I'm going to probably open a can of worms here, but I want your opinion

Natkat, BSN, MSN, RN · May 7, 2006

I was just at a seminar a couple of weeks ago, and the person at one of the lectures commented that they are no longer make a heparin from beef, and it is all pork heparin. This triggered something in my mind, and mad me think if this is the case, can you actually give Heparin to someone of the Jewish, of Muslim faith. Since both faiths from what I understand forbid the use of pork. One nurse I used to work with had told me in the past if I ever come in as a patient you have to use the beef based Heparin. The more I have thought about this the more it really bothers me. I want to here your opinions.
D

I don't know if this is ethical or not, but we just don't tell them whether it's beef or pork.

JeanettePNP, MSN, RN, NP · May 7, 2006

I don't think being injected with porcine products is a problem, only injesting them orally. And, if the person was critical or could become critical without the heparin, and the pork heparin was the only one available, the danger to life overrides the dietary laws. Beef heparin is not necessarily less problematic than pork anyway because if the meat wasn't slaughtered in the ritually proper manner it's non-kosher in any case.

Interesting question, though.

fotografe · May 7, 2006

For Muslims, it is a problem. And for the poster above, it is unethical to not tell them the product is pork-based. My husband and I had this discussion with a group of friends. Some Muslims will outright reject the medication. Others will ask for an alternative, and refuse if there is none. Others will take the porcine med if not taking the treatment will cause certain permanent injury or death. They used the example of a starving person. If the only food around is pork, eating it is not forbidden as the death from starvation is unnecessary. THe same with stealing to feed your family if no other alternative is available.

The bottom line is that like all patients receiving a med or treatment, they should be allowed to weigh the benefits and risks and make their own decision. You wouldn't perform an abortion on a pregnant Catholic woman --even to save her life, by leaving out the detail that her fetus is still alive. That information is vital in her ethical and moral decision-making process.

Jewish patients I have cared for are on this. "Fondaparinux is a synthetic pentasacharide which is a non-porcine base derivative and will be better accepted in Malaysia if proven to be as beneficial as LMWH."

I don't think being injected with porcine products is a problem, only injesting them orally. And, if the person was critical or could become critical without the heparin, and the pork heparin was the only one available, the danger to life overrides the dietary laws. Beef heparin is not necessarily less problematic than pork anyway because if the meat wasn't slaughtered in the ritually proper manner it's non-kosher in any case.
Interesting question, though.

Luv2BAnurse · May 7, 2006

For Muslims, it is a problem. And for the poster above, it is unethical to not tell them the product is pork-based. My husband and I had this discussion with a group of friends. Some Muslims will outright reject the medication. Others will ask for an alternative, and refuse if there is none. Others will take the porcine med if not taking the treatment will cause certain permanent injury or death. They used the example of a starving person. If the only food around is pork, eating it is not forbidden as the death from starvation is unnecessary. THe same with stealing to feed your family if no other alternative is available.
The bottom line is that like all patients receiving a med or treatment, they should be allowed to weigh the benefits and risks and make their own decision. You wouldn't perform an abortion on a pregnant Catholic woman --even to save her life, by leaving out the detail that her fetus is still alive. That information is vital in her ethical and moral decision-making process.
Jewish patients I have cared for are on this. "Fondaparinux is a synthetic pentasacharide which is a non-porcine base derivative and will be better accepted in Malaysia if proven to be as beneficial as LMWH."

I've NEVER told any of my patient's where the heparin came from, other than "the doctor has written a new order for you for heparin, when it comes from the pharmacy, I'll bring it in". heh

SuesquatchRN, BSN, RN · May 7, 2006

I have Orthodox Jewish friends and their attitude is always, "We live by the Torah, not die by it." Saving a life is always preferable to its loss, even if it requires breaking a minor commandment.

fotografe · May 7, 2006

I have Orthodox Jewish friends and their attitude is always, "We live by the Torah, not die by it." Saving a life is always preferable to its loss, even if it requires breaking a minor commandment.

