Is Medical Equipment Halal? Kosher?

A recent intercalating student of mine got in touch with this query the other day:

Total parenteral nutrition is given as a replacement for nutrition where the patient cannot or should not be digesting food: it is given intravenously so bypasses digestion.  Two patients have asked my current educational supervisor if the TPN solution is halal, and no-one, including the manufacturers, seems to know. There are various parts that are derived from animals but the manufacturers can’t say where from, even which animal seemingly.

The two relevant patients have been told the ‘don’t know’ answer and have agreed to continue taking the TPN but the team is now left wondering whether to tell all patients before they commence TPN that they do not know the origin of the products used and therefore the TPN cannot be guaranteed as halal, or indeed kosher either.

A pharmacist has also pointed out that beef gelatine is also used in many tablet coatings and this is generally never discussed with patients.

There is a suggestion in this paper that we should routinely be telling all patients about gelatine in tablets and IV infusions, which is definitely what my instinctual reaction agrees with.  The authors suggest that continuing not to do so would mean modern medicine “might be thought to be following the sort of self certain, paternalistic line that doctors were accused of decades ago in relation to Jehovah’s Witnesses”. I think that sums it up quite nicely!

Another interesting question comes from a legal point of view – of the regulations surrounding labelling of food products, which I think are increasingly strict, and the information provided by manufacturers about origins of medical products and then how much of that is communicated to patients.  (I think Margot Brazier might have mentioned this issue in our regulations seminar.)

Having chatted with the student in the pub since, we agree that, ethically at least, it’s a bit of a no-brainer: since it isn’t an imposition on anyone to warn that we can’t be sure of the origin of the treatment, there’s no harm in doing so – and, for the sake of preserving patients’ control over what goes into their bodies, we ought.

The legal question is potentially quite interesting here.  Going off on one a bit, could there be a negligence issue here – on the grounds that it’s reasonable to suppose that at least some patients might want to know the information, even if they don’t expressly say they would (because it never crosses their mind)?  Not to warn could be a serious omission here – and I’m wondering whether it might make a difference to consent.  I genuinely don’t know: were someone to make a case that they should have been warned and would not have consented had they known, would there be legal mileage in it?

Any thoughts, anyone?

  • I think there is a more interesting question here – which is do we as a society have any duties to cater for the preferences/values of patients where those are non-standard? So for example as a vegetarian I have refused pills due to the beef gelatine – do I have any claim on society to provide me with an adequate alternative if available and not significantly more expensive?

  • And we could push the “provide” question, too: suppose that there happens not to be a veggie-friendly version of some drug or ingredient of a pill to deliver that drug, and for some reason making a veggie-friendly version would require a different production process – so it’s not just a matter of ordering one product rather than another, but reworking it. Once reworked, it’ll be just as effective, and just as cheap. Is there an obligation then?

    Is “provision” a matter of making easily available what’s on the market, or extending the market? Could be either; can’t be both.

  • Muslim patients will greatly appreciate that the medical professionals have made the effort to keep them informed of the origins/sources of the medications and treatments they are receiving. One way of addressing the problem is to have the product/system halal certified.

  • For sure.
    But there might still be hard cases. For example, suppose that there’s some product that is not halal, or at least certified as such, but that there’s no alternative. Might it be possible that that’d lead to some (perceived) pressure not to take a treatment that’s medically indicated? I’m not sure how often that’d happen, but it doesn’t seem impossible offhand.

  • Under most mainstream interpretations of Islamic law and ethics, treatment using normally (religiously) prohibited products is allowed if there are no other alternatives and the danger to the patient’s health is sever. Normal Islamic jurisprudence laws are relaxed in cases when there are no other alternatives. The involvement of an Imam and a Muslim doctor in the process might be required to convince the patient about the permissibility of such products.

  • John Rumbold

    What about where there is an alternative, but it’s considerably more expensive? Should the NHS indulge dietary taboos when there are much better things to spend money on?

  • I was chatting to a fellow medic the other day who told me that heparin, an injectable anticoagulant that the majority of patients are given during their hospital stay to prevent DVT, is derived from porcine and bovine tissue. I’ve never seen patients informed of this – perhaps they are – but it does hold some weight in light of your post regarding the religious and cultural sensitivities of patients. There are indeed alternatives to heparin, which makes this issue all the more interesting.

  • Thomas Mattsson

    A related question seems to be what to do about pre op anti coagulants as low molecular heparin that is usual derived from pig bowl mucus.

    I can´t see this being halal or kosher but know that some doctors are not aware of the manufacturing process and hence do not relay this to patients.

  • Dr. Zia

    If there are alternative(s) but not under the Hospitals formulary due to high cost, the patient should still be made aware of them and given the option to pay for them privately.

    The NHS offers vegetarian options, which are satisfactory for most Muslims, Jews, Hindus and Sikhs etc.