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transcultural medicine - Treating Christian patients

Christianity is by far the largest religion in the UK with around 30 million regarding themselves as nominally Christian and some six million actively committed to the faith. The main Christian communities are the Anglicans, Presbyterians, Roman Catholics and Free Churches. The majority of Christian patients will present few challenges to GPs over and above the norm, but GPs may encounter patients from one of several supplementary groups with belief systems that may impact on care.

Lifestyle and diet

 · Seventh-Day Adventists

Around 21,000 people in the UK and Ireland belong to this non-conformist church. Adventists believe they have a responsibility to God to care for their bodies. Consequently, Adventists are often vegetarian and do not smoke or drink alcohol. Many also avoid caffeine and some opt for a vegan diet. Pastor Richard Willis, spokesman for the church, says male Adventists live six years beyond the national avarage, while women have an extra four-and-a-half years.

Adventists will not eat shellfish or pork and may request medication that does not contain these products.

 · Quakers

Quakers adhere to the principle that God is in all people and oppose anything that harms or threatens them. There are no taboos: alcohol, smoking and meat are not forbidden, but many Quakers do opt for a vegetarian diet.

 · Jehovah's Witnesses

There is no ban on alcohol although Jehovah's Witnesses note that the Bible warns against 'overindulgence' and drunkenness.

Witnesses will eat meat provided it has been drained of blood (similar to Halal or Kosher meat preparation). This may impact on the acceptance of certain medication. All Witnesses will refuse whole-blood products but some will accept products that contain blood derivatives, such as albumin, clotting factors, immunoglobulins and haemoglobin-based oxygen carriers.

 · Salvation Army

There are nearly 60,000 members of the Salvation Army. Generally members practise mainstream Christianity but there is a ban on alcohol, smoking and drug taking.

Birth, family planning,

sexuality and abortion

 · Roman Catholics

The Catholic church teaches against abortion and Catholic patients will not opt for termination even if the pregnancy presents a threat to health. The Guild of Catholic Doctors calls on doctors to look for 'Catholic' solutions to the problem. For example, a woman with pre-eclampsia could be offered the option of having her pregnancy shortened by delivering the child at 28 weeks to reduce the threat to her health. For more information contact the Guild of Catholic Doctors.

Pregnant women may accept amniocentesis or CVS but will use it for information purposes only and will refuse abortion regardless of the test results.

Family planning can be offered but devout Catholics will opt for natural methods of birth control. A newborn baby likely to die should be given an emergency baptism or, if possible, a priest should be called.

 · Seventh-Day Adventists

Adventists view prenatal human life 'as a gift of God' and generally will not favour termination of pregnancy, but abortion can be considered in 'exceptional circumstances' including risk to health or life of the mother, severe congenital defects of the fetus and pregnancy resulting from rape.

Family planning advice is readily accepted, although emergency contraception will be viewed in the same way as abortion. Assisted reproduction is frowned upon.

 · Quakers

There is no uniform view on abortion. Some Quakers will refuse on the grounds that it 'harms' life while others will view it as a means of allowing women freedom of choice.

Quakers are happy to receive family planning advice and many Quakers do use contraceptives. It is also quite common for male Quakers to choose vasectomy rather than leaving the responsibility for contraception to the woman.

 · Jehovah's Witnesses

Abortion is prohibited, regardless of circumstances. Family planning is viewed as a personal matter and GPs should not encounter difficulty offering Witnesses consultation. However, all Witnesses will refuse emergency contraception.

 · Salvation Army

Abortion may be considered but only in exceptional circumstances ­ as with Seven-Day Adventists.

Blood products

 · Jehovah's Witnesses

Witnesses believe allogeneic blood transfusion is prohibited by the Biblical passage: 'You are to abstain from meat that has been offered to idols, from blood, from anything that has been strangled and from fornication' (Acts of the Apostles).

All Witnesses will carry a 'no blood' signed medical card and will have filled out a 'health care advance directive form' (living will) stating their requirement of 'non-blood medical management'. GPs will usually be given a copy of this. The form releases doctors of responsibility for any damage that might be caused by the patient's refusal of blood.

Occasionally, children have been made wards of court to enable a blood transfusion to go ahead.

Witnesses will make personal decisions about whether to accept products based on modified haemoglobin.

Some Witnesses will accept autologous transfusions such as intra-operative blood salvage and haemodilution techniques. Some, but not all, Witnesses will consent to the use of blood derivatives such as clotting factors.

The Witnesses run a 24-hour hospital information service giving information on non-blood techniques for surgery and other procedures.

Death and end of life decisions

 · Roman Catholics

Food and drink should not be withdrawn with the purposes of ending life in a patient, even if they are in a permanent vegative state. Some Catholics will carry a 'Christian advance declaration' spelling out their stance on this. The declaration will also request that a priest be called should the patient's condition become grave.

 · Seventh-Day Adventists/Quakers/ Jehovah's Witnesses/ Salvation Army

There are no special rituals pertaining to health care, but Quakers are encouraged to keep a living will and to give a copy to their GP.

Most Quakers carry donor cards.

Challenges

facing GPs

A non-judgmental approach will be helpful when treating patients who adhere to the strictures of their faith. GPs may find themselves faced with ethical challenges where tenets of faith fly in the face of conventional treatment and usual clinical practice.

For example, termination of pregnancy and the Catholic patient, and the non-blood requirement of the Jehovah's Witness both raise dilemmas. Nonetheless, most devout patients are cognisant of the fact that their beliefs may test GPs and have thus taken the lead in setting up living wills and other mechanisms to ensure they can access mainstream health care without burdening health professionals.

Contacts

·Guild of Catholic Doctors

Tel: 020 7266 4246

·Jehovah's Witnesses

24-hour hospital

information service

Tel: 020 8906 2211

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