That is what I said above about Muslims. But is you know the drug you are going to give a Muslim or a Jew is from pigs, you need to inform them and make the choice. In all honesty, I didn't know heparin was made from pigs until recently. I knew some other drugs are. If I have a patient for whom this information is important I will tell them.

There are alternatives including refusing the med, but it is up to the recipient to decide.

fotografe · May 7, 2006

I've NEVER told any of my patient's where the heparin came from, other than "the doctor has written a new order for you for heparin, when it comes from the pharmacy, I'll bring it in". heh

I am bothered by the little "heh" at the end of your post. Do you think you are pulling some clever joke over on someone by denying them information they should have? If you know the patient is Muslim or Jew, you need to tell them what you are giving them.

Not informing them out of ignorance is one thing, but knowingly violating one of their deeply held beliefs is quite another and I would hope you would rethink your actions.

JeanettePNP, MSN, RN, NP · May 7, 2006

That is what I said above about Muslims. But is you know the drug you are going to give a Muslim or a Jew is from pigs, you need to inform them and make the choice. In all honesty, I didn't know heparin was made from pigs until recently. I knew some other drugs are. If I have a patient for whom this information is important I will tell them.
There are alternatives including refusing the med, but it is up to the recipient to decide.

This is assuming that you know the origin of the med and assuming that you know this med might present a religious problem for the patient. But IMO this is a lot of assuming for a nurse to do. If a patient knows s/he might have a religious issue with a med or treatment it's their job to disclose that information and not rely on the nurse's knowlege of halacha or sharia.

As an Orthodox Jew I don't have a problem with an injectible drug. Drugs that are injested are a problem according to some rabbis (for example gelatin capsules) but then the issue depends on the availability of other brands, how critical the patient is, etc. But I wouldn't consider it the nurse's job to tell me "this pill might contain gelatin, do you have a problem with it?" Rather, it would be my job to let the nurse know that I have an issue with gelatin capsules. I wouldn't want a nurse to hold back from giving me a medication I needed based on her faulty knowledge of my religious practices.

fotografe · May 7, 2006

I agree with you here. But when you DO have the information, ie knowing your patient is Jewish/Muslim and that the drug is of porcine origin, then I think you are obligated to inform. My husband grew up in Kuwait where there are no products of pork origin, as it is many other Middle Eastern countries. It never occured to him that there would be products like medicines that were porcine in origin. He knows enough to always ask now, and to ask for an alternative if possible. Giving the person the choice is what I believe is important.

This is assuming that you know the origin of the med and assuming that you know this med might present a religious problem for the patient. But IMO this is a lot of assuming for a nurse to do. If a patient knows s/he might have a religious issue with a med or treatment it's their job to disclose that information and not rely on the nurse's knowlege of halacha or sharia.
As an Orthodox Jew I don't have a problem with an injectible drug. Drugs that are injested are a problem according to some rabbis (for example gelatin capsules) but then the issue depends on the availability of other brands, how critical the patient is, etc. But I wouldn't consider it the nurse's job to tell me "this pill might contain gelatin, do you have a problem with it?" Rather, it would be my job to let the nurse know that I have an issue with gelatin capsules. I wouldn't want a nurse to hold back from giving me a medication I needed based on her faulty knowledge of my religious practices.

Marie_LPN, RN, LPN, RN · May 7, 2006

when you DO have the information, ie knowing your patient is Jewish/Muslim and that the drug is of porcine origin, then I think you are obligated to inform.

I agree.

A little disturbing to know that some know its origin, yet keep it to themselves ("heh"). I can only hope what goes around doesn't come around in some form or another.

student_girl · May 7, 2006

I would tell them. They have the right to know. Heck, even I would refuse it, along with gelatine caps. I don't eat that stuff either. I'm not jewish or muslim, but I'm vegan. And if I ever come across a vegan pt, and that I'm aware of it, I'll tell him/her. I think it all comes down to respect for your patients.