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Telling porkies: should the doctor tell her patient where the medicine comes from?

In a column in the New York Times this week Randy Cohen fields a question from an anaesthetist. Should the doctor ask a devoutly religious patient whether he minds that his anticoagulant (heparin) is derived from pigs? In reply Cohen suggests that the doctrine of informed consent requires the doctor to consider the non-medical preferences of the patient and make sure Muslims, Jews and vegetarians know where their medicine is coming from.

In the NYT article Cohen suggests that it is a part of the doctor's role to provide the information that patients need to control their care. But is it a doctor's responsibility to take into account these sort of preferences? Does it take the doctors role too far? Imagine a vegan who takes particular exception to drugs that have been tested in higher order primates. Is the doctor expected to ask about all possible preferences and provide corresponding advice about treatments that conform to these? If so, this seems to be unreasonably demanding.

Part of the answer to this might be to distinguish between the normative force of different claims about information-giving.

There is a difference between
1. what would be good for the doctor to do, and
2. what we should expect the doctor to do and
3. what we should sanction the doctor if they don't do.

your doctor knows that you are a devout religious adherent, and that
you may have an objection to a medical product that they know contains
animal products, the doctor should inform you that the drug she is
about to prescribe is derived from pigs. It would be good for them do
so (level 1 above).

And if you ask your doctor – does this drug contain
animal products then the doctor should (stronger – probably level 2, maybe 3)
find out about the drug and let you know.

Whether we should expect them (2) if you haven't asked or sanction them (3) if they didn't tell you is less clear to me.

We might also note that there is another side to responsibility when it comes to personal preferences for different treatments. If your preference is
idiosyncratic or unusual you, the patient, probably have a
responsibility to find out which potential treatments may contain
animal products, as well as to let your doctor know that you really
don't want animal products (or blood products etc). On the other hand if the preference is very common within the population perhaps the onus should be on the doctor.

As for the relevance of all of this for orthodox judaism, Randy Cohen notes that since Heparin is administered subcutaneously rather than orally it is apparently not proscribed.

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1 Comment on this post

  1. Is there a condition on the abrahamic port taboo that it’s ingestion must be knowing? If here is, the interesting ethical question comes down to this: Does the rational believer want not to make a sinful decision and yet get the benefit of the sinful ingestion? In that case, doesn’t the physician most honor the autonomy of the patient by not telling that patient about Heparin?

    Of course, the autonomy of the patient includes the patient’s desire to live and the desire not to sin. Why force a decision on the patient that will compel the patient to choose to risk death in order not to sin?

    A similar ethical problem arises when a prisoner, condemned to death, must be sane before the execution of that sentence is performed. How does the lawyer, loyal to the client, best seek the client’s welfare?

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