dying.
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The Tradition
God,
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Sources,
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Organization:
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Calendar
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Prayer
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Views on the Moral Life
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God is one: "Hear O Israel, the Lord is our God, the Lord is one."
Human beings as God's central creation.
Human beings created in the image of God.
Human beings endowed with free will, inclination to do good/inclination to do evil. (Yetzer hatov / yetzer hara)
Process of teshuva (repentance / return ) to right our path
Path to God through action, not faithful contemplation
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Experience of Sinai: God's words, human accounts of the experience, human beings interpretation of how God works in the world.
Revelation through word of the Hebrew Bible, interpretive tradition of the Rabbis, our interpretations today.
Interpretive tradition (oral law / "unwritten Torah"): Mishnah, Talmud, Midrash, Biblical commentaries Legal codes
The above are the constitution, statutes and cases of the halakhic legal system
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Decentralized leadership.
Nothing comparable to Pope.
Different rabbinic authorities recognized by different movements/sects
Sectarianism/ Disunity – Ultra Orthodox Mod. Orthodox Conservative Reform Reconstructonist Non-affiliated
Religious leadership vs. Secular leadership (fund-raising, fund allocation)
Half of rabbis in non-pulpit positions.
No vows taken by rabbis.
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Integration of lunar and solar calendars: New month – New moon
Holidays –must occur in their seasons.
Shabbat – at core of Jewish life, day of rest and celebration of the essences of Life.
The Holidays- Religious, national, penitential, (High Holidays), Israeli
Rosh Hashana, Yom Kippur, Succot, Hanukkah, Purim, Passover, Yom Ha'tzmaut, Yom Hashoah, Shavout, Tisha, B'av
The year 5760 since creation
Calendar date begins in evening after sunset.
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Fulfilling the Mitzvot - Commandments Intersection of the ethical and ritual.
Halakha frames this religious life
Torah, Avoda, vigimeeloot chasadim –study, service, prayer, and good deeds.
"Study is more important than action, because study leads to action" Naaseh vinishma, (Do then understand)
3 required daily prayer services – core blessings, some medieval liturgical poetry
Community is vital
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Maimonides: "The Golden Mean"
Moderation, the middle path between Humility/pride Anger/repress Etc.
Anti-ascetic.
Family, self-sustenance, education, ethical and ritual precepts.
Primacy of human life.
Land of Israel
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Judaism
Perspectives on Health Care Issues
Notions of Body & Spirit
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Individual Autonomy vs Community
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Views on Rx: Transfusion
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Views on Sustaining vs.
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Who's at the
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G-d is the ultimate healer, the physician is his agent
Maimonides as Model of Physician
Maimonides Prayer
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Individual welfare is generally paramount, though there are situations where the welfare of the community is placed above the individual.
All people have free will and make autonomous decisions.
Many will make important decisions in consultation with rabbinic authority (Rav).
There is an understanding that the person asking will abide by the decision of the Rav.
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Transfusions are licit
Organ transplant and donation are allowed for vital organs. There is a question about cornea donation.
Autopsies are only permitted if they will be of direct benefit to specific living people.
Autopsies, when done, are as limited as possible. As much tissue and blood as possible are buried with the body.
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It is not necessary to prolong suffering simply to extend the life of a patient with a terminal condition.
Treatments including life-support, do not have to be instituted, even if this will shorten survival.
Euthanasia and Suicide (assisted or not) are not permitted.
There are methods by which life support can, in effect, be withdrawn in some circumstances.
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It is a religious commandment (Mitzvah) incumbent upon all to visit the sick.
Many communities have organizations dedicated to meeting the needs of the sick and their families.
Bodies should not be left unattended from the time of death until burial.
Members of the community make up an organization (Chevra Kaddisha) which prepares bodies for burial
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The Tradition
God,
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Sources,
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Organization:
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Calendar
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Prayer
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Views on the Moral Life
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Karma is the ultimate principle of universal justice --not a "creator God."
