Health care providers need to have an understanding of and appreciation for the beliefs and religious preferences of their patients in order to provide optimal care for them. As the population of Americans of the Sikh religion increases, physicians, nurses and chaplains associated with hospitals and hospices will more frequently encounter Sikh patients who require contact with the health care system including those with medical conditions, either acute, chronic or terminal. The information in this document is applicable to all Sikhs.

Nationwide, there are approximately 400,000 to 500,000 Sikhs with 6,000 to 10,000 residing in the metropolitan Chicago area. Sikh faith, considered the fifth largest in the world, has more than 22 million followers world-wide. Its founder Guru Nanak Dev was born in 1469, in Punjab (a region in India). Nine Gurus (divine teachers) followed him.

The tenth Sikh Guru, the last in human form, Guru Gobind Singh ), bestowed Guru-ship forever to the Sikh Holy Scripture, Guru Granth Sahib. This holy book was compiled by the fifth Sikh guru, Guru Arjan Dev in 1604. The Guru Granth Sahib is at the heart of Sikh worship, and its presence lends sanctity to the Sikh place of worship, the Gurdwara, where it is installed on an altar and the devotees pay their obeisance to the Guru. The services consist of singing of hymns from Guru Granth Sahib.

Guru Granth Sahib contains devotional compositions written by the Sikh gurus, recorded during their life times and authenticated by them. It also contains hymns by 32 other Hindu and Muslim religious saints, irrespective of their cast or social status, but with similar ideologies.
The 1430 page text is written mainly in the Punjabi language. Some of the hymns are in Sanskrit, Persian, and Hindi languages. The compositions are set in rhymed couplets that can be sung in Indian classical musical measures called ragas.

Religious Beliefs

The fundamental belief of Sikhs is that there is only One, Universal, Formless, Timeless God of all the people, Who is also the creator of this universe and all living beings. "Sikh" means a disciple, and Sikhism is a path of discipline of meditating on God's name, earning a living by honest means, sharing good fortunes with the needy, and selfless service to humanity.

Initiated Sikhs, also known as Khalsa, at all times wear on their person five religious symbols that are articles of faith. They are known as 5K's because their names start with the letter "K."
The Five K's (Articles of Faith) are:
1) Un-cut hair (Kesh), a gift from God representing spirituality;
2) A wooden comb (Kangha), symbolizes cleanliness;
3) A steel bracelet (Kara), represents self restraint and link to God;
4) A short sword (Kirpaan), an emblem of courage and commitment to truth and justice;
5) A type of underwear knickers (Kachhehra), represents purity of moral character.

The religious significance of the headdress (a male turban or a female scarf) should be respected, because it is a covering for one of the 5K's (Kesh) and is also a symbol of a Sikh's honor.

Generally, practicing Sikhs do not cut their hair, and do not consume tobacco products, alcohol, intoxicants or other illicit drugs.

Sikhs believe that whosoever is born has eventually to die. The physical body is perishable, but the soul is eternal. The soul is a part of God and it yearns reunion with the Supreme Being. Liberation from the cycle of birth and death, from millions of life forms, is the basis of the Sikh understanding of the purpose of life. Human life is the gift of the Divine, and its termination, a return to the Divine source.

Culture and Celebrations

Sikh religion originated within the varied ethnic, religious, and cultural parameters of North India, especially within the region of Punjab. Because of their geographic origins, headdress and bearded males, often times Sikhs are confused with Muslims and Arabs. Many of the prevalent manners, customs, and oral traditions of the Punjab region became a part of Sikh life, and in turn the area received a new cultural resurgence from this religion. Since Punjab has supported a predominantly an agrarian society, Sikh art, song, dance, commemorations and celebrations are marked by the agricultural cycle and seasonal moods.
· Guru Gobind Singh's birthday (the tenth guru of Sikhs), in January, is celebrated in congregations at Gurdwaras.
· Vaisakhi (or Baisakhi) festival falls in mid-April. It is a celebration of the day the Khalsa order was created in 1699. It is also a culturally significant spring festival celebrated with music, song, dance, food and fun-fairs.
· Martyrdom day of the fifth Sikh Guru Arjan Dev is commemorated in June.
· The enthronement day of Guru Granth Sahib (Holy Scripture) is also celebrated in October.
· Divali, in October, is a festival of lights and to the Sikhs a reminder of the time when their sixth Guru returned to Amritsar after the Mughal rulers released him from the fort of Gwalior. People exchange gifts and distribute sweets on this day.
· Martyrdom day of the ninth Sikh Guru Teg Bahadur is commemorated in November in congregations at Gurdwaras.
· Guru Nanak Dev's birthday (founder of Sikh faith) in November is celebrated in congregations at Gurdwaras.

