Use of animal surfactant: should we seek consent?

Uninformed Origins: Should We Be Advising Parents on the Source of Medicines and Therapies?

Respecting patient autonomy through the process of soliciting informed consent is a cornerstone of clinical ethics. In pediatrics, until a child becomes an adult or legally emancipated, that ethical tenet takes the form of respect for parental decision-making authority. In instances of respecting religious beliefs, doing so is not always apparent and sometimes the challenge lies not only in the healthcare provider's familiarity of religious restrictions but also their knowledge of medical interventions themselves which might conflict with those restrictions. We examine a case of a newborn receiving animal-derived surfactant, a common scenario in neonatology, and present considerations for providers to weigh when confronting when such an intervention might conflict with parent's religious beliefs. We end with strategizing ways to address this issue as a medical community.

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Muslims

Islam is the fastest-growing religion across the world and in the United States. Adherents of Islam are known as Muslims. Globally, Muslims comprise the second largest religious group with 1.8 billion people, or 24% of the world's population, and range in racial and ethnic diversity.¹ As this population continues to grow, palliative care clinicians will invariably care for a Muslim patient therefore making it important to have a basic understanding of values, traditions, and beliefs held by them. This article outlines 10 basic principles held by many Muslim patients and their families that can allow for palliative care to be delivered in a culturally inclusive way. This article should serve as a point of initiation for further exploration of their needs as it is not a comprehensive guide.

Settling for second best: when should doctors agree to parental demands for suboptimal medical treatment?

BACKGROUND

Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead (suboptimal being defined as less effective and/or more expensive). Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored.

METHODS

The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents' thresholds for acceptable harm and expense resulting from parental choice, and the role that religion played in their judgement. We also identified and applied existing ethical frameworks to the case described in the survey to compare theoretical and empirical results.

RESULTS

Two hundred and forty-two Mechanical Turk workers took our survey and there were 178 valid responses (73.6%). Respondents' agreement to provide treatment decreased as the risk or cost of the requested substitute increased (p<0.001). More than 50% of participants were prepared to provide treatment that would involve a small absolute increased risk of death for the child (<5%) and a cost increase of US$<500, respectively. Religiously motivated requests were significantly more likely to be allowed (p<0.001). Existing ethical frameworks largely yielded ambiguous results for the case. There were clear inconsistencies between the theoretical and empirical results.

CONCLUSION

Drawing on both survey results and ethical analysis, we propose a potential model and thresholds for deciding about the permissibility of suboptimal treatment requests.

Implications of religious and cultural beliefs on selection of medicines

Medicinal products contain not only active drugs but other ingredients known as excipients that serve a variety of purposes. People who wish to avoid certain substances for religious or cultural reasons need to know about the origin or source of drugs and excipients contained within their medicinal products in order to make an informed decision about treatment. In this article, we provide an overview of the issues and challenges facing healthcare professionals who may need to advise patients on the content of their medicines.

Animal derived products may conflict with religious patients' beliefs

Background

Implants and drugs with animal and human derived content are widely used in medicine and surgery, but information regarding ingredients is rarely obtainable by health practitioners. A religious perspective concerning the use of animal and human derived drug ingredients has not thoroughly been investigated. The purpose of this study was to clarify which parts of the medical and surgical treatments offered in western world-hospitals that conflicts with believers of major religions.

Methods

Religious and spiritual leaders of the six largest religions worldwide (18 branches) were contacted. A standardised questionnaire was sent out regarding their position on the use of human and animal derived products in medical and surgical treatments.

Results

Of the 18 contacted religious branches, 10 replied representing the 6 largest religions worldwide. Hindus and Sikhs did not approve of the use of bovine or porcine derived products, and Muslims did not accept the use of porcine derived drugs, dressings or implants. Christians (including Jehovah’s Witnesses), Jews and Buddhists accepted the use of all animal and human derived products. However, all religions accepted the use of all these products in case of an emergency and only if alternatives were not available.

Conclusions

The views here suggest that religious codes conflict with some treatment regimens. It is crucial to obtain informed consent from patients for the use of drugs and implants with animal or human derived content. However, information on the origin of ingredients in drugs is not always available to health practitioners.

Consideration of religious sentiments while selecting a biological product for knee arthroscopy

PURPOSE

There is an increasing use of various synthetic and biological products in orthopaedics. The use of a biological product can be a major area of concern for patients of various cultures/religions. The purpose of this work is to study various restrictions in different faiths and their compatibility with available products focused on cartilage repair.

METHODS

A systematic search in several databases, CINAHL, EMBASE, Global health, PubMed, MEDLINE and the Cochrane collaboration, was performed to find out various religious beliefs of some major religions regarding the use of animal products. Hindu, Muslim, Christian, Jewish and Buddhist faiths were studied to find out whether animal-derived surgical implants are permitted. Major religious scholars were asked about their opinions, and guidelines related to human/religious ethics were evaluated. A market survey was carried out to find out biological contents of various products and their compatibility.

RESULTS

Jews and Muslims have religious restrictions for porcine products, while Hindus reject bovine products. Vegetarian Hindus reject usage of any animal product. Most Christians do not have any restrictions except those who follow vegetarian dietary regulations. Though there is no prohibition for the use of animal products in Buddhism, a code of non-violence to animals is being followed. However, difference of opinion exists about interpretation of these dietary guidelines for surgical usage amongst various scholars.

CONCLUSION

Products of biological origin have a definite restriction for various religions, with few exceptions. Surgeons should know the source of the product and should be aware of the basic requirements of the patient's faith. Patient should be informed about the source of the product and alternative if available, and an informed consent may be considered.

LEVEL OF EVIDENCE

Type of study, Level V.