Living beings are burdened with varying degrees of suffering or Dukkha – with potential for genuine happiness
Happiness or peace stems from Kindness, Charity, and Insight
Cosmos has diverse types of living beings— All with the capacity for Liberation from the cycle of rebirths or Samsara
Triple Gem or Buddha, Dharma and Sanghi is interactive source of aid.
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Yogic – not prophetic – model of religious knowledge
Buddha's "Ehi passika" – "Come and see" -- invites one to seek awareness
Scriptures include Three Baskets or Tripitaka including Buddha's discourses – Sutra *Rule of Life – Vinaya *Systematic Psychology – Abhidharma
Philosophical Commentary enhances the three part canon "Skillful Means" renders scripture interpretable rather than absolute
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No universal Buddhist hierarchy
Clergy are, in theory, "as free as birds" to go about
Society is split between clergy and laity
Political connection varies with historical time and culture
Buddhism is universal – "for the benefit and happiness of the many"
Present-day Buddhist leaders include Dalai Lama-Tibet Thich Nhat Hahn- Viet Nam Mahaghosananda- Cambodia
Branches: Theravada (South Asia)
Mahayana (East Asia)
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Monthly: Uposatha obsevance days are four according to lunar phases. Monastics recite vows, confess sins, fast, meditate, and teach. Laypeople fast, meditate, take part in devotions listen to a dharma talk, and observe the Eight Precepts
Yearly on full-moon: *April/May is Vesak for Buddha's birth, enlightenment and passing away *February is "Sangha Day" for Buddha's promulgating Monastic Code
*Others
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Devotions in Temple on observance days
Make offerings, chant, pray, meditate, at Domestic altar daily
Traditionally monastics beg alms once per day. In west, laypeople bring food to temples.
Ritual acts include: (i)Preparation –remove shoes, bow down, make offerings of incense, food, water, flowers, etc. (ii) Take refuge, chant scripture, meditate, etc.
(iii) Dedicate merit for all.
Respect not worship Buddha and Saints
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Practice the Eightfold Path, i.e. the Fourth Noble Truth or way to end suffering by doing these "right"
Morality -speech -action -livelihood Concentration -effort -mindfulness -meditation Wisdom -thought -understanding
Belief in cause and effect of actions through many lifetimes of Rebirths
Compassion and Wisdom – "two wings of a bird Loving Kindness for all sentient beings
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Buddhism
Perspectives on Health Care
Notions of Body & Spirit
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Individual
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Views on Rx: Transfusion
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Views on Suffering/Death: Sustaining vs.
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Who's at the
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The Five Skandhas (the body,
Suffering is universal and the goal of beings is to be free of suffering.
The physician is a means by which physical or emotional suffering that is due to a medical illness can be reduced or stopped.
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Theravada Buddhism Only goal is to obtain enlightenment through meditation
Mahayana Buddhism Those who obtain enlightenment then help others. These individuals are called 'bodhisattvas.'
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Each of these are methods that can reduce suffering and are acceptable.
Organ donation is considered karmically to be a very positive act
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Suffering from a medical condition is recognized as a combination of factors: An external event (i.e., the illness) and personal desires (i.e., the desire to become well or be restored to a previous level of health or activity). Suffering is greater the desires are not realistic.
Suffering can be viewed as the result of karma, from this life or previous ones. Suffering also makes us more aware of our one-ness with all beings. Suffering that is not done in this life will have to be done in a subsequent one. However there is no point to endless suffering (that the individual cannot modify) and with-drawing life support is acceptable.
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Goal of being at the bedside prior to death is to relieve or reduce suffering. This can be done by the laity or by monks.
Care of the dead is highly variable. Some forms of Buddhism believe nirvana can be obtained between death and re-birth, making after death rituals extremely important (some funerals can last for many days.)
For other forms of Buddhism the after death rituals are not nearly so elaborate
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