Background: Hinduism is a major world religion. The number of Hindus living in the United States (US) is estimated to reach 5 million by 2050; globally, the Hindu population is already around 1.5 billion (1,2). This Fast Fact highlights care considerations for Hindu patients with serious illness. Importantly, while what is noted in this Fast Fact may apply for some patients, clinicians must always identify and respond to the relevant beliefs and preferences of the individual especially since Hinduism represents a wide variety of practices and beliefs. Cultural responsiveness and humility are crucial.  Fast Fact #19 and Fast Fact #274 offer tips on how to screen and identify patients with specific spiritual beliefs and care needs.

Serious illness care considerations of patients who are Hindu:

• Dietary restrictions: Clinicians should ask patients about the fasting and dietary practices of patients who are Hindu. Many Hindu traditions follow a vegetarian diet, precluding meat, fish, poultry, and eggs and some also avoid onions, garlic, mushrooms, or peppers (3,4). Hindus may decline or ask for more information about common treatments that contain animal-derived products, including gelatin-containing capsules (oxycodone) or tablets with stearic acid (acetaminophen) (5). Consultation with a pharmacist can help identify medications and/or medication administration schedules that may be problematic for their specific practices as well as help identify better substitutes.
• Daily rituals and practices: Clinicians must consider the timing of daily rituals and practices of Hindu patients and make accommodations as feasible. Patients may decline food, liquids, and medications before performing daily rituals which could include prayers and the worship of God using sacred images called murtis. For some, these rituals may be integral parts of their daily lives that significantly contribute to their spiritual health and therefore may be highly prioritized (4). Hindus may also want to practice yoga (some forms of which include mediation and prayers) even while residing in an inpatient facility to strengthen their connection with God and/or ease their mental burden (6).
  • Suggested language: “While in the hospital, do you plan to follow any religious or spiritual practices, like worship or fasting, that could affect how we should schedule our therapies?
• Ayurveda: Hindu patients may consider using Ayurveda, a natural system of medicine with roots in Hinduism, which includes oral and topical remedies derived from herbs, plants, oils, and spices (7). Ayurveda may be used concurrently with disease-modifying treatment. While some preliminary evidence supports certain Ayurveda therapies (8), they also can affect wound care if used topically or the metabolism of other drugs when ingested. Oral turmeric, for instance, contains curcumin that can interfere with the cytochrome P450 pathway (9). Clinicians should consult a pharmacist to clarify any drug-drug interactions, while acknowledging the cultural significance of Ayurvedic remedies.
  • Suggested language: “Are you using any Ayurvedic therapies? If so, can you identify which ones to ensure they do not cause problems with other medications you are taking?”.
• End of life (EOL) care preferences:
  • Some patients with serious illness may prefer to know when their prognosis is poor to allow for pre-death rites and to prepare their family; others may prefer not to know their prognosis. Clinicians should first elicit the patient’s preferences for prognostic disclosure, or if applicable, family and community members who assist with clinical decision-making.
  • For many, family plays a central role—with elders often having a revered position—so decisions may be more family based compared with the general population.
  • Clinicians should identify the family or community members that will take the lead on medical decision-making and final rites, being aware that these may differ.
  • Suggested language: “If your condition worsens and the doctors feel death is near, how would you prefer to hear that information? Who all should be involved in your care?”
• Rituals at the EOL: while these also vary significantly, some commonly described EOL rituals include:
  • Some prefer to lie on the ground when near death to signify the body’s return to the earth.
  • Family and friends often pay their respects in-person when a Hindu patient is nearing the EOL. Requests to sing or listen to devotional music are common.
  • At the time of death, family members may place sanctified water in the patient’s mouth (10).
  • Hindus may perform these and other pre-death rites prior to cremating the deceased. Hence, terminally ill Hindu patients often prefer to die at home to facilitate these final rites. Clinicians should inquire about final rite preferences and EOL location preferences at appropriate times when engaging in advance care planning discussions (11,12).
  • Suggested language: “If your condition worsens such that we are worried you are dying, where would you like to be? Are there any specific care preferences or rituals we should know about?”

Connecting patients to their local community: Hindu patients and families may turn to faith-based and community resources to help with medical decision making.  Clinicians should facilitate access to these resources since serious illness can often disrupt these connections (12). Hindu patients may not be aware of spiritual care services like chaplains who can facilitate access to their faith community (13). Likewise, if the patient expresses preference for someone sharing their cultural background, local Hindu temples or groups may be able to identify someone experienced in psychosocial care.

Summary: Clinicians should explore the beliefs and practices of Hindu patients and accommodate them as best as possible when providing care.

References:

1. Patel, R. V., Patel, V. R., Patel, D. R., Kamal, A. H., & Nelson, J. E. (2020). Top ten things palliative care clinicians should know about caring for Hindus. Journal of Palliative Medicine, 23(7), 980-984
2. Pew Research Center Religion & Public Life: The Future of World Religions: Population Growth Projections, 2010– 2050. Washington, DC: Pew Research Center, 2015.
3. Coward H, Sidhu T: Bioethics for clinicians: 19. Hinduism and Sikhism. CMAJ 2000;163:1167–1170.
4. Simha S, Noble S, Chaturvedi S: Spiritual concerns in Hindu cancer patients undergoing palliative care: A qualitative study. Indian J Palliat Care 2013;19:99–105.
5. Stearic Acid. Drugs.com. Updated October 19, 2022. Accessed April 7, 2023. https://www.drugs.com/inactive/stearic-acid-77.html.
6. Tarakeshwar N, Pargament KI, Mahoney A: Initial development of a measure of religious coping among Hindus. J Community Psychol 2003;31:607–628.
7. Dhruva A, Hecht FM, Miaskowski C, et al.: Correlating traditional ayurvedic and modern medical perspectives on cancer: Results of a qualitative study. J Altern Complement Med 2014;20:364–370.
8. Marx WM, Teleni L, McCarthy AL, et al.: Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: A systematic literature review. Nutr Rev 2013; 71:245–254.
9. Turmeric [Internet]: Memorial Sloan Kettering About Herbs App. Accessed February 3, 2023. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/turmeric.
10. Shrutiprakashdas S: Introduction. In: Parikh P (translator): Hindu Funeral Rites. Ahmedabad, India: Swaminarayan Aksharpith, 2017, p. 11.
11. Khosla N, Washington KT, Shaunfield S, et al.: Communication challenges and strategies of U.S. health professionals caring for seriously ill South Asian patients and their families. J Palliat Med 2017;20:611– 617.
12. Washington KT, Khosla N, Lero C: U.S. providers’ perceptions of the psychosocial needs of seriously ill patients of South Asian origin: Implications for health social work. Health Soc Work 2019;44:177–184.
13. Patel RV. The Missing Voice: Incorporating the Hindu Community in Developing Inclusive Chaplaincy. Journal of Pastoral Care & Counseling. 2022 Sep;76(3):160-1.

Version History:  Originally edited by Sean Marks MD; first electronically published in December 2023
Author Affiliations: University of Alabama at Birmingham, Birmingham, AL¹; New York University Grossman School of Medicine, New York, NY²; Rush University Medical Center, Chicago IL^3.
Conflicts of Interest: None to report.