Aim We present a 6 day old boy who suffered femoral arterial thrombosis. Parents are Muslim and disagree with the use of Heparin, as it contains pork-derived gelatine. We explore medico-religious conflict between Muslim parents and health-care professionals and how to navigate them.
Methods Male, born 38+2 weeks, NVD, 4.63 kg. Antenatal scans and serology were normal, despite maternal gestational DM (Insulin controlled). He was diagnosed with pulmonary hypertension and HOCM requiring mechanical ventilation for 5 days. Umbillical artery catheterisation inserted on D1, removed on D6 leading to femoral artery thrombosis.
Whilst awaiting emergency transfer to a surgical centre, Heparin was required but parents objected on religious grounds.
Results In the absence of suitable alternatives, we explored parent’s ideas, concerns and expectations. Explaining the gravity of the situation, they still objected. Measures such as contra-lateral limb warming, volume expansion and GTN patches were insufficient. Seeking court approval to override the objection was under exploration and if the condition deteriorated Heparin was to be used without parental consent based on ‘best interest’. Parents agreed to Heparin before this occurred. Surgery was averted and the clot resolved with Heparin infusion alone.
Conclusion Muslims come from many theological and legal backgrounds. Some view that unlawful material for consumption is unlawful for use in medicine, such as pork-derived gelatine. Many medicines contain such gelatine, e.g. Heparin, HepSaline flushes and Duoderm. When conflicts arise, the following can help as per the Hanafi legal school;
Explore parents concerns, explain the situation sensitively. Involve chaplains and Muslim scholars.
Consider an alternative if available, e.g. Mepitel for Duoderm.
If no alternative is available or sufficiently effective then one can use the product, as long as it is needed, known to be effective (based on atleast high likelihood) and that this has been established by a qualified doctor who appreciates the ethical framework of Islamic law.
Provide information as many Muslims lack knowledge of the facility present in Islamic law, e.g. a religious edict (fatwa) such as that written by Al-Azhar University for use of Duoderm or articles from reliable Islamic authorities; seekersguidance.org.
It is important for clergy and professionals to learn about Islamic medico-legal ethics.
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