Beliefs Related To Health Care

During times of sickness and disease, Sikhs pray to seek God's help, remember Waheguru (God's name) to obtain peace, ask for forgiveness, and recite or listen to Gurbaani, the sacred hymns, which are God's words, uttered through the Sikh Gurus and enshrined in the Guru Granth Sahib (Holy Scripture). The sacred word provides them with physical and spiritual strength and nourishment. Sikh patients may request audiotapes of Keertan (sacred music) be played by their bedside. Sikh patients may consider illness to be the will of God, and also believe that God is merciful and benevolent, but one has to make an effort to get well which includes medical treatment.

General Beliefs And Practices (Individual Practices May Vary)

· The sanctity of life is an injunction. Human life is of the highest form.

· Blood transfusions are allowed.

· Assisted suicide and euthanasia are not encouraged.

· Maintaining a terminal patient on artificial life support for a prolonged period in a vegetative state is not encouraged.

· Organ transplantation, both donating and receiving, is allowed.

· Autopsy is permitted.

· Artificial reproductive technology is permitted only during the span of an intact marriage between husband and wife.

· Genetic engineering to cure a disease is acceptable. To date, Sikhs are opposed to human cloning.

· Abortion is not advised except for medical indications.

· Male infants are not circumcised.

Medical & Nursing Care

An essential aspect of health care is the health care providers' roles in understanding the concerns of the patient and family and communicating these concerns to all those involved in the decision-making process; to console and comfort the patient and his/her family so that they can accept their or their loved one's disease state; and if possible, to take care of the family's needs beyond the medical aspects.

The principles used by the ethicists include preservation of the patient's faith; sanctity of life; alleviation of suffering; respect for the patient's autonomy, while achieving the best available medical treatment without causing undue harm; and always being honest and truthful in giving information.

Important aspects in care for Sikh patients include:

· Respect modesty and privacy (knock on the door, announce your arrival, etc.).

· Do not interrupt a praying patient for routine care.

· Respect the patient's personal space by limiting unnecessary touching.

· Be sensitive to the significance of the Sikh's five K's, (religious symbols or articles of faith) which they may choose to wear on their person at all times. Again, they are uncut hair (Kesh), a wooden comb (Kangha), a steel bracelet (Kara), underwear (Kachhehra), and a ceremonial sword (Kirpaan).

· After removing their headdress, Sikh patients may want to keep their head covered with an alternative covering such as a small turban or a scarf. (A surgical bouffant cap is acceptable.) The headdress should be respected, and if removed, it should be given to the family or placed with the patient's personal belongings. Do not place the headdress with the shoes.

· Infants may be required to wear religious symbols e.g. "Kara" (a steel bracelet).

· Consult patient, family (or the parents in case of an child) prior to shaving or removing hair from any part of the patient's body. This applies to both male and female patients.

· Sikh women may insist on covering their bodies with more than a hospital gown. They may request that when possible, examinations be done while a female patient wears a gown.

· Although Sikhism does not ban treatment from being provided by a practitioner of the opposite sex, providing the patient with of the same sex practitioner when possible is preferable, especially if the patient requests it.

· Many Sikhs are new immigrants from Punjab, or other countries and may have language comprehension problems. Therefore, take time to explain tests, procedures, side effects and treatments to the patient and appropriate family members. It may be necessary to arrange for a Punjabi language interpreter.

