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|Title: ||Clinical Ethics Case Study 9: Should we inform our patient about animal products in his medicine?|
|Authors: ||Newson, A.J.|
|Issue Date: ||2009|
|Publisher: ||Royal Society of Medicine Press Ltd|
|Citation: ||Newson, A.J. (2009) “Clinical Ethics Case Study 9: Should we inform our patient about animal products in his medicine?” Clinical Ethics, 5(1): 7-12.|
|Abstract: ||Referral to the CEAG: deriving drugs from animal sources and considerations of religion
A 70-year-old patient of Middle-Eastern origin (Mr D) is admitted for management of exacerbation of
obstructive lung disease. Mr D has capacity to consent to, or refuse, medical treatment. As he is likely to
be bed-bound for several days, hospital policy (reflecting national guidance) is that he receives
prophylactic heparin to reduce the risk of potentially fatal venous thrombosis. The standard drugs used
for prophylaxis against blood clots are various forms of heparin, which is given via subcutaneous
injection. All heparins are derived from pigs. A junior doctor has asked her consultant whether she
should ask Mr D if porcine-derived heparin is acceptable to him.
We are concerned about how we should proceed. The animal origin of some drugs may not always be
known to staff prescribing or administering these drugs. Patients may be even less likely to have this
knowledge. Further, information is not easily available to patients or health professionals who may wish
to know more. For example, although the ‘Summary of Product Characteristics’ required to be published
about any drug includes this information, it is not readily available to prescribers (particularly as Internet
access is not always available on the ward) and would have to be sought on each occasion that a patient
is prescribed a new drug.
A proportion of patients will be members of certain religious faiths that prohibit the ingestion of certain
foods. While we need to be careful about making assumptions about whether particular patients are
members of these faiths (and if so whether they follow its doctrines strictly), religious doctrines may be
interpreted by some patients to extend to prohibit the ingestion or other use of pharmaceuticals derived
from specific animals. Similar views may also be held by people who choose to follow a vegetarian or
If we talk with Mr D and make the porcine origin of this drug known to him, he may choose to decline
this drug. However, to not administer it would be contrary to national guidance (although within Mr D's
legal rights) and could affect clinical outcomes. We could perhaps instead prescribe one of the newer
clot-preventing drugs that are entirely synthetic. These may also be easier to administer and monitor,
but are more expensive. Some may also have to be prescribed outside of the product licence, with less
available evidence of effectiveness.
A further issue is that the use in this case is for prophylaxis as opposed to treatment. Heparin is
recommended to prevent a complication which, while potentially serious (including fatal), may also not
occur at all. That said, such administration is increasingly viewed as medically essential.
We are approaching the ethics committee with the following questions in mind:
1. Should we feel a moral obligation to disclose the derivation of heparin to Mr D (or indeed to all
2. If not, is it sufficient to honestly answer questions if he raises them?
3. Is there a morally relevant difference between patients who object to certain animal products on
religious grounds and those who have strong concerns about animal welfare?
4. When considering purchasing drugs like heparin, would the ethics committee be happy to
recommend the purchase of alternative non-animal-derived products which may be more
|Description: ||clinical case study|
|Type of Work: ||Article|
|Type of Publication: ||Post-print|
|Appears in Collections:||Research Papers and Publications. Sydney Health Ethics|
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