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Patient choice in medicine taking: religious sensitivities must be respected
  1. A R Gatrad1,
  2. G Mynors2,
  3. P Hunt3,
  4. A Sheikh4
  1. 1Manor Hospital and Birmingham University, UK
  2. 2Medicines Partnership, London, UK
  3. 3National Patient Safety Agency, London, UK
  4. 4Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
  1. Correspondence to:
    Dr A R Gatrad
    Manor Hospital, Moat Road, Walsall WS2 9PS, UK; sec.gatradwalsallhospitals.nhs.uk

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Children often do not have choice in medicine taking, as it is typically their parents who agree, on their behalf, to receive prescribed treatments. Exploring parents’ (and wherever possible also children’s) beliefs about choice of medication is however important,1 particularly so when strong religious beliefs about contents of medications may be present, as a failure to do so may result in unintended harm and negatively impact on compliance.

In a multicultural context, it is essential that prescribers have a minimal level of awareness of parent’s religious sensitiveness so that these can be considered when prescribing (table 1). Jehovah’s Witnesses, for example, may choose to avoid blood derived products.2 Jewish law forbids any oral use of medication containing glycerol, stearates, lactose, and porcine products.3 Similarly, Hindus and Sikhs may be offended by medication containing animal products, particularly bovine derived products (for example, gelatine containing capsules). Islamic rulings that prohibit any systemic ingestion of pork or alcohol also need to be considered in the context of prescribing decisions involving Muslims.4

Table 1

 Examples of bovine, pork, and blood derived mediations and possible alternatives

A practical way of ensuring that health professionals have sufficient information about treatment options available would be for the British National Formulary to clearly indicate which preparations contain blood, animal, and alcohol derivatives, and, where possible, suggest suitable alternatives. The proposed electronic health records will facilitate the seamless sharing of patient information among multiple healthcare providers. This will therefore offer an additional systematic approach for routinely collecting information, and through use of “prescribing alerts” can help inform clinicians about patient preferences in relation to medications.

But beliefs need to be balanced against clinical need. Recognising that many religious traditions offer a degree of relaxation of their respective laws in extenuating circumstances, there may be a need to work pragmatically with faith leaders to find acceptable compromises in cases where suitable treatments or treatment regimens do not exist, for example in the case of pancreatic preparations, which are all porcine in origin (table 1).

Stereotyping must however be avoided. Arguably, even more important than knowledge of the main tenets of different faiths and access to information about the constituents of medicines then, is that prescribers have the skills and attitudes to explore patients’ own beliefs and preferences during prescribing consultations. Parents and children are not passive recipients of prescribing decisions; they have their own views which are a key influence on whether and how they take medications and these must be respected.

References

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Footnotes

  • Competing interests: ARG and AS have (voluntary) positions with the Research and Documentation Committee of Muslim Council of Britain. They, together with GM, were involved in the production of Informed choice in medicine taking: drugs of porcine origin and clinical alternatives which was supported by an unrestricted educational grant from Sanofi-Synthelabo. Lord Hunt is Chairman of the National Patient Safety Agency.

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