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

[azhiker96, BSN, RN]

The new synthetic insulin is actually produced by modified E. Coli.

http://www.littletree.com.au/dna.htm

Would this be objectionable to vegans?

[yvonnemuse, BSN, RN]

I have found this thread to be quite interesting and previously knew nothing about the origins of heparin.If I knew a patient was vigilant about their religious observations I would most likely ask for a pharmacy consult (as well as the ususal dietary one)

[UM Review RN, ASN, RN]

I also agree that it does have to be up to the patient to inform. I have no idea how most vegans or those with certain religious dietary restrictions would feel about their med being derived from eggs or mare's urine, for instance.

But this has been a very interesting and informative thread for me, too. I never really gave it a thought before, even though our area is very diverse because of tourism.

[wooh, BSN, RN]

The one time I was hospitalized, I was asked my religious affiliation. Ditto for my Mom, husband and son.

On admits I always ask along the lines of, "Do you have any ethical, religious or cultural beliefs or practices that would affect your care or your diet in any way?"

That gives them a chance to spell out to me what those beliefs are, not just, "I'm Baptist/Muslim/Pentecostal/Hindu/Jewish/Vegan/Guatamalen/Canadian" or whatever ethical/religious/cultural system they're a part of.

I'm of the opinion that they need to tell me specifically. Being vegan, I'll tell you specifically what I'll allow on my dinner tray and what meds I've decided I will or won't take. And I spell it out, because I know when I say no meat or animal products, they're going to say, "Well tonight is fish sticks, so you'll be ok" and I'll have to correct them. But it's up to ME to make sure my convictions are respected, not anybody else. If your culture doesn't allow orange flavoring in liquid meds on Thursdays (but orange juice is ok), don't expect me to know that just because you told me your from Ontario. Tell me you won't take orange flavoring in liquid meds on Thursdays and I'll do what I have to do to get you cherry flavor.

[susi_q]

Thanks Wooh ... you stated a very reasonable response. As a nurse, if I know both sides (the origin of the med ... and your possible objection to it) I will of course give you that information. (Drives me nuts to hear a doc or anyone else give "informed" consent that consists of "we need to do a >>>big long medical jargon>>> sign here".) But I also think our patients have a tendency to check their self-responsibility at the door. I'm not a pharmacist, I don't know origins of most drugs. And just because you were asked at admission about religious preference ... doesn't mean we understand all those implications unless you give that information to each caregiver that you encounter.

[psalm_55]

Fotografe wrote: "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."

absolutely agree. it's called INFORMED CONSENT -- which is required as the result of what the NAZIs did in WWII. This international law was borne of the Nuremburg trials.

administeriing even a placebo -- which is harmless in every way -- requires informed consent.

violating informed consent constitutes criminal negligence. it's a slam dunk! and a fast track to court.

[KyPinkRN]

I still believe that it's the patient's job to disclose their religious views and to ask what's in the drug before they take it, if it's important to them. I don't see how it's an ethical violation for a nurse not to disclose information that she was not told is significant. If the patient noted their religious requirements in their chart and their wishes were not honored, that's an ethical violation. With everything that nurses have to do/remember, I don't expect them to keep my religious preferences in mind unless I explicitly tell them. There are many different customs/rulings/practices even within Judaism or Islam and a nurse can't be expected to keep track of them all. I don't see why you'd want to even go there as a nurse - do you want to be blamed now for inadvertantly causing a patient to violate a religious stricture that they didn't inform you of? As a protection for you, the standard should be that the onus is on the patient to inform the healthcare provider of their religious needs.

I agree with you... and would like to add that just because a patient is a certain religion it doesn't mean that they always follow all the rules and practices of that religion. Some people are more religious than others and to assume that just because someone says they are Jewish or muslim they are practicing takes quite a bit for granted. It most definitely should be the patient's responsibility to speak up if they have special needs due to their religion... not a nurses job to investigate.

[JeanettePNP, MSN, RN, NP]

Fotografe wrote: "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."

absolutely agree. it's called INFORMED CONSENT -- which is required as the result of what the NAZIs did in WWII. This international law was borne of the Nuremburg trials.

administeriing even a placebo -- which is harmless in every way -- requires informed consent.

violating informed consent constitutes criminal negligence. it's a slam dunk! and a fast track to court.

My understanding of informed consent is that it applies to treatment issues, possible side effects, risks vs. benefits, etc. If a patient has a personal/religious/philosophical issue with a med/treatment that is not medically related, I don't think the issue of informed consent even comes into the picture. In that case it's the patient's job to let the nurse know. How is the nurse being criminally negligent by not telling a Jewish patient that heparin contains pork products (which may not be common knowledge to every nurse?) Are you aware that taking gelatin capsules could be a violation of Jewish law? Could I sue you for giving me a gelatin capsule if I never informed you that I have an issue with them?

[psalm_55]

My understanding of informed consent is that it applies to treatment issues, possible side effects, risks vs. benefits, etc. If a patient has a personal/religious/philosophical issue with a med/treatment that is not medically related, I don't think the issue of informed consent even comes into the picture. In that case it's the patient's job to let the nurse know. How is the nurse being criminally negligent by not telling a Jewish patient that heparin contains pork products (which may not be common knowledge to every nurse?) Are you aware that taking gelatin capsules could be a violation of Jewish law? Could I sue you for giving me a gelatin capsule if I never informed you that I have an issue with them?

if we knowingly violate the patient's beliefs, wishes, or right to make an informed choice in the matter, then it violates the principle of informed consent.

the operative word is "knowingly".

[JeanettePNP, MSN, RN, NP]

if we knowingly violate the patient's beliefs, wishes, or right to make an informed choice in the matter, then it violates the principle of informed consent.

the operative word is "knowingly".

Right, and the only way the nurse can "know" is if the patient lets her know. Nurses are expected to be knowledgable about medications/treatments and their side effects. They're not expected to know the intricacies of everyone's religious beliefs and practices unless the patient informs them in advance.

[CoffeeRTC, BSN, RN]

I feel like such an idiot. I've never even thought about heparin being objectionable to some religions. In the back of my mind, I remember inuslin. Maybe because I've never been in a situation? I'm aware of the blood products/ Jehovas Witnesses.

Is there a list of meds/ religious faiths, etc that someone can direct me too.

[psalm_55]

Right, and the only way the nurse can "know" is if the patient lets her know. Nurses are expected to be knowledgable about medications/treatments and their side effects. They're not expected to know the intricacies of everyone's religious beliefs and practices unless the patient informs them in advance.

AGREE TOTALLY. i do not know -- nor do i even want to know the intricacies of various beliefs and requirements. We as nurses have enough on our plates. and yes, those who have special requests or needs need to make them known to us.

an example, is a gentleman we had who is from india. he would not allow women outside his family to touch / care for him. we provided him with male aide and nurse. wife stayed with him most of time.