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

[dspring]

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

[LydiaNN]

well, some patients I've had, such as Christian Scientists may not agree w/the above statement; not sure what a "minor" commandment is either....

Yes, I was kind of wondering who something termed a commandment could be considered minor, too!

[carolinapooh, BSN, RN]

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.

As usual, Chaya, beautifully said.

[Luv2BAnurse]

I apologize. What I said was worded terribly, I can see how I was misunderstood. I only meant that it never occured to me to tell of a medication's origin. In the respect of where a med comes from I have told patients that as soon as it comes from pharmacy, I'd bring it in...any med... I am not so naive as to think that they miraculously appear in a pharmacy. Neither would I knowingly hold any information from a patient that they may need or want to know. It seems the more I try to explain what I had originally stated, the deeper hole I am digging. I wasn't taking the pt's "need to know" lightly. Words are only a part of our communication. I don't know about anyone else, but sometimes when I don't know something I do laugh at myself...which is precisely what I was doing on my original post. Others were talking about knowing origins of meds...I don't know them and was actually a bit surprised that you all did. It seems to be something I should know in order to benefit my patients more. I can only hope that this made sense to you all, so you do not think there are nurses out there trying to get something over on others, I am not one of them.

[JeanettePNP, MSN, RN, NP]

well, some patients I've had, such as Christian Scientists may not agree w/the above statement; not sure what a "minor" commandment is either....

Well, I don't know exactly what your friend had in mind, but in Judaism, there are three "major" commandments which you may not violate to save your life: Idol-worship, murder and adultery. All other commandments are considered minor in this respect. This means that if you need to eat/ingest something non-kosher to save your life, you may do so, if the kosher substitute is not easily available.

[firstyearstudent]

Good point, ChayaN! Nurses are busy enough without having to second guess the special needs of special patients.

However, most nurses probably aren't educated or sensitive enough to these issues to respond knowledgably about the origins of heparin or other drugs when asked directly. (As a students, this is news to me!)

But that's why a bulletin board like this is so great.

[Marie_LPN, RN, LPN, RN]

And also to keep in mind, this could be a minor thing to one person and a huge deal to another.

[canoehead, BSN, RN]

Just to relieve everyone from the debate about insulin, at least, here's a link that says most animal insulins are now not being manufactured.

http://www.wtvt.com/investreptr/humulin.html

Again, the new insulin is synthetic. But Ford says the only insulin that successfully allows her to manage her blood sugar levels is the old fashioned kind--the kind that comes from animals. She stashes a supply of it away in a refrigerator because Eli Lilly and Company, the only American company producing insulin, stopped making the beef and beef/pork insulin she's used for 30 years. It still makes the pork insulin, but that doesn't work well for Ford either.

[caroladybelle, BSN, RN]

Well, I don't know exactly what your friend had in mind, but in Judaism, there are three "major" commandments which you may not violate to save your life: Idol-worship, murder and adultery. All other commandments are considered minor in this respect. This means that if you need to eat/ingest something non-kosher to save your life, you may do so, if the kosher substitute is not easily available.

Perhaps the nonJews are not aware, but there are several hundred laws/rules governing Jewish behavior and propriety (isn't it 632?) While they are rules, they are not necessarily absolutely unbreakable, in matters of life and health.

G-d prefers us to use a certain amount of judgement, and accepts that variations may be necessary at times.

In Christianity (catholicism), there are categories of sin, Venal and Mortal. One is much more abhorant and less "forgiveable" than the other.

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The issue of use of porcine derived heparin, falls under rabbinical decisions made previously, notably regarding porcine insulin and porcine heart valves. Both were considered acceptable, as that the initial substitutes were found to be problematic or not of appropriate quality. And given that even Humulin insulin contained some minor porcine components in production for a while, it would be difficult for diabetic Jew to survive without having some porcine content.

This issue has risen its ugly head in the form of genetic manipulation. Major producers of grain and of vegetables have been manipulating growth/production by inserting genetic material fromother sources, including animal sources. That means even your "vegetarian" diet may be corrupted by use of animal DNA in its' production.

If you eat at Taco Bell or some other fast food chains, some of what you are eating is probably genetically modified. But I doubt if you will see this listed on the menu anywhere.

Many Jews are choosing organic produce, to avoid genetically modified products as a matter of conscience. We believe that it is unnecessary, falls into the prohibition of "mixing" materials that should not be mixed. But rabbis have determined that this manipulation is acceptable in many cases.

So just because my religion permits something, does not necessarily mean that it is what I will do.

But if I have a problem with a med, it is MY job to let you know what is or is not acceptable to me, in regards to religious prohibitions. I do not expect the nurse to keep up with the vagaries of my religion, or for that matter, even keep track of what my religion is. I merely ask him/her to treat my religious beliefs with respect as I would treat his/hers.

[MA Nurse]

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

Seventh-Day Adventists also do not eat pork. Patients have the right to know...

[KeithEMU]

Many foods that you buy are marked with one of several symbols for Kosher if they have been verified as such. Is the next step to have meds marked as well? Not saying it would be a bad thing at all. It would make the meds easier to know what requires no deliberation, and what may need to be thought about. Could mark some meds as vegan as well. I would guess it has never been done because the drug companies don't think it worth the cost.

[JeanettePNP, MSN, RN, NP]

Actually, a lot of meds have been checked out for Kosher purposes. There are a few rules at play here: One, Jewish law is not as strict when there's danger to life. Two, if the amount of non-kosher substance is very minute it could be nullified. Three, medication is generally not considered as food. Injection is even less of a problem than taking a pill. People are stricter around Passover time for various reasons, and there are books out that tell you which medications have grain products in them.

I don't think having meds kosher certified is the best idea (although many vitamins and OTCs already are.) The reason being that it will just add another complication in the way of getting needed medication to a sick person. Some people have O-C tendencies when it comes to religious observance and I see no reason to feed it. Me, being slightly neurotic, checked before taking a GTT if the soda was OK to drink - I was told that orange and cherry flavors are ok. But the only reason I asked was because I was drinking something and it wasn't a med.

[caroladybelle, BSN, RN]

Many foods that you buy are marked with one of several symbols for Kosher if they have been verified as such. Is the next step to have meds marked as well? Not saying it would be a bad thing at all. It would make the meds easier to know what requires no deliberation, and what may need to be thought about.

To mark something as officially "kosher", requires assistance of a Rabbinical group to oversee production of the product and verify that it is kosher by rabbinical standard, not merely providing a list of ingrediants. This is expensive, and might be seen as highly unnecessary as such groups already permit this use of drugs w/porcine or nonkosher ingrediants, as medicine is a matter of life and health.

And if one were to push the matter of "kosher" vs. nonkosher, remember that there is "kosher for Passover" vs. merely "kosher". And one could get into the use of alcohol containing products vs. nonalcohol containing products, etc. Some medical products involve use of yeast in production...they would be banned during Passover.

Until recently, while most colas were kosher, they were not kosher for Passover. However, some companies have made the effort to mark some "kosher for Passover", by using different ingrediants (different sweetener/syrup)...they sell the altered product in markets where there is a large observant Jewish population. I think that it was Coke Cola, but am not sure.

As such most rabbinical groups have opted to exclude most meds from "kosher" regulations. This eliminates a lot of potential debate and regulatory issues.