· Cleanliness is part of the Sikh way of life. Daily bathing and personal hygiene care should be provided unless advised otherwise by the attending physician due to a medical reason. Washing and conditioning of hair, including male facial hair, with shampoo or soap should be done as frequently as needed. Hair can be dried naturally or with an electric hair dryer. Hair should be combed daily at a minimum.

· It is a Sikh cultural and religious practice to visit the sick. Beand understanding of visits by family members, children and well wishers, when practical.

· For Sikh patients who are victims of domestic violence in the Chicago Metropolitan area, contact Sikh Religious Society of Chicago ; Apna Ghar ; Indo-American Center or Asian Human Services . They provide specialized shelter and counseling for Asian victims.

Spiritual Care/Prayers

· A prayer room for Sikhs may be provided. The room should be quiet, clean and carpeted. An inter-religious space sensitive to the needs of persons of diverse traditions is acceptable.

· If possible, establish a relationship with a local Gurdwara (Sikh place of worship), and a community leader or a Granthi (Sikh Priest) who could serve as a religious resource.

· Identify Sikh physicians or other health care providers on your staff who can act as liaisons with Sikh patients.

· If congregational Sikh prayers are being held at the institution, inform other Sikh patients.

· Inform individuals of their rights as patients and encourage them to have advance directives.

Diet/Food Preference & Practices

Sikhs do not eat any ritual meat prepared by either sacrificing the animal to please God, or by killing the animal slowly to drain out the blood. Zabiha/Halal meat, (meat prepared the Islamic way), is forbidden for Sikhs to partake. Vegetarian or non-vegetarian meals are individual preferences. If there are no dietary restrictions, the patient may be asked his/her food preferences, and/or allow patients to bring food from home. Sikhs do not observe fasting for any religious reasons.

End of Life Care

In matters of terminal care, the attending physician should consult the patient, the family, the ethicist, and preferably, a Sikh scholar before making a final decision.

Health care providers, including nurses, physicians and chaplains should comfort the terminally ill patient, making sure he/she is pain-free, have his/her relatives and friends nearby, and have access to a Sikh Granthi (a Sikh), who can recite Gurbani (writings of the Gurus) and perform Sikh prayers. At the departure of their loved ones, Sikhs console themselves with the recitation of their sacred hymns.

It is important that funeral and cremation arrangements be made in advance in consultation with the family and according to the wishes of the dying or deceased patient, if possible.

With minimum delay, the body is to be removed to the funeral home for expeditious cremation, unless the family is waiting for a close relative to arrive. Provide routine post-mortem care. The body should be covered with clean linens and shrouded. If the person is wearing any of the 5K's, they should remain with the body.

Allow the family and Sikh Granthi, to follow Sikh traditions for preparing the dead body for funeral. The dead body should be given the same respect as during life.

For hospice care, the family may wash and clothe the body immediately after death, prior to removal.

Resources/References

· The code of Sikh conduct and conventions (Shiromani Gurdwara Parbandhak Committee, Amritsar {India} Publication.)

· Council for a Parliament of the World's Religions, Chicago:

· Sikh Religious Society of Chicago: or

· Sikh American Heritage Organization:

The Metropolitan Chicago Healthcare Council wishes to acknowledge the technical assistance of the following individuals in the preparation of this document:

Rajinder Singh (Mago), Bhai Mohinder Singh, Dr. Amarjit Singh, Dr. Daljit Singh, Dr. Gurbachan Singh (Chadha), Dr. Mohinder Kaur (Chadha), Dr. Jagjit Singh (Teji), Surinder Kaur Singh, Sohan Singh, Jaginder Singh (Ramdev), Kulwant Singh (Hundal), Dr. Harbans Kaur (Deol)

Approved by the Committee on Clinical, Administrative, Professional & Emergency Services - November 29, 2000

© Copyright 2000 Metropolitan Chicago Healthcare Council